Dear Doctor Phelps,

I am 29 male, was diagnosed as BP2 7 years ago. (father too) I tried many medications but with little sucsess. I am almost always depressive and currently on no medication.

I was very hopefull after reading possible relation between bp and hypothyroidsm because I had almost all the symtoms of Hypothyroidism, most peculiars are very cold feet and hands i.e. cold intolerance, fatigue, dryness in the skin, mental slowness and no energy feeling.

I run to have a throid test but the result was a kind of discoureging because as the doctor said I was at the golden middle. My TSH level is 3.13. T4 is 93.98 and T3 is 1.61. And she would not recommend me medication. (this is in Kazakstan and I cannot say they heart about the recent approaches)

But after reading your recent findings I want to give a try for thyroid hormon. I agreed with my doctor that we will check my TSH on regular basis so no worries about becoming hyperthyroid.

Now my question comes, what dose do you recommend me to start with? I know you are in favor of T3 and T4 at the same time, but unfortunately in the country I am living only T4 medication is available. Would it make a big difference? If your answer is yes, I will order the necessary medication from US. Possibly Thyrolar? but which dose better? If you think I can start with only T4 what dose to start with? If you need further clarifications I am very eager answering your questions. I am in a kind of desperate state and need your help.

Thank you very much for your time.
 

Dear Mr. B' -- 
If we in the US were as good at your language as you are in English, perhaps we'd be less willing to run around the globe making warlike noises.  Thanks for your excellence in my language.  

You could just try to get T3 alone to supplement the T4, perhaps that is available to you locally?  In the US the T3 alone is called Cytomel, generic name triiodothyronine.  You can make your own combinations a T3 pill plus a T4 pill, and the rough ratios to try to create are given on my site (the second table on this page).  

But if you have to try to obtain the combination, should you get Thyrolar or generic armour thyroid?  I haven't resolved that question for myself.  I'm still trying both forms.  I use the armour version when the patient will save a lot of money doing that.  I use the Thyrolar when I want to know exactly how much thyroid the patient is getting, or convert to the Thyrolar from some previous T4 dose.  

I am very impressed at what you've figured out on your own, and honored to be read in Kazakstan (remember, you're on your own to do with your doctor what the two of you choose; but if by providing information I can be helpful there, that would be my pleasure).  

Dr. Phelps