General Medicine

» 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

» Elaine Moore - T3/Reverse T3

In response to T3/Reverse T3 posted by aviano:

Hi Avi,
that's a great article and one I hadn't seen. I know that in some European countries T3 levels are relied on more than T4 levels and that FT4 isn't often measured. My question would be where does FT4 fit in the scheme of things?
Measuring reverse T3 is definitely an interesting concept when you consider the tissue level they're talking about. I'll have to see if anyone else has published anything on this. Thanks for sharing it, Elaine

» dana65 - Maintenance Dosage of Tapazole

Hi Elaine . . . Is a maintenance dose of Tapazole usually 2.5 mg or 1.25 mg? And if a doctor wants to take you off the medication once your labs are normal, should one ask to continue a maintenance dose for a longer period of time? (I seem to recall you mentioning once that those on medication for at least a year have a higher rate of permanent remission. Can you reference an article showing that result)?
Actually, when the doctor is ready to take me off, I'd like to stay on and return to a more normal diet to see if that has any impact. (I especially want to do that because the doctor seems to not put much credence into following a low-iodine diet.) Any thoughts on that?
To catch you up: I've been on Tapazol for four months now (10 mg for 6 wks, 5 mg for 6 wks, and 2.5 mg after that.) My labs were completely normal when the dosage was reduced to 2.5. I was due for another appointment 6 weeks after that but couldn't make it so must now wait another 4 weeks to be seen. When I asked if I could reduce the dosage to 1.25, the doctor said, "Yes," but now I'm wondering if I should do that or not. My only symptom at this point is hair loss (which could also happen if I'm hypothyroid, right?).
Thanks for your time, as always.
Dana

-- posted by dana65

» Elaine Moore - Maintenance Dosage of Tapazole

In response to Maintenance Dosage of Tapazole posted by dana65:

Hi Dana,
The literature lists a maintenance dose of 2.5-10.0 mg daily for methimazole, but many people do fine on only 1.25 mg daily. Studies show the highest rate of permanent remission with long-term (average 4 year) low-dose ATD use. There are several studies showing this with the most well known the Yamamato study from the 1970's.
After only a few months, remission is possible, but you'd want to be sure by first lowering your dose and staying on 1.25 mg for at least 6 weeks to make sure you're secreting TSH normally. This would indicate that you're no longer producing significant amounts of TSI.
Dietary iodine has been listed as an environmental trigger of autoimmune thyroid disease for quite a few years now. Avoiding excess dietary iodine in fast/processed foods eliminates reduces this trigger. Also, thyroid hormone is made from tyrosine and iodine. Reducing the amount of iodine you ingest reduces the amount of thyroid hormone you can produce.
ATDs work primarily by blocking iodine absorption.
I have references cited with most of my thyroid articles that you can use if you need resources. Also, check PubMed for article abstracts. Best, Elaine

» dana65 - Avoiding Iodine

Hi again, Elaine . . . I do not have any trouble avoiding fast or processed foods, but I've also totally avoided dairy and seafood for the past several months. (I never eat cheese, I don't even butter my toast, and I never eat egg yolks -- so I don't even use mayonnaise any more.) I would guess that's why I became very deficient in Vitamin D and was prescribed a two-month weekly mega-dose prescription of Vitamin D. So now I'm wondering if I can soften that rigid diet just a bit without triggering the antibody action again . . .or must I wait until I've been in remission for a couple of years before trying to use milk in my cereal or buttering my toast or having a little cheese on occasion? Thoughts on that?

And once again, what defines "remission?"

Many thanks.
Dana

-- posted by dana65

» Elaine Moore - Avoiding Iodine

In response to Avoiding Iodine posted by dana65:

Hi,
remission occurs when your immune system stops producing TSI antibodies at levels that cause hyperthyroidism. Because these antibodies falsely decrease TSH, you can confirm remission with either a TSI level or a TSH level. A normal TSH in someone on a very low ATD dose would confirm remission.

a recent study published in Science showed that although many people are deficient in vitamin D, vitamin D supplements do not necessarily benefit the immune system. It's recommended that vitamin D be absorbed through sunlight. I recently wrote an article on this that you can find with the autoimmune disease articles.

You want to avoid excess dietary iodine. An occasional dairy product is fine. Best, Elaine