Peripheral Thyroid Hormone Conversion and Its Impact on TSH and Metabolic Activity:

Take this study to your doctor if s/he insists on dosing by TSH only.

"There have been recent advances in understanding of the local control of thyroid activity and metabolism, including deiodinase activity and thyroid hormone membrane transport. The goal of this review is to increase the understanding of the clinical relevance of cellular deiodinase activity. The physiologic significance of types 1, 2 and 3 deiodinase (D1, D2 and D3, respectively) on the intracellular production of T3 are discussed along with the importance and significance of the production of reverse T3. The difference in the pituitary and peripheral activity of these deidoidinases under a wide range of common physiologic conditions results in different intracellular T3 levels in the pituitary and peripheral tissues, resulting in the inability to detect low tissue levels of thyroid hormone in peripheral tissues with TSH testing. This review demonstrates that extreme caution should be used in relying on TSH or serum thyroid levels to rule out hypothyroidism in the presence of a wide range of conditions, including physiologic and emotional stress, depression, dieting, obesity, leptin insulin resistance, diabetes, chronic fatigue syndrome, fibromyalgia, inflammation, autoimmune disease, or systemic illness, as TSH levels will often be normal despite the presence of significant hypothyroidism..."

9 Replies

  • Is it peer reviewed?

  • I don't know.

  • I'd like to know more about the author and the journal and yes if it's peer reviewed.

    It certainly rings true with some of my recent and past experiences, especially iron levels. I've felt significantly hypo with Tsh of 2.5 whilst on sertraline. I'm now off it and raising ferritin as I've had rls symptoms all over and significant muscle wastage and my gp said a drug they give to the elderly for rls needed a higher ferritin level. I've been referred to a rheum but (although something else might pop up of course) I honestly think I've been significantly disabled due to this simple thing. Including needing to go on the ads in the first place!!

    I desperately want to know if this is accepted by the consultant and gp community.

    My only point would be that - I feel fibromyalgia could be a result of low t4 (or t3 to be specific) due to other things not being right in the conversion process - certainly even the nhs lists hypothyroidism as an alternative diagnosis for fibromyalgia.

  • ^^i feel I need to add that I'm finally starting to feel an iota of normality after a month on iron tablets and completely off the sertaline.

    The only reason I know for sure its not 'just' depression this time is that I have significant pain and sensory issues, and weakness. Which are finally starting to get better.

  • After googling the Dr, I feel he's hit the books and gathered all the evidence supporting his beliefs on hypothyroidism (he seems to practice outside the norm and has been the brunt of lots of criticism in the us as a result) to back up the credibility of his approaches.

    But, it's an incredibly convincing paper and incredibly well referenced, his credibility aside I'd really like the mainstream medical lot to see it and comment.

    My on going theory regarding hypothyroidism specifically is that it's a bit like diabetes in extremely slow motion. You'd die without proper treatment but it's so slow to occur and you survive with semi treatment that there's no incentive to make things better for us. In diabetes (type 1) you can potentially die very quickly and constantly need to be monitoring blood etc. not wanting to belittle diabetes at all but it does feel like hypothyroidism is therefore a bit 'second class'.

    I've been seen by oc health and the lovely Dr believes I'm covered by the disability at work act, as she pointed out to me that they look at you without your treatment. Without my treatment id be dead. But the treatment it's self is not fool proof nor easy to correct or even manage. And possibly not even correct (not even possibly!) this has helped my frustration but also angered me that as my gp says "we're (gps) aren't v good at managing hypothyroidism"

    I often feel sorry for the gp tjat gets to see me!

  • I would agree with your theory. Someone - wish I could remember who - once said that the thyroid 'isn't sexy', but, it would seem, diabètes is. Can't see it myself, and doubt if anyone with diabètes would agree, but there you are, that's the twisted way they think! lol

    At least your gp recognises that he's not very good at managing thyroid, most of them think their brilliant at everything! That's why they never research or learn from their patients.

  • Doctors that have retained a capacity for critical thinking are generally frowned upon by their peers. Dr. Holtorf's work is well researched. If you missed it try this site, also his efforts. PR

    This is a trailer for Maggie's film about her experiences dealing with thyroid issues, it is the all too common story of thyroid patients.

  • Thanks, I have looked and he's certainly extremely stoic in his referencing.

    I suspect many years from now much of what he says will be accepted.

    I think diabetes is more dramatic in the way it is sudden and extreme. It needs more urgency. Hypothyroidism is like a tortoise, easily ignored.

    My other new theory is that rheumatologists could / should be more helpful for Hypothyroidism. The end impacts of issues with dosing and management is on the muscles, joints etc. it's not 'just' about t4/ Tsh. I feel even physio had a part to play.

  • I think gynecologist should be duty-bound to know about thyroid, too. Because it affects all our female parts, and their workings. PMS, period pain, sterility, all that is very often down to the thyroid. And I believe that many women - like myself - woldn't be forced to go through a hysterectomy if their gynecologists had been more thyroid-literate!

You may also like...