# T4 trial



## Davecon1 (Nov 4, 2011)

Hello everyone

It's been a few months since I found I that I have Hashimoto's. As such I have none of the stereotypical symptoms (though have been subject to recurring skin infections/inflammation) and my thyroglobulin antibodies were really high.

My results back in September were:

T4: 89.8 (58-154 nmol/L)
TSH: 2.75 (.0.4-4.0 mIU/L)
TF4: 13.8 (10-22 pmol/L)
FT3: 4.4 (2.8-6.5 pmol/L)
TG ab: 639 (0-40 IU/mL)
TPO ab: 30 (0-35 IU/mL)

Since then I have cut out almost all gluten and read extensively on the subject. An ultrasound showed no enlargement of the thyroid or noticeable nodules. I have also had 8 amalgam fillings replaced and have actually lost weight though this might be down to anxiety!

I tested again last week and the results were:

T4: 82.9 (58-154 nmol/L)
TSH: 2.31 (.0.4-4.0 mIU/L)
TF4: 12.1 (10-22 pmol/L)
FT3: 4.2 (2.8-6.5 pmol/L)
rT3: 0.37 (0.14-0.54 pmol/mL)
TG ab: 589 (0-40 IU/mL)
TPO ab: 36 (0-35 IU/mL)

I'm pleased that my TSH has gone done along with my thyroglobulin but every other result has decreased slightly except my TPO. My adrenal saliva test is now back to normal.

As part of my research I have seen that there is some merit to treating subclinical hypothyroidism as it can help reduce antibodies and prevent symptoms from coming.

Based on this my endo has agreed to put me on a trial of T4 to see what effect it might have. He has started me out on 75mg but I'm concerned that is too high a treatment to start with as people are know who are hypo are on that dose! At the moment I'm on the slim size anyway and exercise every day (no fatigue as yet) so this is just to see what happens to my antibodies and to a lesser extent TSH. From what I have read most people start on 25 or 50 then build up but I have read on Dr Lowe's site that a tiny dose might actually be detrimental.

I should point out that I am male, 42 and otherwise fit and healthy.

Does anyone have any experience of treating subclinical Hashi's? Am I crazy to think about taking T4 or crazy not too? I figure my body will tell me if it is working and if I experience side effects then I will stop. LDN has also been suggested as an alternative to lower the antibodies.

Any opinions would be greatly appreciated.


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## Andros (Aug 26, 2009)

Davecon1 said:


> Hello everyone
> 
> It's been a few months since I found I that I have Hashimoto's. As such I have none of the stereotypical symptoms (though have been subject to recurring skin infections/inflammation) and my thyroglobulin antibodies were really high.
> 
> ...


You should benefit from the T4 supplementation. Your FT3 is way below the mid-range of the range given by your lab and this is your active hormone. Your FT4 is also below the mid-range (4.6) of the range given by your lab.

Most of us feel best (there are always exceptions) w/ TSH @ 1.0 or less and the FREES @ about 75% of the range given by your lab; especially the FT3.

That is not too high as you are male and it is also based on weight. Have you started taking it yet?

You may have some side-effects that are considered normal during the titration process. It won't be right until it's right. Hopefully the doc is having you come back in 8 weeks for labs and clinical evaluation?


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## Davecon1 (Nov 4, 2011)

Hi Andros

Thanks for the quick reply. It's so nerve racking trying to work out the best route to take.

There is a chance I can also take 25mg T3 if the T4 does not convert effectively assuming i can bend the endo's arm. Normally I would have been laughed at for asking for a trial but he was hypo himself and caught it early.

By the way I read a brilliant book recently called 'Recovering with T3' by Paul Robinson. Well worth reading for anyone struggling with symptoms whilst on T4.

Have you heard any feeback on LDN? Lots of AI people are raving about it.

Thanks

Dave


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## Davecon1 (Nov 4, 2011)

PS Will follow up with tests at 4 weeks and 8 weeks depending on how things go.

There is a great diagnostics lab a 5 minute drive from me or I can use the NHS for less in depth reports.


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## Andros (Aug 26, 2009)

Davecon1 said:


> Hi Andros
> 
> Thanks for the quick reply. It's so nerve racking trying to work out the best route to take.
> 
> ...


Hi, Dave!!! You are on the best course. Firstly try the T4. I have heard of Naltrexone but I would be wary of using it for thyroid issues.


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## lainey (Aug 26, 2010)

> As part of my research I have seen that there is some merit to treating subclinical hypothyroidism as it can help reduce antibodies and prevent symptoms from coming.


Your levels of TPO antibodies are not uncommon in the normal population. Having thyroid antibodies does not guarantee progression to overt hypothyroidism. Your labs at the moment are not technically sub clinical.

It would be nice to see a couple of links if you have them regarding the reduction of antibodies through the use of replacement medication. Everything I have read is to the contrary.


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## jmill (Mar 23, 2010)

Davecon1 said:


> Hello everyone
> 
> It's been a few months since I found I that I have Hashimoto's. As such I have none of the stereotypical symptoms (though have been subject to *recurring skin infections/inflammation*) and my thyroglobulin antibodies were really high.
> 
> ...


Dave,
I have recently been diagnosed with subclinical hypothyroidism (last November) and also have skin problems. In fact, right now that's my biggest problem with it. Most of my other symptoms have gotten a lot better. My numbers were all "in the normal range" but my endo listened to me and agreed that I had a well documented case of subclinical hypothyroidism. He put me on 50 mcg of Synthroid and after three and a half weeks I developed a pounding pulse and an irritated digestive system. However, by this time my skin problems had almost completely resolved. He cut the dose back to 25 mcg and the skin problems started coming back. At this time he said I "have objective evidence that the thyroid was the problem" and added Cytomel to the regimen. I now take 25 mcg of Synthroid and 10 mcg of Cytomel. I am having problems with not quite enough Synthroid and too much Cytomel. Cytomel can cause stomach upset and it's half life causes a lot of ups and down during the day. I'm going to try to eliminate the Cytomel and increase the Synthroid to 37.5 mcg per day. I've found that getting the med's right is a slow and tedious process. However, it's much faster than finding someone who will believe you have a problem. FYI: in addition to the skin problems, I started out with uncontrollable hypertension and countless heart palpitations. After three weeks on Synthroid all the palps stopped dead in their tracks and my blood pressure is now well controlled. Hang in there and work with the doctor. It's trial and error but you'll get there.


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## Davecon1 (Nov 4, 2011)

lainey said:


> Your levels of TPO antibodies are not uncommon in the normal population. Having thyroid antibodies does not guarantee progression to overt hypothyroidism. Your labs at the moment are not technically sub clinical.
> 
> It would be nice to see a couple of links if you have them regarding the reduction of antibodies through the use of replacement medication. Everything I have read is to the contrary.


Hello again.

I've found quite a few links on the whether to treat issue but the one that spring to mind was on the About website (not that I can find it now!). There was a trial in 2007 where subclinical people were put on T4 and for the majority of them their antibodies decreased. I also found this link:

http://jcem.endojournals.org/content/86/10/4585.full

I agree with the comment that I might never progress to overt hypothyroidism but if my antibodies continue to rise that is a greater possibility. As far as I understand you should not have these antibodies at all.

I should also point out that aside from skin/eye issues my fertility is up the spout. My sperm morphology is really bad and recently my motility dived down from a very healthy figure. Whilst I am by no means an expert thyroid problems can cause hormonal imbalances (I have low testosterone on a saliva test but high on serum) so I am keen to see if there is any improvement. As far as I know my levels were not like that in my past so something must have caused the drop.

http://www.ncbi.nlm.nih.gov/pubmed/20573783

What contrary evidence did you see?


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## Davecon1 (Nov 4, 2011)

jmill said:


> Dave,
> I have recently been diagnosed with subclinical hypothyroidism (last November) and also have skin problems. In fact, right now that's my biggest problem with it. Most of my other symptoms have gotten a lot better. My numbers were all "in the normal range" but my endo listened to me and agreed that I had a well documented case of subclinical hypothyroidism. He put me on 50 mcg of Synthroid and after three and a half weeks I developed a pounding pulse and an irritated digestive system. However, by this time my skin problems had almost completely resolved. He cut the dose back to 25 mcg and the skin problems started coming back. At this time he said I "have objective evidence that the thyroid was the problem" and added Cytomel to the regimen. I now take 25 mcg of Synthroid and 10 mcg of Cytomel. I am having problems with not quite enough Synthroid and too much Cytomel. Cytomel can cause stomach upset and it's half life causes a lot of ups and down during the day. I'm going to try to eliminate the Cytomel and increase the Synthroid to 37.5 mcg per day. I've found that getting the med's right is a slow and tedious process. However, it's much faster than finding someone who will believe you have a problem. FYI: in addition to the skin problems, I started out with uncontrollable hypertension and countless heart palpitations. After three weeks on Synthroid all the palps stopped dead in their tracks and my blood pressure is now well controlled. Hang in there and work with the doctor. It's trial and error but you'll get there.


Hi jmill

I looked up your earlier posts and you mentioned blepharitis which is exactly what I have (since October). Am sure that anxiety/stress is partly to blame but it came up as soon as I got my hashi's diagnosis! I've never ever had any eye problems in my life and this is driving me crazy. I have followed all advice but not much helps.

I never believe in coincidence and think that my skin problems relate directly back to my hormones i.e the thyroid. In the post above I also referred to my current fertility problems which I think are a result as well. I remember being told reproductive health is first to go then your eyes when hormones are out of sync.

Aside from the occasional muscle ache and blepharitis I don't have any other problems and rarely have fatigue issues. I row or run almost each day but now take it a little easier to not burn myself out.

My plan is to see how the T4 treatment goes and if necessary add T3 if I do not convert it properly. It's entirely possible that whilst my results are medically OK my TSH could have originally been around 1.00 and has increased to 2.5. I can only try to carefully lower it and see what happens.

You mentioned that your skin conditions got better with treatment. Did it help with the blepharitis?


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## jmill (Mar 23, 2010)

Davecon1 said:


> Hi jmill
> 
> I looked up your earlier posts and you mentioned blepharitis which is exactly what I have (since October). Am sure that anxiety/stress is partly to blame but it came up as soon as I got my hashi's diagnosis! I've never ever had any eye problems in my life and this is driving me crazy. I have followed all advice but not much helps.
> 
> ...


Dave,
The blepharitis is gone. I had a huge drop in my testosterone level when this hit and I'm taking injectable Testosterone Cypionate to bring it back up (it came right back with the shots). One of the worst aspects of this condition was the horribly oliy scalp and seborrhea. Oddly enough, my back is extremely dry. Getting on the Synthroid and T3 is getting it to level out and the seborrhea has been gone since I started on the T3. My TSH number never seems to change much. It's always around 1.6 (avg.) which, by the book, would indicate I don't have a thyroid problem. My open minded doctor commented that my cardiac improvement and skin improvement would prove otherwise. Eighteen months ago I couldn't even take an echo stress test. Now I can do it with no problems what so ever. The first time they put a Holter monitor on me I had 480 "events" in 24 hours. A month ago I had ZERO events. I think the medical community has a lot to learn about diagnosing and treating thyroid problems.


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## lainey (Aug 26, 2010)

> As far as I understand you should not have these antibodies at all.


Thyroid autoantibodies are present in upwards of 12% of the apparently normal population. They are also often found in increased levels in people with other autoimmune disorders and pernicious anemia. While they are considered a risk factor for thyroid disease, the mechanism of progression to overt thyroid dysfunction as measured by thyroid function laboratory tests remains unclear. They are not necessarily considered diagnostic in the sense that they do not have to be present in order for there to be measurable thyroid dysfunction.

Additionally, if you are concerned about sperm motility, according to the study you cited you should then be careful not to promote thyrotoxicosis (hyperthyroidism) which can be caused by an excess of exogenous thyroid hormone. In other words, given your TSH at the start, lowering your TSH too much can have a likewise negative effect on your fertility.


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## Davecon1 (Nov 4, 2011)

lainey said:


> Thyroid autoantibodies are present in upwards of 12% of the apparently normal population. They are also often found in increased levels in people with other autoimmune disorders and pernicious anemia. While they are considered a risk factor for thyroid disease, the mechanism of progression to overt thyroid dysfunction as measured by thyroid function laboratory tests remains unclear. They are not necessarily considered diagnostic in the sense that they do not have to be present in order for there to be measurable thyroid dysfunction.
> 
> Additionally, if you are concerned about sperm motility, according to the study you cited you should then be careful not to promote thyrotoxicosis (hyperthyroidism) which can be caused by an excess of exogenous thyroid hormone. In other words, given your TSH at the start, lowering your TSH too much can have a likewise negative effect on your fertility.


Thanks for your reply. I understand your point about antibodies not necessarily leading to overt hypothyroidism but I am right in thinking I have hashimotos?

On the subject of sperm motility my results have always been very good in that department but dropped over a 3 month period from 60% to 0% only to rise back up. The interesting point was that I have not been on any medication until 10 days ago. Its possible that I fluctuate between 'normal'and hyper although my sperm morphology has been poor fro 2 years.

At least a short trial can give me some form of closure in this area. In my opinion it has to be something to do with my hormones and/or antibodies playing havoc in my system.

Has anyone tried LDN?


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