I'm going to go plead with my doctor to start me on thyroxine at TSH 3.58(0.27-4.2) and t4 11.9 (12-22) before my symptoms get worse. I'm not even at rock bottom and I can't imagine feeling worse.
He's a lovely man. Open minded but not very informed.
Does anyone have any articles to help support my argument? Anything at all to help me?
Wloren, the lovely admins have suggested the following:
CLINICAL MANAGEMENT
[corrected] Because thyroiditis is usually asymptomatic and the goiter is small, many patients do not require treatment. When hypothyroidism is present, treatment with thyroxine (T4) is indicated. Thyroid hormone replacement therapy is also indicated in patients with a TSH level in the normal range, to reduce goiter size and prevent progression to overt hypothyroidism in high-risk patients. Lifetime replacement of levothyroxine is indicated in hypothyroid patients, at a starting dosage of 25 to 50 μg per day, with gradual titration to an average daily dosage of 75 to 150 μg. A lower starting dosage (12.5 to 25 μg per day) and a more gradual titration are recommended in elderly patients and in patients with cardiovascular disease. The dosage may be increased in these patients 25 to 50 μg every four to six weeks until the TSH level is normal.
thyroid.about.com/gi/o.htm?...
Abstract
OBJECTIVE:
We examined the interrelationships of pituitary thyrotropin (TSH) with circulating thyroid hormones to determine whether they were expressed either invariably or conditionally and distinctively related to influences such as levothyroxine (L-T4) treatment.
DESIGN AND METHODS:
This prospective study employing 1912 consecutive patients analyses the interacting equilibria of TSH and free triiodothyronine (FT3), free thyroxine (FT4) in the circulation.
RESULTS:
The complex interrelations between FT3, FT4 and TSH were modulated by age, body mass, thyroid volume, antibody status and L-T4 treatment. By group comparison and confirmation by more individual TSH-related regression, FT3 levels were significantly lower in L-T4 treated versus untreated non-hypothyroid autoimmune thyroiditis (median 4.6 vs 4.9 pmol/l, p<0.001), despite lower TSH (1.49 vs 2.93 mU/l, p< 0.001) and higher FT4 levels (16.8 vs 13.8 pmol/l, p< 0.001) in the treated group. Compared with disease-free controls, the FT3-TSH relationship was significantly displaced in treated carcinoma patients, with median TSH of 0.21 vs 1.63 (p< 0.001) at a comparable FT3 of 5.0 pmol/l in the groups. Disparities were reflected by calculated deiodinase activity and remained significant even after accounting for confounding influences in a multivariable model.
CONCLUSIONS:
TSH, FT4 and FT3 each have their individual, but also interlocking roles to play in defining the overall patterns of thyroidal expression, regulation and metabolic activity. Equilibria typical of the healthy state are not invariant, but profoundly altered for example by L-T4 treatment. Consequently, this suggests the revisitation of strategies for treatment optimisation. This article is protected by copyright. All rights reserved.
ncbi.nlm.nih.gov/pubmed/249...
Full article thyroiduk.org.uk/tuk/TU...
LilyMay posted hormoneandlongevitycenter.c...
Point 2 Additional Studies:-
Many physicians have realized that patients can be profoundly hypothyroid and still have normal values of TSH and Free T4. In the British Medical Journal several physicians noted this by stating, “We wish to question present medical practice, which considers abnormal serum concentrations of free thyroxin and thyroid stimulation hormone-those outside the 95% reference interval-to indicate hypothyroidism but incorrectly considers “normal” free thyroxin and thyroid stimulation hormone concentrations to negate this diagnosis. It is unusual for doctors to start thyroxin replacement in clinically hypothyroid but biochemical euthyroid patients.” They note that of 80 patients who were diagnosed as hypothyroid on established clinical (signs and symptoms), only 5 patients had abnormally low T4 levels and only 4 had abnormal high TSH levels. The averaged TSH concentration was below the middle of the reference range. They state that these people deserve treatment otherwise they are condemned to many years of hypothyroidism with its complications and poor quality of life.
British Medical Journal
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