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Thyroid meds are a hot topic among patients and advocates. I volunteer for
a group called "Thyroid Change" that is trying to improve awareness,
especially among practicing physicians, about how to detect and treat
thyroid disease.

The first thing you need to know is that hypothyroidism is usually caused
by Hashimoto's disease, an autoimmune condition that will produce high TPO
antibodies. That can be measured in a lab to help identify the cause.
Sometimes it's caused by (usually) slow-growing cancer) or a transient
infection or by injury to the gland. I'm sure you know that celiac patients
are much more likely to get Hashimoto's disease as the general public.
Celiac antibodies are separate from Hashimoto's antibodies, but they have
been found munching on the thyroid gland although the implications of this
are unclear and I haven't heard anything more about it for the past few
years.

Second, most doctors dose by the TSH test which is inaccurate for a large
minority of the hypothyroid population so it's best to get a free T3 (the
most active thyroid hormone, also called triiodothyronine) and a free T4
when labs are taken. Some people will show their FT3 and FT4 and different
parts of their ranges. They should be fairly close (both at half, both at
3/4 of the way up the range, etc.). That shows that T4 is being properly
converted to T3, the kind that your cells most need. Every cell in your
body needs thyroid hormone in order to take up oxygen, it's important to
make sure that it's level is optimal.

Finding the right doc may be an issue. Make sure your doctor isn't writing
an order for Total T3/Uptake or Total T4/Uptake tests. Both of these are
outdated, less accurate tests, but they will show that you should re-think
your choice in doctors for this particular condition. Good ones are very
hard to find.

About half of people do well on the standard levothyroxine (Synthroid,
Levoxyl are common brands) treatment, but that is a T4-only drug. If your
hypothyroidism or one of many other issues (including chronic stress) is
keeping you from converting well from T4 to T3 you will need a drug that
contains T3 in order to properly function. Doctors tend to be misinformed
about side effects and quality of T3 drugs, however. If you are one of the
unlucky who need extra T3, there is a list of resources under the tab "FIND
A DOCTOR" on the www.thyroidchange.org page. If you don't get your energy
back on T4-only and your doctor has determined that he won't increase your
dosage, you'll want to investigate other treatment protocols.

I maintain a blog on preventing dementia; hypothyroidism is a common cause
and often incorrectly diagnosed as Alzheimer's diseease. I think I give a
pretty good primer on the topic if you want to take a look; my info is
backed up by lots of good references. Please scroll past the B12 part to
the blog on hypothyroidism:

http://www.logicalneuro.com/2012/11/b12-deficiency-b12deficiency-is-very.html

This will give you a good overview. I also recommend looking at Mary
Shomon's about.com site. She's a good patient advocate and isn't
unreasonable about the fact that some people do just fine on T4-only drugs.
There are some advocates who preach that T4-only is the devil and that
nobody should be on it. While it is true that some are miserable on that
regimen, it's a matter of individual biology, not education, as to which
drug is more suitable. There are a lot of people who find that their lives
are dramatically improved by the addition of T3, and they tend to become
evangelistic about their experience and insist that it's the best for
everyone. http://thyroid.about.com/bio/Mary-Shomon-350.htm

T3 can be found in an artificial version in Cytomel, and it's available as
natural desiccated thyroid (NDT). It's sometimes called desiccated thyroid
extract (or DTE, it's made from the thyroid glands of pigs). It's also
available from any compounding pharmacy in a mixture specially concocted
for the individual patient as a mixture of Cytomel and levothyroxine, or a
mixture of NDT and levothyroxine. I take one T4 tab (75 mcg Syntyroid) and
60 mg of NDT; that seems to work for me.

One problem with taking the thyroid extract alone is that it has a T3 to T4
ratio of 1:4 where human blood levels are 1:11. Too much T3 can stress the
heart and cause anxiety and other issues, so you don't want it to get too
high (or too low).

I recommend the book "The Thyroid Solution" by Dr. Ridha Arem and another
called "Living Well With Hypothyroidism" by Mary Shomon. I dislike the
"Stop the Thyroid Madness" book because of it's insistence that NDT is best
for everyone; I don't believe that's true, but there is some good info in
there about making sure your iron, iodine, selenium and vitamin levels are
at their best in order to support optimal thyroid health.

I would say that it's best to try out levothyroxine and see if it does the
trick. If not, be aware of your other options.



-- 

Kit Kellison
 314-600-5254
co-owner Off Broadway
President Kellison Pohlman LLC
Thyroid Support Advocate
www.offbroadwaystl.com


 
Phyllis Chinn
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