More Thyroid Questions

[Fiddle-Faddle]

I went to my endocrinologist yesterday, who is surprisingly knowledgeable about the connections between autoimmune thyroid disease and celiac. She even said that many people who are diagnosed with diabetes actually have celiac, and their diabetic symtpoms disappear when gluten-free.

About a year ago, I had been complaining about alternating feeling hyper and hypo, which disappeard after going gluten-free. She suggested that before going gluten-free, I might not have been absorbing the Synthroid consistently.

Anyway, I asked her about Armour, and here's what she said:

She said that she felt that Armour has 2 potentially serious problems. One is that the ratio of T4 to T3 is very different that the ration of free (unbound) T3 and T4 we should have in our bodies, and that therefore it has the potential to overload one (I think it was T3?) and cause problems. The other is that, since it is an animal product rather than a synthesized one, it would contain proteins that would be very likely to elicit an autoimmune response, which is something she thinks anyone who already has autoimmune problems ought to avoid.

She also said that she read a study (and of course, she didn't have it in her office, so she couldn't cite the source, and neither can I) that compared two groups of people, one of whom took Synthroid (T4 only, and one of whom took Synthroid and Cytomel (T3), and that there was very little difference in the two groups, both in bloodwork and in how the patients reported how they felt--they all felt good on the correct amount of replacement hormone, regardless of T4 or T4+ T3. She also said that she saw a study on patients who took Armour, and that the patients DID report significant improvement, but that there was no control group in that study.

So, I'm not trying to start a pro or con Armour fight here; I just wondered what all of you (particularly Georgie!) make of this.

At this point, I am feeling just fine on Synthroid (and after 19 years, I have a pretty good idea of when I am hypo and when I am hyper), and don't feel a need to change. My TSH is .9, which is exactly where my endo wants it. But I would like to find out as much as possible before I ever get to a point where I'm not feeling fine!

My endo's comment about the foreign protein does make a lot of sense, especially if a microscopic amount of gluten CC can cause damage, then I would think that pig could, too.

I looked up stopthethyroidmadness.com, but couldn't find actual studies, only testimonials and bashing. They might actually be right about Armour, but I would like to have more concrete evidence and some good explanations of why my endo might be mistaken (if in fact she is).

Ideas, anyone?

[georgie]

There are some people that do fine on T4 meds like Synthroid. Others need the T3 added. And others feel better on Armour. I am a bit confused about these 'proteins' that the Dr is talking of - triggering an autoimmune response. The formula of Armour is made to USP standards, and all ingredients are named. Does the Endo mean all animal proteins are bad - from pork chops for eg?

T3 is a short half life in the body. It would be difficult to overload on it unless you took far too much Armour and went hyper. The levels need monitering - but there is no evidence that a slightly rasied FT3 causes osteoporous - if that is what your Endo rather vaguely referred to. I have a PubMed study somewhere and it states words to that effect.

From STTM they seem to say that many people don't feel a great improvement on synthetic T3 added to T4 - so that backs that up. Most people report a significant improvement when they switch to Armour. Armour has been used since 1900 - its always been working for people. Feedback from the mailing lists and websites all say the same. We are talking a lot of people here now that love Armour. And I know a lot of Drs now are changing their patients over to it - they mail STTM too and tell them.

Interesting. But I am not switching ! I love my Armour !!!!!!! My temps are good. My energy is good. My cholesterol is down.My Hypoglycemia has gone. My Goitre is shrinking. I have a scan soon to check the nodules. I firmly believe that if I hadn't started Armour last year that thyroid cancer would have happened.Since going gluten-free I appear to need less Armour than before but still need 2 grains. I know a lot of people on T4 meds and they seem to need huge amounts of other drugs. The people I know on Armour are gradually so cured - that they throw out all meds over time and just feel well !

[lonewolf]

Fiddle-Faddle,

I found this in the "Prescription for Nutritional Healing", 2nd Edition by James F. Balch, MD and Phyllis A. Balch, CNC.

"A study done at the University of Massachusetts revealed that levothyroxine (Synthroid and others), a drug commonly used to treat thyroid conditions, can cause a loss of as much as 13% of bone mass. An estimated 19 million people in the United States take this drug..."

My mom, who is getting older now, is having problems with bone loss and she's been on Synthroid for about 11 years, I think. It might just be a coincidence, since many older women have problems with bone loss, but my mom eats REALLY well and exercises regularly and doesn't fit the pattern for someone with osteoporosis.

I've been on Levoxyl, Synthroid and Armour and I definitely feel best on Armour. That's just my experience.

[Fiddle-Faddle]

Thanks, guys--this is all very interesting.

Georgie, I wouldn't want you to switch from Armour! Obviously you do well on it. But why do some do well on Synthroid and some not?

I wonder how they determine that levothyroxine is what is CAUSING the bone loss? Are they directly comparing it with Armour, or are they comparing it to people who are not on any thyroid meds at all?

Is it possible that the bone loss they are noticing is actually caused by undiagnosed celiac?

[georgie]

Georgie, I wouldn't want you to switch from Armour! Obviously you do well on it. But why do some do well on Synthroid and some not?

Yes - you would have to take my Armour away over my dead body ! Some people convert T4 to T3 OK. Synthroid is T4 only. So for some people that does work. But .... I have seen so many people with perfect Thyroid labs, on Synthroid and with Fibro pain, Cholesterol, etc. to wonder if they are really that well afterall. Perhaps some people don't even know how GOOD feels anymore. I know I had forgotten. And when I started T3 it felt good by comparism to what I had been before. But I still had issues - which Armour has now resolved.

Good idea about undx Celiac and Osteoporous. Would that show if Vit D was tested more routinely ? It is here in Australia now - but I don't think it is in America. Vitamin deficiencies show up in Celiac.

Armour has calcitonin and if used sublingually I have heard it reverses Osteoporous. I have a few friends that have before and after bone scans to prove that. I don't think anyone has done any clinical trials on all this. It would be good if they did.

[Fiddle-Faddle]

.... I have seen so many people with perfect Thyroid labs, on Synthroid and with Fibro pain, Cholesterol, etc. to wonder if they are really that well afterall.

Many people with FIbro pain actually have undiagnosed celiac. Think about it--the symptoms are identical....

[sherylj]

I went to my endocrinologist yesterday, who is surprisingly knowledgeable about the connections between autoimmune thyroid disease and celiac. She even said that many people who are diagnosed with diabetes actually have celiac, and their diabetic symtpoms disappear when gluten-free.

About a year ago, I had been complaining about alternating feeling hyper and hypo, which disappeard after going gluten-free. She suggested that before going gluten-free, I might not have been absorbing the Synthroid consistently.

Anyway, I asked her about Armour, and here's what she said:

She said that she felt that Armour has 2 potentially serious problems. One is that the ratio of T4 to T3 is very different that the ration of free (unbound) T3 and T4 we should have in our bodies, and that therefore it has the potential to overload one (I think it was T3?) and cause problems. The other is that, since it is an animal product rather than a synthesized one, it would contain proteins that would be very likely to elicit an autoimmune response, which is something she thinks anyone who already has autoimmune problems ought to avoid.

She also said that she read a study (and of course, she didn't have it in her office, so she couldn't cite the source, and neither can I) that compared two groups of people, one of whom took Synthroid (T4 only, and one of whom took Synthroid and Cytomel (T3), and that there was very little difference in the two groups, both in bloodwork and in how the patients reported how they felt--they all felt good on the correct amount of replacement hormone, regardless of T4 or T4+ T3. She also said that she saw a study on patients who took Armour, and that the patients DID report significant improvement, but that there was no control group in that study.

So, I'm not trying to start a pro or con Armour fight here; I just wondered what all of you (particularly Georgie!) make of this.

At this point, I am feeling just fine on Synthroid (and after 19 years, I have a pretty good idea of when I am hypo and when I am hyper), and don't feel a need to change. My TSH is .9, which is exactly where my endo wants it. But I would like to find out as much as possible before I ever get to a point where I'm not feeling fine!

My endo's comment about the foreign protein does make a lot of sense, especially if a microscopic amount of gluten CC can cause damage, then I would think that pig could, too.

I looked up stopthethyroidmadness.com, but couldn't find actual studies, only testimonials and bashing. They might actually be right about Armour, but I would like to have more concrete evidence and some good explanations of why my endo might be mistaken (if in fact she is).

Ideas, anyone?

I am glad your appt. went well and your endocrinologist was knowledgeable and aware of the pros and cons of Armour..I went to the site out of curiousity,,not having any thryroid problems and no preconceived notions and came away feeling it was promoting its product (which is okay)

I am way over my head with the technical jargon but it seems if you are doing well on Snythroid, it is working for you. "Don't mess with something that isn't broke",,,Ha, Still it is good you are keeping up with the latest drugs and updates on this subject.

Sherylj

[georgie]

I am glad your appt. went well and your endocrinologist was knowledgeable and aware of the pros and cons of Armour..I went to the site out of curiousity,,not having any thryroid problems and no preconceived notions and came away feeling it was promoting its product (which is okay)

Actually I think the Endo doesn't know what he is talking about but that is just my personal opinion. If you feel well on what you are taking - stick with it.

Another site you may like to read - also discussing various meds - is www.thyroiduk.org Many may like this site better for explaining the facts of Thyroid illness.

[Fiddle-Faddle]

Actually I think the Endo doesn't know what he is talking about but that is just my personal opinion. If you feel well on what you are taking - stick with it.

Another site you may like to read - also discussing various meds - is www.thyroiduk.org Many may like this site better for explaining the facts of Thyroid illness.

Georgie, I think she does know what she is talking about, but I think that there are two distinct groups of thyroid patients. One group does well on Synthroid and/or other synthetic thyroid hormones, and one group does not, but does do well on Armour. I can't help wondering if there are patients who do NOT do well on Armour? At this point, I have no reason to switch to Armour because Synthroid is obviously working well for me, at least, as far as I can tell!

Instead of a potentially inflammatory criticism ("doesn't know what he is talking about"), would you please specifically address what you feel is not correct information?

And thanks for the new website, I'm about to check it out!

[Jestgar]

J Pediatr Endocrinol Metab. 2006 Dec;19(12):1405-12.

The effect of life-long thyroxine treatment and physical activity on bone mineral density in young adult women with congenital hypothyroidism.

* Kempers MJ,* Vulsma T,* Wiedijk BM,* de Vijlder JJ,* van Eck-Smit BL,* Verberne HJ.

Department of Paediatric Endocrinology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.j.kempers@amc.uva.nl

OBJECTIVE: Normalization of plasma thyrotropin in T4-supplemented patients with thyroidal congenital hypothyroidism (CH) requires elevated plasma FT4-concentrations compared to patients with acquired thyroidal hypothyroidism. We investigated bone mineral density (BMD) in patients with CH. PATIENTS AND METHODS: BMD was measured in 14 adult women with thyroidal CH and nine age-matched female controls. RESULTS: There were no significant differences between patients and controls for femoral neck bone mineral content (BMC) (38.6 vs 37.6 g), BMD (0.98 vs 1.01 g/cm(2)), T-score (0.1 vs 0.3 SD) and z-score (0.1 vs 0.3 SD) and for spine BMC (63.1 vs 71.9 g). The differences in spine BMD (0.97 vs 1.09 g/cm(2)), T-score (-0.7 vs 0.4 SD) and z-score (-0.5 vs 0.6 SD) were significant (p = 0.025, p = 0.023, and p = 0.021, respectively). CONCLUSIONS: Although BMD in patients with CH was slightly lower compared to controls, all scores were within the reference range. This does not support the hypothesis that the upwards shifted plasma FT4-concentrations in patients treated for CH have a deleterious effect on BMD.

J Med Assoc Thai. 2005 Nov;88 Suppl 3:S71-6.

The comparative study of bone mineral density between premenopausal women receiving long term suppressive doses of levothyroxine for well-differentiated thyroid cancer with healthy premenopausal women.

* Sajjinanont T,* Rajchadara S, * Sriassawaamorn N,* Panichkul S.

Division of Nuclear Medicine, Department of Radiology, Phramongkutklao Hospital, Bangkok, Thiland.

OBJECTIVE: To compare bone mineral density (BMD) of lumbar spines (LS) and femoral neck (FN) by Dual energy X-ray absorptiometry (DEXA) in premenopausal well-differentiated thyroid carcinoma women S/P total or near total thyroidectomy with a control group and the effect of Levothyroxine (LT4) to BMD between short term and long term treatment. MATERIAL AND METHOD: DEXA were performed at LS (L1-L4) and FN in 22 premenopausal thyroid carcinoma women S/P total or near total thyroidectomy followed by 1-131 ablation and long term suppressive dose LT4 and 22 healthy premenopausal women. RESULTS: Mean BMD of LS and FN were not significantly different between thyroid cancer group and control (LS 1.023 +/- 0.088 VS 0.980 +/- 0.075 g/cm2, p > 0.05, FN 0.800 +/- 0.068 VS 0.770 +/ - 0.061 g/cm2, p > 0.05). Period of time taking suppressive doses LT4 was divided into 3 groups (2-5 6-10 yrs and 11-14 yrs). Mean LS BMD +/- S.D of 2-5 yrs, 6-10 yrs and 11-14 yrs therapy are 1.042 +/- 0.135, 1.004 +/- 0.044 and 1.042 +/- 0.055 respectively (p > 0.05). Mean FN BMD +/- S.D of 2-5 yrs, 6-10 yrs and 11-14 yrs therapy are 0.808 +/- 0.084, 0.781 +/- 0.067 and 0.816 +/- 0.013 respectively (p > 0.05). CONCLUSION: The suppressive doses LT was not the risk factor of osteoporosis. Although, there was no 4 statistically significant difference of BMD between short and long-term suppressive doses LT groups, the present sample size was not enough to conclude that long-term suppressive doses LT did not decrease BMD.

Horm Res. 2005;64(6):293-8. Epub 2005 Nov 1.

Effects on bone mineral density by treatment of benign nodular goiter with mildly suppressive doses of L-thyroxine in a cohort women study.

* Appetecchia M.

Endocrinology Unit, Regina Elena Cancer Institute, Rome, Italy. appetecchia@ifo.it

OBJECTIVES: Thyroid diseases and their treatment may influence the osseous system. The influence that prolonged suppressive L-thyroxine (LT4) therapy may have on inducing subclinical hyperthyroidism on bone metabolism is still a matter of debate. The aim of the present study was to assess the effects of chronic LT4 treatment at mildly inhibiting serum thyroid-stimulating hormone (TSH) doses on bone mineral density (BMD) and biochemical bone remodeling markers in a cohort of women with benign nodular goiter, and to verify the efficacy of the treatment on nodule size. SUBJECTS AND STUDY DESIGN: A total of 200 euthyroid Caucasian women with nodular goiter (age 52.1 +/- 9; 80 pre- and 120 postmenopausal) were enrolled: 96 had been treated with LT4 for at least 3 years and a matched group of 104 had untreated goiter. LT4 therapy was given at a dose sufficient to reduce TSH under the lower limit of the normal range (0.27-4.20 microIU/ml) without suppressing it below the limit of assay sensitivity (0.005 microIU/ml) and maintaining normal serum values of free triiodothyronine (FT3) and free thyroxine (FT4). The adequacy of the dose was evaluated on the basis of serum TSH levels. The osteopenic effect of LT4 treatment was evaluated directly by total body and lumbar spine dual-energy X-ray absorptiometry (DEXA) and indirectly by biochemical parameters (alkaline phosphatase, osteocalcin, calcium, parathyroid hormone) at the baseline and throughout the follow-up. The efficacy of LT4 schedule on thyroid nodule size was assessed on the basis of the ultrasonographic evaluation. RESULTS: Mineralometric data showed no significant difference between BMD values for treated and untreated patients in both pre- and postmenopausal status. In all patients, serum markers of bone turnover were in the normal range, with no differences in the treated and control groups. The TSH concentrations were significantly lower in treated than in untreated patients (p < 0.0001); FT3 and FT4 were in the normal range for all patients. Evaluation of nodule size during follow-up showed a reduction of > or = 30% in 32 of 96 treated patients (33.3%) versus none in those untreated, whilst nodule size remained unmodified in 60 treated patients (62.5%) versus 35 (33.6%) in those untreated, and an increase in nodule size and/or development of new nodules was found in 4 treated patients (4.2%) versus 69 of the 104 untreated patients (66.3%). CONCLUSIONS: This study suggests that at slightly suppressing TSH doses, LT4 therapy has no adverse effects on BMD in both pre- and postmenopausal women, while having an efficacy on nodule size comparable with that reported using an LT4 schedule able to maintain TSH near or below the assay sensitivity limit.

I didn't include the studies that were with regard to people being given levothyroxine as a treatment for, or follow-up to thyroid cancer.

Excess T3 can give you symptoms of hyperthyroidism.

[Nancym]

I had RAI therapy for Graves disease 20 years ago, so no functioning thyroid now to speak of. I take synthetic thyroid.

I tried Armor and didn't like it. I started with a small dose and worked up but I always felt "tired and wired". I gave up on it about 6 months after starting it. I think the tired part was my undiagnosed gluten intolerance because that went away once I went gluten-free/CF. If you feel good on synthetic thyroid I don't see any reason to change. I tell a lot of people who feel hypothyroid but have normal #'s to look at food intolerances, because that was my experience. Once I got off gluten and dairy my energy came back.

[georgie]

She said that she felt that Armour has 2 potentially serious problems. One is that the ratio of T4 to T3 is very different that the ration of free (unbound) T3 and T4 we should have in our bodies, and that therefore it has the potential to overload one (I think it was T3?) and cause problems. The other is that, since it is an animal product rather than a synthesized one, it would contain proteins that would be very likely to elicit an autoimmune response, which is something she thinks anyone who already has autoimmune problems ought to avoid.

The ratio of Armour which is from pigs is very close to the ratio of our own thyroids. Very close. So if what the Endo was saying was true - we would all have problems in our bodies from our ( healthy) thyroids. A person with a normal working thyroid would have Frees incorrect as well - which is not true. FT3 has a short half life anyway. FT4 should be kept in lab range - which Drs do by testing their patients when they take Armour. As the levels are so stable - these checks are not needed as often as people on Synthetics.

And apart from an allergy to pork - I have never heard of someone getting 'more' Antibodies from Armour. I have only heard of it reducing them. Brilliantly. And reducing Antibodies also reduces the Autoimmune load.

I have only heard of a few people that can't take Armour . Usually a reaction to a filler. When they change brands - they have no problem. Armour is now used by 10s of 1000s of people around the world. Its been around since 1900. The Autoimmune problems are brought under control when the Thyroid function is restored. This is from people that use it and talk about it all day long.

And there are many Drs that support Armour . It appears your Endo does not. But that is merely that Drs opinion and the traditional training.. The medical community has many trains of thought on various medications and treatments.

There are people that do fine on Synthetics and go about their lives, never get another autoimmune disease. And we never hear from them. But for the 100s of 1000s that do not get well - its important to know there is a choice and its a safe choice.

[Jestgar]

There are people that do fine on Synthetics and go about their lives, never get another autoimmune disease. And we never hear from them. But for the 100s of 1000s that do not get well - its important to know there is a choice and its a safe choice.

I think this is the bottom line. If something works for you, don't change it. If it stops working, you know you have alternatives.

[Rachel--24]

I'm another one who had RAI treatment for Graves Disease.

I've tried both synthetics and Armour. I'm currently on Armour but I really feel no "extra" benefit from it. The synthetics worked for me just the same.

I would probably be taking Levothroid instead but I'm sensitive to so many things I'm just sticking with this for now. I was sensitive to the dyes in Levothroid and could only take the "white" pills...which only come in 50mg.

Basically Armour is easier for me right now because I dont have to cut pills.

[Nevadan]

As a recently (mostly self) diagnosed hypothyroid sufferer one of my concerns with which meds to take is related to bone density issues. I was diagnosed with osteoporosis about 6 yrs ago. For the first year my dr prescribed a calcitonin containing nose spray which resulted in my bone density increasing significantly enough to get my density up to osteopenia levels. Subsequently that dr quit his practice and my next dr prescribed Fosamax which after 4 yrs had not improved my bone density any more; therefore, I'm inclined to think that lack of calcitonin may have been my problem all along (I admit not much science behind this prejudice). To make a long story shorter, the thyroid gland secrets calcitonin along with the T3's, T4's, etc, so I'm thinking maybe my bone density problem may have been thyroid related all along. Armour Thyroid suposedly contains calcitonin while the synthetics do not, so this may be something to consider. Another anecdotal case is that a friend's son had to have his thyroid removed as a kid several years ago and took synthetic thyroid meds as replacements and now has been dx'ed with osteoporsis in his 20's - again don't know if this is related to lack of calcitonin but I do have to wonder. Based on this thought process, I've chosen Armour.

Just a thought....