hypothyroid mama needs advice on Thiroyd & ssupplements

[Alexiface]

This is my first post for advice Iol so please forgive me if I make any mistakes.
I have documented hypothyroidism And a tsh level of 9.1. i also have a 4.7cm × 2.3 cm nodule on the right side of my thyroid . I don't do much of monitoring of my body temperature however I do know that my resting pre - hypothyroidism temp was 99.2 a bit above average. Oh and last but not least I have gallstones. And I am female and 28 years old.

Ok so i have been taking synthroyd 150 mcg and still feel like yuck. Tired, moody, lots of head aches, joint pain, pimples , Costochondritis, lots of brain fog & anxiety.

So i want to try ndt and my primary care doctor basically said synthroyd first.
so i ordered Thiroyd. I was researching and pretty much found people start somewhere between .5 and 1 grain a day split into two separate doses.

I really don't know what supplements would help me if any?

So if you have any advice or additional information about this topic please let me know.

 

[aguilaroja]

I have documented hypothyroidism And a tsh level of 9.1. i also have a 4.7cm × 2.3 cm nodule on the right side of my thyroid . I don't do much of monitoring of my body temperature however I do know that my resting pre - hypothyroidism temp was 99.2 a bit above average. Oh and last but not least I have gallstones. And I am female and 28 years old.
...i have been taking synthroyd 150 mcg and still feel like yuck. Tired, moody, lots of head aches, joint pain, pimples , Costochondritis, lots of brain fog & anxiety.
...So i want to try ndt and my primary care doctor basically said synthroyd first....

First, please think about reviewing some of Dr. Peat's articles, interviews and books, for instance:

http://www.thyroid-info.com/articles/ray-peat.htm

http://raypeat.com/articles/articles/hy ... dism.shtml

http://raypeat.com/articles/articles/thyroid.shtml

http://raypeat.com/articles/articles/th ... ties.shtml

http://www.blogtalkradio.com/eastwesthe ... at-is-back

Part of the value of the forums is in recognizing that Dr. Peat's articles are deep, and not instant recipes. It is helpful to have understanding as well as instruction.

Second, how long have you been on Synthroid? (Synthroid is T4, aka thyroxine.) What dose did you start at and how long have you been at the current dose? Have you noticed any improvements during the time using Synthroid?

Third, once you have been at a steady state of Synthroid for a couple of weeks, you might ask your doctor for "trial" dose of T3 (brand name Cytomel, aka liothyronine). NDT has a combination of T4 and T3 in a 4 to 1, T4 to T3 ratio. Since NDT is has much more T4 than T3, adding it to Synthroid will give a high proportion of T4 compared to T3. But even a small dose of T3 (Cytomel) can help utilize T4 (Synthroid). You could ask, for instance, for Cytomel 5mcg three times per day as a trial dose. It is much less than a 4 to 1 ratio, but the goal may be getting the doctor "comfortable" with prescribing first.

Dr. Peat has mentioned a preference for the bio-identical "synthetic" T4 & T3 but certainly many have benefited from NDT.

You could mention to your doctor that T3 is short acting, so if the thyroid became over-active, things would wash out more quickly than with only T4. You might also mention that due to the gall stones, you are wondering if the T3 might help with the conversion of the Synthroid (T4) into the active T3 form.

You can also show your doctor the recent journal abstract below, and tell him/her that there is more research supporting this viewpoint.

There are ways to go from Synthroid to so-called equivalent doses of NDT. In this case, TSH is fairly high with a sizable thyroid nodule. It is always helpful to work with your provider or find a provider you can work with. It would also be good to start tracking resting pulse and temperature regularly, as a guide to tuning your support. While mid/late-morning (after breakfast) is a good time measure things, it is more important to get data than to get data at a perfect time. Also, every month or few months, go over your symptom checklist to track changes.

There are reasons why resting temperature can be vary and need "interpretation" in gauging thyroid function, but that is an extended discussion.
--
Nat Rev Endocrinol. 2014 Mar;10(3):164-74. doi: 10.1038/nrendo.2013.258. Epub 2014 Jan 14.
Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism. Wiersinga WM.
Abstract
Impaired psychological well-being, depression or anxiety are observed in 5-10% of hypothyroid patients receiving levothyroxine, despite normal TSH levels. Such complaints might hypothetically be related to increased free T4 and decreased free T3 serum concentrations, which result in the abnormally low free T4:free T3 ratios observed in 30% of patients on levothyroxine. Evidence is mounting that levothyroxine monotherapy cannot assure a euthyroid state in all tissues simultaneously, and that normal serum TSH levels in patients receiving levothyroxine reflect pituitary euthyroidism alone. Levothyroxine plus liothyronine combination therapy is gaining in popularity; although the evidence suggests it is generally not superior to levothyroxine monotherapy, in some of the 14 published trials this combination was definitely preferred by patients and associated with improved metabolic profiles. Disappointing results with combination therapy could be related to use of inappropriate levothyroxine and liothyronine doses, resulting in abnormal serum free T4:free T3 ratios. Alternatively, its potential benefit might be confined to patients with specific genetic polymorphisms in thyroid hormone transporters and deiodinases that affect the intracellular levels of T3 available for binding to T3 receptors. Levothyroxine monotherapy remains the standard treatment for hypothyroidism. However, in selected patients, new guidelines suggest that experimental combination therapy might be considered.

 

[Alexiface]

I have been taking synthroyd for 5 weeks and this is the amount I started on. I am going to make an appointment with my ent surgeon to discuss the removal of the nodule. Because it is very low and often presses on my clavicle causing pain and it feels like it is putting pressure on my throat.
I also have an appointment with an endo but that is about 7 weeks away.

 

[aguilaroja]

I have been taking synthroyd for 5 weeks..the amount I started on. I am going to make an appointment with my ent surgeon to discuss the removal of the nodule. Because it is very low and often presses on my clavicle causing pain and it feels like it is putting pressure on my throat.
I also have an appointment with an endo but that is about 7 weeks away.

You might google "sub sternal thyroid" or "sub sternal goitre".

If I read things accurately, it would be 12 weeks between finding a thyroid nodule and getting to see the endocrinologist. I hope the endocrinologist might be helpful and don't know if the endocrinologist will entertain some of the things that help readers on this forum. But there will be a chance for feedback and testing from an endocrinologist if you have an in-person appointment.

If you emphasize to the endocrinologist's office that there is an large sub-sternal nodule, that you need a surgical opinion due to the nodule's size, and that there has been only one treatment (at one dose) since diagnosis without specialist input, you may get their attention and a speedier appointment.

The starting dose of Synthroid (levothyroxine) with a high TSH and large thyroid nodule is essentially a guess. It would be quite straightforward to check TSH levels every few weeks in the near term, to help monitor thyroid supplementation. Also, useful thyroid supplementation may change the size of the nodule and the throat symptoms, which may affect an ENT view. A conscientious endocrinologist might pursue this.

It may be that measures informed by Dr. Peat's views, including using combination T4 & T3 supplementation, may help more than so-called conventional treatment. It may also be that at this stage parts of conventional assessment and treatment could be applied more optimally. It could that much has already been done and my view lacks much of the story so far.

 

[Alexiface]

I had met with the ent before and because at that time my thyroid was semifunctional tsh (3.1)we had decided to leave it in. However since that appointment my thyrnoduled has stopped working and I don't see a point to leave in something that doesn't work and causes discomfort.
I have another thyroid blood draw in less than 2 weeks. The biopsy for the nodule show no cancer however it has grown fairly quickly . as for shrinking of the nodule my ent basically said it's not going to happen and the synthroyd will just stop it from growing anymore.

none of my many doctors seem to address the fact that i feel like yuck. Although I have gotten slightly better. I was at the point where if i had to choose between eating and sleeping i chose sleep. So for several weeks basically hibernation was the only thing i could manage. Now i can kind of manage to sleep and eat. :/

 

[Alexiface]

Thank you for your replies.
I have forgotten to mention i recently started suffering from sever allergies so i have to take allegra and singulair. I also take celexa for anxiety and dexilant for acid reflux. All which have manifested in the last year.
I don't know if this is related to my thyroid or what... but i feel like i went from being a healthy active young person to a sickly old lady in the span of a year or so.

 

[charlie]

I have forgotten to mention i recently started suffering from sever allergies so i have to take allegra and singulair. I also take celexa for anxiety and dexilant for acid reflux. All which have manifested in the last year.

Alexiface, yes, that is all things hypothyroid. Bring the metabolism back up and those things will go away.

 

[Alexiface]

I would very much like to do that. Bring up my metabolism. That is one of the reasons why I am interested in the Thiroyd and or anything else that can help make me feel like a fully functional human.
Any suggestions would be great.

 

[aguilaroja]

....I have another thyroid blood draw in less than 2 weeks....
none of my many doctors seem to address the fact that i feel like yuck. Although I have gotten slightly better....

With respect and usual forum disclaimers plus that I am not a specialist in ENT, professional Peat coach, and am merely offering discussion views related to personal experience:

(1) I am sorry to hear that you have had a terrible time. It is even more dismaying to hear the report that the treatment so far has provided little help to relieving symptoms and improving function. Many readers here had treatment like this. I may be old-fashioned in believing that relieving symptoms and improving function was the major part of health care.

(2) It is understood that with the reported brain fog of low thyroid function, it may be hard to get perspective and marshall resources for relief. Get help from family and friends to act as direct advocates if you can. With the account given, it's clear you are an intelligent person even working through brain fog. Impress upon family and friends that even though you are capable, extra oomph (from them) is needed to get the message across to health care providers.

(3) Push for repeat thyroid blood testing ASAP. Five plus weeks is plenty of time to judge the first effects of a single Synthroid dose. Blood tests are not the full story, but blood tests are mainly useful to judge effects of thyroid doses at a steady state. If you are getting blood tests, it's best to get them when they are informative.The sooner you test an approximate steady state, the sooner you can move on to consider other adjustments.

(4) If you are continuing to feel bad, it would be good to make that point repeatedly and in different forms (writing, office visit) to the prescribing physician.
(4a) If the prescribing physician is worried about "overshooting" and high thyroid function, that is even more reason to consider adding T3 in some form. T3 is shorter acting than Synthroid and can be adjusted more quickly. In some cases, it also leads to quicker relief.

(5) You might see the endocrinologists take reduction of benign thyroid nodule size, which would be a non-surgeon's view. I know of situations where thyroid supplementation has clearly reduced nodule size. Dr. Peat may have mentioned experiences, but I have no reference of his on the subject at hand. (See the journal citation[full article free] below.)

(6) There are many posts here about basic thyroid support measures, including assuring intake of protein and salt, as well as avoiding soy, raw cabbage-family vegis and unsaturated oils. If menstrual/gynecologic issues have been prominent, you may also read up on estrogen excess problems. My very rough guess is that in your case, high cortisol is a major compensation for low thyroid function in this case. Has weight gain, bloating, swelling, or a water logged tissue feeling or general feeling been a problem during this flare up?

(7) Fatigue, brain fog, anxiety, low mood, allergies, reflux, joint pain, headache and more are consistent with low thyroid function. The good thing is that even in conventional terms, there is a clear diagnosis. With improved and sustained treatment/support, there is every prospect that you will resume being a vital young adult, hopefully in short order. It sounds like you have already worked resourcefully on early steps.

---
http://www.ncbi.nlm.nih.gov/pubmed/20739581

Clin Med Res. 2010 Dec;8(3-4):150-8. doi: 10.3121/cmr.2010.881. Epub 2010 Aug 25.
Thyroxine suppression therapy for benign, non-functioning solitary thyroid nodules: a quality-effects meta-analysis.
Yousef A1, Clark J, Doi SA.

"On the basis of the analysis, it is estimated that LT4 therapy is clearly associated with up to a two-fold increase in the chance of nodule reduction."

 

[Alexiface]

I haven't noticed much weight fluctuations maybe 2 or 3 lbs. My cycle has changed in the last year from 28 day to 38 day cycle... but still only lasts 4-5 days. I do occasionally suffer from some major pms. Oh and no I haven't been retaining water or feeling puffy. Oh but I will say I can not regulate my own body temperature. I hardly perspire and become over heated easily. Not to mention i have become sensitive to cold as well, walking into an air conditioned store ( target) has sent my teeth chattering and shivering like it was January in Chicago.

 

[aguilaroja]

... Oh but I will say I can not regulate my own body temperature. I hardly perspire and become over heated easily. Not to mention i have become sensitive to cold as well, walking into an air conditioned store ( target) has sent my teeth chattering and shivering like it was January in Chicago.

(I was speculating about a cortisol adaptation to low thyroid function, but that may not be a strong lead. It was kind of a side issue, as a more individual part of the general situation.)

It is common that hypothyroid folk become "cold-blooded". That is, they are over-influenced by ambient temperature. Though the medical stereotype mentions "cold intolerance", heat intolerance is also frequent, even in an also cold intolerant person.

I speculate that lack of perspiration is partly "defensive" in trying to reduce heat loss at the surface to keep the core temperature warm. But there are other metabolic aspects to that adaptive response, including less water production from reduced fuel processing and thus less sweat.

With improved thyroid function, thermoregulation improves in both directions.