This downloadable paper discusses case studies describing treatment for eating disorders by thyroid hormone. It's interesting in that case studies are described in detail and might find resonance for some posters on this forum.
On the Fundamental Efficacy of Thyroid-Hormone Therapy in Eating Disorders: Review of Mechanisms and Case Study
Interesting, thank you diogenes. I notice the problems occurred after being treated for a throat illness and they fT3 was below range. It very much sounds like this was 'low T3 syndrome', which was cured by addition of extra T3.
Thank you for sharing, this is very interesting on a number of different levels and is yet another indication of me having low T3 levels 7 years before I was finally deemed hypothyroid enough to be medicated (by which time my TSH was 150!) My first blood test showing issues was in 1992 when I was being treated for infertility but I'd been symptomatic for at least 3 years before that and was finally diagnosed in 2003.
I had one bout of tonsillitis after another as a child. By the time I was 14 I was really depressed and very unwell. What is low T3 syndrome.? Thank you.
I am waiting to see a psychiatrist after my dietitian thought I am suffering from A.R.F. I.D (Avoidant Restrictive Food Intake Disorder, like the girl in the case study. It looks like I need T3 which is almost out of range. I am on 50 mcg of Levothyroxine. Stopped eating properly in 2013 after two severe bouts of Norovirus. What should I do.
yes a private one would get it all sorted much quicker… you can try to wrestle with the GP by convincing me them you have a conversion issue and then wait to see and NHS endo who will then possibly give you some… the private route is much quicker and easier.
oh yes Meerkat1234 the others are right, sorry I overlooked your point about only being on 50mcg. It is a good idea to get to maximum treatment on levo first and if still don’t feel well, explore T3 🙂 that’s what I would do anyway.
Before adding T3 I would increase your levothyroxine – 50 mcg is a starter dose and not likely to be enough for anyone. If the proper dose of levo doesn't help you then you can consider adding T3.
T3 is not something to be taken unless you've checked everything else fully, and got everything else to an optimal level. T4, Vitamin D, Vitamin B12, folate ferritin, probably a full iron panel. I expect SlowDragon has given you all that information.
T3 is not liked (actually, not learnt) by most UK doctors, and a huge rhetoric has built up around it about it being dangerous. Of course levo can also be dangerous if too much is taken. But T3 is powerful and you must know what all your levels are etc, as above before you think of trying it.
I think one day getting combination therapy as standard will be the norm as it’s what our bodies have us. I wish the scaremongering attitude towards it would go away used sensibly it’s is not dangerous but highly beneficial.
But we are where we are and getting t4 monotherapy as optimal as possible is the route we are forced down by this ridiculous system. Oh that it would be swept away and common sense prevail with freedom of choice in our thyroid hormone therapy be granted to us.
yes, I completely agree. I’ve been thinking about this a lot recently. I’ve decided I believe that we should all be given T3 and T4 as first line treatment.
Why should people with compromised thyroid function be forced to live for conversion alone? Especially when we are most likely to have conversion issues from being hypo in the first place.
We have all gotten used to the idea that T4 mono therapy should be tried first, but if we strip that conditioning away the truth is that a healthy thyroid makes T4 + T3 (and T2,T1, calcitonin, but I know that would be too much to ask for)
Surely it makes most sense to mimic natural thyroid production from the off? And this comes with the added bonus of protecting other endocrine systems (sex hormones and adrenals in particular) from the dire repercussions of suboptimal treatment.
I was day dreaming the other day about a thyroid “pump” like an insulin one. When the body senses a need for more T4 or T3. Maybe they’ll make it one day.
i agree too, TSH110 i've long thought that if you are going to replace thyroid hormones at all ,then it would be most sensible to start at something like the ratio the thyroid makes for itself , and then adjust from there as necessary.
if i was writing a very basic standard guideline i'd start with:
25 mcg Levo + 2.5mcg T3 added a couple of weeks later ~ for elderly / heart issues / longstanding untreated hypo .
50mcg levo + 2.5 / 5mcg T3 added in gradually ~ for 'everyone else'
then increases if needed to:
75mcg levo + 7.5mcg T3
then 100mcg Levo + 10mcg T3
etc .
ok, so it obviously wouldn't work for some people eg. if synthetic T3 really didn't suit them at all ... but i bet the failure rate of my guideline would be lower than the failure rate of the current one .
funny that the ratio a pig makes is (statistically) different to a human yet I feel perfectly normal on NDT. Either my ratio was closer to a pig than most humans or our bodies are able to assimilate what we need and remove what we don’t as long as the dose is as close to optimal as possible.
Looks like if things do move forward we’ll be stuck with synthetic combination therapy, so your ratios look like the way to go. They should be part of the NICE guidelines on combination therapy dosing! I’d use them if had to switch from NDT but somehow I suspect NDT is superior to the synthetics…. but I could be wrong and it does have the advantage that nothing looses it’s life in it’s making - as far as I know. They say NDT is only a byproduct of pig slaughter that they’d never be killed just for NDT so it’s not the driver, but I do feel tainted by association. I thank those poor pigs for helping me.
i wonder if anyone trying to make slow release T3 has tried making a synthetic NDT copy ,,, ie, tried to bind T4/T3 to 'whatever its bound to naturally in NDT ' ? (insert correct word when brain finds it )
that would be handy to have as an option .. same ratio T4/T3 as NDT , but no pigs involved therefore less variability and supply chain less at risk from swine flu etc.
and it would allow different ratio T4/T3 to be produced .. anything from 1:4 to 1:10
I understood there’s no known case of anyone getting swine flu from NDT🤞🏽🤞🏽🤞🏽. But on both counts it could be a good option . I wonder if this growing meat in a lab approach might hold the key to producing it without killing pigs
I think you'll find that the "everything else" in desiccated thyroid consists largely of thyroglobulin (the main substance of the colloid) and the thyroid cells which form the colloid-containing follicles.
Thyroglobulin has a molecular weight of around 660,000. A hydrogen atom has a weight of 1; carbon 12; oxygen 16. If it only had carbon atoms, that would be around 55,000 atoms. In other words, large and inherently complex.
We do produce some large molecules in the chemical industries - but many of them are like polythene - just the same tiny element stuck into long chains.
The only viable source of thyroglobulin is, you've guessed, the natural world. It's not impossible that some plant or fungal source might be similar enough to be of use but unlikely. So we are probably back to animals...
An image showing the overall structure of the thyroid and a close-up of a single follicle.
I think diogenes said such a pump would be incredibly difficult to make which was disappointing to hear. Maybe in the future such a thing could be possible with developments in technology. I was walking along today thinking how amazing it was to be taking thyroxine intended for a different species and to feel perfectly normal on it - it’s quite miraculous. Perhaps NDT would help a lot of people who don’t feel fully well on T4 monotherapy. Odd to think going backwards could in fact be going forwards.
a very interesting read , with lots of issues explained clearly including deiodinases , thanks diogenes.
"Resolution of signs and symptoms must be the main goal of hormone treatment; laboratory tests are unreliable. TSH is often low in LT3S and therefore an inaccurate marker of hypothyroidism and low metabolism.16,47
As discussed above, TSH also appears to be unreliable for diagnosing and monitoring hypothyroidism in general: TSH is controlled by T3 level in the pituitary gland, which converts T4 to T3 more efficiently and reliably than other tissues of the body in health and in illness.46,47,54,71,155 T3 can be low in the blood and other tissues while TSH is also low due to efficient T4-to-T3 conversion in the pituitary.
Quoting the recent consensus document from the American, British, and European Thyroid Associations54: “Thus, while increasing the LT4 replacement dose to treat hypothyroidism, normalization of serum TSH levels will occur before full normalization of serum T3 levels.”
This also helps explain why TSH is usually low or suppressed when thyroid-hormone dose is raised sufficiently to resolve signs and symptoms, as reported by prominent doctors over the decades.50,53,156 "
( Hidden .. you'll be pleased to see they didn't forget to discuss cortisol )
is it me .. or would this whole thing have been avoided if more attention had been paid to potential hypothyroidism when her father first suspected it when she was 7 , (and possibly before that ?) ...... they started treating her fro hypothyroidism when her TSH was 7 (she was then age 10) ... poor kid .
oh I will definitely enjoy reading that then! Thanks. I really feel concerned about cortisol understanding, if we think thyroid is hard to get help for adrenals is a whole new ballgame. I am worried that if T3 is finally accepted into first or second line mainstream treatment by GPs the T3 will be blamed when it doesn’t give the desired effects but in many cases this is due to low cortisol… I spent just under 4 years dicking about with T4, T3, T4-T3 combo, NDT etc. but it was all fruitless because I have adrenal insufficiency and essentially had to diagnose and treat myself! (I have fallen, finally, on some random good luck and an NHS endo is now actually treating me properly) I know many don’t have the capacity to do what I’ve had to do in self diagnosing & treating, so I dread to think how many are thinking T3 just isn’t for them… I will dive in! Thanks Tatty x
Thank you, this is of interest also to those who have been diagnosed with ME where thyroid levels aren't optimal, including low T3 (presumably due to the long-term chronic nature of the illness). I should imagine it's implicated in Long Covid too.
One thing that springs to mind - given that the current protocol for treating diabetes is to put people on a short-term low calorie regime of 800 cals a day, how far would this affect T3 levels?
Or is the fact that it is short term (three month, I think) sufficient to prevent problems?
Relatedly, intermittent fasting, where the calorie intake is 800 for two days a week, is also currently advocated more generally (though scientific studies have shown positive results).
It would be useful to know if T3 levels have been tested as part of the trials for the diabetes regime and in the scientific studies for intermittent fasting.
I read this paper with the shock of recognition that I had experienced a self-reinforcing system lockdown which was only rescued by going entirely on T3. It did indeed feel like a switch had been flipped OFF. In my experience, once this trigger has been pulled, the system remains quite vulnerable to flipping the OFF switch again.
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