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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 58. This is the beginning of the thread.
Posted by KaraS on April 8, 2005, at 1:12:22
I got my latest TSH reading yesterday. It was 1.8. The lab that did the test listed the upper range of normal as 4.7. (How long will it take before the medical establishment readjusts these maximums downward?????) Anyway, I told the doctor that I'm always cold (not to mention quite depressed). He said he wouldn't change my dosage since I was in the normal range. I've been treating my own thyroid condition in the recent past so I could always try adding a little more to the prescription I was given in hopes of getting more energy and a decrease in depression. I've read that between .5 - 1.0 is a more ideal TSH for those of us with depression. I've been taking 50 mcg of T4. I'm considering adding a little Cytomel or just increasing the T4 a little bit. The fact that I'm taking a small amount of doxepin has me thinking that maybe I should stick with the T4 (I've read in a few places that T3 can increase the cardiotoxicity of the tricyclic antidepressants.) What do you think?
Posted by SLS on April 8, 2005, at 1:12:22
In reply to My latest TSH level, posted by KaraS on April 5, 2005, at 19:45:12
Hi.
I responded to Dr. Bob on the Alternative board, suggesting that perhaps your post would be better placed on the main Medication board. My experience with thyroid hormone prescribed specifically for depression yielded a better response to T4 than to T3. It might depend on whether or not there is an impairment in the body's rate of coversion of T4 -> T3. T3 worsened my depression tremendously, despite multiple challenges. I might have to press my doctor to give T4 another try. My latest TSH was over 4.0.
My guess is that TCA T3 might have a greater impact on cardiac function than TCA T4, simply because T3 is the more active form. T4 does have some direct effects in the body. It doesn't always need to be converted to be active.
- Scott
> I got my latest TSH reading yesterday. It was 1.8. The lab that did the test listed the upper range of normal as 4.7. (How long will it take before the medical establishment readjusts these maximums downward?????) Anyway, I told the doctor that I'm always cold (not to mention quite depressed). He said he wouldn't change my dosage since I was in the normal range. I've been treating my own thyroid condition in the recent past so I could always try adding a little more to the prescription I was given in hopes of getting more energy and a decrease in depression. I've read that between .5 - 1.0 is a more ideal TSH for those of us with depression. I've been taking 50 mcg of T4. I'm considering adding a little Cytomel or just increasing the T4 a little bit. The fact that I'm taking a small amount of doxepin has me thinking that maybe I should stick with the T4 (I've read in a few places that T3 can increase the cardiotoxicity of the tricyclic antidepressants.) What do you think?
Posted by Spriggy on April 8, 2005, at 1:12:22
In reply to Re: My latest TSH level, posted by SLS on April 6, 2005, at 7:07:17
I really don't get the numbers for all those tests..
It confuses me (doesn't take much!). LOL
My doctor yesterday told me one of my thyroid test came back at a 5.. and then he said, " 5-10 is really 'no man's land'." I assume he means those numbers can mean ANYTHING.
Isn't it frustrating??
I hope somebody has a good answer for you and that you begin to feel well soon!!
* I'm hot all the time so I'm on the OTHER end of the spectrum!*
Posted by KaraS on April 8, 2005, at 1:12:23
In reply to Re: My latest TSH level, posted by SLS on April 6, 2005, at 7:07:17
Hi,
I could see making a case for this post on three boards actually but since the goal is to use the thyroid hormones as antidepressant augmentation, then I think the strongest case is for the main board also.
But since we're already here...
That's interesting that you've had such a negative response to T3. I was under the impression that it was more useful against depression than T4. If I understand you correctly, you think that in your case the problem has to do with the conversion rate? I've never tried T3 on its own (only as part of Armour thyroid) but neither the T4 nor the Armour have made much of a difference in terms of anti-depression for me so far. Perhaps if I raise the T4 dosage it will help.Your TSH is definitely on the high side. I probably couldn't hurt to bring it down a bit. I didn't know that T4 had some direct effects also.
K
> Hi.
>
> I responded to Dr. Bob on the Alternative board, suggesting that perhaps your post would be better placed on the main Medication board. My experience with thyroid hormone prescribed specifically for depression yielded a better response to T4 than to T3. It might depend on whether or not there is an impairment in the body's rate of coversion of T4 -> T3. T3 worsened my depression tremendously, despite multiple challenges. I might have to press my doctor to give T4 another try. My latest TSH was over 4.0.
>
> My guess is that TCA T3 might have a greater impact on cardiac function than TCA T4, simply because T3 is the more active form. T4 does have some direct effects in the body. It doesn't always need to be converted to be active.
>
>
> - Scott
>
>
> > I got my latest TSH reading yesterday. It was 1.8. The lab that did the test listed the upper range of normal as 4.7. (How long will it take before the medical establishment readjusts these maximums downward?????) Anyway, I told the doctor that I'm always cold (not to mention quite depressed). He said he wouldn't change my dosage since I was in the normal range. I've been treating my own thyroid condition in the recent past so I could always try adding a little more to the prescription I was given in hopes of getting more energy and a decrease in depression. I've read that between .5 - 1.0 is a more ideal TSH for those of us with depression. I've been taking 50 mcg of T4. I'm considering adding a little Cytomel or just increasing the T4 a little bit. The fact that I'm taking a small amount of doxepin has me thinking that maybe I should stick with the T4 (I've read in a few places that T3 can increase the cardiotoxicity of the tricyclic antidepressants.) What do you think?
>
>
Posted by KaraS on April 8, 2005, at 1:12:23
In reply to Re: My latest TSH level, posted by Spriggy on April 6, 2005, at 11:17:50
> I really don't get the numbers for all those tests..
>
> It confuses me (doesn't take much!). LOL
>
> My doctor yesterday told me one of my thyroid test came back at a 5.. and then he said, " 5-10 is really 'no man's land'." I assume he means those numbers can mean ANYTHING.
>
> Isn't it frustrating??
>
> I hope somebody has a good answer for you and that you begin to feel well soon!!
>
> * I'm hot all the time so I'm on the OTHER end of the spectrum!*
Hi,
There's so much the medication establishment doesn't know yet about the endocrine system. Supposedly a TSH or 5 is quite high. People with high levels should feel cold and tired all of the time. My friend has a TSH of 16 and she has so much energy and is always hot. She was prescribed thyroxin but refuses to take it. She claims it makes her feel worse. OTOH, I've got a TSH in the "normal" range and I'm always cold and have no energy. Go figure. Yes, very frustrating!K
Posted by Larry Hoover on April 8, 2005, at 1:12:23
In reply to Re: My latest TSH level » Spriggy, posted by KaraS on April 7, 2005, at 1:18:20
> Hi,
> There's so much the medication establishment doesn't know yet about the endocrine system. Supposedly a TSH or 5 is quite high. People with high levels should feel cold and tired all of the time. My friend has a TSH of 16 and she has so much energy and is always hot. She was prescribed thyroxin but refuses to take it. She claims it makes her feel worse. OTOH, I've got a TSH in the "normal" range and I'm always cold and have no energy. Go figure. Yes, very frustrating!
>
> KI think they need to rethink the whole thing, analogously to insulin resistance. Assuming a standard response to a particular hormone concentration ignores the fact that there are multiple sites of action for these hormones. Individual symptoms should be given as much (or more) weight than the test numbers.
Lar
Posted by Spriggy on April 8, 2005, at 1:12:23
In reply to Re: My latest TSH level » SLS, posted by KaraS on April 7, 2005, at 1:14:43
Kara,
But that is what is sooo weird. If it's a 5 than wouldn't that indicate HYPOthyroid? But I am hot all the time, sweaty, and losing weight- rather than the opposite!Maybe God put me here to confuse the heck out of the medical establishment.
Muwahahahaha.
Posted by KaraS on April 8, 2005, at 1:23:08
In reply to My latest TSH level, posted by KaraS on April 5, 2005, at 19:45:12
Posted by KaraS on April 8, 2005, at 1:27:50
In reply to Re: My latest TSH level » KaraS, posted by Larry Hoover on April 7, 2005, at 9:07:34
> > Hi,
> > There's so much the medication establishment doesn't know yet about the endocrine system. Supposedly a TSH or 5 is quite high. People with high levels should feel cold and tired all of the time. My friend has a TSH of 16 and she has so much energy and is always hot. She was prescribed thyroxin but refuses to take it. She claims it makes her feel worse. OTOH, I've got a TSH in the "normal" range and I'm always cold and have no energy. Go figure. Yes, very frustrating!
> >
> > K
>
> I think they need to rethink the whole thing, analogously to insulin resistance. Assuming a standard response to a particular hormone concentration ignores the fact that there are multiple sites of action for these hormones. Individual symptoms should be given as much (or more) weight than the test numbers.
>
> Lar
>
Absolutely. They also need to look at the endocrine system as a whole rather than just examining thryoid levels in a vacuum. If people are still cold and depressed even though their TSH is in the normal range, then something is still wrong.K
Posted by KaraS on April 8, 2005, at 1:29:32
In reply to Re: My latest TSH level.. Kara, posted by Spriggy on April 7, 2005, at 12:47:21
> Kara,
> But that is what is sooo weird. If it's a 5 than wouldn't that indicate HYPOthyroid? But I am hot all the time, sweaty, and losing weight- rather than the opposite!
>
> Maybe God put me here to confuse the heck out of the medical establishment.
>
> Muwahahahaha.
It's nice to have a purpose in life. :-(
Posted by up'n'down on April 8, 2005, at 2:43:21
In reply to Re: My latest TSH level.. » Spriggy, posted by KaraS on April 8, 2005, at 1:29:32
> > Kara,
> > But that is what is sooo weird. If it's a 5 than wouldn't that indicate HYPOthyroid? But I am hot all the time, sweaty, and losing weight- rather than the opposite!
> >
> > Maybe God put me here to confuse the heck out of the medical establishment.
> >
> > Muwahahahaha.
>
>
> It's nice to have a purpose in life. :-(
>
>I feel like going Muwahahahah right along with you. My body never seems to react like it is supposed according to medical knowledge. I'm Typhoid Mary and Calamity Jane all in one. But we are still up trying to figure the puzzle that is our body out.
When I first started having thyroid problems, my doctor at that time told me that a t3, t4, and a tsh should always be done and the three evaluated together to know more accurately what is going on. I don't think the insurance companies buy that theory in more ways than one:-} U'n'D
Posted by ladyofthelamp on April 8, 2005, at 11:10:17
In reply to Re: My latest TSH level » Larry Hoover, posted by KaraS on April 8, 2005, at 1:27:50
Hi everyone,i have just been told that i have a TSH of 20.9.I am starting treatment today.4 months ago my tests were 2.95 TSH.What on earth has happened in that short time and isn't 20.9 rather high?
Posted by Spriggy on April 8, 2005, at 11:38:48
In reply to Re: My latest TSH level, posted by ladyofthelamp on April 8, 2005, at 11:10:17
Okay, well my husband sat up reading about the thyroid for two hours last night, then came in my bedroom, turned on the light ( I was asleep), woke me up and "briefed me" on his findings. LOL
Apparently, according to all the stuff he printed out, when your TSH levels are lower- that indicates HYPERThyroid (which is what my dr. thinks I have). When your TSH levels are HIGH that indicates HYPOthryoid.
If your levels are that high, what kind of symptoms do you have??
*I stay HOT and sweaty all the time,
*sweaty palms,
*lost quite a bit of weight since Christmas,
*appetite has increased though lately but no weight gain,
*depression,
*ANXIETY like I've never known before,
*messed up monthly cycles,
*increased heart rate,
*No libido- I think it died and we should bury it somewhere- husband refuses to give up on it,
* mood swings- I think I have PMS around the clock now
* more frequent BM's (sorry)So now you have to dish up and tell me how you feel.
I really have no modesty whatsoever, do I? Ha
Posted by Maxime on April 8, 2005, at 11:58:37
In reply to Re: My latest TSH level, posted by Spriggy on April 6, 2005, at 11:17:50
Was it your TSH? Because if it was you are borderline HYPOthyroid. Which isn't consistent with your symptoms. 5 used to be the cut off for normal. Now the medical establishment is finding that .3 to 3 is optimal. 5-10 is not "no man's land". Anything above 5 is hypothyroidism. Of course you still don't know which test he was refering to. If it was your TSH and he think 5-10 is "no man's land" then he is quack. It also depends on the lab that does the testing too.
You should get a copy of test results and post the numbers. Or go www.about.com and type in thyroid. I find it's the best site for thyroid information. It has a link on how to decipher test results.
Maxime
> I really don't get the numbers for all those tests..
>
> It confuses me (doesn't take much!). LOL
>
> My doctor yesterday told me one of my thyroid test came back at a 5.. and then he said, " 5-10 is really 'no man's land'." I assume he means those numbers can mean ANYTHING.
>
> Isn't it frustrating??
>
> I hope somebody has a good answer for you and that you begin to feel well soon!!
>
> * I'm hot all the time so I'm on the OTHER end of the spectrum!*
Posted by Maxime on April 8, 2005, at 12:00:50
In reply to Re: My latest TSH level » KaraS, posted by Larry Hoover on April 7, 2005, at 9:07:34
As usual Larry, you have hit the nail on the head! :-)
Maxime
>
> I think they need to rethink the whole thing, analogously to insulin resistance. Assuming a standard response to a particular hormone concentration ignores the fact that there are multiple sites of action for these hormones. Individual symptoms should be given as much (or more) weight than the test numbers.
>
> Lar
>
Posted by Maxime on April 8, 2005, at 12:07:07
In reply to Re: My latest TSH level, posted by ladyofthelamp on April 8, 2005, at 11:10:17
> Hi everyone,i have just been told that i have a TSH of 20.9.I am starting treatment today.4 months ago my tests were 2.95 TSH.What on earth has happened in that short time and isn't 20.9 rather high?
Yes, when mine was 25 my body temperature was 97 degrees and I could barely move I was so exhausted.
If you were already taking synthoid did you know and do the following:
Take synthroid on an empty stomach
Iron stops the absorption of Synthroid
Dilantin does as well
Don't switch brand of T4 and never take a generic. They don't have the level of T4 in themWith such a different in 4 months I would have the test redone.
Maxime
Posted by Spriggy on April 8, 2005, at 13:08:58
In reply to Re: My latest TSH level » ladyofthelamp, posted by Maxime on April 8, 2005, at 12:07:07
Maxime, the ER doctor told me my number was 5 which he said was "borderline" for "possible problem." He also said, " or it could just mean you once had a problem."
When I told my regular dr. this week he said, " well, 5-10 is 'no man's land' it could be anything or nothing."
I didn't quite get what that meant anyway. BUT, he said, " let me go ahead and do a full panel on you while you are here and see what we get."
I have yet to hear back.
I ASSUMED it was my TSH level the ER doctor was referring to because he got those results back in about 2 hours- the rest he said would take days to find out.
If I am indeed a 5, are you saying that is actually a sign of HYPO?
If I am hypo, could I just be weird and be losing weight instead of gaining? that is the real kicker here- I am dropping the pounds like madness for no apparent reason- OR could that just be the hypoglycemia.
Oh Lord help me.
I am SOOOO lost.. LOL
Posted by Spriggy on April 8, 2005, at 13:10:23
In reply to Re: My latest TSH level » Maxime, posted by Spriggy on April 8, 2005, at 13:08:58
to be my health care professional.
You both seem to know more than they do.
I appreciate you both very much, by the way.
Posted by ladyofthelamp on April 8, 2005, at 13:15:15
In reply to Re: My latest TSH level » ladyofthelamp, posted by Maxime on April 8, 2005, at 12:07:07
When i was tested and the results were 2.95 my endo told me i definitley wasn't hypothyroid.At the time my main symptom was tiredness and extreme thirst plus bone pains.All 3 of my immediate family are hypothyroid so as you can imagine i was still thinking that the problem was with my thyroid.I was to be tsted for DI but being the NHS a bed has not yet been available so as i was getting more and more ill e.g low body temp(96.2)weird throat feelings,cough,fatigue,headaches,bone pains,heavy periods etc,i decided to get my GP to do more tests and surprise surprise i am hypo!
I took my first thyroxine tablet today but i still have to have other investigations re the thirst.I am relieved to have a partial answer to my symptoms after years on Effexor,prozac etc.I have a mental health history(no formal diagnosis as such)and am sick of doctors thinking it was all in my mind.Oh by the way i am 36 and feeling about 80.I will write a bit more later so thanks for your messages and interest.
Posted by Spriggy on April 8, 2005, at 13:19:09
In reply to Re: My latest TSH level Spriggy and Maxime, posted by ladyofthelamp on April 8, 2005, at 13:15:15
Okay, DR. Bob, I don't know if this is against some rule to copy and paste or not so if it, delete me and forgive me. I repent ahead of time if I am committing some sin here.
But this is what I just found:What is a “Normal” TSH Level?
In the United States, most laboratories have as the normal TSH reference range from approximately 0.5 to 5.5. Yet, in early 2001, the American Association of Clinical Endocrinologists (AACE) made what constituted a fairly dramatic reversal of its previous doctrine, stating that a "Even though a TSH level between 3.0 and 5.0 uU/ml is in the normal range, it should be considered suspect since it may signal a case of evolving thyroid underactivity."
A groundbreaking study published in the February 2002 issue of the Journal of Clinical Endocrinology and Metabolism examined levels of undiagnosed thyroid disease in different U.S. populations between 1988 and 1994. In addition to discovering that nearly five percent of Americans suffer from often undiagnosed thyroid disease, the Centers for Disease Control and Prevention (CDC) report on the National Health and Nutritional Survey (NHANES) found that among the disease-free population (those who did not have any presence of thyroid antibodies, or diagnosed thyroid disease), the mean TSH level was 1.5. This finding could bolster the assertions of some practitioners and many patients that the optimal TSH levels are between 1 and 2, and that levels above that may in fact represent an abnormality. It certainly points up the need to reconsider the basis for most U.S. labs measuring hypothyroidism as only at levels of approximately 5.0 and above.
***************
So if I am at a 5 (as the ER doctor states) than according to this, it could indicate HYPOthyroid. Yet my doctor keeps saying he suspects I am HYPER because I am losing weight, staying hot and sweaty, etc..
Could I possibly be going in between to the two?
Can someone be hypo and hyper?
Posted by Spriggy on April 8, 2005, at 13:21:24
In reply to Re: My latest TSH level Spriggy and Maxime, posted by ladyofthelamp on April 8, 2005, at 13:15:15
Have they checked your blood sugar to make sure there is no problems there as well?
I just found out I am hypoglycemic but from what I've read, the thyroid can even mess up the blood sugar. So maybe you have some blood sugar going on too?
I am only 26 and I feel about 80 as well, so I'll join your club. Too bad we can't get those senior citizen discounts yet though.
They say you are as old as you feel, right?
Posted by ladyofthelamp on April 8, 2005, at 14:00:12
In reply to ladyof the lamp..., posted by Spriggy on April 8, 2005, at 13:21:24
> Have they checked your blood sugar to make sure there is no problems there as well?
>
> I just found out I am hypoglycemic but from what I've read, the thyroid can even mess up the blood sugar. So maybe you have some blood sugar going on too?
>
> I am only 26 and I feel about 80 as well, so I'll join your club. Too bad we can't get those senior citizen discounts yet though.
>
> They say you are as old as you feel, right?
>Hi,i had my blood sugar levels checked and they were fine.I haven't had a chance to talk properly to my GP as she was off to a meeting.I had other tests done including inflammatories,bone profile etc and as far as i understand they were okay too.I was slightly shocked that my TSH levels had changed so rapidly and it hasn't sunk in to my very weary 80 year old brain yet:-).I think thyroid problems mess everything up!.I can't wait to see what my Endo has to say on the matter.He absolutely insisted that no way would i be Hypo!.Thank god for the internet!!!!.I am sorry you have got blood sugar problems on top of everything else,it cannot be easy.....
Posted by Maxime on April 8, 2005, at 14:48:50
In reply to Re: ladyof the lamp..., posted by ladyofthelamp on April 8, 2005, at 14:00:12
When I first found out I was hypothyroid in 1996, I started Synthroid. In the meantime, I saw this wacky holistic doctor who did TONS of bloodwork. When I went back to her she said that I had antibodies and that I could swing between hypo and hyper. But then she moved and I couldn't see her again.
When I told my current endo this he said that everyone has antibodies and it doesn't prove anything! But in everything I read it says otherwise only it doesn't specify.
Does anyone know?
See. I KNEW the fact that my endo had a collection of ducks in his office signified that he is a quack.
The aching in the bones is a symptoms of hypothyroidism and I had it bad. I don't right now. I'm just producing milk.
I'm sure the men reading this thread are thanking god that aren't women.
maxime
Posted by TamaraJ on April 8, 2005, at 15:54:50
In reply to Re: Anyone, posted by Maxime on April 8, 2005, at 14:48:50
This is just some info I had previously found on thyroiditis, which may be of interest to both of you.
What I have read is that Thyroid Antibody Tests measure the number of immune system terminators created specifically to do battle against the thyroid. There are two types of these well-named antibodies, therefore, two tests are needed: antithyroglobulin and antimicrosomo. This is the test that helps identify whether you have thyroiditis, an allergy to your own thyroid. This autoimmune condition is becoming quite common. As I understand it, these two tests are the only way to diagnose thyroiditis (but then again, I am certainly not an expert or extremely knowledgeable about this stuff).
In the same book there is a reference to a summary of thyroiditis symptoms, as developed by Stephen Langer, M.D. The list is as follows and is in decending order of frequency:
"(1) profound fatigue; (2) memory loss; (3) depression; (4) nervousness; (5) allergies (6) heart-beat irregularity (7) muscle and joint pain (8) sleep disturbances (9) reduced sex drive (10) menstrual problems (11) suicidal tendencies (12) digestive disorders (13) headaches and ear pain (14) lump in the throat and (15) problems swallowing. Nervousness ranges from mild anxiety to full-blown panic attacks, of which some are true psychiatric emergencies. These are as puzzling to the patients as to their physicians, who, in desparation, recommend psychotherapy and powerful transquilizers."
Spriggy - You may be interested in the following (which could explain the high TSH level, while experiencing symptoms of hyperthyroidism):
Extracted information - clinical features of thyroiditis
The main symptoms are a painful swelling of the thyroid gland and symptoms of hyperthyroidism. These symptoms include heat intolerance, nervousness, palpitations and weakness. The hyperthyroidism is due to the leaking of thyroid hormones from the damaged thyroid cells as a result of the viral infection. This is a temporary situation since once the virus infection has run its course, the thyroid cells recover their normal state. On examination, the patient has a very tender, swollen thyroid gland and mild signs of hyperthyroidism.
Maxime and Spriggy - websites with info on thyroiditis
http://www.emedicine.com/med/topic534.htm
http://www.emedicine.com/MED/topic949.htm
http://www.umm.edu/endocrin/hashim.htm
http://www.nlm.nih.gov/medlineplus/ency/article/000371.htm#Symptoms
http://www.thyroid.ca/Guides/HG05.html#2
Tamara
Posted by Spriggy on April 8, 2005, at 16:14:17
In reply to Re: Anyone - For both Maxime and Spriggy » Maxime, posted by TamaraJ on April 8, 2005, at 15:54:50
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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
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