Thyroid Testing/Selenium Deficiency Anyone?

Post D.S. surgery,I switched docs from internist to an endocrinologist/internist. He ran additional parts of the thyroid tests the internist didn't do. Adjusted my Synthroid to alternate doses every other day, now my levels are perfect he says. The high dose was too much, the lower dose not enough, blending the 2 every other day was just right.

If you have thyroid symptoms, get checked out by an endocrinologist. They know their speciality best. Its a tricky one to interpret for other docs. My symptoms were weight gain, cold, hair loss, brittle breaking nails w/ridges, fatigue. The list is long, look up the rest to see if you qualify for extensive thyroid testing.

I have so much more energy now with synthroid, and my weight loss is in a downward trend, slow but working with the aid of D.S. surgery. After the initial quick loss of 80 lbs, now losing at a rate of 10 lbs a month. Exercise daily, low carb under 50 g, over 64g fluid, about 120g protein daily.

I am not qualified to answer your question. I've had to take thyroid supplements for 40 years and my dosages changed significantly with weight loss. I would ask my physician if there is any reason that you should be tested any more often than a person who has not had weight loss surgery and has not had thyroid issues. I would be very curious to know the answer. My hunch is that you don't need as much testing as you've had.

First of all, I am not a doctor, and absolutely don't consider myself an expert in the details of endocrinology. All I can do is share my experiences, and suggest you take your questions about thyroid issues to an expert endocrinologist. Many people are first diagnosed by their internist like I was, but don't stop there, find a specialist . I wanted to make sure my case was handled by an endocrinologist, especially with thyroid hair thinning, combined with D.S. hair loss. My endocrinologist is watching me carefully, adjusting my dose according to my symptoms. While adjustments are being tried I have blood tests monthly. Once a level is maintained I won't be tested as often.

My current dose of Synthroid is 100 one day, 75 the next, then 100, then 75 and so on alternating pills. The endocrinologists plan was to make my system produce more of the right stuff on its own. My deficiency is now corrected, within one month of making the change. I did read after extreme weight loss from WLS less Synthroid is required, but more may be needed post surgery until the weight is lost. At first with malabsorbtion of D.S. I was concerned about maintaining my necessary medication levels. I asked to increase my Synthroid from 75 to 100 because of this. Since I had taken a dose of 100 before for many years without any problems, the doc agreed to increase it temporarily to see if there was improvement.

Last year, my internist tried 75 for a year( I had been at 100 for many years with no complete resolution of symptoms.) My first endocrinologist at that time was unable to help me with my symptoms, after trying dose increases beginning with 15-25 increasing to 100 over 2 years. I stopped taking Synthroid for over 4 years due to its increasing bleeding during my periods, resolved when Synthroid was stopped. My weight gain increased even though I was on a controlled low carb Atkins/South Beach diet. After making a move to Kalamazoo, from Delaware, my new internist started Synthroid once again raising the dose slowly through out the year from 10-15-25-50-75.

I went through extensive testing of all systems, including heart scans to be sure my symptoms were only related to thyroid. My heart and the rest of me is in great shape. I chose the D.S. because I felt it was the only solution to help me regain my figure and health, be able to exercise to improve mobility, with increasing hip arthritis, and knee pain. I was in so much pain walking, but not any more!!! Being "Hashimotos hypothyroid" makes weight loss almost impossible, not just weight gain, but swelling too. I have a feeling eating a gluten free diet now because of D.S. guidelines has eliminated my swelling all over. I look like a different person, and feel like one too!!!

After my D.S. surgery I knew my blood work for thyroid would need to be monitored by an expert in endocrinology and internal medicine. I found a specialist, Dr Doan at the Bronson Hospital in Kalamazoo, and he is now my PCP. I suggested we try increasing my dose to 100 like it was many years ago. It was an improvement, but I was still deficient. The alternating doses may be working. The first blood test since alternating began has improved , and the doc liked the numbers.

My PCP's office is in the hospital, they do my blood draws. I like their referral system within the hospital for any speciality I may need. I feel I am receiving coordinated care with my PCP at the lead for all my health care, except the D.S. which is completely handled by my surgeons group - Grand Health Partners, in Grand Rapids. All my test results are accessed by any of my docs at the hospital, and sent to my D.S. surgeon Dr. Kemmeter. My surgeons group gives me the D.S. blood work order, to be drawn on specific timed dates, at the location of my choice. Results are sent to my PCP and surgeon. Its all working out very well. Everyone is pleased with my progress. I have lots of energy, look healthy and happy. Its not easy, lots of work, but worth it!!

Don't go by my numbers for synthroid doses. Everyone has different needs.

Sandra ;-)

Hi Sarahanne,
What does your doctor think? what is his speciality? I have found PCPs are usually conservative about treatment for everything. Try going to an endocrinologist. Did you have bariatric surgery, D.S. or what? This is reason to have an endocrinologist review your numbers. It may take a few months to get an apt with them, because they are in high demand, and there are few of them out there. Dont wait, get an apt. soon, you will feel so much better if they can help you.

Sandra ;-)

Are you pre surgery, or post surgery? My Vitamins and supplements cover my needs, other than Synthroid.

Yes, selenium helps in the conversion of T4 to T3, but your T4 also dipped a noticeable amount.

But, this could be due to about a billion different things and I can't say that I'd advise you start taking a mineral that is not easily eliminated from the body if it is taken to excess. Not that it'll kill you...but recommending it would be irresponsible.

I have Hashi's as well and my experience is that endos, for the most part, are idiots. Hashi's patients don't convert very well, something my PCP noticed in me. T4 actually made me very sick. He switched me to Cytomel (pure T3) and the change was remarkable. I doubt you will ever get full relief on Synthroid. I don't want to trash all endo's but the majority have this one treatment fits all mentality that I cannot tolerate. Look up the articles by the late Dr. John Lowe who argued for the use of T3 only treatment for poor converters like us. Selenium is important but I was taking it for years (as well as Vitamin E) and it did little to help me convert T4 to T3.

Also, I have found that Low Dose Naltrexone has helped me even more than Cytomel by putting my Hashi's into remission. I have been able to reduce my Cytomel dosage because of it. Read more here: www.lowdosenaltrexone.org

I started with my PCP and he switched me to Cytomel only when I continued to get worse on Armour, which is a natural desiccated T3/T4 thyroid replacement option. We didn't know then that I couldn't tolerate T4. I can't remember how often I was tested back then but it was through comparing the free T3 to free T4 ratio that my PCP figured out I was not converting. So we tried the Cytomel and as I said, it turned my life around. And the change happened fast.

Fast forward to last year when I had to do all the pre-testing to get the DS. I knew I didn't want to see an endo because I know how they like to push the synthcrap and I wasn't going to have any of that. There aren't many endo's in my town and unfortunately they are all pretty awful. The endo I went to decided I had Graves disease because my T4 was low and my T3 was high. I knew he was way off because I was still gaining weight in spite of a low cal diet and I had absolutely no symptoms of an overactive thyroid. Cytomel will obviously raise your T3 and possibly lower your T4 since your body just doesn't need to produce it since it is being supplemented with T3. But no, he was the doctor and therefore he had to be correct. I happened to have a parathyroid tumor that needed to come out and while the surgeon was in there, he saw a mass on my thyroid along side the parathyroid tumor so he removed the mass. It was biopsied and we got a diagnosis of Hashimotos. The idiot endo still wasn't convinced and insisted the biopsy could have been wrong. Oy, what a jerk! Needless to say, I fired him and begged my surgeon (he's an OTL) to handle my thyroid care since there weren't any decent endos in this town. Last year I had my blood work done constantly but I had to check my PTH and calcium for months after the parathyroid tumor was removed so that wasn't typical.

Just before I got my DS, I asked my OTL if he'd let me try low dose naltrexone and after researching it for himself, he gave me a script a week later. I should have been doing blood work weekly once I started the LDN but we waited until about 6 weeks later and that's when we realized the LDN suppressed the Hashi's and had my thyroid functioning on a much lower dose of Cytomel (I had originally been on 75mcg when my PCP switched me but the idiot endo wouldn't give me more than 12.5mcg and I was practically dead from fatigue.) That was on the lowest dose of LDN. Now I am on the full 3mg dose of LDN (the recommended dosage for Hashi's) and I will see my OTL next week. I will have him write out the lab order to get my thyroid checked again because I have no idea where I am or if I am supplementing enough now that I am on a higher dose of LDN. I am down to 37.5mcg so half of what I needed prior to taking the LDN. Because I am still so early out from my DS, I can't tell if the fatigue I get is from the surgery or if I need more Cytomel. I suppose I will find out soon enough.

If you can find a doc who will work with you as far as supplementing with T3 only, you should have your blood work done every 2 weeks until you find your dosage. Cytomel works within days and I got up to 75mcg within 10 days when I first started using it. I did 25mcg for three days and increased it every three days until I finally felt better. At first I was all the way up to 125mcg but I think that may have been due to the damage done by the T4 during the previous 2 years. I was able to taper off to 75mcg and I stayed on that dose until last February when I had to get cleared for surgery by an endo. I haven't been back on that dose since then and since I was able to start the LDN, I haven't needed it.

If TSH and T4 are ok, and T3 is low, you may not be converting T4 to T3 properly in the liver. T3 is the active hormone that actually controls metabolism. There are various reasons for poor conversion. Selenium deficiency is one, stress (cortisol), infection, weightloss, B vitamin deficiencies, gluten, etc...

I'm going through this now. If it doesn't resolve, my doctor is going to start me on low-dose cytomel to supplement. I have no thryoid function, at all. Mine was knocked out with Radioiodine therapy in 1994 for Graves' Disease. I cannot do cytomel, alone, because it's very short-lived whereas T4 lasts about two weeks in your body. I have no thyroid hormone produced in my body; so, missing a dose of T3 if that was the only hormone I was taking could put me in a myxedema coma.

If LND's were available 20 years ago, I certainly would have tried that before RAI. I have the 'extra-thyroid' complications of Graves (Eye & Skin Disease) which are related to antibody levels.