"There is no evidence that treating an asymptomatic patient over the age of 65 years with TSH 5–10 mU/L produces clinical benefit."

rayban

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I was reading this: https://www.rcpa.edu.au/getattachme...Investigation-of-common-thyroid-problems.aspx

And I read this:

"There is no evidence that treating an asymptomatic patient over the age of 65 years with TSH 5–10
mU/L produces clinical benefit."

This is referenced:
Stott DJ, Rodondi N, Bauer DC, Group TS. Thyroid Hormone Therapy for Older Adults with Subclinical
Hypothyroidism. N Engl J Med. 2017;377(14):e20. doi: 10.1056/NEJMc1709989. PubMed PMID: 28976862.

Im still on my early 30's but I find this interesting. As you age you can manage higher doses of TSH if you have no sides? what's the deal?
 

xeliex

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They most likely are being given Synthroid or T4 only and nothing else being addressed regarding their state of metabolism, mitochondrial health, etc...

I feel close to death with a TSH or over 3.... Thyroid makes me feel better and brings it down to 2 or 1.
 
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rayban

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They most likely are being given Synthroid or T4 only and nothing else being addressed regarding their state of metabolism, mitochondrial health, etc...

I feel close to death with a TSH or over 3.... Thyroid makes me feel better and brings it down to 2 or 1.
What do you take and how do you decide you need more than t4?
 

xeliex

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What do you take and how do you decide you need more than t4?
It's been challenging to figure things out and it seems that the optimal dose is a moving target.

I have been taking Tyromax (NDT) but have dabbled with Cynoplus/Cynomel.
 
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rayban

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It's been challenging to figure things out and it seems that the optimal dose is a moving target.

I have been taking Tyromax (NDT) but have dabbled with Cynoplus/Cynomel.
What I was told by doctors is that NDT is not consistent in its dosage, you never really know who is developing it, the dosages may vary, while synthetics give you high accuracy. Your supplier may also disappear all of a sudden.

Im still on only 75mcg of eutirox and im wondering if I have margin to up my dose given my results. This bloodwork is from 2019 but I always had consistently 4-4.5 TSH. Im getting a new one soon.

Thyroids section:
PTH-i: 50.2 pgr/ml. Range: 18.5 - 88
Thyroglobulin: <1 ng/ml. Range: 1.9 - 59.9
Total T3: 1.02 ng/ml. Range: 0.65 - 1.6
Free T3: 6.1 pmol/L. Range 4 - 8.30
Reverse T3: 0.15 ng/ml. Range: 0.10 - 0.35
Total T4: 6.6 mcg/100ml. Range: 4.70 - 9.70
Free T4: 10.2 pg/ml. Range: 9 - 19.50
TSH: 4.17. mcUI/ml. Range: 0.25 - 5
Inmunology:
Antibodies anti-receptor of TSH (TSI): 0.82 mUI/ml. Range: 0.00 - 1.75
Antimicrosomal Antibody (TPO): 75.6 UI/ml. 0 - 12 UI/ml
Antibodies anti-thyroglobulin (TGL): 88.5 UI/ml. Range: 0 - 18
 

sunny

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Dr. PEAT says TSH in itself is inflammatory, and when people are suboptimally treated with just T4, it at least gives them the benefit of the suppressed inflammatory tsh.

Quotes by Ray Peat, PhD
“TSH has direct actions on many cell types other than the thyroid, and probably contributes directly to edema (Wheatley and Edwards, 1983), fibrosis, and mastocytosis. If people are concerned about the effects of a TSH “deficiency,” then I think they have to explain the remarkable longevity of the animals lacking pituitaries in W.D. Denckla’s experiments, or of the naturally pituitary deficient dwarf mice that lack TSH, prolactin, and growth hormone, but live about a year longer than normal mice (Heiman, et al., 2003). Until there is evidence that very low TSH is somehow harmful, there is no basis for setting a lower limit to the normal range.”

“W.D. Denckla discovered that the pituitary hormones are in some way able to accelerate the process of aging…Removing animals’ pituitaries, Denckla found that their aging was drastically slowed.”

“Denckla’s experiments are reminiscent of many others that have identified changes in pituitary function as driving forces in aging and degenerative diseases.”

“When W. Donner Denckla demonstrated that the removal of an animal’s pituitary (or, in the case of an octopus, its equivalent optic gland) radically extended the animal’s life span, he proposed the existence of a death hormone in the pituitary gland.”

“While Arthur Everitt, Verzar, and others were studying the effects of the rat’s pituitary (and other glands) on collagen, W. D. Denckla investigated the effects of reproductive hormones and pituitary removal in a wide variety of animals, including fish and mollusks. He had noticed that reproduction in various species (e.g., salmon) was quickly followed by rapid aging and death. Removing the pituitary gland (or its equivalent) and providing thyroid hormone, he found that animals lacking the pituitary lived much longer than intact animals, and maintained a high metabolic rate. Making extracts of pituitary glands, he found a fraction (closely related to prolactin and growth hormone) that suppressed tissue oxygen consumption, and accelerated the degenerative changes of aging…A high level of respiratory energy production that characterizes young life is needed for tissue renewal. The accumulation of factors that impair mitochondrial respiration leads to increasing production of stress factors, that are needed for survival when the organism isn’t able to simply produce energetic new tissue as needed. Continually resorting to these substances progressively reshapes the organism, but the investment in short-term survival, without eliminating the problematic factors, tends to exacerbate the basic energy problem. This seems to be the reason that Denckla’s animals, deprived of their pituitary glands, but provided with thyroid hormone, lived so long: they weren’t able to mobilize the multiple defenses that reduce the mitochondria’s respiratory energy production.”

“The “little mouse,” and the experiments of Denckla and Everitt, show that a simple growth hormone deficiency or lack of pituitary function can double the life span: Intervention in the many other self-stimulating excitatory pathways can produce additional retardation of the aging process, acting at many levels, from from the extracellular matrix to the brain.”

“A mutant dwarf mouse, called “little”, has only 5% to 10% as much growth hormone as normal mice, and it has an abnormally long lifespan.”

“The metabolic rhythm should correspond to the light-dark rhythm, because darkness is a basic biological stress, and sleep is protective against the stress of darkness. Since TSH has many maladaptive effects, and rises along with prolactin and cortisol during the night, some thyroid taken at bedtime helps to reduce the stress, moderating the TSH rise while keeping the blood sugar from falling too fast. Ice cream (i.e., sugar and fat with a little protein) at bedtime has a similar effect, reducing the rise of adrenaline, cortisol, etc., with the result that the morning cortisol peak will be lower, preferably below the middle of the common range, and then it should decline in the afternoon.”
 
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rayban

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Dr. PEAT says TSH in itself is inflammatory, and when people are suboptimally treated with just T4, it at least gives them the benefit of the suppressed inflammatory tsh.

Quotes by Ray Peat, PhD
“TSH has direct actions on many cell types other than the thyroid, and probably contributes directly to edema (Wheatley and Edwards, 1983), fibrosis, and mastocytosis. If people are concerned about the effects of a TSH “deficiency,” then I think they have to explain the remarkable longevity of the animals lacking pituitaries in W.D. Denckla’s experiments, or of the naturally pituitary deficient dwarf mice that lack TSH, prolactin, and growth hormone, but live about a year longer than normal mice (Heiman, et al., 2003). Until there is evidence that very low TSH is somehow harmful, there is no basis for setting a lower limit to the normal range.”


“The metabolic rhythm should correspond to the light-dark rhythm, because darkness is a basic biological stress, and sleep is protective against the stress of darkness. Since TSH has many maladaptive effects, and rises along with prolactin and cortisol during the night, some thyroid taken at bedtime helps to reduce the stress, moderating the TSH rise while keeping the blood sugar from falling too fast. Ice cream (i.e., sugar and fat with a little protein) at bedtime has a similar effect, reducing the rise of adrenaline, cortisol, etc., with the result that the morning cortisol peak will be lower, preferably below the middle of the common range, and then it should decline in the afternoon.”
Very interesting points. So basically, up your t4 dosage as high as needed to supress TSH? what about the ft4, ft3, total t4, total t3? I mean, it's one thing to lower your TSH, but you have to take in consideration the actual t4 and t3 hormones etc? or lowering TSH is more important? I mean, there has to be a limit of how much you can take right, you can't just take a bunch of supplementation without considering the rest.
The thing is, my doctor refuses to up the dosage. My mom also has TSH at 4, 4.5 ish, and she says shes ok, and doesn't need to go higher than 75mcg of eutirox which is what I also take, so im not sure how to get my hands on some 100mcg eutirox to test.

Also looks like I was doing the right thing taking the T4 at night? I just based this on a small study where there was some improvement using it at night, and that's all needed because I hated waking up half an hour earlier just to have a glass of water with a pill. However my schelude right now it's screwed up, I should go to sleep earlier, and by taking it at night, you have to wait at least 3 to 4 hours after dinning. So if I end dinning at 12:00 I have to go to bed at 4 am when I take the pill, im ok with that since I work from home and I wake up whenever I want, but the downside is you don't get much sun. But if I actually went to sleep at 4 am, I would wake up at 1:00pm, where I can still get some sun, the problem is at 4 am is when I feel best and more productive, so I end up going to bed at 6 am or so... I have to train myself to go to bed at at least 4 am and I think I should be able to manage this while getting sun.

I found the study which I think it was this one:
 

sunny

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Very interesting points. So basically, up your t4 dosage as high as needed to supress TSH? what about the ft4, ft3, total t4, total t3? I mean, it's one thing to lower your TSH, but you have to take in consideration the actual t4 and t3 hormones etc? or lowering TSH is more important? I mean, there has to be a limit of how much you can take right, you can't just take a bunch of supplementation without considering the rest.
The thing is, my doctor refuses to up the dosage. My mom also has TSH at 4, 4.5 ish, and she says shes ok, and doesn't need to go higher than 75mcg of eutirox which is what I also take, so im not sure how to get my hands on some 100mcg eutirox to test.

Also looks like I was doing the right thing taking the T4 at night? I just based this on a small study where there was some improvement using it at night, and that's all needed because I hated waking up half an hour earlier just to have a glass of water with a pill. However my schelude right now it's screwed up, I should go to sleep earlier, and by taking it at night, you have to wait at least 3 to 4 hours after dinning. So if I end dinning at 12:00 I have to go to bed at 4 am when I take the pill, im ok with that since I work from home and I wake up whenever I want, but the downside is you don't get much sun. But if I actually went to sleep at 4 am, I would wake up at 1:00pm, where I can still get some sun, the problem is at 4 am is when I feel best and more productive, so I end up going to bed at 6 am or so... I have to train myself to go to bed at at least 4 am and I think I should be able to manage this while getting sun.

I found the study which I think it was this one:
Have you read Broda Barnes Hypothyroidism the unsuspected illness? Read Dr peats articles on thyroid on his website?Many people do take at night and Dr Peat does recommend that to keep tsh supressed at night. Ray Peat also says it is best to take thyroid with food, it slows the absorption. You could try some of the idealabs thyroid products - read the threads on them here on the forum. If you do find a way to increase your t4, you want to do it slowly , add a given amount the same for two weeks to get to the full half life of the new dose. You can do your own testing if you need to. Are you familiar with the Sttm website? Stop the thyroid madness. They have a ray peat transcript there of an interview they did with him. Lots of good info there. Also functionalps.com has good ray peat topics and quotes. Here is a lab service where you can order your own labs. Expanded Thyroid Panel - BLT System
 
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rayban

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Have you read Broda Barnes Hypothyroidism the unsuspected illness? Read Dr peats articles on thyroid on his website?Many people do take at night and Dr Peat does recommend that to keep tsh supressed at night. Ray Peat also says it is best to take thyroid with food, it slows the absorption. You could try some of the idealabs thyroid products - read the threads on them here on the forum. If you do find a way to increase your t4, you want to do it slowly , add a given amount the same for two weeks to get to the full half life of the new dose. You can do your own testing if you need to. Are you familiar with the Sttm website? Stop the thyroid madness. They have a ray peat transcript there of an interview they did with him. Lots of good info there. Also functionalps.com has good ray peat topics and quotes. Here is a lab service where you can order your own labs. Expanded Thyroid Panel - BLT System
Yeah im familiar with STTM. They recommend NDT but like I said before, there's no way to get it reliably, you have to trust dodgy steps along the process, and you cannot count on it being permanently availible.

I have never heard before to take it with food. You mean it slows the absorbtion but it reaches the same peak value? because as far as I understand, it was that the full dose wouldn't be reached because some gets lost or something like that, that is why they recommend the 3 to 4 hour gap before taking it before sleep.
 
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Yeah im familiar with STTM. They recommend NDT but like I said before, there's no way to get it reliably, you have to trust dodgy steps along the process, and you cannot count on it being permanently availible.

I have never heard before to take it with food. You mean it slows the absorbtion but it reaches the same peak value? because as far as I understand, it was that the full dose wouldn't be reached because some gets lost or something like that, that is why they recommend the 3 to 4 hour gap before taking it before sleep.

Yes after eating.
 

sunny

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Yeah im familiar with STTM. They recommend NDT but like I said before, there's no way to get it reliably, you have to trust dodgy steps along the process, and you cannot count on it being permanently availible.

I have never heard before to take it with food. You mean it slows the absorbtion but it reaches the same peak value? because as far as I understand, it was that the full dose wouldn't be reached because some gets lost or something like that, that is why they recommend the 3 to 4 hour gap before taking it before sleep.
Dr Peat recommends taking it with food to slow the absorption. It absorbs for a longer period of time. As far as STTM, they just have alot of info on RT3, things that can hamper thyroid, troubleshooting some problems you may encounter. T4 will take 2 weeks to realize the effect of a given dose.

I agree with NDT - I have no thyroid, and I think I felt the best while take an NDT- then they ran into the current problems which still do not seem to be resolved.
 

oxphoser

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What do you take and how do you decide you need more than t4?

You might need some T3 as well as T4. Very few doctors will prescribe T3.
In the April 18, 2022 interview with Patrick Timpone, at around 1:11:00, Peat mentions that too much T4 is not good for women in particular because often women are much less able to convert T4 into T3.

High estrogen levels affect their liver, somehow blocking it from being able to convert T4 to T3. There’s a point at which women can get more and more hypothyroid the more T4 they take because “the excess T4 dilutes the T3 that came out of their own thyroid gland.”
 
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rayban

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You might need some T3 as well as T4. Very few doctors will prescribe T3.
In the April 18, 2022 interview with Patrick Timpone, at around 1:11:00, Peat mentions that too much T4 is not good for women in particular because often women are much less able to convert T4 into T3.

High estrogen levels affect their liver, somehow blocking it from being able to convert T4 to T3. There’s a point at which women can get more and more hypothyroid the more T4 they take because “the excess T4 dilutes the T3 that came out of their own thyroid gland.”
Yeah but how do you decide you need t3. Also im a 30 yo man.

I have never heard anywhere to say to take it with food beside Ray Peat then.
 

oxphoser

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Yeah but how do you decide you need t3. Also im a 30 yo man.

I have never heard anywhere to say to take it with food beside Ray Peat then.
Have a look at
Thyroid: Therapies, Confusion, and Fraud by Ray Peat which is on the internet. In section V “Therapies” he discusses keeping a 14 day log of temperatures and pulses, for starters. If you keep a log like this over 14 days and your temperature never reaches 98.6, you know you are not getting enough thyroid.

If your log shows you are not getting enough thyroid due to low temperatures and pulses, the answer may not be to add more and more T4.

In this piece Peat suggests that instead of adding more T4, start adding T3 at a 3:1 ratio, ie taking 3 times as much T4 as T3. He thinks that people days must take T3 as well as T4, mainly because our livers are unhealthy and we cannot make T3 from T4.

Yes Peat goes against conventional wisdom with his suggestion of taking thyroid with food.
 
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rayban

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Yes after eating.

Have a look at
Thyroid: Therapies, Confusion, and Fraud by Ray Peat which is on the internet. In section V “Therapies” he discusses keeping a 14 day log of temperatures and pulses, for starters. If you keep a log like this over 14 days and your temperature never reaches 98.6, you know you are not getting enough thyroid.

If your log shows you are not getting enough thyroid due to low temperatures and pulses, the answer may not be to add more and more T4.

In this piece Peat suggests that instead of adding more T4, start adding T3 at a 3:1 ratio, ie taking 3 times as much T4 as T3. He thinks that people days must take T3 as well as T4, mainly because our livers are unhealthy and we cannot make T3 from T4.

Yes Peat goes against conventional wisdom with his suggestion of taking thyroid with food.
But assuming you increase t4 and the t3 is also increased, why would you mess with t3? as long as the conversion is good a I mean.
Also I don't even have access to t3.

I'll get the temp log done when the thermometer arrives. What device gets accurate readings for the pulse? I was going to buy an oura ring but you need to pay a subscription now.
 

sweetpeat

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What device gets accurate readings for the pulse?
I suppose there is an app out there, but I just use the stopwatch function on my computer or phone. Count pulse for 10 seconds, then multiply by 6 for bpm.
 

oxphoser

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But assuming you increase t4 and the t3 is also increased, why would you mess with t3? as long as the conversion is good a I mean.
Also I don't even have access to t3.

I'll get the temp log done when the thermometer arrives. What device gets accurate readings for the pulse? I was going to buy an oura ring but you need to pay a subscription now.
If you are taking T4 only and you are getting 98.6 temperatures during the day, that’s great. But some people are still getting 97s, 96s no matter how much T4 they take. Peat spoke of one case where a woman was taking 500 mcg T4 and was still had low temps and other hypothyroid symptoms. When they gave her T3, she started to improve. Her body couldn’t make any T3.

You can get a pulse meter for your finger. They are cheap and clip onto your finger. Or you can just put your finger on your neck or wrist and count the beats per minute.
 
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