Thursday, March 24, 2011

Juggling Thyroid Hormones

After many years of hypothyroid symptoms, I finally found a doctor who tested more than my TSH levels. However, those had been higher than normal since the TSH normal scale was revised downward in 2003. Unfortunately, my HMO neglected to advise their docs to revise their TSH normal scale. So my hypothyroid symptoms progressively increased along with my TSH level during the past 10 years. I felt progressively more fatigued, I felt very sensitive to cold temperatures and I needed 900 mg of magnesium to stay somewhat 'regular'. However for me 'regular' meant a daily bowel movement, which was harder than normal, with frequent inflamed and/or bleeding hemorrhoids. (I had hemorrhoid surgery in 1999, but more hemorrhoids developed during the past 10 years.) My daily fatigue crisis usually occurred in late afternoon. So I often craved and binged on sweets in my attempt to get some energy to function for a few more hours. I also lost the outer third of my eyebrows, which I later learned was a hypothyroid symptom.

However, last June I saw a new naturopath who tested me for anything that could have influenced my 8 gastrointestinal infections during the previous 4 year period. One test for thyroid hormones showed the my TSH was higher than normal and my free T4 was low normal. So she prescribed a T4 supplement. I chose Levoxyl, because it didn't contain any of my allergens. However after 3 months on Levoxyl I still did not notice much decreased hypothyroid symptoms. I still felt cold, tired and constipated. So my doc told me to increase my dosage from 50 to 75 mcg daily. That increased dose caused hyperthyroid symptoms of tachycardia, palpitations, sweating and diarrhea. I didn't mind the diarrhea, but I certainly worried about tachycardia. So I abstained from thyroid supplements until those hyper symptoms disappeared and returned to my original 50 mcg dose and my hypothyroid symptoms.

My experiences with T4 (all or nothing symptoms) made me wonder whether I had difficulty converting T4 to T3. T4 is the 'carrier' hormone, but T3 is the 'worker' hormone which controls various metabolic functions. Because T4 is converted to T3, the body usually makes less T3 than T4. However, if people can't convert T4 to T3, T4supplements won't resolve their hypothyroid symptoms. So I asked my doc to request blood tests for free T3, total T3, free T4, total T4, TSH and TPOab (Hashimoto's antibodies). Those tests showed that my free T3 was very low, my T4 was normal, my TSH was low normal (good) and Hashimoto's antibodies were high normal.

So my doc prescribed a T3 supplement, generic Liothyronine, which was free of my allergens. The combination of 10 mcg of Liothyronine and 50 mcg of Levoxyl resolved all my hypothyroid symptoms. I was 'regular', warm and energetic.

I did well for a few weeks on the T3/T4 therapy UNTIL I began taking LDN (low dose naltrexone) to increase my white blood cells (immunity). LDN positively affects all autoimmune diseases, including Hashimoto's thyroiditis. So within 3 days of starting LDN I again experienced hyperthyroid symptoms (overheating, palpitations and diarrhea). LDN had decreased my need for so much thyroid supplement by decreasing Hashimoto's antibodies (which damage the thyroid and decrease its production of hormones).

Because I needed the LDN to treat mild neutropenia, I decided to abstain from the T4 supplements, because I don't easily convert that anyway. That immediately resolved my hyperthyroid symptoms. I returned to my normal 'warm, energetic and regular'.

However, another blood test showed that my vitamin D levels were higher than normal. One of the results of vitamin D overdose is constipation, because vitamin D uses magnesium. Because magnesium keeps the stools soft, I take daily magnesium. Nevertheless, I noticed I became progressively more constipated, before I saw the vitamin D overdose test results. So I immediately abstained from vitamin D supplements. Yet the severe constipation continued and my hemorrhoids bled daily.

So I took more magnesium and a bit more T3. (I cut my liothyronine tablets into small pieces so that I could take 1-2 mcg more than my original prescription.) About that time I got a very bad sinus infection. So I also took more vitamin C. All those extra supplements helped resolved the constipation. However, I had to just wait for the excess vitamin D to leave my body, which stores extra vitamin D in the muscles.

For 2 months I juggled extra supplements (T3, C and Mg) to counteract the constipating effect of excess Vitamin D. Then I began to notice softer and softer stools. So I cut back on the C and Mg and still had normal stools. I believe that I finally have normal levels of vitamin D in my body. However, I won't take any supplemental vitamin D until I see the results of my next blood test, which I'll take after I finish my LDN prescription.

Now I'm enjoying the effects of just enough T3 (feeling consistently warm, energetic and regular). However, I take T3 twice daily, because it has such a short half life (8 hours). I need to take the first dose when I wake up, but can't eat breakfast for at least an hour after that dose. Then I need to wait 3 hours after the T3 dose before I can take Magnesium supplements. Because I take Mg with breakfast, I had to wait 3 hours to have breakfast, until I realized I could just take the Mg after breakfast.

Nevertheless, I still 'crash' before my afternoon T3 dose takes effect. I usually don't get hungry for lunch until 4 hours after breakfast. Then I have to wait an hour after eating, before I can take my afternoon T3 dose. By that time 8 hours have passed since my morning dose. However, I don't feel the effect of the second T3 dose until 2-3 hours pass. That causes me to 'crash' with low energey and feeling cold until the second dose increases my thyroid hormone levels. I'm working at getting my breakfast earlier (and taking Mg after breakfast) so that I can get lunch earlier so that I can take that 2nd thyroid dose before I totally crash. Nevertheless, I still 'crash' every afternoon. At least I now understand the cause of the crash so that I don't believe bingeing on sweets will resolve my energy crisis. So I plan relaxing activity (like checking emails) during my low energy time.

After I finish the LDN (about 2 more weeks), I may ask my doc for another Levoxyl prescription, but at a lower dose. Even though I don't easily convert T4 to T3, I do convert some. Since T4 levels rise slowly and decrease slowly, I didn't begin to get the afternoon energy crash until after I abstained from T4. So perhaps a lower dose (25 mcg) T4 combined with my current T3 or maybe a higher T3 morning dose could prevent my afternoon energy crisis.

Wednesday, March 23, 2011

I LOVE Spring!!

Last Saturday we had warm, sunny weather after a long dreary, rainy spell. So my husband planted peas, carrots and lettuce. I planted kale seeds and brocolli starts. I was still struggling with that sinus infection. So I didn't stay outside very long that day.

However, today we have 60+ degree weather. I'm wearing sandals, boot cut khakis and one of the many boatneck knit tops I made from a favorite pattern earlier this year. (Once I get a pattern altered to fit, I tend to use it over and over.) I believe I made 5 tops from different colors and patterns of knit fabric from that pattern. I also made matching A-line skirts for 2 of those tops. I'm so glad to have weather warm enough to shed heavy sweaters, skinny jeans, thick sock and running shoes.

I plan to plant new parsley and clean out my herb garden (deck pots) this afternoon. Then I will prune the blueberry bushes and all the roses damaged by last winter's cold weather. I'll wait to plant tomato seeds, because I can't really set out the plants until May. Also I need to wait until May or so to plant green beans and crookneck squash. I hope we have a few warm days this month so that I can clean out the strawberry beds and topdress them with organic mulch.

Best of all I'm almost recovered from that awful sinus infection. I still have a tiny bit of congestion, but don't feel like I have an infection any more. I also suspect the excess vitamin D in my body (which caused constipation) has finally decreased to a normal level, because I no longer need extra magnesium and/or vitamin C for regularity. I'm just taking a normal (for me) amount of vitamin C and magnesium and my regular thyroid (T3) dose 2x daily. I'm trying to change my daily schedule to enjoy as much daylight as possible by getting up earlier and eating meals earlier. That also allows me to take my afternoon T3 dose earlier. Eventually I'll be able to take that afternoon thyroid dose BEFORE I crash. LOL

Finally I will resume full dose LDN (3mg) tonight. I tried that 2 nights ago and slept okay. So I took my last 2/3 LDN dose last night. I will take the rest of my full dose LDN capsules nightly for the next 16 days. After I finish that prescription I'll need to have another blood draw to test my white blood cell (esp. neutrophils) level to verify whether LDN actually improved my immmunity. At this point I really don't know, because I still got that awful sinus infection after almost 4 months of LDN. I'll also requests tests for vitamin D and thyroid hormone levels (T3, T4, TSH and Hashimoto's antibodies) from that blood draw. Of course, my doc will actually have to request the blood draw order from my HMO clinic.

Monday, March 21, 2011

Recovery??

I finally recovered from that cold/sinus infection after almost 10 days of symptoms. Getting that respiratory infection makes me really wonder whether the LDN improved my immunity and raised my neutrophils. I have one 2mg capsule and 15 3mg capsules remaining of my 3 months LDN prescription. Because I divided those capsules into smaller doses (from 3mg to 2 or even 1.75 mg), my prescription lasted more than 3 months. However, I really won't know whether LDN improved my white blood cell level (and immunity) until I take another blood test after I finish my prescription. Meanwhile I plan to begin taking 3mg capsules tomorrow night. I also will try to take my afternoon T3 dose before 4pm, since both T3 and LDN can disturb sleep. If I take the T3 early enough, I may still sleep soundly, despite increased LDN.

I also wonder whether my vitamin D level has decreased enough to be in the 'normal range' and not cause overdose related constipation. I stopped taking extra Vitamin C and/or magnesium a few days ago, after I felt more recovered from my respiratory infection. I took Vitamin C for that infection, but extra vitamin C also helped with regularity. Also I continue to take 1-2 mcg extra T3 with my morning dose, because thyroid supplement also helped resolve irregularity when I had too much vitamin D in my system. However, I still feel bloated and crampy, like I take too much magnesium or maybe too much T3. Nevertheless, I'll wait and see what happens during the next few days before I reduce my T3 any more.

Sunday, March 13, 2011

Another Bad Cold/Sinus Infection

For awhile I seemed to control cold symptoms with my arabinogalactin (Biotiks IAG). I would get symptoms, take my IAG and then experience no symptoms for 12 hours or so. During a couple of days I didn't have any cold symptoms. However, once again I have a really bad cold and/or sinus infection. I really needed sleep last night. I expected to just sleep in, because we set the clocks forward, making daylight later.

After tossing and turning for about 30 minutes to find a position where I could breathe with my stuffy nose, I awoke 5 hours later at 4:30am, because my sinuses were so congested that I could hardly breathe. Eventually I got up, took my arabinogalactin, which clears my sinuses within 30 minutes, and began breathing more easily. However, my sinuses were so inflamed from this infection that every breath was painful. So I couldn't get back to sleep.

An hour later I decided to take some Tylenol for the sinus pain so that I could sleep. Eventually (30 minutes later) I could breathe without pain and went back to sleep. However the light woke me up again after about an hour of sleep. As tired as I was, I gave up, got up and hoped that being upright would reduce my congestion.

When I got up, I felt really hungry. So I went downstairs and ate an orange, which I always crave when I have cold. 2 hours later I had a regular breakfast of blueberries and peanut butter on an English muffin half. Hopefully blueberries will improve immunity.

Now I feel exhausted and sick, but I don't want to go back to bed. Being horizontal prevents me from breathing, because my congestion worsens. So I'm in another vicious cycle situation. I need sleep to overcome this cold, but my sinuses are so congested that I can't breathe when I lay down. I suspect I'll fall asleep sitting up during the sermon at church tonight. I've been sick so often during the past 9 months that I haven't heard many entire sermons. SIGH

Saturday, March 12, 2011

Still Need Extra T3 and Mg

I'm still taking extra T3 (liothyronine) and sometimes extra magnesium to prevent constipation. (When I cut back, the constipation returns.) I only need about 1-2 mcg more T3 for a total of 11-12 mcg daily (vs. my original 10 mcg). I sometimes take a little more (150 mg) magnesium (in addition to my normal 900 mg daily). If I have a bad cold, I take more vitamin C. However all those additions can cause intestinal cramps. So I suspect I still have higher than normal levels of vitamin D, which causes constipation. Nevertheless, even 12 mcg of T3 is much less than I took before I started LDN. I was doing well with 50 mcg of T4 (Levoxyl) and 10mcg of liothyronine, before LDN enhanced the effects of my thyroid supplements and cause hyperthyroid symptoms. Since I have difficulty converting T4 to T3, I opted to just drop the T4. My doc didn't mind my T4 levels being low, because my hypothyroid symptoms were controlled by the T3 ... UNTIL I overdosed on vitamin D.

So I still get constipated if I don't take extra T3 and magnesium. I wonder how long vitamin D can stay stored in my muscles?? My doc said reducing Vitamin D to normal levels can take months. I've abstained from vitamin D less than 2 months now. Oh well, I don't need to waste $$ on vitamin D supplements, because I have soooo much extra in my body. That doesn't seem to help my immunity much. With ongoing neutropenia, I still get frequent respiratory infections. So I'm also still taking LDN and hoping that will improve my immunity.