[WWWI2 April 22, 2013 at 7:21 am Post count: 137]

#1059900

Is there actually a test to determine whether or not T3 is being effectively converted from T4. I know about T4 & T3, Free T4 & T3 and I’ve heard of reverse T4 & T3 testing.

I ask because as I’ve mentioned, I’m on block and replace which basically means my thryoid is artificially shut down with a higher dose of Methimazol and therefore I’m treated with T4 effectively as if I were hypothyroid.

I was hyper then hypo and then most recently within the normal ranges (low end of TSH and high end of normal for T4 & T3, so I believe fairly optimal ranges) with the addition of Thyroxine (T4). And yet my symptoms did not improve greatly.

This was until a few weeks back when my doctor added T3 to the regimine and it made a remarkable difference. So it would appear that I don’t convert T4 to T3 well and yet none of my labs seemed to indicate that. I just know that I felt substantially better.

So, back to the original question, does anyone know if there is a test outside of those that are typciall drawn that actually identify that the T4 conversion to T3 is not occurring as it should?

Thanks!

[KimberlyOnline Facilitator April 22, 2013 at 11:21 am Post count: 4294]

#1178636

Hello – Perhaps others will chime in here, but I’m not familiar with a single test that accomplishes this.

As far as I know, a consistently low T3 along with normal T4 would be an indicator that the conversion process doesn’t seem to be working correctly.

[WWWI2 April 22, 2013 at 2:08 pm Post count: 137]

#1178637

Kimberly,

Thank you for responding. That’s what’s so perplexing, both my t4 and t3 were inline with each other and at the higher end of the normal range.

I wonder if perhaps no effective testing method has been identified or developed to date which may explain why T3 is not typically considered as part of the American standard of care?

WWWI

[KimberlyOnline Facilitator April 22, 2013 at 3:51 pm Post count: 4294]

#1178638

Hello – Total T3 testing is considered reliable, but it’s the Free T3 test where there is some concern about the accuracy.

I do think, though, that with recent research, more doctors are realizing the importance of T3 testing…even though it’s taken a LONG time for this to catch on!

[Harpy April 23, 2013 at 2:12 am Post count: 184]

#1178639

Testing for rT3 may shed some more light on the situation.
RT3 is like neutral version of T3, so it takes up receptor sites and blocks active T3 from doing it’s job.
Many Hypo individuals have high rT3 and often low T3 and hence there is a lot of discussion of T3 supplementation in those areas.

When an individual is in the Hyper state, there is the possibility with an accelerated conversion rate as well, they may well show a normal T3 level, but if their rT3 is also very high then they may well show Hypo symptoms, it’s all a case of balance as the rT3 and T3 are in direct competition for the same receptor sites, so you may well be in a situation where your T3 needs to be maintained at a higher level just to balance out the ratio to rT3.

rT3 is a normal part of the metabolism, the body uses it as a way to adjust normal hormonal activities, at this point in time it is thought to simply have a blocking role, but it may well have a specific functionality that we are not aware of yet.

All just more clues in the bigger picture of thyroid disease.

[WWWI2 April 23, 2013 at 9:24 am Post count: 137]

#1178640

Kimberly – I’m so glad to hear that things are progressing with the realization of T3’s importance. I can only go by my experience and say the difference has been remarkable and dramatic for me. It scares me sometimes that had I not asked for T3, that I would have gone on feeling as poorly as I did as well for many out there without this info or that option.

Harpy – That’s extremely helpful and makes a lot of sense. So to clarify, you are saying it may be possible to see the conversion issues if perhaps my rT3 is also fairly high? In googling rT3, I’m reading that if the rT3 is too high, which from what I’m reading from you may counterbalance a normal range T3, there are many symptoms, which, among others, but most significantly to me, has been hairloss. So there is hope for me yet This is getting good!!! Thank you!!

WWWI

[beach45 April 23, 2013 at 11:31 am Post count: 178]

#1178641

It is good to hear you were given the necessary T3 to function properly.

I was on Methimazole 2 years prior to having RAI in May 2012 and my FT3 was always in the dungeon. I felt horrible. I was not on block and replace though which I wish that doctors had done for me.

After my RAI my FT3 was still horribly low even in range yet not a good number for me. I had horrible symptoms on Sythroid alone. I felt like death even with FT4 and TSH in range yet the FT3 was lagging extremely.

I tried some natural thyroid hormone for a little bit yet that is not consistent, at least not for me and went to a T3/T4 compound. Now I don’t advise that for people only because you have to be careful with Compounding Pharmacies. The pharmacy I use has been here over 30 years and has an excellent reputation. The reason I use it is because I was also having issues with medication fillers. I know some people who use Cytomel or Liothyronine with success added to their T4 medicine with careful monitoring. We are slowly getting me to where I need to be as far as feeling more myself; weight issues are still there yet I do not have a RT3 problem and I see my leptin levels are too high for me yet that is another concept in itself having to do with metabolism which I will not touch on.

What I know as just what Kimberly says that a consistent FT3 when being tested over time is a clue that there is a FT4 to FT3 conversion problem. I am so thankful for my new doctor who listens and is working with me and I don’t feel lousy anymore as I did on the Synthroid alone. Yet we still have work to do to get me more balanced.

Also you may know already there is a Spring Symposium and Research Summit in Washington, DC this weekend through the American Thyroid Association : http://www.thyroid.org/thyroid-events-education-media/educational-programs-of-the-ata/annual-meetings/spring-symposium-and-research-summit-2013/

I hope that was okay to post? They will be talking about T3 when you look at the agenda under Program. It seems they are finding that more people are benefiting; that is, the ones that are poor converters and I believe as a result that maybe more will be revealed in time! Maybe in time there will be a timed release T3/T4 combo available for poor converters!

Good luck!

Beach

[Harpy April 23, 2013 at 1:27 pm Post count: 184]

#1178642

One of the primary roles of rT3 appears to be in the “Hibernation response” as has been found in other mammals, in addition say for humans it also improves survival rates at times of low nutrition or food availability by down regulating metabolism and this then effectively reduces energy demand within the body.

Outside of thyroid issues, there are many conditions where rT3 is popping up and one of those situations is “weight loss plateaus”. In situations where one is calorie restricting, there is often an early weight reduction, then this plateaus, further calorie restriction may have a small weight loss, but not sustained and this usually results in the individual going into a Hypo type of state. The rT3 response comes first and if calorie restriction is maintained then the thyroid itself is down regulated which results in an effect more akin to the “starvation response”. There are obviously some unanswered questions as to why the body does this while it is still carrying quite a bit of excess fat, for whatever reasons the body is not getting some aspect of nutrition that it needs.

Beach45:

Quote:

We are slowly getting me to where I need to be as far as feeling more myself; weight issues are still there yet I do not have a RT3 problem and I see my leptin levels are too high for me yet that is another concept in itself having to do with metabolism which I will not touch on.

Good to hear you are making progress, fully agreed rT3 is not the entire problem just another clue.
Glad to hear you’re looking at Leptin, my partners level’s are also high, just outside of normal range. Finding out about Leptin was a real eye opener for me, to think that that much maligned adipose tissue (fat) is actually a major endochrine organ that produces Leptin and a variety of other hormones.
As research comes through it appears that Leptin may well play the conductors role in our hormonal orchestra.
Elevated leptin levels are often associated with persistantly elevated blood glucose levels, my partners have consistantly been at the high end of normal range, so we are tackling that to see if leptin levels will normalise.

[beach45 April 23, 2013 at 2:39 pm Post count: 178]

#1178643

Harpy,
Love what you have to say here. Definitely RT3 from what I see is a big factor; my doctors are not into testing it or believe in the theory behind it yet I had it tested on my own along with leptin and TPO antibodies and TSH, FT4 and FT3 in between going to the doctor the end of last year; Definitely a connection between the blood glucose and the leptin. The hormone leptin has been found to be a major regulator of body weight and metabolism. A very small portion of doctors work with leptin resistance yet I believe that is something like RT3 that eventually will be researched further and there will be more awareness in time. My leptin levels are way high along with blood glucose being at the high end in range. Like you said they are associated. In fact glucose was out of range right after RAI and when I went very hypothyroid. My current doctor though said that he has worked with some Graves patients who have struggles with metabolism after treatment as they need what he called a jump start for their metabolism. I am sure in time yet not currently more will be revealed. I see some people have no problems and I know others like myself who struggle with the weight issue. You are definitely on top of the latest! Thanks for sharing….beach

[KimberlyOnline Facilitator April 23, 2013 at 2:39 pm Post count: 4294]

#1178644

@Beach45 – Thanks for sharing your story! Any links from the American Thyroid Association are fine. In fact, the GDATF will be exhibiting at this event…and one of our Board members will be attending the presentations. We hope to come back with some good info!

[beach45 April 23, 2013 at 3:49 pm Post count: 178]

#1178645

Your welcome Kimberly! I haven’t been on in a while and glad to be back on because I’ve been going through some times yet I am seeing some more moments of normacly which is a blessing after fighting for 3 years. Still have to keep an eye on Moderate TED yet so far so good! Thank you and I’m excited to hear the outcome from this event in Washington this weekend; did not know GDATF will be exhibiting and involved; cool! I like to be able to help out others if I can with my story because I know how so many struggle and I’ve been there and have just about made it through the fight! And I can say it does get better in time! beach

[Harpy April 24, 2013 at 12:30 am Post count: 184]

#1178646

beach45 wrote:

Harpy,
Love what you have to say here. Definitely RT3 from what I see is a big factor; my doctors are not into testing it or believe in the theory behind it yet I had it tested on my own along with leptin and TPO antibodies and TSH, FT4 and FT3 in between going to the doctor the end of last year; Definitely a connection between the blood glucose and the leptin. The hormone leptin has been found to be a major regulator of body weight and metabolism. A very small portion of doctors work with leptin resistance yet I believe that is something like RT3 that eventually will be researched further and there will be more awareness in time. My leptin levels are way high along with blood glucose being at the high end in range. Like you said they are associated. In fact glucose was out of range right after RAI and when I went very hypothyroid. My current doctor though said that he has worked with some Graves patients who have struggles with metabolism after treatment as they need what he called a jump start for their metabolism. I am sure in time yet not currently more will be revealed. I see some people have no problems and I know others like myself who struggle with the weight issue. You are definitely on top of the latest! Thanks for sharing….beach

Just a bit more to consider is the research of Leptins role in regulating the immune system, basically:
Low Leptin = increased risk of infectious diseases.
High Leptin = increased risk of autoimmune and chronic inflamatory diseases.
The review below is worth a read, although one must keep in mind it is sometimes hypothesizing based on current available studies and data:

Quote:

REVIEW ARTICLE – Tissue Antigens ISSN 0001-2815
Leptin in autoimmunity: many questions, some answers
G. Matarese, E. H. Leiter & A. La Cava

Abstract
It has recently become apparent that several molecules involved in the control of metabolism also play an important function in the regulation of immune responses. Among those molecules, the adipocyte-derived cytokine leptin has been shown to significantly influence innate and adaptive immune responses both in normal and in pathological conditions. For example, levels of leptin are typically low in infection and high in autoimmunity, both systemically and at the site of inflammation.
Moreover, in addition to its long-known effects on the promotion of T helper 1
immune responses and cell-mediated immunity, leptin has more recently been found capable to constrain proliferation of regulatory T cells. As such, leptin represents not only a link between metabolism and immune responses in general but also a pivotal modulator of the magnitude of selected mechanisms of peripheral immunity in relation to body fat mass. We review here the most recent advances on the role of leptin in the control of immune tolerance and critically discuss how strategies aimed at neutralizing the leptin axis could represent innovative tools for the therapy of autoimmune disorders.

http://onlinelibrary.wiley.com/doi/10.1111/j.1399-0039.2007.00886.x/pdf

Although the targeting of leptin as a therapeutic process, i.e. drugs, is fine as a stop gap measure, I would think it would be more appropriate to determine the cause of abnormal Leptin levels as a greater long term goal.

There are many other questions in the leptin story like the issues of weight gain, which is often quite elusive, it is known that obesity is highly corrolated with systemic inflamation, the question is:
Does obesity cause inflamation or is obesity a desired outcome of an immune response to raise levels of inflamation?
(Note: Inflamation generally just means upregulated immune system processes.)

[beach45 April 24, 2013 at 10:24 am Post count: 178]

#1178647

Harpy,

Great points and thanks for sharing. Yes inflammation seems to be a very big issue with metabolism and weight.

I also sent you a PM.

Seems there are a lot of factors involved. I enjoyed your article of “Leptin in Autoimmunity.”

Going back to the original topic yes the T4 to T3 conversion can apparently occur with prolonged increase in leptin. Which also affects other factors.

I know that a lot of doctors right now do not work with this issue yet I see it as something up and coming to be addressed as I attended a webinar not too long ago online discussing this yet not through GDATF.

Beach

[Harpy April 24, 2013 at 1:16 pm Post count: 184]

#1178648

Sorry about the Hijack WWWI2
The conversion of T4 to T3 mostly occurs in specialised cells in Liver, Kidney & Gut, there are certain nutrients that support improved conversion like selenium and zinc, but there is a lot of questions with regard to supplimentation as there is often opposing nutrients that need to be balanced eg Zinc with Copper, Calcium with Magnesium, so more often than not it is better support overall nutrition through diet and improve broad based nutrition through increased food variety, so if you want to boost selenium a bit, then a brazil nut per day may be a good measure to ensure you get some daily.

When conversion rate is improved, we do not know whether this just means more T3 or whether it also means a corresponding reduction in rT3, either way it would mean less reliance on T3 supplimentation.

You may be interested in the study below looking at the circadian rhythems of thyroid hormones, T3 peaks at around 4am, this would send you into a bit of a hyper buzz during the day, but because melatonin, sleep hormone, also peaks at around 4am the T3 effect is balanced.
There is some T3 dosing protocols that try to mimic these rhythems, some individuals set an alarm for early morning, take a dose and roll over and go back to sleep, you’d need to look at it a bit deeper and consider whether it has any value for you.

http://jcem.endojournals.org/content/93/6/2300.full.pdf

[beach45 April 24, 2013 at 4:32 pm Post count: 178]

#1178649

Actually I do take one of my thyroid pills at 3AM and then the other in the afternoon as my T3/T4 compound is dosed to take twice a day. Some say it is more effective taken that way. I do the brazil nut a day thing too.
Thanks for sharing that information Harpy!

beach

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