Friday, May 16, 2008

Hypothyroidism and Heart Disease: Round 2

Well, saw the second endocrinologist today. Let's compare notes!

1. Both agreed I have Hashimoto's Thyroiditis.
2. Both preferred synthetic T4 to the natural Armour Thyroid (AT) preparation citing inconsistency between lots of the AT (the company's website disputes this).
3. Both defended synthetic T4 as being preferable because T4 is longer acting, has to be taken only once per day (AT should be taken more often as it contains shorter acting T3) , and both say most of the body's T3 comes from T4 anyway.
4. Doc 2 also went on to say he wants me on name brand (Levoxyl, Synthroid, etc.) rather than a generic to ensure I get a consistent level of T4. His argument is that the generics are OK if you could ensure you got the same brand everytime but with generics pharmacies can substitute freely between generic brands.
5. Doc 1 wanted to start me at 75mcg (I talked him down to 25mcg). Doc 2 wanted to start me at 25mcg unprompted. I agree!
6. Doc 2 want to treat me to achieve a level of between (1.0 and 2.0). Doc 1 was never really mentioned a treatment level.
7. Doc 1 set me up for a sleep apnea test to see if that was the true source of tiredness. Seems that is not uncommon in thyroiditis. I also got the impression he was pushing it for financial reasons.
8. I mentioned having another TSH test and Doc 2 jumped right on it and ordered the test which was done at his onsite lab. Think perhaps he makes a buck there?
9. Both docs took fairly extensive health histories and physical exams with Doc 2 taking a little more health data and Doc 1 doing a little more physical examination.
10. Neither doc hurried me and answered any questions I had.

Well that's all for now. Pretty dry and clinical. Neither doc was a ball of fire! I'll add more as I think of it. Next, let's see what results I get from treatment but that may be a while!




onewaypockets said...

Hi HH,

I have not read your blog for awhile, sorry to hear you are not tip top.

In the past I never felt we had that much in common. Unlike your high LP(a), mine has always been either 4 or 6 on every test I have had done, but I still somehow ended up with three stents. It was a mystery until I eventually discovered by not leaving well enough alone and seeking help that I do have hypothyroidism, low Testosterone, and sleep apnea!

In my personal experience endos treat diabetes 95% of the time, they are not good hormone doctors at all. I was extremely mismanaged by one, all she would ever test was my TSH and T4 total. I did talk her into testing my testosterone once, she said it was fine. When I told her (after almost a year of visits) that I felt worse under her care than when we started out, she said my TSH of 4.8 and low T4 was fine, that it was all in my head, and perhaps I needed Prozac. I never went back to her and started my reading and personal education. Absolutely any blood test result that was between the huge ranges of “normal” was fine to her. B.S. I also scribe to quite a few Yahoo boards various related hormones and hear endo disaster stories almost daily.

I eventually found a good anti aging doc, and he did not only blood work (FT3, FT4 are the most important and should be in the upper ranges for optimal health, TSH is not a thyroid hormone at all and only corresponds loosely to blood thyroid levels), but he physically showed the different ways I exhibited hypothyroidism.... via my skin tone on the outer upper arms that I have mild exedema (a thickening of the skin associated with hypothyroidism), very slow reflexes, a hypothyroid hairline, thick heal pad, and others physical symptoms during my exam the endo never checked, and concluded that based on my history that I have been hypothyroid probably most of my adult life. He also pointed out my testosterone on a chart was normal... for a 90-97 year old man! Gee, no wonder I had high blood pressure, sky high cholesterol, ED problems, gain weight easily, have stents, etc. My metabolism is in the dirt!

That was a year ago, and now I am taking Armour, injectable T (very small needle self injected and much better and cheaper than any gels that often do not work due to skin problems), and am feeling much much better. When I more normalized my thyroid and male hormones my need for Lovastatin went from 40mg down to 10mg for the same results. My BP med has been cut in half.

IMO bro, what you need is a anti-aging doc or a D.O. They tend to be much more into Armour and natural hormone replacement and less into the Prozac. Run from any endo, they are the pits.

As far as 25mcg of Levoxyl, that little amount will not suppress your thyroid enough to lower your Hashi antibodies a whole lot. Based on your FT4 level, and high antibodies, you are quite hypothyroid and as your gland gets eaten up and burnt out you will need much more thyroid med as time goes by to feel well.

If you even suspect that you may have sleep apnea, get checked! I used to snore every night, and my wife said I tossed and turned often. When I mentioned to my doctor that sometimes I had dark circles under my eyes in the morning it was time for a sleep study. They found that I had O2 levels around 87% at times, and had 66 hypoapneas in the three hours before they quickly put a mask on me. I also had something called sleep disordered breathing that causes a great problem long term with my heart. I now sleep with a CPAP machine and feel great in the morning! Lots more energy and felt better from the first night on the machine. It was placing a huge load on my heart, and sleep apnea is strongly linked to heart rhythm problems that you mentioned you were experiencing.


HeartHawk said...

Hey OWP:

Good to hear from you. Yeah, I'm beginning to wonder how much we are missing even with our intensive lipoprotein management. I know even Doc Davis is surprised. Hypothyroidism could be another key for his most resistant patients. He told me he worked with T3 in the past but never saw it have much success That could be due to other co-factors. He also does not have much use for endos but I wanted some first-hand experience with them. I started the levothyroxine low because I want to experience a slow ramp up. Your are right, I will likely need much more than 25mcg! I am getting the sleep apnea test if for nothing else than the experience of taking the test and learning from what those docs might have to say.

The big thing we both seem to have resolved is that we must each take our health into our own hands and not blindly trust the docs.



Anonymous said...

Hearthawk, just came across your site and am hoping you check for postings since this thread is a little old. Most people report doing better on Armour though info is scant and you know how scientists hate anecdotal information. So I thought I'd send you over to:

Click on the link at the top of the page for Ray Peat's full discussion (it's a Word doc)

and then there's Dr. Lowe's site:

I hope this helps to round out your perspective.

HeartHawk said...

Dear Anon:

Thanks for the links. I'll check 'em out! And, yes I do check every post regardless of how old! In fact, I just had my ACTH Stim Test today. I should post on it.


Anonymous said...

hearthawk, I bookmarked the page to come back and see if you got my comments.

I did this because hypothyroid therapy is problematic and it helps to get out in front of the medical profession.

Neither levothyroxine or Armour treatment replicate thyroid function. (Forgive me if you already know this stuff.) Synthroid leaves the body perpetually low on t3 and Armour creates a peak of it followed by a low. Sensitive individuals exaggerate the effects. On levothyroxine the body's poor ability to create t3 from t4 (a natural function) is the problem and with Armour rapid metabolism of t3 resulting in a spike followed by a trough is the problem. Endocrinologists think nothing of insisting on levothyroxine as the way to go and then either leave you with chronically low t3 or wind up having to add Cytomel (t3) to prop up excessively low t3. With Armour, sensitive individuals can simply divide the dose to level out t3 levels (Ray Peat talks about the t3/t4 issue with his own take on it.)

Dr. Lowe raises another issue which is the problem of regulating dose based strictly on lab values. Many people do poorly symptom wise but look terrific on paper (lab results within "normal" ranges). It is much more difficult to find a doctor who is willing to place more weight on your symptoms than lab values. You will need to talk about 95% reference ranges in regards to lab values to get their (the obstinate dr.'s) attention. I see your personality and perspective clearly from your blog and you will need these qualities to find and deal with the right professionals to give you what you need to improve your symptoms and not just make your labs look good. In this regard I would say pay close attention to Dr. Lowe's message. From what I can tell people like him and Ray Peat are rare so you will need them as a source of inspiration to stay focused on getting the best results for you.

I wish you success as the medical profession isn't on your side (not that you needed me to tell you that.)

Anonymous said...

Now get rid of all your worries about getting answers to questions you have about Hypothyroidism. We've done your work for you and it's all here, ready for the reading.

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