Low T3 on keto

[MartinaM]

Dear community,I started keto about 3 month ago and have test my thyroid and my T3 is crazy low (I am on medications- 50 mg tirosint). Do you have experiences if this will go back or is better to go back on carbs?

Thank you 🙂

[SlowDragon Administrator]

keto often results in very low Ft3

You presumably mean 50mcg levothyroxine

But presumably on just 50mcg your Ft4 is likely low too

50mcg is only the standard STARTER dose levothyroxine

Bloods should be retested 6-8 weeks after each dose change in levothyroxine

Essential to also test vitamin D, folate, B12 and ferritin levels

What vitamin supplements are you taking

[MartinaM in reply to SlowDragon]

Thank you fot your answer, for my endo everything seems fine and I am new in all stuff a diets regarding thyroid, so if you can give me advice, it will be good . My t4 is 16,3 (range of lab is 12-22) and t3 is 2,9 (range of lab is 3-5,7) and TSH is 0,6 (range is 0,4 to 6,0) I started low carb/keto because I was wondering it could help me with antibodies, but it did opposite. In 3/2023 mi Tpo were 63 and now 153 (range is below 34). I didn exclude dairy, so probably this can cause problem. I am taking reishi,crodyceps,ashwaganda and selenium.If you can tell me your opinion it would be helpful

[SlowDragon Administrator in reply to MartinaM]

FT4: 16.3 pmol/l (Range 12 - 22)

Ft4 only 43.00% through range

t3 is 2,9 (range of lab is 3-5,7)

Was test done early morning, fasting and last dose levothyroxine 24 hours before test

Get increase in levothyroxine to 75mcg daily and retest in 8 weeks

Meanwhile get vitamin levels tested and improve to optimal levels

Approximately how much do you weigh in kilo

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Lalatoot]

You need carbs and calories to convert t4 to t3. If you don't consume enough this can compromise conversion resulting in low t3virtahealth.com/blog/does-y...

Discusses diet and thyroid.

[radd]

MartinaM

The issues of keto & thyroid problems come up quite frequently. I have just answered another post here …. healthunlocked.com/thyroidu...

[SilverAvocado in reply to radd]

This is a very useful reply that contains info I don't think has been mentioned elsewhere in these comments.

My observations from reading the forums and seeing low carb and ketosis discussed often is that some hypo people seem to do very well on it, and others do very badly. Personally when I tried a low carb diet several years ago (while very hypo) I had a terrible crash in energy that was quite scary. It seems to be a not uncommon reaction. I suspect there is a bit of a medical difference between the two groups.

My experience overall is that I feel like I am very dependent on food I have recently eaten. I feel like my body is not good at taking food energy out of long or medium term storage (burning fat, etc). This is a recognised hypo symptom, as the body has several mechanisms of accessing stored food energy, and being hypo disrupts some or all of them. I suspect this is linked to how a person will manage on keto, as being in ketosis requires your body to have flexibility in what kind of fuel it burns for energy.

This is a little like converting T4 into T3. It's a complex mechanism in the body that healthy people can do without problems. But once we are hypo a lot of our body doesn't work properly and can't unproblematically do all these conversions. A healthy body should be able to burn ketones, stored fat, glycogen, food you've just eaten, or whatever it is given to make energy, and this is what you will see described in most writing about keto diets. But hypo people may not have bodies competent in all these mechanisms, so some step in the chain may break down.

[Manjushri]

I find the article that Lalatoot shared very interesting and actually seems to disprove that the keto diet is bad.

Can we have some feedback about how others on very low carb diet are feeling .We need to be scientific about this as if it means we can use the available T3 better on a very low carb diet we should feel a whole lot better ,the blood numbers are guidelines only -it’s how we feel that matters!

[MartinaM in reply to Manjushri]

Manjushri, you right, but to be honest I feel good on both sides. I am trying to find oit what helps me to lower antibodies.

[Regenallotment Ambassador in reply to Manjushri]

Low carb but not keto suits me, keto (I’ve done it a few times pre diagnosis) usually results in mental health issues for me, anxiety, paranoia, etc. my behaviour can get a bit snappy/manic too. Although physically I feel great with good energy.

What works for me is to eat root veggies and potatoes (but not every meal) GF oatcakes occasionally. I am a regular daily salty crisp/potato chip muncher. This keeps me out of keto while dodging all the carbs I don’t actually like, so ii suits me as I prefer no pasta, no pizza, no flour in sauces, no bread (not even GF) I made a loaf from ground linseeds and eat that occasionally. Brown rice less than once a week. No cakes, pancakes, waffles etc. On the plus side I eat pears, occasionally bananas, berries, lots of lentils, carrots, beetroot etc.

I try to limit adding sugar/syrups but fail regularly on that as I enjoy cooking 🤣

My antibodies have just been raised TPO 400+ (usually 250) so I don’t think diet alone helps bring them down, i have had symptoms of over medication or Hashi flares which are coming down now, so this could cause antibodies to clean up. I feel as though I am coming out of that now and testing Monday find out more. 🌱

[arTistapple]

I definitely can’t benefit from keto. I end up in such a state I go crazy for carbs and end up both mentally and physically ill, therefore my experience is not positive. However if it works for you that’s great. As long as I keep some good quality carbs I am ok. I see you are trying to lower antibodies. This I do see often expressed on the forum and from the many writers on the subject but I find that aim spurious, in that antibodies are in the blood after the body has already cleared out its inflammatory issues. Antibodies are natural and correct in their work. What you are trying to do presumably, is reduce your inflammation, not clear out antibodies. The two are related but it’s not the antibodies doing the damage, it’s the inflammation

[radd in reply to arTistapple]

arTistapple,

We have useful antibodies (to heal cuts, stings, infection, .etc) which disappear after doing their job, and we have auto-antibodies created after a destructive attack on own self that mops up debris caused by dieing cells, etc.

If Hashi swings go on for years (as in most cases) and autoantibodies remain high, this autoimmune inflammation become chronic with all the negative accompanying factors. This includes preventing our thyroid hormone meds form working effectively.

[Noelnoel]

To no one in particular

Doesn’t keto just mean no rubbish carbs

I think people forget that lots of fruit and veg can be included (or am I mistaken) and that these are indeed carbs but good carbs that we actually need and that help keep nutrients up and bowels moving

Bread, cakes, pasta bring nothing worth having to the party, lovely as they are, except maybe a transient sense of well-being that I enjoy every time I fall off the gluten-free waggon. I’m happy to avoid pasta and cakes but we have a fantastic artisan baker and his bread is heaven on earth. Toasted with a good layer of butter and marmalade, a sprinkling of sea salt, accompanied by a steaming hot, frothy black coffee are my idea of a Saturday morning treat that I frequently fall off the waggon for

[Regenallotment Ambassador in reply to Noelnoel]

Hardcore keto followers limit the fruit and vegetables too. They aim for ketosis and pee on sticks to measure ketones in their pee or have a breath meter, I’ve binned that particular T Shirt. The idea being that your body burns fat rather than the carbs in your diet, it works for some but I’d argue long term they’d all benefit from a bag of chips. It was my CBT psychotherapist who convinced me to stop it on a trial and within a week of just something small and carby once a day I was much improved.

[Noelnoel in reply to Regenallotment]

Your comment on benefitting from a bag of chips is hilarious. Well said and I couldn’t agree more. After all, a potato is a vegetable and I love them cooked in any way you can think of but a chip or a roasted one is hard to beat and my life would be less of a joy without them

[Regenallotment Ambassador in reply to Noelnoel]

glad you approve 🤣

[Polo22 in reply to Regenallotment]

I have tried a few, well to be honest every diet , good bad and bloody awful over the years. My go to comfort food is nice homemade bread, hubby does a parmesan and sun dried tomato one, nom nom nom, with a good dollop of proper butter, heaven. I find it difficult to cut carbs completely I end up a very hangry not pleasant person. I do like a nice bit of cheese and occasional glass of cabernet or merlot but I can have a quite restricted diet often. When you go to GP and they blame everything on your weight , tell you not to eat take aways, don't fry food , don't eat processed foods , none of which I eat and when you tell them this they roll their eyes like your lying. But try to tell them if you treated my thyroid properly or and or my deficiencies properly we wouldn't need to be having this discussion they don't want to know. The "bag of chips" comment is brilliant, in Liverpool the equivalent would be " could do with a good pan of scouse in yea " 😂

[Regenallotment Ambassador in reply to Polo22]

Good for you, sounds like you know what you are doing! Ah yes love the scouse, same sentiment for sure ❤️🙏

[Lovecake in reply to Regenallotment]

My goodness. Peeing on a stick and checking it!

What on earth is in our food/atmosphere for these people to be needing to do this?

The thought of not having food is freaking me out and my head is saying “migraine!”

[Cavapoochonowner]

Hello there,I had a total thyroidectomy due to graves last June.Everything seemed hunky dory on levo until January this year.A visit to my GP regarding something else resulted in blood tests showing TSH over 10 and T3 under range.My T4 was nearly top of range.I have since been referred back to endo and am trying to get my dose right.I had cut out alot of carbs because I was having alot of symptoms such as very restless sleep and urinating alot during the night.I thought it was due to high blood sugar though I have been tested by GP and it's normal.I usually have to have supper(only cereal) as I get very hungry during the night otherwise.I cut that out and was trying to stick to no eating between meals.I did feel hungry even though I was eating normal meals.I am now wondering if I messed up my conversion by being too strict with sweets and carbs.I am still under range on T3 though on my last bloods I was very over on T4 and have had to reduce my dose.At the moment I still feel very over medicated but due a blood test this month so will have to stick it out.I am just eating what I want when I want now and hoping it will resolve itself.I can't really face all the complications of trying to get T3 prescribed.This is just my experience but I'm hoping it can be resolved by an adjustment in my diet. Best wishes to you.

[arTistapple in reply to Cavapoochonowner]

My sympathies. I too thought diabetes but turned out, eventually for me, one of the causes is my blood pressure medicine but the real game changer was treatment for sleep apnea that I would have argued for a year that I could not possibly have as I did not snore. Poor muscle control in oesophagus etc due to hypothyroidism closing off my breathing.

[Cavapoochonowner in reply to arTistapple]

Yes they tested my bloods and urine for sugar but negative.I sleep really deeply with very vivid dreams but also wake up alot if I eat too late.My cholesterol has also increased but I know that will be due to my low T3 at the moment.I saw that on my private bloods that I also have done at the same time as my NHS ones.Hoping it sorts otself out.My T4 is at very top of range so can't really increase levo any more.Hoping conversion improves,fingers crossed.

[Lovecake in reply to Cavapoochonowner]

It’s a shame you can’t try a small amount of T3 added to your T4 (maybe reduced a bit). I never felt right on T4 only. Bloods said I should have felt ok (ish), but they lied 🤨

[Cavapoochonowner in reply to Lovecake]

I was going to ask my endo about an NHS T3 trial but as usual he contacted me by letter so I didn't have the chance.My T4 was up at 33 but my T3 was under range.All he has said is to reduce levo from 125mcg every day to 100mcg Mon-Thurs and 125mcg Fri-Sun.I still feel over medicated.Don't really want my T4 that high just to scrape bottom of range T3.Due bloods end of September on NHS but will do my own too.It's all a frustrating mess isn't it.Think I'll end up looking at options for T3.Best wishes to you.

[Lovecake in reply to Cavapoochonowner]

I went private for my T3. Couldn’t be bothered with the rigmarole of begging on the nhs. Or having it withdrawn if they did say yes.

I think your levels are worse than mine though, so I think you stand more chance of getting it on nhs.

[Cavapoochonowner in reply to Lovecake]

I did read a post on here where someone rang Rosedale pharmacy I think and spoke to a pharmasist and sent their private blood results and they sold them T3.Will have to double check.I did ask on here if anyone had had experience with a private endo near me but no-one replied.I don't want to waste the money seeing a rubbish one.To be honest I think there's more chance of pigs flying than my NHS endo agreeing to a trial or even knowing what one is.Nice man but out of his depth with Graves I think.Will wait for bloods then will have to regroup.I can afford a bit of money per month but it will stretch me .Don't want to commit to something if I can't afford it long term,that's why I thought I'd try NHS route first.Also if I end up going private I'll be able to tell my GP I was forced to do it because NHS wouldn't prescribe. Keep on carrying on.

[Lovecake in reply to Cavapoochonowner]

My T3 is via Roseway, but through the endo. My GP is ok with me seeing the private endo (saves them money), but he asks for bloods through my surgery and recently, a DEXA bone scan. I usually have reviews by zoom. At least I get looked at which is more than most people get with their GP.

If he starts to play up, I’ll consider going to Roseway direct.

[Cavapoochonowner in reply to Lovecake]

That's good to know.Thankyou for that.I'll weigh up my options when I next get my bloods at the end of the month.So glad I'm on this forum,hate to think what situation I'd be in without it.

[Regenallotment Ambassador]

oh and if you dig around in Dr Sarah Myhill’s website you can find info on her recommendation for paleo ketogenic diet which isn’t all day everyday keto, but more in and out of it, I’m not suggesting this is the way forward, just sharing the resource for you to find out more 🌱

[Molly161018]

I have done keto in the past, but mainly live just low carb now. Definitely did feel good on keto, energy levels were a lot better. Don't remember it having any effect on my antibodies or other related thyroid levels...

[Miffie]

I eat a low carb diet and find I am generally better than when having carbs. I don’t eat much fruit other than berries, loads of green veg, bread/ rice/ pasta/ noodles are for high days and holidays only. I am also T2 so have to be careful, even on 50g carbs a day I can have high blood glucose. Sixty odd years of hypothyroidism and many of those under medicated I have over the decades tried more diets than I care to remember. My experience has always been that I am unaffected by low carb but on low calories my bloods are usually rubbish.

[Lovecake]

Less stress in my life seemed to lower my antibodies.

They were over 1300 when first tested. I’d been struggling for years with the docs ignoring symptoms and TSH results. They have come down as low as 300. But I’ve given up looking at them and just sort me out as a person and my symptoms now.