Thyroid Therapy for Chronic Digestive Issues
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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.
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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.
I understand your approach. I know that it's nitpicky but by "several weeks" do you mean every two or three? I would see no issues with that, especially if you're considering either equal dosing(1.25gr as you're doing rn) or slightly modified(up or down) with more T4 to T3.
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.
My best advice would be being around 1gr +/- 0.25gr. I don't see an issue with gradually moving towards 1:3 over several weeks. If you're getting an occasional hyper episode, then it's probably the low T4 converting quickly to T3, making your T3 doses larger than on paper.
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.
Awaiting your next update.
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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Specificity in discussions like this is good! So far, I've changed my protocol every two weeks. I think this has given me ample time to adjust to the new ratio and dosage, and assess my body's response.
With your feedback in mind, the plan is to stick with gradually increasing the T4 dosage, pulling back if any protocol change suddenly leads to daily episodes of hyperthyroidism.
I'll continue to update this log with my progress.
Your advice is much appreciated!
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@CO3 said in Thyroid Therapy for Chronic Digestive Issues:
@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!
What Iodine sources do you have in your diet?
I stopped using iodised salt for years, resumed using it again after reading about its role in thyroid health.
We don’t need much iodine, but iodine deficiency can exist -
If you feel that two weeks allows you to feel changes(or at the very least, no negatives), then keep on keeping on.
I'll continue to update this log with my progress. Your advice is much appreciated!
Best of luck
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@GreekDemiGod said in Thyroid Therapy for Chronic Digestive Issues:
What Iodine sources do you have in your diet?
I eat seafood more than once a month. Done. All the iodine you need and then some.
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I would definitely consider trying thiamine B1. Potentially in high dose. It was the only thing to help my debilitating digestion and it helped near instantly after years of suffering. It could be worth a try
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@bubble Last year I tried very high dose thiamine HCl (3g+/day) to no effect. On this forum and Twitter I've read many success stories, but it proved ineffective for my condition.
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@CO3 Yep this is called the Wolf-Chaikoff effect.
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@banquos-ghost I've gone high thiamine HCL and subutiamine too with little effects. I want to try one of the other forms.
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Update #3 on thyroid therapy:
I'm staying at 25 mcg T3 and 50 mcg T4 for now, as work and family activities are too overwhelming this week to worry about adjusting the dosage and monitoring my response.
In Update #4, I'll provide a more comprehensive overview of my experience so far. For this one, I only wanted to share recent endocrine bloodwork results after about 6 weeks of T3/T4 combination therapy (all previous bloodwork data are in this thread):
- TSH: 0.456 uIU/mL (Ref: 0.450-4.500)
- T4, Free: 0.98 ng/dL (Ref: 0.82-1.77)
- T3, Free: 4 pg/mL (Ref: 2-4.4)
- Cholesterol, Total: 197 mg/dL (Ref: 100-199)
- HDL Cholesterol: 55 mg/dL (Ref: >39)
- LDL Chol Calc : 133 mg/dL (Ref: 0-99)
- Dihydrotestosterone: 51 ng/dL (Ref: 30-85)
- DHT, Free: 3.21 pg/mL (Ref: 2.30-11.60)
- FSH: 1.2 mIU/mL (Ref: 1.5-12.4)
- Testosterone: 748 ng/dL (Ref: 264-916)
- Free Testosterone (Direct): 221 ng/mL (Ref: 109-353)
- DHEA-Sulfate, Prolactin, Estradiol, and LH were all in range
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@banquos-ghost see my post in the other thread. Your T4:T3 ratio of 2:1 is way too low and it’s what causing the low ft4. You have to add more T4 and lower T3.
How do you feel with the current blood tests? -
Update #4 on thyroid therapy:
- Protocol at 25 mcgs T3 / 50 mcgs T4, taking T3/T4 in morning and evening, only T3 during the day.
- Sleep has improved tremendously. For the first time in well over a decade, I can sleep soundly through the night, for 6-8 hours, without waking to urinate. As a result, I'm not as fatigued as I was before treatment.
- BBT is consistently at or above 97.8 degrees Fahrenheit, unless experiencing an hypothermic adrenaline spike from digestive issues
- PR is at 70-80 BPM and stable, unless (again) experiencing adrenaline issues.
- Lightheadedness and fainting are gone. I can now stand up without reaching for the wall to stabilize myself.
- Mood has improved dramatically. Ambition and drive has been mostly restored, which were all but gone before treatment.
- Appetite is much higher. On most days I can eat enough to satiate it without exacerbating digestive issues.
- Gyno was transient. Maybe once a week I'll notice slight nipple tenderness. At this frequency, it's not concerning.
- I'm pleased with the bloodwork results I pasted earlier.
As you may gather from the above, thyroid therapy has been a success; in almost all areas it could directly improve my health, it has. However, I think it has taken me about as far as it can. No changes have been observed in my digestive health. All digestive symptoms I dealt with at the start—severe bloating, indigestion, oral thrush, stool biofilm, cognitive impairment—still persist. I think that thyroid can only do much on its own to resolve chronic intestinal overgrowths, or whatever it is I'm dealing with.
That is not to say that I'll discontinue treatment; in fact, I see no reason at all to discontinue, as I've not experienced any real side effects. Instead, I'll likely continue at this dosage for the foreseeable future. I hope that being euthyroidic will improve my immune system resilience as I begin another self-treatment protocol for these digestive issues. I'm very satisfied with this experience over the last three months, and grateful for the insights you all have provided.
I'll update the forum either in this thread or another with the progress I make on resolving my other issues.
@GreekDemiGod Per my above comments, I feel that thyroid treatment has taken me as far as it can. Despite the low fT4, I feel mostly euthyroidic at this dosage and frequency.
