O/T Thyroid Meds

The thing to understand with any endocrine problem is that the way hormones work in your body in always a rube-goldberg complicated process... In the case of thyroid, what happens is that the cells in your body tell your pituitary "we need T3!!!" Then the pituitary dumps TSH into your bloodstream and it makes its way to your thyroid gland, which makes T4. A small amount (~20%) of the T4 gets converted to T3 by the thyroid, but most gets converted in the liver. Then the T3 gets sent out to your bloodstream where every cell in your body uses it in the process of burning calories. The cells tell your pituitary, "we have plenty of T3 now!" and your pituitary turns the TSH down. If the cells are awash in too much T3, it's like revving the engine in your car -- they burn lots of calories and do stuff that wears out your "motor". Having too much T3 circulating around your body is really hard on your heart.

So as you can see, there are lots of DIFFERENT ways that this process can go wrong. ANY one of the types of hormone receptors or transmitters in your cells, pituitary, thyroid or liver could stop transmitting or receiving. And the right treatment depends on what's going wrong and the mechanism of exactly how it is going wrong.

I have Hashimoto's Thyroditis. This is an autoimmune disease where my immune system has decided that the cells of my thyroid are evil and attacks and kills them. But my pituitary, liver, etc. are just fine. Untreated, the symptom of this is that my TSH is high but T3 and T4 are low. I have a particular form of Hashimoto's where my thyroid grows bigger and bigger in reaction to the high TSH, and without treatment I actually produce low-normal levels of T4, which my liver converts to low-normal levels of T3. BUT, my thyroid, which is a mixture of working cells and nodules of dead cells and inflammation, just gets bigger and bigger and eventually I'll look like Jabba the Hut! A lot of other people with Hashimoto's don't overproduce thyroid, and theirs just fails to produce much thyroid at all. Those are the people whose TSH goes into the teens or even hundreds (normal is 1 to 4 or 5) while their T4 and T3 doesn't come much off zero.

But, anyway, if the only problem that you have is the damage to your thyroid tissue, and your liver converts T4 to T3 well, then you can fix the problem by taking a supplement which is only T4. If your liver is not doing its job, then you will need both T3 and T4. But you don't want to take T3 if your body makes it well, because the endocrine system is highly sensitive and balanced and continuously adjusts the amount of T3 that it is producing according to what you need at the moment, while taking pills is a blunt instrument which will leave you with levels that are either over or under what you need most of the time. And if it is TOO far out of balance it might just kill you...

The other common form of autoimmune thyroid is Graves Disease. In Graves, the immune system goes after the structures in the thyroid that turn your thyroid off, and it just continuously makes more and more. In Graves the pituitary stops producing TSH pretty much at all trying to get your thyroid to STOP!!! but your thyroid doesn't know how to respond any more to the stop messages. People with Graves will usually get a goiter because their thyroids need to get really big to produce enough thyroid to kill them!

The main problem with doctors and thyroid is that virtually all of the people who come through their offices with thyroid issues have the plain vanilla simple problem of Hashimotos or Graves, and the rest of the system works fine. A simple T4 supplement in the case of underproduction or destroying part or all of the thyroid and then adjusting with T4 in pill form in the case of overproduction, and the most of the patients are fixed right up. Then the doctors get lazy, and stop noticing when this or that patient is not responding to the treatment. Or they decide that the patients are non-compliant and that's why the treatment isn't working. When the real problem is that some patients have the uncommon things go wrong.

cathyf

Excellent discussion of the complexities of thyroid disease.
That's why it is important to monitor TSH, T4, and T3 if you are on thyroid meds.
When first starting, your doc will follow all of these until you are stabilized.
After that, its a good idea to monitor at least once per year just to make sure that something peculiar is not going on.

Have been on Synthroid for 3 or so years now.

My Drug Insurance (NOT Medicare) has always substituted the Brand Name Synthroid for the Generic, so I pay the price for a Generic, but get the brand name instead.

I used to take Armour Thyroid, but the manufacturer could never keep up with the production of tablets in my dosage level.
Because of that, it was difficult to find the right combinations of other dosage levels to make up the amount I needed.

With those kinds of problems with manufacturing, I was afraid that "quality" problems might also exist. So, I went to another Doctor to get Synthroid because my then current Internal Medicine Doctor was a die hard Armour Thyroid proponent.
The fact that he was also a tad crazy & sent himself to the hospital TWICE (he almost died both times) using therapies that no one in their right mind would try kind of also pushed me to someone else.

WOW, This is soo interesting to me.
Since almost buying it in post op recovery 2/12 years ago with a ruptured Gall Bladder, i have been wondering what next ? Because of the RA(another auto-immune nasty) & learning to live with methotrexate , i keep looking over my shoulder for the reaper. CPAP, no doubt has slowed down the thermal dynamic equilibrium process.
None of us would be on this forum unless we wanted to be pro active concerning our own health issues.
now i am learning what is a thyroid & it's function. ...Just never came to mind what a metabolic mgr. this gland is & how it routes chemicals throughout the anatomy .
God Bless all of you that have responded. Have only taken the first 25mcg. this a. m., but now feel like i'm not completely ignorant on this subject !
Rock On
tim

There is some correlation between thyroid issues and Celiacs (also an autoimmune disease) So you may want to investigate a GF diet. HOWEVER going GF will mean you will never have a Celiacs diagnosis because the symptoms (destroyed villi) will disappear.

Given where your thyroid is, it could be obstructing your wind pipe if it is enlarged. On the other hand, the continuous panic reactions to desaturations & apneas in untreated OSA dumps cortisol into your bloodstream and throws your whole endocrine system out of whack. I'm hoping that treatment will help my thyroid levels. Sleeping better is well-known to be associated with improvements in all sorts of metabolic diseases.

BlackSpinner wrote:There is some correlation between thyroid issues and Celiacs (also an autoimmune disease) So you may want to investigate a GF diet. HOWEVER going GF will mean you will never have a Celiacs diagnosis because the symptoms (destroyed villi) will disappear.

Could Never give up my daily bread ! if i eat nothing else in the morning(at least 30 min after thyroid meds) it is a thick toasted slice of Amish Sour Dough Bread with a generous slathering of country Butter, Coffee , an orange & out the door


cathyf , Thank You so Much for your indepth research & knowledge on this subject .
Last i saw my rheumatologist P/A , was cut loose for a year interval this time. has been every three months. at least i have a good primary doc who takes care of me. when it comes to meds, i'm in the less is better camp.

BTW, if you miss your thyroid pills for a day or two, your body may start producing more thyroid on its own, and you may find that you are hyperthyroid for a period of time after you start the pills again.

I have been hypothyroid and had Hoshimoto's for about 20 years and got a thyroid cancer diagnosis last year with removal and treatment after. I have been on both brand name synthroid and levothyroxine at different times and for me it made no difference in anything but price. Just the last 2 months I have added generic cytomel which is a T3 med and my endocrinologist and I are working on regulating that. After thyroid cancer your numbers are supposed to be as close to 0 and hyper as possible to avoid metestasis.

I would make sure you wait at least an hour to eat or drink anything but water after taking you meds. Some people take them at night and studies have shown it works better but some people who are sensetive swear they can't sleep when taking it at night. Everyone is different and everyone will have different issues from having thyroid problems, it is not one size fits all with thyroid symptoms. That butter your putting on that toast contains calcium so you might want to try to eat it about 4-5 hours after meds. Calcium in my multivitamin is the one thing that threw off my levels at one point in my treatment. My other suggestion is to ask the doctor to test you for hoshimoto's and graves disease. Since you have RA you will be prone to getting other autoimmune disorders like hoshimoto's, celiac disease, etc.

Good luck to you.

Thank You Angel,
Never even gave the butter a thought it's hard enough for me to adjust to: first thing slug down a glass of water w/ pill, then watch the clock for a 1/2 hr. to get my cup of black joe.
Just about screwed up this morning . poured a glass of milk & then it hit me(no milk for you !)....soup nazi voice
so far can't tell if it's making a difference .....Followup in oct

deerslayer wrote:Thank You Angel,
Never even gave the butter a thought it's hard enough for me to adjust to: first thing slug down a glass of water w/ pill, then watch the clock for a 1/2 hr. to get my cup of black joe.
Just about screwed up this morning . poured a glass of milk & then it hit me(no milk for you !)....soup nazi voice
so far can't tell if it's making a difference .....Followup in oct

It took my daughter several weeks to feel the difference too.

We did the two alarm system. I woke her to take the pill an hour before she had to get up. So get two alarm clocks, use one to take the pill and go back to sleep, let the other ring to wake you to get up.

Thank You Black Spinner , good thinking ! Guess i need to keep them little suckers on the night stand & start reading labels more.
Thought when you got older things got simpler....Wrong
guess i will find out something when i go back for followup in oct......Counting Blessings in the meantime *

Oh, and this is a general tip -- if you go to the web site Drugs.com and put in all of the medications that you take, you can run a report that maps out all of the drug interactions between drugs, and between the drugs and food, and between the drugs and conditions. Put in everything -- prescription and OTC. In my case it was a bit of a puzzle to figure out what to take when so that things that interact are separated in time. There are also sections that have all of the listed side-effects for drugs. A really clever thing that they have is that if you put in any writing stamped on a pill and look it up, it will show you a picture and tell you the manufacturer. Sometimes when you take generics they will switch manufacturers on you, and you will have a different reaction to the new pills as the old. If you look up the manufacturer, then you can request that the pharmacist give you the good one and you avoid the bad one.

You can also print out a wallet-sized card that you carry with you, so when you go to the doctor you just give it too them and they make a copy. I keep mine folded up in front of my insurance card, so if I'm ever in the ER unconscious hopefully they will find it when they go looking for ID.

As long as your not a before bed snacker maybe taking them at night would be worth a try and solve all the drink and food issues in the morning.

angeltink wrote:As long as your not a before bed snacker maybe taking them at night would be worth a try and solve all the drink and food issues in the morning.

don't reckon that would work since i take the simvastatin before turning in
did do the 5 am deal this morning and slept for another hr. & felt great today....Coincidence ? dunno, but i sure do appreciate the
wonderful feedback !