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Feel better on T4 than you did on Natural Desiccated Thyroid?

Occasionally, hypothyroid patients will exclaim with conviction and truth that they outright feel better on Synthroid or Levothyroxine (T4-only meds) than they did when they tried Natural Desiccated Thyroid (NDT) or even T3-only.  And we believe them.

But…there is an explainable reason which does not mean T4-only is better for you. It really isn’t. Bear with me and read on…

Years ago, as many of us were starting on NDT after being on T4, we were seeing our lives change in a huge way, far more than T4 did! It was like a miracle! Those five hormones really made a difference.

But some others were having problems when raising something so miraculous for others. Huh?? We didn’t get that.

It took awhile longer to finally see why and to answer the “huh?” i.e. we began to see that there were three strong and correctible reasons why someone was not seeing the miracle of NDT as others were, and instead, were blaming the NDT (or T3) and moving back to T4-only…

The three main and correctible reasons why NDT, which gives all five thyroid hormones, seems to fail…

1) NOT BEING “OPTIMAL” WITH YOUR NDT DOSE (it’s NOT about just being in range and not about being held hostage to the TSH)

We all have had a tendency to believe that our doctors know what they are doing with NDT or T3. But, the majority do not. They tend to leave you on too-low doses, and/or pay attention to the lousy TSH. Thus, due to the natural suppression of the feedback loop (hypothalamus to pituitary to thyroid), you will get worse on those lower doses, sooner or later. i.e. you will get more hypo, and/or have rising adrenaline, cortisol, anxiety or other. And because of that, some exclaim “NDT didn’t work for me!” and they rush back to T4-only.  But NDT, with all five thyroid hormones, could have worked well IF you had known to be more optimal. Optimal puts the free T3 towards the top of the range and the free T4 mid-range, and puts the TSH below range…all three…and removes all symptoms. What amount does that is very individual—some start to achieve that in mid-2 grains, others are in the 3-5 grain area, others may be higher.

What if you tried to raise to be optimal, but had worsening problems? Read #2 and #3 below.

2) NOT BEING OPTIMAL WITH YOUR IRON LEVELS (it’s not about just being in range)

When this is brought up to patients who once tried NDT and failed, they will exclaim with all sincerity “But my iron levels were great”. We know that a very small percentage may have had good iron. But what is common with the majority is they did NOT have good levels “Falling in the normal range” does not equal a good level of iron. It’s WHERE one falls that tells the story.

For example, with two types of ranges for serum iron (NOT ferritin):

a) When the range is approx. 40?155: women who have optimal serum iron tend to be close to 110, or 109, or 108, etc. They are NOT in the 90’s and definitely not lower when optimal. Men tend to be in the upper 130’s.
b)  When the range is approx. 7-27: women are optimal around 23ish; men are towards the top.

If they are lower than the latter examples, it messes up the ability to raise NDT and feel great without issue. Why? Inadequate iron levels tend to raise the reverse T3 (RT3) as one is raising their NDT.  As the RT3 goes up due to inadequate iron, you will feel worse. And because of that, some exclaim “NDT didn’t work for me!” and they rush back to T4-only…but if they had had optimal iron, NDT WOULD have worked…as long as they also had optimal cortisol (See #3 below) and were working to find their optimal dose of NDT (see #1)

See more details about iron here: http://stopthethyroidmadness.com/ferritin

3) NOT BEING OPTIMAL WITH YOUR CORTISOL LEVELS (it’s not about just being in range, and it’s NOT about blood cortisol)

We noted years ago that at least 50% of those with hypothyroidism had a cortisol issue as revealed by saliva, not blood. What does a cortisol issue mean? Either their cortisol was too high (due to the stress of being undiagnosed, poorly treated, or being on T4) or was too low (due to the stress of being undiagnosed, poorly treated, or being on T4), or had both high and low (due to the stress of being undiagnosed, poorly treated, or being on T4).

And what happens with a cortisol issue when you are trying to work with NDT? Either RT3 will go too high (the inactive hormone), or one’s T3 will pool in the blood and not make it to the cells, or both…and you won’t feel well or have bad reactions like excess adrenaline, anxiety, shakiness, feel-bads.

And because of having a cortisol issue, some exclaim “NDT didn’t work for me!” and they rush back to T4-only…but if they had…

a) done the 4-point saliva test, not blood
b) compared the saliva results it to the lab-values page (it’s not about that normal range)
c) CORRECTLY treated it (see this page, plus Chapter 6 in the updated revision STTM book if saliva is VERY low, which also applies to Adrenal Cortex),

….they would have soared on NDT…along with good iron and being OPTIMAL on NDT (or T3)

Note: it’s always about the results of a saliva test, NOT blood cortisol.

Bottom line, it’s not as simple as “feeling better on T4”. It’s more about that you are NOT experiencing the side effects that you did on NDT from any of the above three problems, which were all correctible. That is different.

“That all sounds like too much trouble–I’m staying on T4-only!”, you may be exclaiming….

There is a big problem with that reasoning that I hope you will be open to….Namely, T4-only outright…

  • CAUSES low iron
  • CAUSES a cortisol problem
  • CAUSES many other issues like lowered B12, lowered Vitamin D, rising blood pressure, rising cholesterol, depression, anxiety, heart issues, bone thinning, chronic pain….and more. The individuality is in who gets which…but T4 users do get problems of their own kind, sooner or later.

Please note that the above is not an empty strong opinion. It’s based on years of reported patient experiences from many who were on T4! i.e. most of the following hypothyroid symptoms were experienced by T4 users!! They were still hypo!

Now you may state “But I know people on T4 who do not have those problems!”.

First, some outright DO have some of those problems, but don’t realize it or they deny it (while others see it in them). Adrenal issues, even those denied, can make certain people awash with defensiveness, argumentativeness, denial, anger, paranoia towards others observations, low patience, moodiness, etc.

Yes, some on T4 do, in fact, do better than others. But you know what we have observed? The longer they stay on T4-only, the more problems WILL, in fact, raise their ugly heads eventually…like either adrenal issues, or low iron, or low B12, or depression, or rising cholesterol, or rising blood pressure, or heart problems, or dry skin and hair, or chronic pain, or bone loss, or rising illnesses…..on and on. Forcing the body to live for conversion alone backfires….sooner or later.

Summary: A working Natural Desiccated Thyroid, or adding T3 to that T4 as a second choice and getting those frees optimal, is a much better way to go than being on nothing but T4, according to years of worldwide patient experiences

A working NDT gives you all five thyroid hormones, and does NOT force you to live for conversion of T4 to T3 alone, i.e. some of NDT is direct T3. Additionally with T4-only, some people have genetic mutations which hinder the conversion of T4 to T3 and may not realize it.

There is a good reason that millions of patients found out that T4-only is not the way to go for many reasons, and NDT is the way to go if you correct the reasons you did NOT to do well...or even adding T3 to your T4 in an OPTIMAL amount. But you will still need optimal iron and cortisol!

P.S. The above three reasons are the most common for not doing well on NDT (or T3) and should be considered first. A 4th less common reason: chronic inflammation of any cause. Read about inflammation. If this is true for you, the sad part is that T4-only will also backfire, as it raises RT3.

Mold exposure can also effect conversion.

Click on the graphic to order an excellent saliva cortisol test.

101 replies

The Problem that Aging Hypothyroid Patients Face and How to Deal With it

Perhaps because millions of baby boomers are hitting their “senior citizen” ages, we are seeing an increase in statements by doctors, websites, and pharmaceutical reps implying that seniors should not have T3 in their treatment like NDT (Natural Desiccated Thyroid) or synthetic T3, calling it “dangerous”.

So I hope you are as impressed with the words below of this wonderful 72-year-old lady named Pat as I was…because her experience refutes the growing and ridiculous fallacy that T3 is globally and inherently “dangerous”.

I am 72 years old and up until four years ago, I was on Synthroid for over 30 years. Back then, I noticed my hypothyroid symptoms about six years after my second child. But if I’m honest and look back on my life, I now know that even as a teenager, I had brain fog….actually pretty serious brain fog. But I learned how to cover it up…

During all this time, I was diagnosed with multiple problems (which are typical for too many people on the poor treatment with T4-only or those undiagnosed): fibromyalgia, high cholesterol, high blood pressure, arthritis in my fingers, fatty liver syndrome and more. 

I also had the inflammatory disease called sarcoidosis in one nerve and in my lungs. I can’t actually connect sarcoidosis to my hypothyroidism and poor treatment with Synthroid, even if hypo people can report seeing increased inflammation. But it did happen when I was taking Synthroid. I had to take prednisone to beat it back and have been in remission for 15 years now.

But the bottom line is that for all those other issues mentioned above, I used to take multiple medications to treat all of them.

And guess what? Changing to Natural Desiccated Thyroid (NDT) four years ago took away all the above issues I was having, meaning I was also able to get off most of my prescription meds. I have less fatigue. I now have the flexibility of a 40 year old. The arthritis I had in my fingers just went away. I don’t need cholesterol or blood pressure meds anymore.

I sometimes add in compounded T3 if my RT3 (reverse T3) inches up.

My latest doctor now takes Natural Desiccated Thyroid after she saw how well I was doing. She has hypothyroidism and Hashimoto’s. We share a lot of ideas on how to conquer this disease.

My husband often goes to my appointments and says he does not understand a thing we discuss. I gave my doctor my copy of the “Stop The Thyroid Madness” book.  Interestingly enough, i knew when I went to my doctor that she used to recommend Synthroid, but also recommended herbs and other things to help with this disease. She was open to change, I think, because of her own experience.

So I think I blew their office up on my first appointment. I came in with all my labs and history. It was a 3-hour appointment with 2 people plugging in my info – my doctor and her assistant. It was later that I realized, when she asked me how I took my NDT, that she had switched to an NDT herself!

On our last appointment when we were talking about my slowly rising antibodies she told me that hers were in the thousands (my mouth dropped) and that she was taking 6 grains of her NDT. I’m thinking of recommending that she take LDN (low dose naltrexone) as I have heard it can reduce the antibodies.

Bottom line, it wasn’t staying on Synthroid that changed my life. It was moving over to Natural Desiccated Thyroid that has direct T3 in it. And in my opinion, my experience tells me the drug companies are lying! They want to keep people unhealthy so they will buy their drugs and then buy more drugs to take care of the damage the first drugs caused.   ~Pat

Here are some of the crazy issues seniors face (and there are more):

1) Medicare in the United States dropped all NDT’s from their Part D formulary—i.e. they won’t be paid for if you rely on Medicare. Armour on page 2, Naturethroid on page 16, NP Thyroid on page 17, Westhroid and WP Thyroid on page 29. See here.  Luckily, most prescription NDT brands are not that expensive anyway. Armour did go up, while the others stayed less expensive like NP Thyroid. Some use the prescription comparison called GOOD RX to find the best price in your city. 

2) Medicare in the US states “….the serum TSH test is reliable, valid, and acceptable to patients.”   To the contrary, patients of all ages have found it to be the most ridiculous test to either diagnose or treat by. It should always be about clear symptoms along with the free T3 and free T4, plus about where the latter fall in those so-called normal ranges. This is why you HAVE to be informed and be prepared to stand up for what is right and wrong. Read http://stopthethyroidmadness.com/tsh-why-its-useless There is also a complete chapter against the lousy TSH lab test in the STTM II book, and written by an MD! THAT is a chapter your doctor should read. 

Even worse, the ATA (American Thyroid Association) has stated that the target serum TSH should be 4-6 mIU/L in hypothyroid individuals age 70 or older.  That is in spite of the fact that so many of us at ANY age can have raging hypothyroid symptoms even with a TSH in the 2’s.

3) Or take the British Thyroid Association (BTA), which has stated that British thyroid patients shouldn’t be put on any thyroid meds whatsoever until their TSH is over 10, and that seniors should have a TSH around 4-10…in spite of the FACT that no matter what age, we can have raging hypothyroid symptoms even with a TSH in the 2’s–symptoms which UK doctors may blame on something else!!  Equally as bad, the UK National Health Service only endorses levothyroxine, and refuses to provide T3 to patients anymore.

4) The American Thyroid Association (ATA) states “As with the younger patient, pure synthetic thyroxine (L-T4), taken once daily by mouth, fully replaces the function of the thyroid gland and successfully treats the symptoms of hypothyroidism in most patients”  YET, we know that’s a joke. Time to inform whomever you can that a healthy thyroid does NOT make the human body solely depend on conversion of T4, a storage hormone, to T3. A healthy thyroid gives some direct T3 to counter any issues with conversion.  Read http://stopthethyroidmadness.com/natural-thyroid-101

But you CAN bypass this craziness, say informed seniors, with these steps

  1. Finding the right doctor: As with any age, senior patients state they all-the-more need to DO THE WORK to find a smart doctor who WILL let you be on T3 or NDT, and will NOT go by the lousy TSH lab test. It can be work, but it’s possible to find one. http://stopthethyroidmadness.com/how-to-find-a-good-doc
  2. Understanding the iron and cortisol issue: Seniors who have either been undiagnosed or on T4 for years say it’s extremely important to check iron and cortisol levels, since they can be off from all the years of no treatment or a poor treatment with T4. If they are off, they can cause reactions to T3 or NDT, causing the misinformed doctor to proclaim “See, I told you so”, when in reality, reactions to NDT or T3 are revealing inadequate iron or a cortisol issue. They will need to be treated. See http://stopthethyroidmadness.com/iron-and-cortisol
  3. Commiserating with other seniors: If you are OVER 60…consider joining the Facebook FTPO 60-and-over discussion group and see where others have found a good doctor. (FTPO stands for For Thyroid Patients Only) https://www.facebook.com/groups/FTPO60andover/ NOTE: you canNOT be approved if the admins can’t discern that your age fits this group, or we can’t see either your wall posts or friends list–the latter to know you aren’t a spammer.
  4. If you have to go in the hospital…have an informed family member or friend) who will advocate for you about your current NDT or T3 treatment. Too many patients have reported they were taken OFF their needed T3 or NDT and put on T4-only…and they regret not bringing their own meds or having an advocate.
  5. Keep a document stating what thyroid meds you are on, and why, that your advocate can have access to.

To read more: https://stopthethyroidmadness.com/thyroid-patients-getting-older

To get the very important STTM Books: http://laughinggrapepublishing.com …. because YOU have be informed!! If we put all our apples in a doctor’s cart, the risk is high we’ll stay sick or poorly treated. We have to be prepared to guide our doctors!

 

 

 

 

42 replies

LYME SUCKS!! In Loving Memory of Paige Adams, FNP, B-C

Paige Adams, FNP, B-C UPDATED(Paige Adams died Sunday night/early Monday morning, due to her Lyme disease. And if you didn’t know her, I want you to.

In honor of Paige Adams, the Lyme Warrior….)

When I was contacting certain medical practitioners in 2014 to be in the STTM II book, one that I knew I wanted in there was Paige Adams.

Paige was a Nurse Practitioner with a fabulous reputation among patients as owner of The Center for Proactive Medicine in Nashville, Tennessee.

And Paige herself was a fighter! She had problems for many years and successfully treated her hormone imbalances like PCOS and infertility, Crohn’s disease, severe adrenal fatigue and Hashimoto’s disease. Perhaps that is why she specialized in treating difficult cases at her clinic…

And oh was Paige a fun and extremely loving individual, as so many others know! In our many email correspondences, she would start her message with things like “Hey Lovely Lady!” or “Hey Gorgeous!” or “Hi Ladybug!”. Or she would end her emails with “Much Love n Blessings”.  She always made me chuckle with her exuberant, sweet and loving personality.

Paige strongly supported this thyroid patient movement for better health care as well as our power in being informed patients and our best advocates. Her chapter happened to be about Reverse T3 in the Stop the Thyroid Madness II book, titled “Moving Forward with Reverse T3: The Causes and Health Implications”. And she wanted me to include all sorts of wonderful and cute graphics in the chapter, which you will see in Chapter 11. You can discern her dynamic personality in the way she wrote that chapter.

She concluded her wonderful chapter with the following words of wisdom:

The best best advice I can give to my patients is this:

– Eat clean (preferable gluten-free)
– Drink plenty of filter spring water
– Exercise to tolerance
– Find time to enjoy life and to laugh. I mean laugh a LOT!
– Get your face in the sun for even a few minutes every single day
– Keep your [internal] gutters and downspouts clean
– Get your caboose in bed for plenty of uninterrupted sleep every night

Paige also knew about the importance of B12, supported the use of Low Dose Naltrexone, understood personally about the MTHFR mutation, was concerned about the connection between certain viruses and cancer, was interested in genomics, supported the use of Natural Desiccated Thyroid in the treatment of hypothyroidism, and had an special interest in autism in children, many of whom she treated.

One of several treatments that Paige loved was the Myer’s Cocktail–an intravenous nutrient mixture that could contain high doses of the B vitamins as well as magnesium, vitamin C and sometimes calcium.

Paige was an “avid and outspoken animal lover”, too, which she never hesitated to talk about in her Facebook posts. Paige also loved the Alabama Crimson Tide.

And Paige had Lyme disease

For those who don’t know, and in simple terms, Lyme is a tick born infection via a bacteria of what is called the Borrelia type. It is estimated to affect 300,000 people a year in the United States and 65,000 people a year in Europe¹, even though many more individuals get bitten by a tick without getting Lyme.  The good news about the bite is that if it’s attached for less than 36-48 hours, there is less risk you’ll get Lyme.²  But it happens.

If someone does get Lyme, the signs and symptoms of the disease vary and usually appear in stages.³ Many will get a bullseye rash on the skin within the next week or more: some do not. Others will get flu-like symptoms, ranging from achiness to fever to fatigue. Over time, which can take months to years and especially if untreated, individuals can develop viral infections, inflammation, aches and pains, shakiness and/or neurological issues…to name a few. Lyme is nasty.

Paige, unfortunately, had active Neuropsychiatric Lyme Disease, which she explained to me in the Fall of 2015 and was fighting it all with IV antibiotics and a great amount of oral medications.  Also known as Lyme neuroborreliosis, it’s the neurologic involvement of either the peripheral or central nervous system.

Bottom line, Paige was one sick lady and fought like a champion. Her dear mother confirmed that she lost her battle with Lyme during the night. There will be no service, but as soon as her mother announces it, there will be a way to make donations, which I will include as a comment to this post.

Lyme disease and you

Do know that each person’s case of Lyme is individual with many variables, both in outcomes and treatment protocols. Many do quite well after treatment. For more information…

– A video to watch about Lyme: https://www.youtube.com/watch?v=6OdP8Jndnyk

– And another video by Dr. Horowitz about the co-infections that can go with Lyme: https://www.youtube.com/watch?v=O9a-2Nb2sbk

- – Here’s an interesting page where the results of this gal’s survey questions were tabulated about Lyme treatments: http://willtherebecake.org/2015/11/11/success-rates-of-various-lyme-treatment-options-a-personal-study/ The rest of the website is excellent.

More sites:

http://ilads.org/

http://www.lymediseaseassociation.org/

http://whatislyme.com/where-to-start-lyme-info-for-newbies/

http://www.tiredoflyme.com/http://www.betterhealthguy.com/blog

Groups:

– This group is for women only and focuses on abx: https://m.facebook.com/groups/243181499182129?ref=bookmarks
– This one is all about various herbal protocols like cowden, buhner, white     https://m.facebook.com/groups/263709223729311?ref=bookmarks
– This one follows dr. Klinghardt: https://m.facebook.com/groups/712530532196662?ref=bookmarks
– LDI: https://m.facebook.com/groups/828673227222144?ref=bookmarks
– Another Cowden group: https://m.facebook.com/groups/1547743332142929?ref=bookmarks
– Cannabis for Lyme: https://m.facebook.com/groups/1506598772889860?ref=bookmarks
– Lyme and mold (mainly follows dr. Shoemaker): https://m.facebook.com/groups/1485904731739075?ref=bookmarks

Dear Paige, you will be missed by so many people! Thank you for touching all our lives with your sweet spirit, highly positive outlook, loving attitude, tireless efforts to help others in your practice and passions…and your wonderful contribution to the STTM II book! And we all send our deepest condolences to your mother and the rest of your family and closest friends.

*******************

  1. https://en.wikipedia.org/wiki/Lyme_disease
  2. http://www.cdc.gov/lyme/transmission/
  3. http://www.mayoclinic.org/diseases-conditions/lyme-disease/basics/symptoms/con-20019701

Here is a great article by Paige:

Intravenous Therapies – Miracle Help for All

And remarkably, this is the beautiful graphic she posted on Facebook the day before she died… We should all post it on our pages in her honor.

Paige Adams quote she posted

52 replies

What do these people have in common: Adams, Bouc, Dach, Edwards, Heyman, Heiser, Luber, Lynch, Phan, Roberts, Saleeby, Stone, Trumbower and Yang?

1-Screen Shot 2014-08-13 at 5.22.27 PMWhat do these people have in common: Adams, Bouc, Dach, Edwards, Heyman, Heiser, Luber, Lynch, Phan, Roberts, Saleeby, Stone, Trumbower and Yang? 

Answer:  Brilliance in thought, courage in action, intelligent reasoning, and a willingness to learn from their patients as medical practitioners.

And that is all exactly why each of them was chosen to contribute as an author to a new Stop the Thyroid Madness book, titled

Stop the Thyroid Madness II: How thyroid experts are challenging ineffective treatments and improving the lives of patients

Each of them are medical practitioners who strive to….

  • create a patient-centered practice and personalized method of treatment based on the symphony between the thyroid and all other bodily systems
  • understand that treatment of thyroid disease is more than the use of a single synthetic medication and a pituitary hormone lab result.
  • have the courage to question the basic assumptions held by the traditional medical community as to what constitutes good thyroid treatment
  • listen and learn from their patients.

Why else did I choose these particular practitioners for the book?

First and foremost, it was based on patient reports. The majority of these professionals were reported by thyroid patients to be the better cream of the crop in the medical field.

Could I have chosen others?

Yes. There are others of whom patients have reported they like! But serendipity led me to each one of these masterful professionals and it has all played out like a well-tuned chorus.

How is this book different than the revised STTM book?

The revised STTM will forever stand out as a compilation of highly important and life-changing experiences and wisdom of thyroid patients worldwide.

The new STTM II book brings the minds and brilliance of medical professionals into the mix, not only giving you more details that only a trained professional can give, but the book can also be seen as a practitioner-to-practitioner book, as well. THIS is a book that will end the refrain among certain doctors “Who is Janie Bowthorpe and where is her medical degree?” (i.e. as if only someone with a medical degree can know something important medically!).

THIS is the book that you can give your doctor since it’s written by his very colleagues!

THIS is the book that will play a dynamic role in changing the worldwide medical mindset about the proper treatment of thyroid disease.

What did they write about?

CHAPTER 1 The Integrative and Functional Medicine Approach to Thyroid Diseases by James Yang, MD, MPH and Andrew Heyman, MD, MHSA

CHAPTER 2 Stress, Adrenals, Your Thyroid, and You by Laura R Stone MD, Andrew Heyman, MD MHSA and Carla Heiser MS RD LD

CHAPTER 3 Thyroid Replacement Therapy: Natural Desiccated Thyroid (NDT) by Yusuf (JP) Saleeby, MD

CHAPTER 4 The Unreliable TSH Lab Test by Jeffrey Dach MD

CHAPTER 5 When Normal Ain’t Normal by Geoffrey T. Bouc MD

CHAPTER 6 Nutrition and Hypothyroidism by William D. Trumbower, MD

CHAPTER 7 Hashimoto’s Autoimmune Thyroid Disease by Jeffrey Dach MD

CHAPTER 8 Why Are Doctors Like That? by Nguyen D. Phan MD

CHAPTER 9 Gluten Intolerance and Thyroid Disease by Paula Luber, MD

CHAPTER 10 Thyroid Toxicity by Philip L. Roberts, MD

CHAPTER 11 Moving Forward with Reverse T3: the Causes and Health Implications by Paige Adams, FNP, B-C

CHAPTER 12 Methylation, MTHFR and Thyroid Dysfunction by Benjamin Lynch, ND

CHAPTER 13 Hypocortisolism: An Evidence-Based Review by Lena Edwards, MD, FAARM, FICT; Andrew H. Heyman, MD MHSA; Sahar Swidan, PharmD

Who wrote the Foreword?

Dr. David Brownstein, MD.

Where can I order the book?

Currently, only at the publishing company website. It will eventually catch up to Amazon, but that can take time.  You can order one or multiple copies of the new STTM II book here: http://laughinggrapepublishing.com/stop-thyroid-madness-ii-book/

Or you can order a set(s) of both the revised STTM book and the STTM II book here:  http://laughinggrapepublishing.com/stop-thyroid-madness-books-revised-and-ii/  ALSO NOTE that by snail mail, you can order an amount of each book. There’s an Order Form to print out on the above page.

Want to read more about each author?

Go to the following page and click on their photo: //www.stopthethyroidmadness.com/stop-thyroid-madness-ii

 

9 replies

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

arrowPlease note this is a HYPOTHESIS, based on limited information, from 2014, and not to be taken as gospel.

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?

*******************

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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