Member ecchho received radioactive iodine for hyperthyroidism (over-active thyroid) and as commonly happens, developed hypothyroidism (under-active thyroid). Despite t4 levels which appear to be normal symptoms persist, so ecchho inquires about ways of dealing with this common problem.

Here is the Q and A regarding ecchho’s post:

Hi Dr. Pepper:

I had Graves disease at 23 and then had RAI at 28 and have been on synthroid for 18 years. I did try ARmour once, but I found it had too much t3 (I think the pig’s ratio of t4 to t3 is much more potent than humans) and I actually had a real hard time regulating. I don’t have a thyroid anymore, and I take 225 synthroid. i still suffer a bit with impossible weight loss (despite running, dieting, etc) and some depression that feels quite hormonal at times. My dr. brought up adding t3 last visit and tested me, and then said, oh, you don’t need any xtra t3, you seem to be converting fine.
what are the levels that the t3 should be, and is this free t3 or t3? thanks.

My reply to Ecchho’s post:

Your question regarding the correct level for thyroid functions, is frequently raised on this website. I would respond to your question with this question, ” What is the correct shoe size?” Obviously, the answer is, whatever shoe size fits best. Similarly with thyroid function, everyone has a different “comfort zone” where their body functions best. That is their “correct” thyroid hormone level. You also refer to a t4 to t3 ratio for pigs versus humans. These ratio’s are averages of several hundred individuals (human or pig)and do not apply to any particular individual. Some people function better at a t3 to t4 ratio which is higher than the average. As pointed out in my article,http://www.metabolism.com/2009/11/07/breakthrough-discovery-thyroid-hormone-therapy-part-2/ , there is recent evidence that due to genetic differences, a percentage of the population does not convert t4 to t3 efficiently and therefore are likely to require t3 supplementation when treated for hypothyroidism.

Rather than spend the money for genetic testing to discover whether the genes for conversion of t4 to t3 are abnormal, some doctors recommend simply adding an appropriate dose of t3 to the standard t4 (levothyoxine)treatment and following the patient for improvement in clinical symptoms. You might want to consider discussing this approach with your doctor.

Gary Pepper, M.D

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We thank those of you who submitted your thoughts to this contest and hope that by keeping up with Sally’s comments, problems and progress that you can gain useful information to help you achieve your own goals. We also plan to rerun the contest in the near future so keep your eyes open for more information.

Sally’s winning comment is as follows:

The biggest obstacle to acheiving my weight loss is many-fold and complex as I believe it is for most. I believe my sleep apnea is the worst “culprit”. I also have Hashimoto’s thyroid disease and in 2006 I crash dieted and lost 82 lbs in 11 months only to suffer a rapid rebound weight gain of 40 pounds. For over two years, I have not been able to get this weight off. I was previously insulin resistant and had surgery on PCOS. The fibromyalgia affects working out. I feel that all of these issues feed off one another. It is crystal clear to me that feeling poorly every day from debilitating fatigue is the biggest obstacle to acheiving the weight loss I so desperately need. I really do need help. I want to live before I die.

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BeachEMS writes:

I am 28 y/o 5′9″ and I weigh 146 lbs. I have a high metabolism and it bothers me, too. I currently go to the gym at my rescue squad (which is free, thank god!) 3 days a week. I know that I have to eat more protein, carbs and high calorie foods in order to “pack on the lbs” especially since I workout regularly, but it is difficult to really discipline myself to eat them daily and in abundance because I get tired or sick of eating them. Anything worthwhile isn’t easy so its discipline, discipline, and more discipline.. and its pasta, pasta, and more pasta lol

I used to be really stressed out through highschool and college, too.. because of being in school, being underweight, having mild acne, not sleeping much at night, etc. Finally, I am in a good place in my life. I am with EMS, got a good job as an EMT, I go to the gym frequently, manage my stress levels with quiet/down time to myself and have cleared my acne.. I am slo getting plenty of sleep at night, which is a huge factor for those of you who work out in the gym.. because you know your muscles need time to repair and rebuild (plenty of water helps, too.. ) STRESS can cause weight loss so it might be a good idea for those of you with high stress levels to MAKE time for yourself to reduce stress. Consider every day events and feelings that cause you stress and work on eliminating them.. not for peace of body, but for peace of mind, too. Pilates, yoga, breathing exercises, meditation and a good self image are all good sources of stress relief.

How you see yourself is who you are. If you see yourself as being weak and nothing then you are telling yourself thats who you are.. and ultimately that is who you will be. A huge part of becoming someone you want to be (the best version of yourself) is to become that person from the inside out. Think like the beast and tell yourself “I am a raging beast!” When you’re at the gym, let out some groaning and moaning or shout something aggressive when you reach your peak rep of whatever set you’re doing. It will push you to go harder. What you put into the gym is what you get out of it and I have learned that recently. I’ve got to “step it up”.

Plenty of water, good/lean protein, carbs, vitamins, sleep at night (at least 8 hrs) and aggressive workouts are doing it for me, little by little, but I’ve got to step it up. My goal is 160 lbs by summer 2010. I am going to acheive my goals.. ARE YOU??

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1)  EAT WHAT GROWS OUT OF THE GROUND.  A pretty simple concept, yet the best way to have a healthy diet high in fiber, antioxidants, phytonutrients, good fats and good carbs.  Eating 5 or more servings of fruits and vegetables combined can reduce your risk of cancer, heart disease,  high blood pressure and even osteoporosis.  Ideally eat 9 or more servings per day for optimal health.  Add whole grains, legumes,  nuts, seeds, herbs and spices and you are on your way to a truly health promoting diet.  Of course it is important to minimize exposure to pesticides and toxins that can end up in our produce and we’ll cover that in a future post.

2)  HYDRATE.  Drinking adequate amounts of fluids is extremely important to our metabolism.  Our bodies are at least 60% water and even mild dehydration can lead to headaches, fatigue and impaired athletic performance.  Preferably our fluid intake will mostly come from purified water (I recommend Reverse Osmosis for several reasons we will cover in a future post).  You can use RO water to make tea, coffee, lemonade and fruit seltzers.  Most of us need at least 1 ounce per kilogram of body weight to start.  We need to take in additional fluid in case of hot weather, losses during exertion, fever and other specific conditions.

3)  BE ACTIVE.  We all know that a sedentary lifestyle can increase our risk of heart disease and even cancer!  Moderate activity that lasts at least 60 minutes should be done daily , or at least 5 days per week.  To improve our fitness level, aerobic activity can be added a minimum of 3 times per week along with some weight training to build and maintain lean body mass.

4)  RELAX.  Stress can be as detrimental as a poor diet.  The “fight or flight” response is great if you have to wrestle a foe or escape from one.  A chronic “fight or flight” response is not great as the hormones coursing through our bloodstream can actually wreak havoc on our systems over time.  A constant barrage of cortisol can even negatively affect parts of the brain.  Deep breathing can reverse the stress response and begin to restore balance and harmony.  Plan play time and get adequate sleep in order to keep that balance.

5)  SMILE!  Just the thought of a smile can make us feel really good.  Imagine what the real thing can do!

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Here is what Maya writes about her own life:

I replied some time ago to this thread and would like to add something. Everybody here posted a personal story of dealing with weight gain after quitting smoking. I went through that too. I smoked since I was 15, quit to have a child, picked up just that one cigarette a year after…, and than quit again 7 years ago for good. I did start gaining weight and was diagnosed with hypothyroid condition right prior to quitting. However what was effective for me is to modify almost all my life habits, not only eating and exercising. I did go to gym every day (and worked out hard) , ate small portions, meditated, made peace with few people in my life, looked at the bright side of things, etc. I even got certified as a fitness trainer! By no means it was easy but it was worthwhile doing. I wrote down all my life patterns and changed them all – even good ones modified slightly. I did it to reset my system completely. All the women in my family are very overweight and I’m not – only due to the discipline and frame of mind I choose to keep.
I started helping people to quit smoking with customized individual hypnosis sessions, because it is the best thing you can do – quit smoking forever. All it takes is a firm decision and sometimes some help.
I know that you can do anything when you make a decision to do it. Real firm once-and-for-all decision. I came to Dr. Pepper four years ago as a mess on Synthroid, and now with Armour, Selenium, meditation, and holistic medicine even my antibodies levels are going down. I decided to get healthier and did everything it took that is healthy for me. We all are not getting younger so I choose to take care of my body and eliminate unhealthy habits on daily basis, and help my patients do the same.
Good luck to you all, congratulations on quitting, and I wish you health.

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While I cannot offer medical advice on this website I can make some general comments that may be helpful. In my medical practice I see many men of this age with low testosterone. Usually the testosterone levels are in the low 200’s or slightly less. Symptoms of moodiness, fatigue, weakness, low motivation, and loss of sexual interest and function are the most common complaints. Evaluation for causes of low testosterone usually reveals a failure of the pituitary gland to make enough gonadotropins, the hormones that cause the testicle to manufacture testosterone. In almost all these cases the pituitary gland appears otherwise normal. Many of these men are started on testosterone replacement and generally have a nice improvement in their complaints.

What concerns me about Dennis is that a level of testosterone of 70 is extremely low and can suggest more unusual causes of low testosterone. Tumors of the pituitary gland, injury to the testicle, or rare genetic defects (usually discovered in childhood), cause testosterone levels as low as this. Alcoholic liver cirrhosis may also have similar effects. The fact that his breast is tender is another clue that this is a severe form of testosterone deficiency. My advice to Dennis is to have his V.A. doctors perform a full endocrine evaluation to make sure nothing else is causing the low testosterone. Giving testosterone replacement may only cover up the symptoms of a more significant medical condition.

I hope that helps. Dennis…let us know how this turns out.

Gary Pepper, M.D.
Editor-in-Chief, metabolism.com
The disclaimer of metabolism.com applies to this and all of my posts.

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Not a lot of laughs during the typical lecture at this three day meeting of the world’s experts on thyroid diseases and treatment but I did hear a few guffaws, giggles and snorts today during the single lecture devoted to using combination t4 and t3 therapy for treating hypothyroidism. The speaker on this topic, Dr. Michael McDermott a Professor of Medicine and Pharmacy at the University of Colorado, was actually significantly more open minded about using combination t4/t3 therapy then speakers from previous meetings on the same topic. He prefaced his comments by acknowledging that about half of patients treated with synthetic t4 continue to experience symptoms typical of thyroid hormone deficiency. What, if anything, doctors are to do to help their patients in this situation appears to still mystify the experts.

The laughs came when Dr. McDermott polled the audience of professionals about their opinions regarding treatment of a hypothetical hypothyroid patient with normal thyroid function blood tests continuing to complain of symptoms suggestive of thyroid hormone deficiency. The speaker put up a slide with 5 or 6 treatment options which the audience then voted on. Although a good portion of experts here gave a philosophical shrug of the shoulders by not choosing any of the options, it was reassuring to see a significant portion of the audience agreed with the statement that some hypothyroid patients appear to improve when t3 is added to traditional t4 treatment. This is far short of a strong endorsement of combination therapy but I would say it is a least a nod to those of us who routinely make use of this treatment option. The laughs and giggles came when the next to last option was read to the audience, proposing that Armour Thyroid was the best choice of treatment in this case. The last choice, that this type of patient should see a psychiatrist also got a few chuckles.

Not much more about dessicated thyroid treatment was mentioned after this curt dismissal but Dr. McDermott expressed his opinion that Armour Thyroid was a poor choice for treating hypothyroidism because it contains too much t3 and that synthetic t3 should be used exclusively if combination therapy was attempted. No one seemed aware that as of this month Armour Thyroid and similar dessicated thyroid medications were no longer available in the United States.

Despite the disturbing aspects of the first part of Dr. McDermott’s lecture he did end with some exciting ideas that I will soon be reporting on. The main idea he reviewed is that a genetic defect may cause resistance to t4 treatment in hypothyroidism. Those with the genetic defect would require the addition of t3 to achieve a healthy thyroid balance and elimination of the symptoms of hypothyroidism. I am sensing that this may be a breakthrough in thinking about why some people require combination therapy with t4 and t3. If so, endocrinologists will be forced to reconsider their reluctance/refusal to provide combination therapy for treatment of their symptomatic and dissatisfied hypothyroid patients. More to come on this breakthrough in my next installment.

Gary Pepper, M.D.

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Here is the email sent by Tina to the NY Times Editor

Dear Ms. Kolata: I am writing in regard to recent restrictions on the availability of alternative, though highly effective, medications for hypothyroidism. Dessicated thyroid generics (made from the thyroid glands of pigs), known as Armour or NatureThroid, help thousands of people who suffer from low-functioning thyroids. I was on Synthroid, a synthetic thyroid medication, for years, but still suffered from symptoms. It was only when I began using NatureThroid, which treats all four of the hormone levels affected by the thyroid (vs. Synthoid, which only treats one), that my symptoms cleared up. I can’t tell you what a relief it is to no longer feel agitated and inexplicably moody, nor to have my hair falling out, my skin dry, etc. But it is becoming harder and harder to find dessicated thyroid generics. Armour, which has been around for about 50 years, is virtually out of business. Apparently the shortage has to do with FDA documentation requirements (which is odd; why now?)!
. Meanwhile, the American Academy of Clinical Endocrinologists (AACE) is backing Synthroid, which makes big money for its manufacturers (i.e., Abbott Laboratories). I hope this captures your interest. I don’t know what I, or thousands of others who have found relief with dessicated thyroid generics, will do if they are no longer available. If you would like more information, it may be helpful to go to http://www.metabolism.com. Thank you very much for your attention, Tina Montalvo West Palm Beach, FL

ARTICLE REFERENCED (if any):
None

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Beth – perhaps you are under-medicated. The numbers don’t really mean much – you must convince your doctor to pay attention to how you feel, rather than your labs! Remind him/her: prior to 1973 there was not measure for TSH. Doctors would give their Hypo patients Armour, and increase the dose until the patient felt “right” again – and considered that to be successful treatment! I consider that to be successful treatment too! We’ll see what my doc says next week – I’m feeling great after an increase in meds (in spite of a TSH of 1.9), and I’m sure my TSH has gone WAY low – but it i hard to argue with success! I have absolutely NO Hyper symptoms. I think it is time to throw out TSH testing altogether, and treat patients instead!

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Leslie writes:

I am at a total loss as to how to loose weight! Five years ago, I became chronically fatigued, and had lots of other symptoms that led me to believe that I was hypothyroid. My Dr. tested me, and declared that I was not, and suggested that I should excersise more. My symptoms continued, and I began to gain weight at an alarming rate. I went back several times, presenting with hypothryroid symptoms, and he finally admitted that I was “borderline hypo with a TSH over 5″ but “we don’t treat that.” I lived the next two years with debilitating symptoms and weight gain that I simply could not control with diet and excersise. By the time I found a doctor who was willing to treat me, I had gained over 50 pounds and had developed fibromyalia as well. Even then, it was difficult to get treatment – but finally he relented. Now my TSH is below 1, and my fatigue is not quite so so debilitating, however my weight loss efforts are dismal. I know that my metabolism is very slow – because my temp. in the morning is usually under 96. I’ve been on Adkins for six months now – keeping my carbs under 20 grams a day, and relying on lots of fiber to keep me from being terribly hungry – but I’ve only managed to lose about 13 lbs. I know there has to be help for me, but I just don’t know what to do. Five and a half short years ago I weighed 140 lbs, had energy to burn and felt great, and looked pretty good too!. Now I weigh 180 lbs, live with chronic pain, and fatigue, and I’m unable to work. I’ve done a huge amount of research into hypothyroid and all the problems it causes – and bringing my TSH down has brought my glucose, triglicerides and cholesterol down, but not my weight. I am fearful of developing diabeties and really need help. I take Armour Thyroid, which has been much better for me than Synthroid was, but still – I am startled and upset when I see a picture of myself – looking fat and puffy instead of toned and slim. Please help me!

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