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My pdoc and I were talking about my (mild) rapid-cycling on Thursday. He was going to up my lithium, then he looked at my thyroid check results from three months ago again and said they were low normal, and that he wanted to try putting me on thyroid hormone (because it has a relationship with bipolar disorder).

I was actually going to ask him for another thyroid check, because I started being colder than normal (a four-degree subjective drop) and sometimes unable to feel warm even when I was warm.

It was supposed to kick in in 2-3 days. I started taking it on Friday. On Sunday I went to martial arts class and I not only wasn't freezing and unable to get warm, I didn't have major problems commanding a team. I also didn't have any problems that morning in a meeting, either figuring out what to do next or generating ideas. This morning I woke up and I woke ALL THE WAY UP instead of struggling up from sleep and confusion. I made the walk into work in a normal time rather than the longer time it's been taking for several months. I feel clearheaded for the first time in months and months - I'd assumed it was damage from bp or suppression from medication.

god damn.

(I hope it's not a mood swing.)

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I've had 4 increases since starting synthroid. Generally the thryoid system is slow to stabilize. Blood level checks are generally taken after about a month (at least with my internist). My blood levels have always shown the increase at that point, but it takes at least another couple weeks (total 6 weeks) before I notice the improvement.

I'm glad your doc is proactive. The medical community in general is NOT receptive to increased dosing if levels are anywhere in the normal range. However, there was study published in the last couple years showing that bipolars who had T4 levels at the upper end of the spectrum responded much better to their psych meds.

a.m.

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How often have you had increases?

Weirdly, I got prescribed Cytomel, which works on T3, not T4. I found a bunch of stuff saying T3 was a good supplementation for T4, but nothing suggesting it was useful by itself.

I'm not going to complain at this point, though.

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Yes the most common supplements provide T3T4.

Here is how the cycle works.

Body senses Hi/Low T4 (iodine complex) levels:

TSH (Thyroid Stimulating Hormone) gets goes Hi if more T4 is needed, Low if less is needed. This is essentially like a car throttle.

T3T4 is the intermediate form which responds to the TSH orders. It gets converted to T4 in many places in the body.

T4T3 is the final form the body uses.

Again, the common supplements provide T3T4 and the general assumption is that even if you are hypo/hyperthyroid, that there is no problem with the body converting T3 to T4. Some doctors will prescribe "Armour" a supplement that contains both T3 and T4 on the idea that providing a little T4T3 jump starts the body by bypassing the conversion process.

Interestingly T4 T3 only lasts about 4 minutes in blood circulation before it is grabbed and used up. Patients who have any form of thyroid surgery must be given supplements immediately at the end of the surgery because it is possible to go into adrenalin crisis within 30 minutes due to low levels from lack of T4T3.

Many times the docs will only check TSH levels when doing routine bloodwork. The fallacy of this is that you don't know the actual T4 level. Since I've been behind the power curve on thyroid levels with increasing demand, I've started demanding or checking the box myself on the lab order form.

a.m.

[edited to correct my sleep deprived brain and lack of recent review of thyroid]

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Oh, I see the problem. Thanks for writing that out! I've run into the same information on other websites but couldn't get it into my head right. So TSH is the signaler, but then you don't know for certain that T3 is responding to that signal (or maybe also don't know that it's getting converted to T4 correctly?). Then, as long as the T3-T4 conversion is working correctly, then supplementing with T3 should be equivalent to supplementing with T4, because it gets turned into it. And supplementing with T4 should be mostly like supplementing with T3, except for some instances where T3 wouldn't have been converted to T4.

Cytomel contains only T3 (its maker says it is the only commercially available drug that contains only T3): http://www.kingpharm.com/kingpharm/Product...p?id_product=36

The other ones I've found contained either both T3/T4 or just T4. So I'm thinking maybe it is T3 they talk about as a supplement?

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I've read about T3 supplementation and monitoring for psych reasons. I mean they do it for other reasons, but there are some articles about using T3 because they thing some people have low T3 even when their levels read normal due to how thyroid works. My doctor tests my T3, reverse T3, T4 and TSH. (He's not paying for it sadly.) I take armour.

I think cytomel needs to live in the fridge?

I'm glad you're feeling better.

I love my thyroid supplement. I too was low-normal, but my body temp was really low so we "pushed" me to close to high-normal. Added bonus was my hair stopped falling out.

I had always thought T4 was turned into T3 and T3 is the active form.

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ack, fridge! I don't know. I will check on that. I hope it's okay if not, I have a 3-mo supply sitting on a set of drawers at home.

Yeah, it's nice to feel good. I hadn't even realized I was feeling particularly bad.

ok. back to programming.

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"Store Cytomel Tablets at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Cytomel Tablets out of the reach of children and away from pets"

So, don't worry about the fridge, i think that's when you have it compounded to be time released. Some people split their cytomel into 2 doses because it is fast-acting in the body. But some people do almost everything, yanno?

i was right about the other issue though, T4 -->T3, T3 is the active form.

thyroid.about.com is a good thyroid resource, imho.

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My feet are hot! It's 79 in the office and I have socks and jogging shoes on, so that might be kind of normal but actually my feet are always cold. My fingers too.

If anything else bizarre happens (a rain of frogs, coworkers spontaneously combusting) I will attribute that to thyroid medication as well.

On the weirder side of things things that rarely happen to me, I'm getting a lot of sparklies in my vision. And I have a headache. A regular headache, not a migraine.

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As a follow-up, I've noticed that my internal cues have changed. Being hungry has involved a headache and sparkly vision instead of my usual shakiness and feeling bad mentally, being thirsty is more subtle, and being anxious (the cyclical kind of anxiousness I've been getting) has involved, variously, feeling spacy and like my hands aren't part of my body or feeling floaty, instead of a subjective feeling of anxiety. I'm also ravenous - hungry every 2 hours or so.

It's weird to have my longstanding internal cues change. I feel much more solidly grounded most of the time, though.

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Here is how the cycle works.

Body senses Hi/Low T4 (iodine complex) levels:

Interestingly T4 T3 only lasts about 4 minutes in blood circulation before it is grabbed and used up. Patients who have any form of thyroid surgery must be given supplements immediately at the end of the surgery because it is possible to go into adrenalin crisis within 30 minutes due to low levels from lack of T4T3.

Many times the docs will only check TSH levels when doing routine bloodwork. The fallacy of this is that you don't know the actual T4 level. Since I've been behind the power curve on thyroid levels with increasing demand, I've started demanding or checking the box myself on the lab order form.

a.m.

[edited to correct my sleep deprived brain and lack of recent review of thyroid]

4 minutes! jesus christ. do you have this in an online or text form where i can show this to my endo (shove it in her fucking face is how i was wording it in my mind) i had radioactive iodine back in november of 2005, and went officially hypo at the beginning of last march (TSH = 54) it has been over a year and i still have not reached a normal thyroid level (and this is with pushing my doctor every step of the way to increase cytomel, instead of synthroid) thyroid supplementation for radioactive iodine patients is a crock of shit shoved down our mouths by the drug manufacturesr, and checked off on by the medical community. pills can never match the balance achieved by an actual functioning organ. i went from being in perfect health thyroid wise on anti-thyroid drugs in june 2005 (a very low dose of tapezole) through a nightmarish rollercoaster of hyper and then hypo thyroid over the past two years. all for fucking what? nothing

sorry i wanted to vent. i've really been stressing about this issue ever since i switched to a compounded form of cytomel back in november, and my TSH levels start slipping back to hypo again. i was not aware of this though. i was on 200 mcg of synthroid and 25 mcg of cytomel (that i split up because it did NOT last throughout the day). my doctors office found a pharmacy that would compound cytomel, and i switched over to it, but a month later my TSH had gone up again. after adding 5 more mcg of regular cytomel did not help, my doctor wanted to pull me off of the compounded form and double the amount i was taking (which would have melted me literrally, that's twice the normal supplementation dose) plus uncompounded cytomel can be really hard on your adrenal system i read, and i definitely noticed a change when i switched back to the regular cytomel at a higher dosage. 25 mcg in the morning and 12.5 mcg at night just pounded my stress hormones. i was angrier, quicker to be moodier and depressed. it was hell, so i switched back to the compounded form, with 12.5 mcg of the regular but i still have not heard back from my doctor about this.

do you know that much about compounded medicine A.M., and how it would relate to how quickly the T3 is used up by your system. its compounded with methocel, or (hydroxypropylmethyl cellulose) which is supposed to be a gummy substance that takes 12 hours to break down by your body, but it obviously is not as effective as the regular cytomel. but i need something that will also not punish my adrenal system either.

sorry for the long winded thread hijack, i was just really shocked to see that T3 is used up so quickly by the body, although its what i suspected all along.

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My apologies for only half skimming this and then asking a question that is probably already answered somewhere in here, but I'm super-tired and have a lingering migraine...

Am I understanding correctly that it is believed that thyroid levels can be off even if blood tests show they are normal? The symptoms for high thryroid levels describe just about every single thing wrong with me (except I'm always cold, not hot), but my test results always come back normal. Then again, the symptoms of hypothyroidism describe a lot of things... including depression and ADD!

These are my last test results. I'm not sure why there are two different listings for T4. The results were printed like they were in an Excel spreadsheet and some of the text in each "cell" was cut off, so maybe it's for two different things related to T4. I don't know why there isn't a reading for straight T3.

Anyway... the only thing that's out of the normal range is FT4 (normal is 9-24).

FT4: 5.21

T3 Uptake: 1.07 Unit

T4: 5.57 mcg/dL

T4: 0.83 Nanogram

TSH: 1.76 mclU/mL

Any thoughts?

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