TSH not going down

ladioffaith · 07-27-2004, 07:46 PM

My endocrinologist diagnosed me hypothyroid about 18 months ago, based on my TSH levels, which were above 4. Every time I have seen her, she has bumped up my dosage of synthroid. (I'm currently at 100 mcg a day, plus an extra 1/2 pill once a week.) But the last time I saw her, my TSH had gone UP (from 4.23 to 4.3) instead of down. (That's when she added the extra 1/2 pill.)

I am now on a controlled carb diet, but I know this diet has no impact on the thyroid, although some people experience some relief from symptoms because some symptoms associated with thyroid problems are also common to those with insulin resistance. (BTW, the only significant symptom I have of hypothyroid is weight gain.)

I do not have Hashimoto's (I've been tested) so I have no idea why my thyroid thinks it needs more TSH.

I think my thyroid might explain why I'm not losing weight as quickly as some do on this plan (although I'm losing at a healthy rate, so I'm not complaining anymore.)

I see my endo next month. Does anybody know anything I can do to help my thyroid function better, and what tests I should insist on? (They have never done a T3 and T4 test on me, because they say a high TSH means hypo even if the other numbers are normal, so I'd like some justification for this other than, "I've heard it really should be done!"

Help me educate myself, please!

shenacat · 07-30-2004, 08:10 AM

There is such a thing where the pituitary (the gland that produces TSH) screws up and sends the wrong signals to the thyroid.

My questions to you:
1. how do you know you do not have hashi's? Have you had your antibody levels tested?
2. have you felt hyper on your meds? ie racing heart, headaches in your eyes, short attention span, diarrhea etc.

It is normal for the thyroid to peter out a little when you start meds. It is working itself to the bone trying to give you what it can, and the stress is taken off it when you start meds so it relaxes. This is not a bad thing. It can take a while to find the right doseage!

ladioffaith · 07-30-2004, 11:34 AM

I have been tested for Hashi's. My antibodies are normal. My thyroid, from the TSH tests, is simply underactive.

No, I DEFINITELY have not felt hyper on my meds. The only one of the symptoms you mentioned that I have experienced are the "stomach" issues, which are on and off, but I also take Met and now, am being more dilligent about getting fiber into my diet.

The thing that frustrates me is that my problem SHOULD be easy to fix. I have been on Synthroid for 1 1/2 years, and yet my TSH is going UP, and not down. (They check me every 6 months, so THAT is how I know!) I am losing weight slower than my friends despite the fact that I am younger and exercise. So again . . . how do I know if this medication is right for me? What tests should I INSIST on? Should I have them explore "estrogen dominance" which I've heard can be linked to thyroid problems? Where can I find info to give my doctor to back all this up?

(Luckily, she's an endo, so at least she knows about the "new TSH" guidelines!)

shenacat · 07-30-2004, 01:28 PM

If I were you I'd repost my question to the ladies at http://forums.about.com/ab-thyroid/

For article searches you can visit:

http://www.thyroidmanager.org/
http://thyroid.about.com/
http://www.thyroidrevolution.com/

As I said it's not uncommon for a person to need a long time to regulate levels. I know it sounds like it should be ok overnight but that's not the case. Thyroid management is often much more detailed and difficult than the doctors and mainstream knowledge can lead you to believe.

lovleylady300 · 08-04-2004, 06:18 PM

Are you taking your Synthroid (or generic) on an empty stomach?? This med needs to be taken on an empty stomach to be effective. Just a quick suggestion if you are not currently doing that!!!

ladioffaith · 08-04-2004, 06:36 PM

Yes I have, and since when was there a generic??

If there is one, it would save me $20 on my next refill!

Another web site to sign up with? Sorry, don't think so. Silly me, I thought I could get an answer to my question here, but I guess I was wrong.

Rosie1028 · 08-04-2004, 08:12 PM

Umm, excuse me! Shena was trying to help you?? She knows her stuff about thyroid disease!! She was just trying to give you access to more info.

ladioffaith · 08-05-2004, 12:13 AM

Sorry if I was misunderstood . . . I really do appreciate the information. I did click on the links but, quite honestly, concluded that I didn't have time to sort through that much information. I'll look at them again when I have more time.

However, I don't want to sign up for YET ANOTHER message board because my life is crazy enough already. I'm already signed up here, and I know there are plenty of knowledgable people here who I thought could help me educate myself. But in the past week, only a few of them have posted in this thread. (And again, I really DO appreciate those who have!)

If I have a few extra hours, I might see if somebody ELSE has asked a similar question, but I really don't want to go through the process of registering elsewhere to ask a question I have already asked here. Not to mention the "spam factor" that goes with registering for a new account every time I turn around.

Then again . . . by the time I find enough time in my schedule to look elsewhere for information, my doctor's appointment will have come around so it would be easier to just ask her . . .

nobimbo · 08-05-2004, 06:12 AM

I know you said that you take your thyroid med on an empty stomach, but is it at least 4 hours apart from any of these meds? (If not, they can interfere with the efficacy of the med):

Aluminum or calcium antacids
Calcium supplements
Iron supplements
Cholestyramine (Questran), colestipol (Colestid) and similar anti-chloresterol/bile acid drugs
Sucralfate (Carafate, Sulcrate) mucosal liners/anti-reflux
Sodium polystyrene sulfonate (antacids such as Amphogel, Di-Gel, Gaviscon, Gelusil, Maalox, Mylanta, Phillips, Riopan, Tums)

Are you eating any of the many low-carb products available now? If so, most of them contain soy, which can interfere with your thyroid med. Here is a list of foods which can inhibit synthroid action:

Foods That Interfere With Thyroid Medication & Function
The following foods bind iodine which in turn affects your thyroid function, whether or not you have thyroid disease. You can take your thyroid medicine at any time of the day or night - just be consistent with when you take it. If you take your thyroid medicine in the morning, you can easily separate these foods by several hours from your thyroid medication. As for quantities of these foods - go easy on them and vary the ones you eat, as they may have one or more and varying quantities of the several known goitrogenic phytochemicals.

Buckwheat
Cabbage
Calcium-enriched foods (juices, cereals, etc.)
Collard
Fenugreek
Flax
Garden cress
Garden sorrel
Kale
Lentil
Linseed
Milk and milk products (cheese, cream cheese, cottage cheese, yogurt)
Oats
Rye
Soybean (tofu, soymilk, edamame, etc.)
Kelp
St Johnswort

A good endo would run a FT4 and a FT3, not just a TSH. Most hypothyroid patients will find it difficult to lose weight when their free T4 and free T3 levels are towards the lower end of the range. Btw, I have read numerous posts on the about-thyroid.com site from women who have actually gained weight from taking synthroid, but were finally able to lose once they added cytomel (a T3 med), or switched to Armour (which contains T4 and T3).

Some professionals recommend that, generally speaking, patients need a thyroxine dose (in micrograms) of around twice their body weight for a full thyroid hormone replacement dose. It is also believed that the 'lean body weight' (muscle tissue) has an effect on the dosage of thyroxine. This needs to be discussed with your doctor in order to get the dosage right.

Btw, how are your female hormones doing? Estrogen-dominance (too much estrogen compared to progesterone) can slow the thyroid. If there is an imbalance, you may be able to decrease your TSH level by balancing out those hormones. The thyroid needs an adequate amount of progesterone to function optimally.

Here is a blurb from an article I found that you might find helpful:

If the free T3 level is significantly lower than the free T4 level, it is unlikely to use treat with Synthroid/ Levoxyl/Levothroid (T4) only replacements. This is based on the assumption that if the patient could produce enough T3 from their gland or convert enough T3 from T4, then they are unlikely to do so by adding more T4. This is a key issue because T3 is 4-9 times as potent as T4. Most of the T3 found in the blood is made by the conversion of T4 into T3. The thyroid gland only makes about 20% of the T3 that is found tin the blood. Using T4-only preparations assumes that in the body it will convert to T3 in fairly standard amounts and at fairly standard rates. Unfortunately, clinical experience shows this is not true for the majority of patients. Measuring both free-T3 and free-T4 blood levels in hypothyroid patients who are on T4 only therapy proves that this is not a foregone conclusion. While a certain percentage of hypothyroid patients do convert enough T4 to T3 at a sufficient rate for T4 treatment to be adequate as a source of T3; many require both T3 and T4. In fact a recent article in the New England Journal of Medicine showed that no-one who took only T4 did better than those people who took T3 and T4 in terms of psychoemotional function, irritability, fearfulness, tension, anger, tiredness, physical coldness, nausea, etc. Thus there is certainly no advantage in using T4 alone.

You might wonder then why combination T4 and T3 products are not the first choice for all low thyroid patients. For some, pork is not well tolerated. Natural thyroid, despite what the manufacturer claims, is subject to variation between batches - not only in the exact total quantity of thyroid, but in the proportions of T3 and T4. This is rarely a problem. Another consideration is that it is probably best to take preparations that contain T3 twice a day because T3 does not stay in the blood for more than 4-6 hours. Thus, natural thyroid products are not as convenient as the once in the morning T4-only products.

In my practice, my choice is to use a combination of T4 and T3 unless I have a compelling reason not to use it. For the patient who shows no feature of persistent low thyroid function that has been on T4 only, I leave well enough alone.

CytomelÂ®, a T3-only product, and can be used alone or in combination with a T4-only preparations. Because T3 has a short activity (or "half life"), it needs to be used twice a day. E. Denis Wilson, MD, in his book "Wilson's Syndrome", found that many of patients respond best to T3-only (liothryonine). He believes there is a difference between thyroid gland dysfunction and thyroid system dysfunction. Although the TSH and T4 levels may be within the normal range, the important thing is not how much hormone is in the blood, but how effectively the T3 hormone is affecting the cells. At the present time, no tests can test the cellular function.(1) Therefore, he often diagnoses hypothyroidism by observing the patient's symptoms. Often T3 (liothryonine) therapy will alleviate or eliminate many symptoms even those previously attributed to other causes. Dr. Wilson used T3-only because T3 is 4-9 times as active as T4.

How do I know if I'm on the right dose on thyroid. In addition to relief from many of the obvious symptoms, the basal body temperature can be a guide. As a clinical observation, I have found that when the pulse rate goes up but the temperature does not rise any more, taking more thyroid will not help. You are getting all that you will out of it and side effects or biochemical/hormonal affects from overdosage will become more and more likely.

http://64.233.167.104/search?q=cache...&hl=en&start=6

Linda

ladioffaith · 08-05-2004, 11:30 AM

Linda,

Wow! Thank you for your insightful and very detailed reply!

I just heard about the soy connection from a friend who is hypothyroid. Luckily I have tried the low-carb wraps that contain soy flour, and concluded that I didn't like the taste of them. I suspect I probably consumed more soy before starting my controlled-carb plan (which is when the last tests were taken) because I didn't give much thought to what I ate and consumed a lot of processed food. I have discovered other low-carb sweets (I need to watch my intake of them for the sake of calories) and recently was relieved to discover that they don't contain soy.

I don't take any of the meds you mentioned, but I DO take cholesterol pills and met an hour or two after eating. But oats and milk??? I often have at least one of these for breakfast, and sometimes BOTH! I had no idea either could have any impact on my thyroid.

I am going to print out your post, read it over and over, and insist on some additional blood work the next time I see my endo. My female hormone levels (which also have never been tested) and T3 and T4 will be on the list. I find it odd that my doc has not already checked these, and I think it was an oversight. My cousin (who is seeing the same doctor!) is the one that first told me my T3 and T4s should be checked!

Blessings,

Di