I know there are going to be wildly varying opinions on this, but I’m still interested in opinions, especially if you can share links/studies. My question arises because I feel like I’ve read it all—all the dogma, perceived wisdom, latest journal articles, etc. and feel like I one really knows......one group says T4 in upper part of range, but research shows higher T4 linked to AFIB and other heart problems. Some say ignore tsh, others say if it’s too low it’s risky. I feel like most of the advice on here talks about ideal lab values as they relate to symptom improvement. I’ve had numbers everywhere and always feel pretty much the same??????
Thoughts? Links to good research about “healthiest” values?
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Timsywhimsy
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I always have fatigue! High (ish) tsh. Totally suppressed. High free t4. Low free t4. The only thing I’ve never had is a free t3 past midrange. We’re going to try working on that.
I meant when it’s been high or suppressed I’ve felt largely the same—tired. And by working on t3 I meant by trying to bring my numbers up with more meds
But, the TSH itself doesn't make you feel anything, whether it's high or low. It's the T3 that causes symptoms when it's too high or too low. And, yours is too low because you are a poor converter, shown by the fact that your FT4 is high and your FT3 is low. And, continuing to increase the levo is not going to change that. What you need is T3 - your doctor should be working on giving you T3, nor more levo.
Of course, your poor conversion could be caused by low nutrients. So, has he tested your vit D, vit B12, folate and ferritin?
I would imagine there are as many ideals as there are members. And, for myself, I don't even bother with numbers anymore. Haven't had a blood test since 2014. I know my body well enough now to know when I'm on the right dose, and the numbers are irrelevant.
Absolutely, yes, you need to know. Forewarned is forearmed. So many doctors are utterly confused when someone has a Hashi's 'hyper' swing - and can even accuse the patient of 'abusing' their meds, or talk about 'going hyper' - so it's as well the patient knows what's going on. Do you know how Hashi's works?
well no I am new to this so I dont know many things. But what I meant is once you do know that you have Hashis and you have confirmed that your antibodies are high, is there any usefullness in testing them regularly and seeing where you are with them ?
No, there's no point in that. Once they've been high for one test, it means you have Hashi's, and it doesn't go away. Antibodies fluctuate all the time, but you still have Hashi's.
what about when taking Low dose naltrexone LDN? do you think that it doesnt help with antibodies? I have been takimg it for a couple of months and its lowered them by half.
I have no idea about ldn. Impossible to try it here in France. Your antibodies may have lowered, but there's nothing to say they won't rise again. And, even if you get rid of them completely, you'll still have Hashi's. The important thing with LDN is: does it make you feel better? If it does, then carry on.
Are you sure that's exogenous T4 these studies are talking about? I've never heard that. Your heart has a great need of thyroid hormone. And, it's high doses of endogenous T3, as with Grave's, that causes heart problem.
Thats a very interesting topic. I also have the same question. Here is an interesting artice where this is mentioned, and would like to know what you think about it if you read it. ndnr.com/anxietydepressionm...
If you want to work on conversion of T4 to T3 start with selenium. Good luck
I am confused too my dr wont test either he goes by symptoms and only tested the antibodies. My levels I think have improved but my free t3 and free t4 are are still a little low and idk how to raise them? I went to a new dr recently who tested me) He said up my ndt which I did by half a pill feel no different yet. I have disabling feet pain for 14 years now I buy best shoes and inserts and they still kill me. I just wasted 80 bucks on insoles and my heels hurt just as bad a s before and I have $180 gym shoes.it has ruined my life in prayed it was my thyroid causinfnthis when I first began ndt my feet pain did almost go away but 2 weeks later it came back.
My vitamins r ok except my b12 is a little low and I take supplement of it daily.
Timsywhimsy, a person with a healthy thyroid will have a TSH of around 0.8-2, and freeT4 and freeT3 around the middle of the reference range. These ranges are both normal curves (which means most people are in the centre, and if you looked at everyone in the population in a graph it would have a bell shape), while for TSH it's skewed towards the lower part of the range.
Once people become ill or are on thyoid hormone replacement this is all thrown out the window. Most people won't feel well if they return to blood test numbers resembling a healthy person. At this point symptoms become most important.
Oncecon replacement, freeT3 is the most important of the 3 numbers. This is the active hormone and most closely reflects symptoms. Most people will need this high in range to feel well. Of course everyone is different, some need it over range, some are happy with it as low as halfway through the range.
TSH and freeT4 are not as important. To get this high freeT3, most will have a TSH right at the bottom of the range or suppressed below it (T3 is very good at pushing the TSH down). Most people don't mind where freeT4 is in the range as long as freeT3 is high, some unusual people feel better with good freeT4 levels. If you take Levothyroxine you'll need a high freeT4 to get a good freeT3, if you take a treatment that includes T3 (NDT, T3 monotherapy or a mix of T4 and T3), freeT4 will probably end up lower in range. It's a matter of trial and error to figure this out.
If you are looking for journal articles to support this a good starting place is the work of Diogenes' team (John Midgley). Or hang around and read the forum for a few months and pick up references and links that way. I think its easiest to learn by reading about other people's experiences.
"a person with a healthy thyroid will have a TSH of around 0.8-2, and freeT4 and freeT3 around the middle of the reference range. These ranges are both normal curves (which means most people are in the centre, and if you looked at everyone in the population in a graph it would have a bell shape), while for TSH it's skewed towards the lower part of the range.
Once people become ill or are on thyroid hormone replacement this is all thrown out the window. Most people won't feel well if they return to blood test numbers resembling a healthy person. At this point symptoms become most important.
Once on replacement, freeT3 is the most important of the 3 numbers. This is the active hormone and most closely reflects symptoms. Most people will need this high in range to feel well. Of course everyone is different, some need it over range, some are happy with it as low as halfway through the range.
TSH and freeT4 are not as important. To get this high freeT3, most will have a TSH right at the bottom of the range or suppressed below it (T3 is very good at pushing the TSH down). Most people don't mind where freeT4 is in the range as long as freeT3 is high, some unusual people feel better with good freeT4 levels. If you take Levothyroxine you'll need a high freeT4 to get a good freeT3, if you take a treatment that includes T3 (NDT, T3 monotherapy or a mix of T4 and T3), freeT4 will probably end up lower in range. It's a matter of trial and error to figure this out. "
This is a brilliant summary! OK to quote it if needed? Only polite to ask, but going to anyway! Something brief to show the doctor if necessary without taking too much of his time.
This link will take you to a list of works where the name Midgley, John is in the "author" field and the word "thyroid" appears anywhere in the document.
I believe Dr Lowe was right because well before blood tests were introduced - along with levothyroxine (T4) alone - we were diagnosed according to our clinical symptoms alone - and ALL doctors knew symptoms and we were given NDT (gradual increases) until all symptoms were gone and we felt well. From that first prescribing of NDT in 1892 thousands of lives were saved from a dreadful death i.e. myxedema coma.
Big Pharma was out to make money from the millions of hypo patients with regard to blood tests and levothyroxine (T4 only) by replacing doctors' skill alongside NDT, (T4, T3, T2, T1 and calcitonin) with levothyroxine (T4 only). NDT was eventually banned in the UK and Dr Lowe's statement that it was due to corruption and payment to doctors/endos (in USA) to prescribe levo alone. Plus the additional prescriptions to try to alleviate continuing symptoms.
I don't think you should go by labs alone. But, the trouble with symptoms is that so many of them can be bother hypo and hyper. A blood test as a back-up can be useful.
"Once people become ill or are on thyroid hormone replacement this is all thrown out the window. Most people won't feel well if they return to blood test numbers resembling a healthy person. At this point symptoms become most important"
This has been exactly my experience. I felt a bit better when results got back to "Normal" with TSH near bottom of range and reasonable T3 and T4 levels, but the next increase sent TSH "Rock bottom" (0,01) and T3 and T4 near top of range. On this dose I began to feel almost normal again.
Annoyingly, I had to accept a decrease in Levo in order to prove it was not a good idea to reduce it!
After nearly three months I began to suffer from breathlessness and swollen ankles. Tests on heart and kidneys didn't show anything wrong, so, thankfully, I was given an increase back to the previous level.
Ankles still swell, but my breathing improved a lot within a couple of weeks. I can also concentrate for longer and haven't had any bad episodes of "Brain freeze" (where inability to concentrate makes the simplest task almost impossible) since the increase.
Unfortunately, most doctors would be in agreement as would the AMA as to the optimum levels for thyroid blood tests; they all learned he same thing in medical school. However,
there is a movement among some doctors and medical professionals who disagree with the numbers. If you research the internet you will find dissenting opinions that believe TSH is unimportant and that it is Free T3, Free T4 and their ratio that counts.
I've been using FT3>3, FT4 0.9-1.2 and FT3/FT4>25%. Although it works for me, I'm not an authority to say it's for everyone. More research needs to be done to update the levels currently recommended by the medical community as they don't work for most people with thyroid disorders. It's been ignored too long.
Came across this research that describes the history and future of treatment for hypothyroidism. No hard and fast answers, but it did help me to understand "how did we get here?" ncbi.nlm.nih.gov/pmc/articl...
Dr. Amy Myers has written an interesting article on various thyroid tests and what the ranges mean. amymyersmd.com/2016/10/thyr...
"In my functional medicine practice, I have found that the ranges below are the ones in which my patients (and myself) thrive. I listen to my patients as well, and take how they are feeling into account.
TSH 1-2 UIU/ML or lower (Armour or compounded T3 can artificially suppress TSH)
FT4 >1.1 NG/DL
FT3 > 3.2 PG/ML
RT3 less than a 10:1 ratio RT3:FT3
TPO – TgAb – < 4 IU/ML or negative"
Once I began taking T3, several of my persistent hypothyroid symptoms improved, but my TSH dropped below the bottom of the range (0.300 - 4.200 uIU/mL) which has terrified my GP. I have no, zero, none, symptoms of hyperthyroidism. My cardiovascular health is excellent and my recent DEXAscan came back showing no bone loss (I am 73).
Don't ignore tsh. But if tsh is normal and you still feel like crap dig deeper. The hormone specialist I found did my labs. T4 was low normal but too low to be optimal. T3 was below normal.
One thing she's taught me so far is it's recently been discovered a lot of people with thyroid issues lack something that converts t4 to t3. That's why taking t4 (armour I think is just t4) does not work for everyone. Because we can't convert it to t3 which is what we need.
I just started taking bio identical hormones (natural desiccated thyroid). I also was way below normal for dhea so I'm taking that too. It will take a couple months to really work I guess, although today I finally feel I have a tiny but more energy.
My dr gave me a booklet that's very informative."bioidentical hormone replacement therapy for men and women" by Neal Rouzier M.D.
It explains the difference bw synthetic hormones and bioidentical hormones. The benefits and risks. It's very informative.
I have fibro...one of the conditions that wipe you out. Research shows a huge majority of those with fibro and other such conditions have thyroid issues or hormone issues in general that contribute.
For me t3 really low and dhea is 10% of optimal. Dhea is linked with chronic fatigue.
So it may not be thyroid but all hormones need to be investigated
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Something brief to show the doctor if necessary without taking too much of his time.
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