[Leslie]

Since gaz_gtr has an issue with his thyroid I though I might ask a question...

I had a thyroid test done 1 month ago which indicated my Free T4 was 1.22 and my TSH level was 0.17. My endo has adjusted my medication. I had an appt. yesterday and my levels are still the same.

I was diagnosed with Hashimotos disease at 30 and then 3 years later I had a partial thyroidectormy. A few weeks ago I celebrated the 20th anniversary of my 30th birthday which tells you I have had this med. issue quite a while. I get a physical in Jan. of each year and at that time my GP indicated that all was fine so I don't really know how long I have had the elevated levels. My thyroid has enlarged just a bit and I shared this with my doc in Jan. She agreed with me about the enlargement, did the thyroid test, and indicated that we would watch it for a while. I had always assumed that an enlarged thyroid indicated thyroid levels out of adjustment. Am I wrong?

Now, what I really want to know is, could these minor elevated levels be the culprit behind my PN?

I can tell that my PN getting worse and I seem to be obsessed with finding the little devil that caused this... I am driving my docs nuts! But, I figure that's what they get the big bucks for.

By the way, I have been examined by drs., 6 times since my Jan. appt with my GP. Not one of them mentioned my enlarged thyroid...

[dahlek]

and 'phased out' or something...long response lost!
PM me and I'll try to address issues in particular? Dunnow what else to do....
Just want you to know I understand. - j

[mrsD]

I think thyroid issues are very misunderstood.

I was suffering for decades (and thru infertility and a pregnancy and no doctor helped me with it). After I had my C-section, several doctors including the Pediatrician thought my neck showed a goiter in the hospital. Did anyone of them order tests? NOPE.

Hypothyroidism creates a PN by depositing a form of tissue in the tendon spaces at the ankle and wrist. Carpal tunnel and tarsal tunnel are names given when those nerves get pinched.

I had a very poor technicium uptake (radioactive isotope) finally to explain my goiter, which was only on the right side. The left side of the thyroid did not take up the radio isotope properly. My right lobe was 50% bigger than normal to make up for that loss. After being on Synthroid .075 for several years, that goiter reduced to 10-15% larger (my last ultrasound). Neither doctor I had/have cares about my feet and the thyroid. Compared to what I had before--the severe pain, I really don't have many complaints, just some numbness in two toes, and burning occasionally.

My TSH varies from 1.25 to 2.0 depending on the season.
My other readings seem "normal".

There is controversy about using T3 (many endos will not do it still today). There is controversy about TSH levels, and which scale to use. There is controversy about it ALL.

I do NOT have Hashimoto's, or antibodies. But I have a very abnormal gland. (as per the endo). But no one really seems to want to do anything about it, except give me Synthroid.
What I have today is light years above what I was. So I don't pursue it. I really don't have the energy anymore to do that.

But if you are progressing with symptoms, I think you should try at least to find an answer. But be advised, you may not get one.

[dahlek]

Diagnosing and treating thyroid issues hyper or hypo are tricky and subtle at the same time. I got lucky with one astute GP and the rest was 'on record' as they say. I did have a goiter years ago which was explored and thought to be a non-issue. My last endo sonogram showed the thyroid to be truly 'dead'. I had managed to save the tests from those ages ago as I'd gotten all my films a few years ago and this one was scheduled to be destroyed in a couple of months...I just kept it and it was useful for comparisons...
The thyroid and all the other endocrine glands are amazing organs in our body. They do far more than we realize or appreciate! But, also, they are dependent on the rest of our systems to help them work and work right.
Enlarged thyroid and levels out of sync are not hand-in-hand at all. Mainly because the treatments for thyroid can mask or help the issues. It's all about getting the right tests at the right times and a whole heap of luck in having the right doc! Hang in there! - j

[caliTJ]

Hi Leslie, I was glad you brought this up. I have been googling PN and hypothyroid and have found that there is indeed a connection. If you are chronically hypo, you can develop PN. Resolving PN once it has started, even after correcting any thyroid imbalance, will be a long road.

I have been undergoing tons of tests as you know, and my hypo is out of control. I basically have no thyroid and they have increased me to 3-400 mcgs (every other day for each strength). BUT I want to see an endo after reading all the info on the web. My Aunt wants my absorbtion tested, she thinks there is something wrong.

When I was with the neuro he basically stated, there is no connection between hypothyroid and PN....soooooo....I won't be seeing him again since he doesn't seem to have time to keep up with the current research.

Don't you just wish there really was a Dr. House?

Terra

[Leslie]

Originally Posted by caliTJ

Hi Leslie, I was glad you brought this up. I have been googling PN and hypothyroid and have found that there is indeed a connection. If you are chronically hypo, you can develop PN. Resolving PN once it has started, even after correcting any thyroid imbalance, will be a long road.

I have been undergoing tons of tests as you know, and my hypo is out of control. I basically have no thyroid and they have increased me to 3-400 mcgs (every other day for each strength). BUT I want to see an endo after reading all the info on the web. My Aunt wants my absorbtion tested, she thinks there is something wrong.

When I was with the neuro he basically stated, there is no connection between hypothyroid and PN....soooooo....I won't be seeing him again since he doesn't seem to have time to keep up with the current research.

Don't you just wish there really was a Dr. House?

Terra

You know...are are correct, I am looking for Dr. House which may be why I am so disappointed. I thought doctors really put forth that herculean effort in trying to help patients. My dad died of leukemia but his doctors went above and beyond to help extend his life and give him quality of life while extending it. I saw this day in and day out in his remaining time and I thought they all did the same.

In reading all that can cause PN, I was under the impression that it was only hypothyroidism that was untreated that can cause PN. Is that not the case? My endo said that since my thyroid levels were only a bit off, this did not cause the PN.

[mrsD]

Originally Posted by caliTJ

Hi Leslie, I was glad you brought this up. I have been googling PN and hypothyroid and have found that there is indeed a connection. If you are chronically hypo, you can develop PN. Resolving PN once it has started, even after correcting any thyroid imbalance, will be a long road.

I have been undergoing tons of tests as you know, and my hypo is out of control. I basically have no thyroid and they have increased me to 3-400 mcgs (every other day for each strength). BUT I want to see an endo after reading all the info on the web. My Aunt wants my absorbtion tested, she thinks there is something wrong.

When I was with the neuro he basically stated, there is no connection between hypothyroid and PN....soooooo....I won't be seeing him again since he doesn't seem to have time to keep up with the current research.

Don't you just wish there really was a Dr. House?

Terra

That is way too high a level of hormone replacement!
Even people who have their thyroids removed don't take those high doses.

Either you do not have the proteins in the blood to transport the hormone--- thyroid is protein bound

or you are taking it wrong. It needs to be taken on an empty stomach away from food. Food will inhibit and reduce absorption.

If you are low in zinc and selenium you will not convert T4 to T3.

Be advised that high dose thyroid hormone will lead to bone tear down and osteoporosis. This is very critical and becomes a serious problem as the patient ages.

I have NEVER seen doses like this in my 40 yrs of handling thyroid patients.

Something is not right here.

[caliTJ]

Originally Posted by mrsd

That is way too high a level of hormone replacement!
Even people who have their thyroids removed don't take those high doses.

Either you do not have the proteins in the blood to transport the hormone--- thyroid is protein bound

or you are taking it wrong. It needs to be taken on an empty stomach away from food. Food will inhibit and reduce absorption.

If you are low in zinc and selenium you will not convert T4 to T3.

Be advised that high dose thyroid hormone will lead to bone tear down and osteoporosis. This is very critical and becomes a serious problem as the patient ages.

I have NEVER seen doses like this in my 40 yrs of handling thyroid patients.

Something is not right here.

Really? I have run the dosage by my Aunt and she didn't say much...now you have me a bit concerned. I even checked the bottles to make sure I wasn't losing my mind. I will make an apt with an endo today, Thank you. Edited to add that I have always taken my dosage in the evening on an empty stomach....when I was taking it. I went through a period where I didn't take it regularly, and have always believed that is why it stopped working all together. Oh, and you realize I meant 300 AND 400 mcgs, not 3400?

Sorry to highjack your thread Leslie!

[mrsD]

Originally Posted by caliTJ

Really? I have run the dosage by my Aunt and she didn't say much...now you have me a bit concerned. I even checked the bottles to make sure I wasn't losing my mind. I will make an apt with an endo today, Thank you. Edited to add that I have always taken my dosage in the evening on an empty stomach....when I was taking it. I went through a period where I didn't take it regularly, and have always believed that is why it stopped working all together. Oh, and you realize I meant 300 AND 400 mcgs, not 3400?

Sorry to highjack your thread Leslie!

Thyroid hormone is transported via binding proteins.
Here is an example of a common drug that can disrupt this
factor:
http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

Other drugs also are protein bound, and may displace thyroid hormone.

Poor protein intake can lead to lowered production of these proteins as well.

Another drug that affects thyroid:
http://www.ncbi.nlm.nih.gov/pubmed/346267?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pu bmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pub med_Discovery_RA&linkpos=3&log$=relatedarticles&lo gdbfrom=pubmed

http://endo.endojournals.org/cgi/content/full/146/3/992
This gets pretty complex, but increased metabolism of T4 does occur with some drugs.

Thyroid hormone is suggested to be taken in the morning on an empty stomach with no food for an hour, because the diurnal effects it has. Some people take it at other times, but CONSISTENCY is most important.
Skipping doses interferes with the feedback loop and the hypothalamus. Microgram doses of any drug can be lost in the fiber of the food you eat. Most breakfasts have fiber (cereals).
Digoxin for the heart is also affected this way.

The highest dose of levothyroxine I have seen was .3 mg (300mcg) and that was in one man who was given this before statins were introduced to lower his extremely high and deadly cholesterol.
Also dogs require higher than normal doses compared to humans and I have had several dogs get those .3mg doses as well. I occasionally see .2mg to .250 mg but very rarely, in people. I have never seen a 400mcg dose for a human, in 40 yrs. I suspect you have something going on that requires careful diagnosis by an astute physician.

http://www.medicinenet.com/script/ma...ticlekey=18637

http://thyroid.about.com/gi/dynamic/...teoporosis.htm

I'd like to reiterate that DAILY doses of 300mcg or more are very rare.
Sometimes a doctor will give a larger dose to be taken once a week, or every 5 days in
long term care where oral meds are difficult to administer. (this is to help the nursing staff).
Since T4 (levothyroxine) is long acting, this can be done for difficult patients (hospitalized or in long term care).

Evaluation of adrenal function should be done as well as pituitary.

[caliTJ]

Leslie, thank you for starting this thread and mrsd, thank you for all that great information. I have to print it all out. I have a call into an endo that I might have to wait a bit to get in with. I also will have to self pay as he is not part of our HMO. However, my gp, as well meaning as she is...has never even tested my T3 or T4 or, quite honestly, even palpitated my thyroid. The endo on my HMO is apparently not great, so I will have to self refer.

Thank you again, the information you provided has definately opened up my eyes.

Terra