Thyroid Therapy for Chronic Digestive Issues
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I, male aged 32, presented to my general practitioner 8 months ago with the following symptoms: fatigue, cognitive impairment, depression, muscle and joint soreness, cold intolerance and frigid extremities, indigestion, chronic constipation, abdominal distention and bloating, oral thrush, and biofilm elements present in stool. After a brief physical examination, she advised that I “eat more fiber” and continue to monitor my symptoms. Prior to this, all forms of dietary and lifestyle intervention had been tried.
Upon my request, she referred me to a gastroenterologist in my area, who, based on my digestive symptomology, prescribed antibiotics (Rifaximin) for empiric treatment of small intestine bacterial overgrowth. At a dosage of 550mg thrice daily for 14 days, the treatment provided no symptom relief. Antifungals (Nystatin) and antiparasitics (Ivermectin) were tried but also proved inefficacious. General bloodwork (comprehensive metabolic panel) conducted subsequent to treatment showed no abnormal levels.
Without medical supervision, I decided to undergo hormonal bloodwork, under the suspicion that I was hypothyroidic. The results, though within the reference ranges, have confirmed that:
- T4, Free: 1.44 ng/dL (Ref: 0.82-1.77)
- TSH: 3.7 uIU/mL (Ref: 0.45-4.5)
- Reverse T3, Serum: 19 ng/dL (Ref: 9.2-24.1)
- T3, Free: 2.6 pg/mL (Ref: 2-4.4)
(Additional bloodwork results can be provided upon request.)
Today, my diet is rich in pro-metabolic foods, I consume plenty of coffee and tea, live in a tropical region, exercise regularly with wife and friends, and get adequate daily sunlight. Since all my symptoms and bloodwork suggest hypothyroidism, and since I have been unresponsive to other interventions, I am preparing to supplement with thyroid-promoting minerals (e.g. iodine, selenium) and/or treat directly with thyroxine (T4)+triiodothyronine (T3) combination therapy. Going forward, I will update this log with dosage, duration, and efficacy of treatment, as well as with updated blood markers when those are tested.
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@banquos-ghost Look up what Ray had to say about iodine supplementation. Don't worry about supplementing it. If for some reason you want to, you can use iodized salt, but again, that has thyroid suppressive effects. The idea of using iodine to cure thyroid dysfunction is a woefully archaic thing, from when people in mountainous areas would develop goiters due to never getting any amount in their diet.
Good luck!
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essential reading:https://dannyroddy.substack.com/p/demystifying-thyroid-supplementation
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Thanks, @CO3. I'll read Danny's article.
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+1 to CO3's posts. Keep an eye on your total cholesterol levels while you experiment and based on my own experiences I would skip using any NDT powdered products, if you were considering them. Best of luck.
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Have you tried the carrot salad? (I know it's a meme but it's really powerful)
If not carrot salad, then white button mushrooms?
I had all your symptoms, I supplement T3/T4 now using Idealabs Tyromix. Plus, I do mushrooms daily since the carrot salad became too powerful (when I first started, it was just right).
This has radically reduced my symptoms.
In this, you haven't mentioned much about the food that you're eating which would also be helpful.
For example, you need a good source of B vitamins + other good stuff (liver) and other important vitamins and minerals (oysters). Do you have a clean source of milk and cheese and eggs?
Have you limited what you are eating to nutrient dense foods that I have listed above + some more?
Fiber and iodine won't help you. Thyroid will help but it will hurt more if you don't have your diet right.
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Consider that your thyroid is producing adequate hormones, but extrathyroidal conversion of T4 to T3 is impaired, as evidenced by the sufficient T4 and low T3. One therapeutic route would be detoxifying your renal and hepatic conversation pathways; for this, selenium and iodine would prove ineffective, while direct supplementation with synthetic hormones, which would place your body in a euthyroid, pro-metabolic state, may promote natural detoxification.
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First thing I noticed was that 3.7 TSH. Ray mentioned on many occasions that he rarely heard of anyone claim they were in good health when TSH was above 1.
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@evan-hinkle Yes, I’ve heard that too.
I think once T3 levels are brought back in range, either with endogenous production or exogenous supplementation, OP’s pituitary will stop producing as much TSH. Right now it should be regarded as a sign of general thyroid dysfunction, as the TSH negative feedback loop is not being activated.
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@secondkelping Thank you for the comment; it gives me hope of recovery.
The carrot salad and mushrooms were eaten daily for ~4 months at the beginning of '23; no symptom relief was provided, though my movements were bulkier.
My diet is dialed-in at this point. It consists mainly of locally grown ruminant meat, raw milk, and produce, as well as a good deal of fresh seafood (I live on the coast).
The plan is this: Await arrival of Cynoplus and Cynomel, reread thyroid books (Barnes, McGavack), prepare for T3/T4 treatment protocol, administer thyroid and monitor symptoms.
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@banquos-ghost Seems like a great plan. I'd bet my paycheck you're hypothyroid to some degree. Have you checked your pulse and temperature?
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@brad My average morning body temperature is highly suggestive of hypothyroidism. Now, whether that's the cause of all my symptoms is still uncertain, but we'll find out soon.
Always frustrating that physicians proved entirely useless in arriving at this conclusion, but at least we have communities like this to rely on. Thanks for all you've done in advancing the bioenergetic movement!
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@banquos-ghost Makes sense. No problem. Looking forward to hearing about your progress.
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@banquos-ghost sounds like a good plan. specifically the liver and oysters should be focused on, and do you eat gelatin and collagen?
If you're still having chronic digestive issues dialing down your meat and making up more of your meat with gelatin protein is also ideal since a lot of protein can also cause issues due to inability to properly digest BCAAs.
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@secondkelping Ruminant muscle meat (bison, beef, venison) is normally consumed at only one meal a day. Increased consumption of muscle meat of all kinds (poultry, etc.) has in the past provoked an inflammatory response and slowed my digestive process, so I try to limit that.
Gelatin is consumed in stews, often added to fish soup, and in the form of bone broth when available; glycine powder is added to milk on occasion. I think the balancing of BCAAs has provided some symptom relief over the last several months, and will be continued during and after thyroid therapy.
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Update #1 on thyroid therapy:
- Package from La Farmacia arrived after 5 weeks of waiting (to my surprise it was not seized by customs)
- Retested TSH before commencing therapy; serum TSH level rose from 3.7 to 4 uIU/mL
- Started treatment two weeks ago, building up to around 5mcgs T3 (Cynomel) four times daily (around meal time and before bed)
- BBT increased by .5 degrees F, PR by a few beats (60-65 BPM)
- Core and hands are now warm to the touch; feet are still very cold
- Appetite has not returned, nor have my digestive symptoms improved
- Trying to force-feed when comfortable, increasing from ~2000 to ~3000 cals, to blunt adrenal response to thyroid
- Today I started to experience rapid resting pulse rate, mostly in the range of 90-100 BPM, and my sleep quality diminished
- Plan is to start taking T3/T4 (Cynoplus), as recommended by users here and on RPF, likely at moderate dosage before bed
Generally pleased with my response to synthetic thyroid and fully expected to experience these issues when I began; I regard them as a sign to incorporate T4 into the protocol. Still several weeks of experimentation before I can draw any conclusions about whether synthetic thyroid is the right treatment. In the meantime, I'll continue to update this thread as things progress.
Thanks to all who've provided insights so far!
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Thanks for the update. The diminished sleep quality and rapid heart rate sound like adrenal activation, increasing your calories will no doubt help. Make sure that you are getting a good amount of salt(3.5-4g, usually) as that is a major component for keeping the adrenal activity from being stressed.
Look forward to more.
Greift nur hinein ins volle Menschenleben! Ein jeder lebt's, nicht vielen ist's bekannt, und wo ihr's packt, da ist's interessant.
Ray Peat first-ever interview(July 1987 on UofO Student Radio)
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Update #2 on thyroid therapy:
- 5 days ago, I added T4 into the protocol, at 25mcgs nightly, increasing my total daily dose to 25mcgs T3/25mcgs T4
- BBT has markedly improved; hands and feets are consistently warm to the touch, so much so that my wife was startled at how hot my fingers were
- Digestive issues (extreme bloating, indigestion, BM irregularity, biofilm in stool) have not improved at all
- Cognitive impairment and depressive mood swings, which are likely the result of digestive issues, have also not improved
- Sleep quality has returned to pre-thyroid quality, which is about 6 hours of semi-restorative deep sleep, with the occasional interruption in the early morning
- PR have risen to euthyroidic levels (75+ BPM); no cardiac signs of hyperthyroidism
- I haven't passed out since starting thyroid; before, I'd weekly have one or two incidents of extreme lightheadedness and fainting
- Appetite has increased considerably; I can now comfortably consume 3000+ cals daily without feeling overfed (@JulofEnoch, thanks for your input)
- Oddly, I have noticed some nipple tenderness and hardness but no visible enlargement
- I've tried to cut out caffeine and nicotine to assess my response to thyroid without conflicting variables, though I still use dipping tobacco and drink coffee on occasion (mainly to stimulate BMs)
My thought here is that addressing chronic issues resulting from years of hypothyroidism will take time—likely several months—before I experience significant improvement.
Why the gynecomastia? I'm not sure. It could be that thyroid supplementation has elevated levels of testosterone, which is then aromatizing and causing estrogenic symptoms. The severity of those symptoms has gradually decreased over the last several days, but still persists. Libido, muscle hardness, confidence, sociability, and other androgenic signals have not changed. I've taken anti-androgens (5ARIs) in the past (pre-Peat), so I know what being in a weak, estrogenic state feels like.
Additionally, in my latest La Farmacia order, I also purchased 10 tablets of 100mg doxycycline. Over the last week, I took 50mg after breakfast and 50mg after dinner. Nothing to report here, and I'll likely stop this evening. Inflammation has not diminished; the only notable effect was worsening of oral thrush, as well as some esophageal pain after the first few doses.
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5 days ago, I added T4 into the protocol, at 25mcgs nightly, increasing my total daily dose to 25mcgs T3/25mcgs T4
What is your thought behind the 1:1 ratio? I can see as a stimulatory dose for a serious hypothyroidism, though I don't know if you'd count as such. The T4 may be converted quickly into T3, so your 1:1 is like taking a larger dose of T3, by itself. This is probably behind your rapid temp increase. I would suggest shifting to a 1:3 or 1:4 dosage.
From my understanding, 25mcgs of T3 and equivalent T4 would be about 1.25 grains(1 gr of T3 and 1/4 gr from T4). This might give you some perspective on how your T3 and T4 doses are working out in the grains.
My thought here is that addressing chronic issues resulting from years of hypothyroidism will take time—likely several months—before I experience significant improvement.
I believe Barnes said that one should supplement for, at least, one month with thyroid before coming to any conclusions.
I've tried to cut out caffeine and nicotine to assess my response to thyroid without conflicting variables, though I still use dipping tobacco and drink coffee on occasion (mainly to stimulate BMs)
The coffee is probably fine to take and I would support restricting tobacco as much as possible.
Why the gynecomastia? I'm not sure. It could be that thyroid supplementation has elevated levels of testosterone, which is then aromatizing and causing estrogenic symptoms.
Entirely possible, I would give it time to normalize and, if possible, consider more zinc and iodine foods. Have you tested your cholesterol?
Greift nur hinein ins volle Menschenleben! Ein jeder lebt's, nicht vielen ist's bekannt, und wo ihr's packt, da ist's interessant.
Ray Peat first-ever interview(July 1987 on UofO Student Radio)
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I'd like to arrive at a long-term T3:T4 dosage of about 1:3, but started with T3 monotherapy to test my responsiveness to thyroid in general. After confirming that I can tolerate it, my plan was to gradually add in T4 over several weeks (1:0, 1:1, 1:2, 1:3), until I reach a more sustainable combo-therapy dosage. While I read Barnes and agree with much of what he said, I diverted from his advice on this question of starting with combo- versus monotherapy, but I think his advice and yours hold in the long term. Would you advise switching immediately to 1:3 ratio, and at what dosage is advisable? Again, at this dosage I've only experienced the occasional episode of mild hyperthyroidism.
As I mentioned in my #2 update, the gynecomastia is beginning to normalize. Over the years, my endocrine system has been very responsive to exogenous anything (5ARIs, progesterone, pregnenolone, etc.), so this estrogenic response to thyroid is not unexpected. It is not very concerning, but I thought I'd mention it for other men experiencing the same thing. As you recommend, I'll increase my intake of oysters and seafood to see if this improves, though it seems to improve by the day.
