Why Do I Need Such A Massive Dose Of T3?

[CrimsonMacaw]

I started taking T3, T4 and NDT meds around 2 years ago - the dosage that keeps me functional is 80mcg of T3 (but 100mcg is better), and 3 capsules of 300mg ThyroGold (equivalent to around 4-5 grains of NDT I've been told). When I try and switch it out for 200mcg of T4 or 100mcg of T4, the relief of symptoms isn't as strong. I've seen multiple naturopaths plus doctors and endocrinologists and no one can explain why I need such a massive dose.

I tried switching out to Tyromax but didn't get a good response from that - I took 14 drops in the morning and 14 drops in the afternoon and still felt like hypo symptoms were slowly creeping back: constipation, bad digestion, low energy, poor memory, etc.

My cortisol isn't low. It's elevated in the morning and day, but becomes normal at night.

I've been taking supps to lower my estrogen and raise testosterone and that's not doing anything.

I would keep taking these massive doses, but my blood work showed that they're causing a big turnover of my bone tissue (my ALP marker for bone is off the charts - I initially thought it was a liver issue, but it turns out that huge doses of T3 meds lead to high bone turnover by keeping you in a hyper state). If I keep this up the endo said it may lead to osteoporosis.

The issue is that whenever I try and lower my dosage and try and raise thyroid by natural means (and attempt lowering estrogen at the same time) all the hypo symptoms come back. I last for a week or two before I have to go back.

My autoimmune thyroid antibodies are also going through the roof so I don't see myself lowering my dose anytime soon under these conditions.

My question is: Why would I need to take such huge doses? Why do I need to take 100mcg of T3 just to get my T3 levels mid-range? And at the same time, why the need for even more massive doses of NDT to get a better relief from hypo symptoms? It's not due to lowered cortisol - I know that much. The other advice I read was to start taking hormone meds to support the thyroid, but that was in the case of chronically low cortisol.

I've taken all the different herbs and supps (including pregnenolone and progesterone) for adrenal fatigue...that did nothing. Dropping my estrogen and increasing testosterone only caused cracking joints and bones.

Someone out there must be in the same boat as me and I'm curious what their solution was.

BTW, my morning temps usually range from 36.2 - 36.6 degrees celsius. For some reason when I lower the amount of thyroid I take my morning temps actually go up to 36.6. The drawback being that hypo symptoms return.

[jimh111]

You say 'Why do I need to take 100mcg of T3 just to get my T3 levels mid-range?'. How long after taking the L-T3 do you have the blood taken? Do you split the doses? Also it woud be useful to see these blood test results. It's important to know if you are absorbing the hormone before trying to assess whether you are actually on high doses.

[CrimsonMacaw in reply to jimh111]

I wait 24 hours before having blood tests done. I do 80mcg in the morning and 20mcg mid-afternoon (the morning dose is around an hour before breakfast and the afternoon dose around 1.5 hours after lunch and 1.5 hour before my next snack/meal). That dose is to maintain my FT3 right in the middle of the range. My FT4 doesn't budge though, that's why I need to take either an NDT or thyroxine/T4.

[jimh111 in reply to CrimsonMacaw]

I would try splitting your dose fifty / fifty with half in the morning and half in the evening. I find the bedtime dose helps with good sleep and being better the next day. A gap of 24 hours is too long to get an accurate estimate of your average fT3 levels.

As requiring very high doses the only thing I have found that causes this is endocrine diruption, chemicals that we all ingest that can affect hormone action, usually without affecting the pituitary. (If they affect the pituitary it is picked up in testing and they are banned). This is a very big topic.

[CrimsonMacaw in reply to jimh111]

jimh111 thanks for all your assistance, and I realize this is a big topic but I'd appreciate any help to get to the bottom of it. Any links to outside resources would help. My long-term health depends on finding these chemicals (if that is indeed the issue) and doing my best to remove them from my diet.

Regarding the dose, I've found that what works best for me is doing 75%/80% of my thyroid dose in the morning and the rest either mid-morning or mid-afternoon. Taking a small dose a few hours before bedtime just launches my heart racing and feels like I took 4 shots of espresso (whereas in the morning and mid-afternoon I don't feel anything).

[jimh111 in reply to CrimsonMacaw]

If you find you can’t get to sleep when taking some L-T3 before bedtime I suspect it is a sign you are on too much hormone. Try reducing your overall dose and taking half your L-T3 at bedtime, you may find you get the same benefit with less hormone.

As regards endocrine disruption I had this problem and was able to eliminate the endocrine disrupting chemicals by taking simeticone. My profile gives details of my website which describes PBDEs which can disrupt thyroid hormone action. Taking simeticone seems like a weird idea but it is science backed. You would need to try it for several months, fortunately simeticone is available over the counter and cheap.

[CrimsonMacaw in reply to jimh111]

Got it. Thanks. I'll give simeticone a whirl.

Quick question: My hypo state is caused by Hashimoto's. From what I've gleaned from your site, yours is workplace/chemical induced hypo. Would the simeticone still help in alleviating my acquired resistance to thyroid hormone given my autoimmune condition?

BTW, I've also suffer from chronic IBS - constipation and gas. I read through your IBS section but wasn't sure as to what your final suggestion is for those with IBS. Is it just magnesium citrate? If so, what dose would you take if you had constipation dominant IBS?

[jimh111 in reply to CrimsonMacaw]

If you had a TSH > 10 and / or low fT4 or fT3 when diagnosed then you can be confident that your hypothyroidism was primary hypothyroidism which is usually caused by Hashimoto's. It's possible some patients happen to have a mildly elevated TSH or antibodies and mistake this for the cause of their hypothyroidism. At the moment we can't confirm endocrine disruption other than trying to eliminate sources of environmental toxins and trying simeticone which will probably eliminate most lipophillic toxins, which are the ones likely to affect thyroid hormone action. Simeticone will inhibit thyroid hormone absorption so take it away from hormone tablets.

My view on IBS is that intracellular magnesium deficiency causes IBS by reducing the threshold for chronic / visceral pain transmitted by NMDA receptors. These receptors also control the contractions that are abnormal in IBS. Low magnesium status also induces smooth muscle (in the gut) to contract giving rise to spasms and a sensation of bloating. So, it makes sense to take a magnesium supplement, I used magnesium citrate but some other forms are good also (NOT magnesium oxide or hydroxide). I took the dose advised on the bottle but after a week or two you might notice loose stools so you should then reduce the dose a little.

Secondly, we want to find the cause of magnesium deficiency assuming it is not just poor diet. In my case it was hypothyroidism which lowers intracellular Mg. I couldn't find good studies to show this but it was in a textbook written by a top researcher (Prof Jean Durlach).

[CrimsonMacaw in reply to jimh111]

I just received my simeticone capsules today from the Pfizer brand.

You mentioned it took you 8 weeks before you began to feel the effects of simeticone (at a dose of .4g). I just wanted to know if there are any long-term side effects of simeticone. It seems like a substance that has few studies behind its long-term safety.

Or from your experience do you think the dose should be dropped or stopped altogether once you start consuming fewer thyroid meds?

[jimh111 in reply to CrimsonMacaw]

I'm not familiar with the Pfizer brand. Some brands contain sorbitol which could cause diarrhoea in large quantities. Simeticone is not metabolised so it shouldn't have side effects. Since it is a non absorbed lipid it could theoretically lower the levels of lipophillic substances such as fat soluble vitamins but the quantity of simeticone is very small and I haven't noticed any effect on vitamin D levels.

I haven't found any long term studies, I guess it is assumed safe on the basis of being non absorbable. I need to take it so I don't have much choice although I take two 125 mg capsules now instead of four.

As regards lipophillic toxins such as PBDEs it's important to reduce exposure as simeticone works slowly. This can be done by removing soft furnishings made between the 1970s and 2004, by damp dusting or HEPA vacuuming occasionally and by opening windows for a short time.

[CrimsonMacaw in reply to jimh111]

Thanks for that. Just as a side note that may interest you, I was reading through the Ray Peat Forums and some people posted studies showing that TUDCA and perhaps testosterone help raise Deiodinase 2. Obviously the higher it is the less T3 medication one would need to consume.

[jimh111 in reply to CrimsonMacaw]

Thanks, I haven't heard of TUDCA. There are studies demonstrating that Forskolin increases D2 in-vitro. The problem is that if you increase deiodinase it will also happen in the pituitary and push down TSH. You would need something that increases peripheral deiodinase but not pituitary deiodinase. The ideal product that does that is bioactive TSH, so we need to try and keep our TSH up, which may not be possible.