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An hypothesis about RT3 – did you know you might have a hidden pool of it?

arrowPlease note this is a OLDER post from 2014, a HYPOTHESIS based on limited information, and not to be taken as gospel. We’re just leaving it here for kicks sake. 

Everyone makes Reverse T3 (RT3)–an inactive thyroid hormone. It’s a way to clear out excess T4 when your body isn’t needing that extra storage hormone. i.e. instead of the T4 converting to the active T3, your body (and specifically your liver), will convert it to RT3. If someone without a thyroid problem gets the flu, up goes the RT3 to conserve energy. If someone has a bodily injury, up goes the RT3 to conserve energy.

And thyroid patients seem to see their RT3 go up in the presence of low iron or a cortisol issue.

But if you think about it, why doesn’t it go down faster when we decrease our T4? T4 has a half life of one week, yet it can take 8 – 14 weeks for RT3 to go down. Hmmmmmm…

Thyroid patient Sebastian from Germany sent me this information about Reverse RT3 that I find fascinating. What do you think?

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I’m studying biology and chemistry and have Hashimoto’s Thyroiditis with high RT3. I just wanted to inform you about an interesting idea/hypothesis I have found.

There seems to be a “hidden pool” of RT3 in the human body. This RT3 pool can increase in size while enough T4 is available, and then secrete RT3 in times where the body needs it but hasn’t got enough T4 to produce it via deodination (the removal of an iodine molecule).

“It is concluded that a hidden pool of RT3 production exists in vivo in man.”
“It would appear that hypertrophy of this hidden pool of rT3 production occurs in high T4 states […]”

Source: LoPresti et al., “Does a hidden pool of reverse triiodothyronine (rT3) production contribute to total thyroxine (T4) disposal in high T4 states in man.”, J Clin Endocrinol Metab. 1990 May;70(5):1479-84. http://www.ncbi.nlm.nih.gov/pubmed/2335581

I have made observations regarding my own thyroid blood tests and the blood tests of other patients that seem to support this hypothesis. I have been on T3-only for 6 weeks now, started with an RT3 of 330 pg/mL at approx. day 0, and now have measured a RT3 of 685 pg/mL (twice as much!), even though my TSH is low, FT4 has fallen rapidly to 0.5 ng/dL, and no T4 medication has been taken for full 6 weeks.
Another patient I know has also made interesting correlations between FT4 and RT3. He isn’t on T3-only, but observed a time-delayed (!) correlation between both values – which could be interpreted as an indicator for the presence of an RT3 storage pool in the body, that grows when enough T4 is available, and sets RT3 free in times when there is less T4 available.

I also found studies which found that RT3 has a 1000 times less feedback on the TSH than T3 has, and 100 times less than T4. This could explain any differences between TSH and symptoms, as the “RT3-system” seems to be almost completely isolated from the thyrotropic regulation system (the latter is that which directly influences the secretory activity of the thyroid gland). RT3 can obviously rise and fall without having (almost) any effect on the TSH.

Source: Cettour-Rose et al.: “Inhibition of pituitary type 2 deiodinase by reverse triiodothyronine does not alter thyroxine-induced inhibition of thyrotropin secretion in hypothyroid rats”, European Journal of Endocrinology (2005) 153 429?434.

In combination, this could explain why the clearing process of RT3 takes approx. 8-14 weeks, although T4 has a plasma half-time of only 8 days, and rT3 only 4.5 hours!

The intracellular T3 receptors aren’t “clogged”, and then suddenly become free after that period of time has elapsed. Instead, RT3 is a competitive inhibitor of T3, meaning it constantly goes in and out of the T3 receptor. You probably know that already.

Patients report feeling well with T3 only dosages of approx. 80-120 µg T3 per day. According to Celi et al., 2010, this would be equal to 240-360 µg of T4. I always wondered why they don’t end up feeling hyper.

This all makes sense now under the assumption that a hidden RT3 storage pool exists somewhere in the body. Although there is no new T4 being produced or taken in, and although the remaining T4 and RT3 have both decayed rapidly after one starts with the T3 only method, there is still alot of RT3 being set free by the storage pool all the time. This storage pool might be big enough to last for several weeks to months. Since RT3 is the competitive inhibitor of T3, this might be why patients are able to tolerate (and even need) so very large amounts of T3.

Then, after the storage pool has been emptied, the remaining RT3 rapidly decays because of its short half-time and no new RT3 can be produced because no T4 is available in the body. Therefore, RT3 concentrations within blood and cells drop. Thus, the competitive inhibition gets a lot weaker at that point, and patients start feeling hyper because the same amount of thyroid hormones (T3) is now significantly increased in its effect, since it can stay much longer in the T3 receptors without being competitively inhibited (kicked out of the receptors) by RT3.

This process of totally emptying the RT3 storage might occur very quickly, therefore the drop in RT3 concentrations is very suddenly, all of which might happen within several days. And this is why patients then get hyper and have to reduce their dosage to half or less of what they’ve taken previously over the 8-14 weeks.

“Clogged receptors” don’t make sense because RT3 is a competitive inhibitor, capable of traveling in and out of the T3 receptor all the time.

“Clearance” occurring after 8-14 weeks, although both educt (T4) and product (RT3) have significantly (!) shorter lifetimes, doesn’t make sense either. Neither does a totally defective TSH lab test, because in principle, it worked fine for all the patient’s lifetime before they got their thyroid disease; and because significant correlations between TSH and FT3 and FT4 can be observed.

This all makes sense to me now, based on two assumptions:

1. While T3 and T4 have a strong negative feedback effect on TSH secretion, RT3’s effect on the TSH secretion is minimal, being about a thousand times smaller in effect than that of T3, and about a hundred times smaller in effect than that of T4….as described in the study of Cettour-Rose et al., 2005, mentioned above.

2. The body has a large, previously unknown storage for RT3. This storage can grow while enough T4 is available, and the storage’s content can be set free when needed. As described in the study of LoPresti et al., 1990, mentioned above.

I hope you can use this information for further research. Thanks for reading.

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58 replies

Companion Nutrients: The Key to Success on the Iodine Protocol

ImportantCompanionNutrients

Iodine experts will state that to succeed on iodine supplementation, it’s recommended to prepare with companion nutrients to help counter the detox that iodine can cause.

The following informative Guest Blog Post was written by thyroid patient Jane. She is a mother and a member of the Weston Price Foundation. Years of battling a very painful disease, and experiencing the indignity and futility of mainstream medicine for managing chronic illness, led her to a path seeking true health, which included her use of iodine. Jane states: The iodine protocol has given me back my energy, cleared brain fog and erased the pain of fibrocystic breast disease. After extensive reading and over a year on the high iodine protocol, I’m personally convinced it is one of the best things you can do to help solve a wide range of major health problems, and ensure good health for many years to come.

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The entire body uses iodine, not just the thyroid. Various tissues and organs are designed to concentrate large amounts which are necessary for their normal structure and function. Conversely, low iodine levels are associated with autoimmune thyroid disease, breast cancer, thyroid cancer, goiter and fibromyalgia, as well as cysts and nodules of the breast, thyroid and ovaries.

Iodine researchers Drs. Abraham, Brownstein and Flechas tested 35,000 people — and 96% are deficient in this nutrient!

So why do so many people state that they cannot take iodine due to a reaction?

The answers may lie with what are termed the “companion nutrients”, which was coined by Lynne Farrow of the Iodine Workshop group. Each of these nutrients are critical to the success of the Iodine Protocol, and thus is essential to the proper working of your body. Those companion nutrients are as follows:

  • Selenium (see note below): 200-400 mcg per day
  • Magnesium: 400-1200 mg per day
  • Vitamin C: 3,000-10,000 mg per day
  • Vitamins B2/B3 (ATP CoFactors): 100mg riboflavin and 500 mg no flush niacin, inositol hexanicotinate form, 1-2x per day
  • Unrefined Salt (Celtic): 1/2 tsp. or more per day

Note: the above amounts are recommended dosages given in the writings and lectures of the iodine researchers listed above. They are not to be used as medical advice. For your particular health concern, you should consult an iodine literate practitioner — one who uses high amounts of iodine in their practice regularly and has read the research published at Optimox.com and in Dr. Brownstein’s book “Iodine: Why You Need It, Why You Can’t Live Without It”.

Note about selenium from Janie Bowthorpe: it can be important to test your levels before getting on selenium. Because of the MTHFR mutation, some people can have high levels, and being on selenium can make that worse with side effects to match, such as hair loss and more.

Here are the reasons why each of the companion nutrients are so necessary:

Selenium

  • high amounts of iodine without selenium induces AIT (Auto Immune Thyroiditis) and goiter.
  • selenium + iodine reduces goiter and inflammation of the thyroid gland.
  • selenium supplementation reduces TgAb that may be elevated by taking iodine.
  • TPOAb antibody levels were inversely associated with selenium levels (if you have high selenium, you have low antibodies and vice versa).
  • selenium + iodine increases the regulatory immune cells which prevent the development of autoimmune diseases.
  • necessary for the body to produce glutathione peroxidase, which detoxes pesticides, mercury, chlorine and bromide.

Analysis of the medical literature is clear: selenium plus iodine is the best combination for thyroid health. When iodine has been shown in studies to be damaging to the thyroid, it appears that concurrent selenium deficiency is the true culprit.

Not only that, if you are iodine deficient, selenium supplements “induce a dramatic fall of the already impaired thyroid function in clinically hypothyroid subjects“. https://www.ncbi.nlm.nih.gov/pubmed/2045471?dopt=AbstractPlus

Therefore, if you are already hypothyroid, taking selenium supplements while iodine deficient will make you MORE HYPOTHYROID.

***Please note that Brazil nuts are not a reliable source for selenium. You have no way of knowing if the soil they are grown in is sufficient in this mineral.

Magnesium

  • necessary for over 300 enzyme reactions in the body.
  • along with 100mg of iodine per day, improves patients self reported fibromyalgia scores.
  • along with iodine, improves autoimmune goiter, atrophy and fibrosis.
  • essential for the production of ATP, which is used for maintaining body temps and as a source of energy.

The iodine researchers found that what leads to development of autoimmune thyroid disease (Hashimoto’s, Graves) is magnesium deficiency together with low iodine, low antioxidants, and high calcium. Sounds like a description of the standard modern diet, heavy on the dairy and processed foods, doesn’t it?

Vitamin C

  • heals the iodine transporter system which may be damaged by toxic halides.
  • aids cellular uptake of iodine.
  • key antioxidant that supports detox.

The iodine researchers found that some of their patients were excreting large amounts of iodine which was not being absorbed by the body. Since these patients had known iodine-deficiency disorders, the doctors’ theorized that that they couldn’t possibly be iodine sufficient. This was thought to be due either to a “defective cellular iodine transport system”, or due to a body load of large amount of environmental goitrogens such as fluoride and bromide that prevented the iodine from entering the cell. Clinical improvements in their symptoms, and enhanced iodine uptake, was reached with 3 grams (3000 mg) or more of vitamin C in sustained release form.

[Author Note: If sustained release is not available, I split my daily dose and take with breakfast, lunch and dinner. And I always take it with bioflavonoids such as amla, camu or acerola powder.]

Vitamins B2/B3 (ATP CoFactors)

  • supports production of adrenal hormones.
  • stimulates mitochondria to produce more energy.
  • aids proper oxidization of iodine in thyroid for AIT patients.
  • clears brain fog, chronic fatigue, pain and other symptoms associated with fibromyalgia.

It is no surprise that the protocol improves fibromyalgia. The “striated muscles contain 33% of the total body iodine”. If the muscles do not contain a high amount of the natural mineral iodine like they are meant to, it would make sense to me why they would not function well. Perhaps iodine deficiency is the key to the mystery of this disorder?

Unrefined Sea Salt

  • supports adrenals and reduces oxidative stress.
  • kicks bromide out of the body through the urine.
  • relieves symptoms of bromide detox.
  • helps get iodine into the cells via the NIS (sodium iodide symporter).

Unprocessed salt is a necessary nutrient for many reasons — but on the iodine protocol, it can also be a real life saver! The chloride in salt competes with bromide in the kidneys, so a person who is low in salt will hold on to more body-busting bromide. At 6-10 grams per day, salt can increase the urinary excretion of bromide by up to 10 fold!

Salt Loading Protocol — Optional

From Dr. Shevin, based on the U.S. Military’s salt IV protocol for bromide intoxication. Relieves side effects that can result from bromide detox such as headache, acne, fatigue, etc.

Drink 1/4-1/2 teaspoon unrefined salt dissolved in 1/2 cup warm water, then followed immediately with 12-16 oz pure water.

Repeat in 30-45 minutes if needed. May repeat again until copious urination begins, or until symptoms are relieved.

On a final note, if you are having reactions, try Pulse Dosing.

This means that taking a break from iodine, while continuing to take companion nutrients and salt each day, can allow your body to clear toxins more efficiently.

Recommended by Stephanie Buist ND if having reactions to iodine: “Take iodine for 5 days with 2 days off while continuing to take the companion / supporting nutrients along with one of the other liver supporting products (such as Milk Thistle, Dandelion Root Extract, and Liver Cleansing products like Pure Zen Health TLC, Metagenics, Ultra Clear Plus.”

LAST NOTE FROM JANIE, site owner and hypothyroid/Hashi’s patient: Experiences over the years seem to underscore that Hashi’s patients may want to go low and slow with iodine to prevent any detox issues—the latter which can push antibodies up!

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References and more information

The term “companion nutrients” was coined by Lynne Farrow!
https://www.facebook.com/groups/IodineWorkshop

Clinical results and research of Dr. Guy Abraham, Dr. David Brownstein and Dr. Jorge Flechas
https://www.optimox.com/iodine-research

Iodine and Hashimoto’s Thyroiditis by Mario Renato Iwakura — Part 1 & 2 https://perfecthealthdiet.com/2011/05/iodine-and-hashimotos-thyroiditis-part-i// https://perfecthealthdiet.com/2011/05/iodine-and-hashimotos-thyroiditis-part-2/

Salt Your Way to Health by Dr. David Brownstein
http://www.celticseasaltblog.com/articles/salt-articles/salt-your-way-to-health/

Iodine Yahoo Group
http://groups.yahoo.com/neo/groups/iodine/info

Iodine 4 Health Facebook Group
https://www.facebook.com/groups/iodine4health/

STTM Iodine page, plus more in the Odds and Ends Chapter of the STTM book.
https//stopthethyroidmadness.com/iodine12345

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330 replies

Here we go again, thyroid friends: Endocrinologists wear their pointed DUNCE hats.

Duncecap

Ah me.

Ever heard of Clinical Thyroidology?

It’s a physician-targeted publication by the American Thyroid Association (ATA). The ATA states they are the “leading organization devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.”

And a Letter to the Editor in the December 2013 publication of Clinical Thyroidology only underscores why so many thyroid patients report that they…

  1. Avoid Endocrinologists like the plague for the treatment of their hypothyroidism.
  2. Can hardly contain their disgust about Endocrinologists they have seen!

The letter is based on the March 2013 study I have mentioned before, titled “Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: a randomized, double-blind, crossover study.” It was done by the Department of Endocrinology at Walter Reed Military Medical Center and headed by Thanh D. Hoang, DO and associates.

The objective of the study was to investigate the effectiveness of DTE (acronym for Desiccated Thyroid Extract, which is more popularly termed Natural Desiccated Thyroid for thyroid patients) compared with L-Tâ‚„ (more popularly known as T4-only for thyroid patients).

At the conclusion of the 16-week study, they found that…

“34 patients (48.6%) preferred DTE therapy, whereas 13 (18.6%) preferred levothyroxine; 23 (32.9%) did not specify a preference, he said. Further analysis confirmed those who preferred DTE lost even more weight over a 4-month period.” i.e. the patients who preferred it “lost 4 lb during the DTE treatment, and their subjective symptoms were significantly better while taking DTE as measured by the general health questionnaire-12 and thyroid symptom questionnaire (P < .001 for both).”

Yet the study concludes: “DTE therapy did not result in a significant improvement in quality of life”.

And why did the study conclude there was no significant quality of life improvement? Is it possible that this study was flawed in ways they don’t understand…

Two easy answers:

  1. Patients canNOT be held hostage to the TSH lab test (which the study did for those participants) if we want to find that “significant” quality of life improvement! When thyroid patients are at their very best with desiccated thyroid, they end up finding their TSH is below the so-called “normal” range, and without one iota of “hyper-like symptoms, i.e. no bone loss or heart issues”. (Hyper symptoms will only occur if there is an undiscovered or untreated cortisol or iron issue. See #4 below).
  2. We have to have optimal cortisol and iron levels with desiccated thyroid to achieve that “significant” quality of life improvement!

Back to the Letter to the Editor….

Doctors David S. Rosenthal, MD and Kenneth H. Hupart, MD proceed to present misinformed criticism and obtuse conclusions. The last part of their letter states the following…and I have bolded what I’m going to respond to:

…..Such nonphysiologic changes in serum T3 [serum T3 rose 23% and 36% in the participants] after DTE administration and resultant risks have long been known (2) and are the subject of concern (3).

 

Exploring a role for DTE in the treatment of hypothyroidism with a well-designed, blinded, randomized clinical trial is laudable. However, when evaluating a therapy for a condition that affects millions of patients and for which an effective treatment already exists (4), this clinical trial should be powered and designed to detect adverse consequences. When the goal is physiologic replacement, care also needs to be exercised that normal physiology is restored. The study of Hoang and colleagues is provocative, but it does not achieve the minimum standard required to alter current clinical practice.

And my response to what I bolded:

  1. Risks? Concern? When are the risks and concern going to be mentioned about T4-only medications—the latter which forces us to live on ONE hormone, in spite of the fact that a healthy thyroid would be making FIVE. Where is the concern about the fact that a huge body of patients worldwide have continuing hypothyroid symptoms in their own degree and kind, either at the beginning of T4-only treatment, or the longer they stay on it? To the contrary, WE have concern when our doctors repeatedly ignore or blame those clear symptoms of continued hypothyroidism on other issues!
  2. Why are you so concerned about a higher FT3?? Thyroid patients have been doing fabulously, and have seen their lives change, on desiccated thyroid for over a decade now, and especially when we find our FT3 in the upper quarter of the range. Before that, there were a good sixty years of near-exclusive desiccated thyroid use! A higher range FT3 has done nothing more than strengthen our hearts, lower our cholesterol and blood pressure, rid us of depression and anxiety, improved bone strength, helped us lose weight, taken away the need to nap, improve our gut health, given us back our lives…and so much more.
  3. Can you be SO blind as to think that T4 treatment is that “effective”? Are you that destitute of observation about the clinical presentation of your T4-treatment patients who, sooner or later, complain of depression, rising cholesterol, higher blood pressure, aches and pains, hair loss, gut problems, the need the nap, heart problems, anxiety, weight gain and more symptoms of a POOR treatment?
  4. Have you not figured out that “adverse consequences” on desiccated thyroid, or even T3-only, are related to either inadequate iron and/or a cortisol problem? Patients are so FAR ahead of you in knowledge about the problems that cortisol and iron problems can cause with desiccated thyroid…and what to do about it. Once we correct those, we SOAR on desiccated thyroid.

A better way to look at the Walter Reed study

Nearly 49% preferred desiccated thyroid! That is nothing to sneeze about! It means something. It sends the beginning of the right message. And yes, it would have been a far greater percentage if those in the Endocrinology department had understood why it’s important NOT to go by the TSH, and why the participants needed to first be properly screened for their iron and cortisol levels, then property treated! And by the way, lab results have NOTHING to do with just “falling in the normal range”.

To all thyroid patients and friends worldwide:

Sadly, we all know that the majority of Endocrinologists we have seen wear Dunce hats. Of course, there are some exceptions in the Endocrinology field! We applaud those few courageous Endocrinologists who have dared to listen to our experiences and positive clinical outcomes.

But too many remain in a stubborn, dark world of their own, represented by the comments above—a mindset which only keeps us sick.

Your solution? Give your money elsewhere!!! Give your money to medical professionals who live in a lighter world and have an understanding of the efficacy of Natural Desiccated Thyroid (NDT), or even T3-only use, and who will let you teach them about the problems of cortisol and low iron, how to treat both, and how to read labwork (as the book will also help you do). P.S. Spanish in on sale for a limited time.

Seize the wisdom,

Screen Shot 2013-12-11 at 11.37.51 AM

39 replies

Very sad news: Dr. Gordon P. Skinner of the UK has passed away!

skinner TPAStop the Thyroid Madness is saddened to report of the passing of Dr. Gordon P. Skinner of the UK on Tuesday, November 26th due to a stroke. Skinner was a champion of thyroid patients, plus a medical practitioner who was beloved for his willingness to look outside the box in the diagnosis and treatment of hypothyroidism.

Dr. Skinner was a man of high education and esteem. He “graduated in Medicine at the University of Glasgow in 1965 and following house jobs in Glasgow and Midlands of England specialized in Obstetrics and Gynaecology and later in Virology and in 1976 became Senior Lecturer in Medical Microbiology at the University of Birmingham with Consultant status at the Queen Elizabeth Hospital in Birmingham. Dr Skinner’s research portfolio for which he was awarded the prestigious Doctorate of Science by the University of Birmingham can be found in his CV”.

Dr. Skinner was brilliant about the connection between ME/CFS and hypothyroidism. Years ago, he was one who saw the association between the condition of Myalgic Encephalopathy (which is also a term for Chronic Fatigue Syndrome) and hypothyroidism, in spite of so-called normal ranges. This was huge information and the same association was also seen by some thyroid patients around the turn of the century when they were moving over to natural desiccated thyroid (NDT) and doing so much better than they did on T4-only like Synthroid. Read about Chronic Fatigue Syndrome right on STTM.

Dr. Skinner was sadly challenged by the GMC. In June of 2005, Dr. Gordon Skinner, who was a private practitioner in the UK, was called before the General Medical Council to ascertain his “fitness to practice”. And why was he called before the board? Because of alleged “inappropriate clinical practice including maintaining medication for patients at dangerous levels and failures of communication with other medical practitioners.” I mentioned this in October 2006. i.e. Dr. Skinner dared to listen to thyroid patient symptoms over what is deemed “normal” labwork via the TSH. He also dared to use natural desiccated thyroid, aka porcine thyroid extract, to treat his patients until they saw the removal of symptoms. He began to receive restrictions in his ability to practice.

Dr. Skinner was now prohibited from seeing new patients unless they had been referred by a General Practitioner, and his decisions were to be reviewed by the GMC every six months for the next three years.

In 2007, I heard from Lyn Mynott, chair of Thyroid UK about Dr. Skinner being brought before the General Medical Council (GMC) because he dared to treat his patients with thyroid hormone when they have so-called “normal” blood lab test results. The GMC attempts to dictate what is “a good standard of practice and care” for patients and the “proper standards in medicine”. I spoke about this folly in the July 2007 blog post. His restrictions continued.

Dr. Skinner was appalled by the belief that a TSH up to 10 was normal. The Royal College of Physicians and the Royal College of General Practitioners had implied by 2010 that patients should not received a diagnosis of hypothyroidism if their TSH was less than 10, and Skinner found it senseless. They had also stated that the thyroid extract called Armour was a bad medication (in spite of the fact that millions of us worldwide have had our lives change thanks to NDT).

Dr. Skinner was free to practice fully again in November 2011. i.e. his restrictions were lifted and his Fitness to Practice was restored. But in May 2012, he was forced to appear before the GMC once again, where conditions were imposed on him, including being supervised by a particular Endocrinologist

Dr. Skinner was the creator of the World Thyroid Register. This was created to “address the parlous situation of patients who are hypothyroid and have yet not been diagnosed and indeed patients who are being managed with an unacceptably low level of thyroid replacement.”

Dr. Skinner wrote the book “Diagnosis and Management of Hypothyroidism” about the symptoms of hypothyroidism and issues with getting diagnosed.

Thyroid UK summed it up well: “He will be sadly missed by his family, friends and thousands of thyroid patients whom he has helped to regain their lives through his diagnosis and treatment of hypothyroidism. Many patients became firm friends with Dr Skinner, enjoying his quirky sense of humour and it is so sad that we will never be able to hear his lovely Scottish lilt again.”

SkinnerYou will be missed, Dr. Skinner, and remembered by Thyroid Patients worldwide with admiration! We send our condolences to your family and closest friends, as well as to all your patients who will miss you greatly. Rest in Peace!

**Photo on top from the TPA UK site; below from Thyroid UK

 

 

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42 replies