01-25-2004, 01:22 PM #1
T3/T4 Side Effects - From A Doctor
Potential Side Effects
If someone has blockages in the arteries that feed the heart and is on the verge of a heart attack, taking thyroid hormone can trigger a heart attack or angina, just like exercise could. Thyroid treatment can trigger heart palpitations as well. These are usually benign, but atrial fibrillation is possible. Because of this concern, and because using T3 or treating for hypothyroidism with a normal blood test is still controversial, I often recommend that patients at significant risks of angina--people who smoke, have high blood pressure, are over forty-five years old, have cholesterol levels over 260, and a family history of heart attacks in individuals under sixty-five years old--have an exercise treadmill test done before treatment, even if they can't complete the test.
To put the risk in perspective, in the many hundreds (and perhaps thousands) of patients that I have put on thyroid, I don't remember any having a heart attack or dangerous problems from taking it. In the long run, I suspect thyroid treatment is more likely to decrease one's risk of heart disease by lowering cholesterol.
The other main concern is that excess thyroid hormone can cause osteoporosis (bone thinning). In my research, I have seen no studies showing any increase in osteoporosis in pre-menopausal women if one keeps the Free T4 thyroid blood levels in the normal range. I do not consider TSH to be a reliable monitor of thyroid levels in CFIDS/ FMS because of hypothalamic dysfunction. We don't know for sure if keeping the T3 level above normal in FMS patients with thyroid resistance worsens the osteoporosis already commonly seen in CFIDS/ FMS, but this has not been a problem. If you need to keep T3 or T4 above the upper limit of normal, you should consider a DEXA (osteoporosis) scan each six to twelve months. If this is showing osteoporosis, lower the thyroid dose. If this is not possible, consider other osteoporosis prevention measures.
Below is the section from the preprinted treatment protocol we use with our patients. The full treatment protocol with over 150 treatments listed by category can be seen at www.endfatigue.com. Click on the "treatment protocol" link (on the far left, bottom button). If you would like a free copy of the file with the complete treatment protocol and the patient questionnaire, which you are welcome to use in your practice (both of which will save you an incredible amount of time), feel free to e-mail me at: email@example.com
01-25-2004, 01:25 PM #2
Main Risks Of Thyroid Treatment
1. Triggering caffeine-like anxiety or palpitations. If this happens cut back the dose and increase by 1/2 to 1 tablet each 6 to 8 weeks (as is comfortable) or slower. Sometimes taking vitamin B1 (thiamine) 100 to 200mg a day will also help.
2. Exercise (i.e., climbing steps), if one is on the edge of having a heart attack or severe 'racing heart' (atrial fibrillation), thyroid hormone can trigger it. In the long run though, I suspect thyroid may decrease the risk of heart disease. If you have chest pain, go to the emergency room and/or call your family doctor. It will likely be chest muscle pain (not dangerous) but better safe than sorry. To put it in perspective, I've never seen this happen despite treating many hundreds of patients with thyroid. Increasing your thyroid dose to levels above the upper limit of the normal range may accelerate Osteoporosis (which is already common in CFIDS/FMS). Because of this, you need to check your thyroid (Free T4--not TSH) levels after 4 to 8 weeks on your optimum dose of thyroid hormone. All this having been said, we find treatments with thyroid hormone to be safer than Aspirin and Motrin. If you have risk factors or Angina, do an exercise stress test to make sure your heart is healthy before beginning thyroid treatment. These risk factors include: 1. Diabetes, 2. Elevated cholesterol, 3. Hypertension, 4. Smoking, 5. Personal or family history of Angina, 6. Gout, 7. Age over 50 years old.
There are several forms of thyroid hormone, and one kind will often work when the other does not. Do not take thyroid within 6 hours of iron or calcium supplements or you won't absorb the thyroid.
Synthroid (Rx)--(L-Thyroxine) 50mcg--(100mcg=.1mg)
* Armour Thyroid (Rx)--30mg (1/2 grain = 30mg) (natural thyroid glandular). If (Cortef) is checked, begin the Cortef and/or adrenal support 1-7 days before starting the thyroid.
For each of these 3 forms, take 1/2 tablet each morning on an empty stomach for 1 week and then 1 tablet each morning. Increase by 1/2 to 1 tablet each 2 to 6 weeks (till you're on 3 tablets or the dose that feels best). Check a repeat Free T4 blood level when you're on 3 tablets a day (or your optimum dose) for 4 weeks. If okay, you can continue to raise the dose by 1/2 to 1 tablet each morning each 6 to 9 weeks to a maximum of 5 a day and then recheck the Free T4 4 weeks later. Adjust it to the dose that feels the best (lower the dose if shaky or if your resting pulse is regularly over 88/minute). Do not go over 5 tablets a day without discussing it with your doctor. When on your optimum dose, you can often get a single tablet at that strength. If your energy wanes too early in the day, you can also take part of your thyroid dose between 11 a.m. and 3p.m. OR Iodine--1500mcg a day for 2 months (if you have daytime body temperatures under 98.3 degrees). May flare Hashimoto's Thyroiditis.
Thyroid Glandulars--mg capsules in the morning and at noon. Thyroid L-Tyrosine by Enzymatic Therapies or Thyrosine Complex by PhytoPharmica. Take 1-2 capsules up to 3 times a day.
Desiccated Thyroid--130mg from www.nutri-meds.com--it is over-the-counter. 1/2-2 tablets each morning (caution--contains active thyroid hormone. Use only under a doctor's supervision).
Thyrolar (Rx)--1/2 (this equals T4 25mcg plus T3 6.25mcg)
* Cytomel (Pure active T3) (Rx)--5 and 25mcg tablets. Using this treatment is controversial, but can be very helpful. In Fibromyalgia, resistance to normal thyroid doses may occur and patients often need very high levels of T3 Thyroid to improve. Dr. John Lowe's research group feels that the average dose needed in FMS is 75-125mcg each morning--much higher than your body's normal production of 25 mcg/day. Because we are often going above normal levels with T3, the risks/side effects noted above increase. Because of this, if you have risk factors, it is more important to consider an exercise stress test to make sure your heart is healthy (i.e., no underlying Angina) before beginning this protocol. Also, consider a Dexa (Osteoporosis) Scan each 6 to 18 months while on treatment. There may be initial bone loss the first year, then increased bone density. This having been said, in our experience this treatment has been quite safe and, in some FMS patients, dramatically effective. Begin with 5mcg each morning and continue to increase by 5mcg each 3 days until you're at 75mcg a day and then increase by 5mcg a day each 2 to 6 weeks until (whichever comes first):
1. You reach 125mcg each morning (or 60mcg if you're over 50 years old unless approved by your physician).
2. You feel healthy.
3. You get shakiness, worsening significant palpitations (occasional "flip flops" are common), anxiety, racing heart, sweating or other uncomfortable side effects. If this happens, lower the dose a bit for 2-4 weeks and then try raising the dose again till you note significant improvement without uncomfortable side effects or you tried to raise it 3 times and still became shaky/hyper.
Blood tests for thyroid hormone or TSH are not reliable or useful on this regimen. If you feel no better even on the maximum dose, taper off (decrease by 5mcg each 3 days until you're at 15mcg a day. Take 15mcg a day for 3 weeks and then drop to 5mcg a day for 3 weeks--then stop).
After being on treatment for 3 to 6 months, some patients can
lower the T3 dose or stop it. Feel free to try dropping the dose. If you feel better initially and then worse (beginning more than 4 weeks after starting a new dose), you probably need to lower the dose. If you lose too much weight, try to eat more (and discuss this with your physician).
I think you will find that treating subclinical hypothyroidism (i.e.--low thyroid with normal labs) can have a dramatically beneficial effect in your patients' lives. If they are tired, achy, cold intolerant, and/or have weight gain--think low thyroid! I feel that, in the absence of cardiac risk factors, a therapeutic trial is the best way to tell. Dr. Richard Shames is an excellent thyroid expert (author of Thyroid Power) who can consult with your patient by phone (707-823-2077) and help you optimize your patient's thyroid treatment. In addition, Mary Shomon has a superb on-line support group, books, and newsletter for you and your patients as well (see www.thyroid-info.com/ contact.htm). Have fun watching your "untreatable" patients get well!
Jacob Teitelbaum MD is director of the Annapolis Research Center for Effective CFS/ Fibromyalgia Therapies, which sees patients with CFS/FMS from all over the world (410-573-5389; www.EndFatigue.com) and author of the best selling book From Fatigued to Fantastic! His newest book Three Steps To Happiness/Healing Through Joy has just been released. He gives 2-day workshops on effective CFS/Fibromyalgia therapies for both prescribing and non-prescribing practitioners. He accepts no money from any company whose products he recommends and 100% of his royalty for products he makes is donated to charity.
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01-25-2004, 01:29 PM #3Junior Member
- Join Date
- Jun 2002
good info...thanks bro
01-25-2004, 02:06 PM #4
I dont know t-3 was always off limits to me. Screwing with the thyroid can actually change your physical appearance by giving you bug eyes. And thyroid problems are some of the most under diagnosed problems so many people dont know they have a problem at all. Last thing I need is to take t-3 and wake up the next day looking like the fly.
01-25-2004, 02:33 PM #5
01-25-2004, 05:09 PM #6
Very informative RDB. I have a heart murmur so I stay away from all that stuff. Not gonna risk it.
01-25-2004, 05:54 PM #7
ouch.......i know im staying away from everything that will affect my thyroid
01-25-2004, 06:00 PM #8
I felt the same way, but I'm going to give it a go for 21 days and see how it goes. I'm not going over .75mcg though. I'll be doing that at the beginning of March.
01-26-2004, 12:40 AM #9
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