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Old 01-08-2009, 07:59 AM   #13
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Re: why does my FT4 not change on meds?? (newbie hypo)


I would really like to know, how can you be hypo in T4 and normal or hyper in T3. YEAH QUESTIONS TO LEARN FROM! Alright lets see if I can eplain this in laymans terms.

It comes down to adrenal control/regulation of your T4 to T3 conversion process. How?

Well some basic background first to make sure we are on the same page. While T3 is the active thyroid hormone almost every cell needs for metabolic processes it is short lived and doesn't store well. T4 is much more stable and can be easily converted to T3 by a simple striping of a lone iodine atom. So the thyroid produces hormone in a healthy normal function individual of 80% T4 and 20% T3.

Now in a hypothyroid patient with a NORMAL functioning pituitary and adrenal gland supplementation of thyroid hormone depends on two factors.. how much T4 they need for their body's needs AND does there body convert T4 to T3 properly. Rarely do you get hyperT in T3 in this type of patient. Instead you can get hyperT in T4 if the body can not convert to T3 and T3 supplementation is needed. This case were a patient goes hypert in T4 while remaining hypoT in T3 is often caused by TSH watching MDs that keep driving up the T4 meds with out looking at both the Ft4 and Ft3 levels. To make sure you are converting T4 to T3 well you look at two factors your bodies ability to bind and move T4 (T3 Uptake and TBG are the blood tests for this..) and your RT3 level. If you have a low T3 Uptake/TBG there is an error in your transport mechanism. If you have normal T3 Uptake/TBG but are high in RT3 your iodine stripping mechanism is flawed. In either case the Ts supplementation needs to managed artificially.

NOW the reverse case.. hypoT in T4 and hyperT/normal in T3. Well this occurs mainly due to increased uptake and transport of T4 and lack of conversion inhibition. Cortisol is the main traffic control cop so to speak in the T4 to T3 conversion process. SO if you have too much cortisol it is like putting a damn in and the T4 builds up and it is not released for conversion and use.. resulting in Cushing's Disease symptoms and effects. In my case my adrenals are traumatized and suffering due to my increasingly over active AI issues. My adrenals do not produce sufficient cortisol or aldosterone to meet my metabolic needs.. so I have no traffic cameras or stop/yield signs or damns with functioning flood gates to inhibit T4 to T3 conversion with out taking cortisone tablets. What T4 I was taking (before cortisol supplementation) in or making, my body bound up and shot off for processing. The result was LOW/Steady T4 levels with increasing T3 levels with increasing every time we added more T4 to boost my T4. Now on a complete cortisol replacement regime and managing my PCOS and IR with Metformin I have been able to slowly increase my T4 supplementation. I am still over converting my T4 to T3.. but the difference is 20-30% now versus 50-100%. at one point my ft4 was 45% in range. My ft3 levels was 190%. So you can have a thyroid hormone imbalance if your hypothalamus-pituitary-thyroid-adrenal communication and function loops are messed up.

Did I answer your question clearly? WTMI?

I'm pretty sure I'm hyper in T3 as my thyroid swells more when I feel worse. but if T3 is converted from T4? shouldn't both be high
Your body needs both T4 and T3 to function. If you do not have enough T4 or T3 mechanisms will request that more be made. In the case of hashimoto's thyroiditis the calling for the synthesis of more T4/T3 and the actual synthesis and transport of T4/T3 inspire TPOAb and TGAb attack and inflammation of the thyroid. THUS The more a traumatized thyroid is asked to work, the more it works and becomes inflamed.. AND the more it is attacked and inflamed. it is a lose lose situation. as the thyroid is progressively destroyed it can not make enough t4 to meet both T3 and T4 needs. If you are not supplementing at this time the low hormone yield can be converted improperly and leave you with too much of one and not enough of the other to meet you physical needs. Make sense?

BTW I also had a cortisol test before my Dr would put me on Hydrocortisone (and i knew from the past that inhibiting cortisol helped me a little), it was 24 hour and results were in mid range 178 range 38 to 270. infact I have a few natural products which take the edge off discomfort by inhibiting cortisol. Your cortisol average is 60%. This is right at the bottom of optimal range. You want 60-80% of normal. How to tell if you are getting enough is to see what your ACTH is at this time. If your ACTH is high you may need more. if it is low you may need less. Checking your cortisol rhythm through out the day can help to show if your have a cyclic issue. But given this result your MD will be reluctant to look deeper that a fasting ACTH and cortisol morning blood draw.
How does inhibiting cortisol seem to help?
What OTC stuff are you taking to do this?

I believe I have discovered why Vitex help reduce my symptoms, I think as a dopamine agonist it slightly reduced TSH because my goiter decreased in size, "some" other dopamine agoinsts have helped me live moments of a normal life, I seem to get slightly high prolactin levels otherwise, although my TSH is always around 1.

have you come across people that have found dopamine a relief?

just before I went on vitex, heat made but symptoms so much more worse, I lost 1 stone in a week it was so hot in the summer, bad times, I had no relief.
I am not familiar with this drug or the dopamine factor. I will have to look into it and do some research. Off the top of my head reducing TSH will reduce the demand on ones thyroid resulting in less call and function of the thyroid. This will help with hyperT symptoms but will aggravate hypothyroid symtpoms.

recently i found atenolol has helped my a little too
Beta-blockers help reduce TSH in high doses. They also calm and relieve hyperT influences on BP and HR. I take pindolol to lessen my BP and HR issues as a result of my wacky thyroid and adrenal mess.

a dr put me on Methimazole a a few years ago to see if it would help me and sort out the goiter but my body kept fighting it, it helped for about 15 minutes then my body would fight back and i'd become more hyper and uncomfortable.
Hummm... well the ATD would cut back on your T4 and T3 production.. but if there is a significant imbalance it would aggravate the issue making your body want more of the hormone you have too little of and inspire the thyroid to as you say FIGHT back with increased production. The 15 minutes is interesting. That is the time it takes for your body to begin to uptake oral medication through the stomach and intestines. Very interesting. The chemist in me is intrigued. What is your TSH, Ft3, and Ft4 levels and ranges. You have me curious...

I do not know if I answered more questions or caused you to have new ones. Ignore run ons.. they are my nemesis.

If we learn by our mistakes, I am working on one hell of an education.