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What to do if naturopath and doctor disagree on thyroid care?
I am afraid to make a decision in my care at this point becasue my regular doctor and my naturopath are giving me different information on my thyroid care. I have been on Synthroid for years for full removal of thyroid, but the last couple years my levels have been fluctuating.
In March 2021 my TSH was 1.63 Reference Range 0.27- 4.20
Free T4 was 16 Reference Range 10-22
Free T3 was 3.2 Reference Range 2.6-5.8
My PC Doctor was fine with these levels, My naturopath however said the conversion was very poor and that the ideal ratio fo t4 to T3 is 3:1. She put me on selenium and ashwaganda to see if conversion would improve.
June 2021 Bloodwork, my TSH is 4.63 Reference Range 0.27-4.20 High
Free T4 is 13 Reference Range 10-20
Free T3 is 2.3 Reference Range 2.6-5.8 Low
The Naturopath wants to put me on Dissicated thyroid hormone since the selenium and ashwaganda did not help.
My GP says he does not think I am at that point yet. He heard my reluctance to stay at my current dose, even though he thought it was fine still. He will try increasing the synthroid dose to .150 and repeat the bloodwork in 6 weeks.
I need other opinions. I don't know of anyone else with thyroid supplementation to talk to. I even just asked my GP about adding some T3 to my regular does and he said that since I was in normal range, it shouldn't be done.
In March 2021 my TSH was 1.63 Reference Range 0.27- 4.20
Free T4 was 16 Reference Range 10-22
Free T3 was 3.2 Reference Range 2.6-5.8
My PC Doctor was fine with these levels, My naturopath however said the conversion was very poor and that the ideal ratio fo t4 to T3 is 3:1. She put me on selenium and ashwaganda to see if conversion would improve.
June 2021 Bloodwork, my TSH is 4.63 Reference Range 0.27-4.20 High
Free T4 is 13 Reference Range 10-20
Free T3 is 2.3 Reference Range 2.6-5.8 Low
The Naturopath wants to put me on Dissicated thyroid hormone since the selenium and ashwaganda did not help.
My GP says he does not think I am at that point yet. He heard my reluctance to stay at my current dose, even though he thought it was fine still. He will try increasing the synthroid dose to .150 and repeat the bloodwork in 6 weeks.
I need other opinions. I don't know of anyone else with thyroid supplementation to talk to. I even just asked my GP about adding some T3 to my regular does and he said that since I was in normal range, it shouldn't be done.
After you read the link, it will be clear why your T4 is not adequately converting to T3. I suggest giving your doctor a copy of the paper, along with a list of all symptoms that you have, and ask for some T3 med to get your FT3 up to at least mid-range. In view of symptoms and your FT4 at only 30% and your FT3 below range, if the doctor won't increase your med dosage, you need to find a good thyroid doctor tht will treat for symptoms.
I was on T4 for probably 25 years without ever feeling normal. I still had hypo symptoms. Finally found out about the importance of FT3 on this Forum and got my doctor to test for first time and found it low in the range because I was also not converting T4 to T3 adequately. This is quite common when taking T4 med only. After changing my med and tweaking dosage, I felt better than I could ever remember.
After doing extensive research over 8 period, in order to pay back help I got here, I have co-authored 2 papers, including as co-author a retired Endocrinologist with great knowledge and experience. Following is a link to the latest.
https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/
Since everyone can be different in what thyroid levels they need, dosages should be adjusted as needed to relieve hypo symptoms. You haven't talked about the symptoms you have, only discussed levels. So please tell us about all symptoms you have.
As Barb pointed out FT3 is the most important since it is used be every cell to create the metabolism needed by our bodies. T4 is a prohormone that must be converted to T3 to be used. There are many causes for inadequate conversion of T4 to T#, including the lack of a thyroid gland. You can read all about this in the link.
Also note that it is important to have adequate cellular response to thyroid hormone. So it is important to have Vitamin D at least 50, B12 in the upper part of its range, and ferritin at least 100. If not tested for those you should do so and supplement as needed to reach those levels.
After doing extensive research over 8 period, in order to pay back help I got here, I have co-authored 2 papers, including as co-author a retired Endocrinologist with great knowledge and experience. Following is a link to the latest.
https://thyroiduk.org/further-reading/managing-the-total-thyroid-process/
Since everyone can be different in what thyroid levels they need, dosages should be adjusted as needed to relieve hypo symptoms. You haven't talked about the symptoms you have, only discussed levels. So please tell us about all symptoms you have.
As Barb pointed out FT3 is the most important since it is used be every cell to create the metabolism needed by our bodies. T4 is a prohormone that must be converted to T3 to be used. There are many causes for inadequate conversion of T4 to T#, including the lack of a thyroid gland. You can read all about this in the link.
Also note that it is important to have adequate cellular response to thyroid hormone. So it is important to have Vitamin D at least 50, B12 in the upper part of its range, and ferritin at least 100. If not tested for those you should do so and supplement as needed to reach those levels.
1 Comments
Maybe I can use some info in the link to convince my family doctor to try me with a little added T3 to my synthroid. I was hoping it would help alleviate my fibromyalgia symptoms a bit.
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I'm having a hard time figuring out how your pcp can think your levels are "normal" when, both, your TSH and FT3 are out of range. Obviously, that indicates a problem.
Our bodies can change over time, so even though many of us have been stable on a certain dosage, that can change very quickly for a number of reasons.
I'm not sure that tweaking your thyroid levels will do much to help your bone density, but it certainly could help alleviate some of the fibro symptoms, since hypothyroidism and fibro have many of the same symptoms.
I would have to agree with the Naturopath, in regards to the FT3 being too low. The rule of thumb is that FT4 should be mid range, or slightly above. Your March FT4 was exactly 50% of the range (mid range). The other rule of thumb is for FT3 to be upper third of the range - your March FT3 is only at 18%, which, obviously leaves a long way to go to hit that upper third.
Many Naturopaths prefer Armour or another desiccated hormone... sometimes, it can be a personal preference for the patient. However, from my own experience, I found that staying with my Levoxyl and adding T3 was the best way to go. Desiccated hormones (Armour is currently the only one on the market in the U.S.) have much more T3 (because pigs produce more T3 than humans) and not enough T4 for many of us. Because Armour contains both T4 and T3, you can't regulate them independently. With synthetic hormones you can. It's customary to start out with the lowest level of T3 (5 mcg) and increase as needed, based on symptoms and FT levels.
Selenium is necessary for the conversion of FT4 to FT3, which would be why your Naturopath added that to your regimen, but supplementing it only works if you're deficient. Although Ashwagandha is "good" for us, I've never heard of it being beneficial for conversion.
If you simply keep increasing T4 dosage, without adequate conversion, you'll simply end up increasing FT4 levels, without affecting FT3, which is the hormone that's actually used by individual cells (whereas FT4 must be converted to FT3 before it can be used).
In view of that, personally, I would got with the Naturopath and ask him to simply add a T3 dosage to your current T4 (Synthroid) dosage. As I noted, start with a very low dose and adjust as needed.
There could also be a problem with the way your body is using (not using) Synthroid. It might be beneficial to consider changing to a different T4 medication, but don't do that at the same time as adding a T3 med as we should never make more than one change at a time, because if one of them work, we don't know which it might have been and have to start the process of elimination.
Our bodies can change over time, so even though many of us have been stable on a certain dosage, that can change very quickly for a number of reasons.
I'm not sure that tweaking your thyroid levels will do much to help your bone density, but it certainly could help alleviate some of the fibro symptoms, since hypothyroidism and fibro have many of the same symptoms.
I would have to agree with the Naturopath, in regards to the FT3 being too low. The rule of thumb is that FT4 should be mid range, or slightly above. Your March FT4 was exactly 50% of the range (mid range). The other rule of thumb is for FT3 to be upper third of the range - your March FT3 is only at 18%, which, obviously leaves a long way to go to hit that upper third.
Many Naturopaths prefer Armour or another desiccated hormone... sometimes, it can be a personal preference for the patient. However, from my own experience, I found that staying with my Levoxyl and adding T3 was the best way to go. Desiccated hormones (Armour is currently the only one on the market in the U.S.) have much more T3 (because pigs produce more T3 than humans) and not enough T4 for many of us. Because Armour contains both T4 and T3, you can't regulate them independently. With synthetic hormones you can. It's customary to start out with the lowest level of T3 (5 mcg) and increase as needed, based on symptoms and FT levels.
Selenium is necessary for the conversion of FT4 to FT3, which would be why your Naturopath added that to your regimen, but supplementing it only works if you're deficient. Although Ashwagandha is "good" for us, I've never heard of it being beneficial for conversion.
If you simply keep increasing T4 dosage, without adequate conversion, you'll simply end up increasing FT4 levels, without affecting FT3, which is the hormone that's actually used by individual cells (whereas FT4 must be converted to FT3 before it can be used).
In view of that, personally, I would got with the Naturopath and ask him to simply add a T3 dosage to your current T4 (Synthroid) dosage. As I noted, start with a very low dose and adjust as needed.
There could also be a problem with the way your body is using (not using) Synthroid. It might be beneficial to consider changing to a different T4 medication, but don't do that at the same time as adding a T3 med as we should never make more than one change at a time, because if one of them work, we don't know which it might have been and have to start the process of elimination.
If you have been on Synthroid for years why are you questioning the levels now? People with normal thyroid can have fluctuating levels. If you are going to try a different dose of Synthroid, I would avoid any supplements during that period. Only take what you need because the more you put into your body the less certainty you will have. Keep it simple when it comes to medication.
3 Comments
I'm questioning the levels because I was on .200 for over ten years with no troubles. Then I went very hyperthyroid and my synthroid has had to be tweaked. I am interested in having my levels optimized to see if it would help my fibromyalgia and low bone density. My bloodwork shows that it is quite out of range.
The same happened to me after 20 yrs on Synthroid. I became hyper again and took about 6 months to get the right dose down. Your March results weren't too bad. Again, I would not take any new supplements that could affect the thyroid until you have been stabilized. Good luck!
Thank you!
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