Gailís Thyroid Tips
NOTE: I am not a doctor or medical professional, nor do I play one on TV (ha ha). The following information is the story of how I came to achieve wellness, and the information I found during that process. No warranty is expressed or implied (ha ha again).
NOTE: If you think you might use the information contained in the various links Iíve listed here, go to the link and print out the article immediately. Some of these sources archive their articles over time and you cannot access the links again. This is especially true of the New England Journal of Medicine articles. I have printouts of all these articles. If an article has been archived so you cannot get it, post me at email@example.com and I can scan my copy for you.
NOTE: If you click on a link which begins with "www" rather than "http" and it doesnít work, just add the "http://" in front of the address in your browser window. Some software requires that.
NOTE: If you want to do your own searches but donít know where to begin, try going to www.yahoo.com. At the top of the page is a "search" window. Just type in words relevant to your search. Donít use commas, quotation marks, or the word "and." Here is an example: Ward Dean thyroid. Try putting the most unusual words first; we seem to get better results that way.
This info is on many levels; there is basic info many of you will already know but I include it because many of you are newly diagnosed and just learning about this disease. Other info is so scientific you need a medical dictionary! In addition, I started compiling this info after being contacted by Americans, but now have requests from as far away as Australia. I do not know the international policy of Great Smokies Diagnostic Laboratory!
I also recommend that you subscribe to Mary Shomon's newsletter (www.thyroid.about.com) so you can keep up to date on all the latest thyroid news from a reputable source (rather than some of the hearsay that goes around the forum; all sorts of unfounded rumors abound in the forum, in addition to the wonderful support and helpful hints offered).
OK, for starters, here is some basic background information about the function of the thyroid gland. This info is vital to understanding why synthroid doesnít provide full relief from your symptoms and why natural desiccated thyroid is a superior medication for most people. It is true that not all women are alike and therefore what we do with one will not necessarily have the same effect on another. However, my research has shown that at least 80% of people feel best on a natural desiccated thyroid product (such as Armour or Westhroid) than on the incomplete synthetic products (synthroid, levoxyl, unithroid, cytomel, thyrolar etc). Why? Because the healthy thyroid gland does not produce merely T4 and T3. It also produces reverse T3, 3 kinds of T2, T1, T0, and calcitonin.
What is calcitonin, you ask? Well, this is the hormone (produced by the parathyroid gland) which removes calcium from your blood and deposits it into your bones. You know how thereís the big worry about osteoporosis when you are on thyroid replacement therapy? Thatís probably because 95% of people today are given synthetic hormone which does not contain calcitonin. The desiccated thyroid products do have it. This is just one more reason to take Armour or Westhroid or some other natural thyroid product. The calcitonin helps counter the bone-destroying effects of thyroid hormones.
Donít EVER forget that people with normal thyroid glands have the full spectrum (including T3) of thyroid hormones coursing through their blood streams all day long every day! So they are at just as much risk for osteoporosis as a woman on natural thyroid supplement! A doctor who leaves you hypothyroid in order to "protect your bones" is a doctor to fire. The best thing you can do for your bones is to exercise; light resistance training (weights) will increase your bone mass very significantly (you donít even have to use heavy weights). How well does it work? Studies with the elderly in nursing homes using just 5-pound weights a few minutes daily increased bone mass so well the test group got fewer than half as many fractures as those who did not exercise with weights. And not only that, it builds muscle which will raise your metabolic rate and make you lose weight more quickly and easily.
Whenever anyone tries to tell you "natural thyroid is dangerous because it has T3," you tell them "Hurry! Run to the hospital and get your thyroid gland yanked out QUICK!!! Itís pumping T3 into your bloodstream NIGHT AND DAY!!!!!!" Did you know those studies that say oral thyroid causes osteoporosis were all done on SYNTHROID, not desiccated thyroid (Armour)????!!!! And these studies showed that the connection existed only in post-menopausal women. Meanwhile a whole slew of studies were done that showed no connection between oral thyroid and osteoporosis, not even in post-menopausal women. In other words, there is no proof either way and the doctors need to start doing their homework and actually REALIZE this instead of listening to the slick marketing techniques practiced by the makers of synthroid. Millions of women in this country are being forced to take synthroid to protect their bones from Armour---not because of scientific research proving osteoporosis but because the makers of synthroid said so.
Now, back to the various other thyroid hormonesÖ
As you know, the thyroid hormones consist of a tyrosine molecule with iodine molecules stuck to it. If 4 iodines are stuck on, you have T4. 3 iodines gives you T3. Reverse T3 is created with 3 iodines stuck in different positions. T2 has 2 iodines; there are 3 types of T2 all depending on where the iodines are stuck. Etc.
The hypothalamus gland takes note of how much thyroid hormone there is in the bloodstream and if the amount is too low, it releases a hormone called TRH. This is Thyrotropin Releasing Hormone. It goes to the pituitary gland and stimulates it to release TSH. This is Thyroid Stimulating Hormone, and it goes to the thyroid gland to tell it to make some more thyroid hormone. So the thyroid gland takes in the amino acid tyrosine and the mineral iodine and then combines the two, creating the thyroid hormone. There is T0 and T1 (0.5%), T2 (4.5%), T3 (15%), and T4 (80%) (These percentages are approximate; I have found different numbers from different sources). Each of these hormones is stored in the thyroid gland and also released into the bloodstream. No one knows what T0 and T1 are for. T4 is very stable and courses through the bloodstream, ready to be taken up by a needy tissue for conversion to T3 and T2. What your gland does is to make a little bit of T2 and T3 and release them to the body for instant usage. Then your gland also produces a stockpile of T4 which it releases to travel around in your blood, ready for any needy cell to convert over into useable T3 (and T2). To convert T4 into T3 (and T3 into T2), your tissues use an enzyme, deiodinase, to knock one of the iodine molecules off. Well, some of your tissues require a supply of T2 in order to make this enzyme (while other tissues are able to make deiodinase without T2). Now, there are also several different deiodinase enzymes and they knock different iodines off. This means you will sometimes get reverse T3 instead of T3. And this is how your body creates the 3 different types of T2.
http://www-hsc.usc.edu/~hkaslow/Teach/Handouts/Thyroid-2000.pdf This is a scientific treatise about how thyroid hormone is made, the different deiodinase enzymes that are necessary to convert the various hormones, and what happens next.
Synthroid (levoxyl, unithroid, and all other levothyroxine products) consist only of T4. The theory is that since T4 is barely active metabolically, when you take it you wonít notice any metabolic effect on your body (heart palpitations, etc). But then it will start to break down into T3, reverse T3, (which go down to the T2s, etc) and your body will use these hormones. Well, thatís the THEORY.
OK, why doesnít synthroid make us feel great then? Well, because some cells in our bodies need the T3 that is made by the thyroid gland directly. They cannot convert T4 into T3; they must have T3 directly from the bloodstream. About 75% of the T3 your body uses is converted by your tissues from T4. But at least 25% of the T3 your body needs comes directly from the thyroid gland. Your different tissues throughout your body use T3 at different rates. And some of the tissues, such as your brain, require serum T3 for good function. These tissues are not adept at converting T4 into T3. Because people with healthy thyroid glands receive at least 25% of their T3 directly from the thyroid gland, hypothyroid patients should also receive direct T3, either from their glands or from their medication. NO ONE SHOULD BE EXPECTED TO GET ALL OF HER T3 FROM T4 CONVERSION. IT SIMPLY IS NOT ENOUGH. And other cells must have T2. So you see, you just donít get the same effect from synthroid. Your body demands all 9 of the thyroid hormones that a healthy thyroid gland makes. Desiccated thyroid products come closest to providing the exact hormones your body would make if it could. http://freespace.virgin.net/smokey.quartz/gaby.html
NOTE: Forest Pharmaceuticals does not "add" calcitonin, T0, T1, or T2 to their product. These hormones are present already because of what Armour is. Armour is desiccated pig thyroid. The thyroid gland is removed from a pig, dried, and then ground to powder. The glands from many pigs are mixed together until testing shows that the T3 to T4 ratio is exactly 1:4.22 (there is 1 mg of T3 for every 4.22 mg of T4). Then binders and fillers are added to produce tablets. So every hormone present in the live gland is also present in the tablet. However, since medical professionals currently believe that only T4 and T3 are active hormones, Forest does not measure or even acknowledge the presence of calcitonin, T0, T1, or T2 in their product. They only measure and guarantee the amount of T3 and T4 in each tablet.
Here is a scientific study proving the body needs T3; notice the last sentence of the "conclusions" section clearly states that this study shows your body needs the T3 DIRECTLY SECRETED by the thyroid gland (not the T3 made from T4 conversion). http://content.nejm.org/cgi/content/abstract/340/6/424?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Prange%2C+A&author2=Bunevicius%2C+R&titleabstract=triiodothyronine&fulltext=neuropsychological&searchid=QID_NOT_SET&stored_search=&FIRSTINDEX=&fdate=1/1/1975&tdate=5/31/2001&journalcode=nejm
OK, now here is some scientific proof that T2 is not some inactive substance ignored by the tissues. Youíve heard that Iím sure. I just got a comprehensive thyroid labwork done and it talked about the T4 levels, the reverse T3, the active T3, and then mentioned T2 as "an inactive byproduct." WRONG! This study is contained in the below link and it is very technical. Several hours with a medical dictionary unlocked the mysteries. Hereís what it basically says, in laymanís terms:
--T3 is taken up by the cells and used for protein synthesis. Protein synthesis means the actual building of cells (to replace dead cells, fix damaged cells, and make new cells). So you see, T3 is needed to maintain the tissues of our body.
--T2 is taken up by the cells and acts directly on the mitochondria. The T2 is used to produce ATP. ATP is the fuel for our cells; it is the energy our cells use to function. So you see, T2 is absolutely vital for the cells to function. Yes, it is true that a healthy thyroid gland does not make very much T2. But certain cells in the body depend on it.
This would explain why so much of your overall body pain goes away when you take Armour and are thus getting plenty of T2; without T2 your cells are starving for ATP. I experienced this firsthand myself; when I switched to Armour most of my pain was relieved. I immediately told my hypothyroid sister who has been on 100 mcg synthroid plus 100 mcg of cytomel daily and still hurting all over (100 mcg cytomel is FOUR TIMES the normal daily dose!). She lowered the two synthetic hormones to 75 mcg each and added in a grain of Armour; her body aching improved tremendously within 2 weeks. Even though this provided her with LESS oral T3 intake than she had before, nearly all of her fibromyalgia disappeared! She was left only with some foot and leg pain on one side, but the rest of her body was completely better. We all know that Dr. John Lowe has recommended using T3 to cure those pains (fibromyalgia) and he is right. (http://thyroid.about.com/health/thyroid/library/weekly/aa042799.htm). The T3 is VITAL. However, I offer up my sister as proof that it is more than just T3 we need to use. I have no proof of this, but I believe that it is the T2 (and perhaps the T1---no one has figured out what it does yet) in Armour which produces the kinds of results she had.
I myself was on only synthroid last year, but at Christmas I took some of my sisterís cytomel. There was a minor improvement in my fibromyalgia but I still hurt all over. However, when I switched to Armour in January, my pain went away almost instantly (all except my feet, which were cured by supporting my adrenals) even though I was getting less oral T3 from the Armour than I had taken over Christmas with cytomel. Dr. Lowe states that it can take months or even years to undo the fibromyalgia using T3, but he feels it is the cure. I plan to write him a letter and tell him the story of my sister and me and also include the research on T2 which I have found. My sister and I had lived with our pain for years, and for both of us, it was alleviated in less than a month using natural thyroid. T3 breaks down into T2, but the body cannot perform that transformation without deiodinase. I have found research suggesting that cells need some T2 directly from the thyroid gland in order to make deiodinase at all. I wonder if Dr. Loweís treatment with oral T3 takes so long because the cells have such trouble converting the T3 into T2. I have no proof of any of this, but I think it warrants research. And if you are a thyroid patient with aches and pains, itís worth trying natural thyroid to see if it will go away.
Here is another article proving that T2 is a metabolically active hormone:
T2 is so metabolically active, as a matter of fact, that it is used by bodybuilders to lose fat and buff up:
This is actually quite exciting news for us thyroid patients. First of all, this could explain why many hypothyroid women struggle to lose weight: they are on synthroid so their bodies are deprived of T2. And if you read these articles, youíll see that oral T2 does not make you hyPERthyroid. This suggests that an overweight thyroid patient on a TSH-suppressive dose of oral thyroid hormone might be able to use oral T2 as a weight-loss aid. I just began taking T2 last week; my ďT2 Weightloss JournalĒ is below so you can follow along with my progress.
NOTE: If you wish to do your own search for info on T2, you must type "diiodothyronine" into the search engine; you donít get results if you put in "T2."† To purchase T2, put ďBioTech T2Ē into your search engine; there are many places to buy this product and lots of different prices so youíll want to shop around.
This does not mean that the body does not need T4!! I cannot find the reference right now but we also have research showing that certain cells must have serum T4 to convert to T3; these cells cannot use serum T3. Well, the same is true for all 9 thyroid hormones; almost every one of these hormones is required by a particular type of cell. This is why you cannot take just synthroid and be fully healthy.
While I believe that natural desiccated thyroid is the best medication to take, each of us has different amounts of semi-permanent damage to our bodies from years of untreated hypothyroidism or years of synthroid. If you are making too much reverse T3 out of the oral T4 in your Armour, your doctor will have to add in a dose of Cytomel to the natural hormone (take BOTH). I have also found in myself and other women that T4 levels may not be quite high enough when using Armour (or other natural products) alone. No one is sure exactly why yet. Some theorize that T4 isnít absorbed through the gut well. Others theorize that pigs make more T3 than humans do so that natural products arenít quite the right proportion. Others think that it is so easy for the body to convert the T4 in natural products that the result is high serum T3 and low serum T4 levels. Whatever the reason it happens, probably the best solution is to take mostly Armour and then add a very small dose of synthetic T4 to it. So if you are taking 100 mcg of synthroid daily, perhaps you should switch to 2 grains of Armour and 50 mcg Synthroid. Perhaps youíll need 2.5 grains Armour and 25 mcg synthroid. Or maybe YOUR body will need only 1.5 Armour and 75 mcg synthroid. Mine needs 3 grains of Armour and 25 mcg of synthroid. Everyone will need a different amount depending upon how long she had untreated hypothyroidism and how resistant her cells have become to T3, etc. The dose will vary between individuals, but this is probably the best combination of medications for most of us and is the most likely to make us feel good (and ideally, you wonít be given Synthroid at all; theyíll give you Unithroid instead since synthroid is so unstable. I am using the term "synthroid" to refer to any pure levothyroxine product). There is nothing wrong with combining the different thyroid medications and a really good doctor will do this if it is necessary to optimize your health. In addition, your doctor should be willing to try different brand names because of the different binders and fillers used. Naturethroid, for example, is natural desiccated thyroid made with different binders to be gentle on your stomach. It is made by Western Research Labs.
And it is important for the doctor to allow you to take ENOUGH hormone (havenít we all heard that before?!). I had a doctor finally switch me to Armour but he wouldnít let me take more than 2 grains because his boss had decided that no one should take more than 2 grains. Never mind that I was half dead and barely functioning (I was fine as long as I just stayed in my house and didnít do anything except cook a bit and fold the laundry). Just 3 months ago he told me "I will not give you more than 2 grains of Armour. You have an incurable disease so you will always feel bad. Youíll never feel really healthy again." Well, I changed doctors to a man who said for me to increase my medication at the rate of Ĺ grain per week up to 4 grains. I stopped at 3 grains because I felt great at that level. So much for feeling bad forever! If you have thyroid disease, you just donít have to feel bad. Period. What you need is a doctor who is willing to treat you as an individual and figure out what replacement therapy works on YOU.
Your doctor may tell you that he cannot give you Armour or any other medication containing T3 because it is "dangerous." But T3 is natural and your body must have it in order to live. Without it you DIE. Your doctor has it in HIS body! However, when taken orally it does enter the bloodstream quickly. The solution is simple; patients using Armour (or other T3 medications) simply split their dosage up and take a little bit throughout the day. How can you tell if you are taking too much T3 at once? Your heart-rate will increase and you may start to sweat. So just break up the dosage and donít take it all at once. If this means having to break your pill, get a pill-splitter from Wal-Mart and break it!
The only people who need to be concerned about taking oral T3 are cardiac patients. Does this mean they should be deprived of T3 just because they have cardiac issues? No! They need it just as muchóif not more thanóthe rest of us. They just have to take it in very small doses throughout the day and should be carefully monitored.
The fact is that a thyroid deficiency CAUSES cardiac problems. Hypothyroidism will give you heart disease. So if you already have a heart problem, you sure arenít going to get any better if you leave the thyroid only partially treated! You will only get worse. My aunt who is 84 years old has been on synthroid for 30 years (she had her gland removed in the 50s). Sheís had heart disease so bad sheís had quadruple bypass surgery 4 times already. Well, she just started showing the signs of Alzheimerís, and Alzheimerís is related to low T3. Her doctor just switched her to 3 grains of Armour and she is doing great. As a cardiac patient, itís a miracle she was able to get the Armour. Thank the Lord she has a reasonable doctor.
OK, what will happen to you if you are currently taking pure T4 (synthroid, levoxyl, unithroid) and do not get switched over to a natural thyroid medication? Well, your body will suffer. Left completely untreated, hypothyroidism will kill you. And if you treat it "halfway" (meaning that you take only T4 and do not take natural hormone), your tissues develop T4 resistance, which means that they lose the ability to convert the T4 into T3. Also, cell receptor sites shut down and cease to function, which can leave you semi-permanently damaged. The longer you leave it untreated, the harder it is to respond to the medication when you do get it. You will spend the remainder of your life in a state of cellular hypothyroidism, regardless of how high your blood serum levels are. Thus you will be at risk for all long-term effects of hypothyroidism (Chronic fatigue, fibromyalgia, high blood pressure, diabetes, emphysema, arthritis, sleep apnea, speech impairment, depression, weight problems, ME, carpal tunnel syndrome, high cholesterol, heart disease, cancer, etc). Your body will continue to be in a constant state of partial hypothyroidism; some of your tissues will be just fine because they are capable of using the Synthroid, but the rest of your body will always be "hungry" for T3 and will be chronically sick without it. This can be true even if you are feeling pretty good on your synthroid; even if you feel no physical pain, there are tissues in your body which are still deprived of the hormones they need.
And any patient
who still has hypothyroid symptoms while on hormone replacement therapy is at
risk for two major catastrophes:
a)she may permanently lose the use of her cell receptor sites
b)she will be at risk for all the long-term effects of low thyroid (high blood pressure, diabetes, emphysema, arthritis, depression, weight problems, ME, carpal tunnel syndrome, high cholesterol, heart disease, cancer, etc).
Overweight thyroid patients will also need more thyroid hormone (just as a 140-pound woman needs more than a 90-pound woman). They have a lot more cells in their bodies and will therefore require their serum levels to be closer to the higher end of the normal range. Low serum levels will only serve to create a low metabolic rate which means they will only get fatter. More supplementation should be given, raising serum levels and increasing metabolic rate. The patient will then be able to lose the excess weight and will require a lower dose of thyroid hormone in the future to maintain good health. Does this mean that switching to Armour is going to result in an instant weight loss? No. Thyroid hormone does control your metabolism; without thyroid, you have no metabolism and you will gain weight. But once you have good high serum levels of T3 and T4, you are now on a level playing field again, and the equivalent to all the others out there who don't have thyroid disease. This means you have to exercise and eat properly for good health and weight, just like everyone else.
Is your doctor a Synthroid Nazi? If I get a urinary tract infection and the doctor gives me amoxicillin and the infection persists, does the doctor just keep handing me amoxicillin and tell me to learn to live with it? No! He changes medications until he finds one that kills the infection. I recognize that a hormonal imbalance is different from an infection; I understand the differences quite clearly. But when you consider that there are over a dozen medications for thyroid disease, why should a patient be forced to use only synthroid if it is not making her better? Synthroid lowers TSH very well, but that does not mean your tissues and cells can use it. As a matter of fact, our research has shown that T2 is necessary for the creation of certain deiodinases and you just donít get T2 from Synthroid. No wonder your serum T4 levels go so high! The synthroid just goes into your bloodstream and circulates 'round and 'round, lowering your TSH and shutting down your own thyroid gland, but depriving your cells of hormone since they cannot use T4 as easily as they use T3 and T2. Did you know that T4 is what lowers TSH when it enters the pituitary? This is why synthroid is so effective at lowering TSH. But a low TSH doesnít mean the patient is healthy. If a person eats rocks and they lower her TSH, does that mean that her hypothyroidism is controlled? Health comes only when the cells and tissues of the body are getting T3 and T2. And most doctors measure only TSH. Sometimes theyíll go ahead and measure free T4 as well, but they rarely measure T3. You know, if I eat potatoes, there will be potatoes in my stomach. Well, if I eat T4 tablets every day, there will be T4 in my blood! How about we see if itís actually being used and converted to T3????? But it took me almost a year to convince someone to measure my T3 levels; prior to that Iíd had only TSH tests and free T4 tests.
And while we're on the subject of lab tests, I would like to emphasize that lab tests should be only secondary to clinical presentation (symptoms). Why? Well, there are several reasons. We'll start with the TSH test. This is not a measure of the function of the thyroid gland. TSH is produced by the pituitary. Using the TSH to diagnose poor thyroid function is a reverse approach. TSH can be elevated even if the thyroid gland is fine. For example, if you have a pituitary tumor, your TSH will be very high even if your thyroid gland is functional. In addition, TSH can be low even if you have thyroid disease. Dr. Barry Durrant-Peatfield discusses this effect; if your body is deficient in thyroid hormone, every cell in the body is affected---including the cells of the pituitary gland. Yes, even these cells cannot function well without thyroid hormone. So if your body is very hypothyroid, your TSH may actually be very low (and thus your doctor may refuse to treat your condition). In other words, there is absolutely no correlation at all between TSH and thyroid symptoms. And yet the TSH test is used almost exclusively to diagnose and treat this disease. Though there is much literature by thousands of doctors discussing the uselessness of the TSH test on patients taking oral thyroid hormone, almost every doctor out there continues to base our dosages on our TSH. Oral hormone can circulate in the blood, lowering TSH even if it is not used by the tissues. So the doctor measures your TSH, sees a 0.4, and declares you to be hypERthyroid even if your skin is scaly, you're depressed and in brain fog, and you're getting fatter by the minute. Once you are on oral thyroid hormone of any kind, the TSH test is nearly worthless and does not need to be performed.
Another little note about the TSH test: you know how the doctor will yank your medication when your TSH is too low even if you still are hypo? And you say "why?" and he says "because you are starting to become hyperthyroid." He is basing this solely on your TSH, which has nothing whatsoever to do with the actual use of thyroid hormone by the tissues, and you may very well be full of hyPO symptoms from head to toe. But he is all up in arms over your low TSH and wants it to move up to a nice "normal" level of at least 1 rather than a 0.3 so you won't be hypERthyroid. I take this opportunity to remind everyone out there that this is 100% NUTS. Doctors and patients alike MUST remember that millions of women are given TSH-suppressive doses of thyroid hormone every single day in order to stop thyroid cancer. Are you familiar with this situation? If you have thyroid cancer, a treatment option can include high doses of oral thyroid in order to lower your TSH to 0; this stops the function of the thyroid gland, which stops the growth of the cancer. Read up on this treatment and you will find that these patients--with those 0 TSH levels due to oral thyroid hormone--are perfectly normal and not hyPERthyroid at all! And the doctors all think this is a fine treatment---and yet they will refuse to give a Hashimoto's hypo patient enough hormone to make her healthy if her TSH goes below 1, no matter how awful her hypo symptoms are.
What about other blood work? These tests are useful but should not be used alone to titrate your medication. Again, symptoms are the most important factor. When lab work is ordered, both free T3 and free T4 tests should be done, together, every time. Free T4 alone is not good enough; you need a free T3 test to see if you are converting the T4. And do not be in a huge rush to get these blood tests. Natural thyroid doses are adjusted upward every few weeks until symptoms are alleviated. If you are taking 2 grains (120 mg) or less and feel good, you really donít need any more labwork. If you are on 2 grains and still have mild symptoms, get a free T3 and free T4 test to see if the T4 is too low. If it is, add a small amount of unithroid and see if the last of your symptoms go away. If they do not, you can increase your Armour as well (and also check your adrenals; this topic is discussed in detail below).
If you are on 2 grains and have severe symptoms, you should keep increasing your Armour (as well as assessing your adrenals, discussed in detail below). Your body may very well have cellular resistance. Gradually increase to 3 grains and see if your symptoms are alleviated. You may need 4 grains if you have extensive tissue damage. When should you get labwork? Go ahead and get a blood draw around 3 grains if you still have mild symptoms, to see if you should add a touch of Unithroid. But do not be surprised if your labwork is not in "normal" ranges. And do not be alarmed if it isn't. Why? Because if you have been hypo for many years and have a lot of tissue damage, you are no longer normal and you will not be healthy when you are in the normal range. My T3 levels, for example, are above the top of the normal range. But I am not even remotely hypERthyroid. I haven't the slightest symptom, in any form. Actually, I feel wonderful and if I take any lower dose, I become hypo again. My doctor says that my cells have a lot of resistance due to 5 years of untreated thyroid disease. We hope they recover in time, but for now I am not "normal" and do not fit on the reference range anywhere. This may very well be true for you too, so do not be surprised if your labwork does not fit on the "normal" range. The important thing to judge is how you feel. If you are not hyPER and all your hypO symptoms have been alleviated, you're probably on just the right dose, regardless of what your bloodwork says.
So please, do not depend on lab work to adjust your dosages! Too many doctors are already doing exactly that; we don't need the patients to start doing it as well! Go by your symptoms and find a doctor who will also do so. Forget about the TSH test; you won't need it anymore. Use the free T3 and free T4 tests only to determine if you need to add in some Unithroid. Beyond that, don't bother getting blood tests unless you start to feel bad again. Use the blood work solely to see if it is your T3 that is low or if it is your T4, so you know which medication to add or adjust. This is how my doctor is taking care of me and I am comfortable with this approach based on my research into thyroid disease.
Back to the medicationsÖ. If your doctor absolutely REFUSES to let you have anything but Synthroid, go to this link about Synthroid and the FDA.
Read through each of the links about Synthroid and print them out for your doctor.† BE SURE to include the actual letter from the FDA to Knoll Pharmaceuticals which denies them "Generally Recognized as Safe and Effective" status. And if that doesnít work, fire your doctor and get a new one. If your mechanic wonít fix your car properly and keeps charging you for bad work, you go to a new mechanic. Well, your body is more important than your car, so fire your doctor if he wonít fix you! You can feel good again! There are over a dozen different thyroid preparations on the market so there is no reason for your doctor to force you to use a medication that isnít working on you.
Most of you are well aware of this: Synthroid is now in big trouble. Synthroid is prescribed to about 60% of thyroid patients and has been in use for almost 40 years. Knoll Pharmaceuticals was allowed to bypass the FDA drug approval process by grandfathering it in with Armour even though the two products are totally different (Armour got in because natural desiccated thyroid has been used successfully for more than a century). Well, since then synthroid has had so many potency and stability problems that it has been recalled numerous times. So in 1997, the FDA announced that all sodium levothyroxine products would have to submit New Drug Applications by August 2000! This is an unusual step, but it was taken due to the problems with Synthroid. Knoll Pharmaceuticals responded by protesting and delaying. They delayed as long as possible and did manage to get the FDA to extend the deadline to August 2001. Meanwhile, Jerome Stevens Labs submitted their application by Aug 2000 and their product Unithroid was given FDA approval. Unithroid is now the reference drug for all sodium levothyroxine products.
But Knoll continued to whine and delay. They insisted that there was no reason for THEM to submit this NDA. To drum up support for their cause, they began sending letters to doctors and pharmacists all over the country. In this letter, Knoll actually claims that they successfully petitioned the FDA for "Generally Recognized as Safe and Effective" status! This is a blatant lie; the FDA did NOT grant such status to Synthroid and is still requiring a New Drug Application. The FDA rebutted with a scathing letter which denied all of Knollís requests and clarifies that Synthroid does NOT have "generally recognized as safe and effective" status. http://thyroid.about.com/health/thyroid/library/weekly/aa050301a.htm
On 25 May, King received FDA approval for their levothyroxine product Levoxyl. http://thyroid.about.com/library/weekly/aa052501a.htm
Do my levothyroxine patients feel perfect?
Is EVERY symptom alleviated?
Are they 100% satisfied with their medication?
Are they taking anti-depressants, cholesterol-lowering medication, pain-killers or other drugs to alleviate problems that are known to be hypothyroid symptoms? If so, are those drugs the only things keeping them "feeling good?" If a patient requires other medications, her thyroid medications are not correct.
Have freeT3 levels been checked?
Are their free T3 levels in about the same percentile as their free T4 levels? Free T3 should not be significantly lower than free T4.
Now letís move on to the adrenal issue. This is vitally important to thyroid patients for 2 big reasons.
First of all, the job of the adrenal gland is to produce adrenal hormones. One of these hormones is cortisol. This is the hormone your body demands when it is faced with any kind of stress. Stress does not just mean having your dog die or flunking a test. Stress is as simple as going outside on a hot (or cold) day, or eating lunch. Menstruation is a stress to the body. The adrenal gland reacts the same way when you eat lunch as when your dog dies. Itís all the same to your adrenals.
Another thing produced by the adrenals is DHEA. DHEA is a hormone precursor; in a healthy body it is converted into the sex hormones (testosterone, progesterone, estrogen, etc). DHEA is absolutely vital to our health. Here is a very brief link about DHEA (this isnít my best one since it talks only about sexual and mental health, but itís something! Iíll get the others set up later). DHEA is important to prevent Alzheimerís, heart disease, diabetes, cancer, skin problems, and about a million other things. Testosterone, as you may know, is what gives us our sex drive. Men have tons more testosterone than women (which is the main reason why their minds always seem to be in the gutter!). Where does testosterone come from? It is made by the body from DHEA. DHEA is made by the adrenals and is turned into all the sex hormones (estrogen, progesterone, etc). So, are you suffering from no sex drive? You probably have low testosterone which means you probably have low DHEA and why would you have low DHEA? If your adrenals arenít working well. If you are a lactating hypothyroid woman (but arenít pregnant or nursing a baby), you probably need DHEA because DHEA turns into testosterone. If you have had your prolactin measured and the test came back normal but you lactate anyway, you may very well be deficient in testosterone. In order to not lactate, the ratio between testosterone and prolactin must be correct. If you have "normal" prolactin but very low testosterone, it is just like having high prolactin. http://www.wholehealthmd.com/print/view/1,1560,AR_955,00.html
Decreased libido, galactorrhea, obesity, increase in abdominal fat, pubic hair loss, decreased muscle mass and strength, clitoral atrophy, increased risk of breast cancer, lack of motivation, premature ovarian failure, osteoporosis, decreased memory, increased risk of Alzheimerís, increased risk of diabetes, decreased feeling of well-being, depression, and fatigue are more symptoms of low testosterone. Read through these links and see if you recognize yourself there.
http://www.stenlake.com.au/showdocument.asp?DocumentID=152 In this article, a chemist has found that testosterone can protect against Lupus.
Here is another article
with some really great information about testosterone.† Take note of where the author says that both
free and bound testosterone are the components of total serum testosterone
(TST).† Free testosterone is what your
body can use.† Bound testosterone cannot
be used until it is unbound.† So you
see, your TST might be a nice healthy number, and yet you may have all the
signs of low testosterone because all of your testosterone is bound.† What binds it?† Sex Hormone Binding Globulin (SHBG).† If you have too much SHBG, it can bind up all your sex hormones
so you cannot use them.
Another possibility is that you are making DHEA but that your body simply isnít converting it into the various sex hormones.
Here is an article on galactorrhea (chronic lactation): http://www.uspharmacist.com/NewLook/DisplayArticle.cfm?item_num=141
http://www.nal.usda.gov/ttic/tektran/data/000009/42/0000094260.html This study may be of little interest to you unless you are lactating for no reason (or if you are a dairy farmer!). This is a study done on cows showing that changes in their deiodinase activity plays a role in their lactation. My husband found this study as he researched lactation because the one thyroid problem I have that has not gone away is lactation. I weaned my last baby in Nov í98 and STILL lactate! Hasnít ever stopped in all that time (but I least I feel great!). So weíre still researching this one. If it turns out that changes in your deiodinase activity affects lactation that sure would explain whatís going on in a lot of us hypo women!
And here is a natural remedy to stop lactation. http://www.herb.co.za/herbal/sage.htm
You can get DHEA in the vitamin section of nearly any store (Wal-Mart has it). Notice in the link above that it took up to 4 months for the patients to see results (http://www.wholehealthmd.com/print/view/1,1560,AR_955,00.html). Also, you do not want to take too much. My doctor has me take 25 mg daily Monday through Friday with a break on the weekends (the dose for men is 50 mg daily). If you start taking DHEA and notice that you are getting acne like a teenager, you donít need that much. Quit taking it altogether until the acne clears up and then you can try taking a half-dose 3 days/week instead. If the acne comes back, your DHEA levels are probably just fine. Iím not getting any acne at all on my dose, but I am not surprised considering that I had a lab test showing that my adrenals donít work (and by the way, if DHEA gives you acne, that does not mean your cortisol levels are OK).
Here is another article that concerns osteoporosis, but on page 4 you will see a discussion of DHEA and the role it plays in bone density. http://www.thorne.com/altmedrev/fulltext/osteo2-1.html
Now, the first reason why hypothyroid women should be concerned about their adrenals is that the adrenal gland is highly dependent upon thyroid hormone. It cannot function properly if you become hypothyroid. I have a study (Iíve got to find it again) which shows that almost 100% of women with thyroid disease are deficient in DHEA. Yep, thatís right! If youíve got thyroid disease, you are probably facing an adrenal insufficiency. This is especially true if you were hypothyroid for a long time and denied treatment (I was denied treatment for more than 5 years). Also, if you spend years on incomplete thyroid therapy (such as the synthetic thyroid hormones), you are more likely to have weak adrenals. The adrenals just canít do their job if theyíre getting only T4.
And the thyroid gland cannot do its job without the adrenals. I have a great article discussing this: Peatfield_Suggest.htm (if you print nothing else, print this article). The amazing Dr. Barry Durrant-Peatfield of Great Britain has found repeatedly that if a woman on thyroid therapy continues to exhibit symptoms, if he treats her adrenals, her symptoms go away. Without the adrenal hormones, the body cannot use the thyroid hormones. Treatment of the adrenals results in the thyroid hormone finally making it into the cells and tissues. This usually results in the patient being able to lower her thyroid medication. In addition, over time the adrenal support will help heal the damaged cell receptor sites so that thyroid hormone can pass into the cell to the mitochondria again. In other words, proper adrenal support means the difference between a life of good health and a life full of nagging, miserable, painful hypo symptoms.
Now, this is a really radical and unusual approach to thyroid disease! But it shouldnít be! Notice I said that he treats the adrenals of his patients. What a concept; did you know that actually, all hypothyroid women are supposed to have their adrenals tested BEFORE getting any kind of thyroid hormone? Yep! If you read the inserts which accompany thyroid medications, you will find that the contra-indication for the use of thyroid hormone is "uncorrected adrenal insufficiency." And you do NOT know if a patient has adrenal insufficiency if you do not test for it. Here are the links to the cytomel and synthroid inserts, but you will find this to be true on the insert of EVERY thyroid medication.
This should make you pretty mad. Why? Because if your adrenals have become weakened by your thyroid disease and arenít functioning well, when you are put on thyroid hormone it can cause an adrenal crisis. If the situation is very bad, it can KILL you. Thatís right---death. But are the doctors testing our adrenals ahead of time? No, they are not, even though it clearly states that they must do so in the Physicians Desk Reference. Every doctor who prescribes thyroid hormone without testing the patientís adrenals first is putting the patientís life at risk (in other words, almost every doctor on this planet).
Here is an article by a doctor discussing the treatment of hypothyroidism. On page 4, you will see a section entitled "Special Cases: Recent Heart Attacks and Weak Adrenal Function." The paragraph about the adrenals describes me perfectly! That is me all over and a lot of women I know. Go to the very next section on page 5 entitled "Problems in Converting T4 to the T3 Hormone." Reading that paragraph you will see that cortisol is necessary for the body to convert T4 into T3. Thus we must have our adrenals working in order to utilize the oral thyroid hormone we take. http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=528
So you see, if the body has poor thyroid function, poor adrenal function will result. And then the doctor will start to give you thyroid hormone but you wonít feel better because your body simply canít use the thyroid without cortisol. You must address adrenal function. And you are supposed to address it FIRST. Yet I was on synthroid for a whole year before I got my first adrenal test. And the only reason I got the test then was because my husband went to my doctor and demanded it, not because the doctor thought of it himself. Meanwhile, by that time my adrenals were so weakened and non-functional that I was near death---all because no doctor had bothered to check them before giving me synthroid. Then the pure T4 weakened my adrenals even further so they shut down almost completely; it nearly killed me.
Are you a woman who is hypothyroid and yet any tiny amount of oral hormone gives you hyPERthyroid symptoms? When I read these articles about adrenal function and how oral thyroid taken by a hypoadrenal person can cause hyPERthyroid symptoms, I have to wonder if perhaps you need an adrenal test.
Read these next two articles and take especial note of "Table 1" in each of these articles. Notice the list of symptoms hypoadrenal people experience. See how they sound almost exactly like hypothyroid symptoms? Makes you wonder which came first, low adrenal or low thyroidÖ. Chicken and the egg. And you must fix both to be healthy.
The first article, just above Table 1, points out that you must check adrenals before giving thyroid hormone. He also points out that none of the doctors in this world are doing so even though it is clearly stated in the Physicianís Desk Reference. He even quotes the Physicianís Desk Reference.
This next article also discusses adrenal insufficiency. The big thing that stands out to me in this article is where the writer mentions that body temperature may be below normal. Thatís true for hypothyroid patients also. Have you read articles in which the Barnes method is discussed and the writer often says it can take up to a year after thyroid hormone is begun for the patientís body temperature to come up to normal? Well, I suspect thatís because the patientís adrenals have not been addressed! If you address both the adrenals and the thyroid together, the patient will feel much better much sooner. Without cortisol, she cannot use thyroid hormone properly and without thyroid she will not make cortisol. Neither the thyroid nor the adrenal can correct without the other. You must treat both together! http://www.merck.com/pubs/mmanual/section2/chapter9/9b.htm
And here is an interview with the Drs. Shames, who specialize in thyroid disorders and the adrenal connection. In this interview you will note that they say you can actually diagnose adrenal weakness by default if your thyroid patient experiences a WORSENING of symptoms when she is given thyroid hormone. Now, I greatly admire the Drs. Shames and if I lived in Boca-Raton FL Iíd choose them to treat my disease. But what angers me about this interview is how they completely ignore the adrenal issue until AFTER they treat a patient for her thyroid. They say "oh, if you are on thyroid drugs and still donít feel well, maybe itís your adrenals." This is WRONG! The adrenals are supposed to be treated FIRST. Go back and read those thyroid drug inserts; they clearly state that doctors must not prescribe thyroid meds if there is adrenal insufficiency. And yet the doctors---even the great Drs. Shames---keep giving us thyroid meds and waiting until we collapse before checking adrenals (if they bother to check them at all). This bit of malpractice on the part of doctors can KILL you. http://thyroid.about.com/health/thyroid/library/weekly/aa052801a.htm
So, what is an adrenal test? WATCH OUT! My husband found all this wonderful information about adrenal function and how you must address this issue in thyroid patients, but we had a hard time convincing the doctors to do so. I was sent to an endocrinologist because all the GPs who had seen me couldnít figure out why I still wasnít feeling well even with a low TSH. They decided there must be further endocrine imbalances (adrenals are part of the endocrine system) and a specialist was needed. So I went to the local Endo and got her to admit that there is an adrenal-thyroid connection, but she refused to run tests. I went back to the GP and told him what had happened. I was so upset that he immediately ordered an 8 AM serum cortisol test. See, the way that cortisol works is your levels are much higher in the morning and they fall throughout the day. In addition, cortisol is not stored anywhere; the body makes it as it needs it. So I got an 8 AM cortisol test and I had 6.7 with the normal range being 6.2 to 29. In spite of this very low number, the doctor said "Well, itís normal" and sent me home. And a morning serum cortisol is the only test most doctors will run.
I changed doctors and got myself put on Armour. I immediately began to feel better but still had many unresolved symptoms because this man was afraid to give me enough medication! (it has T3 in it, after all, so must be badÖ..). So I changed to a Top Doc (http://www.thyroid.about.com/health/thyroid/library/weekly/bldoc1.htm I drive 2 hours to get to his office and then 2 hours back) and he just about died when he saw my cortisol test! He said that clearly I was in bad shape since I was at the very bottom of normal range and the levels only fall off from there. He likes to see your morning number between 12 and 15 for optimum health.
So he ran an all-day adrenal test on me. THIS IS VITAL!!!! Even if your insurance wonít pay for it, get this test! What you do is spit in test-tubes at 8 AM, noon, 4 PM, and midnight. I got the test and it showed that I was still starting off in the low normal range at 8 AM, but it was better than it had been back on synthroid. Armour is not only better for your body but also better for your adrenals; my 8 AM cortisol level had come up to 11 after 2 months on Armour. But it also showed that I was even farther down in the normal range at noon, was below normal by 4 PM, and had no adrenal function at all by midnight. So you see, had my new doctor given me only an 8 AM cortisol test like the last guy did, it would have showed that I was just fine, and yet the all day test proved conclusively that I was close to death by the end of the day, every day. One of the symptoms I had at this time which hadnít improved from the Armour was aching feet and breathing problems while sleeping (I would either snore or have sleep apnea or chokes where I would stop breathing completely). However, the same day that the doctor started me on oral cortisol, my feet quit hurting, I had enormous energy, and all my sleep problems disappeared. I feel more rested and energetic than I have felt in years! It totally alleviated every single remaining "thyroid" symptom I was dealing with. While Armour did great things for me and nearly restored me to normal (on synthroid, I was actually dying; my new doctor told me it is just a miracle I did not actually DIE at some point over the last few years while my health was so mismanaged), the oral cortisol turned back the clock 10 years. I went from feeling like a decrepit 90-yr-old to a 25-yr-old (and Iím 34, by the way). Go back and read again the "Table 1" on those adrenal links I listed above. Those symptoms, especially the aching and pain, are always written off as hypothyroid symptoms and fibromyalgia. But if your adrenals are weak, then even T3 isnít going to cure all your ills. You must begin taking cortisol and then you will feel like new. I want to reiterate how much my adrenal function improved after a couple months on Armour. On synthroid my 8 AM cortisol level was only 6.7. After 2 months on a too-low dose of Armour, my 8 AM level moved up to 11. I would argue that the adrenals need more than just synthroid to function well; these glands probably require either T2 or T3 or both for good function.
You can get this all day adrenal test for only $106 dollars from the Great Smokies Diagnostic Laboratory (www.gsdl.com). They are in North Carolina but they will overnight mail to you a special test kit (at their expense) and give you a prepaid mailer to overnight it back to them. The phone number of Great Smokies is 800-522-4762 and they are worth every penny because very few labs do this test at all. They take insurance payments, or you can pay up front and file the insurance yourself, which costs less. Your doctor has to order the test, but all he has to do is call that toll-free number and they will set up an account with his medical license to authorize your lab work. (and in the meantime, you may want to peruse their website to see what all you can learn from them too!)
Some of you have told me that you had an ACTH test, which is supposed to tell you if your adrenals are working properly. And the doctor told you that your test was normal so you donít need adrenal support. Well, an ACTH test is similar to a TSH test; ACTH is the hormone which tells the adrenals to get busy and make cortisol. So if your ACTH is elevated, then your adrenals arenít working, right?
I had an ACTH test too, when I first told a doctor that I had concerns about my adrenal function. My results were perfectly normal so he decided that I did not have adrenal problems. I changed doctors not long after that and was given the all-day cortisol test. This test showed that I had almost no adrenal function by evening and that by midnight, my adrenals were nearly completely shut down. So as you can see, that ACTH test was worthless.
There is another type of "all day" adrenal test your doctor may offer you. This is a test in which you collect all of your urine in the same jug for a full 24 hours. This test is pretty worthless too; donít get excited if your doctor orders it. The type of day-long cortisol test that you must request is an exam that takes individual measurements of your cortisol levels at least 4 times throughout the day. This test is usually referred to as an "Adrenocortex Stress Profile." For further information on the types of tests which are good and those which are worthless, go back to the interview with the Drs. Shames. http://thyroid.about.com/health/thyroid/library/weekly/aa052801a.htm
I offer this to you as further emphasis on the importance of having an ALL DAY cortisol stress index to determine if your adrenals really are ok. My 8 AM cortisol test was fine. My ACTH test was fine. And yet the all day cortisol test showed adrenal shut-down by evening, which nearly killed me. Every night in my sleep I wasnít breathing much of the time. Go back to that article by Dr. Durrant-Peatfield; he has an explanation for this. Peatfield_Suggest.htm† It is because your thyroid disease has weakened your entire body so much (since every cell you have depends on thyroid hormone) that even your poor little pituitary gland can no longer produce ACTH in proper amounts to stimulate your adrenals. So the ACTH test is worthless; if the number is low the doctor will believe your adrenals are fine (just like a low TSH means you must have lots of thyroid hormone in your body, right?). When really that low ACTH may mean your body is so weakened by thyroid disease that your pituitary is unable to do its job either. Keep this in mind; Dr. Durrant-Peatfield also points out that this very same thing can be true about low TSH. If you are hypo from head to toe and your TSH isnít real high, your doctor will usually send you home. But if you are really low in thyroid, your pituitary may be so weakened by that fact that it canít even produce TSH.
Another point Iíd like to make: if your all day adrenal test comes back showing that you are somewhere in the normal range all day, even at midnight, but the numbers are rock-bottom, thatís not good enough. My doctor wasnít satisfied even with that 11 I had at 8 AM. He wants your 8 AM level between 12 and 15 for optimum health. Thatís right at mid-range and this is where you will feel best. Too much is not good for you but too little is bad also. You need to be right in the middle throughout the day for the best health. So if you are scraping along the bottom of the reference range all day long, itís no wonder you arenít feeling good. Your doctor should not look at this and say "OK, itís still in normal range so go home and take some Prozac." He should say "No wonder you feel dragged out and exhausted and achy. You are barely scraping along with hardly any cortisol at all! Clearly you will feel better if you had a little more."
Several women have posted me and said that their adrenal tests showed yo-yo levels, with a high at 4 PM or something wacky like that. Today I got a note from a lady who just got her Great Smokies saliva results, and she too had that same phenomenon. Here are her test results, with the reference range in parenthesis:
DHEA at 8 AM: 1.3 (.75-2.5)
8 AM: 28.6 (5-23)
12 noon: 2.39 (1.8-11)
4 PM: 6.22 (1-6.5)
12 midnight: 0.56 (.8-4.7)
As you can see, her cortisol was very high at 8 AM and 4 PM but much too low at noon and nearly non-existent at midnight. Included with her results is a "Conclusions" paragraph from the laboratory. It says:
"A pattern showing both elevated and decreased cortisol levels in the presence of normal DHEA is clinically significant. The presence of cortisol fluctuations suggests an underlying hypofunction that is interrupted by episodic hyperfunction. This may be seen in adrenal fatigue with hyper-reactivity, such as physiological or psychological stress induction of cortisol in an otherwise hypofunction state. DHEA within the refernce range suggests there is no evidence of zona reticularis hypofunction at this time. In this pattern there is increased probability of poorly regulated blood glucose, presenting as hypo or hyperglycemia. This pattern represents a degree of adrenal hypofunction and has been noted in fatigue disorders, physiological or psychological stress and hypertension."
I asked her when she took her thyroid medication. She took the morning dose at 7:30 and the second half of her Armour in the afternoon. This could very well be the "physiological stress induction of cortisol!" This woman has the classic clinical symptoms of adrenal hypofunction, including a worsening of her thyroid symptoms 2-3 days after she increases her Armour dosage.
I include this for the people who have posted me saying that they, too, have yo-yo cortisol levels which are high at the wrong times or go up and down throughout the day. The Great Smokies Lab states this IS significant and seen in adrenal fatigue. If your doctor refuses to address this, perhaps you need a different doctor.
Now, here is the second huge reason why adrenal function is so important to thyroid patients. The first reason was that hypothyroid people are usually hypoadrenal. The second reason is that every time you switch thyroid medications or change your dose, you are stressing your body (the same as going outside on a hot day stresses your body too). I have foundóand so have many other womenóthat every time I had my dosage changed or my medication switched, Iíd go on a "crash." Iíd feel ok the first day or 2 but then my symptoms would come back even worse than before. Iíd be a wreck for 3-5 days and then slowly Iíd improve and end up feeling better than I had felt before the change. I always thought this crash must be because my thyroid gland was putting out some amount of hormone and the increase in my oral dose caused my TSH to go down so my thyroid gland shut down too, and then it recovered after a few days. But I kept researching and found out that actually, it is because my adrenals were in such horrible shape from spending 5 years with untreated thyroid disease. My adrenals simply couldnít handle the stress of changing medications. This is exactly the problem described in those links I listed above Dean_Adrenal.htm and http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=528). And this is true for almost everyone with thyroid disease; they always feel bad when changing thyroid meds because of the stress to their adrenals. By the way, I have a theory that this is why so many women will say "Oh I tried _____ medication and it just didnít work for me." And actually, the change in thyroid medication might have been a good idea but the adrenal crash made the patient believe that she was much worse off with this different medication. Re-read that interview with the Drs. Shames. They say exactly the same thing.
Why don't you get a big adrenal crash on synthroid like you might get when you try Armour? Because synthroid is pure T4 and so metabolically inactive that it barely moves through your system and does nothing to you. Armour on the other hand, increases metabolic activity so effectively that the adrenals can't handle the sudden return to health so they crash. Knoll Pharmaceuticals would have you believe that this proves Synthroid is better than Armour. In actual fact, the adrenals crash because Armour is so much better than synthroid! Synthroid limits the body and keeps the metabolism sluggish and barely functioning (which means no adrenal stress). Armour, on the other hand, gives back to you the nice healthy metabolism you had before your thyroid gland got sick, and it does so quickly and effectively. But if you were hypothyroid for quite a while without getting treatment or if you spent a long time on just synthroid, your adrenals will be weaker. The sudden return of your normal metabolism when you start Armour sends these weak adrenals into a crash. This is why Armour must be given to a patient in a small initial dose (1/2 grain) which is then increased little by little (1/4 grain every 2 weeks); this dosage schedule is printed on the Armour package insert. Armour is much better for your adrenals and they will begin to heal when you switch from synthroid. But this takes time, which is why you should increase the Armour slowly. If you take more Armour too quickly, your adrenals may crash and you will feel much worse for several days or even a couple weeks. And if your adrenals fall off too seriously, you could end up in the hospital. [NOTE: women who have strong adrenal function will be able to increase their Armour doses more quickly than indicated on the package insert.]
So you see, the reason you feel worse when you start Armour is because it is better for you than synthroid, not worse for you! But there is an easy solution to the adrenal weakness that every doctor should be giving his patients: oral adrenal support. Used in conjunction with Armour, the patient will feel much better much sooner. And her Armour doses can be increased at a faster pace so she will not have to lie around the house being hypo on a half-grain for 2 weeks. The oral adrenal support allows the patient's adrenal glands to heal while supporting the other systems in her body so she can safely take her thyroid medication and restore a healthy metabolism.
So, what do you do about weak adrenals? Well, my doctor cured mine by putting me on a physiologic dose of daily cortisol and DHEA. I took 25 mg DHEA daily 5 days/week, and 20 mg cortisol daily, which is the amount your body should make on its own. Cortisol is not stored anywhere; your body makes it as it needs it. Some people make too much and it just runs around their bloodstream, which is bad for them and leads to heart disease. But if you are making too little, it is just as bad for you and will lead to early death. So you take 20 mg daily (5 mg at each meal and 5 mg at bedtime). My doctor had me on oral cortisol for 3 months so that my own adrenal glands could take a nice big rest and recover from the terrible stress theyíve been under all these years. It worked. I began taking these doses as soon as I got home from his office so I ingested 15 mg before bedtime that first day. That night, for the first time in years, I could breathe normally while I slept; I had been suffering from sleep apnea and had also developed "chokes"---each night when I first fell asleep, my saliva would run down and fill my windpipe and Iíd wake up drowning on my own spit, coughing and sputtering for 10-15 minutes before my windpipe would fully clear, gasping for air the entire time. The Cortef cured this problem on the first day! My constant foot pain was gone in 2 days. About a month later, I forgot to take my suppertime and bedtime cortef doses; that night I choked again for the first time since I started Cortef. I made sure not to forget my doses anymore! After 3 months, I quit taking the Cortef completely and am feeling great. My adrenals rested and healed and are doing the job on their own again. No chokes, no foot pain, no symptoms at all. I'm healthy as a horse again.
If you start to come down with a cold or flu, you take more. I found that out; the nurse forgot to give me the cortisol instruction sheet (which describes how you take more in those instances), so between appts I got a bad cold and all my "thyroid" symptoms came back! That happened right on top of my menstrual cycle too. Suddenly my feet hurt so bad I couldnít even walk when I first got up in the morning. My body ached, I was snoring and constipated, etc. I thought maybe the body demands more thyroid during menstruation and illness, so I started taking 3.5 grains each day but it didnít help. When I went back to my Top Doc the following week, he explained to me that the body demands more CORTISOL during illness and menstruation due to the stress on the body. He felt real bad he no one had given me the handout describing how you should take more during coldsÖ.. You need more when sick because illness is a stress; people with normal adrenals always make more cortisol when sick. And by the way, the immune system cannot work properly without cortisol. This explains why a major symptom of hypothyroidism is frequent colds and sinus problems. Because hypothyroid women are hypoadrenal and their bodies canít fight disease without cortisol. The body demands twice as much cortisol when sick as when healthy; if you have weak adrenals, they just canít handle the workload. This is why your illnesses drag on and you feel like you are in a hypothyroid fog.
Oral cortisol is a prescription medication. In addition, it can cause constant hunger and rapid weight gain. It can also reduce the secretion of melatonin. I experienced some of these side effects; while on Cortef I was very eager for my dinner and also stayed up late every night. But does this mean that we should all avoid taking any oral cortisol? No. If your adrenals are very weak, you will not be getting enough cortisol, and you must have cortisol for life. To counter the side effects of Cortef, I took 3 mg melatonin every night 1 hour before bedtime and it worked. You can buy melatonin in any vitamin store.
But there are other alternatives to oral cortisol. Here are a few links describing things you can eat and things you can do to help bolster your adrenals naturally. I recommend you start doing these things immediately but if your body pain is severe or the slightest stress sends you on a hypothyroid crash, you most likely are going to need cortisol tablets to optimize your health.
These links are about the herb maca, which is also supposed to boost your adrenal function and prevent sugar cravings. I have corresponded with women who are using it and say it is great. One woman told me it cured her chocolate cravings! Now that I've completed my 3 months on cortef, I am taking maca too and am feeling wonderful.
One of the ladies on the forum was asking people for help with her strange skin conditions and was wondering if anyone else had similar problems with their thyroid disease. She described peeling skin and "acne" that didnít really act like proper acne.
I had some "acne" that didnít behave so I posted her asking if she had any of these other symptoms that I too, had. For example, I had a discoloration of my skin in some patches on my lower back and below my breasts. I also noticed that even though I never had foot odor in the past (even when I didnít wear socks), my feet had begun to reek! Iíd buy new shoes and theyíd stink anyway after just 1-2 wearings. Also, my breath was starting to smell some and I was always careful to make sure I applied plenty of deodorant each day. I also noticed peeling skin on my scalp. The "acne" was located primarily along my hairline but sometimes popped up elsewhere.
And since I have thyroid disease, I figured all this stuff was related to my thyroid---especially since the symptoms actually improved some when I first started thyroid medication. But it never seemed to go away completelyÖ.
Well, my Top Doc is much more holistically oriented. I went to him to get more Armour, but he did much more for me than that. One thing he does when he gets new patients is to have them fill out a very long questionnaire discussing just about every aspect of your body and health---dozens of things youíd never think of. He recognizes that if your thyroid it out of whack, your whole system can go haywire and youíll develop other imbalances that need correction even after you get the thyroid disease and adrenals under control.
I filled out the questionnaire and it led us to concerns about the bowel and yeast. So he ordered a stool analysis for me and it turned up a pathogenic level of yeast in my bowels! I was placed on a 30-day course of Nizoral tablets. This is the same drug youíll see ads for on TV for dandruff shampoo. Iíd never heard of it before I was taking the oral versionÖ.
Anyway the first two days I noticed no change. But then the next 3 days my lower back was just aching horribly and my guts hurt. I figured this was probably the yeast dying off, and so I waited through it. Sure enough, from that point on, things were great. My scalp healed up and is smooth and clear as a babyís. My "acne" is totally gone which is very nice. I must emphasize that the "acne" really wasnít like acne at all. It was more like painful red bumps that I thought were pimples but they held mostly blood instead of pus. Anyway, they disappeared. And my body is fresh as a daisy! I donít have to wear deodorant if I donít want to; there is no odor at all. My feet are nice and fresh, my skin soft and supple and pretty. When I get up in the morning, my breath is just as fresh as it was the night before.
So I wanted to mention this to you as well just in case you had experienced the same types of symptoms. Another symptom that goes right along with this is itching. Yeast infections are usually accompanied by itching. I know my scalp definitely itched and I seemed to be scratching my whole body a lot more.
So where does this problem come from? Since my symptoms actually had gotten better when I first started thyroid meds, I figured it was all thyroid related. But now that Iíve had a stool analysis, I know it was a yeast infection. I think this is probably because a thyroid deficiency allows yeast to overgrow and take over your system. Your immune system canít work properly if there is no thyroid hormone. And 60% of your immune system is located in your digestive tract. So the yeast gets out of control and takes over. When you start thyroid hormone orally, the immune system gets a boost and can start fighting back and getting the yeast under control. It might win all by itself, but in my case, it was so far out of control that I had to take an oral fungicide to complete the cure (probably from years of untreated hypothyroidism).
There is one doctor I know of who believes that Hashimotoís is actually caused by yeast imbalance. www.health-science.com/thyroid.html He claims to have cured Hashimotoís patients and weaned them off their thyroid medications by bolstering their immune systems. Iím not sure I agree with him, but he says that a yeast overgrowth results in the immune system producing antibodies against the yeast, and these antibodies also happen to attack the thyroid gland. So he thinks if you kill off the yeast youíll make fewer antibodies and can actually halt the progress of Hashiís. And if you stop it soon enough (before the gland is badly damaged) you can quit taking oral thyroid. Again, I am not sure I agree with him, but he claims to have cured many patients so maybe he has hit the nail on the head. If he is right that yeast or Epstein-Barr is causing the autoimmune response, then if you got rid of those infections your body would make fewer antibodies and thus youíd have less damage to your thyroid gland. Perhaps youíd be able to go off your thyroid medication if your gland wasnít too damaged. I just donít know. He seems to think so and he claims to have cured Hashimotoís patients.
Regardless, it is common for women with thyroid disease to have yeast imbalances. The question is whether the yeast caused the thyroid disease or whether the thyroid disease resulted in poor immune function that allowed a yeast overgrowth to occur. I donít know! I honestly donít know if there is a connection between the two. What I DO know is that when I got tested for yeast and it came back with pathogenic levels, I also got a Hashimotoís test at the same time. I had enormously high levels of both kinds of Hashiís antibodies (my doctor said they are the highest he has ever seen). He said that the Hashiís antibodies themselves can interfere with the bodyís use of oral thyroid hormone.
We are going to get another Hashiís test now that I have killed off the yeast. I am very curious to see if the Hashiís antibodies levels go down too. Should be VERY interesting, donít you think? If they do, it wonít PROVE anything but it should raise some eyebrows and warrant investigation. Maybe other Hashiís patients should check for yeast infections too.
How is this yeast overgrowth diagnosed? I had the Comprehensive Digestive Stool Analysis and Parasitology done by Great Smokies Laboratory. This is the same lab located in North Carolina that does the day-long adrenal test; they do labwork that other labs do not do (they also do a really excellent Thyroid Profile which includes TSH, free T4, free T3, reverse T3, the ratio of reverse T3 to T3, the T4-T3 ratio, and both kinds of antibodies). You donít have to be near NC; you just Airborne Express your lab samples to them (they pay the shipping). My doctor ordered this labwork, gave me the test kit, and Airborne picked it up from my house. How does it work? You have to poop into a tray and then use their little kit to scoop up a sample of your poop and put it in the bottle (the kit is so well-made that you donít have to touch the poop at all; a scooper is built-in to the lid of the sample jar so you just scoop the poop and screw on the lid). You do this on 3 different days, call AirEx, and then wait for the results. Yeah, it sounds gross but it was SO informative and improved my quality of life astronomically. It was so worth it. If you are suffering from any of these symptoms and suspect you may have a yeast infection, I highly recommend you have this done. In addition, be sure to take "pro-biotics." What are these? These are the good flora you are supposed to have in a healthy digestive tract. Acidophilus is one. However, there are many others and you should take these as you kill off the yeast, to fill in the gap. Yeast can overgrow when the good flora is too low. When you kill the yeast, you must fill back in with good flora to prevent some other pathogen from overgrowing and taking over.
Here are some links about yeast. Go to yahoo and put "systemic yeast treatment" in the search engine; you will be amazed at what you find.
http://pages.prodigy.net/angelkay/DISCOVERING%20WELLNESS/candida.htm An excellent site to help you see if you have a yeast infection too.
Brain fog, fatigue and aching can be caused by yeast too! http://www.sgreen.com/05.htm
More yeast symptoms: http://www.fitnessculture.com/disease/skin/balatis.htm
The GERD-yeast connection http://www.rumormillnews.net/cgi-bin/config.pl?read=4933
Types of yeast infections http://members.aol.com/caloradpoe/yeast.html
http://www.tjpc.com/home.htm for yeast tips
This is a link about CFS and fibro and the link between them http://www.foogod.com/~torquill/immune.html
A book that sounds interesting http://www.alternativemedicine.com/digest/issue33/33082.shtml
Here is an amateur site put together by some woman who has been fighting vaginal yeast infections. Perhaps her info will help you. http://www.msu.edu/user/eisthen/yeast/
And the very best thing you can do for your health is to start taking a good quality multi-vitamin tablet daily. The body requires selenium and other vitamins and minerals to use thyroid hormone. http://www.equinevetnet.com/nutrition/Topics/selproteins.html And it requires all the vitamins and minerals for overall good health. If you want to get the very most out of your life, include a good multi vitamin/mineral in your daily diet. In addition, I recommend you start taking amino acid and enzyme supplements as well. A very good product (which I take) that contains nearly every vitamin, mineral, amino acid, lipid, cell salt, phytonutrient, antioxidant, and enzyme you need is Wellness Source Multis, available from HealthWatchers/Puritanís Pride. You can order by phone at 1-800-321-6917. This "multi" may cost a little more than Centrum or One-A-Day but it also contains 5 times more necessary nutrients! It is worth it (and itís often on sale too, so stock up when the price is right). Feed it to everyone else in your family too.
Here are some other links which we found very informative as we began our search for knowledge about thyroid disease. Be sure you go over all the symptoms of thyroid disease; this is important to identify problems caused by hypothyroidism that your doctor may treating as a separate problem---when really all you need is the proper adjustment of your thyroid medications.
This link is just superb in every fashion:† http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=528
If your doctor is determined to decide your health based on your TSH tests rather than your clinical symptoms, here is a link which may help. This shows that endocrine activity is NOT steady; it is pulsate. So the results you get can vary just simply depending upon the time of day the blood was drawn! This study is also useful when your doctor insists to you that you must have only oral T4 to avoid "spikes" that you get with natural thyroid. As you can see in this study, those spikes are NATURAL. Your doctor spends all day long having his thyroid hormones spike.Ö Perhaps HEíD like to try existing only on oral T4Ö. http://arbl.cvmbs.colostate.edu/hbooks/pathphys/endocrine/basics/control.html
Antidepressants are often prescribed to thyroid patients. Of course, we donít get depressed due to a deficiency of drugs in our bloodstream, but the doctors donít mind handing out Prozac by the handful anyway! Here are two very significant scientific studies on the topic.
This first study is one I mentioned before; they discovered that giving people T3 along with their oral T4 alleviated their depression and improved neuropsychological function. http://content.nejm.org/cgi/content/abstract/340/6/424?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Prange%2C+A&author2=Bunevicius%2C+R&titleabstract=triiodothyronine&fulltext=neuropsychological&searchid=QID_NOT_SET&stored_search=&FIRSTINDEX=&fdate=1/1/1975&tdate=5/31/2001&journalcode=nejm
Here is a study proving that certain anti-depressants actually lower your T3 and T4 levels: ht NEJM_perkypills.htm†
This study claims that patients with hypothyroidism and depression may need synthroid and antidepressants (too bad these guys didnít read the first study, eh? All the patients need is T3, not synthroid and Prozac!). However, the study goes on to state that patients given the antidepressant Zoloft had lower levels of both T3 and T4 in their bloodstreams, plus an elevated TSH. In other words, the anti-depressant made the hypothyroidism WORSE. And of course, this is only going to make the depression worse too, as well as bring on other hypothyroid problems. Read to the end of the article where Pfizer points out that other anti-depressants have similar effects. The solution to your depression is to get some T3 into your system.
If your thyroid disease is being treated but you are still suffering from depression or moodiness, it is quite likely that you need more T3. All of us are different and what works for one wonít necessarily work for the others, but studies have shown that T3 is crucial to your mood. In my own experience with thyroid disease, depression was not a factor at all UNTIL I was on such a high dose of synthroid that my TSH went nearly to zero (which of course, completely shut down my thyroid gland and deprived me of everything except the oral T4 I took). Once my body was deprived of T3, I became depressed. I was a wreck, crying and miserable and barely functioning. We visited my family for Christmas and I took 25 mcg/day of my sister's cytomel (no, I didnít have permission from my doctor!). My depression was cured instantly---literally overnight. I went to bed crying and woke up smiling. I took the cytomel the whole time I was there and was very happy! But after Christmas I was back on the other side of the country and had just synthroid again. The depression returned immediately. The day I switched to Armour---even though I started out with Ĺ grain---my depression was completely alleviated. I havenít had any problems with depression since I changed to Armour.
And if you are on antidepressants already, read again that second study I listed above. The antidepressant may very well be making your thyroid disease and depression WORSE.
Finally, there is some research about anti-depressants that you might find a little too scary to read. In the July 2001 issue of Discover Magazine, doctors admit that drugs such as Prozac actually change the physical structure of your brain. These drugs cause permanent changes--yes, even one dose. To read the full article you will have to get the magazine, but here is the first part of it: http://www.discover.com/july_01/gthere.html?article=featsurprise.html
http://www.health-science.com/thyroid_problems.html This article mentions a scientific study that proves 3,5 T2 stimulates the production of 5í deiodinase. Go to page 4 of this article where they mention the action of T2. Now, one thing they get wrong is where they say that "the only active hormone is T3." Not true! Your cells will use T4 but they donít like to do so; they have little affinity for T4. They prefer T3. And T2, as I mentioned near the start of this treatise, is highly active metabolically; it is responsible for the production of ATP in the cells. I think this article was written before the research on T2... Anyway, go to the bibliography of this article and look at #2. This is the study discussing how T2 stimulates the production of 5í deiodinase. Please remember that there are different deiodinase enzymes and they each have different actions. We have been searching for the study referenced in this bibliography but havenít found it yet.
http://www-hsc.usc.edu/~hkaslow/Teach/Handouts/Thyroid-2000.pdf This is a very scientific treatise about thyroid hormone. On page 2 youíll see a diagram showing which deiodinase enzymes break down T4 into T3 and reverse T3. Youíll notice that the deiodinase which turns T4 into T3 is the same deiodinase that is produced using T2. This shows that we must have T2 in order to produce the deiodinase which turns T4 into active T3. HmmmÖ. Sounds like weíd better start taking Armour so we can get that T2, so we can use our T4!
Mary Shomonís Thyroid Drug Database: Learn the basics about the different types of thyroid medication. http://thyroid.about.com/health/thyroid/library/drugs/bl-drugs.htm
Thyroid Disease Widespread, 13 Million At Risk--A major study found that 13 million Americans may be unaware of and undiagnosed for their thyroid conditions and that more widespread thyroid testing is needed in order to avoid the health effects- including high cholesterol-of even slighly elevated TSH levels. http://thyroid.about.com/library/weekly/aa022800a.htm
Dangers of Soy Products for Thyroid Patients--Soy may be a wonder food to some, but it can be a danger to thyroid patients. Find out about the risk that soy products have for adults with thyroid disease, and infants on soy formulas, including how much soy is safe to eat. http://thyroid.about.com/library/weekly/aa083099.htm Hereís one about soy; when fed lots of soy, these rats had lower T3 levels and higher reverse T3 levels. http://www.elis.sk/endo/endo498.htm#anchor31610
http://journals.endocrinology.org/joe/163/joe163r005.htm In the "Introduction" portion of this article you will see that thyroid hormone transport into cells is inhibited by a lot of things, including tryptophan. Do you take tryptophan to help you sleep or lose weight? Read this study to see what all you might want to avoid. Here is more by Dr. Ritchie. http://www.dundee.ac.uk/anatphys/Ritchie/jim1.htm
This is an article by Dr. Ward Dean. Heís really good. http://www.smart-drugs.net/ias-thyroid.htm Go to www.vrp.com, www.healthcentral.com and www.smart-drugs.net for a lot of excellent health information. Dr. Ward Dean contributes to these sites regularly; you can read more of his excellent articles on both sites. He writes about thyroid disease all the time; I recommend visiting both of these sites and scanning all of his articles for thyroid info and treatment.
www.morehead.org/wellconnected/doc38.html This article is very informative in many ways about thyroid disease, what drugs may cause your body to be unable to use thyroid hormone, the effect on children, and a host of other things. The one area in which I totally disagree with this author is on page 17 where he discusses levothyroxine as "the treatment of choice" for hypothyroidism. Heís a synthroid-pusher! I have included his article, however, so you can read the great information in the first half, and also to be unbiased (yeah right, like Iím not pushing natural thyroid).
http://content.nejm.org/cgi/content/abstract/340/6/424?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Prange%2C+A&author2=Bunevicius%2C+R&titleabstract=triiodothyronine&fulltext=neuropsychological&searchid=QID_NOT_SET&stored_search=&FIRSTINDEX=&fdate=1/1/1975&tdate=5/31/2001&journalcode=nejm this is the scientific study I mentioned above showing that the body needs the T3 DIRECTLY SECRETED by the thyroid gland.
www.mercola.com/article/hypothyroid/treatment.htm Sign up for this guyís newsletter; heís very good with more than just the thyroid. My sister gets his free e-letter and it is great! www.mercola.com/article/hypothyroid/diagnosis_comp.htm
http://thyroid.about.com/health/thyroid/library/weekly/aa081999.htm Planning to have children? Hereís a study which shows youíll want to get your thyroid in order first. What infuriates me about this is that I had abnormal TSH tests (a full point above the reference range) and tried to get treatment, but was denied it. I had 2 more kids after that and was severely hypothyroid both while pregnant and nursing those children but was denied treatment because "itís NORMAL for a pregnant/nursing woman to be hypothyroid! Thereís nothing wrong with you!" Fortunately, they are both very intelligent (ages 3 and 4 now) as are my 6 and 8 year olds. But maybe theyíd be Einsteins if I had gotten treatment while pregnant and nursing them?
http://thyroid.about.com/health/thyroid/library/weekly/aa072500a.htm?terms=i This is a Mary Shomon interview. I recommend going to http://thyroid.about.com/health/thyroid/cs/expertinterviews/index.htm and reading all the interviews she has done. They are very informative.
Here is an interesting link, if you canít get natural thyroid from your doctor (the upper right corner says you can order it without a prescription). I wonít tell you to order your own medicines; that is your call. But my sister purchases her thyroid meds in Mexico without a prescription and Iíve done it myself. http://www.smart-drugs.net/Inserts/insert-thyroid.htm
www.drmirkin.com/morehealth/g171.htm Depressed and canít seem to get over it? You need T3!
www.alternativemedicine.com/digest/issue14/14053R00.shtml This oughta make you mad.
www.bruha.com/fluoride/html/pfpc__2.html Here is a discussion of the dangers of fluoride and how it affects your thyroid. Item #4 is especially interesting.
http://www.dr-bob.org/tips This is essentially a "chat page" for doctors; they discuss their treatment protocols with one another. We have found this to be a really useful page for leading us to new things to try.
http://www.healthboards.com/thyroid-disorders Want more support? We have also read a lot of great information on this message board; this is where we first heard that T2 was active so we were able to find the scientific research proving it.
http://www.ithyroid.com This is a site about how to correct your thyroid disease nutritionally.
http://www.emedicine.com/EMERG/topic280.htm Hereís what happens if you donít treat your thyroid disease.
Got Bipolar Disorder? I donít but we ran across this link one day so Iíll include it here for anyone to whom it applies: http://people.ne.mediaone.net/pmbrig/BP_pharm.html
A word about T3 and thyroid hormone in general. The body will DIE without this hormone. This is not merely a quality of life issue. Weíre talking about life and death. If you have high free T4 levels and low free T3 levels, you are not healthy. If you have been taking thyroid medication for years and still feel awful, you are not just miserable---you are dying. The cells in your body are being deprived of a hormone they need and they will die without it. You must get your medication changed! Donít put up with it any longer! If your doctor brushes you off and tells you that "all thyroid patients feel bad because their disease is incurable," heís WRONG! I was, literally, at deathís door and now I feel WONDERFUL again.
But to get myself feeling this way I didnít put up with the doctors. I went through TEN doctors before finding someone who would listen to me and take care of me. Oh, doctor #8 listened to my complaints and felt very sorry for me and how I felt, but all he did was to offer me Prozac and insist that since I had "normal" bloodwork (high T4 and low T3, but still within normal ranges so who cares?), I must have some other disease rather than hypothyroidism. He concluded my thyroid was managed fine and we should look for lupus or arthritis etc. And you know, as nice of a man as he was and as much as he cared about me, I left him. I was not getting the problem addressed so I left. Dr. #9 gave me Armour, but not enough, so I left him too.
I cannot stress enough the importance of changing doctors. I know all about the financial concerns and the fact that your insurance will pay only for this or that. The same is true for me. The doctor I see now is not in my insurance plan but I have my health back and no longer sit at deathís door. I think thatís worth the money I pay out of pocket.
Obviously, you are thinking the same thing I was thinking when I started going outside my insurance plan. "How do I find a good doctor without driving hither and yon, paying all these fees and then finding out that the guyís no good anyway?" This is exactly what I was wondering. So how did I find Dr. Perfect on the first venture outside my insurance? Well, I started by phoning the doctors in my insurance plan and asking which ones used Armour or some other natural hormone. If the nurse was reluctant to say or blew me off, I told her flat-out "Listen, I need a doctor who knows all about Armour because I have used synthroid, it doesnít work on me, and my doctor says I HAVE to use Armour! He just wants a second opinion on how to adjust the dose. If this doctor does not use Armour, then he will not be qualified to adjust my dosages and it will be a waste of both his and my time to set up an appt with him." This statement usually resulted in the nurse going straight to the doctor and asking him if he would use Armour.
When I didnít find a doctor inside my insurance (yeah, all the ones in my plan use synthroidÖ.), I checked Mary Shomonís Top Doc list (http://thyroid.about.com/health/thyroid/library/weekly/bldoc1.htm) to see if there was anyone on it from this town. There wasnít. So I began calling all the doctors in my town and asking them if they use Armour. This is a small town and they all use synthroid too. So then I moved on to the Top Doc list, knowing I was going to have to drive a ways for treatment. Now, you may be interested to know that one of the doctors on the Top Doc list is actually in my insurance plan, but I did not choose him! Why? Because his nurse said on the phone that he uses synthroid and cytomel together and does not like Armour and will not use it or prescribe it for me. He refuses to have anything to do with it; he is devoted to synthroid and cytomel. Well, I knew he couldnít help me then. I had already found all the research about T2 and decided that it was important to my health. And I knew it was making me feel better than I ever felt on Synthroid. I did not want to give up my Armour just to go see a man in my insurance plan. Also, my sister was taking huge amounts of levoxyl and cytomel and was not much better off than me. As a matter of fact, once I got onto Armour, I was doing better than she was, even though I was taking only a small dose and needed more.
So I skipped over that doctor and read up about all the other Top Docs in this section of the country. I looked specifically for doctors who were listed as using Armour. I found several, actually. How did I choose? Well, Dr. Dean was closest (130 miles away) and also was listed as preferring to use natural remedies before resorting to drugs. His listing also stated that he searches for the cause of your symptoms so he can eliminate the problem rather than just treating the symptoms. This really sounded good to me. I noticed that a lot of Top Docs are listed as "going by the book with tests" or "ordering lots of tests" and Iím not so sure thatís the answer. I had had tons of tests and was still not cured. I wanted a doctor who would acknowledge that I still had physical symptoms even though my TSH had come down to only 0.3 and my T4 and T3 were "normal." So I read these listings looking for a doctor who "prescribes Armour" and "relies on symptoms" rather than tests. Then I called Dr. Deanís office and asked flat-out if he relies on TSH or if he is interested in a patientís clinical health. She said he is very interested in your symptoms and actually has you fill out a long questionnaire to take a measure of your clinical health.
Another very good thing to search for when seeking a new doctor is someone who is listed as practicing "complementary," "alternative," "integrative," or "holistic" medicine. These are the doctors most likely to prescribe natural thyroid and who will treat your adrenal imbalances as well. These are the types of doctors who are most likely to try to make your body balanced and optimized throughout rather than just ANYWHERE in some reference range on a lab test. I spent a year dying on synthroid because my TSH, T4, and T3 were all "in the range." Never mind that the T4 was all the way at the top of normal while the T3 was all the way at the very bottom of the range and I was a walking textbook of hypothyroid symptoms (a typical profile for someone who is not converting T4 into T3). Those numbers fit some profile from some lab so that is all that mattered. Once I found a more holistic doctor, I got my health repaired. He had a lot to say to me, as a matter of fact, about how too many doctors will treat problems only when the numbers are below or above the lab range. He said that he isnít happy to see my cortisol levels at the bottom end of normal. He knows people feel best when the cortisol levels are right in the middle of the range all day long.
My doctor, in case any of you are interested, is Dr. Charles Dean of Oglethorpe GA. He is on the Top Doc list if you live anywhere near here and would like to see him. The person who sent in that listing messed up the area code; his phone number is actually (478)472-2550. Heís wonderful. He started out in pharmacy school back when they taught herbal medicine, so he is thoroughly grounded in natural remedies. Then the drug revolution came along so he is thoroughly grounded in that area as well. And then he became a doctor so he knows all about that too. Heís really good! If you donít live near him and are looking for a doctor, maybe my experience will help you too. Find someone who prescribes Armour and is listed as going by symptoms as opposed to testing. In addition, you might try calling Dr. Dean's office to ask if he knows of a good doctor in your area. I can't promise that he will, but he was able to recommend a doctor to one of the women who posted me asking for help.
By the way, I recently had a comprehensive thyroid work-up and the results would give most doctors a heart attack. My TSH was 0, my T4 was mid-range, and my T3 was off the top of the range, well above "normal." The antibody levels were sky-high on both types (Dr. Dean said he has never seen levels that high in anyone). Most doctors would freak out at those high T3 levels and immediately take away my medication. Not Dr. Dean. He instead said "your T4 level could be a little higher and while this T3 level is high, you show no signs at all of hyPERthyroid symptoms. I believe you have a lot of cellular resistance and also these high antibody levels are interfering with the use of your hormone. Your T3 is high because your body is having trouble using it in the tissues so it is staying in your blood. With your T4 only at mid-range, we have the option of increasing your dosage further if you still have any hypo symptoms at all, as long as you show no signs of hyPER symptoms." Can you believe it? Dr. Dean is a dream come true and I feel wonderful!
A tip for interacting with doctors and getting them to listen to you:
One way I help get good results is this: as the doctor begins his examination, I make comments about how "Iím really looking forward to some solutions with you. My last doctor is a really great guy, but he didnít test my adrenals even though I have the classic signs of adrenal dysfunction. And as you know, hypothyroidism regularly leads to hypoadrenalism. I wish to have an all-day adrenal test because of course, as you well know, cortisol levels are highest in the morning so an 8 AM test wonít show if my adrenals are working properly at the end of the day."
When you talk to him, make comments about what you know but say it like "of course he knows" this and that. I get much better results when I say "and as you well know, thyroid disease leads to adrenal dysfunction" instead of saying "I read that thyroid disease leads to adrenal dysfunction." See the difference? The first sentence tells him that of course youíre positive he already knows everything. The second sentence implies that you have read something that you think he doesnít know. He wonít want to hear that! The last thing a doctor wants to hear is that the patient knows more than he does.
This technique works! You just keep telling him everything you have learned (that he may very well not know) but you give him credit for knowing all this. And heíll love it! Yeah, thereíll be some doctors this wonít work on, but most of them lap it up and will run all the tests you want if you use this diplomacy. Build him up; make him feel good. Heíll work better for you if you do.
Of course, the best doctor is like my Doctor #9. I would take him reams of articles and studies Iíd gotten off the Ďnet and he would eagerly xerox them. Every time I saw him, the first thing heíd ask is how I feel and the second was "do you have any more research for me today?" He said that he wanted to learn as much as possible and didnít have as much time as heíd like, so he was glad I shared my research with him. You may wonder why I didnít stay with Dr. #9. Actually, I recommended him for Top Doc status and he is on Mary Shomonís list. He is wonderful. But right after I sent in his name, his commander (heís military) slammed him for switching me to Armour. On Synthroid, my T4 was jammed high against the very top of the reference range and my T3 was at the very bottom (the lowest number you can have and still be "normal"). And my TSH was only 0.3. So obviously I was cured, right? All the bloodwork was "normal," after all. So Dr. #9 got in trouble for switching me to an "antiquated" drug (Armour) and taking me off of the Gold Standard SynthroidÖ. You arenít supposed to change meds if the patient is "cured!" He was forbidden to treat me anymore no matter how he argued with his commander; at my next appt with him, he just gave me a referral slip and said I had to go get treatment from an endocrinologist from now on instead of him. It was horrible. I was devastated because I had found this wonderful WONDERFUL man (in my insurance too!) and now he couldnít take care of me anymore. But I had no choice. I moved on and found Dr. Dean. And Dr. Dean is the man who diagnosed my hypoadrenalism.
Thyroid disease has been grossly complicated through the use of pure levothyroxine products and also the use of TSH tests. I was forced to spend 5 years hypothyroid because of that lousy TSH test; even though I had a TSH a full point above the normal range in Jan Ď95 and exhibited gross clinical symptoms, I was denied treatment until Jan Ď00 when my TSH was 8. And Iím not alone; millions of others have also been denied treatment with a high TSH even though they have every symptom in the book. And after 5 years of being denied treatment, my body has been permanently damaged. Not only are my cell receptor sites so messed up I have to take extra-high levels of thyroid hormone in order to function, my adrenals have been damaged so I may have to take Cortef for the rest of my life. The really sad thing is that Iím not unusual in this respect. http://thyroid.about.com/health/thyroid/library/weekly/aa012301a.htm
To finalize, I want to emphasize that Iím not a thyroid expert nor am I in the medical profession. Iím just a thyroid patient who had to do her own research to save her own life. In addition, I havenít had thyroid cancer. And my Hashiís has been atrophic thyroid disease. This means that my thyroid gland has atrophied; it has shrunken and disappeared. I never had glandular swelling or nodes like the majority of Hashiís patients have had. And I havenít gotten hyPER on my medications---no palpitations, sweating, anxiety, etc. So I havenít experienced many of the problems that other women have dealt with.
But I have had fibromyalgia, CFS, depression, skin cancer, dry skin, hair loss, menstrual complications, libido issues, and a host of other symptoms common to all of us, no matter what form our disease takes. Iíve done a lot of research to figure out a solution and I feel WONDERFUL. And I have found information that is being ignored by nearly every doctor out there: the metabolic effect of T2 is not even recognized by any doctors (not even my wonderful Dr. Dean) because the research is so new. And for some reason I canít comprehend, nearly every doctor on the planet is ignoring the adrenal function of their thyroid patients. The physicianís desk reference clearly states that patients must have their adrenals tested PRIOR to thyroid treatment, but the doctors arenít doing it.
So, while I know nothing about thyroid cancer, goiter, and glandular nodes, I do hope I can help as many as possible with this vital information that should be applicable to every thyroid patient regardless of how she came into her disease. Iím no expert and am not seeking any glory or recognition. I just want everyone to feel better!
Hope this helps!
"Man cannot live on T4 alone."
PS Here is a doctor a friend recommended I pass along to anyone living in the New York area. She says he wonít even CONSIDER using synthroid! And he has an office in Dallas Texas as well, so if you are in the Dallas area, you can get his brand of treatment through his office there.
Fred Pescatore, M.D.
144 East 44th Street
New York, NY 10017
Here is the letter I wrote to Oprah Winfrey, so youíll know more about me---my illness and the treatment I received.
Hello Ms. Winfrey!
I want to tell you my story.
I am a highly intelligent woman (real modest too!) who spent my youth coasting through school, taking all the top honors classes but never having to study to make my straight A+ grades. I graduated at the top of my class with twice as many honors credits as any of my peers. I had participated in so many extracurricular activities that I earned four separate letter jackets! My bedroom was filled with my trophies and awards.
On 2 separate full academic scholarships, I headed off to college where I majored in math. It was just as easy as high school; I rarely had to study to earn top grades even though I also worked part time. I graduated Magna Cum Laude and was active in numerous clubs and social service groups throughout my college years.
I married an Air Force officer and happily moved across the country with him. I worked part time and served on the board of our Officersí Wives Club; as a matter of fact, I held THREE board positions and wrote 2 different articles (on 2 different topics) for our monthly magazine (as well as being the asst. editor). My life was rich and full and I never felt too busy or overwhelmed. It was easy.
I was thrilled to learn of my first pregnancy in 1992. I continued to work out at the gym throughout my pregnancy and actually completed more than 100 miles during my last trimester, earning a Century Club T-shirt from the Wivesí club. But I also developed carpal tunnel syndrome and an awful ache in my knees.....
I had a beautiful baby boy and when he was nearly a year old, I became pregnant again. I didnít have the same energy I had before; I was tired more often and never made it to the gym even though my husband was happy to stay home with our son so I could work out. The OB told me I was tired because I was pregnant again "too soon." That sounded like bull to me, but I believed him anyway; heís a professional, right? In Sep 94, I had another beautiful baby boy.
But I just didnít feel good at all. By Jan 95 I was in the doctorís office wondering why my hair was falling out, my skin was so dry it was cracking and bleeding, I was so tired all the time, and I was gaining weight even though I ate sensibly and was nursing my 4-month-old baby. My sister has thyroid disease and those are classic symptoms, so I asked my doctor for a thyroid test.
My bloodwork came back abnormal, indicating that I did indeed have thyroid disease; the TSH was well above the normal reference range and the T3 uptake index was too low. But my doctor brushed it off, saying "Oh, you just had a baby so this is irrelevant. Itíll pass." He assured me that there was nothing to worry about and then told me I shouldnít have babies less than 3 years apart because my body was still "tired" from being pregnant with my first child.
I went home and dealt with it. I got pregnant again in Oct 95. During this pregnancy, my knees hurt so badly I could hardly walk. I developed such severe pain in my feet that I saw a podiatrist twice for treatment. My carpal tunnel was coming back. My skin was dry and scaly, cracked and bleeding. My hair became coarse, brittle and began to fall out. My body temperature was always well below 98 and sometimes even below 97 degrees, even in the middle of a hot summerís day. My memory started to suffer, which was crushing to a person who had always had the sharpest mind in the class. I had intermittent ear pain, tinnitus and numb arms. My eyes became so sensitive to light that I had to wear sunglasses even on a cloudy day. My face became puffy. I began to get mildly depressed, feeling worthless. Although I am a stay-home mom who adores children and think mine are the greatest in the world, I began to lose interest in playing with them, instead spending hours sitting at my computer staring mindlessly at a solitaire game.
I had my baby in July 96, nursed him, and gained 20 pounds while nursing him (DURING my pregnancies, I would gain only 17-22 pounds and would lose all of it by my 6-week postpartum checkup. Yet while nursing the babies, Iíd gain 10-20 pounds even though I ate less than ever). My other debilitating symptoms didnít go away after having the baby, either. I became pregnant with our last child in June 97. During this pregnancy I developed such severe anemia the doctor wondered how I could even be alive! I also had higher blood pressure, and yet I had always had lower-than-normal blood pressure my whole life. My cholesterol also went way up. In addition, I still had all those other awful symptoms that I had during the previous pregnancy.
I had this last baby in February 98. I weaned her in November 98. In the past, every time Iíd wean a baby my milk would dry up completely within 2 weeks. But this time, I weaned her and my milk did not dry up. As a matter of fact, I am still lactating today, nearly 3 years after weaning my last baby! It has never dried up in all that timeónever.
I also developed borderline hypoglycemia; if I got hungry but didnít eat immediately, Iíd soon be so nauseated Iíd have to lie down and try desperately not to throw up. Often I would dry-heave.
So, between 1995 and 1999, I gained nearly 80 pounds even though I was eating less than ever before. And I felt horrible. But I did not think it was my thyroid since more than once, my doctor had told me my thyroid was fine.
However, by the fall of Ď99 I was so miserable I thought I was dying. I had never had a menstrual cramp or heavy period in my life but suddenly I was menstruating so severely that it was out of control. 2 super-plus tampons and a maxipad per HOUR still didnít control my bleeding; it streamed unabated down my legs. I was cramping so severely I couldnít get out of bedóIíd never had a menstrual cramp before and this was far worse than labor! My hair fell out so much I had to sweep the bathroom floor every morning after brushing it. In the shower, I lost so much hair that I had to clean out the drain 2-3 times per shower to keep the water going down.
I was sleeping constantly. Iíd get up at 7:30 AM and make lunches for my 2 oldest to take to school with their dad and then collapse on the sofa. Iíd sleep all morning while the two little kids played around me. Theyíd beg for lunch around 11 AM so Iíd drag myself from the sofa to feed them. Then Iíd collapse again and sleep until 3:30 PM when I had to go pick the older boys up from school (I actually set an alarm clock for 3:30 to make sure Iíd wake up in time; more than once the school called at 4 PM, wondering where I was). As soon as we got back home, Iíd collapse again until 5 when my husband got home. At that time, Iíd get up to start dinner while heíd oversee homework. Weíd eat, put the kids to bed, and then Iíd sit like a zombie on the sofa folding laundry before collapsing back into bed by 10.
My skin was awful. It was thickened and scaly, coarse, cracked and bleeding. I developed what I thought was dandruff but no medicated shampoos helped. Upon closer inspection, I realized that it was not dandruff. It was dry skin on my head! It got so dry, thickened, and scaly that my scalp began cracking open and coming off in big chunks, leaving bloody holes all over my head. My husband told me I had begun to snore loudly. My memory was shot; I felt brain-dead and stupid. My eyes were super-sensitive to the light. My entire body, from head to toe, ached severely. It was like every cell in my body was in constant pain; it hurt just to exist, let alone move. My right arm was so painful (whenever it wasnít numb) that I could barely use it.
I went to the doctor Jan 2000 for my annual gyn and requested a thyroid check again. Now my TSH was 8.0, well above normal and indicative of thyroid disease. We had moved by this time and my new doctor immediately began me on 75 mcg of synthroid. When I showed him my bloodwork from 1995, he was horrified that I hadnít received treatment. He said I had suffered horriblyóand gained 80 poundsófor 5 years needlessly. Meanwhile, he did another blood test to see if I had thyroid antibodies in my bloodstream. I did, so I had Hashimotoís autoimmune thyroid disease, in which my own immune system is destroying my thyroid gland. There is no cure.
My husband immediately began intensive research on the Internet to learn all he could about the disease. He read everything: medical journals, research studies, thyroid forums, alternative medicine websitesóyou name it. Meanwhile, my reaction to the synthroid was to give me severe constipation, destroy my libido, and make my hair fall out even more. My January menstruation hadnít been quite as bad as in 1999 (I had begun taking vitamin B complex and it helped), but when I started the synthroid my February menstruation was even worse.
By late March 00, my TSH had gone down to 1.8. My skin and scalp had improved some, and my hair was falling out at the rate of only one drainful per shower (instead of 2-3 drainfuls per shower). But I was still tired and still lactating. The doctor suggested we wait a bit to see what would happen.
By June 00 my TSH was down to 0.7. My skin had improved with the high humidity of the San Antonio summer (even before treatment, it always got better in the summertime). My menstrual cycle was under good control, but I was still lactating and still tired constantly. Meanwhile, my husband had read that a healthy thyroid gland produces 9 different thyroid hormones (T0, T1, 3 kinds of T2, 2 types of T3, and T4). 80% of what your gland makes is T4, which is a stable compound that your cells convert into useable T3 as needed. However, 15% of the T3 your body needs comes directly from the thyroid gland. Some of your cells demand serum T3 straight from the thyroid; they cannot convert T4 into T3. Well, my gland didnít work. And Synthroid contains only T4! I told my doctor that perhaps I needed to have my T3 measured, that maybe I didnít have enough since synthroid wasnít providing any. And maybe my cells werenít converting the synthroid into T3; this could easily explain my unresolved symptoms.
Unfortunately, doctors are taught very little about thyroid disease in medical school. They are just told "give a TSH test and if it is over 5.0, give the patient a synthroid tablet to take daily." So when I suggested that my doctor measure my T3 levels, he said "Oh, they should be fine because synthroid IS T3." Well, he was wrong. Itís pure 100% T4.
He recommended I go to an endocrinologist to figure out why I was lactating (my prolactin levels were normal). But we moved in July 2000 so I couldnít get in to see an Endo beforehand.
We arrived here in Georgia in late July. We found a house and got settled in, but I went way downhill during the month of August. My hair was coming out by huge handfuls; back to 2 drainfuls per shower. I could not stay awake; Iíd barely get the kids to school and then sleep until noon. My skin was horribly dry in spite of the high humidity. The "dandruff" came backówith huge bloody holes in my head again where chunks of dry skin were coming off. My husband said I began to exhibit sleep apnea; he spent several nights lying awake listening to my breathing so he could shake me every time my breathing stopped. And I got a urinary tract infection (common for thyroid patients).
On 31 August 00 I went to my new doctor to tell him that my last doctor in Texas had recommended I see an endocrinologist. He quickly wrote out a referral and was about to send me home when I showed him my scalp and the big bloody holes in my head where the skin was coming off. That so horrified him he wrote out a new prescription for synthroid, for 100 mcg/day.
Well, a couple days later I noticed a strange mole on my shoulder. I went to the doctor to check it, and happened to get my appt with a different man from the one I saw the week before. He suspected skin cancer and gave me a dermatology referral. While he was examining me, I told him about my thyroid condition. He too did not know about T3 and T4, and all the other things we had read in our research. I told him I really wondered why no one had ever measured my T3 levels to determine if my body was converting my synthroid into useable form. So he looked up some stuff in one of his textbooks, realized I had a good point, and ordered full lab tests.
On 6 Sept those lab samples were drawn. My TSH was 2.6. My T4 levels were at a good amount, but my T3 levels were so low they were borderline. However, since they were still just barely within the "normal" range stated by the lab, my doctor said they were just fine. This blood profile, by the way, is classic for patients who take synthroid. The synthroid quickly lowers their TSH and raises their serum T4 levels, but their T3 levels are very low for 2 reasons:
1)their bodies are being deprived of the T3 which is normally excreted by the healthy thyroid gland
2)many of their cells are unable to convert the synthroid into T3.
By October, I had seen the dermatologist and he confirmed I had a skin cancer on my shoulder (basal cell carcinoma). He removed it, and shortly after that I found some research which showed that benign and malignant tumors result from untreated hypothyroidism (http://www.healthy.net/asp/templates/article.asp?PageType=Article&ID=528 page 3 under the heading "Medical History"). Gee thanks. So I spend 5 years with untreated hypothyroidism and now Iím dealing with skin cancer.
In October, I wasnít sleeping as much and my skin wasnít cracked open quite as much. My hair was falling out a little less; I had to clean the shower drain only once per shower instead of twice. However, I started hurting severely all over my entire body. Every cell just ached horribly; it was excruciatingly painful just to EXIST, let alone move. And I began to develop some new symptoms I had never had before. My tongue became thickened and unwieldy; it was hard to control. I couldnít form the words I had in my head and I was biting my tongue and cheeks a lot. I would think one word and say something else. I also developed bad "brain fog;" my head was cloudy and I just simply couldnít think straight anymore.
By November, we did another blood draw and my TSH was down to 0.3. My husband had done further research and found a scientific study in a medical journal in which they gave some patients just synthroid while others were given synthroid plus oral T3. The patients on oral T3 felt better, did better on tests, and had less depression. The conclusion of the study was that it is clear the body needs the T3 which is produced directly by the thyroid gland so patients who had non-functioning glands and are taking only oral T4 are not getting what they need; they need oral T3 in addition to the oral T4 to make up for the T3 they are not getting from their glands.
But the doctor had given me an endocrinology referral so I simply bided my time until my appt on 7 Dec. We were sure that Iíd finally get the care I needed; this endocrinologist I was to see was a woman so sheíd understand a womanís body well (and thyroid disease is far more common to women than men).
I went to my Endo appt with great anticipation. I walked in with my skin so thick and scaly I looked like an alligator. It was cracked open and bleeding; I left blood smears on the paperwork and the exam table. My scalp was coarse and scaly too. My hair was falling out everywhere. I hurt so bad from head to toe that I could barely walk. My tongue was thick and unresponsive. I was exhausted, couldnít think straight and was having difficulty forming words. I was so brain-dead I stared blankly at the wall and tried to remember why I was there. I had gained another 5 pounds since August so now my weight was 222. I was depressed and moody and felt like I wanted to just DIE.
She checked my reflexes and they were non-existent. But that was it. She looked no further at me at all; she ignored my skin and scalp and aching joints. Instead, she looked in my records and saw my old lab report from Sept (a 3-month-old report) and said "Oh, a TSH of 2.6. Well then you are fine." I said I sure didnít FEEL fine. I told her I was still lactating and had been for 2 solid years and she said "oh well these things take time." I showed her my bleeding dry skin and she said "but it is cold outside so that is normal!" even though HER skin wasnít thick and scaly and bleeding..... I told her I had gained 20 pounds all year long while taking synthroid and she said "oh well." She then informed me that she didnít need to see me again in person for 6 months. She said that I could get another TSH test in Jan 01 and have it faxed to her office, and that from now on there would be no reason for us to see one another; she would simply call me if she thought I needed anything. Then she wrote "Diagnosis: Hashimotoís" on my chart and charged my insurance company $225 for it! Good grief; I already knew I had Hashimotoís a year ago!
I was so upset I went back to my Primary provider the next day and complained. He immediately agreed to check my adrenals, but he too, could not see past my "normal" thyroid labwork. But at least he could see that I was clearly a very sick woman. So he did a thorough exam of me from head to toe and concluded that he should check for rheumatoid arthritis to explain the pain, and lupus to explain my skin problems. I told him how frustrated I was and he offered me ProzacÖ.
I told him to go ahead and draw his blood but that the tests were going to come back completely normal. I told him that I needed T3 but he said he wanted to check for other problems first. I also refused to take his Prozac. I went home miserable.
For Christmas we went to Texas to visit my family. But my knees were so painful I couldnít climb the stairs in my momís or my sisterís homes. My dear sister ran up the stairs for me whenever I needed anything. I felt awful and helpless. I was so depressed that I spent one whole day crying nonstop.
By Jan 01, I was really depressed and frustrated. My hair was coming out 2 drainsful per shower. I ached severely all over. I was exhaustedóIíd sleep all day if you let me. I had terrible difficulty thinking and speaking. My skin was still cracked and bleeding from dryness. The "dandruff" was getting even worse. And now something new: I was starting to get really cold all the time. I was badly constipated. Then the menstrual irregularities began to return and I got another urinary tract infection. I called the doctor to see what his blood tests would say and he confirmed what I already knew: I did not have lupus or arthritis. He had read all the research I left with him and said "I think you need T3 but I must check with my peers before writing the prescription." I also asked about my adrenal tests and he said that an 8 AM serum cortisol showed 6.7, with anything between 6.2 and 29 being "normal." For some reason, this extremely low number did not trouble him at all.
So I waited while he called his peers. The next morning he called me back and said "I think T4 is the answer; weíre going to leave you on synthroid." I was so upset I began to cry. He said that he wasnít convinced that I did not have something else wrong with me besides thyroid disease. The more I spoke with him, the more I realized that his boss had forbidden him to give me anything except synthroid. He wanted to, but had been forbidden to do so.
On 17 January, I saw a new doctor. I described my symptoms and his first words were "You need T3." He immediately switched me off of synthroid (pure T4) onto Armour natural thyroid. Armour contains T0, T1, T2, T3, and T4 in the proportions which the healthy thyroid gland produces them. I was thrilled; it was so obvious that synthroid did not work for me and yet I had spent a year suffering while the doctors forced me to take it. If I get a urinary tract infection and the doctor gives me a medicine which does not cure it, does he just make me keep taking it? No, he switches me to a different medication. Well, I have thyroid disease and I spent a year taking a medication which clearly did not make me better (the more I took, the worse symptoms I got). But no one would let me take a different thyroid preparation even though there are at least a dozen to choose from. Doctors are programmed to give patients only synthroid no matter how poorly they respond to it.
So I began to take Armour in a very small dose (1/2 grain) because my new doctor had never put anyone on Armour before and did not know how much I would need. His plan was to build me up slowly until my symptoms were fully alleviated. He assured me that it was not OK for me to be so miserable and that he was going to heal me. I was so happy! When I started taking Armour, I immediately felt so much better; the depression cleared up by the second day! (the study we found showed that patients given oral T3 quit having depression; the brain is dependent upon serum T3; it cannot convert T4 into T3). The doctor continued to increase my dosage slightly, looking for the right amount for me.
When I reached 1.5 grains, I crashed bad. I spent 2 whole days in bed sleeping nonstop (fortunately that was a weekend so my husband was home to care for the children) and I didnít eat ANYTHING for 5 days. I could barely move. I was a wreck. My body hurt from head to toe and I was weak as a newborn kitten. I was so depressed and apathetic I wanted to die. My poor husband had to force-feed me my thyroid medications. I called the doctorís office and begged for help but all I was offered was Prozac! That made me pretty mad; I wasnít feeling horrible due to a deficiency of Prozac in my bloodstream, but thatís the only help I was offered (Just think what would have happened had I taken the Prozac; my T3 and T4 levels would have dropped even further because anti-depressants lower your thyroid levels). And yet, as bad as I felt, I still felt better on the Armour than I did on synthroid, believe it or not!
By mid-February Ď01 I started on 2 grains of Armour. The crash wasnít as bad this time, but it was there. I recovered and felt better than I had felt in 6 years---and WAY better than I ever felt on synthroid. My skin was nearly normal; it was thin and pliable instead of thickened and scaly and cracked. Still a little dry though. Most of the body aches were finally alleviated, but my feet were still very painful, especially in the morning or after I had sat for a while. I was still having some breathing problems at night too. I was so much better; I had a few mild symptoms but mostly I felt normal much of the time. Then my menstrual cycle came and I spent the whole time sleeping and depressed with cramps. Once it was over, I was better again. I felt like I was sitting on top of a razor-thin wall. On one side of the wall was good health and the other was the Pit of Despair and uncontrolled hypothyroidism. I was balancing on the top with mild symptoms and the slightest thing would push me off into the Pit. My menstrual cycle was one thing that knocked me off the wall. I felt that another half-grain would push me over onto the side with Good Health where I could live happily and be safely away from that horrible Pit.
I went back to this wonderful new doctor in mid-March expecting to be given another half-grain/day so I could finally get rid of the last of my symptoms. Unfortunately, he could no longer help me. He had gotten in very bad trouble with his boss for switching me from synthroid to Armour! Apparently, because I had "normal" bloodwork and very low TSH while on synthroid, the boss decided I was cured and no longer needed further care. Never mind the fact that I my brain had ceased functioning, I slept all day, I was going bald, and I had severe fibromyalgia making my existence one massive painful experience. On synthroid my T4 had been sky-high (but still just within the normal range) and my T3 rock-bottom (right at the bottom number of the "normal" range). And my TSH was low. So obviously there was nothing wrong with me that a little Prozac wouldnít fix, right?
My new doctor was clearly upset that he had been forced to quit treating me and I was devastated. What was I to do now? I left his office in tears and cried for the next 2 hours. Here I had found this wonderful doctor who was going to cure me and now I was being shoved out of his office and forced to start all over from scratch again. Itís only my LIFE at stake here, but who cares? What does it matter that under-treated hypothyroidism will kill you? Just learn to deal with it, Gail. Have some Prozac.
Well, the experience threw me right into the pit of despair again. My symptoms came back full blown. I ached all over, my hair fell out more, I was depressed, my skin dried up and fell off---overnight I developed severe symptoms from head to toe. I spent about 4 days totally miserable and barely able to function.
Once I recovered from this latest blow, I got on the phone and called every doctor and endocrinologist within my health care plan---even the ones located over 6 hours away. None of them used anything except synthroid and you can bet I wasnít going back to THAT! Even just 2 grains of Armour had me feeling better than synthroid ever did. Thatís when I realized that I was going to start paying for my own medical care. I visited Mary Shomonís Top Doc list and found the nearest doctor who prescribes Armour. His practice is 130 miles away, but I made an appointment. I was still too unwell to drive there by myself, so my husband took a day off from work, loaded up the kids, and drove for me.
This latest doctor didnít hesitate to increase my Armour. He said that I was probably either making too much reverse T3 or had cellular resistance which was causing me to need more oral hormone; this is caused by years of untreated hypothyroidism. He told me to start taking another half-grain per day for a week and if I still didnít feel well, to go ahead and increase the dosage again at my discretion at a rate of a half-grain per week, up to 4 grains. He warned me to watch for heart palpitations and anxiety, signs that I was taking too much. But otherwise, he said to monitor how I felt and take what made me feel good. He pointed out that thousands of people die each year from ibuprofen, but no one has died from taking Armour. And yet doctors hand out Motrin by the truckload and refuse to prescribe Armour. Makes no sense. Especially since a few days of hypERthyroidism wonít hurt you and is easily cured by decreasing your dosage. It says so right there on the insert of all thyroid medications.
Meanwhile he was going through my labwork from my previous doctors and found the 8 AM serum cortisol test Iíd been given in mid-December. The 6.7 disturbed him very much. He immediately ordered a day-long adrenal test and explained to me that cortisol levels start out at their highest in the morning and drop off throughout the day because your glands rest at night. His concern was that I might be doing all right in the morning when my glands were rested, but that I might have poor function by the end of the day.
I did a saliva test which measured my cortisol levels at 8 AM, noon, 4 PM, and midnight. The Armour had done a lot to improve my health and it showed in my adrenal test. After 2 months on Armour, the 8 AM cortisol level had come up to 11, which was an improvement but my new doctor looks for 12-15 to optimize your health. So it was still lower than it should be. The noon level was even worse, way down at the bottom of the reference range. My 4 PM level was well below the reference range, which showed that my adrenals were really struggling. And by midnight, my body had ceased making any cortisol at all, so I wasnít even on the chart.
This underscores the importance of day-long adrenal tests. Any other doctor would have looked at that 8 AM level of 11 and told me I was perfectly OKÖ.. Clearly I was not.
The doctor started me on a physiologic dose of 20 mg daily. I took 5 mg at each meal and 5 at bedtime. I began taking these doses as soon as I got home from his office. That night, for the first time in years, I could breathe normally while I slept. The next day I woke up with no pain in my feet! I hadnít been pain-free in many years. Over the next few days, the very last of my "thyroid" symptoms disappeared. My husband did more research and found articles describing hypoadrenal symptoms. Funnily enough, they turned out to be very similar to hypothyroid symptomsÖ. And the two conditions go together; most hypothyroid women are also hypoadrenal.† You have to treat both to recover your health. So maybe that one doctor was right in a way; I did have something else wrong besides thyroid disease.
It is now May 2001 and I feel WONDERFUL. Not only have all my symptoms disappeared but I have the energy and enthusiasm of a child. While the Armour made me feel much better (especially when I was finally permitted to increase my dosage), the cortisol really did the trick. On 3 grains of Armour, I thought I had gotten back to my normal self; I felt so much better than I had felt in years and I was no longer depressed. But once I started the cortisol, I found out what life is really supposed to feel like again! Now that I feel so great, I remember that this is the way I always felt when I was in college. Best of all, it has made me back into a real mother again. Since I started the cortisol, I am once again reveling in my wonderful children and able to play and frolic with them---instead of just barely making it through each day with only enough energy to cook and fold laundry.
That is my story and I think it raises important questions. First of all, why was I not given treatment beginning in 1995? The bloodwork clearly showed I had abnormal thyroid conditions. My TSH was a full point above the reference range and my T3 uptake index was well below the reference range. Not only that, but my sister was a hypothyroid patient, and family history of thyroid disease is a well-known risk factor. However in our research we have learned that many doctors regard hypothyroidism during a pregnancy or nursing to be "transient" and not warranting treatment. Well how do they KNOW it is transient? How many months or years or decades must a woman wait before they decide it isnít going to go away? And look at what happens to her during that time; she is gaining weight and her cholesterol levels are skyrocketing (so she is building up her arteries nicely), plus she is working on hypoglycemia (untreated hypothyroidism results in diabetes and heart disease, among other nasty things). In addition, our research has shown us that women who develop postpartum hypothyroidism are much more likely to develop the lifelong autoimmune disease than women who do not develop postpartum hypothyroidism. So obviously, the fact that I clearly had the postpartum disease indicates that my doctors should have been checking my thyroid levels and looking for antibodies every few months, especially when I was pregnant and nursing my next two babies over the next 5 years. But they didnít. Instead, my symptoms were blamed on my pregnancies; arenít all pregnant/nursing mothers depressed and aching all over and hair falling out and skin cracked and bleeding and so exhausted they can barely walk? Uh, yeah, right.
I believe ALL pregnant and nursing women should be screened for thyroid disease. Why? Because I just read research in which they showed babies nursed by hypothyroid mothers suffer from hypothyroidism in the first few months. Why? Because the only hormone a nursing mother passes to her baby in her breast milk is the thyroid hormone (which is why so many women become hypothyroid while nursing). A baby who isnít getting enough will be small and sleep too much, plus has a lower IQ (this is from a double-blind study in which they tested the IQs of 5-6-yr-olds they had followed since birth, and the thyroid condition of the mothers). Well, I am mad. My last baby was born weighing 9#3oz and yet never grew much, so by the time she was 4-6 months old, people in the grocery store were asking me if she was a preemie. She also would often sleep up to 17 hours straight. And I was so sick with hypothyroid symptoms during those months I nursed her..... In addition, my first babyís eyes were so sensitive to sunlight that we could hardly take him outside. This light sensitivity is a hypothyroid symptom.... I am very angry! What kind of long-term damage has been done to my children by the doctorís failure to treat my condition?
So the doctors clearly have no idea which hypothyroidism is "transient" and which is going to stay with you for life. My doctor who brushed me off in Jan 95 should have checked my blood for Hashimotoís. Not only do women with postpartum thyroid disease often go on to develop permanent autoimmune hypothyroidism, but their babies may be permanently damaged by their deficiency. In addition, once a patient begins to exhibit clinical signs of hypothyroidism, her body has already been damaged in a fashion that could be permanent. She MUST receive treatment immediately.
Another question this raises is the training of our doctors in thyroid disease. They are taught that the TSH test should be used alone. Unfortunately, this doesnít work. Synthroid (the most commonly prescribed thyroid preparation--95% of patients take it) will lower TSH rapidly even if the body does not convert the synthroid into T3. So the patient has tons of synthroid (T4) coursing through her bloodstream and thus has a healthy low TSH levelóand is dying from hypothyroidism because her body is unable to use her medication. Doctors should be measuring patientsí T3 levels too. And letís not forget the adrenal factor, which, unfortunately, all the doctors are! The Physicians Desk Reference clearly states that patients exhibiting hypothyroid symptoms should have their adrenal function checked BEFORE the doctor administers thyroid hormone, or she could go into an adrenal crisis (which is what happened to me in Dec í00 and Feb Ď01, and it nearly killed me). And yet thereís hardly a doctor on this planet who does so. Not only does this leave the patient feeling miserable, but it endangers her life and sets her up for an early death. Gee thanks.
Another thing: we found a scientific study which shows that people also need the T2 that a healthy thyroid gland produces! This study showed that some cells use T2 to produce the enzyme which converts T4 into a useable form. So if you give a patient only T4, not all of her cells will be able to use it. Sure, SOME of her cells will be ok and will convert that T4 over, but she must have T2 for total health. Also, T2 is used by the cell mitochondria to produce ATP, the fuel for cells.
Another problem we thyroid patients are having: doctors rely too much on the labwork. Doctors have been treating thyroid disease for more than 100 years. Before we had labwork, they would examine the patient and her symptoms and then give her desiccated thyroid tablets , increasing the dosage until she felt good (by the way, Armour thyroid is desiccated thyroid). However, with the advent of these thyroid lab tests, doctors are ignoring a patientís symptoms and looking only at her labwork. I hold up that endocrinologist I saw last Dec as a prime example of this: she ignored my horrific symptoms, looked at an out-of-date lab test, proclaimed it "normal" and told me not to come back for 6 months. When I pointed out to her that the labwork was old, she said "Ok, have them draw another and fax it to me but I donít need to see you; weíll just handle your case over the phone." In other words, she had no interest in my symptoms or how I felt. She was interested only in my labwork.
I have had 6 different doctors look only at my labs and ignore my symptoms. Or they try to blame my symptoms on lupus or arthritis or anything else they can dream up even though every one of my problems is clearly a thyroid deficiencyóall because my TSH test came back in "normal" ranges. Several have refused to do T3 tests so how they heck do they know if my body is using the medication at the cellular level? They donít! I was also told that I will ALWAYS feel yucky because I have an incurable disease so I need to just live with it. Well, guess what? I changed doctors and found someone who would switch me over to Armour (which contains ALL the hormones my gland would make if it could). And you know what? I no longer have all those horrific problems that the other doctors said I would just have to learn to live with.
Another problem that we seem to have is those "normal" ranges. First of all, the TSH "normal" range is typically 0.5 to 5. For many doctors, once they get you into that range they quit treating you no matter how awful your symptoms are. Well, the American Association of Clinical Endocrinologists recently announced that they think a TSH above 3 is a matter of concern. Think of all those poor women whoíve had a TSH of 3.5 or 4 and been sent home as hypochondriacs during the last 30 yearsÖ.
The second thing to consider about these "normal" ranges is that what feels good for Janey may feel awful to Susie. These doctors are working from the standpoint that once your blood test comes back showing that your TSH, T3, and T4 numbers are falling anywhere within the reference range, you are ok. Well guess what? Perhaps Janey feels really good when her T3 levels are at 1.98, but Susie feels as though she is dying. Susie needs her personal T3 levels to be at 2.9 before she is healthy and functioning normally. Those reference ranges should not be used as a treatment protocol! They are there simply to give the doctor a rough idea of why you might not be feeling well. If you feel horrible and are depressed and your brain is in a fog and your tongue isnít working and your T3 levels are right at the very bottom level of the reference range, the doctor should NOT look at the lab test and say "Oh gee Susie, that is still within the normal parameters so go home and deal with it---have some Prozac." No, he should look at that lab test and say "gee whiz Susie! No wonder you feel so bad! Your T3 levels are at the rock bottom edge of our reference range! Obviously you need more T3 and would probably do much better if YOUR T3 levels were higher."
You see, those reference ranges donít mean that an individual will feel wonderful any time her bloodwork shows that she is anywhere within that range. Those reference ranges mean that some people have good health at the lower end of the range while others have good health at the higher end of the range and so typically your average person is going to fall somewhere in between these two numbers. Once the doctor draws the blood he must then go on to judge that patient as an individual; if she is somewhere within that range it doesnít mean she is cured. It just means that she is getting closer to the serum level which will make her feel her best.
There is also a belief among todayís doctors that a person with thyroid disease is meant to always have unalleviated symptoms of her disease. Doctors did not use to believe that. 50 years ago when they gave patients desiccated thyroid, doses based solely on how the patient felt, doctors were so happy to see the patients feeling good again with all their symptoms cleared up (I own some medical textbooks from back then and that is what they say in the sections on thyroid disease). But today, doctors ignore the patientsí symptoms and rely strictly on bloodwork. They quit helping the patient as soon as her bloodwork falls somewhere in the "normal" range no matter how bad she feels.
In addition, todayís crop of doctors has been told to treat patients only with Synthroid rather than with natural thyroid. For 30 years now, patients have been taking pure T4, their bodies deprived of the other 8 thyroid hormones a healthy gland makes. These people then go on to live with hypothyroid symptoms for the rest of their lives because they are lacking in T0, T1, T2, and T3. So it has become a part of our medical lore that "thyroid patients never feel good!" When really it does not have to be that way. I am proof; I am now taking a preparation which contains all 9 thyroid hormones my body would make if it could, and my symptoms are gone! Am I unusual? No, before the invention and marketing of Synthroid, all women were given those 9 hormones and they felt great.
Chronic Fatigue Syndrome and Fibromyalgia are two diseases which are new. Funnily enough, they came onto the scene right after Synthroid and the TSH test went into widespread use. Most people with fibromyalgia and CFS have hypothyroidism. Joint aches and fatigue are two of the most common hypothyroid symptoms. A few doctors are now examining this situation and have CURED their patientsí fibromyalgia and CFS by administering T3. Donít forget that since the invention of the TSH test, doctors are giving the patients just enough medication to lower TSH to less than 5, leaving them undertreated. And remember, T3 is not present in Synthroid.... The combination of these two truths is what has created the diseases fibromyalgia and CFS.
Your show reaches so many people. Hypothyroidism is a deadly disease. It will kill you. It must be treated. Yet millions of women are undiagnosed. Millions of others have been brushed off, the way I was in 1995 just because Iíd had a baby. Millions of others have had TSH tests showing a 3.5 or 4 or 4.5 and were sent home with the words "Oh, thatís normal so thereís nothing wrong with you." Millions of others are taking synthroid and are being put on anti-depressants because their bodies are deprived of T3, even though scientific research has shown that T3 will cure their depression. And millions of others are living half-lives; they are being treated for their hypothyroidism but they are being given just barely enough medication to keep them aliveóbut not enough to alleviate their symptoms. Whatís wrong with that, you ask? This is not just a quality of life issue. Itís not just about wishing your hair would quit falling out. Hypothyroidism results in heart disease, diabetes, Carpal tunnel syndrome, tendonitis, fibromyalgia, chronic fatigue syndrome, PMS, infertility, dangerously high cholesterol, severe depression (including suicidal thoughts), obesity, heart failure, stroke, and death. So you see, this is a life-or-death matter. Patients who are being treated for thyroid disease but who still have symptoms are UNDERtreated. Their cholesterol levels are still building up, their blood is clotting too easily, their pancreases do not work properly, etc. You see, itís not just about whether my hair and skin looks good. Undertreated hypothyroidism is ravaging my insides too. My organs and glandsóevery cell in my bodyóare crying out for the correct hormones and proper levels. I am at risk for an early death.
And itís criminal. It doesnít have to be this way. The doctors of the past didnít treat their patients like this! There is no reason at all not to give me the proper levels of thyroid hormones. If I still have symptoms, change my medication until we get it right! But thatís not whatís happening in our medical system today. No, our doctors are just reading a lab test, ignoring physical symptoms and relying strictly on a single blood test (TSH) which several doctors are now suggesting has no basis at all in clinical reality. My endocrinologist is the poster child for this one, folks! She even said sheíd treat me over the phone based on whatever lab results got faxed over to her!
So, should we just be left half-alive, our bodies slowly dying from thyroid deficiency, leaving us with diabetes and heart disease? Or should our doctors look past the bloodwork and recognize that we are all individuals? We each have a thyroid level which is right for us personally, and what is right for me is not necessarily what is right for you.
And that goes for medication too. When synthroid doesnít work, perhaps the doctor should quit blaming the patient and instead change her medication! What a concept.
Oprah, I think you should do a show on this topic. You could save millions of lives.
Thanks for your time.
PS All of those symptoms I described to you that I have experienced over the years are classic hypothyroid symptoms, including the anemia.... I didnít know that at the time, but have learned about it since then in my research over the last year.