Thyroid inflamation after months of supplementing
-
@Sippy
As others have said, my first thought would be that T4->reverse T3 is an issue to address (now apparently confirmed by your blood tests).Therefore, why not stop NDT and synthetic T4 (as a temporary measure along the healing path) and try T3 only for maybe 8 weeks? Then re-test and check that TSH has been suppressed, which should mean reverse T3 has been, or is still, clearing. If you can afford it, another reverse T3 test would help confirm.
Once reverse T3 is cleared, then you can think about titrating up with NDT again and see if your response is better next time. Or stay on T3-only at 2 to 4mcg per hour.
The Wilson protocol (over-simplified) is to use T3 acutely to clear reverse T4 and re-boot the T4-to-T3 mechanism (mostly in the liver), followed by more moderate dosing of T3 (or mixed T3-T4 dosing ala NDT or no exogenous thyroid whatsoever, depending on the person and context).
-
@T-3 I was considering the Wilson protocol. What do you mean by it being oversimplified?
I have tyronene and could start with a 8mcg drop per hour, or should I dilute to start? I have been taking 1 drop, 3x a day without noticing much. Temps don't go up.
Do you think my liver enzymes went up, from the T4?
-
@Sippy said in Thyroid inflamation after months of supplementing:
tyronene
@Sippy
I'm very sympathetic about the challenges you're having with thyroid blood-test numbers not responding as wanted/expected and suffering with hypothyroid symptoms even on a relatively high dose of NDT. Many of us have found ourselves confused and frustrated by the complexity of the task of figuring out how each of us might benefit from exogenous thyroid meds -- and continue adjusting as our environments and bodies change.All I meant about "oversimplified" was that my own very brief summary of what I took away from reading about the Wilson protocol 8 or 10 years ago probably omitted a lot of detail that Wilson would regard as important, although I do think the main idea is: temporary high-dose T3 clears revers-T3 and unblocks a deranged T4-to-T3 process in the liver. I didn't mean any slight on the Wilson protocol as being “oversimplified”. I recall that he used a number of criteria and advised his patients to do different things AFTER the acute high-dose T3 phase of the treatment. I think Wilson wrote that some of his patients got off of exogenous thyroid altogether after the high-dose phase; some continued on sustained-release T3; others used mixed T3/T4 after the acute high-dose phase, depending on a few factors. I'd suggest not to worry about that complexity but only focus on the main idea of clearing reverse-T3 by using supraphysiologic T3 dosing temporarily. I never followed Wilson's recommendation to use slow-release T3. I think it can be ignored without undermining his main idea.
I don’t think anyone will be able to say with much confidence what caused your liver enzymes to rise. I wouldn’t focus on determining the cause. I would try to clear the reverse T3 and address the hypothyroid symptoms, and then check again to see if the liver enzymes
-
@Sippy
Does anyone have statistics on allergic reactions to NDT? I would have thought that is exceedingly rare and unlikely. -
@Sippy I’m not a medical doctor. I think you’re idea to increase tyronene and stick with a T3-only protocol for a while until your reverse T3 is cleared would be a good idea very much in keeping with the main idea of the Wilson protocol. I would do so carefully, however, to make sure you are comfortable with the hyperthyroid symptoms you will experience and do not panic when your heart rate is speeding. Consider it a training protocol where you titrate up gradually just to suss out what hyperthyroid symptoms feel like.
Before warming up to try the high-dose T3 for a few days, I would make sure someone had experience feeling how their heartrate and reflexes respond to smaller doses of T3, titrating up 2mcg, 4mcg (per hour ok) and then try 10mcg or 25mcg at a single time to learn what supraphysiologic dosing feels like.
Peat said anything greater than 4mcg at one time was supraphysiologic. So caution should be taken going above 4mcg in an hour.
My own experience was to try a daily 25mcg (single dose) a few times; then 50mcg in a single serving; or 100mcg (even 100mcg 2x per day for a couple of days). The heartbeat races. The reflexes will feel faster than normal (i.e., twitchy).
I don’t think it’s likely people will get afib and hurt themselves, although the orthodox endocrinology literature seems to think afib and permanent heart problems from over-dosing thyroid meds is a real problem. Personally, I doubt that (barring other risk factors). I think it’s more likely that people taking supraphysiologic doses will SCARE THEMSELVES and go to the emergency room, worrying that they’re having a hear attack. These hyperthyroid effects should typically fade after 3 or 4 hours max.
It's been a long while since I read the Wilson protocol in detail. I did at the time I was experimenting with it. His idea was that a high dose of T3 for a relatively brief time would clear reverse T3 and “unblock” the endogenous T4-to-T3 process that euthyroid people enjoy.
[@Sippy, Would you please read up and refresh our memory as to how long Wilson recommended that the high-dose T3 stage of the protocol should last???] -
@Sippy I feel best on an all-T3 protocol nibbling through one or one and a half 25-mcg tablets per day.
Sometimes I switch to high-dose NDT (two or three grains per day).
I think the high-dose T3 experiment following the core idea in the Wilson protocol did “unblock” my deranged T4-to-T3 conversion process. I can now feel good on NDT for about two months or more. Then if I get a counterintuitive hypo signal from high-dosing NDT, I conclude (without testing reverse T3, i.e. guessing) that my T4-to-T3 conversion in the liver is mucked up again. Then I switch back to all-T3.
The NDT protocol is more convenient (not having to nibble the T3 tablet all day or go hypo when I forget to or can’t reach for my meds). I feel consistently warm for about 2 months of NDT at 2 grains in summertime or 3 grains in wintertime – when it’s working. When it doesn’t, I go back to T3-only, which has the advantage that there’s no risk of conversion to reverse T3.
I never get hypo symptoms from taking T3 only (provided nutrition and calories are adequate). With T3-only, there’s no 4-week accumulation of T4 to worry about, so the feedback and learning, leading to a temporary equilibrium (i.e. good-feeling) T3-only dose, is relatively (compared to T4) quick and easy (although still challenging) to dial in (without the accumulation of T4 to worry about).
On T3-only, my blood work freaks out my doctors: suppressed TSH; above-range free-T3; very very below-range free T4.
Do we need free T4? I guess that’s an open question. I’ve never heard a convincing theory as to why free T4 is independently of any importance. But if a person has the goal of using exogenous meds to emulate a euthyroid person’s bloodwork, then the T3-only protocol long-term does NOT achieve that, because you’ll likely get the results I mentioned above.
Personally, I don’t care about my abnormal bloodwork on T3-only. As long as I’m organized enough to keep up with very frequent T3 microdosing throughout the day (some sloppiness is ok for me, with a few larger doses of 5 or 10mcg now and then won’t hurt -- but may be a “shock” away from euthyroid equilibrium)…then I like the feel of T3-only with no drawbacks aside from going somewhat hypo when I stop taking T3 for 8 hours or more. But that’s easy to correct.
I hope this discussion of pros and cons of NDT vs T3-only (or mixing a bit of the two) – all three of which I sometimes do and can feel good on, depending on weather, stress, diet, context, etc – might be helpful.
-
@Sippy said in Thyroid inflamation after months of supplementing:
so your TSH is elevated still and t4 hasnt gone up even though t3 is still low. i guess implies high deiodinase 3 activity , converting the t4 to rt3 and t3 to rt2.
seen in low carbs/calories, high oxidative stress, chronic inflammation https://pubmed.ncbi.nlm.nih.gov/16150911/ etc(about the wilson protocol sounds worth a shot for some people - mainly applies to people with high T4 right . the rT3 thing its more of an indicator of high deiodinase 3 activity as dio3 = t4 -> rt3 and t3 -> a t2, apparently rt3 cant bind nuclear receptors because it lacks an iodine atom in the right place. so it cant actually block the main signalling of t3. t3 has some extra action outside of nuclear receptors so maybe it can have some effect but at extreme amounts studied . (hyperthyroidism often has high rt3 too and they still have hyperthyroid effects)
https://thyroidpatients.ca/2019/11/14/deiodinase-type-3-plays-a-t3-blocking-function/
https://thyroidpatients.ca/2019/11/16/rt3-versus-a-dose-of-anti-thyroid-medication/
(but the idea isnt ruled out it just shifts in focus - to deiodinase 3 which degrades t3 to a t2 and prevents t4 becoming t3. or less dio2 which = t4->t3. And there's more than high T4 being able to counter t3, dio3 elevation , but its 1 approach). My ft4 was on the lower end when i checked after about a week of stopping t3, with no temp response to t4:t3 or t3. test was a month before trying higher t3. I gave a modified version of this a shot and laddered up to 56mcg solo t3 , just to see if i could overwhelm the countering enzyme with high dose at once. but it did nothing new, he mentioned u can escalate up to dosing in the 90s if getting no response, but i figured if an entire days worth of t3 at one time isnt enough then that approach isnt for me.
on the other side of that extremely high T4 has been used with success for mood disorders , i guess t4 has some signalling so if you overwhelm with t4 maybe it makes up for less t3 . or if not then maybe it overwhelms the amount that can be degraded to rt3. but being high end without extremes its not enough and can play a countering role (shown in brain slices), by having a little t4 around you get the benefit of extra t3 from conversion of t4 by deiodinase 1 that gets boosted by having more t3 around, as t3 wears off
--
right now i'm trying lower doses for longer (1 month).
high TSH itself can worsen inflammation & cause the high antibodies and they can go away over months with lowering tsh. but need to actually get t4 t3 levels up for this. https://www.youtube.com/watch?v=OVs-SlJnzs4#t=11m
4 options i see you could try dosing t3 only as others mentioned , even tho your t4 is low idk might be worth a go, or smaller doses at once, or higher overall dose. or if not then focusing on attempts to lower deiodinase 3 and see if get a response -
@Sippy said in Thyroid inflamation after months of supplementing:
I started taking Tyromax and Tyronene 3 months ago. Worked my way up to 2 grains Tyromax and added a drop of Tyronene during the day. I had great improvements in my mood and energy, my temps went up a little and my heart rate a little too. Over the past month I started to get the feeling of a lump in my throat and general swelling in the neck and under the chin. Now I'm feeling a bit depressed in the AM and have a slight headache. I also started spotting just a little before and after my period. No hyperthyroid symptoms. My temps are 97.4-98 in the AM and 98-98.6 during the day. Heart rate is 60-70. No change after I take Tyromax or T3. Still have severe constipation and tingling in limbs.
I've had high thyroid antibodies in the past and on my most recent blood work, before I started supplementing thyroid.
Any advice on how I should precede would be greatly appreciated.
Should I reduce my dose of Tyromax, or switch to T3 only or Tyromix? Should I taper off altogether?
Hi
Who put you on thyroid medication?
How did they determine that dose?
-
@cs3000
This is important information to consider: that deiodinase 3, and not RT3, inactivates T3: "(hyperthyroidism often has high rt3 too and they still have hyperthyroid effects)"The explanation in the two links you kindly provided, with good cites of the studies supporting their claims, is excellent (new to me and I think new to many on RPF who have circulated what these links claim is a misunderstanding: namely, that RT3 is a “metabolic brake”.
[from your first link]: “a paradox occurs in cases where RT3 and FT3 are both high-normal. In some people on desiccated thyroid (NDT / DTE) therapy, RT3 can climb to high-normal or high levels. In many of these people with high-normal RT3, illness and/or hypothyroid symptoms occur, even though their FT3 is high-normal at the same time. “I’d never seen this before. Thanks! And the more general point that “RT3 blocks T3” is invalid. Good that we correct this misunderstanding and base our analysis on the deiodinase 1, 2 and 3 – although we don’t have direct blood tests to directly measure any of these as far as I know.
-
@cs3000 What, then, is the mechanism that explains why high-dose T3 can re-set one’s metabolic set point and improve hypothyroidism and “adrenal tone”? I guess that high-dose T3 could downregulate or decrease deiodinase 3? I pasted some relevant passages below.
I can’t recall all of my own details about high-dose T3 precisely because I did this 7 to 10 years ago. Then I was on T3-only at more moderate doses for 5 years or so before experimenting with NDT. But I think it worked for me. We are, of course, all different.
I think it was several weeks of extremely high-dose T3 that worked for me, after which I felt a clear resolution of hypothyroid symptoms and noticeably improved mental/psychological “tone”.
What did the Wilson protocol prescribe for the short-term high-dose T3 intervention? How long was it supposed to last?
-
@Peatful I consulted with a naturopath who did recommend trying 4mcg t3 and maybe a half grain of NDT. I am not an established patient of hers, though. I just get blood work done at her practice and she will do short phone consults. I mostly have been working slowly upping the Tyromax dose and then I decided to try some T3. I have been monitoring temps and pulse, which remain about the same. The main symptoms I struggle with are numbness in my arms and legs (which has gotten worse), constipation, heaviness in my chest, and feeling awful in the morning despite getting 8-10 hours sleep.
-
@cs3000
Would it be worth considering trying 50mcg or 100mcg in one go for several days in a row to see if you get a clear response?Or would the deiodinase 1/2/3 mechanism that is theorized at the links above suggest more moderate dosing or shorter duration for the temporary high-T3 intervention?
-
@T-3 I was thinking it could be more of a histamine response than an actual allergy. I am recovering from toxic mold exposure for many years, so this could be a possibility. Any dried product is high in histamines.
-
4 options i see you could try dosing t3 only as others mentioned , even tho your t4 is low idk might be worth a go, or smaller doses at once, or higher overall dose. or if not then focusing on attempts to lower deiodinase 3 and see if get a response
@cs3000 are you meaning just T3 with all of these options? I was wondering if T3 only still made sense with my T4 still being low.
-
@Sippy said in Thyroid inflamation after months of supplementing:
@Peatful I consulted with a naturopath who did recommend trying 4mcg t3 and maybe a half grain of NDT. I am not an established patient of hers, though. I just get blood work done at her practice and she will do short phone consults. I mostly have been working slowly upping the Tyromax dose and then I decided to try some T3. I have been monitoring temps and pulse, which remain about the same. The main symptoms I struggle with are numbness in my arms and legs (which has gotten worse), constipation, heaviness in my chest, and feeling awful in the morning despite getting 8-10 hours sleep.
Ok. This is helpful.
Anything of significance in your pmhx?
That’s past medical historyI have something to add
But
I’d also like to hear from you about your dietary historyJust briefly
Nothing in depth required -
@Peatful I was a vegetarian from age 9-30. Was a raw food vegan for some of that time. I was so sick eating that way. Then when I got pregnant I started eating meat (and raising it myself) and did GAPS type diet. I'm 40 now and have been back and forth with restricting sugar in the past 10 years, while trying to heal my gut. In the past 3 years, I have cut out most PUFAs and increased my sugar intake- mostly raw honey, coconut water, and some fruit. I eat lots of raw egg yolks and fresh goats milk. Goat, lamb and some beef. High collagen cuts mostly. Organs. Coconut oil, ghee, butter, raw cheese.
-
@Peatful also, I have had lots of mold exposure my whole life, as well as Lyme and Bartonella. Most of my family is diagnosed with Hypothyroidism and on thyroid. After I had my daughter, my TSH was 60. I was only put on thyroid once by a naturopath when I was 19 or 20. It was Armour and she just kept on increasing the dose because I felt nothing. Eventually I stopped getting my period for almost a year and then decided to stop taking it. I was reluctant to try again until finding Peat's work.
-
@Sippy said in Thyroid inflamation after months of supplementing:
@Peatful I was a vegetarian from age 9-30. Was a raw food vegan for some of that time. I was so sick eating that way. Then when I got pregnant I started eating meat (and raising it myself) and did GAPS type diet. I'm 40 now and have been back and forth with restricting sugar in the past 10 years, while trying to heal my gut. In the past 3 years, I have cut out most PUFAs and increased my sugar intake- mostly raw honey, coconut water, and some fruit. I eat lots of raw egg yolks and fresh goats milk. Goat, lamb and some beef. High collagen cuts mostly. Organs. Coconut oil, ghee, butter, raw cheese.
Where do I begin here
I will be direct or to the point
But unfortunately- now I have many pointsSo:
If you were ever on the Ray Peat forum
I speak a lot about this
Some directly
Most indirectlyBeing on supplemental thyroid is hurting you
You saw it once
And your seeing it again
The evidence is there for youYou’re the classic case of restrictive eating and then the stress (of pregnancy) really tipped you over
Thyroid currently is revving your engine
But nothing is in the tank
This is destructiveBtw
As I understood Ray
He never endorsed supplementing thyroid the way allopathic medicine does
But that’s an asideYou have been basically undernourished since the age of 9 ish
Your body has been (mal)adapting for you
Mainly using a stressed metabolic pathway vs bio energeticUsing thyroid now with no firm foundation has pushed you deeper into a stressed state
And a stressed metabolism cannot heal -
@Peatful To clarify, I was pregnant 10 years ago. I have improved my diet tremendously, specifically increasing calories and carbs over the past 3 years. I feel 10 times better than I did at 30 but I still struggle with constipation, low pulse and numbness in my extremities. I didn't want to supplement thyroid at all, but I thought it might be necessary to improve some of my symptoms. How long would you wait until you add a thyroid supplement?
I also would love to have another child before I'm too old and was thinking supplementing thyroid would be wise to figure out before trying to conceive.
I am interested in your approach to healing metabolism and thyroid. What has worked for you? Did you have hypothyroidism and did you ever take thyroid? I have read a lot on the old RPF and some of Ray's writing. I still don't have a clear idea of the best approach when you know you've been hypo your whole life. I do favor food over supplements.
-
I hate answering with what I did- because your needs may differ from mine
What we do know is that the supplemental thyroid isn’t working for you
I would personally
Set it aside
And get my diet in order
As well as anything else that keeps me in the stressed laneBlood sugar regulation is really really important here
40/30/30 c/p/f at each meal is a good goal
Plus eating five or six versus three meals a day to stay steady is wiseWith just this alone
You may see the tingling or numbness subside, temps go up, increased energy and possibly your bowels begin to moveIt takes intentionality and time
It’s a bit laborious
But it really helped me looking backFor reference:
I started on 120 NDT
Got down to 30 pretty quickly
And now im on nothing for two or three years now
As you said- I use food as medicine
