OK, if you are on thyroxine (T4) only and you feel fine - lucky you. Most people who are given T4 only seem to do OK on it and if they don't feel completely perfect than at least they feel 'good enough'
This is probably not the case if you are a member of this forum.
So, if you're on T4 and not feeling so good and your TSH, FT4 and FT3 are all 'normal' and you still feel hypothyroid then what can be said about that?
Let me assume that a full range of reasonable T4 dosages have been explored with your doctor. Some people are remarkable sensitive to slight dosage adjustments - so dosage adjustments need to have been fully explored before you can really say that T4 isn't working.
First, what is considered 'normal' for these laboratory tests? The Thyroid UK website has excellent information and guidelines on how to interpret these. To aid this blog I will just provided a brief summary of typical UK lab reference ranges.
The typical TSH reference range for UK laboratories is 0.4–4.5 mU/L. For free T4 (FT4) the range is 9.0–25 pmol/L. For free T3 (FT3) the range is 3.5–7.8 nmol/L.
So, assuming that someone is on T4 and doesn't feel well and their labs are all looking really healthy what are the first things to consider? Well, in order for thyroid hormones to be processed properly the thyroid hormone needs to exist in the presence of adequate amounts of adrenal hormone and adequate levels of some of the key vitamins and minerals that are used in the various biochemical pathways involved.
So, one of the first things to do is to have a ferritin test to assess the level of iron that is being stored by the body. Without adequate iron no amount of thyroid hormone will stop you from feeling hypothyroid. Sometimes, you may even feel like you are having an adverse reaction to the thyroid hormone. So, a serum ferritin test is worth doing. If there is a problem then your doctor can address it by providing you with adequate iron replacement.
B12 is also worth having checked. Many other vitamins and minerals can be problematic. B vitamins, magnesium, selenium are among some of the main ones. Most thyroid patients are well advised to have a good all around vitamin and mineral supplementation regime.
Adrenals are a massive area also and like iron if your cortisol level is very low then you'll still potentially feel hypo when on thyroid replacement. Worse still, you may get hyper-like reactions if you begin thyroid treatment with low cortisol. This should be checked. Don't be fooled by a single cortisol serum test. Even a Synacthen test may not reveal an issue because this is a very forceful test and places an unusually high demand on the adrenals that is not representative of the normal demand by your body. The 24-hour urinary cortisol test is a better test as it measures cortisol over 24 hours (you have to collect all your pee). The newer, 24-hour adrenal saliva test is also available privately but I have limited experience of that and I'm still making my mind up on it.
OK, So assuming that adrenals are OK, all the vitamins and minerals are OK and you still feel rubbish on T4 - how can that make any sense if the laboratory tests are all looking good?
I just wanted to talk about some of the assumptions that are essential foundations behind these laboratory tests that so many doctors put their faith in. These assumptions rarely get any discussion - but they must exist or doctors couldn't put their trust in the lab tests could they?
Let's keep this brief and start with TSH. TSH is produced by the pituitary gland. The pituitary gland sits under the brain and has a good blood supply. The pituitary uses T4 and T3 in its blood supply to determine TSH. So, for TSH to be meaningful several assumptions need to be true:
1) The pituitary needs to be functioning correctly.
2) The cells of the pituitary need to be accepting T4 and T3 at the same rate as the rest of the tissues.
3) The cells of the body were able to correctly utilise the T4 and T3 once the hormones arrive in the cells.
Point 1 should be detectable if there is a serious problem but perhaps not so easily if the issue is fairly mild.
Points 2 and 3 are not so easy to detect, er, or rather they are impossible to detect to be more precise.
What about FT3 and FT4 - don't they just tell us that we are normal in terms of thyroid hormones? Er, No! The problem here is that this is just FT4 and FT3 in the bloodstream.
What do FT4 and FT3 do in the bloodstream exactly? Nothing! FT4 and FT3 float around waiting to find their way into cells where they can be of use, but serum levels of FT3 and FT4 alone tell us naught about cellular levels of thyroid hormone. They also tell us nothing about whether the thyroid hormone in the cells is actually being effective.
So, the big assumption with FT4 and FT3 tests is that we are all normal and without problems in the way thyroid hormones are being used within out cells.
Do our doctors or endos ever think about any of these assumptions? Usually No! If you happen to have one of the very few enlightened ones then maybe they will.
There are many examples of research findings that illustrate that all of the above assumptions can be flawed.
My particular interest is the assumptions surrounding the use of FT4 and FT3 within the cells. In my case thyroid hormone is not utilized correctly until I remove most of the T4 from my body and only use T3. This approach of saturating my cells with T3 only appears to be the only way to overcome the problems that I have.
Incidentally, the above assumptions are still important for someone who is on a combined T4/T3 therapy. Many things can go wrong between the T4 and T3 in bloodstream and the arrival of enough T3 at the important targets for the thyroid hormone within the cells.
Last point. Is there anything that gives us a real clue about how much of the biologically active T3 thyroid hormone is actually doing some work within the cells?
Believe it or not it is how you feel that tells you whether you have enough working thyroid hormone. By fully assessing how you feel in detail, including measures like body temperature, heart rate and blood pressure you can begin to assess how much real thyroid hormone is at work. This is over simplified because other tests can also be done like ECGs, serum calcium (to check for bone loss), measures of adrenal hormone output. But the primary indicator is how we feel. We can break this down a little into whether we feel well, energetic, bright minded, warm, with working digestive function, good hair and skin condition etc.
At the present time there are no blood tests to detect the active level of T3 within the tissues of the body. This test, if it existed, would be the definitive test of whether you were properly medicated with the right type of thyroid hormone and the right amount. It does not exist today. This is the test I want to see be developed as a result of research more than any other.
Today we have crude tests that can be misleading and unfortunately are believed to be totally accurate by the majority of the medical profession. These crude tests of bloodstream content of thyroid hormones do tend to work most of the time if your pituitary functions normally and you have no significant biochemical issues affecting thyroid hormones within the tissues of your body.
So, I have no complaint that these tests are in use because they are excellent but only if your body works as it was intended to. These tests are simple, cheap and easy to use if your body is working as nature intended it. Your doctor just needs to have the wit to realise when to call it a day and try a different approach.
Now, if you have worked with your doctor on your treatment with T4 or T4/T3 and you still feel terrible having explored many dosages and these tests still say you are normal then talk to your doctor about his views on managing your treatment a little differently. If the response you get is that actually your thyroid hormones are normal, so you must have some other condition then consider changing doctor. If it is suggested that you may need some form of counseling or that you might need antidepressants to resolve what is obviously a psychological issue then definitely change your doctor.
This stupid, rigid and unintelligent adherence to the blood test results for diagnosis and treatment in the face of massive evidence that the treatment is not working is what I tend to refer to as our 'Elephant in the Room'. In our case, the beast is in our doctor's waiting room, in heavy disguise. It is taking up two seats of course. It also has a large pair of shoes on, a suit and a hat and is reading a newspaper. But the giveaway is the trunk dangling over the top of the paper. We can see the elephant pretty clearly, even though there has been a good attempt to not draw attention to it. But no one else wants to speak about it. If someone does mention the fact that it's there to the doctor then he may get annoyed and angry and offer you those antidepressants - time to move on then. If you are lucky and you find an open-minded doctor then he may just nod quietly and admit to you that it's there - he may be just the doctor you want!
If anyone has any particular topics they want to hear discussed in a future blog then please post them somewhere, as comments on this blog#2, and I'll make a note for the future. I just thought the blood test thing needed to be dealt with.
What I have never seen satisfactorily discussed is how the fT4/fT3 levels are controlled within the body. Other than simple availability, whether endogenous or exogenous, and adequacy of binding mediums, what factors influence and manage the dynamic balance between bound and free thyroid hormones?
Effects on this balance seem to be mentioned in relation to quite a number of medicines. Quite often, it seems, because the medicine binds to the same medium.
Rod
Hiya, I don't know all the details of that either but I do believe that apart from the pituitary involvement that the liver uses TSH level or a related chemical to determine conversion rate. If the TSH is very high because the amount of T4 and T3 is low in the bloodstream the liver converts more T4 to T3. I found a research piece on this years ago,but can't locate it now, which said that this was a defence mechanism against thyroid gland destruction which humans developed prior to the advent of replacement hormones.
I also think it 'feels' right. My experience is that simply taking more T4 or T3 does not result in a straight additive result in terms of the amount of active thyroid hormone I feel I have. I know when I used to take T4 the only time I even felt vaguely well was when I stopped taking T4 altogether. I'd typically have a few days when I felt slightly better - as my TSH rose, but before my thyroid hormone levels fell substantially.
So, I think there is a TSH-liver conversion relationship tha combined with the pituitary provides a reasonable degree of control.
Paul
<b>Updated on Feb 6 2011 7:57PM:</b> Very sad, but couldn't help looking for the links between TSH and T4 to T3 conversion. I've quickly found 3 research papers based on experiments with rat/mice livers and kidneys that clearly indicate rising thyrotropin (TSH) levels increase T4 to T3 conversion. So, the level of patients TSH is likely to have some bearing on conversion rate BUT only for those people who are converting normally. Not bothering to post the links. If you are desperate to locate the references then search for 'Thyrotropin T4 to T3 conversion'. Medical researchers often use the name Thyrotropin rather than Thyroid Stimulating Hormone (TSH) - just to sound more clever!
Paul wrote: "I know when I used to take T4 the only time I even felt vaguely well was when I stopped taking T4 altogether. I'd typically have a few days when I felt slightly better - as my TSH rose, but before my thyroid hormone levels fell substantially."
Ditto ditto ditto! I've recently stopped yet another 'T4 trial' (hoping that a different 'brand' would work) and the same thing has happened. Best thing so far for me has been straight desiccated - not perfect by any means, but then I do have other issues going on that contribute to my problems.
I didn't notice getting vit D level checked in your list above. This is apparently quite common in patients with AITD, and I believe low level may have a more significant effect for thyroid patients than has so far been generally recognised, especially on muscle function etc.
<b>Updated on Feb 6 2011 12:55PM:</b> Since writing this post, I've read an article discussing the potential wide ranging effects of gluten (even in non Coeliacs), and amongst other issues, there's suggestion that:
" A vitamin deficiency can trigger an autoimmune disease, particularly vitamin D."
Yeah I forgot to put the vitamin D in although this is usually more of a benefit to calming the immune system down and alleviating any depressive symptoms than making the hormones work better - which is what I had my focus on. I don't think the D helps the biochemical pathways involved in conversion of T4 or takeup of T3 at all. I take quite a bit of vitamin D myself. It is very useful for Hashis patients and anyone with allergies.
well written paul, what about reverse t3, there is a lot of confusion about that.
Wow, whole other topic. Lot's of opinions. There are the rT3 zealots who think rT3 is THE issue. There are those that don't even believe a conversion issue is possible - like a lot of doctors (real open minded people in my opinion - NOT!).
Then there are people like me in the middle who think that there are many problems down at the cellular level that can cause problems.
One of the most recent pieces of research was passed on to me by Lyn Mynott a while back. One of the researchers was the now Professor Colin Dayan. Here's the link:
This is a solid piece of research that doesn't mention rT3 once BUT if the deiodinase enzyme is deficient or defective then it must mean that insufficient T4 is being converted into T3. The excess has to be cleared from the body and the only mechanism I know for that is via converting it to rT3. So, I am sure that in some cases people may have excess rT3.
However, I am also sure that there are many other causes of a failure to regulate cell function by T3. Some examples are:
a)Defective T3 receptors in the cell nuclei.
b)Incorrect levels of co-factors and enzymes involved in the myriad processes necessary to take T4 and T3 and provide them beautifully to the right places in the cells.
c)Damage to the mitochondria which provide cellular energy.
d) Other chemicals that are present at the wrong levels which block the effective procession of T4 and T3 to the intra-cellular targets. My suspicion is that in a lot of cases these chemicals may arise out of immune system dysregulation.
I was going to write about all this separately and put some of the research references in. In my case I suspect one or more immune system chemicals that get in the way of T3 reaching the cells. Cytokines in particular are poorly understood immune system chemicals that have been implicated in partial cellular tissue resistance to thyroid hormone.
I processed thyroid hormones perfectly until I had Hashimoto's thyroiditis. More Hashis Patients appear to have to resort to pure T3 than patients with other forms of thyroid problems - this is just my impression having talked to many patients who use T3.
Anyway, long answer as usual - sorry!
Yes - I think rT3 may be important but it isn't the Holy Grail by any means. I think people that pin their hopes on measuring T3/rT3 ratio being the definitive measure of whether thyroid hormone is working right are a bit deluded. Their hearts may be in the right place and it may work for some people but it is definitely not the whole story.
Until we have some real deep measures of how much T3 is reaching the mitochondria and the nuclear thyroid receptors and actually being effective there (because both T3 receptors and mitochondria may be partially damaged) we won't have a single, usable measure that everyone can trust.
Until then we have the best measure of all that we can trust - the answer to the question: "How do you feel?", and a few other symptoms and signs (that is another blog all on its own).
on the money again. have you ever had the mitochondrial function tests and proper immune panels (Natural Killer Profile which includes the CD3, CD4, CD8, CD19 etc). in both of these my tests are very wonky and support what you say. i have hashi's and poor conversion to t3, poor mitochondrial function and poor adrenals. have gone gluten free to try to calm the immune system using the CD4/CD8 ratio as a marker, trying to deal with the auto-immune problem rather than just thinking of it as a replacement issue. think i may be getting somewhere and will be repeating the natural killer profile in the next few weeks and will blog if i have success.
jonny
Jonny,
That's really sophisticated stuff. Sounds a bit like Kharrazian's approach [Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal: A Revolutionary Breakthrough In Understanding Hashimoto's Disease and Hypothyroidism. Datis Kharrazian]. Do you have these tests done in the UK?
Of course the conversion and the mitochondrial issues are not the same. Is there any evidence of being able to correct both of these? How do you know it is poor conversion for sure?
Never heard of Natural Killer Profile - any more info.?
I'd struggle to come off gluten. I have done it once for about 18 months but it was really hard and I felt no better but it may work for others (or I missed something else I should have been doing).
Paul
<b>Updated on Feb 6 2011 4:48PM:</b> I had to add this. I've just been chuckling over the idea of two non-health professionals (unless you are and then I apologise!) debating these kinds of details. All the time we are doing this, some (many! most?) of the doctors are still scrawling on their cave walls that we're all fine if our blood tests are in the normal range and that conversion problems and the like don't actually exist! What sort of situation is this? Its all f*****d up!
Just madness!
<b>Updated on Feb 6 2011 4:59PM:</b> ..... and if you are a medical professional Jonny - I apologise for any offense caused.
..... and well done for getting out of your cave!
<b>Updated on Feb 6 2011 6:52PM:</b> OK Jonny,
Just tell me you're not a medical professional and I've not just deeply offended you with my banter.........
........now I'm worried......and there's no delete button just for the additions!
Paul
<b>Updated on Feb 6 2011 9:23PM:</b> Dear Jonny or should I say Dr. Winston,
I offer my humble apologies as I have just had a visit from what I can only describe as your 'assistants'. They told me in no uncertain terms that you are indeed the renowned Dr. Robert WInston. They informed me, if pressing me up against my living room wall and shouting at me can be called 'informed', that you had sent 'the boys' around.
So, I apologise for any previous references to doctors in caves and I completely retract everything I have said about those wonderful blood tests of yours.
My wife would really like to have our dog and our youngest son returned at your earliest convenience.
I apologise again and support my wife's request for the prompt return of our dog.
My very best regards to you and the entire medical profession.
(But don't for one moment think that I have fully read and understood all of that.)
And thyroid hormone secretion into bile.
Though again, what actually controls these processes is also fairly unclear to me.
Rod
Just had a glance Rod.
....er .... I'll wait with interest for your forthcoming translation, or the discovery of a real life Babel fish.
My focus on research has always been to give me enough, just enough knowledge to be very certain of:
1) whether pure T3 use is appropriate
2) how to use pure T3 safely and effectively
and to have a reasonable understanding of the conditions that give rise to the need to use T3 in the first place. I am no general, expert in a wide range of biochemical issues that are off the major topics above.
Most of my focus has always been on identifying a safe, organised and controlled way of using T3 for full thyroid hormone replacement. You need some theoretical information to do that but it is fairly specific.
If anyone does know of any credible, published, medical research that covers:
1) links between TSH and liver conversion of T4 to T3
2) identified conditions that occur within the cells that prevent thyroid hormones being processed correctly e.g.
mitochondrion problems, T3 thyroid receptor issues, immune system or other interfering chemicals that result in T4/T3 problems within the cells.
Then please post a reference to the link somewhere in this blog. I'm collecting as much of this as I can but to be honest I'm sick to death of searching for it - it is pretty dull once you've found one or two. I do need more though. So, if any of you folks already have relevant bookmarks to research web pages then I'd appreciate it.
Anything on partial tissue resistance research in terms of specific causes would be great too.
NK1 £ 326.50 (Natural Killer Profile which includes the CD3, CD4, CD8, CD19 and others)
from the doctors laboratory in london. at the moment i am consulting a doctor in california, where i believe dr k is practicing.
re poor conversion, on 150 of t4 was over the range in t4 and under in t3. dr myhill re mitochondria, think she is right about the problem, but the protocol had little impact on my health. will send you a link to dr b.
Thanks Jonny!
Please let me know how this goes - really interested - do you know how long it it supposed to take?
I'm just so thick I think most of this goes right over my head
Jan Xx
Just re-read and then ask very specific questions about anything that you think you are interested in Jan. I am at home a lot at the moment because I have a very sick dog whose time is coming close to an end - poor love. So, I would welcome the distraction.
I read these things all the time and I don;t know if it a thyroid thing but as soon as I have read it its gone , does that sound right !! like when the doctor say's things to me as soon as I have left the room I can't remember what he has said ! it's just like my short time memory has gone it's like some things that I have done in the last few years have'nt happened , friends will say about things we have done and I don't remember it at all ??maybe I've just lost the plot !!!!!
Hi Jan,
Blog#2 is like a darts competition with the 10 best darts players in the world. Except there are also some doctors at the side of the darts players and the doctors are going to get asked some questions in a minute.
The doctors cannot actually see the dartboard because there is a curtain between them and it. They can see the player and how many darts he is holding though.
So, assuming these players are the 10 best darts players in the world then, let's say that after throwing 3 darts that the vast majority of their scores (on 3 darts) is somewhere between 60 and 140, almost all of the time.
So, I turn to the doctors before Fat Sam (that's his name right) is about to throw his next three darts and I ask the doctors what Fat Sam's scores are going to be between. They all say really quickly that this is an easy question and the score will be between 60 and 140. They turn out to be right - it was 120 I tell them and the doctors are pleased that Sam is doing well (and really pleased they got it right).
This happens another 150 times with various players and scores with three darts. The doctors are feeling really smug.
OK, now I say to the doctors and the darts players. OK from now on we are going to switch the dartboard each time. The you try again.
Fine, say the darts players and the doctors - no problem.
But, occasionally I'm going to arrange to have a dartboard that is slightly faulty and doesn't let all the darts stick in it properly - I don't tell anyone about that. In fact the doctors and darts players don't even know that it is possible to make a dartboard like that.
But there is a problem. Because every so often one of the darts players throws three darts and maybe only one or two of them stick. In these cases the doctors guess the scores will be between 60 and 140 and occasionally the scores are much lower. The doctors can't see the board of course.
The can see the darts players reactions and disappointment and hear the crowds murmurs of discontent.
I tell the doctors that the scores were a lot lower and the doctors don't believe it. They just don't accept it. I eventually tell them that some of the dartboards don't work right and they don't believe that either.
All I get back from the doctors is - well we saw he had three darts in his hands so he must have a good score!
This is just like blood levels of thyroid hormones which doctors measure. They measure the levels in your blood. This is like having 3 darts in your hand. The darts don't do a damn thing of any use until you throw them into a dartboard. In the case of thyroid hormone the thyroid hormone has to leave you blood and go into the cells in your muscles, your heart, your lungs your brain etc etc. before it is active and helping you to feel well.
The thyroid hormone has to go somewhere it can be used and then it has to be used right when it gets there. In some people it just isn't used right when it arrives at the cells. But all the doctors can see is what is in your blood as measured when you have a blood test.
The things that can go wrong with the thyroid hormone in your cells appear to be numerous and to be honest it doesn't really matter.
What is important is finding a treatment that works. To do that may require not using the blood tests so much and relying far more on whether you feel well or not.
If you have a doctor that only uses blood tests and won't accept that if you don't feel well still then it might be the treatment that is wrong then it may be time to find a better doctor.
I hope that is a little clearer. If not then please ask any specific questions you want.
Paul
Then maybe it is indeed time to look for a new doc.
Have you been offered anything other than T4?
Have you been asked to take your body temp and heart rate regularly by your GP?
<b>Updated on Feb 8 2011 6:16AM:</b> This was supposed to be to Jan. I really keep forgetting that this site doesn't automatically put who you are responding to in the message.
Thanks for that Angie , I do feel like sometimes I have lost it altogether and today is even worse as I have just been told I have sleep apnea , what next , no wonder I have no brain cells left
Jan Xx
And Paul thanks for the game of darts lol , I think I am now getting there with my meds 100mcg levo 10 mcg litho , and I have even lost some weight so just hope the Endo does'nt want to change them when I see him next week .
Hi Paul -I can't agree with your comment about vitamin D not affecting the uptake of thyroid in the tissues -it does accroding to Dr Skinner but they don't know the mechinism to how that happens. I would always strongly recommend that vitamin D levels are checked and should be in the 50-80 level for optomin effect. I only know this because correcting mine made a massive difference and I was on dessicated thyroid prior to this being added into the mix.
Sorry????
When did I say that vitamin D doesn't affect the uptake of thyroid in the tissues??????
I said that I didn't know if it did.
I didn't and now maybe I stand corrected but I'd really appreciate it if you can post in reply at least one research reference to back it up - thank you. I always like to have at least one piece of credible medical research for every thing that I may in future refer to as a fact.
So, have you been able to go back to T4 now that you're on vitamin D?
If so then your problems were mild compared to most of the people I am focused on.
My knowledge is really centred on chronic cases where no T4 will work in any form. People whose lives are totally destroyed and they cannot function at all on natural thyroid or T4/T3.
I have very little to offer in terms of practical knowledge for people that can recover on natural thyroid or small amounts of T3 with T4
If T4 is a total train wreck then I may be able to offer some insights.
I would appreciate any research references you have on vitamin D affecting the uptake of T4 into cells as this will be a new piece of information for my notes. Please just post them here and I'll look into it.
Many thanks,
Paul
<b>Updated on Feb 8 2011 10:02PM:</b> I actually said I don't think it does - by which I meant I didn't know or I am not sure.
I certainly didn't intend to make a statement which was definitive.
You have though. So please post the research reference(s).
Point taken Paul -equally I didn't mean to cause you upset -I just wanted to make sure that it was represented on the site that Dr Skinner believes there is a link between low vitamin D and T3 uptake in tissues but no one yet knows how the mechanism works -yet to be researched. I'm afraid I don't have any specific research references to quote for you, but may be Dr Skinner does? Dr S said there was a PhD project in this for someone! Any takers out there? You could be famous!
As far as I am concerned -I was very poorly for several years -would have been severe ME if I hadn't found a way through. I need to take a large dose of dessicated thyroid, adrenal support and vitamin D to get me working! So I am no mild sufferer.
Hope this helps.
I'd still like to have the reference if you can get it. Presumably Doc Skinner wouldn't say it unless it was backed up with something. It would be of real use.
Not sure I can help you more Paul -you're best to contact him yourself, that way you can talk to him about it direct - but seeing as he said there was a PhD project in it am sure its a case of more research needed...... however I do respect his opinion & having worked in medical research himself I don't believe he would say something like that without any foundation. Why he has come to that conclusions you would need to discuss with him.
Below is not a research document but an article that is on Mary Shomon's website.
The text says (for others reading this): '.....crucial final metabolic step, which takes place at the site where thyroid hormone actually works. This happens inside the nucleus of the cell. Vitamin D needs to be present at sufficient levels in the cell in order for the thyroid hormone to actually affect that cell. '
So, it implies that Vit D is needed for T3 to be used by either the mitochondrion or the T3 receptors. I haven't got a lot of time for the author/doctor to be honest but I'm guessing he must have got that info from some reputable source.
I'll have to dig more deeply.
If anyone comes across any reference to the actual use of vitamin D in the final take up of T3 within cells just let me know. It's the sort of thing you come across every day I know!!!!! But just in case you do - please let me know.
Ta!
Well done and thanks - it is new info to me.
Apologies for being a bit feisty. I'd had a really bad day on a US forum dealing with some really annoying people. I was grumpy! Not normally but I was - sorry!
No probs Paul -it happens to us all! Apology accepted. And I am truely glad that you found the info interesting - as I said it made a massive difference to me - but I probably wouldn't make a very good lab rat! Have a nosey at the Vitamin D Council as there is loads of dispute over optimum levels....
Thanks chaps - I have found this very interesting as I already have been taking sh** loads of supplements, includind 10,000 iu of Vit D3 but since I have been deteriorating recently have been forgetting to take things and am way behind on them so will pull my socks up and get a grip!
I have been on vit D for about 6 months and it is my first winter without SAD.
But the info (even without the research info) is very interesting. I will need to dig.
I would like to recommend a really good book on vitamin D which I read a couple of years ago, along with various other research articles, but because I have been forgetting to take it my brain has been necrotising and I can't remember what it's called!
Hi Julie -I would be reall interested in the book on vit D so when you feel a bit better and feel up to it would you let me have the details of the book......thanks and I really hope you feel better soon. x
This paper suggests that D3 down-modulates T3 receptors.
Calcitriol down-modulates the 3,5,3' triiodothyronine (T3) receptors and affects, in a biphasic manner, the T3-dependent adipose differentiation of Ob 17 preadipocytes.
I'm finding this conversation about vit D of particular interest. My D level was tested this last autumn for the first time and it was below the range. My GP told me to take OTC supplements 2 x 400mg daily.
Unfortunately I am unable to tolerate even the lowest 400mg dose of vit D. I've tried every variety on the market (D3 tablets and capsules and D2 also) . I also tried rubbing the oil from capsules into my skin instead of swallowing, hoping that transdermal absorption would do the trick. Well it obviously worked in that I did absorb through the skin, but with the same negative reaction.
Within three days of taking just 400mg daily, I am a complete wreck. The symptoms are very similar to being under medicated for hypo. It feels as though I’ve not taken any thyroid meds and it takes me several days to recover from this. Have tried increasing my thyroid dose, but it doesn’t help.
Researching vit D intolerance does suggest I'm not alone, but the cause seems to be obscure (except in the case of certain specific diseases such as sarcoidosis).
I am battling SAD again this winter and I'm sure that my declining D level is a strong contributor.
I also have another condition that inhibits me from spending time in the sun, so even if it was an affordable possibility, a holiday in the sun to boost D levels is not an option for me.
Since I've also struggled to regain my health since the AITD diagnosis / treatment started over five years ago, I'm sure this is more than simple co-incidence.
So if anyone takes up the phd challenge suggested by Dr skinner, I’d love to be involved!
Thanks Rod.
That's not good or what I expected!!!!!!
Maybe I should stop the vit D!!!!!
Paul
Well, if Rod's piece of research is right then Vit D can reduce the number of T3 receptors. If your thyroid problems are fundamentally a receptor issue then Vit D may be a bad idea. If you do have a receptor issue and are still hypo then adding T3 to the mix may be the way to go as this at least maximises the number of hits on the available receptors.
Whats AITD? Is that Autoimmune Thyroid Disease? It might be worth not taking the D2. I was advised to supplement with only D3 as D2 does not build up your store in your body -NHS Consultant Orthopeditrician -have no idea of the spelling. You also need to ensure that you have plenty of calcium in your diet with your Vitamin D3 if I remember rightly but please don't quote me on this as he may have advised me of this because I was in danger of developing osteomalcia (soft bones|) -obviously well away from your thyroid hormones. I have severe Vitiligo so burn in the mildest/shortest period of time in the sun...so no chance of building it up that way. I was prescribed Adcal & of my choice decided to follow the vitamin D council guidelines. I actually found I needed less thyroid meds since taking it so am at a loss as to what to say to you. What does your GP say about your poor tolerance? Could you afford a private visit to see Dr S or P?
oh and another thought Red Apple -have you checked the ingredients in your vitamin D tablets? You probably have! I only ask because I decided to take some supplements to boost my antioxidants -became really ill after a few days and when i looked at the contents I found it was suspended in soya oil........
The whole terminology around vitamin D is horribly complex. So I shall simply quote:
Calcitriol (INN) (pronounced /?kæls?'tra?.?l/ or English pronunciation: /kæl's?tri.?l/), also called 1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin D3, is the hormonally active form of vitamin D with three hydroxyl groups (abbreviated 1,25-(OH)2D3 or simply 1,25(OH)2D). It increases the level of calcium (Ca2+) in the blood by (1) increasing the uptake of calcium from the gut into the blood, (2) decreasing the transfer of calcium from blood to the urine by the kidney, and (3) increasing the release of calcium into the blood from bone.
Oh dear one other thing -magnesium plays an important role in vitamin D resistance -article says that if you having problems your probably deficinet in magnesium (best sources are seeds -sunflower & pumpkin)don't know if that is you but the link is below if you want to read.
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TSH, FT4 & FT3 normal! (?)
TSH is just the 'opinion' of your Pituitary about your dose ~ but your Pituitary's 'opinion' is a bit warped once you take Thyroid Hormone.
Blood Test ft3 ft4 TSH - Round 2
TSH/FT3/FT4 Test Results 
FT3, FT4 and cardiovascular correlation
