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Levothyroxine for high insulin
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nancyochi
My vet feels strongly that I should give Thyro-L to increase insulin sensitivity, citing this report from Nicholas Frank:
Dr K previously advised that it does NOT improve insulin sensitivity, citing this report from a student of Nicholas Frank: I’m confused reading the student’s report. The Abstract says T-L does not improve sensitivity, but page 88 in section 3.4 Discussion seems to say it does. I don’t have a medical background at any level, so all of this is Greek to me. Please help me know which way to go! Dot’s insulin was over 400 last reading despite weight loss and diet under control. I am working to get my vet on board on testing for iron overload also. -- Nancy O, Elbert County, CO, 2022 |
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Sherry Morse
Hi Nancy, The short answer is that it will help jump start weight loss but will not lower insulin just through giving it. The study that was done by Dr. Frank was done on healthy horses, not ones that had IR. The conclusion of the study by his student specifically says: We conclude that levothyroxine sodium induces weight loss and reduces mean neck
circumference in previously laminitic obese horses and these changes occurred when horses
were provided with a weight maintenance diet, supporting our hypothesis. Although no
significant improvement in insulin sensitivity was detected in this study, AUCi results
suggest that L-T4 alters insulin dynamics. Looking at your CH if Dot was 821lbs when you had him on Metformin he was being slightly underdosed and that could be the reason why you didn't notice a change in his insulin while he was on it. If he does not respond to Metformin dosed at 30mg/kg twice daily, diet and exercise as possible your next step would be to have your vet contact Dr. Kellon about using Invokana to get his insulin down.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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The definitive statement from that thesis is
" Levothyroxine induces weight loss and reduces neck circumference in horses with EMS when animals are kept on a weight maintenance diet, but does not influence glucose dynamics or insulin sensitivity. " I agree with testing for iron overload but you need to get ACTH down into the low 20s and consider an SGLT2 inhibitor if your diet is properly balanced by one of our balancers. -- Eleanor in PA www.drkellon.com |
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PS I don't know how comfortable he is now but exercise is the best insulin buster.
-- Eleanor in PA www.drkellon.com |
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nancyochi
Thanks Sherry. The metformin was given prior to joining ECIR so Dot was closer to 900#. If I am doing the math right he should have gotten twelve 1,000mg pills twice per day. Vet prescribed eleven. Now he tapes at 807 so the eleven pills twice per day would be correct I think. His insulin was >200 when we began the metformin, it went down to 124, but after 5 months of it insulin was back up >200. He got it for 5 months. We dropped it when it went back up, but I am not against trying it again.
Dr K, vet originally had reservations about trying SGLT2 given the liver enzymes, but after discussing it with their internist they have no concerns about the liver. I increased Prascend to 2mg/day last week. He also said they would test iron through Cornell and did not respond yet when I asked why not KSU. Hay was balanced by you and all recommendations followed. He is comfortable with boots on. The weather has improved enough for us to hand walk with boots a solid half hour/day outside. He is happy about that! He moves a lot in his sand turn out also, visiting the mares along side. It’s the biggest grass free turn out we have. Are there any negatives to giving levothyroxine if the vet continues to push the issue? I feel the need to keep the relationship with them on a positive note. If I follow his advice and there is no improvement, at least I can say I gave his suggestion a shot and it didn’t work. Thank you SO much!! -- Nancy O, Elbert County, CO, 2022 |
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Sherry Morse
Hi Nancy, The downside of giving an unneeded thyroid medication is twofold - one to your pocketbook and it may cause him to lose weight that he doesn't need to lose at this point. It will also suppress the function of his thyroid so if you decide to stop it you will need to wean off of it slowly so his thyroid will start to work again. It sounds like he had a positive response to the Metformin previously so using it again at the correct dosage (30mg/kg twice a day) may be all he needs at this point.
Thanks, Sherry and Scutch (and Scarlet over the bridge) EC Primary Response PA 2014 https://ecir.groups.io/g/CaseHistory/files/Sherry%20and%20Scutch_Scarlet https://ecir.groups.io/g/CaseHistory/album?id=78891 |
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Hi Nancy,
I agree with Sherry on the downsides but also think it's important to work with your vet. Thyro-L is unlikely to do any harm, it's an easy one to give in on. Normally we recommend only changing 1 thing at a time. If you add Metformin and Thyro-L at the same time, your vet is going to attribute success to the Thyro-L. But don't let fussing with Thyro-L delay any real treatment that might be needed though, like Metformin or an SGLT-2 Inhibitor...you do not want more permanent hoof damage because you didn't get insulin down sooner. -- Kirsten and Shaku (EMS + PPID) and Snickers (EMS) - 2019 Kitimat, BC, Canada ECIR Group Moderator Shaku's Photo Album Snickers' Case History Snickers' Photo Album |
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