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Old 02-28-2005, 03:50 PM   #1
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Question Importance of Free T4?

I have a question about the importance of Free T4 that hopefully someone will be able to help me with.

I am being treated for Hashimotos and initially started on thyroxine. I started getting much worse with this course of action. My reverse T3 was really high and I am now being treated with 90mcg of slow release T3. I am feeling much better and my reverse T3 is nearly normal again.

Although I am starting to feel MUCH better, I still have enough off times to know that I am not quite there.

My tests results for the past 5 months have indicated that on my current treatment, my TSH is really low (has been constantly less than 0.05) - normal 0.5-4. My Free T3 has been in the middle of the normal range (doctor is aiming for the top third of the range though), but my Free T4 is way under the normal range. Would this be having any effects?

Sorry I am unable to post specific results, but my doctor is a bit funny about giving me a print-out of my results - but believe me, without this doctor, I am not sure how I would have coped with the miserable existence I was leading.

 
Old 02-28-2005, 04:02 PM   #2
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Re: Importance of Free T4?

Quote:
Originally Posted by LMS1306
I have a question about the importance of Free T4 that hopefully someone will be able to help me with.

I am being treated for Hashimotos and initially started on thyroxine. I started getting much worse with this course of action. My reverse T3 was really high and I am now being treated with 90mcg of slow release T3. I am feeling much better and my reverse T3 is nearly normal again.

Although I am starting to feel MUCH better, I still have enough off times to know that I am not quite there.

My tests results for the past 5 months have indicated that on my current treatment, my TSH is really low (has been constantly less than 0.05) - normal 0.5-4. My Free T3 has been in the middle of the normal range (doctor is aiming for the top third of the range though), but my Free T4 is way under the normal range. Would this be having any effects?

Sorry I am unable to post specific results, but my doctor is a bit funny about giving me a print-out of my results - but believe me, without this doctor, I am not sure how I would have coped with the miserable existence I was leading.
LMS, I would be a little worried if I were you. You know that you've got Hashimoto's Thyroid Disease, which means you're definitely hypothyroid. The course of treatment your doctor has you on sounds suspciously like Wilson's Protocol. This coupled with his unwillingness to provide you with your lab results would worry me - a lot.

Wilson's protocol involves giving the patient only T3, a sustained time release T3. The FT4 is driven down on purpose and then once the FT3 is high enough and rT3 is low the patient is weaned off of the T3 hormone. If you have a functioning thyroid your own would then commence making T4 like healthy thyroids do and you'd improve. HOWEVER, if you have been diagnosed with Hashi's then this isn't likely to happen to you - your thyroid is under attack by antibodies that think it is a foreign object that must be destroyed.

What it boils down to is this: If you have hashis you are hypothyroid and wilson's will not work on you - it will actually make you sicker in the long run.

As for your Low FT4, yes, it would definitely be making you feel like Extra Special Crap. T4 is absolutely necessary to feel good. How's this for irony; the brain needs high concentrations of T3 to function optimally or we suffer from brain fog, depression, poor memory, etc. However, T3 cannot pass into the brain. T4, OTOH, can - and does, where it's turned into T3 for use by the cerebellum and cerebral cortex.

I would push for a copy of my resutls if I were you; I don't know where you are geographically speaking but in most states and Canadian provinces you are entitled by law to those results.

Best.
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Old 02-28-2005, 05:21 PM   #3
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Re: Importance of Free T4?

Thank you for your informative reply gopherhead. I am certainly going to raise the issues you mentioned with him.

I am in Australia, so I am not sure what the law is with supplying results. I will try to get a copy of them though.

I feel as though my energy levels have increased, but a lot of the other symptoms have not eased - mainly the brain fog.

I also forgot to mention that I have had Hashimotos since about 2001, although didn't start treatment until Jan 2004 when I found my current doctor (I was under some **** of a Endo who wanted my TSH to reach 10 before he treated me ) At my last visit my doctor graphed my antibody results since 2001 and they almost looked like a perfect wave pattern. They ranged from 400 - 1800, but in a constant, consistent manner. Only once did they go back to the normal range of less than 50. I can't see any reason for this, and my doctor thought it was bizarre. Surely my thyroid has got to give up soon.

 
Old 02-28-2005, 05:28 PM   #4
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Re: Importance of Free T4?

Just want to throw in for you, LMS. Thyroid Australia has an excellent website, and I believe it has a doctor referral list... not sure, though.
Good luck to you!

 
Old 02-28-2005, 09:28 PM   #5
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Re: Importance of Free T4?

Gopherhead - you wrote:

As for your Low FT4, yes, it would definitely be making you feel like Extra Special Crap. T4 is absolutely necessary to feel good. How's this for irony; the brain needs high concentrations of T3 to function optimally or we suffer from brain fog, depression, poor memory, etc. However, T3 cannot pass into the brain. T4, OTOH, can - and does, where it's turned into T3 for use by the cerebellum and cerebral cortex.

Please tell me how you know this.

Thanks

 
Old 03-01-2005, 06:16 AM   #6
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Re: Importance of Free T4?

From reading an article by Dr. Dommisse, where he states:
Two current popular reference texts on the thyroid and endocrinology Braverman & Utiger, 1991; Greenspan & Rappoport, 1991) point to the great functional importance of T3 thyroid hormone. It is 9 times more hysiologically active, in comparison to the T4 hormone. The T4 hormone merely serves as a pro_hormone or pre-hormone, with the possible exception of brain-function, which may require a significant amount of T4 for its optimal function because T4 is transported through the choroid plexus and T3 is not (Whybrow, 1991; Whybrow, 1994).
A little time spent at NIH's pubmed pulled up a number of studies showing just this; T3 is necessary in high concentrations in the brain, but the bulk of it comes from peripheral conversion of T4->T3 in the brain itself.

Nat
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Old 03-01-2005, 10:04 AM   #7
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Re: Importance of Free T4?

Quote:
Originally Posted by Gopherhead
From reading an article by Dr. Dommisse, where he states:
Two current popular reference texts on the thyroid and endocrinology Braverman & Utiger, 1991; Greenspan & Rappoport, 1991) point to the great functional importance of T3 thyroid hormone. It is 9 times more hysiologically active, in comparison to the T4 hormone. The T4 hormone merely serves as a pro_hormone or pre-hormone, with the possible exception of brain-function, which may require a significant amount of T4 for its optimal function because T4 is transported through the choroid plexus and T3 is not (Whybrow, 1991; Whybrow, 1994).
A little time spent at NIH's pubmed pulled up a number of studies showing just this; T3 is necessary in high concentrations in the brain, but the bulk of it comes from peripheral conversion of T4->T3 in the brain itself.
Thanks for that. I find this info counter to my personal experience. My depression wasn't touched by huge doses of T4 but cytomel cleared it!

 
Old 03-01-2005, 10:22 AM   #8
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Re: Importance of Free T4?

I've noticed something similar, Lili - but then I thought, what if it was the added T3 that allowed the needed T4 cross the blood/brain barrier? Not enough T4 was making it to where it needed to be because too much was being kept to be converted to T3 for use outside the brain.

I know that in my own case my brain fog, memory, depression, were terrible and yet my FT3 was in the upper 3rd of the range. My FT4 was in the bottom 3rd however. And yet, I didn't feel really better until I was also on T3, even though it didn't look like I needed it.

I've read that it many cases of primary hypot the body shunts production toward T3 and converts as much as possible into T3 because it doesn't know how much it's going to get in the long run.

Nat
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Old 03-01-2005, 10:37 AM   #9
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Re: Importance of Free T4?

That explanation makes a lot of sense! All I know is without cytomel I am a near dead woman! Thanks, Nat

 
Old 03-01-2005, 07:36 PM   #10
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Re: Importance of Free T4?

Thanks for posting part of that article gopher. I am going to print that out and take it to the doctors. I feel far more empowered if I can take something on paper. For some reason my brain fog is at its worst when I visit the doctor. I usually walk out only asking him a quarter of what I had planned.

 
Old 03-02-2005, 05:39 AM   #11
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Re: Importance of Free T4?

I know exactly what you mean, LMS. Good luck.

Nat
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