You wouldn’t need to invoke the idea of ‘hormone resistance’ because TSH and T4 tests normally used to diagnose hypothyroidism don’t measure the active hormone—T3. T4 is just a prohormone with very little direct activity on metabolic rate.
In primates, metabolism is regulated primarily in the liver by T4->T3 conversion, so if this is inhibited for any reason it will suppress metabolism without showing up on those tests. Low calorie intake, and poor nutrition are known to cause this (e.g. Euthyroid sick syndrome). In cases of poor liver conversion, supplementing T4 can actually make symptoms worse, as it will further suppress metabolism by lowering the small amount of T3 production from the thyroid (via the TSH feedback loop).
I assume you have heard of Ray Peat? I personally had good luck applying his ideas to increase my energy levels, and my pulse, body temperature, and cold tolerance raised as well—without supplementing thyroid. His general idea is pretty simple- just look at what conditions and nutrients maximize T4->T3 conversion, and provide them (low stress, high nutrient diet).
Broda Barnes work is very interesting. It blows my mind that he published a paper in The Lancet showing that desiccated thyroid lowered cholesterol levels and seemed to prevent cardiovascular disease in his patients, and that it remains virtually un-discussed and uncited (http://www.ncbi.nlm.nih.gov/pubmed/13796871).
The reason why Barnes’ paper showing that desiccated thyroid lowering cholesterol levels and seeming to prevent cardiovascular disease isn’t cited is because he was basically making his patients hyperthyroid. Lower cholesterol levels occur in hyperthyroidism.
There is a doctor I know of in California who gives his patients supra-physiological levels of T3 hormone (cytomel) to increase their metabolism, to help them lose weight, and to lower their cholesterol levels. It basically suppresses the thyroid’s own production of hormone. In the short term, it works. It’s brilliant. But it’s crazy. We have no idea what the long-term consequences are. And since I’m pretty sure he’s not running a study on it, we won’t.
Why is this a reason not to reject it? He is essentially arguing that the major cause of cardiovascular disease is population-wide high rates of hypothyroidism. It would be a circular argument to dismiss that because his treatment leads to a greater than average metabolic rate. One would also need evidence of a disadvantage that outweighs the advantages. His patients seemed to be doing well, or at least he doesn’t report them exhibiting any classic signs of hyperthyroidism. He was primarily adjusting dose based on body temperature to the upper end of the normal non-hyperthyroid range.
to help them lose weight
I have seen studies on thyroid supplementation as a weight loss strategy, and it causes loss of lean tissue (muscle, etc.) more than fat.
Hi, there can be all sorts of things going wrong! Mysterious resistances, gland failures, conversion disorders, broken pituitary, broken hypothalamus, faulty deiodinase enzymes, etc. All potentially inherited or acquired. We really do seem to have no idea how this complicated system works or what it’s all for, or what can cause it to go wrong.
But I would have thought that if there was widespread ‘central hypothyroidism’, someone would have twigged by now, since that form does show up if you do a full panel of hormone tests.
Or I would have thought that when I wrote this. By now I am in such despair about the pitiful state of medical research that I wouldn’t be surprised if they’d never thought to look, so maybe it is all just perfectly obvious from blood tests and the fools have ignored it.
And the question of ‘what is the optimal treatment’ is bound to be tricky. I’m just trying to demonstrate that the problems exist and are widespread and thus worth looking at!
Although Skinner certainly thought ‘clinical hypothyroidism’ could usually be fixed by bunging enough T4 at the problem. He does mention in his book that he sometimes used T3 or NDT, but he doesn’t go into details. Various other people say ‘mostly T4 with a bit of extra T3’, but no-one has particularly clear ideas on what works and what doesn’t or why.
Thanks for the reference to Ray Peat, I hadn’t heard of him before. Can you link to the best expression of his thoughts?
But I would have thought that if there was widespread ‘central hypothyroidism’, someone would have twigged by now, since that form does show up if you do a full panel of hormone tests
Which tests? I am not aware of any simple blood test that measures the endpoint of thyroid activity on metabolic rate (except, arguably, cholesterol levels), rather than just the state of the T4->TRH->TSH->T4 feedback loop.
mostly T4 with a bit of extra T3′, but no-one has particularly clear ideas on what works and what doesn’t or why
The challenge with T3 is it has a very short half-life, one would need to take very small doses impracticably often to achieve stable levels. Taking mostly T4 with a bit of T3 helps compensate for the reduction in T3 production due to feedback without the problems caused by trying to obtain nearly all T3 directly from a supplement.
Thanks for the reference to Ray Peat, I hadn’t heard of him before. Can you link to the best expression of his thoughts?
His own essays at raypeat.com are the only accurate source, but can be challenging to read. Most of the summaries you will find online don’t do him justice.
You wouldn’t need to invoke the idea of ‘hormone resistance’ because TSH and T4 tests normally used to diagnose hypothyroidism don’t measure the active hormone—T3. T4 is just a prohormone with very little direct activity on metabolic rate.
In primates, metabolism is regulated primarily in the liver by T4->T3 conversion, so if this is inhibited for any reason it will suppress metabolism without showing up on those tests. Low calorie intake, and poor nutrition are known to cause this (e.g. Euthyroid sick syndrome). In cases of poor liver conversion, supplementing T4 can actually make symptoms worse, as it will further suppress metabolism by lowering the small amount of T3 production from the thyroid (via the TSH feedback loop).
I assume you have heard of Ray Peat? I personally had good luck applying his ideas to increase my energy levels, and my pulse, body temperature, and cold tolerance raised as well—without supplementing thyroid. His general idea is pretty simple- just look at what conditions and nutrients maximize T4->T3 conversion, and provide them (low stress, high nutrient diet).
Broda Barnes work is very interesting. It blows my mind that he published a paper in The Lancet showing that desiccated thyroid lowered cholesterol levels and seemed to prevent cardiovascular disease in his patients, and that it remains virtually un-discussed and uncited (http://www.ncbi.nlm.nih.gov/pubmed/13796871).
The reason why Barnes’ paper showing that desiccated thyroid lowering cholesterol levels and seeming to prevent cardiovascular disease isn’t cited is because he was basically making his patients hyperthyroid. Lower cholesterol levels occur in hyperthyroidism.
There is a doctor I know of in California who gives his patients supra-physiological levels of T3 hormone (cytomel) to increase their metabolism, to help them lose weight, and to lower their cholesterol levels. It basically suppresses the thyroid’s own production of hormone. In the short term, it works. It’s brilliant. But it’s crazy. We have no idea what the long-term consequences are. And since I’m pretty sure he’s not running a study on it, we won’t.
Why is this a reason not to reject it? He is essentially arguing that the major cause of cardiovascular disease is population-wide high rates of hypothyroidism. It would be a circular argument to dismiss that because his treatment leads to a greater than average metabolic rate. One would also need evidence of a disadvantage that outweighs the advantages. His patients seemed to be doing well, or at least he doesn’t report them exhibiting any classic signs of hyperthyroidism. He was primarily adjusting dose based on body temperature to the upper end of the normal non-hyperthyroid range.
I have seen studies on thyroid supplementation as a weight loss strategy, and it causes loss of lean tissue (muscle, etc.) more than fat.
Hi, there can be all sorts of things going wrong! Mysterious resistances, gland failures, conversion disorders, broken pituitary, broken hypothalamus, faulty deiodinase enzymes, etc. All potentially inherited or acquired. We really do seem to have no idea how this complicated system works or what it’s all for, or what can cause it to go wrong.
But I would have thought that if there was widespread ‘central hypothyroidism’, someone would have twigged by now, since that form does show up if you do a full panel of hormone tests.
Or I would have thought that when I wrote this. By now I am in such despair about the pitiful state of medical research that I wouldn’t be surprised if they’d never thought to look, so maybe it is all just perfectly obvious from blood tests and the fools have ignored it.
And the question of ‘what is the optimal treatment’ is bound to be tricky. I’m just trying to demonstrate that the problems exist and are widespread and thus worth looking at!
Although Skinner certainly thought ‘clinical hypothyroidism’ could usually be fixed by bunging enough T4 at the problem. He does mention in his book that he sometimes used T3 or NDT, but he doesn’t go into details. Various other people say ‘mostly T4 with a bit of extra T3’, but no-one has particularly clear ideas on what works and what doesn’t or why.
Thanks for the reference to Ray Peat, I hadn’t heard of him before. Can you link to the best expression of his thoughts?
Which tests? I am not aware of any simple blood test that measures the endpoint of thyroid activity on metabolic rate (except, arguably, cholesterol levels), rather than just the state of the T4->TRH->TSH->T4 feedback loop.
The challenge with T3 is it has a very short half-life, one would need to take very small doses impracticably often to achieve stable levels. Taking mostly T4 with a bit of T3 helps compensate for the reduction in T3 production due to feedback without the problems caused by trying to obtain nearly all T3 directly from a supplement.
His own essays at raypeat.com are the only accurate source, but can be challenging to read. Most of the summaries you will find online don’t do him justice.