Question About T4 And Thyroid

[Caitlin]

Hi all,

I wanted to follow up on my thread about my hypoxia and muscle weakness with a question about thyroid. I am trying to figure out what is going on with my thyroid as I know some thing is very wrong.

Almost one month ago my physician upped my T4 dosage (I am taking levothyroxine only... no t3) from 150mg to 175mg. While on 150mg my TSH had been 11 which is why she upped it. Two weeks later (which is now about two weeks ago from today) I had my TSH and free t3 and free t4 tested again, and levels were normal-ish. Well, my TSH was down to 2.96. So now in total, I have been on 175mg for nearly four weeks, and in the past two weeks have become the combination of a zombie/sloth/garbage pile. The fatigue is crushing and my limbs feel like they weigh 9,000 pounds. I am perma-tired.

I have tried adding Cytomel in the past and it hasn't changed the hypoxia. I want to revisit that now, maybe this time by trying the T3 from the Mexican pharmacy.

My question is this: Is there any way that adding a higher dose of t4 would make me feel MORE hypothyroid? I know it doesn't make sense, but it's the only thing I think could be causing this recent slump. I mean, I felt like ***t before, but now it has intensified. If I have issues converting T4 to T3, wouldn't that show up with a low t3 level?

Given that the half life of T4 is about two weeks, perhaps that is why I have taken a sudden turn for the worst in the past two weeks?

Thanks, as always, for your insight.

 

[lampofred]

My question is this: Is there any way that adding a higher dose of t4 would make me feel MORE hypothyroid? I know it doesn't make sense, but it's the only thing I think could be causing this recent slump. I mean, I felt like ***t before, but now it has intensified. If I have issues converting T4 to T3, wouldn't that show up with a low t3 level?

Yes, I don't really know the mechanism how (it's more than just T4 not converting into T3, the T4 itself is actually antithyroid), but RP has said that a build-up of T4 can make hypothyroidism even worse than not taking any thyroid at all and that this happens when estrogen is high/progesterone is low.

 

[Caitlin]

Yes, I don't really know the mechanism how (it's more than just T4 not converting into T3, the T4 itself is actually antithyroid), but RP has said that a build-up of T4 can make hypothyroidism even worse than not taking any thyroid at all and that this happens when estrogen is high/progesterone is low.

Hmm... Good to know. Thanks!

 

[lampofred]

Hmm... Good to know. Thanks!

Not sure if you've read RP's view on estrogen, he thinks estrogen is not the "female" hormone that most people think it is (which is actually progesterone) and that it's actually a stress hormone responsible for hypothyroidism, hypoxia, PCOS and all sorts of issues.

 

[Caitlin]

Not sure if you've read RP's view on estrogen, he thinks estrogen is not the "female" hormone that most people think it is (which is actually progesterone) and that it's actually a stress hormone responsible for hypothyroidism, hypoxia, PCOS and all sorts of issues.

Thanks. Does he have a view about what the ideal estrogen range is?

 

[tara]

My question is this: Is there any way that adding a higher dose of t4 would make me feel MORE hypothyroid? I know it doesn't make sense, but it's the only thing I think could be causing this recent slump. I mean, I felt like ***t before, but now it has intensified. If I have issues converting T4 to T3, wouldn't that show up with a low t3 level?

Yes, I think in some circumstances more supplemental T4 can have the effect of reducing metabolism.
Have you read all Peat's articles on thyroid on his website?
Ray Peat
Thyroid: Therapies, Confusion, and Fraud
Thyroid, insomnia, and the insanities: Commonalities in disease
Preventing and treating cancer with progesterone.

 

[lampofred]

Thanks. Does he have a view about what the ideal estrogen range is?

As low as possible via many different means; one that he emphasizes is keeping animal protein intake high. Without enough protein and the B vitamins that come with protein, the liver cannot detoxify estrogen, and the estrogen builds up to block thyroid.

He does a much better job of explaining it than I do at raypeat.com.

 

[Caitlin]

Yes, I think in some circumstances more supplemental T4 can have the effect of reducing metabolism.
Have you read all Peat's articles on thyroid on his website?
Ray Peat
Thyroid: Therapies, Confusion, and Fraud
Thyroid, insomnia, and the insanities: Commonalities in disease
Preventing and treating cancer with progesterone.

Yes, I have read them and am trying to understand them but some of it goes way over my head right now.

 

[Caitlin]

As low as possible via many different means; one that he emphasizes is keeping animal protein intake high. Without enough protein and the B vitamins that come with protein, the liver cannot detoxify estrogen, and the estrogen builds up to block thyroid.

He does a much better job of explaining it than I do at raypeat.com.

What's interesting is that when this whole mess started 9 years ago, I was on an extremely high protein diet. Basically I was eating animal meat, veggies, and nuts. No grains or tubers. I lost a lot of weight but within a few days to a week of starting the extreme diet, the co2 switches flipped and that's when the muscle weakness started. I have had my estradiol measured throughout the years and it has been normal, but I want to get it tested again now. Estradiol is what measures estrogen, right?

 

[lampofred]

What's interesting is that when this whole mess started 9 years ago, I was on an extremely high protein diet. Basically I was eating animal meat, veggies, and nuts. No grains or tubers. I lost a lot of weight but within a few days to a week of starting the extreme diet, the co2 switches flipped and that's when the muscle weakness started. I have had my estradiol measured throughout the years and it has been normal, but I want to get it tested again now. Estradiol is what measures estrogen, right?

I think it is but Dr. Peat mentions that people can have normal or even low estrogen on blood tests and still have very high estrogenic activity (I think especially in PCOS and other "hyperandrogen" issues) because the ratio of estrogen to progesterone is more important than just estrogen by itself. So maybe get progesterone tested as well? I don't remember exactly, but I think Dr. Peat said progesterone should be 100x - 400x estradiol. Or maybe 40x - 100x. Either way it was a pretty large multiple.

 

[Caitlin]

I think it is but Dr. Peat mentions that people can have normal or even low estrogen on blood tests and still have very high estrogenic activity (I think especially in PCOS and other "hyperandrogen" issues) because the ratio of estrogen to progesterone is more important than just estrogen by itself. So maybe get progesterone tested as well? I don't remember exactly, but I think Dr. Peat said progesterone should be 100x - 400x estradiol. Or maybe 40x - 100x. Either way it was a pretty large multiple.

Got it. Good to know! thanks!

 

[sweetpeat]

Something that has helped me with taking t4 is to split the dose into 3 or 4 pieces. I know technically you can take the t4 all at once since it's more a storage hormone. But I found for me personally taking more than 75 mcg at once seems to have negative effects. Maybe it's easier for the liver to process smaller doses, depending on one's state of health. I take the split doses with my meals and at bedtime. Worth a shot, if you're not already doing it.

 

[Caitlin]

Something that has helped me with taking t4 is to split the dose into 3 or 4 pieces. I know technically you can take the t4 all at once since it's more a storage hormone. But I found for me personally taking more than 75 mcg at once seems to have negative effects. Maybe it's easier for the liver to process smaller doses, depending on one's state of health. I take the split doses with my meals and at bedtime. Worth a shot, if you're not already doing it.

Thank you. Good to know. What's the theory behind taking the t4 with food?

 

[sweetpeat]

Thank you. Good to know. What's the theory behind taking the t4 with food?

It's processed more slowly. You could take it in between meals if you prefer. It's easier for me to remember to take it if I do it with meals.

 

[tara]

Yes, I have read them and am trying to understand them but some of it goes way over my head right now.

I know what you mean. I had to reread, and as I read more of them they started to make more sense to me.

I'm not sure where I read it, but IIRC, Peat told of woman who was in deep trouble - brain function dangerously compromised from low metabolism - and the more T4 they gave her the worse it got.

 

[Caitlin]

I know what you mean. I had to reread, and as I read more of them they started to make more sense to me.

I'm not sure where I read it, but IIRC, Peat told of woman who was in deep trouble - brain function dangerously compromised from low metabolism - and the more T4 they gave her the worse it got.

It's funny, I didn't take my pill today and already felt slightly better. Definitely not "good," but not as zombie-ish as yesterday!

 

[tara]

It's funny, I didn't take my pill today and already felt slightly better. Definitely not "good," but not as zombie-ish as yesterday!

Not medical advice, but just from reading, my understanding is that because of the long half-life of T4, dose changes are best made cautiously and slowly.
Eg make a small change up or down, and watch what happens over 3-4 weeks before making further adjustments if it seems warranted.

 

[Caitlin]

Not medical advice, but just from reading, my understanding is that because of the long half-life of T4, dose changes are best made cautiously and slowly.
Eg make a small change up or down, and watch what happens over 3-4 weeks before making further adjustments if it seems warranted.

Absolutely. I hear ya. I didn't take it today because I needed to slow the brakes a little. But I am going to go back to 15o and titrate back down. I am thinking that this jump up to 175mg over the past month caused the issue given my zombie state started two weeks ago and I made the change a month ago.

 

[sweetpeat]

It's funny, I didn't take my pill today and already felt slightly better. Definitely not "good," but not as zombie-ish as yesterday!

It probably means that 175 is too high for you. You may need something between 150 and 175. I can attest that taking too much t4 is not a good feeling. When I recently lowered my dose by just 10 mcg (for the summer) it made a world of difference.

 

[Caitlin]

It probably means that 175 is too high for you. You may need something between 150 and 175. I can attest that taking too much t4 is not a good feeling. When I recently lowered my dose by just 10 mcg (for the summer) it made a world of difference.

Oh, it definitely meant that:)! But I felt more HYPOthyroid, not HYPERthyroid. How do you lower your dosage by just 10mcg? Are you getting compounded meds?