Ok, let's talk about thyroid. Here's a person's opinion that I respect:
To find our optimal dose, we dose by three criteria in no particular order: 1) the complete elimination of symptoms, 2) a mid-afternoon temp of 98.6, using a mercury thermometer, and 3) a free T3 towards the top of the range, no matter how low it WILL get the TSH. The three criteria have to be in conjunction with plenty of cortisol, whether from healthy adrenals or cortisol support.
Dosing by the elimination of symptoms was done successfully for decades before the TSH came into existence in 1973, and we are repeating that success. The free T3 being in the upper part of the range is simply another guide (and we make sure that we do NOT take Armour before our labs, which only results in a false high reading).
We have learned that finding an optimal dose of Armour has rid us of chronic low-grade depression; softened our hair and skin; stopped our hair loss; lowered our high cholesterol; removed the aches and pains that doctors told us was Fibromyalgia or Chronic Fatigue Syndrome; given us the stamina and renewed energy that we never had. It has improved bone density; removed headaches; and improved female hormonal issues. It has helped us get pregnant when that goal was desired. It has given us back our SANITY! Some issues take more time than others, but they do work out.
From this link:
http://www.stopthethyroidmadness.com/th ... ve-learned
And she is saying to get the Free T3 in the upper 1/3 of normal.
At first glance, Beth has that - but why does she feel so fatigued???
Here's her bloodwork on thyroid, click to enlarge:
Her Free T3 is in the upper 1/3, but there are 2 issues. The first one, is that we know her Cortisol levels are TERRIBLE.
So this is what Janie says:
Since cortisol, a corticosteroid hormone, helps cell receptors receive thyroid hormones from the blood to the cells, low cortisol can result in high amounts of thyroid hormones to build in the blood, making your free T3 and/or free T4 labs look high in range with continuing hypo symptoms
And this entire page should be reviewed:
http://www.stopthethyroidmadness.com/adrenal-info/
I am going to go out on a limb, and say that Beth doesn't "really" have a nice, high, upper 1/3 Free T3. I say that, because she told me this morning that she feels like garbage. And I think the T3 is reading high on the blood test, because it isn't getting into the cells, because of low cortisol.
And this brings us to the 2nd Issue, look at her "total" T3. It is toward the bottom of normal range.
Her Free T3 is 3.1 within a range of 2.0-3.5 (upper 1/3)
Her Total T3 is 94 within a range of 80-190 (bottom)
The "total" T3 includes the T3 that is "bound" to proteins and not able to be absorbed in the cells. I just have a suspicion that her body is making barely adequate thyroid levels, and the "Free" T3 that should be jumping into her cells is "building up" instead.
The thyroid hormone has been described as the "gas pedal" of the body. It just doesn't make sense to have such a nice, upper 1/3 reading on the Free T3 yet she feels "out of gas".
That same link I posted above goes on to talk about this issue of getting the thyroid hormone into the cells:
HOW MUCH CORTISOL DO YOU NEED for SUPPLEMENTATION?? If you confirm that you have low cortisol production, whether from the self-tests above, or the saliva test, or simply the very strange reactions to Armour, patients have learned that they need approx. 20 mg of cortisol, and sometimes more, to bring sluggish adrenal function up to it’s proper and optimal normal daily amount, and for thyroid hormones to be received by the cells.
Up to 20 mgs. and occasionally higher, is called a ‘physiologic’ supportive dose, as compared to the high ‘pharmacologic’ doses. According to doctors like Peatfield and Jeffries, a physiologic dose is safe and doesn’t cause the side-effects of larger pharmacologic doses. This would also bring your cortisol up to the amount to tolerate thyroid hormones and distribute them from the blood to your cells. You’ll know you are on enough when you once again do the temps mentioned above from Dr. Rind’s site, and find them stable instead of fluctuating.
If my theory is right, and she took a significant amount of Cortef (cortisol) without building up from a SMALL dose, GRADUALLY, she could experience an unpleasant "thyroid dump"
That is described here:
If you are already on Armour when you start cortisol, patients have discovered that they need to decrease their Armour a bit at the same time they are increasing cortisol to prevent a “dump” of thyroid hormones from their blood to their cells when the right amount of cortisol is reached. If you do get the dump of thyroid hormones from your blood to your cells, it feels like hyper with extreme anxiety, racing heart, and/or other uncomfortable symptoms. If you feel this discomfort, even after decreasing the Armour, patients find it helpful to stop the Armour completely for a day or two or more, then raise back up.
http://www.stopthethyroidmadness.com/ad ... w-to-treat
Even though she isn't taking thyroid meds right now, I suspect that the thyroid that has been building up, unable to get into the cells, would have this reaction if she didn't start very slow on the Cortef.
Dr Peatfield says it here:
We must return to our theme. It is essential where low adrenal reserve is suspected, or indeed, obvious, that no thyroid supplementation should be considered until adrenal support is in place. Undoubtedly for the physician, the replacement of choice is hydrocortisone, since this though synthetically produced, is identical to naturally produced cortisone. But, the initial approach has to be restrained and cautious, and the lowest possible dose given at the start. I find that 1/4 of a 10 mg. hydrocortisone (that is 2.5 mg) is an excellent starting point. The reason hat it is so low to start with is that patients ill for some time, and perhaps receiving synthetic thyroxine, may have substantially high levels of T4 and T3 which the system cannot use. The adrenal support may kick in quite quickly, causing the T4 -> T3 conversion and receptor uptake to start working quite abruptly. This may cause a sudden overdose situation to occur. The patient may find the pulse rapidly accelerates to give palpitations in the chest or even promote irregularity of the heartbeat. They may feel ill, may collapse, they may have tremors in the limbs as if they were thyrotoxic. With small starter doses of adrenal support the risk of this is avoided. The first two or three days of 2.5 mg. of hydrocortisone given in the morning soon after waking, will be monitored by the patient for any adverse symptoms, checking pulse two or three times a day, and of the course morning basal temperature.
Normally there are no symptoms good or bad; but everyone is different and occasional marked sensitivity occurs. In such a case the hydrocortisone will be stopped for a day or so, and a much lower replacement level will be sought for.
And here's the full article:
http://featherstone.bravehost.com/thyro ... renal.html
