Many people with Hashimoto's disease, or other hypothyroid disorders, complain of continued fatigue even when their T4 and TSH levels are normalized as a result of treatment (e.g. levothyroxine). In many cases this is overlooked by physicians; however, others are diagnosed with idiopathic hypersomnolence and given Modafinil. In addition to improved wakefulness, this medication can reduce hair loss, reduce night time urination frequency, reduce salt cravings and improve serum salt levels. Has anyone looked into the mechanisms of action that would explain how this would work? Intuitively, I am thinking that there must be an increase (or decrease) in a specific hormone produced by the hypothalamus that has a cascading effect on the endocrine system. Can any one shed a light here?
Dear Amy~No, not with Modafinil, but rather Benicar (olmesartan Medoxomil) and various doses of Liothyronine. These two drugs can be used to treat and reverse the Hashimoto's Disease(HD). This is a model based in the molecular activity of the Human VDR. See the following papers and links.
Also, when looking to only T4 and TSH values, one misses an opportunity to assess the actual activity of the active T3 free levels. HD is really about a lack of T3 hormone docking in the nuclear receptors. Supplemental D3/d25 competes for these receptors as well as capnine. T3 fails to dock and resultant symptoms occur. Best to treat the cause: an underlying intracellular infection.
Short of partnering with the immune system and reversing HD, at least some judicious Liothyronine can be administered twice daily (half-life 8 hours) to relieve symptoms. When assessing efficacy, always time the T4 free and T3 free blood draw at 4-5 hours after dosing. Note: if you do eventually add Benicar for immunostimulation, carefully monitor Liothyronine and Levothyroxine as the patient will need decreasing amounts in the treatment phase. Regulate the blood levels to the high end of the "normal" range. Your patients will love you! For more on this and other clinical hormone practice see World Link Medical.
Hope this provides some fresh approaches for you.
SIncerely,
Trudy Heil, MS, ARNP, CLNC
http://np-privatepracticeassoc.com/
http://mpkb.org/home/publications
bit.ly/2af83oU
http://worldlinkmedical.com/
Thank you so much. In New Zealand they completely ignore the T3 levels, although I think this is in err. I will follow up on the articles you suggested. Thank you.
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