General Medicine

» Elaine Moore - Reverse T3 and other questions

In response to Reverse T3 and other questions posted by aviano:

Hi,
The FT3 test is a good indicator if one is converting T4 into T3 properly since it measures the available free T3 in the system. Selenium and zinc are needed for this conversion. If these levels are low, conversion can be impaired.
Some people don't absorb thyroid replacement hormone well. Sometimes, taking essential oils like the omega-3's along with replacement hormone helps absorption since thyroid hormone is fat soluble. Some people with hypothyroidism also need digestive enzymes. And studies have shown that people with celiac disease or even mild gluten sensitivity who are eating gluten have damaged villi and malabsorption. They often need to take extra replacement hormone to ensure that enough is absorbed.
I'm doing great on LDN. It's even brought my blood pressure down, which supports the theory that hypertension has an autoimmune component. The book is at the publishers and will likely be out in the fall. Usually, production takes around 10 months. Take care, Elaine

» Elaine Moore - New Labs

In response to New Labs posted by kitykatt:

Hi Jackie,
I'm glad I was able to help you. Please keep in touch and let us know how things work out with your new doctor. Best to you, Elaine

» Elaine Moore - Please Help

In response to Please Help posted by cowlover614:

Hi Shirl,

Sometimes, when RIA is recommended, doctors think that removing thyroid tissue removes the antigen stimulus, and the resultant thyroid antibody production. However, this is incorrect. Like most toxic substances, RAI causes the immune system to respond dramatically, and this increases thyroid antibody production. The antibodies and the immune system chemicals produced during the immune response trigger TED.
With surgery you don't have this dramatic increase in thyroid antibodies, and thyroid antibody levels often fall. But sometimes they can rise because the antibodies are produced against the TSH receptor, a protein on many different cells besides thyroid cells.

The goal with TED is to help the immune system heal and reduce thyroid antibody production. It's important to keep thyroid hormone levels, primarily FT4, at least at mid-range. Hypothyroidism needs to be avoided. If FT4 falls too low, the thyroid gland speeds up its activity trying to fix the problem. This causes increased thyroid antibody production. It's important to recognize that TSH is falsely decreased whenever there are TSH receptor antibodies. A low TSH doesn't mean that you're still hyperthyroid. Some doctors get confused by this. Your FT4 is the best indicator of thyroid status when you have Graves' disease. Hope this helps, Elaine

» aviano - New Labs

In response to New Labs posted by daisyelaine:

Elaine:
Glad to hear you're doing well on the LDN..My ENT is a particular fan of your Graves book and has a patient on the protocol, but is a little concerned about far/long-reaching effects. He'll be excited to hear that you have a book coming out re: same.
I was trying to figure something out for myself on the RT3 as well. Mine has been high (past lab range of 245 in one instance, high normal most other times well into 200's)..I seem to have plenty of Free T3..but have had a hard time getting that number down..I supplement with selenium (eat Brazil nuts regularly) and believe that I'm getting enough zinc..but am unsure..
My condition has been very erratic..hypo to hyper (on meds) and back again..One reason I'm interested in the LDN..
Interestingly enough when I was diagnosed with Graves in '04..my Free T4 and T3 levels were high normal, but never technically out of range..however, reverse T3 and Total T3 were high..and I certainly was symptomatic..severe anxiety, weight loss, hair loss, low-grade fever, etc.
My question was does Total T3 measurement include Reverse T3..or more to the point..how does RT3 affect Total T3 measurement? If I had depended on free levels only (TSI was well over acceptable ranges also), I never would have been diagnosed. Comments, thoughts?? I so enjoy picking your brain!
Thanks in abundance,
Avi

-- posted by aviano

» nurseheatherone - Internal Racing Feeling

In response to Internal Racing Feeling posted by daisyelaine:

Hi Elaine, any thoughts on SSRI's like Zoloft and prozac in pregnancy? My OB and psychiatrist have both suggested that I could continue on either one of these medications during my pregnancy and I am trying to decide what to do before I get pregnant. For now my endo suggested this would be a good tiem to get pregnant since my Thyoid is functioning normally at this point. I am just trying not to be in denial about my panic disorder but also want to make a safe choice as well. ANy info would be greatly appreciated.
Thanks, Heather

-- posted by nurseheatherone

» Elaine Moore - New Labs

In response to New Labs posted by aviano:

Hi Avi,
Total T3 measures free and reverse T3 that's bound or linked to protein molecules. In this form, which is how T3 travels through the blood, thyroid hormone is inactive.
When T3 is elevated and FT3 isn't, it generally means that binding proteins are high. Binding proteins are elevated by estrogens and many drugs, including some non-steroidal anti-inflammatory drugs.Best, Elaine

» Elaine Moore - Internal Racing Feeling

In response to Internal Racing Feeling posted by nurseheatherone:

Hi Heather,
You might want to read this article from the FDA. I read an article last week somewhere that said the changes in dopamine levels caused by SSRI's occur in the fetus as well, and that this can lead to permanent changes in brain chemistry. I read quite a few health advisory columns so it's hard to say where I read it, but based on the FDA report, its seems that more studies are needed before SSRIs can be considered safe in pregnancy. You probably want to do more research on this. Best, Elaine

» snoozieq312 - Long Term Effects of Graves?

I was treated with RAI 14 years ago when I had Graves' disease. I am now 53 and have been on 137 mcg of synthroid ever since. In the past couple of years I have started to experience severe joint pain in my knees as well as constant muscle stiffness. I am very active in racquet sports, but my level of stiffness and fatigue seem way beyond that of my contemporaries. Could these be long term effects associated with my thyroid?

-- posted by snoozieq312

» Elaine Moore - Long Term Effects of Graves?

In response to Long Term Effects of Graves? posted by snoozieq312:

Hi,
Often, our lab results are misleading for many years after RAI. This is because RAI increases our levels of TSH receptor antibodies for many years. And these antibodies falsely decrease TSH levels. So our TSH level could suggest that we have adequate thyroid replacement hormone even though we're hypothyroid.
It's important to have levels of both FT4 and FT3 tested. These tests measure the levels of available thyroid hormone in your blood. Many of us are unable to convert enough T4 into T3 if we're on levothyroxine alone. It could be that your FT4 level is ok but your FT3 level is too low. This happened to me and many people I know 6 or more years after RAI. I now take Armour thyroid, a glandular extract containing T4, T3, T2, and T1. For me this has made a big difference.

Joint pain and muscle stiffness fatigue are common symptoms of hypothyroidism. Even if your levels are within the normal range, they may be too low for your body's needs.

Studies show that 1 year after RAI most people need a dose of replacement hormone of about 0.10 mg (100 mcg), and 6 years after RAI the average dose is 0.175 mg (175 mcg) levothyroxine. Over time, after RAI hypothyroidism generally worsens. Best, Elaine

» aviano - T3/Reverse T3

Elaine:
What is your opinion on the below? I have had some positive experience with T3/Reverse T3 being close to 1:1 ratio...and feeling MUCH better. Generally, my RT3 is on the high end EVEN if Free T3 levels look good (mid 3's). BTW, I take 1 and 1/8 gr Armour.
Avi

Reverse T3 is the Best Measurement of Tissue Thyroid Levels
The Journal of Clinical Endocrinology & Metabolism 2005;
90(12):6403-6409

Thyroid Hormone Concentrations, Disease, Physical Function and
Mortality in Elderly Men
Annewieke W. van den Beld, Theo J. Visser, Richard A. Feelders,
Diederick E. Grobbee, and Steven W. J. Lamberts Department of Internal
Medicine (A.W.v.d.B., T.J.V., R.A.F., S.W.J.L.), Erasmus Medical
Center, 3000 CA Rotterdam, The Netherlands; and Julius Center for
Patient Oriented Research (D.E.G.), University Medical Center Utrecht,
3508 GA Utrecht, The Netherlands

This study of 403 men investigated the association between TSH, T4,
free T4, T3, TBG and reverse T3 (rT3) and parameters of physical
functioning. This study demonstrates that TSH and/or T4 levels are poor
indicators of tissue thyroid levels and thus, in a large percentage of
patients, cannot be used to determine whether a person is euthyroid
(normal thyroid levels) at the tissue level. In fact, T4 levels had a
negative correlation with tissue thyroid levels (higher T4 levels were
associated with decreased peripheral conversion of T4, low T3 levels
and high rT3). This study demonstrates that rT3 inversely correlates
with physical performance scores and that the T3/rT3 ratio is currently
the best indicator of tissue levels of thyroid.

This study showed that increased T4 and RT3 levels and decreased T3
levels are associated with hypothyroidism at the tissue level with
diminished physicial functioning and the presence of a catabolic state
(breakdown of the body). This study adds to the mounting evidence that
giving T4 preparations such as Synthroid and Levoxyl are inadequate for
restoring tissue euthyroidism and that a normal TSH cannot be relied
upon as as an indication of euthyroidism, as it has a very low
sensitivity and specificity for hypothyroidism. This poor sensitivity
and specificity is further decreased with the presence of one or more
systemic illnesses, including diabetes, heart disease, hypertension,
systemic inflammation, asthma, CFS, fibromyalgia, rheumatoid arthritis,
lupus, insulin resistance, obesity, chronic stress and almost any other
systemic illness.

Low T3 syndrome, with low T3 and high reverse T3, is almost always
missed when using standard thyroid function tests, as the T3 level is
often in the low normal range and reverse T3 is the high normal range,
again making the T3/rT3 ratio the most useful marker for tissue
hypothyroidism and as a marker of diminished cellular functioning. The
authors of this study conclude, "Subjects with low T3 and high reverse
T3 had the lowest PPS [PPS is a scoring system that takes into account
normal activities of daily living and is a measure of physical and
mental functioning]...Furthermore, subjects with high reverse T3
concentrations had worse physical performance scores and lower grip
strength. These high rT3 levels were accompanied by high FT4 levels
(within the normal range)...These changes in thyroid hormone
concentrations may be explained by a decrease in peripheral thyroid
hormone metabolism... Increasing rT3 levels could then represent a
catabolic state, eventually proceeding an overt low T3 syndrome."

This study demonstrates that TSH and T4 levels are poor measures of
tissue thyroid levels, TSH and T4 levels should not be relied upon to
determine the tissue thyroid levels and that the best estimate of the
tissue thyroid effect is rT3 and the T3/rT3 ratio.

-- posted by aviano