Endocrinedoi.org/10.1007/s12020-020-...
ORIGINAL ARTICLE
Standard hypothyroid treatment did not restore proper metabolicresponse to carbohydrateAgnieszka Kozacz 1●Gilmara Gomes de Assis1●Urszula Sanocka2●Andrzej Wojciech Ziemba
1Received: 17 February 2020 / Accepted: 27 April 2020
Damn , i think the more research that comes out in the future, t4/t3 combo looks like the best option to treat thyroid diseases,
The more that I read, the more it seems that low T3 arising from T4 monotherapy greatly increases risk for cardiac disease, diabetes, anaemia and now this article adds to the list inflammation from obesity and thus inflammation based risk to other disease. I'm in a furious mood today.
In which case you'll find this interesting.
Prevalence rates for 10 chronic disorders at various FT4, TSH and FT3 levels
thyroidpatients.ca/2020/10/...
Thank you. Most interesting What strikes me is that combination therapy is treated as a last resort, a treatment one tries to get if mono therapy doesn’t work well after years of diligently trying to make a bad thing good. But perhaps one should aim for it as soon as possible in order to get the high T3 and T4/t3 ratios she describes as quickly as possible so as to minimise risk of all the other chronic diseases.
Totally agree it should be the first line therapy not an afterthought for the very few that manage to fight for it and actually get it. I feel miles better on NDT than Levothyroxine monotherapy. Two really miserable years of suffering on that stuff could have been completely avoided in my case had I got NDT straight away.
There were so many facts and figures in these papers, I am afraid I was protesting whilst reading it. This an unfortunate problem I have, I am sure linked to my hypothyroid state. However I have the jist of it. Us hypothyroids, particularly those of us not doing wonderfully on T4 mono therapy are definitely not being treated properly by the powers that be. Will this be enough to quote to my GP in the absence of my full understanding? Same with the other paper quoted in this thread. Gosh I admire you lot.
I found the discussions helped me to make sense of what I was looking at. Click on the arrows pointing right to see them.
For example, in the discussion of hypertension it says :
In this population NOT treated with thyroid hormones,
High TSH (>6.80 mU/L) had the highest prevalence rate of hypertension, 59.1%.
These people would be diagnosed either with subclinical hypothyroidism (if TSH >10 but FT4 “normal”) or overt hypothyroidism (if low FT4, especially if TSH >10).
High FT3 with overt hyperthyroidism and a high FT3:FT4 ratio had the lowest prevalence rate for hypertension, 35.3%.
There is a lot more to the discussions than just that, but it is worth starting there.
Suddenly it made sense due to your explanation. Thanks.
Thank you for this diogenes . I am hashis plus Type 1 diabetic so this article resonates strongly with me. I have noticed for a very long time that my blood sugar control changes depending on where my thyroid hormones are. This paper helps explain why.
This is a really useful paper. Thank you!!
I've started eating a low-carbohydrate high-fat diet this year, in an attempt to normalise my blood pressure. I suspect that years of under-medication with T4 only has made this necessary!!! The signs so far are good, but it's going to take time!!
It’s interesting they talk about post perandial thermogenesis. One weird thing I get sporadically is suddenly feeling really hot after eating. I read it’s called gustatory sweating and affects diabetics. I am not diabetic, take NDT and have no idea why it occurs.
This happens to me too, also not diabetic and take glandulars and it's worse if it is a higher carb meal or a sweet treat however small.
So I am not alone 😁 it instantaneous too rather like a hot flush or power surge as the Americans call them giving them a kind of magical positivity 😉
I had one last night after eating a baked potato with lashing of butter and cheese 😋 - it was worth it 🤣🤣🤣
Jus saw this on fb and posted a question about it - perhaps you can help too?I’m not sure what to make of this and would really appreciate help. I had an eating disorder in teenage years, was almost sort of recovered and then developed hashimotos hypothyroidism. The fear of weight gain then drove me back into an ED. I really struggle to straddle freedom from an eating disorder and managing hypothyroidism, if you see what I mean.
Drs assure me I can eat normally like everyone else, but this study I guess confirms my fears?
(Note: my weight has never been more than a low-normal bmi)
So how should I eat? Low carb? No carb? No sugar? Confusing because I had read low carb is bad for t3 levels? I’m very active and have a slow digestion, so really feel I depend on fruit when my blood sugar drops. I just wish I knew for certain how/what I should eat.
Thanks!
Whatever you fancy that makes you feel well, is my mantra. My weakness is pineapple juice but I read up about what’s in it and it is jam packed with goodies, so I follow my body’s inclination towards it. We must have some sort of innate ability to eat the right things or we’d have become extinct a long time back and although some would like to pretend otherwise we are an animal and they seem to manage ok. I guess highly proccessed empty calories are the things to steer clear of…like pineapple juice 🤣🤣🤣
I love this response. Thank you!
Balanced diet with a mixture of carbs, fats & proteins and without processed food seems to be the ideal. I substitute rice for brown rice and pasta for gluten free brown rice pasta.
I didn’t used to eat butter but I eat it as much as I like now and feel healthier for it. Other good fats are coconut oil and avocados & olive oil.
One other trick to keep blood sugar balanced is to eat some fat or protein BEFORE eating carbs.
No human being should eat sugar, processed carbs or processed vegetable oils they are very inflammatory. You might consider a keto diet which means that your body uses fat to make ketones for fuel rather than carbs. This would mean that you wouldn't get blood sugar drops once you had become adapted to burn fat. I am pretty much carnivore and feel much better than on a diet including carbs. A lot of people use the keto/carnivore diet to overcome digestion issues. A lot of gut issues are caused by various plant proteins such as Gluten and Lectins. Worth a thought. There is evidence that a high fat diet can result in lower your T3 levels. This is not necessarily a problem as a healthy animal based diet can reduce inflammation and therefore the body naturally needs less T3 and levels can be lower.
Very, very interesting and not at all surprised by the results just disgusted that doctors are.
I've low carbed for a number of years, it's the only thing that works really well for me. When I got diagnosed, I'd been off it for a little while (combination of holidays and just feeling really unwell), and put some weight on.
I was started on 25mcg levo initially, and decided to get back to low- carbing, but it just didn't work at all. Literally didn't shift 1lb, in fact was still putting weight on. I put on 4 stone in total. It was awful. I also tried eating sensibly, again, it didn't work and I carried on putting on weight.
It was only when after getting up to 150mcg of levo and still feeling like a zombie (even though on paper my T4 and T3 results actually looked really good) that I decided to add some T3 medication in. I started low and slow, and decided to try low carbing again. It was only at that point, having added some T3 medication, that it started working, and I lost the weight.
I come off it for holidays, and we've been fortunate enough to have a lot in the last year, so I haven't lost as much as I'd like, but I'm generally 3 and a half stone down (4 stone if I've had a while to recover from holiday excesses!).
That was the same for me I used to feel like I was wearing a fat suit on T4 monotherapy but 4 extra stone is a lot of excess to carry around all day long. Once I started NDT the weight fell off effortlessly. I was always thin previous to the final throes of hypo and then the horrors of treatment with Levothyroxine. I used to wish I hadn’t survived as my life was not worth living on T4 only, I felt like a thing.
I figured this out 4 years ago. If I had a pudding I got palpitations within the hour followed by this feeling I was going to self combust. Yesterday I stupidly had a small portion of lemon drizzle cake at a function. By the time I got home I had to lie down, palpitations followed by thermogenesis. When it eventually subsided I slept for 2 hours and was then awake till 4 am. I’m well medicated on T3 and T4 but also on a fasting 6/18 low carb keto type diet. Seems I’m more intolerant than ever to sugar!
I count myself very lucky as mine is a minor annoyance that I can laugh at. Sorry yours is so dramatic.
This is really interesting. I've recently signed up for the Zoe Predict Testing (quite expensive but I thought it might be a cheaper way of reducing my fatigue than seeing a private endo for T3 prescription) As well as testing your blood lipid response and your microbiome quality it also involves wearing a glucose monitor for the first two weeks. I think I eat a fairly good diet already, no sugar or refined carbs (I know these make me feel bad), no ultra processed food and plenty of veg, good quality fats and protein. I was rather shocked by how much my glucose levels spike whenever I have any carbohydrate even if it's something like brown rice. I'm assuming this is related to me having Hashimoto's and probably being undermedicated on levothyroxine only. One thing that I've learned from doing this that has really helped me is learning about converting carbs into resistant starch. Basically you cook rice/pasta/potato as usual then you chill overnight and reheat before you eat it. This converts the starch into resistant starch which doesn't spike your blood sugar in the same way and also it feeds your gut microbes really well. I experimented with this while on the glucose monitor and it really reduced the blood sugar spikes for me. For rice I've found it quite easy - I cooked about 10 portions of rice, spread it out on a tray and chilled it as quickly as possible then put it in freezer bags in a thin layer and froze it. It is then easy to break a portion off when you need it and defrost it and use it as usual. It also saves energy and time if you eat black, brown or red rice. I haven't tried it with potatoes yet, I suspect that might be trickier.
I might see if I can forward this paper to the Zoe Predict team once I've had all my results.
Tsh and t4 rising on treatment 
Levo t4 vs t4 and t3 treatment 
Sign petition for law allowing doctors to try non-standard treatments
