thyroid question

interesting you mention the t3 making you feel mentally sharper and that a tsh of 1 feels best. i was on a .75 levoxyl + .0125 cytomel when i was able to train at what i considered a normal level. i stopped taking the cytomel but increased the levoxyl but that is when i started the slow, dowhill spiral.

i just told my doc i want to go back on the levoxyl/cytomel combination again. I've done a bit of reading and i found a study where they cut open rats with no thyroid after being given t4 alone and in conjunction with t3(cytomel) and found that.. "T4 levels were normal in groups infused with thyroid hormones. On the contrary, T3 in plasma and most tissues and plasma TSH only reached normal levels when T3 was added to the infusion". it's a long, detailed article that i haven't read very thoroughly but muscle tissue is one of those tissues where the t3 was low. i suspect this could lead to decreased recovery.

one more question...do you know if hashimotos is harder to control than a non-autoimmune type? in other words, do your TSHs and t3s tend to vary more?

i found a study where they cut open rats with no thyroid after being given t4 alone and in conjunction with t3(cytomel) and found that.. "T4 levels were normal in groups infused with thyroid hormones. On the contrary, T3 in plasma and most tissues and plasma TSH only reached normal levels when T3 was added to the infusion".

Can you post a link to this article if it's on the web. Thanks.

it's not on the web but here is the referece if you are at a university that carries the journal "Endocrinology":

Escobar-Morreale, HF, Escobar del Ray, F. etal. "Only the combined treatment with thyroxine and triiodothyronine ensures euthyroidism in all tissues of the thyroidectimized rat. Endocrinology 137(6), 2490-2502.

if you learn anything, please share. i haven't had time to thoroughly read this and i don't have much of a science background so it's a slow read.

Thanks!

Do Dr. regular consider t3 therapy? My dr never suggested this. Does your t3 need to be way out of whack to get therapy?

Prescribing T3, Cytomel if you will, is controversial. Not amongst those who take it mind you, but amongst the endocrinologists and internal medicine docs who can prescribe it.Most practicing physicians were trained to prescribe T4 only - and that the body will convert T4 to T3 as needed.Studies have supported this theory in general, except one area of the body in particular does a poor job of converting T4 to T3. The brain.This is probably why the body produces T3. If converting T4 were enough, why would our body produce it?The natural thyroid hormone replacement, Armour, contains both T4 and T3. This is why many thyroid patients prefer it. The challenge with taking Armour is getting the proper T4/T3 ratio. With the Synthroid and Cytomel pills you can make adjustments to find the proper mix.My experience indicates that I know much more about thyroid disorders than the physicians that have been visited. Read, converse, and learn about it. Then be very assertive about what you want to do and find the doc who will work with you. Younger docs are generally more flexible and will be more apt to prescribe Cytomel. Some older docs can be paternalistic and condescending - implying you are a head-case or foolish. Don't buy it. Only you know well you should feel.For the record I take 125 Synthroid and 10 Cytomel units daily. Always at the same time relative to when I eat. Think of Cytomel as fast acting, fast to disappear. Synthroid hangs longer in the system. I believe roughly half of it leaves the system daily. This is why you will feel okay if you forget to take the pill for a few days. Some individuals take Cytomel more than once a day to address the short lasting effect it has on the body.I know of no doctor who uses the Free T3 number to analyze whether or not you need Cytomel. I would suggest stepping down from 75 units of Synthroid, to 50 units and offsetting the reduction with 10 units of Cytomel. Strangely, Cytomel doses are available in 5 unit pills, and the next lowest dosage is a whopping 25 units! So go for a big order of five unit pills and take multiple pills per day. With the increase in drug copays and deductibles, push for 90-day prescriptions, and mail order it if possible. Beats standing at the local pharmacy every month and can reduce your copays as well.

avgjane wrote:

Do Dr. regular consider t3 therapy? My dr never suggested this. Does your t3 need to be way out of whack to get therapy?

I stated taking cytomel because i have raynauds. i found several studies that found high doses of t3 was alleviating the raynauds symptoms. i gave my doc all of my literature and told him that rather than do high doses of t3 over a short period of time like the studies, what about trying to add a low dose of t3 to my levoxyl. so, i was taking .75 levoxly and .125 cytomel (i cut the .25's in 1/2). i suspected that it would also help my recovery since there is a graph in an exercise phys book that shows t3 decreases steadily with exercise time. my thought is that if you are hypothyroid, it would be difficult to have the t3 come back to normal after exercise. this combination let me train more than i had in years-but i didn't realize that at the time. i decided that since it wasn't helping the raynauds, i could drop the cytomel and go on a 1.00 levoxyl. that was late last fall and i slowly started falling apart -chronically overtrained doing less mileage and my hamstrings just don't recover.

on my last tsh lab sheet, i marked the free and total t3 box - if you are hypothyroid then this is a legitmate test to have and insurance will cover it even though the doc tends to not to think of marking it. the low end of normal is 210 and i was 208. of course, the doc didn't call me and say "you are slightly below normal" - they just figure that being slightly below doesn't matter. but based on this, and the fact that my cholesterol went up 20 points in the past year, i just went back to the 75 levoxyl 12 cytomel combination this week. we'll see what happens in a few weeks.

i've talked to a couple of medical people about this and one states that the norms of what the thyroid hormones are supposed to be are based on sedenatary people and that we don't have established norms for athetetes. edurance exercise puts more demands on your thyroid than being sedentary so my theory is that we need to be at the high end (or low on tsh) of all of the thyroid values in order to maintain a training pattern. i'm talking with a sports medicine doc on monday who is has a reputation of having lots of insights on this type of thing. i have all my literature and my labs and i am going to ask him a ton of questions.

if there is anything you want me to ask, let me know.

So you have Reynaud's too. It also is an autoimmunity health issue. I had ecsema and was unaware it was an autoimmune problem. It appears once an autoimmune issue occurs, the liklihood of inurring more of them soars.

My father who has Graves disease, also has Reynauds. I didn't realize T3 could potentially assist those with Reynauds.

It's my hunch that people like us who develop Hashimotos, possess a genetic tendency toward it that is somehow triggered. A virus, serious physical stress, maybe by something else. I pushed myself very hard at a young age and somewhere along the line my thyroid came under attack.

I'm not sure how much it impairs the performace of an endurance athlete, but my tip off came when my performance decreased with increased training. A former college runner putting in 3,000 miles per year, I started going backwars at six miles per day. It is an insidious problem because elite athletes tend to push their limits. They must believe more training and more effort equals better results. Undiagnosed Hashimotos plays hard on the mind because at the margin more effort equals lower performance.

I'm not sure how long you have been medicated. But my body had a real hard time the first year. Ingesting hormones is serious business. Changing your protocol takes time before knowing whether or not it is effective. The patience of Job is needed.

Hang in there and good luck with it.

i have a hunch that my raynauds came on because i was hypothyroid and continued to train and had an experience with some pretty extreme cold. about 3 months before i was diagnosed hypothyroid, i climbed a mountain in mexico and my toes went numb on the ascent. this wasn't a big deal except that i didn't get feeling back in them for months. did some snow camping a couple months later and my hands hurt so bad that i almost puked. finally, on a 60 degree day riding home, i noticed them going white. i finally went to the doc and said that i think it's hypothyroidism (runs in my family). i'd been falling apart running-wise for 4 years by the but it took a series of things to make me suggest testing (i was told they generally don't test people who are not overweight-but i found my appetite decreased so i would loose weight).

you're so right about it messing with your head. that's the hardest part. you don't know whether you should push it more and when you start feeling that fatigue from training, you don't know whether it's just fatigue or your whacked out again.

but, my point is that i think the hypothyroidism was there, i pushed too far, and that was how my body reacted. i gotta wonder if that is how autoimmune disorders get going. i didn't know that once you have one, you are susceptible to others. do you have a positive ANA? mine is sky high so they sent me to a rhumatologist who told me to wear a hat to keep warm...grrrh. i've been getting more info on letsrun than from the docs! but i do have a ton literature now. i'll send you the abstracts i have if you want.

good luck to you too.

Dear 2slow:

There have been many threads on this topic but your replies have by far provided me with the most useful info. I was diagnosed as hypo 4 years ago and have been seeing my doctor regularly with annual blood tests once I got into "normal" range. Last night I pulled my most recent lab results and found that my TSH was 4.3! I poked around some more on the internet and am CONVINCED that I am undertreated. Actually, I've been telling my Doctor that I supected that was the case for quite a while. So, either she starts working with me or I find another Doc. Thanks for the info- it got me to pull my head out of the sand real quick!

RB

I agree. These posts have been the most informative since I was diagnosed. I have been hard pressed to find information about hypo issues and endurance athletes. I see my dr. next week and I plan to bring these points up.

Actually, the person I see is a nurse practitioner and former triathlete. The only reason I eventually got my thyroid problem diagnosed is b/c my regular dr. couldnt see me and I had to make an appointment with the practitioner. My regular dr. kept poo-pooing my symptoms (I originally thought I may be anemic). When the nurse practitioner heard I was a runner he ordered a full work-up and looked at my levels in the context of an endurance athlete.

I'm not sure when exactly my symptoms started, but I have wondered if running contributed to my auto-immune problems (I have hashimoto's). I have also have waxing and waning aches and pains that I have wondered were auto-immune based.

all came after a jump in my training (and stress of my lifestyle).

I had a friend develop chrone's disease (auto-immune related) and rhuematoid arthritis after a jump in cycling training and after her first 100 mile ride. I have heard of other endurance athletes developing auto-immune problems as well.

My theory is there is critical threshold for you body to tolerance chronic stress (be it training or other stress). The body eventually responds to the constant stress (the constant elevated stress hormones like cortisol, and physical damage of training) and viola, and auto-immune disorder starts. It doesnt happen to everyone, just those that subject themselves to constant stress and those that are genetically pre-disposed. I havent read anything that confirms this, just a theory - I'm not a dr.

I try to make sure I balance training and recovery, keep up on my sleep, and keep stress in the rest of my life in check. I took my diagnosis as a red flag to keep everything in balance.

Thanks for the Reynauds info. I'll be talking to my Endo about it. A few weeks ago I got my levoxyl dosage adjusted to hopefully correct my undertreated hypothyroid condition. Well, now the dosage is too high so my heart rate is elevated, I can't sleep, etc. The weirdest thing is that I have so much energy that I'm almost manic but I'm tired at the same time because of lack of sleep. I'll be calling the Endo tomorrow to try again. This just sucks. My doc has not ruled out t3 therapy but is waiting until my next blood test to see where those levels are and I'm fine with that.

Yes, an underactive thyroid can lead to muscle strains and fatigue. I found myself constantly fighting calf strains, even though I stretched them quite a bit. I was also finding myself falling asleep @ 8:30-9:00pm every night. I thought it was due to being over 40 years old. During the course my annual over 40 physical (all men over 40 need to get their prostrate checked annually), I had blood work done and they found out I had an underactive thyroid (I don't remember if it is hypo or hyper). I started on .5 mg of sythroid, daily, and I immediately felt like I had new energy and my calf problems went away. Get your's checked, the medication is relatively inexpensive and it will change your life!

my hunch on the way the process works is that

1. You are hypothyroid but don't know it. you continue to train even though you get hurt, are overtrained, are tired and cold and don't feel like running - but you fight through it anyway cause you assume you can handle it and it'll get better.

THEN

2. The stress of training without the thyroid levels to recover then causes the autoimmue disorder.

it's the order of the way it was for me. after treatment, i could tell that i'd been running on low thyroid for several years. the hamstring issues went away and i just felt better. i wish there was a more objective symptom to warrent testing. the symptoms of cold, fatigue etc just scream WIMP!!

btw - how did they find out you had hashimotos as opposed to hypothryoidism due to something else?

hey runnerbabe,

did you happen to find some published lit on what your TSH *should* be rather than "below 5.00 and you're fine". i've seen 1.00-2.00 cited it's from websites that seem to be pushing "if you are overweight, it's not your fault - you have a thyroid problem"...kind of thing. i am looking for an article in a medical journal that did a real study and found that endurance athletes should be between xxx and xxx in order to maintain a regular training program.

i would like to see some drug company do come up up with an automatic dosing system that could be set to make sure your t3 and t4 are always at a level that keeps your tsh at this xx level. they are working on this for insulin (insulin pump) so the technology is there in some respect. but, there needs to be better data on what that optimum level is.

Man, that would be nice.

I'm still trying to figure out my correct dose. I take a combo of t4/t3. I went over the top for a while and thought I was losing my mind. Myt doctor dropped it back and I started to come around. Now, my Doc has cut the t3 to see what happens and I can barely run 20 mins without feeling like I'm in the finishing straight of an 800m! It's crazy, when the dose is right you feel like superman, strong focused, excited to run but when the dose is wrong you feel like you haven't slept in 2 days, the whole world falls apart.

I wonder though how "correct" the dose needs to be in order to run at full potential.

i just started back on the t3 last week and i'm curious to see if this really was what was helping me train last summer. you sure said it "when the dose is right you feel like superman, strong focused, excited to run but when the dose is wrong you feel like you haven't slept in 2 days, the whole world falls apart"..

it's sure nice to get some verification that i'm not whacked. i'm so afraid of using this as an excuse for not running well and wanting to sleep as much as possible.

"I wonder though how "correct" the dose needs to be in order to run at full potential."

i just don't think there are any data out there on what the correct levels are supposed to be because everything is geared towards "normal"...running alot isn't normal.

it makes you always wonder whether or not you ever have run to your potential.

I got a full blood work up b/c I was feeling like crap and racing like crap, despite good quality training.

Results came out high on TSH (6+). My doc said "well it's not THAT far out of normal so you may not want to medicate". My response was "give me the damn pills".

I got a full thyroid workup t3, t4, tsh, and a test for anti-thyroid antibodies ( which shows your body is attacking your thyroid). My antibodies were through the roof, resulting in a diagnosis of hashimoto's a common cause of hypothyroidism.

My t3, t4 numbers werent that bad. t4 was borderline. I am on a minimal dosage (for the past 3 months). Textbook, I could probably be considered subclinical hypothyroid due to hashimoto's.

I suspect I will need to continue to monitor to make sure my thyroid function does not decrease due to the hashimoto's. I have read that synthroid helps stop or slow the autoimmune response.

Just got my tests back. In the past three months my TSH has been cut in half (about 3+) and my t4 is at 1.3 up from 1.0. I am hesitant to increase the dosage so soon (as the thyroid is a slower responding gland). My dr. didnt recommend an increase. I continue to wonder if I should be shooting for 1 - 2 TSH.

I had a few days I felt hyper thyroid b\c as I adjusted to the synthroid and I thinks it's worse than being hypo. So I decided to wait to ask for any adjustment.

I realise that this is a very very seriois matter and I have great admiration for those that are taking the best steps to recover and esp do serious sport.

But out of interest, has anyone checked if any of the drugs used are banned or could be said to be related and thus could be banned.

Again well done on those taking charge of their lives and making progress.