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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by psyclist on February 11, 2009, at 13:11:14
Results:
"Serum free T4 level" 11 pmol/L (10 - 22)"Serum TSH level" 2.0 mu/L (0.30 - 5.50)
My anti-depressant, Mirtazapine (Remerol) seems to have pooped out. (45 mg at night)
I feel dysthymic and like I am suffering from Sluggish Congnitive Tempo (ADHD-I). My "Serum lithium level" is 0.80 mmol/L (0.40 - 1.00)
Can anyone tell me if my T4 is low enough for there to be a causal link to my depression?
Posted by Phillipa on February 11, 2009, at 18:57:29
In reply to Thyroid Function Test, posted by psyclist on February 11, 2009, at 13:11:14
According the lab my endo uses normal on TSH is .27-4.2 and Free T4 is .93 to 1.7 His goal is to have my TSH at l-2. Sounds like Free T4 up. Honestly I don't understand the thyroid loop. But since my TSH went up to ll been very tired and changes in synthroid again need higher dose to lower the level. Could be you have a much better understanding of Thyroid so I did find many google searches that listed the meanings of if one number was low or high what it meant and used the Free T4 also. Love Phillipa ps not on lithium? As that can cause thyroid damage.
Posted by Phillipa on February 11, 2009, at 18:58:51
In reply to Thyroid Function Test, posted by psyclist on February 11, 2009, at 13:11:14
Oh you are on lithium need to let pdoc know. If for mood stabalization may have to change meds. Phillipa
Posted by psyclist on February 12, 2009, at 3:24:05
In reply to Re: Thyroid Function Test » psyclist, posted by Phillipa on February 11, 2009, at 18:57:29
> According the lab my endo uses normal on TSH is .27-4.2 and Free T4 is .93 to 1.7 His goal is to have my TSH at l-2. Sounds like Free T4 up. Honestly I don't understand the thyroid loop. But since my TSH went up to ll been very tired and changes in synthroid again need higher dose to lower the level. Could be you have a much better understanding of Thyroid so I did find many google searches that listed the meanings of if one number was low or high what it meant and used the Free T4 also. Love Phillipa ps not on lithium? As that can cause thyroid damage.
Thanks Phillipa. Most of my life I have lacked motivation and felt listless. More so since I started Lithium about 32 years ago. Maybe I just had a naturally underactive thyroid which was just made worse by the lithium. The lithium certainly isn't helping my thyroid levels. Trouble is here in the UK the NHS uses different laboratory techniques (I think) for measuring thyroid levels so the normal range differs. If anyone can answer my original question I would be very grateful.
Posted by Glydin 3.9 on February 12, 2009, at 16:41:42
In reply to Thyroid Function Test, posted by psyclist on February 11, 2009, at 13:11:14
> Results:
> "Serum free T4 level" 11 pmol/L (10 - 22)
>
> "Serum TSH level" 2.0 mu/L (0.30 - 5.50)
>~~~ I think a free T4 level at low normal may indeed indicate your thyroid level could be contributing to your lethergy. While your TSH isn't especially troublesome, it may be your body is compensating at this point to maintain your various thyroid hormone levels at, essentially, a lower normal. Some folks are symptomatic at border levels.
Mostly, screening labs are just that - for screening. I think it's worth a more indepth look. Levels are good tools but the whole picture is a mesh of physical and emotional/functional findings also. Some docs are willing for a trial of supplemental thyroid hormone(s) to see how it might fit into a plan for wellness.
Just to add, the main depressive symptoms I have are that of lethergy, lack of motivation, lack of drive.... basically sloth-like findings. So, if your AD is no longer making the grade, maybe a change or adjustment there is needed and would help.
Posted by Phillipa on February 12, 2009, at 18:55:17
In reply to Re: Thyroid Function Test » Phillipa, posted by psyclist on February 12, 2009, at 3:24:05
Ahh info you didn't include. And each lab results differ even here so to interpret yours would require someone from Uk. Phillipa
Posted by Glydin 3.9 on February 12, 2009, at 19:07:53
In reply to Thyroid Function Test, posted by psyclist on February 11, 2009, at 13:11:14
Just to clarify....
I took into account your UK values in making my comments. Yes, different countries and even different labs within areas differ in what they use.
I noticed the normal value's ranges were in line with what I found when I researched as I wanted to assure I was looking at what I thought I was looking at.
Posted by psyclist on February 13, 2009, at 16:07:54
In reply to Just so you know... » psyclist, posted by Glydin 3.9 on February 12, 2009, at 19:07:53
Thanks for your comments Glydin. I suffer from the same symptoms that you mention, in fact I have suffered from these symptoms for most of my life including the time before I was taking lithium. This leads me to suspect that I have a naturally under-active thyroid which of course is further suppressed by the lithium medication.
Posted by Glydin 3.9 on February 13, 2009, at 16:24:53
In reply to Re: Just so you know... » Glydin 3.9, posted by psyclist on February 13, 2009, at 16:07:54
> Thanks for your comments Glydin. I suffer from the same symptoms that you mention, in fact I have suffered from these symptoms for most of my life including the time before I was taking lithium. This leads me to suspect that I have a naturally under-active thyroid which of course is further suppressed by the lithium medication.
~~~ You are very welcome.
I hope you are able to look further into a potential help from thyroid supplementation if that's a desire. It's not unusual to hear of the use of T3 to boost an AD's effect, some have found that to be a good addition. I know folks in which T4 supplementation has made a great difference in getting to be the "me" they want to be also.
Posted by bleauberry on February 14, 2009, at 18:06:09
In reply to Thyroid Function Test, posted by psyclist on February 11, 2009, at 13:11:14
I am not familiar with the lab numbers themselves. I am more familiar with "patterns". As some mentioned already, the lab numbers are basically for screening. While many doctors look at them as diagnostic and reliable, they really are not. A typical "normal" range is actually quite broad. Someone could test low/high normal and yet have bad symptoms that fit thyroid issues, and yet not be treated because they were within normal. Normal is too broad.
What we want is optimal, not normal. That is, each number should be close to the borderline on the extremely good side of the normal range, to where it just couldn't be much better than that. Each number has to be that way, not just one or the other.
You need to find out what the "normal" ranges are that your lab used, plot your numbers within those ranges, and see where they stand.
That said, treating thyroid is often a clinical diagnosis and not a lab diagnosis. Challenge tests, or trials, or T3, or T4, or both, or Armour Thyroid, are much more diagnostic. If you improve on one or more, then it makes no difference what your labs say. The labs are wrong pure and simple in that case. Many people are treated this way, where labs are used more a guideline to see where you are now compared to where you were a few months ago, but not used to make a definitice diagnostic decision. That decision is more accurately made by clinical observation of what happens when meds are tried.
In Dr Bob's Tips there were numerous doctors around the world that supplemented thyroid for mood/energy improvement even when there was no basis on labs to do so.
To make it even more complicated, as my doctor told me, we can measure thyroid in the blood, but we cannot measure thyroid within the cells where it actually works...in other words, it might not be getting in the cells where it is supposed to work. Causes could be genetic, heavy metal blockage, or some other unknown reason. What circulates in blood is not meaningful. What happens at the cellular receptor level is. Sometimes it takes more thyroid in the blood, from supplementation, to break through whatever road blocks exist. When symptoms improve, you may never know why, just that they did.
Posted by Larry Hoover on February 14, 2009, at 18:28:12
In reply to Re: Thyroid Function Test » psyclist, posted by bleauberry on February 14, 2009, at 18:06:09
> To make it even more complicated, as my doctor told me, we can measure thyroid in the blood, but we cannot measure thyroid within the cells where it actually works...in other words, it might not be getting in the cells where it is supposed to work. Causes could be genetic, heavy metal blockage, or some other unknown reason.
I'd like to expand on that idea. T4 is a prohormome. Virtually all of the activity attributed to thyroid hormone comes from T3, which is the same molecule with one crucial difference.....one less iodine atom. The enzyme that accomplishes this transformation is called deiodinase, and Type 2 deiodinase is the crucial form. It is localized in tissues that will utilize the T3 (heart, muscle, fat, CNS, and the thyroid itself). Its activity depends on selenocysteine being in good supply. That is an unusual amino acid wherein a selenium atom replaces the sulphur atom found in cysteine.
A genetic deficiency in this enzyme can only be treated with supplemental T3. A deficiency in selenocysteine can be corrected with selenium supps, especially those forms based on selenium yeast. The yeast will have incorporated selenium into methionine and cysteine already, making it immediately bioavailable. Another kind of deficiency can occur because of heavy metal toxicity, especially via mercury, as mercury is extremely reactive with selenium atoms which in the hydrogenated form seen in selenocysteine or selenomethionine. Again, selenium supps can help with that issue.
If you're "low normal" on thyroid indexes, you may feel a heck of a lot better if you receive supplemental hormones to push you to "high normal".
Lar
Posted by Phillipa on February 14, 2009, at 21:11:52
In reply to Re: Thyroid Function Test, posted by Larry Hoover on February 14, 2009, at 18:28:12
Lar on the synthroid and almost two years now the endo has been trying to regulate mine. It goes from low normal to last test 4 weeks ago ll. I get tested again this coming week. I tried T3 supplement from the endo only 5 but didn't work out like coffee jitters. So if hashimotos where does this leave me. Besides 30 lbs lighter at this time not the way I chose weight loss. Some was the surgery and lipo to avoid diabetes as runs in family but that was only 12 lbs. Thanks Phillipa
Posted by Larry Hoover on February 15, 2009, at 14:57:31
In reply to Re: Thyroid Function Test » Larry Hoover, posted by Phillipa on February 14, 2009, at 21:11:52
Hashimoto's is tough to treat, and tougher to predict. Two theories about the fluctuations are episodic tissue destruction in the thyroid releasing any stored hormones, and periodic decreases in immune attack, allowing the thyroid to function better. They can't both be true, methinks. All they can do is monitor your hormone levels and try to adjust quickly.
I know I've mentioned it before, but selenium supps help stabilize Hashimoto's. Antibody levels decrease. Hormones become more stable. Probably improves tissue response, too. Clinical trials have used 200 mcg daily selenium as selenomethionine.
Lar
Posted by Phillipa on February 15, 2009, at 20:50:10
In reply to Re: Thyroid Function Test » Phillipa, posted by Larry Hoover on February 15, 2009, at 14:57:31
Thanks Lar will try this pdoc also thinks that personalized hormone testing would be helpful as well as bioidentical ones not personalized were helpful in past. Any thoughts on this? Thanks Phillipa
Posted by Larry Hoover on February 16, 2009, at 17:41:32
In reply to Re: Thyroid Function Test » Larry Hoover, posted by Phillipa on February 15, 2009, at 20:50:10
I don't understand what you're asking. Prescription thyroid hormones are bio-identical. What is personalized hormone testing?
Lar
Posted by Phillipa on February 16, 2009, at 21:30:30
In reply to Re: Thyroid Function Test » Larry Hoover, posted by Phillipa on February 15, 2009, at 20:50:10
Lar can see why you'd be confused. Long story made short. I used to use bioidental hormones, estrogen the two good one, progesterone, testosterone at one time prescribed by OB-GYN for menopause and then that woman's study came out saying bad so went off the creams from compounding pharmacy. But never any individualized hormone testing a kind of trial and error. Now the pdoc thinks so bioidentical estrogen would be good for me. But she wants me to get tested to see what my individualized levels are. No more one size fits all and no cancer in family and just had a good mammogram. Since she feels thyroid patients are so hard to treat. Phillipa
Posted by psyclist on February 18, 2009, at 5:58:55
In reply to Re: Thyroid Function Test » Phillipa, posted by Larry Hoover on February 16, 2009, at 17:41:32
I hear what you are saying but I am surprised neither of you suggested coming off Lithium as a cure. I understand that Lithium depresses the thyroid making it less active and if this is the case then the easiest solution is surely to come off the Lithium and see what that does to the thyroid hormone levels. If the T4 and T3 levels improve then this is the solution. Actually my thryroid blood tests only measure "Serum free T4 level" so this blood test might be inadequate. As I have been on Lithium for a long time, 30 years, I hope there is not any permanent damage to my Thyroid hormones 'loop'. Do you think my thryroid will go back to optimum level if the Lithium is removed?
Posted by Larry Hoover on February 20, 2009, at 20:45:17
In reply to Re: Thyroid Function Test » Phillipa, posted by Phillipa on February 16, 2009, at 21:30:30
That makes sense, to be tested for your actual hormone levels. And bio-identical sex hormones are less problematic. The only problem with the creams is getting the dose right. The amount of cream you apply has to be very strictly managed, to keep the dose in the right range.
Lar
Posted by Larry Hoover on February 20, 2009, at 20:58:39
In reply to Thanks bleauberry and larry, but...., posted by psyclist on February 18, 2009, at 5:58:55
My understanding is that chronic lithium use causes a gradual and irreversible decline in thyroid function in some individuals. After 30 years exposure, I don't think discontinuation is going to help you much. And what of the loss of mood stabilization that withdrawing from lithium would cause?
Your thyroid tests were about the minimum to get any sense of how that's all working. Usually, free and total T4 together give a sense of how much thyroid binding globulin you have, and at least a free T3 to check for liver conversion. Your borderline low T4 could be augmented towards the upper bound of normal. If your doctor agrees with that assessment, that's a fairly commonplace first intervention. Do you have any symptoms, apart from depression, that might be correlated with hypothyroidism?
Lar
Posted by Phillipa on February 21, 2009, at 18:59:00
In reply to Re: Thyroid Function Test » Phillipa, posted by Larry Hoover on February 20, 2009, at 20:45:17
Lar he also uses pellets inserted just estrogen and then creams progestone and I think a compounded testosterone if needed or I reversed and the tablet is progesterone. He Is a doc here ob-gyn wrote a book "The Youth Connection". And he treats both men and women. Bought the book in his office as stopped and got appointment first available end of April. So far in the reading he feels if hormones balanced you don't need ad's or anti anxiety meds as he said in book who ever heard of a deficiecy of ad's or anxiety meds? Totally Holistic. Phillipa
Posted by Phillipa on February 21, 2009, at 19:06:12
In reply to Re: Thyroid Function Test » Larry Hoover, posted by Phillipa on February 21, 2009, at 18:59:00
Link isn't bringing you there when I went there book was sold out. Docs name is Ronald L Brown MD Charlotte Nc his website is undergoing work so the website as there are several that apply to him the first won't open but the executive one will. It's underneath first one www.carolinahealthspan.com He's an OB-GYN practiced in the same practice I use for over 25 years. Phillipa
Posted by psyclist on February 24, 2009, at 14:23:58
In reply to Re: Thanks bleauberry and larry, but.... » psyclist, posted by Larry Hoover on February 20, 2009, at 20:58:39
> My understanding is that chronic lithium use causes a gradual and irreversible decline in thyroid function in some individuals. After 30 years exposure, I don't think discontinuation is going to help you much. And what of the loss of mood stabilization that withdrawing from lithium would cause?
>
> Your thyroid tests were about the minimum to get any sense of how that's all working. Usually, free and total T4 together give a sense of how much thyroid binding globulin you have, and at least a free T3 to check for liver conversion. Your borderline low T4 could be augmented towards the upper bound of normal. If your doctor agrees with that assessment, that's a fairly commonplace first intervention. Do you have any symptoms, apart from depression, that might be correlated with hypothyroidism?
>
> LarWell it looks like there is probably no hope for my thyroid given the length of time I have spent on continuous Lithium treatment. If this is the case then I have a few choice things I would like to say to the psychiatrists who have treated me for the last two decades.
My understanding is that hypothyroidism in itself causes mental health problems. Thus Lithium treatment which leads to hypothyroidism is paradoxical. It recreates the very problems that it sets out to solve.
I believe that I suffer from sluggish cognitive tempo. I cannot concentrate sufficiently to read a book or to watch a TV program longer than 30 minutes. This I put down to hypothyroidism. I am tapering off my Lithium at a rate of 100 mg every 10 or 14 days. So far I am down from an initial 900 mg to 800 mg but I cannot say I have noticed any improvement yet. As I am on the British NHS I don't know how many blood tests I will have access to. My GP, who is a recent change due to travel problems, is not very promising. He described my Serum free T4 level of 11 pmol/L within an allowable range of 10 to 22 pmol/L as quote "perfect". My own view is that one does not need to be an endocrinologist to see that it is rather low. One only needs to be numerate.
Larry your prognosis for any future T4 or T3 tests does not seem to be very optimistic. How comfortable and easy is it to take an augmentation? I would be grateful to hear from anyone who has experience of this.
Posted by Larry Hoover on February 25, 2009, at 20:05:03
In reply to Re: Thanks bleauberry and larry, but.... » Larry Hoover, posted by psyclist on February 24, 2009, at 14:23:58
> Well it looks like there is probably no hope for my thyroid given the length of time I have spent on continuous Lithium treatment. If this is the case then I have a few choice things I would like to say to the psychiatrists who have treated me for the last two decades.
I hope I haven't misled you. Lithium may inhibit thyroid output. So does aging. It's a known risk, and it's clearly unfortunate that you weren't given sufficient information to provide informed consent.
> My understanding is that hypothyroidism in itself causes mental health problems. Thus Lithium treatment which leads to hypothyroidism is paradoxical. It recreates the very problems that it sets out to solve.
> I believe that I suffer from sluggish cognitive tempo. I cannot concentrate sufficiently to read a book or to watch a TV program longer than 30 minutes. This I put down to hypothyroidism.
Have you tried any supplements? As you're in the NHS, then you're also in a low-selenium geographical zone. You may also benefit from the antioxidant N-acetylcysteine.
> I am tapering off my Lithium at a rate of 100 mg every 10 or 14 days. So far I am down from an initial 900 mg to 800 mg but I cannot say I have noticed any improvement yet.
I hope you are doing what is best for you. It's hard to tell from way over here.
> As I am on the British NHS I don't know how many blood tests I will have access to. My GP, who is a recent change due to travel problems, is not very promising. He described my Serum free T4 level of 11 pmol/L within an allowable range of 10 to 22 pmol/L as quote "perfect".
Dear me. That does not sound promising. Nor enlightened. And as I said earlier, there is not yet a complete picture of your thyroid function obtained from the tests performed. There is probably some flow-chart they use, and they'll only do the simplest of tests unless a gross abnormality has been discovered.
> My own view is that one does not need to be an endocrinologist to see that it is rather low. One only needs to be numerate.
Indeed. The "normal range" of thyroid tests is more and more being seen as a guide, and ought to be interpreted in light of symptoms that may be related to hypo- or hyper- thyroid function. It's not like blood sugar, which really does have physiological/functional boundary concentrations.
> Larry your prognosis for any future T4 or T3 tests does not seem to be very optimistic. How comfortable and easy is it to take an augmentation?
It's blessedly easy to try, if you can obtain the hormones themselves. That is the obvious rub. I've obtained them online.
> I would be grateful to hear from anyone who has experience of this.
They didn't help me, so I'm not a good source for greater insight into benefits.
Lar
Posted by psyclist on February 26, 2009, at 12:11:44
In reply to Re: Thanks bleauberry and larry, but.... » psyclist, posted by Larry Hoover on February 25, 2009, at 20:05:03
Thanks for all the information, Larry, much appreciated. One last thing - in your opinion how long do I need to wait to see some sort of recovery by my thyroid as a result of reducing my Lithium? (Assuming that it can recover.) So far I have only reduced from 900 mg down to 800 mg. My guess is about two months possibly three but that is only a guess.
This is the end of the thread.
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