Posted by Larry Hoover on January 1, 2006, at 16:07:43
In reply to Re: Endocrinology consult » Larry Hoover, posted by Tabitha on January 1, 2006, at 15:02:58
> Thanks for that info about protein sponges and uptake and half-life and all. That helps clarify what might have been going on with my last blood draw. He did another draw after my appointment, and I was smart enough not to take my dose that morning, so it had been at least 24 hours. I'm going to call this week and ask to discuss the results. I'm guessing it'll be way different.
Just get the results, if you can. At least. A blood draw gives you a snapshot of a moving target. It's only accurate for the moment that is captured.
If you get the numbers, you can interpret them. You can learn how to confidently do that.
> He said T3 med stays in blood for 2-3 weeks.
But then, your own feedback mechanisms begin to respond, to recapture direct management of the ratios between all the hormones that are involved. His request to see you in 3 months might be a touch excessive, but it's in the reasonable range. If you know calculus, this is an asymptotic response curve. The longer you wait, the more closely it approaches the limit (the "perfect" measurement).
> But I really think you're right that a reading 2 hours after the full dose is not valid.
Your TSH is still meaningful. It's a response to your "T3 history", so to speak. Whatever value it is, it's the minimum stimulatory response to your body's T3 demand.
> So you found that heart arrythmia is only a risk for males? Am I understanding correctly?
No, sorry if I wasn't clear. When I looked at it, I found a gender bias in the osteoporosis data. Relative risk for women was 1.03 (a virtual irrelevance), whereas for men it was 1.86 (nearly double the background rate).
I didn't look at arrythmia risk, because your dose is too low to worry about it at all. Your free T3 level was in the risk range, I'm sure, but if and only if it stayed that way. But it doesn't, once the carrier proteins mop the stuff up.
Ideally, you'd have a trickle pump of some sort, gradually releasing the synthetic hormone into your blood. Instead, for convenience, we pop pills. So you get these concentration spikes of free T3. 25 mcg twice a day might be better than 50 all at once. Or 12.5 four times a day, better still. (Smaller spikes in concentration.) But that's not usually convenient.
> Well with what you say about protein sponges, I wonder if maybe I am taking more than I need. I pretty much just stayed at 25 mcg for a while, then thought the initial benefit was dropping, so I went up to 50, noticed no ill effects, and decided to stay there. I'll be interested in what my new bloodwork shows.
You would need to do experiments like this, no matter how you became involved in carrying them out. Titrating the dose is always a trial and error process.
> He didn't tell my my TSH level. I'm guessing it was totally suppressed.
Even if it's "suppressed", that's an interpretation. Some doctors freak at anything less than 3.0. Others at 1.5. But, anything above zero might be okay, depending on the pattern. How it fits in with the other numbers, like total T3. Not just free T3.
> He said my free T3 reading was 'off the chart' which is why they're so alarmed.
Off the "normal" chart. It's a statistical thing. Maybe you're an outlier, one of the couple of percent of people who don't fit on the chart.
Maybe you're "off the chart" because you just swallowed some. Or maybe, off the chart for other reasons. But we don't know that. And, he's not so alarmed that he said to stop taking it altogether.
> I'm staying at the 37.5 mcg this week. I guess I'll take his advice and try reducing. Although if I start to feel worse, or get a 2nd opinion, I may stop reducing.
The best indication would be a series of blood tests. And, how you feel. You might need "high normal" values to feel normal. Or off the chart values. If you're still producing TSH, off the chart free T3 might be normal for you.
Here's the thing. There are many variables. Antithyroid antibodies (Hashimoto's thyroiditis) make blood test results for T3 virtually meaningless. You're unique, and your feeling of well-being is a critical variable. But not all doctors, even endocrinologists, give your well-being sufficient weight.
> I'm going to push for a bone density scan-- if not from the HMO bunch then I'll go thru private practice.
It's good medical practise, even without these thyroid concerns. You need baseline data. Concern shouldn't come from ignorance, from not knowing. It should flow from data.
> Oh and you asked what sent me down this path. Well I got interested a few years back, based on one of the popular books about under-treated thyroid. At that time I asked for the T3 from my pdoc. He wasn't particularly enthusiastic about it, but he did Rx it (25 mcg). I used it for about a year then, and didn't notice much from it, so I just stopped using it. But at that time I was also on Neurontin, and a different AD, and my depression was generally not as well-controlled. The Neurontin disrupted my sleep, causing somnolence (translation sleeping 10-12 hours a night) so I don't think I would have noticed the sleep improvement.
> Somehow I just got interested in the idea again, as it seemed my energy level had dropped further, my hair loss thing had been going on so long, I was easily chilled, having a lot of water retention, carpal tunnel, sluggish digestion, slowly creeping weight gain, all stuff that can be thyroid.
Absolutely true. Classic pattern.
> So I just decided to experiment again. In hindsight I wish I'd gone for bloodwork at that point, but for some reason I didn't.
> With the first 25 mcg my energy improved a lot. It's just like it flows normally through the day, yet I don't feel hyper. And I figure if I sleep well, then I'm not over-stimulated.
There are other ways to measure basal metabolism, which is what thyroid hormone controls. If you obtained one of those highly sensitive thermometers that women use to determine when they're ovulating, called basal thermometers, you can chart your normal body temperature with great accuracy. Temperature is a sensitive but indirect measure of thyroid function, for example.
Hyperthyroid conditions are strongly linked to hyperpyrexia, i.e. fever. If your temp is normal....
> So over the year, my life just got subtly better. It's a lot easier to keep up with stuff when your energy doesn't poop out after 3-4 hours in the day.
That's the function of those protein sponges.....to average things out. But over time, you bumped up the average thyroid hormone exposure your body experienced. And you felt better. Which is so important, with respect to what's happening in your body, that I can't believe how your doctors are trivializing your physical response. Hyperthyroid is an illness state. You are not ill.