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Old 06-23-2017, 01:35 PM
 
7,997 posts, read 10,378,641 times
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Quote:
Originally Posted by Ruth4Truth View Post
Because insurance requires them to refuse. Insurance sued my doctor, who was a true thyroid specialist, for ordering too many of those tests. She was shocked, and refused to practice the way they demanded (telling patients they were "fine", even if preliminary results indicated the probably presence of antibodies), so they booted her off their rolls.
My PCP (an integrative med doc) takes insurance, and she had no problem ordering the tests. And my insurance covered them.

 
Old 06-23-2017, 03:15 PM
 
6,504 posts, read 4,909,973 times
Reputation: 7952
Quote:
Originally Posted by suzy_q2010 View Post
I never implied that thyroid replacement is being used to treat hyperthyroidism. Too much of any thyroid replacement medication, including desiccated thyroid, can cause symptoms of hyperthyroidism. It may be that some people like being slightly hyperthyroid because they perceive that they are more energetic; however, being hyperthyroid has adverse effects, particularly on the cardiovascular system. That is why I wonder if those who had weight loss on desiccated thyroid were being overtreated.
I went back and re-read those posts and see what happened. Because those on NDT lost weight, you're just assuming they were overdosed and became hyper. Of course that's possible. It's also possible those on synthetics were underdosed. It's also possible they all got the correct dose for their situation and the published results are correct. Who really knows unless they were there??


Quote:
Originally Posted by suzy_q2010 View Post
It is indeed harder to adjust the dose of T3. It has a short half life, which means it needs to be given in multiple doses. Even with twice a day dosing you will get peaks and troughs in blood levels.
I have not personally found that to be the case. I am sure it's happened to some.
I also think you stated you've never used NDT? So you don't have first hand experience in that.

Quote:
Originally Posted by suzy_q2010 View Post
I feel completely normal now. I have no hypothyroid symptoms at all. How could I feel "better"?
Woo-hoo!! Fantastic!!! No lie, that's great. Not everyone is so lucky.

Quote:
Originally Posted by suzy_q2010 View Post
Yes, some people are inflexible, including those who will insist that anyone new to thyroid replacement therapy absolutely, unequivocally will do better on desiccated thyroid, like some posting in this very thread.
Or the reverse possibly?

Quote:
Originally Posted by suzy_q2010 View Post
The internet thyroid gurus who advocate measuring body temperature often suggest using a reading taken under the arm. Since those readings are always lower than core body temperature by 0.5 to 1.0 degree F, that pretty much guarantees that a lot of healthy people will have readings less than 98.6 - which is an average temperature, not a minimum one. Body temp varies during the day, is lowest while sleeping, and increases with physical activity.
That's really interesting. NONE of the groups I follow recommend under arm temps. They specifically recommend oral temps using a mercury thermometer as they feel digitals vary too much.

General rule of thumb is that if you're not 98.6 around 3pm, you are probably low. Lowest daily temp would be upon waking. I don't know anyone who uses it as an exact science. For me, I can tell when I've got poison ivy in my system as everything reads higher, that's about it.

I always feel hot yet my temp is always low. Go figure. So for me I'll go by blood tests.


Quote:
Originally Posted by suzy_q2010 View Post
You can get any test you want if you are willing to pay out of pocket. Just pay at the lab and do not give insurance information
That's not true in every state. Mine requires a requisition from a doctor. I can choose to self-pay but I need that piece of paper. We can't even change the tests or ask them to add something on the fly.

I can order tests from a couple of online places and I am lucky there is a local lab that will draw the blood for me. But even that place has about half dozen states they can not ship to.

Quote:
Originally Posted by CarnivalGal View Post
My PCP (an integrative med doc) takes insurance, and she had no problem ordering the tests. And my insurance covered them.
Right - even when I've been to a doctor who does not take insurance, the labs are typically covered. Not under routine labs, but they have been covered. I think I get one free routine lab a year.

Saliva cortisol tests have never been covered for me no matter who orders them. It will go towards my out of network deductible if I bother to make the claim - but since it's unlikely I will ever come near that I don't bother.
 
Old 06-23-2017, 07:50 PM
 
Location: State of Transition
102,126 posts, read 107,381,087 times
Reputation: 115942
Quote:
Originally Posted by suzy_q2010 View Post
Hypothyroidism usually causes excess sleepiness, not insomnia. Hyperthyroidism can cause difficulty sleeping, but not because it "steals your main sleep hormone".

Thyroid disease does not cause painful periods or amblyopia. Source for those statements?
The internet thyroid gurus who advocate measuring body temperature often suggest using a reading taken under the arm. Since those readings are always lower than core body temperature by 0.5 to 1.0 degree F, that pretty much guarantees that a lot of healthy people will have readings less than 98.6 - which is an average temperature, not a minimum one. Body temp varies during the day, is lowest while sleeping, and increases with physical activity.

https://en.wikipedia.org/wiki/Human_..._Variation.png

Women who are having normal, ovulatory menstrual cycles will have a lower resting body temperature, taken orally, immediately after waking up, in the early part of the cycle. After ovulation, progesterone is produced and resting temperature goes up. That is the the reason measuring morning temps can be used to see if a woman is ovulating. Here is a sample chart from an actual cycle. note that before ovulation all readings are less than 98 degrees.

https://usercontent2.hubstatic.com/8425083_f496.jpg

Body temperature cannot be used to diagnose thyroid disease.

Estrogen can make fibroids grow, and they often shrink after menopause, but women with normal menstrual cycles and normal estrogen levels can have fibroids. It is not a matter of too much estrogen or too little progesterone. In fact, both estrogen and progesterone are involved in growth of fibroids, and progesterone blocking drugs can shrink them.



"Insurance" would not "sue" a doctor for ordering too many tests of any kind. "Insurance" might drop a doctor from its panel of preferred physicians if that doctor ignores the medical indications for ordering those tests. Did your doctor share how many of the tests she ordered came back completely normal?

You can get any test you want if you are willing to pay out of pocket. Just pay at the lab and do not give insurance information
Thyroid disease can cause fibroids due to the hormone imbalance it creates, via a phenomenon called "progesterone steal". It causes estrogen dominance. Progesterone is also the sleep hormone that prepares the body for sleep at night, and induces sleep. Depending on the age of the patient, it can cause a range of poor sleep symptoms, from light-sleeper/easily awakened symptoms, to extreme insomnia during, and in the first few years after, menopause--worse than the insomnia of women with healthy thyroid function.

RE: amblyopia & other symptoms (ptosis (droopy eyelid) in some patients, headaches centered between the eyes) can be caused by thyroid disease (doesn't mean it's always due to thyroid), according to ophthalmologists who specialize in thyroid-related conditions.

Sure, fibroids can have other causes. The presence of fibroids alone doesn't indicate thyroid disease.

Insurance companies do sue doctors who order thyroid antibody tests for too many patients. They sue for "excessive testing".

Last edited by Ruth4Truth; 06-23-2017 at 08:13 PM..
 
Old 06-23-2017, 08:01 PM
 
Location: State of Transition
102,126 posts, read 107,381,087 times
Reputation: 115942
Quote:
Originally Posted by CarnivalGal View Post
My PCP (an integrative med doc) takes insurance, and she had no problem ordering the tests. And my insurance covered them.
That's great! Those are rare practitioners. Every endocrinologist I've ever been to, except that one thyroid specialist, said the saliva test is not a valid test. Most primary care docs I've spoken to about it haven't heard of it. The Mayo Clinic website had a post saying there's no such thing as adrenal fatigue, for years. I don't know if that's still there. It sounds like you have a great doc, though! You're lucky.
 
Old 06-23-2017, 09:01 PM
 
Location: Georgia, USA
37,029 posts, read 41,087,048 times
Reputation: 44970
Quote:
Originally Posted by WouldLoveTo View Post
I went back and re-read those posts and see what happened. Because those on NDT lost weight, you're just assuming they were overdosed and became hyper. Of course that's possible. It's also possible those on synthetics were underdosed. It's also possible they all got the correct dose for their situation and the published results are correct. Who really knows unless they were there??
The only difference between the two groups was the weight loss. All of the other symptoms were the same in both groups. That tells us the people who did not lose weight were not under dosed.

In the past desiccated thyroid was used as a weight loss treatment. It can cause weight loss if you get too much of it.

Quote:
I have not personally found that to be the case. I am sure it's happened to some.
I also think you stated you've never used NDT? So you don't have first hand experience in that.
It's physiology. I do not have to have "first hand experience" with it.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737508/

"On the other hand, the absorption of T3 is around 90%, peak levels are reached 1–2 hours after ingestion, the serum concentration may rise by 250% to 600%, and it has a shorter half-life of about 19 hours. Because of these characteristics, L-T3 administration results in widely variable serum levels, making it a less appropriate form of thyroid hormone replacement."

That is also why free T3 is not used to diagnose hypothyroidism. The blood level varies too much even for an individual with no thyroid disease.

Quote:
Woo-hoo!! Fantastic!!! No lie, that's great. Not everyone is so lucky.
In the study I cited about 40% of the participants had no preference for either desiccated thyroid or Synthroid. About 10% or a little more preferred the Synthroid.

I guess that means half the participants were "lucky".

Quote:
Or the reverse possibly?
Endocrinologists prefer T4 replacement alone. That is because there is no evidence that desiccated thyroid is superior to T4 alone.

Quote:
That's really interesting. NONE of the groups I follow recommend under arm temps. They specifically recommend oral temps using a mercury thermometer as they feel digitals vary too much.

General rule of thumb is that if you're not 98.6 around 3pm, you are probably low. Lowest daily temp would be upon waking. I don't know anyone who uses it as an exact science. For me, I can tell when I've got poison ivy in my system as everything reads higher, that's about it.

I always feel hot yet my temp is always low. Go figure. So for me I'll go by blood tests.
Google brings up a lot of hits on axillary temps. It's dishonest for anyone to suggest doing that unless you adjust for the fact that axillary temp is lower than core temp.

http://www.thyroid.org/wp-content/up...eb_booklet.pdf

"WAYS THAT HYPOTHYROIDISM CANNOT BE DIAGNOSED

• Low body temperature is not a reliable measure of hypothyroidism. People with
hypothyroidism as well as people who do not have hypothyroidism can have temperature
well below 98.6 degrees F."


Quote:
That's not true in every state. Mine requires a requisition from a doctor. I can choose to self-pay but I need that piece of paper. We can't even change the tests or ask them to add something on the fly.

I can order tests from a couple of online places and I am lucky there is a local lab that will draw the blood for me. But even that place has about half dozen states they can not ship to.
Yes, you need an order for the test. However, you can pay out of pocket for it.

Quote:
Right - even when I've been to a doctor who does not take insurance, the labs are typically covered. Not under routine labs, but they have been covered. I think I get one free routine lab a year.
If you bill insurance for a specific test the doctor may be required to provide a diagnosis justifying the test.

In general, doctors do not like to do shotgun testing because of the risk of false positives and false negatives with any test.

Quote:
Saliva cortisol tests have never been covered for me no matter who orders them. It will go towards my out of network deductible if I bother to make the claim - but since it's unlikely I will ever come near that I don't bother.
Here is one insurance company's policy on salivary cortisol:

https://www.bcbsnc.com/assets/servic...mone_tests.pdf

They will cover it if Cushing's syndrome is suspected. That would produce chronic, significant elevation in cortisol levels.

https://sciencebasedmedicine.org/fat...-fake-disease/
 
Old 06-23-2017, 10:16 PM
 
Location: Georgia, USA
37,029 posts, read 41,087,048 times
Reputation: 44970
Quote:
Originally Posted by Ruth4Truth View Post
Thyroid disease can cause fibroids due to the hormone imbalance it creates, via a phenomenon called "progesterone steal". It causes estrogen dominance. Progesterone is also the sleep hormone that prepares the body for sleep at night, and induces sleep. Depending on the age of the patient, it can cause a range of poor sleep symptoms, from light-sleeper/easily awakened symptoms, to extreme insomnia during, and in the first few years after, menopause--worse than the insomnia of women with healthy thyroid function.

RE: amblyopia & other symptoms (ptosis (droopy eyelid) in some patients, headaches centered between the eyes) can be caused by thyroid disease (doesn't mean it's always due to thyroid), according to ophthalmologists who specialize in thyroid-related conditions.

Sure, fibroids can have other causes. The presence of fibroids alone doesn't indicate thyroid disease.

Insurance companies do sue doctors who order thyroid antibody tests for too many patients. They sue for "excessive testing".
No one knows what causes fibroids. Both estrogen and progsterone can cause them to enlarge.

Uterine Fibroids - Now@NEJM Now@NEJM

Thyroid disease cannot "steal" progesterone. If thyroid disease is severe enough to interfere with ovulation, then no progesterone will be produced because ovulation does not happen. An egg follicle does not mature and no corpus luteum forms. It's the corpus luteum that makes progesterone.

Hypothyroidism is typically associated with sleeping too much, not insomnia. DH was practically hibernating before he started treatment. He does fine on Synthroid, too, by the way.

Eye problems can happen with hyperthyroidism, in particular Graves disease. "Lazy eye" is not a feature of hypothyroidism.

Strabismus in Thyroid Eye Disease - EyeWiki

Insurance companies do not "sue" doctors for ordering too many tests. They just drop them from their panels of preferred providers.
 
Old 06-24-2017, 06:38 AM
 
6,504 posts, read 4,909,973 times
Reputation: 7952
Quote:
Originally Posted by suzy_q2010 View Post
The only difference between the two groups was the weight loss. All of the other symptoms were the same in both groups. That tells us the people who did not lose weight were not under dosed.

In the past desiccated thyroid was used as a weight loss treatment. It can cause weight loss if you get too much of it.
It can tell us that for the people who lost weight, it worked well for them.

ANY excess thyroid dose, synthetic or NDT, can cause weight loss if you get too much of it.

One of the most prominent symptoms of hypothyroidism is weight gain. Getting on the correct dose of whichever drug works for you will likely cause weight loss. Pretty simple.

Stop trying to grasp at straws here.


Quote:
Originally Posted by suzy_q2010 View Post
That is also why free T3 is not used to diagnose hypothyroidism. The blood level varies too much even for an individual with no thyroid disease.
T3 is just part of the picture. I don't think anyone here is saying that only T3 levels can diagnose any thyroid issue at all. Free T3 and Reverse T3 are also part of the big picture. There is not one single test that will give you the entire thyroid picture.


Quote:
Originally Posted by suzy_q2010 View Post
Google brings up a lot of hits on axillary temps. It's dishonest for anyone to suggest doing that unless you adjust for the fact that axillary temp is lower than core temp.
Since I never would have googled "axillary temps", I googled "hypothyroidism taking temperature how to"

The top hit for me was STTM, which discusses oral temps. It does mention Dr. Broda Barnes and underarm testing. It states the temp range for underarm and they do say it is lower than if you took an oral temp.

Regenerative Nutrition quotes Barnes and says to place it under your tongue. If you take it under your arm readings will be lower (but gives a range to add to to make it equal to under tongue)

Mercola's site says armpit, but gives an underarm normal temp of 97.8-98.2 degrees F. They recommend treatment if the temperature averages 97.4 or less and suggest testing for 4 days.

Verywells site: (never heard of this one - once I get past the top few they always seem to be paraphrasing from other sites) armpit, normal range is 97.8 to 98.2. They say it should be part of the picture, not a sole indication of hypothyroidism.

Joanne Brophy: does armpit or urine, stating one can have sinus infections and cause a higher reading if done orally. This is also quoting Barnes, so I think some of these sites pull from others at different points in their research and never update. This one says a temp of 97.8 is considered low and suggests 10 days of testing.

So 5 out of 5 of my first hits do state that the armpit temp will be lower.


Quote:
Originally Posted by suzy_q2010 View Post
Yes, you need an order for the test. However, you can pay out of pocket for it.
You originally stated you can get any test you want by just not giving insurance info to the lab and paying for it. That is not true if you need an order for the test.

Here, I'll quote you again so you don't have to go back and look. It's post 50.
Quote:
Originally Posted by suzy_q2010 View Post
You can get any test you want if you are willing to pay out of pocket. Just pay at the lab and do not give insurance information
 
Old 06-24-2017, 07:18 AM
 
Location: Central IL
20,726 posts, read 16,283,321 times
Reputation: 50370
Quote:
Originally Posted by suzy_q2010 View Post

In the study I cited about 40% of the participants had no preference for either desiccated thyroid or Synthroid. About 10% or a little more preferred the Synthroid.

I guess that means half the participants were "lucky".



Endocrinologists prefer T4 replacement alone. That is because there is no evidence that desiccated thyroid is superior to T4 alone.
I have yet to understand your snideness in pushing a treatment that works for you but not everyone. You don't consider it worthwhile to consider that when only 10% have an outright preference for a treatment that it's worth investigating and perhaps fine-tuning the other options?

Do you know anyone on an antidepressant? You may not actually KNOW but no doubt you come across someone every day...do you know that there are at least a dozen antidepressants in current use? How would you feel if your mother, who does well on one lesser-used medication was told that tomorrow, only the one used by the plurality of depressed patients would be available? Because it was clearly the "best". It wouldn't matter that she responded best to the one she had discovered after trying maybe half a dozen over the years. Why is it so difficult to believe in individual differences regarding treatment efficacy for depression, hypothyroidism, or most any other disease?

There is in fact a number of lines of research looking at variations in thyroid functioning and treatment - here is one great article that gives you all the primary sources you can dig into:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980994/
One excerpt:

In the 1995 American Thyroid Association (ATA) guidelines, biological and synthetic thyroid hormone preparations containing T4 plus T3 were not recommended out of concern for fluctuating and often elevated serum T3 concentrations (71). In conjunction with the American Association of Clinical Endocrinologists in 2012, the ATA continued to recommend l-thyroxine monotherapy and noted that evidence does not support using synthetic combination therapies; in addition, they stated that “desiccated thyroid hormone should not be used for the treatment of hypothyroidism” (72). In 2014, the ATA recommendations evolved with the recognition that 1) serum T3 levels might not be normalized in all l-thyroxine–treated hypothyroid patients and 2) some patients remain symptomatic while receiving l-thyroxine monotherapy. Titration of l-thyroxine dose to achieve normal TSH concentrations remains a first-line approach, but trials with combination therapy can be considered. In addition, the guidelines recognize that although superiority data are lacking, some patients do experience a clinical response with desiccated thyroid preparations or combination therapy with l-thyroxine plus l-triiodothyronine (1). The European Thyroid Association has similar recommendations (2).


Another excerpt:
Clinicians noted several differences in the ability of l-thyroxine monotherapy to normalize markers of hypothyroidism at doses that normalized serum TSH (45). For instance, in many l-thyroxine-treated patients with a normal serum TSH, the BMR remained at about 10% less than that of normal controls even after 3 months of therapy (53). At the same time, doses of l-thyroxine that normalize the BMR can suppress serum TSH and cause iatrogenic thyrotoxicosis (28, 45, 46). The clinical significance of this was not fully understood because many patients appeared clinically euthyroid with a BMR between −20% and −10% (36, 37). It's of note that the reference (45) is dated 1971 showing that for DECADES there have been known issues with using T4 alone.

You can harp on and on, but the world of T4 monotherapy is cracking...and as long as you can get yours, try not to stop others from using what works best for them. I'm thankful there are doctors who actually keep up with the research and have an open mind in evaluating it.
 
Old 06-24-2017, 09:38 AM
 
6,504 posts, read 4,909,973 times
Reputation: 7952
Quote:
Originally Posted by reneeh63 View Post
I have yet to understand your snideness in pushing a treatment that works for you but not everyone. You don't consider it worthwhile to consider that when only 10% have an outright preference for a treatment that it's worth investigating and perhaps fine-tuning the other options?
Great point - can't rep you again.

Really, all that needs to be said is "XYZ works great for me".

But to insist that's ALL that's viable is just ignorant.

The biggest concern I have with new thyroid patients is that they know they do have options and to find a doctor who is open to them. If synthetic works for them, great. But if they are only allowed to use synthetic because their doctor refuses to consider anything else - not so great.

I have found it incredibly helpful to talk to others around me who have similar issues, with similar ages and activity level, to learn what works for them. I know full well it gives me knowledge but what works for them may NOT work for me at all.

I do not have close-minded friends like some people here though!
 
Old 06-24-2017, 09:55 AM
 
Location: Southern California
29,267 posts, read 16,655,017 times
Reputation: 18903
I have NOT been here at C-D that long especially when hearing from some of the old timers, but I do know that MANY who argue their "STUFF" is the best etc etc...have special interests in what they argue. Like are doctors or have doctors in their families, and I'm not talking integrative MD's.

Thanks for the good work from some of you. This is not just the thyroid issue but about every issue.


Just thinking, these are very exciting times to be alive, with so much information that we can make decisions with all the info we receive. I often think info overload but believe too we can form our own decisions so much today.

Last edited by jaminhealth; 06-24-2017 at 10:29 AM..
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