Defy Medical - overmedicated on Thyroid Medication?

[tarnation]

Hey everyone.

I apologize in advance for the long post. But I would greatly appreciate any insight anyone can share with me.

I am a patient with Defy Medical, and I am currently undergoing trt as well as thyroid treatment with Dr. Saya. Dr. Saya has done an amazing job getting my testosterone levels back to normal whilst managing my e2 levels. However, I am not sure if I am on the right track with my thyroid protocol.

Initially, I was told to take 2 grains of NDT (one in the morning, and one in the afternoon). These were my labs before starting this protocol:

THS: 3.36 (.51-6.27)
Thyroglobulin, Tumor Marker: 5.7 (1.8 - 4.0)
T3 Reverse, Serum: 30 (10-24)
DHEA-S 105 (89-457)
Free T3: 1.4 (2.0 - 4.4)
Progesterone: .358ng/ml
PSA Diagnostic: .174 (0.0 - 4.0)
Throxine Free 4: .96 (.93 -1.70)
Thyroperoxidase Ab, S: .7 (<9.0)


After being on this protocol for around 5 months my labs were:

TSH: .345 (.27-4.2)
Thyroglobulin, Tumor Marker: 5.4 (1.8 - 4.0) (HIGH)
T3 Reverse, Serum: 18 (10-24)
Free T3: 2.9 (2.0 - 4.4)
Throxine Free 4: .78 (.93 -1.70) (LOW)


I sent the most recent labs to defy medical prior to my consultation with one of the nurses. The nurse suggested that I add 50mcg of levothyroxine to my morning dose. So she wanted me to take 50mcg of levothyroxine + 1 grain of NDT in the morning and 1 grain of NDT in the afternoon.

I felt amazing for around 4 weeks, but then I started experiencing some scary symptoms. My heart started racing, my muscles started twitching at night, I started having shortness of breath, I started experiencing anxiety, and I also could not sleep at night. I called the clinic and they said I should drop the evening NDT dose. It's been 3 days since I stopped taking my evening dose, and I have noticed a slight difference in the symptoms. However, I am still experiencing insomnia as well as a rapid heart beat.

My questions to you are:

1. Do you think my current protocol is still too much for me (1 grain NDT in morning + 50mcg Levo)?
2. A family doctor suggested that I drop the NDT all together and work on finding the right dose of Levo. Do you think this is a good idea?
3. I am going to make sure my next consultation at Defy is with Dr. Saya and I will definitely ask him as well, but if someone could please explain why I was put on NDT instead of Levo in the first place? I remember Dr. Saya explaining it to me but unfortunately i can't remember what he told me.

Thanks in advance!

 

[Will Brink]

1. Do you think my current protocol is still too much for me (1 grain NDT in morning + 50mcg Levo)?
2. A family doctor suggested that I drop the NDT all together and work on finding the right dose of Levo. Do you think this is a good idea?
3. I am going to make sure my next consultation at Defy is with Dr. Saya and I will definitely ask him as well, but if someone could please explain why I was put on NDT instead of Levo in the first place? I remember Dr. Saya explaining it to me but unfortunately i can't remember what he told me.

Thanks in advance!

Thyroid is like T, it can take a while to dial in the right dose etc for a person, some times quite a long time in fact. I'm more concerned with Thyroglobulin Tumor Marker numbers. Are you leaving some essential info out? There's ongoing controversy about t4 mono therapy vs t4/t3 and desiccated products. Traditional docs usually favor t4 monotherapy, more progressive/alternative types prefer "natural" preparations containing t4/t3.

- Will @ www.BrinkZone.com

 

[HarryCat]

1. The half life of the T4 in the NDT is about a week. It will take 4-6 weeks for your levels to reach steady state. 3 days is not enough time to draw any conclusions about your dose.
2. As Will said, conventional doctors are taught that levo is all you need and that your body will make the T3 it needs from it. This is clearly not the case for a large number of people. It will take time to get dialed in no matter what medication you're on.
3. I don't want to speak for Dr. Saya, but he probably put you on NDT because he has a lot of success treating his patients with it. Perhaps more success than treating them with levo.

 

[tarnation]

Thanks for taking the time to reply my man. That makes a lot of sense. I guess I'll continue with 1 grain of NDT + 50mcg of levo in the morning. The symptoms I had were just unbearable, and I was worried about still being on a high dose.

 

[tarnation]

Thyroid is like T, it can take a while to dial in the right dose etc for a person, some times quite a long time in fact. I'm more concerned with Thyroglobulin Tumor Marker numbers. Are you leaving some essential info out? There's ongoing controversy about t4 mono therapy vs t4/t3 and desiccated products. Traditional docs usually favor t4 monotherapy, more progressive/alternative types prefer "natural" preparations containing t4/t3.

- Will @ www.BrinkZone.com

Hey Will - thanks for the reply. What do you mean by leaving some essential info out? I wasn't aware that the Tumor Marker numbers were off. What additional information do you think is necessary?

 

[Will Brink]

Hey Will - thanks for the reply. What do you mean by leaving some essential info out? I wasn't aware that the Tumor Marker numbers were off. What additional information do you think is necessary?

It says in caps "HIGH" so hard to miss if you look at the two tests. Other info such as why you may have elevated Thyroglobulin Tumor Marker. There are a number of reasons it can be elevated, such goiter, thyroiditis, hyperthyroidism and others, and I'd discuss with doc as to if it warrants further investigation.

 

[Vince Carter]

Hey Will - thanks for the reply. What do you mean by leaving some essential info out? I wasn't aware that the Tumor Marker numbers were off. What additional information do you think is necessary?

He's asking if you've been otherwise diagnosed with a Thyroid specific disease or condition besides HypoThyroid. This tumor marker is a new one for me, never saw that before but that's that Will is asking...

 

[tarnation]

Gotcha, thanks. I haven't been diagnosed with any condition other than hypothyroid. I'll bring it up with Dr. Saya during our next consult though

 

[CoastWatcher]

Not jumping on you, but you noted you didn't remember why Dr. Saya prescribed NDT. Take notes during your consultations. If you don't understand something, ask. If you still don't understand, ask again.

We have to be our own advocates.

 

[tarnation]

yup, it was a bad move on my end

 

[Dr Justin Saya MD]

Hi tarnation,

The addition of levothyroxine (T4) was a perfectly reasonable addition given your levels, however clinical response is always the "trump" card (no pun intended). Your FT3 still has quite a bit of room for improvement and your rT3 is gradually coming down. At this point, given your apparent sensitive response to T4 (levothyroxine), I would discontinue the levothyroxine and substitute T3 (liiothyronine) 10mcg po qAM to determine if your symptomatic/subjective response is different...and recheck labs in 6 weeks. The elevated thyroglobulin AB simply indicates a protein level auto-immune component, which typically (but not always) means more aggressive management is needed for symptom resolution. You can forward this thread to office staff for inclusion in your chart and to proceed with the regimen changes once uploaded to chart.

 

[ratbag]

tarnation,

Your FT4 level was low on your first labs and even lower on the labs 5 months later. I had this same problem after I started TRT. My FT4 was always ok before TRT and was mid range. After starting trt for some reason my FT4 went way below range. Mine went so low that the lab called my MD and me to be sure we were aware of this. So for a person who always had mid range FT4 suddenly I was having to take 200mcg T4 to get it mid range again. Can I assume that you started trt before your 1st labs posted above? if so, how long were you on trt before those 1st labs above? Just curious.

 

[tarnation]

tarnation,

Your FT4 level was low on your first labs and even lower on the labs 5 months later. I had this same problem after I started TRT. My FT4 was always ok before TRT and was mid range. After starting trt for some reason my FT4 went way below range. Mine went so low that the lab called my MD and me to be sure we were aware of this. So for a person who always had mid range FT4 suddenly I was having to take 200mcg T4 to get it mid range again. Can I assume that you started trt before your 1st labs posted above? if so, how long were you on trt before those 1st labs above? Just curious.

Thats really interesting. Why would TRT decrease FT4 though? I started TRT a couple of weeks before the first labs were done. So I was on TRT for 5 and a half months before the second set of labs.

 

[tarnation]

Hi tarnation,

The addition of levothyroxine (T4) was a perfectly reasonable addition given your levels, however clinical response is always the "trump" card (no pun intended). Your FT3 still has quite a bit of room for improvement and your rT3 is gradually coming down. At this point, given your apparent sensitive response to T4 (levothyroxine), I would discontinue the levothyroxine and substitute T3 (liiothyronine) 10mcg po qAM to determine if your symptomatic/subjective response is different...and recheck labs in 6 weeks. The elevated thyroglobulin AB simply indicates a protein level auto-immune component, which typically (but not always) means more aggressive management is needed for symptom resolution. You can forward this thread to office staff for inclusion in your chart and to proceed with the regimen changes once uploaded to chart.

Thanks for taking the time to reply, Dr. Saya. Would you like me to stop all thyroid medications (T4 + NDT) and only take the T3? I've read that NDT does not provide the same amount of T3 conversion consistently, so I'm worried that it might be skewing results. Also, I was reading that levothyroxine is preferred since T3 is absorbed very rapidly which may cause hyperthyroidism. So do you think I should start on a very low dose of T3 since I am already experiencing some of the hyperthyroid symptoms?


Thanks again for your time.

 

[Dr Justin Saya MD]

Thanks for taking the time to reply, Dr. Saya. Would you like me to stop all thyroid medications (T4 + NDT) and only take the T3? I've read that NDT does not provide the same amount of T3 conversion consistently, so I'm worried that it might be skewing results. Also, I was reading that levothyroxine is preferred since T3 is absorbed very rapidly which may cause hyperthyroidism. So do you think I should start on a very low dose of T3 since I am already experiencing some of the hyperthyroid symptoms?


Thanks again for your time.

I would continue NDT as the core thyroid treatment for now and since it appears you only experienced problems after addition of T4, would lean the T3 route to see if tolerated better. Your symptoms certainly are discordant with the lab results, which are far from hyperthyroid territory. The T3 starting point can be trimmed back to 5mcg as a very conservative trial.

 

[Dr Justin Saya MD]

Thats really interesting. Why would TRT decrease FT4 though? I started TRT a couple of weeks before the first labs were done. So I was on TRT for 5 and a half months before the second set of labs.

A less known fact about testosterone is that it can lower TBG (thyroid binding globulin), thus impacting free T3/free T4 levels. As with SHBG and sex hormones, the consequences of this TBG lowering are NOT always universal or straightforward. For instance, many folks can experience and INCREASE in FT3/FT4, as somewhat expected, with the decrease in TBG. However, some folks can experience (over time) a DECREASE in FT3/FT4 concurrent with the decrease in TBG, presumably from more rapid excretion of the thyroid hormones with lower TBG (analogous to more rapid excretion of testosterone with lower SHBG).

 

[tarnation]

A less known fact about testosterone is that it can lower TBG (thyroid binding globulin), thus impacting free T3/free T4 levels. As with SHBG and sex hormones, the consequences of this TBG lowering are NOT always universal or straightforward. For instance, many folks can experience and INCREASE in FT3/FT4, as somewhat expected, with the decrease in TBG. However, some folks can experience (over time) a DECREASE in FT3/FT4 concurrent with the decrease in TBG, presumably from more rapid excretion of the thyroid hormones with lower TBG (analogous to more rapid excretion of testosterone with lower SHBG).

That's really interesting. I was always told that treating hypothyroidism would increase testosterone levels, so I just assumed that an increase in testosterone levels would be anything but bad for my thyroid.

I have forwarded this thread to your staff so that they can update my chart. Just to clarify: I should continue with 2 grains of NDT and add 5mcg of T3 - Or would you like to lower my NDT dose/increase the T3?

Thanks again for taking the time to share your insight.

 

[Dr Justin Saya MD]

That's really interesting. I was always told that treating hypothyroidism would increase testosterone levels, so I just assumed that an increase in testosterone levels would be anything but bad for my thyroid.

I have forwarded this thread to your staff so that they can update my chart. Just to clarify: I should continue with 2 grains of NDT and add 5mcg of T3 - Or would you like to lower my NDT dose/increase the T3?

Thanks again for taking the time to share your insight.

Yes, what you outlined above is accurate. If symptoms recur or persist with the T3, then D/c it and call the office and order a repeat thyroid panel (minimum of FT3, FT4, rT3) - it's always most useful clinically to have labs representative of the exact time of symptoms...in fact, if within your budget, a panel now if any of those symptoms are still present would be useful.

 

[tarnation]

Yes, what you outlined above is accurate. If symptoms recur or persist with the T3, then D/c it and call the office and order a repeat thyroid panel (minimum of FT3, FT4, rT3) - it's always most useful clinically to have labs representative of the exact time of symptoms...in fact, if within your budget, a panel now if any of those symptoms are still present would be useful.

After changing my dosage, the symptoms have definitely gone down so I am not sure if it will be helpful to get a panel done. However, if you think it will be useful, I can definitely get the lab work done and sent to your office before starting the T3. Please let me know if you would like me to do so.

 

[Dr Justin Saya MD]

After changing my dosage, the symptoms have definitely gone down so I am not sure if it will be helpful to get a panel done. However, if you think it will be useful, I can definitely get the lab work done and sent to your office before starting the T3. Please let me know if you would like me to do so.

If the symptoms persist (over the next week or so) or worsen (at any time), then labs would be suggested.