Search for T3 Only Doctor

The naturopath, who diagnosed my hypothyroidism and initially prescribed a T4 drug, later added a T3 drug, because T4 only didn't eliminate my hypothyroid symptoms. After a year of intermittent success with various combinations of T4 and T3, I decided to eliminate the T4 and continue T3 only, which my naturopath approved.  She continued to prescribe whatever dose of T3 which worked best work for me, even after I began taking 75 mcg of my T3 drug (generic liothyronine) in 3 divided 2 5mcg doses.  I continued that dose for 18 months while experiencing neither hyperthyroid nor hypothyroid symptoms. I also had no cold during the 2 of the 3 years I was on higher t3 doses.
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 However, after my ND saw my DEXA scan results, she recommended bone building supplements, biodentical HRT and a much lower dose of my T3 only drug. Her last recommendation was based on research that suggested that TSH is related to bone density.  Unfortunately, taking T3 only supplements often suppresses TSH, even when the T3 dose is very low.  Nevertheless, my ND recommended that I lower my T3 dose enough to raise my TSH to a 'normal' range, even though the doctor who oversees my ND does not believe TSH is an effective measure of thyroid function.


So during a few weeks in August 2014 I reduced my total T3 dose from 75 mcg to 37.5 mcg (still 3 divided doses).  That lower dose was where I started with T3 only in January 2012 and did well for over 6 weeks before hypothyroid symptoms returned.  After a month on 37.5 mcg T3 only, I retested my thyroid hormones (free t3, free t4, tsh).  Unfortunately, my tsh was still lower than normal, although a bit higher after a month of the lower t3 dose.


Then my ND asked me to reduce my t3 dose to 25 mcg and retest after a month on that dose.  At 25 mcg daily I acquired my first cold in over 2 years. That cold turned into a severe sinus infection, from which I finally recovered over 3 weeks later. Also I experienced all my typical hypothyroid symptoms (feeling cold, tired and constipated all the time, as well as being vulnerable to respiratory infections and having fragile fingernails that tore, split and developed vertical ridges).  My next blood tests at that 25 mcg level showed that my free t4 was still very low (I stopped taking t4 in early 2012), my tsh was still below normal although slightly higher and my free t3 was now below normal range.  My ND blamed the low ft3 result on the timing of the dose preceding the test (not close enough to the blood draw) and insisted I again reduce my t3 dose to 15 mcg total daily for at least 6 weeks and retest.  She sent me home with a prescription for that amount and a lab test order.




I initially reduced my dose to 18.5 mcg total daily t3 for awhile. However, I was so hypothyroid at that dose (and had found so many articles dismissing the value of tsh testing for free t3 levels), that I talked to my primary care doctor about my hypothyroid symptoms. She encouraged me to return to my previous 25 mcg total daily and gave me a prescription for 37.5 total daily t3 (6 months worth). After she talked to my naturopath, my PCP said I needed to see an endocrinologist for further thyroid treatment.  Unfortunately all endocrinologists in my 'network' required history from my previous/prescribing doctor (my naturopath) before they would see me. Because I couldn't get an appointment until the following year, I had time to change health care plans and find an endocrinologist who actually prescribed t3 medication.


I found online a list of doctors in my area who prescribed t3 supplements. One of those doctors actually practiced at a clinic covered by my plan.  However, he would no longer see medicare patients (perhaps  because medicare plans don't pay as much as private insurance plans). So I was referred to another endocrinologist in his clinic. The first appointment with that endocrinologist seemed to go well.  He ordered many blood tests, a 24 hr urine collection,  and a one month prescription for my current level of t3 supplement.  Rather than discuss my thyroid supplements, he focussed on testing me for hypoparathyroid problems which could explain my osteoporosis.  I already told him about my years of undiagnosed celiac disease and treatments for gut symptoms which exacerbated bone loss.


When all my hypoparathyroid tests showed normal levels, that endo strongly encouraged me to begain taking Forteo for osteoporosis,  despite resasearch which showed that drug causes bone cancer. Also the benefits of Forteo on increased bone density are only temporary.  I agreed to consider Forteo until I discovered it contained mannitol, to which I react with cramps, bloating and diarrhea, as I also react to sorbitol, xylitol, etc. So I called his office and reported my discovery and declined to take Forteo.  That endocrinologist also did not like my thyroid blood test results.  However, he never tested free t3, but preferred to test total t3, which says nothing about the amount of  biologically available thyroid.  He wouldn't even listen to my experience and research about t3 medication. I never saw him again.


Next I saw a new PCP, whom my previous naturopath had recommended as a more naturopathic medical doctor. She was affiliated with the same clinic as the endocrinologist whom originally I wanted to see.  That PCP seem very caring and attentive to my history about celiac disease, food allergies, and prescribed meds which influenced my osteoporosis. She even physically examined me (listened to my heart, lungs, intestines, etc.), which my previous PCP had never done. However, when I returned for a followup visit to discuss my thyroid history and medication, she said that she must defer to the endocrinologists in her clinic, because she was only a 'family medicine' doctor.  I gave her a handful of studies about T3 supplement use and problems with using TSH tests.  However, she recommend I talk to another endocrinologist.  I told her that I had wanted to see an endo in her clinic who supposedly prescribed T3 but he wouldn't see medicare patients.  So she agreed to call him and talk about my history. She later called me to say that he recommended I cut my T3 and add a T4 supplement in order to raise my TSH levels.  However, I had already tried T4 plus T3 supplements for over a year.  When my T3 levels were high enough to eliminate hypothyroid symptoms, even while taking some T4, my TSH was suppressed.  Been there, done that ...


My last hope was a new naturopath, who supposedly prescibed T3 supplements.  I had tried seeing traditional docs within my health insurance 'network', but the PCPs all deferred to endocrinologists who were focussed only on TSH test results, not my hypothyroid symptoms or lack thereof.  I wanted to avoid paying out of pocket for healthcare, because I already paid for my medicare healthcare plan.  However, I previously only received accurate diagnoses and treatment from  naturopaths.  Traditional doctors had misdiagnosed or discounted my symptoms of celiac disease, food allergies, hypothyroidism and gut infections. 


The new naturopath listened to my history and current osteoporosis treatment approach (nutritional and bio HRT) as well as treatment for hypothyroidism (T3 only).  I left her office with a prescription for my current level of T3 and 3 refills (enough for a one year supply).  She encouraged me to consider taking a T4 drug to raise my TSH level.  However, after reviewing my history with T4 and T3 combinations, I noticed that my TSH level was suppressed even when taking T3 and T4 drugs.  So I called her office to remind the naturopath to review blood test results from the year I was on both T4 and T3.  Adding T4 to my current T3 dose would just further decrease my TSH.  My TSH level had only been normal when my T3 was too low to eliminate hypothyroid symptoms.  That naturopath never called me back.  Nevertheless I have enough prescriptions for about 16 months of T3 only.  I really don't know what a suppressed TSH will do to my bone density.  However, I'll get another DEXA in September or October and find out.

Biodentical HRT

I never considered HRT after menopause, because I never had hot flashes or other postmenopausal symptoms. Thanks to having undiagnosed hypothyroidism, I was cold all the time and my blood pressure and pulse were 'nice and low' (according to my traditional PCP).I also didn't want to risk getting cancers associated with HRT. However, after I fractured my hipbone and had a DEXA scan, my naturopath suggested that I consider biodentical HRT, which was less likely to cause cancers.  Also Lara Pizzorno in "Your Bones" described how estrogen and progesterone help bone growth.  So 17 years after menopause I decided to try biodentical HRT for no more than 2 years.


My insurance company agreed to cover the Estradiol patch (0.05 mg/24 hr ptwk).  However they wouldn't cover the biodentical progesterone product, Prometrium (micronized 100 mg caps), one cap daily. My ND recommended that I take both the estrogen and progesterone products together to minimize side effectt. After my ND appealed twice, my insurance company agreed to cover Prometrium. So I started taking a daily prometrium capsule and wearing the Estradiol patch.


I had read that I would experience side effects. However what I experienced during the first five days seemed more like my typical food allergy reaction, than menstrual cramping pain.  After five days of intestinal cramping I rechecked the ingredients, which I foolishly assumed my naturopath had checked before prescribing to me, and found SOY (one of my diagnosed food allergies) among the inert ingredients.  When I confronted my ND, she said 'some of my patients react to the soy'. GRRRRR!!!! I ALWAYS react to soy with gut cramps, bloating, gas, diarrhea or constipation.


So I went off both the estrogen and progesterone for a week to let side effect symptoms subside.  Meanwhile my friendly compounding pharmacist created a compounded version of prometrium without soy.  So after a week break to recover from soy symptoms, I resumed taking my 'safe' prometrium and estrogen patch.  During the next 4 weeks I experienced many of the listed side effects for estradiol patch and prometrium, including breast swelling and tenderness, weight gain, abdominal bloating and tenderness, significant white vaginal discharge with no odor, and pretty severe reflux.


I could tolerate the other side effects, but I would not tolerate severe reflux.  I do NOT have excess stomach acid.  I actually have to take betane hydrochloride capsules to digest proteins and fats.  I don't want to take acid blocker pills or even biocarbonates, because I need stomach acid to digest all the calcium I take for bone health. So I stopped the HRT for another month to recover from all those side effects.


During the first 2 weeks after I stopped taking the estrogen and progesterone, the other side effects subsided, but I increasingly felt faint when I stood up. So I wondered whether I had low blood pressure and started checking my blood pressure and pulse regularly at local drugstores.  Initially my blood pressure was 86/56.  So I continued to check that every other day and noticed my pulse and blood pressure slowly rose back to normal (for me) over the next 2 weeks. When I talked to my ND after discontinuing bio HRT, she suggested I cut my dose in half. When I reminded her that the progesterone was a capsule, not a tablet, she suggested I stop taking the progesterone.  However I had recently read that estrogen raises blood pressure and progesterone lowers blood pressure. I knew I needed both for balanced blood pressure.
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I waited a few more weeks to overcome all the side effects before I asked my compounding pharmacist to show me how to accurately split the contents of each prometrium capsule.  That was a time consuming procedure, but I learned shortcuts as I went along.  Then one month ago I resumed half dose of estradiol patch (1/2 patch or 0.025 mg/24 hr ptwk) and 1/2 dose of compounded prometrium (25 mg capsule daily).  During the past 4 weeks, I experienced some breast tenderness and swelling and slight vaginal discharge, which seem to be diminishing now.  Actually I welcomed the breast swelling, which gave cleavage without wearing a push-up bra.  I began my second month today and hope the side effects really do disappear after the first month, but neither side effect is bothersome. Nevertheless, I will reassess the benefits of bio HRT after I see my next DEXA scan results.

OSTEOPOROSIS TREATMENT

After fracturing my left femoral neck (hip bone) last June 2014, I had a DEXA scan in mid August which showed pretty significant osteoporosis. Just getting an order for the DEXA was challenging. The doc substituting for my PCP (who was on maternity leave) insisted that a hip fracture already says I have osteoporosis. He wanted me to take Fosomax (side effects: jaw necrosis, spontaneous fractures and gastrointestinal damage) ASAP.  I convinced him to order the DEXA and postpone Fosomax until I saw the results. 


The naturopathic doc, whom I'd seen regularly for 5 years, freaked when she saw my DEXA results. However, she prescribed a great nutritional supplement plan, biodentical hormones and lowering my T3 supplement. She also recommended I read "Your Bones" by Laura Pizzorno and Jonathon Wright MD, who heads the clinic where I first met my ND. 


I had taken calcium regularly when I was younger, before I had hypothyroid symptoms (esp. constipation).  Then after my celiac and dairy allergy diagnosis, I tried to get calcium fron nondairy sources.  Obviously many years of undiagnosed and misdiagnosed celiac disease prevented me from absorbing calcium and other bone strengthening nutrients. So, despite my doing regular weight bearing exercise and lifting weights for years, I have significant osteoporosis now.  I knew I was losing height (I'm 2 inches shorter than when I was in my 20s), but didn't realize the extent of bone loss before my DEXA.


So after my DEXA and visit to my ND I started taking the following supplements: 

AlgaeCal 5 caps daily for 1250 mg total calcium (Per cap 250mg Ca, 22 Mg, 333 D3);

Magnesium 3-3/4 caps daily (Per cap 300mg Mg, 200mg K) plus AlgaeCal Mg;

Strontium 2 caps daily (680 mg for 2 cap) 3-4 hours after calcium;

Vitamin D3 (1000 IU per tab) 1-1/2 tabs daily (plus Algae Cal which also contains D3);

Vitamin K2 (100 mcg per cap) 1 cap daily;

Vitamin B Complex (includes 80mg Niacinamide, 400mcg Folate, 600mg B12) 1 cap daily;

Vitamin B (balanced B 100) 1 cap daily;

Niacinamide (500mg per cap) 1-2 caps daily for thumb joint and elbow arthritis;

Vitamin C (500 mg per cap) 2 caps daily;

Vitamin E (400 IU) 1 cap daily;

Zinc (30 mg tab) 1 tab daily 

Custom Probiotics Adult CP-1 Formula (50 billion live cells per cap); 1 cap daily;
IAG (arabinogalactans) 1 tsp dissolved in 6 oz water daily (2 g arabinogalactans) for immunity;
Betaine Hydrochloride (650 mg per cap) 2-4 caps per meal w/ fats and protein for hypochloridia

I also do weight bearing exercise (walking, jumping and lifting weights, as well as pt exercises to strengthen my hips and back) daily.

I'm still taking all those supplements and doing well.  However, I had to battle my insurance company to get biodentical hormones.  I also had to find a doc who would give me an effective level of my thyroid supplement.  Neither too little or too much thyroid hormone is good for bone health.  However, I'll describe those battles in another post.

I suspect this post will make me  vulnerable to loads of comments, criticizm and suggestions by posting my osteoporosis treatent supplements. However, I'll try to respond to every comment, unless it's really an advertisement for drugs for osteoporosis, which I will immediately delete and/or block. Nevertheless I'll reply to questions about treatment and my experience with supplements.