When last we left the riveting story of my ongoing adventures in functional medicine, it was August, and I'd just been to my first appointment...Read More
Thyroid Update: Cleared For Takeoff
I know everyone isn’t interested in my hormone experiments, so if you’re less than enthralled by tales of T3 and TSH, skip this one. For my #FUThyroid friends, welcome!
To get up to speed, you might want to read these posts:
My status in April, 2012, a.k.a., the one where I decide to see Dr. Sebring
My update from July, 2012, a.k.a., the one where I get a little better but have more work to do
Wilson’s Syndrome Protocol, August, 2012, a.k.a., the one where I get really kooky
Need more context? You can read all of my previous posts about my thyroid adventures here.)
Before I get into my details, I think it’s worth repeating that all of this is about my situation. I’m glad to share my experiences with you, but we’re all different, especially regarding hormones and how our bodies behave. Remember: you are a special, special snowflake. If you think you’re experiencing something similar to me, or you’re curious about what you read here, please consult an expert. The only things on which I’m an expert are myself and how to pet Smudge’s belly without waking her up. (But I’m glad to answer questions in comments or via email, so hit me up.)
When I saw Dr. Sebring in April 2012 to talk about my recent weight gain and flagging energy, he tested my DHEA and Reverse T3, thinking that I was low on testosterone (which is affected by DHEA) and that my Reverse T3 was too high. He was right! The numbers were not good. One might even say they were (very) bad. He started me on a bunch of supplements, encouraged me to continue with my strength training and paleo diet, and said to come back in three months. Then we re-tested the DHEA, Reverse T3, and testosterone — then we decided I should try the Wilson’s Syndrome Protocol and switch my thyroid meds from Synthroid to Armour Thyroid. If any of this doesn’t make sense to you, you need to read the posts at the links above.
So… after diligently completing the Wilson’s Syndrome Protocol in August/September 2012, I started taking Armour Thyroid instead of Synthroid. Meanwhile, I continued with all of my supplementation, plus Whole30-style eating 90% of the time (with a strict Whole30 plus autoimmune protocol for a month, a.k.a., Hell), plus dedication to heavy lifting, meditation, kundalini yoga, and plenty of sleep (minimum 8 hours per night, usually 8 1/2 to 9).
Where has that gotten me? I’m cleared for takeoff!
I’ve been feeling pretty damn good, and at my recent check-in with Dr. Sebring, my feelings were confirmed by lab numbers. My TSH, T3, Reverse T3, testosterone, and cortisol all look good… and not “regular doctor who just follows the rule books from the pharmaceutical companies” good. No, my numbers look good to Dr. Sebring. So good, he gave me the greenlight to add some high-intensity workouts back into my routine. I’m not broken any more! I need to be smart about it, but I can get back to superhero training — as long as I continue with restful sleep, meditation, supplements, and clean eating (because while my systems have healed, there’s still that one, pesky fact: I don’t have a thyroid).
The details below explain where my blood work is right now, in case you’re interested in the science-y stuff. Please keep in mind that my descriptions below are boiled down to the basics for easy explanation. Later this week, I’ll share the squishier side of the experience: what I’m doing with my mind and my body to chase after my superhero goals now that I have an almost clean slate to start again.
A quick reminder of what I know about DHEA, thanks to the Google oracle: Dehydroepiandrosterone (DHEA) is a hormone controlled by the adrenal gland. Hormones like estrogen, testosterone, and our old friend cortisol depend on our bodies’ production of DHEA. Low DHEA means low production of these hormones, which can lead to all kinds of lame sh*t like lack of energy, low libido, and fat gain. DHEA supplementation can help with adrenal function and is used to treat lupus, HIV, obesity, depression, menopause, and osteoporosis.
When we tested DHEA in April 2012, my level was so low, it barely registered on my blood test. The expected range for DHEA is 27-206 UG/DL, and mine came in at a whoppingly unimpressive <30.
The next time we measured it, my DHEA was at 137, so we increased my dose to try to move that number a little bit more, but I misunderstood and doubled my dose. Oops! My DHEA was too high in March 2013 (359 mcg/dL), so I’ve backed off my dose to a more reasonable level. Dr. Sebring didn’t seem too concerned, so this goes in the “win” column.
TSH is Thyroid Stimulating Hormone and is secreted by the pituitary gland. It’s a messenger that tells your thyroid to produce thyroid hormones. In healthy people, its message is based on whether blood levels have too little (or too much) thyroid hormone to meet the demands of the body. Many doctors use TSH as a way to gauge how well the thyroid system is working. Experienced thyroid patients know that this is just one variable that needs to be measured. It’s informative, but not the be all and end all.
A “regular” doctor will tell you the acceptable range for TSH is 0.4 to 4.5 — but my endocrinologist wants me around 0.5 to 1.5.
In April 2012, my TSH was 1.3. That’s pretty good on paper, but it’s important to note that I wasn’t feeling great or looking great — and that’s why TSH has to be analyzed in the context of T3, T4, and Reverse T3.
In March 2013, my TSH is 0.71. I like it!
What’s Free T3?
T3 is the active form of thyroid hormone. TSH tells your body to release T4 and then your body transforms T4 (which is inactive) into T3 (which is active) and Reverse T3; there’s more detail about Reverse T3 below.
My Free T3
The expected range for Free T3 is 2.3 to 4.2. In April 2012, my Free T3 was 2.1, which is (wah wah) “Out of Range.”
In March 2013, my Free T3 is 3.5. F*ck yeah, middle range!
What’s Reverse T3?
In a nutshell, Reverse T3 is a by-product that is made when T4 is converted into T3. When things are working properly about 40% of T4 becomes T3, and the rest is chucked out as RT3. But… when emotional, physical, and biological stress enter the picture, those percentages can be disrupted and T3 — the active form of thyroid hormone we need — goes down. For more on this, read my previous, lengthier description.
My Reverse T3
When looking at RT3, the raw number is informative, but even more telling is the ratio of free T3 to RT3. As explained above, when the proportions of those two hormones get out of whack, mayhem ensues. Generally speaking, when comparing free T3 to RT3, a healthy ratio is 10. (Here’s a calculator to determine Reverse T3 to T3 ratio.)
In April 2012, my RT3 was 523. The “expected range” is 90-350, so I was way off that chart. Additionally, my ratio was lousy. When I plugged in my numbers, I got a 4.
When we tested my RT3 a few months later, I was still, as the lab report so drily puts it, “Out of Range.” Again, the Reference Range is 90-350 pg/mL, and my measurement was 410. Not quite as bad as last time, but still too high. My new ratio was 5, which is still sucky.
In March 2013, my RT3 was 250, with a ratio of… 14. WOOT!
I’m continuing with my supplementation for now, although Dr. Sebring said that we’ll look at everything again in 6 months to see if I’ve lost weight and if I can back off some of the supplementation. I’m sharing this list for informational purposes; please talk to someone who knows what they’re doing before you start dosing yourself. This is serious stuff.
– Corti-B Plex
– Fish oil (formulation made especially for Dr. Sebring)
– Pharmax PLC High Potency Powder
– Cortisol (prescription)
– Melatonin (time-released)
– I’m also still taking Vitamin D, Natural Calm
Synthroid vs. Armour Thyroid
I think for most physicians and endocrinologists, Synthroid (Levothyroxine) is the go-to to treat thyroid issues. For some people, it works great. For some people it works great for a while, then stops working. For some people, it doesn’t work at all.
There’s a raging debate online and in health care circles about Synthroid vs. Armour Thyroid that rivals the Kirk vs. Picard wars. I’d like to stay out of it (although I’m proud to say I’m firmly on Team Picard). So here’s what I have to say about Armour Thyroid and Synthroid:
I started on Synthroid, and it worked OK for a year or so. Then I started feeling crappy. Then I learned I had adrenal fatigue and I gained weight and I felt droopy and I looked bloated and things were really blechy. Then I did the Wilson’s Syndrome Protocol, and I switched to Armour Thyroid, and I feel better. I feel Good. (Capital G is intentional.) I have friends with thyroid challenges who take Armour and feel awesome. I have friends with thyroid challenges who take Synthroid and feel awesome.
What does this mean for you?
If you’re on Synthroid, and you feel good… AWESOME!
If you’re on Synthroid, and you don’t feel good (and it’s been more than 6 months or so)… maybe talk to your doc about trying Armour.
And absolutely, if you’re on thyroid medication — and it’s been more than 6 months or so — and you don’t feel good yet, keep plugging away at it. Request the “kooky” blood tests like Reverse T3 and Free T3, in addition to TSH. Try the paleo diet with autoimmune protocol to see if it’s a food sensitivity getting in the way of your meds. Meditate to see if you can help your body help you.
Don’t settle for feeling crappy, and remember that it’s your right — and responsibility — to work with your doctor to get the answers you need. Make yourself your doc’s partner (Hell, think of it as partner-in-crime if that makes it seem more fun… that always works for me), and keep investigating and experimenting until you find your equilibrium.
So that’s my story for now. I’ll update you in a few days with my workout plan, eating plan, meditation plan… dang it! Let’s just call it the Life Plan… for reaching my superhero goals. Feel free to hit me with questions in comments or email. I might not be able to help, but I’m glad to listen. We’re all in this together.
The Thyroid Diet Revolution
This is the most helpful book I’ve read on the subject of thyroid challenges. I did a complete review of it here. If you read only one book on the subject, this is the one I recommend.
Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?
This is another helpful book, especially if you feel like hypothyroidism has made you a crazy person. This book includes lots of anecdotes that made me feel less alone in my thyroid weirdness.
Stop The Thyroid Madness
The tone of the site is a bit strident for my taste, but there’s no denying it’s loaded with helpful information. Warning: It might make you feel stabby, but it really is an excellent resource for understanding all the variables that can affect thyroid function — just try to weed out the histrionics as you read.
About.com: Thyroid & Thyroid-info.com
These pages are maintained by Mary Shomon, the author of The Thyroid Diet Revolution.