This gives an indication as to why T4 monotherapy does not satisfactorily restore carbohydrate response

[diogenes]

This is interesting in that it combines T4 monoterapy and carbohydrate response. could be a clue as to why patients on T4 only can have difficulty losing weight.

Agnieszka Kozac, Gilmara Gomes de Assis, Urszula Sanocka, Andrzej Wojciech Ziemba

Received: 17 February 2020 / Accepted: 27 April 2020© The Author(s) 2020

Endocrine doi.org/10.1007/s12020-020-...

Abstract

Hypothyroidism is associated with a lower metabolic rate, impaired glucose tolerance, and increased respon-siveness of sympathetic nervous system to glucose ingestion. The Levothyroxine (LT4) monotherapy is the standardtreatment for hypothyroidism; however to what extent this treatment restores the patientmetabolism has not been verified.The aim of this study was to test the hypothesis that standard LT4 therapy may not restore proper metabolic response to carbohydrate ingestion.

Conclusion

Standard T4-only treatment for hypothyroidism does not restore the normal metabolic reaction to carbohydrate which is observed in healthy people.

[Lulu2607]

I would agree with that as it fits with my own experience. Is there a solution though, or is it just 'watch the carbs'? I imagine the majority of hypo patients are on T4 treatment.

[jimh111]

A zero has been left of the end of the doi link doi.org/10.1007/s12020-020-... .

[dolphin5]

That’s useful! Thank you!

[Musicmonkey]

Going low carb has helped me.

[arTistapple]

Makes sense. Just had a similar conversation this morning with my enlightened physio. He called it ‘carb tolerance’; reckoning it interferes with T4 to T3 conversion and until this ‘tolerance’ is dealt with (ref:Lulu2607) conversion will continue to be poor. Hence perhaps the good reaction many people report from introducing T3 into their equation - if only some of us could at least try it.

[bluejourney]

So as far as I can make out, the question is, what’s in natural thyroxine other than T4 and T3 that is so necessary for the metabolism of carbohydrates? And is anyone finding out? And can they hurry up!

[diogenes Remembering in reply to bluejourney]

It's now agreed that, in T4 mono therapy, a given dose of T4 doesn't produce as much T3 for the same T4 level. It won't be theT4 that is given, but the relative failure to produce enough T3 from it for weight control purposes

[TSH110 in reply to bluejourney]

I think T2 is supposed to be involved in metabolism, but not sure if it affects carbohydrates I think it has an action on mitochondria & it does seem to aid weight loss. One would get more of it if taking T3 or NDT There is some research been done on it.

[bluejourney]

As I understood it, although the hypothyroid subjects were only on T4, they did measure FT3 levels, and on page 21 they referred to lack of RMR increases despite increasing FT3 levels. One of the explanations of the lower metabolic rate they put forward was “..deficiencies in other than triiodothyronine and thyroxine active substances secreted by the thyroid gland and/or THs-active intermediate metabolites. Some of the active substances from thyroid gland are present in desiccated thyroid extract, which may be one of the explanations of increased satisfaction with the therapy of patients taking desiccated thyroid extract than patients taking LT4..” I took it to mean there were substances in desiccated thyroid extract other than T4 and T3 that were at work.

I thought it was very interesting what they said on page 17 about higher plasma sodium levels in the hypothyroid patients at all time points. I wake up feeling very dehydrated every morning.

Thanks, a very interesting read.

[tattybogle in reply to bluejourney]

"While lower RMR is a characteristic of hypothyroid state, patients undergoing treatment should demonstrate normalized RMR levels. Such normalization was reported by Wolf et al. (1996), however, TSH-suppressive doses were used for this [39]. Although, lack of RMR increases despite increasing plasma fT3 level, was also reported [22]. The normalized TH blood concentration with slower RMR suggests a state of “tissue hypothyreosis condition” characterized by a difference between plasma THs and THs concentration and/or activity inside cells which is assumable when considering the complexity of mechanisms governing the proper tissue response to TH stimulation [40, 41]. Such phenomenon has already been observed in NA dynamics in non-treated hypothyroid subjects [42]. Other possible explanation of lower RMR can be resulting from deficiencies in other than triiodothyronine and thyroxine active substances secreted by the thyroid gland and/or THs-active intermediate metabolites........"

This suggests that with higher Levo doses (TSH-suppressive doses ) ~ ? and therefore potentially higher fT3 levels on levo ? ~ RMR can be restored for some people , as long as Levo dose is high enough .

The reference to a report of "lack of RMR increases despite increasing plasma fT3 levels" is a finding from a different study (ref 22).... but unfortunately there is no easy access to any of the data from that one , just a brief abstract which doesn't mention the fT3 findings, so it's difficult to know the strength of the evidence which led them to this conclusion .

The study that is the subject of this post doesn't give us any fT4 /fT3 data, and they don't mention any of their own observations about fT3 levels from this study .

So i think it's still possible that improving an individual's fT3 level ( by any source, including higher doses of levo and or /adding synthetic T3) would be able to improve the RMR ?

[bluejourney in reply to tattybogle]

Yes, it’s hard to know what it could all mean, when they haven’t included data on FT3 (as usual!).

[Kimkat in reply to bluejourney]

What is RMR?

[radd in reply to Kimkat]

RMR - resting metabolic rate

[Kimkat in reply to radd]

Thanks for that

[bluejourney in reply to Kimkat]

In the study they used resting metabolic rate as a measure, as it reflects what your metabolism is doing, including thermogenesis, eating, digesting and processing food.

[Kimkat in reply to bluejourney]

Thank you for explaining

[Fluffysheep]

Interesting. I've followed a low carb diet for years, as it's the only thing that really works for me.

When I first got diagnosed, I put lots of weight on, and also stopped low carving for a while as I felt so terrible.

Was on levo, and started back on low carb diet, and it just didn't work at all. It's only when I started adding T3 medication in that the diet started working again, and I lost the 4 stone I had put on.

[Adam10]

Is there a suggested typical low-carb diet for people with hypothyroidism and Hashimoto’s?I suffer from weight gain and inability to lose it.

Is there a suggested protocol for switching from T4 mono-therapy to combined T3/T4 treatment plan? I appreciate Endo supervision will be required.

I am in Thailand long-term where I understand desiccated T3 is more readily available. Does anyone have any experience or knowledge of this?

[diogenes Remembering in reply to Adam10]

This available paper links low carbohdrate diet and Hashimoto's disease

Drug Des Devel Ther. 2016; 10: 2939–2946.

Published online 2016 Sep 14. doi: 10.2147/DDDT.S106440

PMCID: PMC5028075

PMID: 27695291

Effects of low-carbohydrate diet therapy in overweight subjects with autoimmune thyroiditis: possible synergism with ChREBP

Teresa Esposito, Jean Marc Lobaccaro, Maria Grazia Esposito, Vincenzo Monda, Antonietta Messina, Giuseppe Paolisso, Bruno Varriale, Marcellino Monda, and Giovanni Messina

[TSH110 in reply to Adam10]

This is a good guide to taking NDT:

tpauk.com/main/article/trea...

I dropped Levothyroxine by 25mcg as I added 1/4 grain NDT rather than stopping the Levothyroxine abruptly.

I take ThyroidS and have been well in it for over 7 years. I felt dire on T4 monotherapy

[OudMood in reply to TSH110]

Thank you for the link.

In the paragraph in red it states “Thyroid hormone may increase symptoms of diabetes mellitus, diabetes insipidus, or adrenal insufficiency. Adjustment of treatment measures for these endocrinological diseases is necessary if thyroid hormone therapy is added.”

Any idea to what “symptoms of diabetes Mellitus” means?

It’s quite an unusual phrasing so I’m not sure if it means increases/decreases insulin/carb sensitivity, increases or decreases hypoglycaemic or hyperglycaemic events… or what? 🤔🤔🤔

[TSH110 in reply to OudMood]

Excessive thirst is one symptom but I am not very knowledgeable about diabetes.

I think Diabetes mellitus must be type 2 diabetes.

This is a list of type 2 symptoms on NHS website that might help:

nhs.uk/conditions/type-2-di...

And these are for diabetes insípidus:

nhs.uk/conditions/diabetes-...

[OudMood in reply to TSH110]

Diabetes mellitus can be Type 1, 2, Lada, etc

I couldn’t see the relationship between diabetes symptoms and Thyroid hormone, as normally it’s quite the opposite with thyroid function improving blood sugars can improve too.

But don’t worry, I was just curious if you knew, maybe someone will stumble on our exchange 😬😬

[TSH110 in reply to OudMood]

Perhaps they were just being cautious and warning people it might change