Letter to my doctor re: using TSH to guide dosage

[vocalEK]

Thank you for working with me to optimize my treatment for hypothyroidism. My health improved so much since adding Cytomel that I began working with my Psychiatrist to titrate down, and hopefully off, my antidepressant. I have switched to 200 mg per day, taken in the morning and afternoon, instead of the timed release 300 mg pill.

I have not noticed any ill effects of reducing my levothyroxine dose to 150 mcg instead of 175. It would appear the Cytomel is "taking up the slack." And hopefully it will continue to take up the slack when I discontinue bupropion.

I am attaching a PDF copy of an article published in BMC Endocrine Disorders titled, "Time for a reassessment of the treatment for hypothyroidism." If you prefer to read it online, the link is bmcendocrdisord.biomedcentr...

The article points out:

"The interrelationship between TSH, free thyroxine (FT4) and free triiodothyronine (FT3) is patient specific and highly individual. Population-based statistical analysis is therefore subject to amalgamation problems (Simpson's paradox, collider stratification bias). This invalidates group-averaged and range-bound approaches, rather demanding a subject-related statistical approach."

and

"Studies relating TSH and thyroid hormone concentrations to adverse effects such as osteoporosis and atrial fibrillation invite similar caveats, as measuring TSH within the euthyroid range cannot substitute for FT4 and FT3 concentrations in the risk assessment. Direct markers of thyroid tissue effects and thyroid-specific quality of life instruments are required, but need methodological improvement."

Another good article on the subject is this one: frontiersin.org/articles/10...

Let me know if you need a PDF copy.

[MissGrace]

Excellent articles. Thank you. 🤸🏿‍♀️🥛

[cazzaleo]

Love it! I’m currently trying to compose something similar for my endo so this is really helpful thank you - in particular the first article and quote, as what I’m trying to dispute is the endo’s suggestion that I should reduce liothyronine because of suppressed TSH due to the risk of osteoporosis and atrial fibrillation

[diogenes Remembering]

You also could use this one:

It's at base a study that could be criticised strongly as to its design, but seeing as it comes from the establishment scientists who believe in TSH, it will help your cause. Though they do not discuss it much if at all, the study shows that low TSH has no effect on promoting atrial fibrillation or bone fractures overall:

366:l4892 | doi: 10.1136/bmj.l48921RESEARCH

Thyroid replacement therapy, thyroid stimulating hormone concentrations, and long term health outcomes in patients with hypothyroidism: longitudinal study

Rasiah Thayakaran, Nicola J Adderley, Christopher Sainsbury, Barbara Torlinska,Kristien Boelaert, Dana Šumilo, Malcolm Price, G Neil Thomas, Konstantinos A Toulis, Krishnarajah Nirantharakumar.

The graphs show all you need to display to a doctor.

[vocalEK in reply to diogenes]

Wow! Thank you. This is now in my arsenal and I have a feeling this battle is not yet over. I am thinking that doctors -- especially young ones, as mine is -- are afraid to deviate from practice guidelines. So I will need an argument that assures her that it is OK to do so if that's what is in the best interests of the patient.

[Saffy2206]

Hi Miss Grace

Please do forward me a PDF copy as I’m very interested in this info.

I’ve been hypo for over 39 years and steadily my health has declined but with results always in the normal range.

I’m now wanting to fight back before I’m to old to enjoy what life I have left.

Kind regards

[diogenes Remembering in reply to Saffy2206]

Just put the link below in Google:

bmcendocrdisord.biomedcentr...

[humanbean in reply to Saffy2206]

A direct link to the PDF :

bmcendocrdisord.biomedcentr...

[Gingernut44]

All you have to do is click on the links in the original post and when they come up on your screen, click on download PDF, then print. It worked for me on both links in that post.

[Gingernut44 in reply to Gingernut44]

Sorry, that was meant for @ saffy2206

[vocalEK]

Just received her response. Looks hopeful!

"Thanks for the update, glad to hear we are gaining secondary benefits as well with your depression!

And thanks for linking the articles, will take a look in between patients today.

Take care!"

[Rose200]

Could I please have the pdf

[humanbean in reply to Rose200]

bmcendocrdisord.biomedcentr...

[Hidden]

I'm so pleased to hear that you're doing so well that you're tapering off your antidepressant. That's amazing!

Re the taper, I am not trying yo be a downer, but it seems common for doctors to taper people off antidepressants much, much too fast (over several months).

I tried it the doctor recommended way (over 4 months or so) and it was a disaster. That wasn't my first attempt either. This time, I've had to drive it my own way and am now four years into a taper off a fairly standard dose of an SSRI. The brain changes what it does in response to the SSRI, and my hope is that taking my time means I can parent/work/be functional in the meantime, and allow my brain time to recover normal function a bit at a time.

Absolutely not trying to talk you out of trying to taper! Also not trying to tell you what to do. Happy to chat about it, if that's helpful.

Sim

[vocalEK in reply to Hidden]

Thanks. I get 90 days worth of meds with each refill. I am thinking I will go 6 months on the full current dosage, and then try leaving off the afternoon dose.

[Hidden in reply to vocalEK]

The forum where I've got good information and support suggests lowering the dose no more than every four weeks by 10% of the previous dose = so it's an ever decreasing number that I drop. (That forum has a collection of good information and practical tips as well as a collection of academic/medical papers on the topic.)

I'm not trying to frighten you! There must be some people who go fast and get away with it, but it wasn't my experience so I'm very wary of going fast. Happy to chat more if you're interested.

Hope all goes well with whatever you decide to do and that you continue to feel well.