Hypothyroid Part 2 – Jamie
Profile:
- 34-year-old female
- Married
- Two children, 5-year-old and an 8-year-old
- SAHM
- Taking 88 mcg of Synthroid. Her doctor lowered her dose from 100 mcg because her TSH was too low
- Jamie is really upset bc her thyroid medication lowered. She went to the dr bc she was having a lot of low thyroid symptoms and now they got worse after her dose was lowered from 100mcg to 88mcg.
Symptoms:
- Weight gain of 30 lbs in 3 years. Jamie thought the thyroid medication would help her lose weight. Instead, she keeps gaining weight.
- Exhausted (“always tired”)
- Used to exercise frequently, now can’t because she is too tired
- Hair loss all overhead from the root. Her hair is half the thickness it was 10 years ago.
- Anxiety because she doesn’t think she can get everything done and she has two small kids
- Can sleep for hours if allowed
- Constipated
- Low mood
Lab Testing:
Treatment Ideas:
Multifactorial process
- Lifestyle
- Dietary modifications
- Supplementation
- Possibly BHRT bioidentical hormone treatment
This is part two in our two-part series about hypothyroid. Jamie has all the classic hypothyroid symptoms but she is on medication.
What is the problem here? Number one, you should not base your thyroid dose on a TSH level alone. TSH/thyroid stimulating hormone is released from the brain and technically is suppose to monitor thyroid levels in the body. It works in a negative feedback loop. In theory, if the thyroid levels are low then the TSH is high. And if the thyroid levels are high, then the TSH is low.
In Jamie’s case, her TSH was low, so her doctor interpreted this as her thyroid dose was too high. Which he then promptly lowered her dose. While it is important to test the TSH, it is just as important to look at the Free T4 and the Free T3. Hormones that are unbound are considered free and bioavailable. Looking at Jamie’s Free T4 and Free T3 levels would give us insight to the thyroid levels were in her body.
The T4 is a stable molecule but doesn’t have a lot of activity other than it will convert to Free T3. Free T3 is an unstable molecule with a short half-life. But it is the active form of thyroid hormone. After running Jamie’s Free T4 and Free T3, we found that her Free T4 was high normal but her Free T3 was low. Remember, the Free T3 is the active form of thyroid. Jamie was still experiencing symptoms because her Free T3 was too low.
This is also really common in people that have all the low thyroid symptoms, but their doctor says they are “fine”. In most cases, docs run a TSH. Sometimes, they might run a Free T4. If those levels come back in normal range, people are shuttled out of the doctor’s office, being told they do not have a thyroid problem. Again I cannot stress how important it is to check the Free T4 and Free T3 levels to accurately determine if a person has a thyroid issue going on. There are many reasons for a person to have low Free T3 levels. We are going to be doing more videos and articles on ways to improve Free T3 levels whether a person is on or not on medication.
As mentioned previously, there are not many options in the conventional medical system to treat hypothyroid. In most cases, doctors just prescribe Synthroid or levothyroxine. Levothyroxine is the thyroid hormone for T4. Remember when I talked about Free T4 and Free T3? T4 is a stable molecule with a long half-life. But it really doesn’t do anything in the body. The goal for T4 is for it to convert to T3. Often the levothyroxine/T4 does not convert very well to the T3. Then you have a higher level of T4 and low levels of T3 in the bloodstream.
This is what was happening to Jamie. Jamie was getting plenty of T4 from her Synthroid medication. But it was not converting to Free T3 so she was experiencing all the symptoms of hypothyroid. Because Jamie’s Free T4 levels were high, that sent a message to the brain, causing her TSH/thyroid stimulating hormone level to drop. When her doctor saw her TSH level low, he reduced her Synthroid medication.
There are other options for thyroid replacement. There is Cytomel, which is a synthetic instant release version of T3. Most docs do not use this, because it needs to be done in low doses as most people cannot tolerate it. We are not an advocate of Cytomel because of instant release aspect.
There is also porcine (pig) thyroid called Armour, Nature-Thyroid, Westhroid, NP thyroid, compounded porcine thyroid and there are others. These are made from a pig’s thyroid gland. Porcine thyroid does have T4 as well as T3 in it. A lot of people do really well on porcine thyroid because it has T3 in the compound. Porcine thyroid comes in a 4:1 ratio, meaning there is 4 mcg of T4 to 1 mcg of T3. This type of thyroid is considered natural thyroid.
There is also compounded bioidentical T4/T3 which is a combination of levothyroxine and liothyronine. You can have an instant release or sustained release. Because it is compounded, the T4 and T3 can be in any ratio or mcg dosage. This gives the patient and prescriber lots of dosing options. There is also available a T3 liothyronine stand alone. Meaning T3 can be compounded without any levothyroxine. This can be helpful in people that have low T3 but perfect levels of T4. Liothyronine can come as an instant release but it is much better tolerated as a sustained release.
Now I could go on and on about these various treatments and combinations. And there are a lot of lifestyle and supplementation that can help with raising the T3 levels in the body. Including sleep, stress, exercise and caloric intake. But we are going to save that for another course and video series.
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