Hypothyroid - Hoshimoto's

Andy,

I have been reading up on the thyroid quite a bit lately.  I have Hoshimoto's and have been on synthroid since 1997 (between 100mcg and 125mcg).  I feel best on 125mcg but my doctor prefers to have me on 112mcg.  At 125mcg I occasionally feel anxiety and palpatations - but any lower and I begin to have symptoms of hypothyroid again - lethargy etc.  Like mos doctors, my doctor monitors my thyroid using the TSH value only.  Whens he observes a decrease in TSH value she immediately lowers my synthroid dose. 

My understanding is that the thyroid makes 5 hormones - T0, T1, T2, T3, and T4 - and that synthroid replaces only T4.  Also, that the T3 produced by break down of T4 is mostly inert and that our bodies require T3 itself.   Would it be a good idea to have T4 and T3 medication?  T3 in the form of Cytomel?  Or is it best to take dessicated thyroid medication which would include all five forms of thyroid hormone.  My only reluctance to taking dessicated(pig thyroid) is that the dessicated has higher T3 than the human body requires (80/20 - rather than the 90/10 T4/T3 ratio in humans). 

Being anemic due to thalassemia and this thyroid issue together can take their toll - especially when taking care of a thal child, his antibodies - balancing another child and being a student.  I am hoping to see an endocrinologist - he was the first to diagnose me with Hoshimoto's - I am not sure how open he will be to treating me with anything other than synthroid.  I am hoping to be fully informed before seeing him so that I can be more persuasive in seeking more complete treatment.

Do you have any advise Andy?  I know that you and your family have battled thyroid disease for a long time. 

Thank you!

Sharmin

Best of luck with everything  i didn't even know you had thyroid problem,well i have been busy so much with my business and studies and kids.

Thyroid causes lethargy too?

Zaini.

Thanks Zaini,

Yes, I've been treated for hypothyroid for 15 years now.  Lately I have noticed that despite being treated with synthroid - having good T4 and TSH levels I feel hypothyroid.  Maybe it's time to add T3.  I hope to see an endocrinologist soon.

I hope you and your family are doing well!

Best,

Sharmin

Hi Sharmin,

I am hypothyroid too, with antithyroid antibodies - I think thats called Hashimotos.

My thyroid medication ( levothyroxine sodium ) is adjusted based on only total T3 and T4, my TSH seems to have an independent life of is own. One downside of a high TSH can be a possible goitre in future.

If my thyroid dose is even slightly high, I get palpitations, and I get warm and hyper, then i cant switch off - feels like i'm burning myself out.

Its best to see an endocrinologist, who will better understand you. Thyroid medicines based only on TSH, are not very useful for all cases. My TSH will sometimes be high, even if my total T3, T4 are normal. Its a signalling mismatch, and doesn't accurately tell how much thyroid mediation I need.

Hi Sharmin,

This is one of the most frustrating aspects of my own life. Thyroid disease runs rampant in my family, who somehow manage to represent all three types of thyroid disorders. My daughter also has Hashimoto's and has felt the same frustration as you because she was also told thryoxine alone is all that is required. I am hypothyroid and even though my TSH level is in range, I have never felt that my thyroid works properly. I would suggest talking to your new endocrinologist about the possibility of using the combination treatment. In this study, patients preferred the combination treatment even though weight loss was the sole observed difference in testing of various parameters. It reminds me of how I feel taking wheatgrass extract. I can't give much in specifics, but I feel better when I'm taking it. I think sometimes the difference isn't easy to measure with tests. If the doctor is willing to allow a trial adding T3 in combination with thyroxine, you would be able to assess if you feel better. Perhaps considering the context of thal minor and its fatigue causing effect, the doctor may be more willing to give the combination a trial.

http://www.ncbi.nlm.nih.gov/pubmed/15705921

J Clin Endocrinol Metab. 2005 May;90(5):2666-74. Epub 2005 Feb 10.
Combined therapy with levothyroxine and liothyronine in two ratios, compared with levothyroxine monotherapy in primary hypothyroidism: a double-blind, randomized, controlled clinical trial.
Appelhof BC, Fliers E, Wekking EM, Schene AH, Huyser J, Tijssen JG, Endert E, van Weert HC, Wiersinga WM.
Source
Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, F5-161, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. b.c.appelhof@amc.uva.nl
Abstract
Controversy remains about the value of combined treatment with levothyroxine (LT4) and liothyronine (LT3), compared with LT4 alone in primary hypothyroidism. We compared combined treatment with LT4 and LT3 in a ratio of 5:1 or 10:1 with LT4 monotherapy. We conducted a double-blind, randomized, controlled trial in 141 patients (18-70 yr old) with primary autoimmune hypothyroidism, recruited via general practitioners. Inclusion criteria included: LT4 treatment for 6 months or more, a stable dose for 6 wk or more, and serum TSH levels between 0.11 and 4.0 microU/ml (mU/liter). Randomization groups were: 1) continuation of LT4 (n = 48); 2) LT4/LT3, ratio 10:1 (n = 46); and 3) LT4/LT3, ratio 5:1 (n = 47). Subjective preference of study medication after 15 wk, compared with usual LT4, was the primary outcome measure. Secondary outcomes included scores on questionnaires on mood, fatigue, psychological symptoms, and a substantial set of neurocognitive tests. Study medication was preferred to usual treatment by 29.2, 41.3, and 52.2% in the LT4, 10:1 ratio, and 5:1 ratio groups, respectively (chi2 test for trend, P = 0.024). This linear trend was not substantiated by results on any of the secondary outcome measures: scores on questionnaires and neurocognitive tests consistently ameliorated, but the amelioration was not different among the treatment groups. Median end point serum TSH was 0.64 microU/ml (mU/liter), 0.35 microU/ml (mU/liter), and 0.07 microU/ml (mU/liter), respectively [ANOVA on ln(TSH) for linear trend, P < 0.01]. Mean body weight change was +0.1, -0.5, and -1.7 kg, respectively (ANOVA for trend, P = 0.01). Decrease in weight, but not decrease in serum TSH was correlated with increased satisfaction with study medication. Of the patients who preferred combined LT4/LT3 therapy, 44% had serum TSH less than 0.11 microU/ml (mU/liter). Patients preferred combined LT4/LT3 therapy to usual LT4 therapy, but changes in mood, fatigue, well-being, and neurocognitive functions could not satisfactorily explain why the primary outcome was in favor of LT4/LT3 combination therapy. Decrease in body weight was associated with satisfaction with study medication.

PMID: 15705921 [PubMed - indexed for MEDLINE] Free full text