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12 WAYS YOU CAN BE MAKING YOUR THYROID TREATMENT WORSE!

STTM 12 waysA healthy thyroid makes five hormones, of which T3 is the most powerful. T4 is the storage hormone, meant to convert to the life giving T3.

But sadly, there are a variety of reasons why conversion of T4 to T3 my be inhibited, and which especially makes being on Synthroid or any other T4-only medication a risky choice in the treatment of hypothyroidism.

Even if you finally found the right treatment for you (which is adding direct T3 (the active hormone) to that T4 (a storage hormone)…or moving over to Natural Desiccated Thyroid…it’s important to learn the following reasons why you may not be converting that T4 to T3 in the most optimal way.

1) GETTING OLDER: Just as getting older can influence even the production of thyroid hormones, it can affect your ability to convert the storage hormone T4 to the active hormone T3! i.e. deiodination decreases.  www.hormones.gr/205/article/thyroid-hormones-and-aging.html

2) EXCESS GOITROGEN FOODS EATEN DAILY (broccolli, soy, etc) CAN GET YOU INTO TROUBLE!  www.stopthethyroidmadness.com/goitrogens

3) GOING THROUGH HIGH STRESS DAY AFTER DAY RAISES CORTISOL, WHICH IN TURN INHIBITS CONVERSION of T4 to T3! www.stopthethyroidmadness.com/ps/

4) CERTAIN SUPPLEMENTS OR FOODS NEED TO BE TAKEN AWAY FROM YOUR THYROID MEDS Calcium, iron and estrogen are examples. Though this talks about levothyroxine (which patients are moving away from all over the world), the information is solid: www.peoplespharmacy.com/2010/08/26/taking-thyroid-medicine-properly/

5) NUTRIENTS ARE NEEDED TO HELP CONVERT T4 to T3!!  Are you low in Selenium? If so, it negatively affects the conversion of T4 to T3! So do low levels of zinc, B12, B6 and more. http://www.naturalthyroidchoices.com/ThyroidNutrients.html And why do we, as thyroid patients, find ourselves with low nutrient levels?? Besides having Celiac, here’s the most common reason for all: www.stopthethyroidmadness.com/stomach-acid 

6) CHEMOTHERAPY and RADIATION CAN NEGATIVELY AFFECT YOUR T3 LEVELS:   http://www.ncbi.nlm.nih.gov/pubmed/9204611

7) THOSE WHO FIND THEMSELVES WITH HIGH LEVELS OF HEAVY METALS DUE TO MTHFR CAN ALSO SEE THYROID HORMONE PROBLEMS!  www.stopthethyroidmadness.com/mthfr

8) MORE THAN MODERATE EXERCISE CAN DECREASE CONVERSION OF T4 to T3!  www.ncbi.nlm.nih.gov/pubmed/18539729

9) LOW IRON IS A KNOWN INHIBITOR OF T4 to T3!  Just as low thyroid can cause low levels of iron due to low stomach acid, conversely, that low iron can inhibit conversion of T4 to T3!! www.stopthethyroidmadness.com/ferritin

10)  CHRONIC INFLAMMATION IS NOT YOUR FRIEND WHEN IT COMES TO CONVERSION OF T4 to the ACTIVE T3! Just as undiagnosed or undertreated hypothyroidism can cause inflammation, the latter in turn can negatively effect conversion! www.stopthethyroidmadness.com/inflammation

11) LIVER HEALTH IS KEY TO GOOD CONVERSION of T4 to T3! Since your liver is the main component in conversion, any kind of liver stress (fatty liver disease, hepatitis, heavy metals and more) will see reduced conversion to T3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC301912/

12) ESPECIALLY IN MEN, LOW TESTOSTERONE MAY INHIBIT CONVERSION! And like the two incidences about, undertreated or untreated hypothyroidism can lower testosterone, and low testosterone can further inhibit production of T4 to T3. http://www.allthingsmale.com/community/threads/interesting-testosterone-d1-increase-and-gh-increase-t4-to-t3-conversion.17213/

NOTE: you will sometimes see Diabetes listed as an inhibitor of T4 to T3, yet studies are not conclusive and some see higher T3 with diabetes, not lower.

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114 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?

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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

New chemical analysis showing important difference between NDT and T4-only!

I found this fascinating…and I think you will, too.

I got an email from Peter Guagliano, the owner of the website thyroid-s.com. And he directed me his latest post titled “Natural Desiccated Thyroid and Synthetic are NOT the same”. 

But this wasn’t the basic information that we all know i.e. comparing a single synthetic hormone to all five natural desiccated thyroid, which makes the latter wonderful.

Instead, it was about a bio-analytical chemist who decided to test synthetic T3 (Cynomel and Cynoplus) as well as the Thailand-made Natural Desiccated Thyroid (NDT) called Thyroid-S, by extracting each tablet with methanol, then diluting and injecting them on an LC/MS system–a sensitive instrument used to detect and identify compounds and molecules in a substance.

And what he discovered and reported is that the thyroid hormones of NDT are tightly bound with thyroglobulin, a large iodine-containing protein….whereas synthetics are bound by nothing. i.e. synthetic hormones are exposed; NDT hormones are protected (until they are released by your digestion).   The diagram on this blog post gives you a powerful visual of this reality, but specifically in comparing natural desiccated thyroid with synthetic T4-only. You will see the large mass of thyroglobulin on the left, each containing either T4, T3, T2, T1 or calcitonin within. Then the tiny synthetic hormone on the right, alone.

But is that bad NOT be bound by thyroglobulin??  Possibly yes in the opinion of Peter. As Peter explained:  “The [exposed] synthetics might be affected by stomach acids in different ways in different people.  Low acid, high acid, various digestive and pancreatic enzymes in varying amounts, bacteria/flora in the stomach and small intestine, all kinds of possibilities here which would vary by the person.”  And, he says, that can mean instability!

Peter continues:  “Perhaps the thyroglobulin in NDT (and completely missing in the synthetics) is absorbed, or necessary, or utilized, or forms other products during digestion that could affect blood levels of various substances, numerous carrier proteins for example, thereby affecting the results obtained.”  And he concludes:  “The NDT hormones are bound to thyroglobulin and not available for reaction or breakdown until after they first digested (from Janie: which saliva begins, by the way, even in your mouth).  This would be a more stable compound.”  His original post is here.

A side note about thyroglobulin and iodine:   The protein Thyroglobulin takes up a lot of space in your thyroid with the purpose of taking ahold of iodine and storing it to produce thyroid hormones. That purpose alone tells you how important it is to have healthy levels of the nutrient iodine. And each molecule of thyroglobulin has just over 100 sites where the iodine can take ahold along with the assistance of thyroid peroxidase (TPO) and hydrogen peroxide. When you are iodine deficient, it’s been noted that your thyroglobulin will increase, which is why you can see a bulge in front of your neck–also called a goiter. (Even taking too much iodine supplementation can cause this increase, which can block thyroid hormone production).

**Enjoy more scientifically technical information about thyroglobulin? Go here. 

**To read about the process of making porcine-derived NDT via thyroglobulin, go here. 

**To know more details about Natural Desiccated Thyroid–its history, the breakdown of the hormones, and how patients dose it, see Chapter 3 in the revised STTM book, here. 

**To read how T4-only is only a reverse mirror image of the real thing, read my blog post from May 10, 2012. 

Whether these findings are completely correct or not, patients simply know from ten years of experience that NDT has been giving them far better results than T4-only…and even those on T3-only who moved to NDT reported they liked the results even more. It’s all important patient-to-patient information.

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A legendary soccer player with hypothyroid who was forced to quit, plus one creative YouTube video.

A guy posted about this one of the STTM Facebook groups, and I found it hauntingly familiar. When I was in my early 30’s, I was forced to quit my beloved career as a well-trained and talented fitness instructor due to hypothyroid complications causing debilitating dysautomia reactions thanks to T4-only medications. It was very grievous and hard.

But famous Brazilian soccer football player Ronaldo, who was the all-time leading scorer at the 2006 World Cup,  has had to retire because the game rules FORBID him from taking the hypothyroid meds he needed, even if they have been the lousy T4-only levothyroxine meds. i.e. the rules see taking thyroid hormones as against the anti-doping rules.

What a shame. He’s young, 34 years old, and could have continued with a great career. But you also have to wonder how long he would have lasted at that, because Brazil doctors are still putting people on T4-only medications like so many other clueless doctors around the world.

You can read about it on CNN here.  Did you identify with losing a career or hobby thanks to hypothyroidism? What’s your story?

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I get really interesting emails from folks, and one arrived last week from Brian, the creator of a YouTube video called Our Holy Miracle of the Infallible TSH Test that he wanted me to view.

I confess that when I first saw it, I thought it was quite bizarre! Wasn’t sure what I thought of the humor with the female as she was dressed.  But the more I thought about it, I also see it as extremely creative, a good sense of humor, and a pertinent message. In fact, it may strongly appeal to younger folks because of it’s intentional hip irreverence.  So, go there with an open mind and sense of humor, and you just might like the message as I do and others are! http://www.youtube.com/watch?v=tOb2POQGE6g

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15 replies

Confessions of an Undercover Thyroid Advocate

The following guest blog post is written by Amy McMullen, who had undiagnosed & symptomatic hypothyroidism for 20 years due to the sole use of the TSH, resulting in multiple health problems. She is now treating per the guidelines on STTM including T3 for thyroid hormone resistance, adrenal support, and desiccated thyroid.

I found her story below as an undercover advocate fascinating,  and think Amy is caring and committed,  in spite of severe restrictions! Bless you, Amy.

I spend an inordinate amount of time these days contributing to a well-known online thyroid disorders forum I’ll call “Thyroid Health Forum” (not its real name).

It’s a tricky forum with draconian rules: they don’t allow you to post any links to resources, talk about where you get your online labs done, include quotes from studies, or post any names of thyroid advocates. You can’t use a username you’ve used on any other forums and you can’t mention using their personal messaging system.

I’ve received a few “infractions” from the ever-vigilant board “administrators” and “moderators” (never could color inside the lines, I guess) and have been warned to never, under any circumstances, use the words “Stop the Thyroid Madness” or any references to this website or book in my posts.

At more than one point I was ready to walk away and just give up on it.  How can you share your experiences when there were so many rules that seemed designed to inhibit a free flow of information, to the point of not being allowed to mention the title of a good book by name or type in the word Google?

But I would read the following posts submitted by desperate people and this would keep me coming back to try, somehow, to help:

  • “Hi, my doctor says my labs are all normal but I’ve got so many symptoms, I can hardly function…”
  • “My doctor says that free T3 and free T4 testing is not useful, that my TSH is normal and that unless my TSH is high he won’t order any antibody tests…”
  • “My doctor says that my TSH is too low and wants me to cut back on my thyroid hormones, but I know I will start feeling bad if I do this… Help!”
  • “I am taking Synthroid but I feel terrible and my hair is falling out and now my doc wants me to take an antidepressant…”

You see, I was in this very same boat for far too many years. About 20 years back I started noticing symptoms:  fatigue, depression, menstrual irregularities, and dizzy spells. I went to see my doc who did the usual TSH test and when it came back “normal”, prescribed antidepressants. The antidepressants did help, but my menstrual problems intensified and other symptoms increased until I finally underwent a hysterectomy for dysfunctional uterine bleeding. Shortly thereafter, I collapsed with heart irregularities and autonomic nervous system dysfunction in the fall of 2006.

I went to over 10 different specialists spending thousands of dollars for medical bills with no real answers–just a lot of shrugged shoulders and a fibromyalgia diagnosis.

It wasn’t until my mother was hospitalized and routine blood testing came back with a TSH of over 6 that I looked again at my own thyroid. My TSH was never above 3. I had one free T4 test done following my initial collapse but, again, all tests were flagged “normal” and thyroid was passed over once again.

But a search about TSH lab ranges led me to Mary Shomon’s About.com articles, and while she seemed to be stuck on the idea that 3 was an acceptable number for the top of range for TSH, based entirely on the American Association of Clinical Endocrinologists recommendations, I finally found the Stop the Thyroid Madness site and learned otherwise.

It was here that I learned about other testing like free T3, free T4, thyroid antibodies, vitamin and ferritin levels and, very importantly, that the TSH should be the LAST test done for diagnosing hypothyroidism instead of the ONLY test. I finally caught on to how the medical establishment has failed miserably to adequately diagnose and treat hypothyroidism. I felt both incredibly empowered and very, very angry.

I quickly delved into the thyroid forums to share what I’d learned and to learn from others. The first forum I found was the aforementioned  “Thyroid Health Forum”, and since this is one of the best-known, it is where many of the newbies, like me, find themselves. There were both natural and synthetic hormone proponents on the board and the advice ranged from very good to quite bad. I soon found there were better forums like Realthyroidhelp and the natural thyroid hormone Yahoo groups that had really smart people who were happy to share resources and information that was truly useful. I spent a lot of time on these and learned a great deal.

But for some reason I couldn’t seem to leave the “Thyroid Health Forum”. The people who stumbled on there seemed so lost and I felt compelled to impart what I had learned to them. I would offer alternatives to the synthetics and explain why natural desiccated thyroid (NDT) was a superior treatment option and, more importantly, that they did have an option for their treatment, despite what their doctor told them. I’d relay what I had learned from other boards about access to NDT during the shortages.

When I figured out I had adrenal fatigue and later thyroid hormone resistance as a result of being undiagnosed for so long, I started relaying information about these issues to the many who were having difficulties getting optimized on their hormone replacement therapy. I found it to be both rewarding and enormously educating for myself as I would spend time researching questions that were asked about supplements, lab tests, and studies. I was not allowed to post links so had to summarize things I had learned and this taught me even more. The main messages I pushed were (and are):  get the right labs done, learn how to interpret them correctly, be your own advocate, know your treatment options, and don’t implicitly trust doctors.

I will continue to contribute what I’ve learned to the “Thyroid Health Forum”. So far I’ve managed to fly under the radar and play, however grudgingly, by their rules. I figure if I can get just one or two people to question the present thyroid clinical guidelines, as written by our friends at big pharma, I’ll be more than satisfied. I actually believe that by getting good information out there to as many sufferers as possible, we may create a groundswell of people who will no longer accept being dismissed as depressed complainers by their healthcare providers. And this is one more way we can help enact real change to the currently abysmal medical practice of thyroid diagnosis and treatment. Well worth it in my book!

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Latest news from RLC: Shipments of Naturethroid are beginning Monday, January 4th and the first two weeks with backorders going out ASAP.  Medco should have some by the end of January. Their Patient Information Line: Naturethroid/Westhroid: 877-600-4752

Thyroid  patient guest posts can be read about here: /writing-a-guest-blog-post-on-sttm/

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9 replies