This is a sticky. DO NOT POST YOUR PERSONAL DETAILS HERE, CREATE YOUR OWN THREAD.
This post has been updated/improved over a few years. The flow and organization is probably not great as a result and probably will remain in this state.
A note about Thyroid “normal” ranges:
Thyroid normal ranges are totally horrible and the foundation for millions of cases of institutionally ignored pathologies.
Case in point; someone has “mid-range” TSH and thinks that things must be OK and so does the doctor. TSH should be near 1.0, mid-range means misery, low energy, low libido, lack of clarity of thought, low body temperatures, feeling cold, sparse outer eye brows, dry skin, mood/depression issues, lethargy and more - but you are “normal”. And if a doctor treated such cases aggressively insurance companies and State medical boards would put a stop to this unnecessary medical treatment. If you get TSH>4.5 and can barely function, then you are “treatable”.
Iodine: You will see a large focus on iodine and iodized salt. Iodized salt was introduced in many countries in 1922 to address a near universal severe problem with whole populations except for some seas side populations. UK is an example of things done badly and for things to improve they would have to admit that they were wrong headed for nearly 100 years.
Selenium: Selenium is required absolutely by enzymes that cleanup the free radicals produced during normal thyroid hormone production. Without selenium free radicals damage cells and the immune system cleans up the damaged/dead thyroid cells and there is inflammation. It is not unusual to have the immune system sim-interpret the wreckage as “foreign” and create immune cells to attack which means that healthy thyroid cells are also attacked and you have a thyroid autoimmune disease. Please do not ignore selenium a trivial side issue.
Treatment: Often when a doctor does treat a case of low thyroid function, otherwise “lab normal” they can be putting a patient on a life time of Rx thyroid meds when the root cause is iodine deficiency and treatable with iodine+selenium. I have only seen one case in this forum where a doctor asked a guy about iodine intake. As a strong rule, doctors will not recognize a case of iodine deficiency.
So now we are about to get started and if you are grasping most of the above you already know more that most doctors and many endocrinologists.
TSH is a pituitary hormone: When I refer to low thyroid hormones, this means T3, T4, fT3, fT4. TSH regulates thyroid activity but is a pituitary hormone, not a thyroid hormone. A distinction that needs to be understood.
Body temperature: Your body regulates your body temperature via fT3 as part of a control loop. fT3 is regulating mitochondria in side your cells which produce pregnenolone and ATP. ATP is the energy source that powers your cells and is the foundation for your energy, metabolic rate and vitality. As body temperature and thyroid function are do intimately linked, we can use body temperature to evaluate overall thyroid function. Faces with a patient having low body temperature, most health care professionals will simply dismiss such concerns because some people just have lower body temperatures and are thus “normal”.
More fT3: Most/many doctors do not test fT3 or use obsolete indirect labs that they probably do no understand. T4 only meds are the general rule that feeds into a simplistic understanding. But that depends on T4–>T3 conversion is the body. However some do not convert T4–>T3 very well. They can be horribly affected, doctor sees good T4 and lowered TSH and that is the cure, they can be resistant to any discussion of fT3, they simply do not want to learn or think about something getting that complicated and dismiss a wide swath of hypo symptoms.
Thyroid system is more complex than TRT. But easy to understand if you take some time. There is only one thyroid hormone receptor, fT3. There is no known T4 receptor. So fT3 is the key to ones metabolic rate and generally mid-range fT3 will provide good body temperatures, libido if T and E2 are good, and energy levels. But another level of complexity is that a form of T3 that is folded/twisted the wrong way, rT3 interferes with fT3 at T3 receptors and even with ideal fT3 levels elevated rT3 can make one hypo. As everything else looks great your doctor will say that there is nothing wrong with you, even if he does [rare] understand what optimal fT3 is VS “normal”. You will find a discussion below how stress, over training or starvation diets can increase rT3.
If you want to know more than basics, see this: http://www.altmedrev.com/publications/13/2/116.pdf
In the above the reasons why selenium is vital are shown.
IMPORTANT: You must have selenium in your diet or vitamins to prevent possible auto immune thyroid damage
NOTE AND UPDATE: I have had a lot of traffic with Bill Roberts re total iodine storage capacity. The 1500mg figure that I have found has it roots in total storage under long term high doses, not in any way a normal storage level in the body and Bill questions the validity of the basis for that as [Bill claims] the urine based work ignored sweat&fecal loss. While the IR protocol that I have been suggesting has been shown to produce effective results, Bill Roberts suggests that 2mg iodine per day may yield similar results. So its up to you. I don’t have the capacity to edit a few years of thyroid related posts. Bill is concerned that IR can cause thyroid problems, activating existing underlying pathologies. While that can happen, it is also known that this can occur in iodine deficient populations with the introduction of iodized sale, which is a very low amount relative to typical IR amounts. So I don’t quite agree with Bill about the risks of larger IR amounts when the same risks exist for very small amounts of iodine. I have found good references stating that high doses of iodine do not present a health risk if there is no preexisting thyroid pathology.
So no clear answers. Bill’s position is clear and has merit.
I am concerned about the “medical” sources that Bill depends on because I am generally skeptical about the medical community been very conservative about any advice. For example, they also trump up fear of salt when salt does not create/cause heart/artery problems.
I also need to point out that my IR recommendations are not extreme - if you do web searches. Bill thinks that none/most of what you will find has any merit.
I may alter this text over time.
We have many guys here with thyroid issues. Somehow I want to think that these are uncommon. But here, we see these problems all of the time. Perhaps the guys who come here via Google or other search engines are as a group more likely to have these issues.
You cannot live without thyroid hormones. Thyroid hormones control metabolic rates and body temperature. The time frame for this is hours. You body temperature drops at night and warms up in the morning. As you will see later, thyroid problems can lead to lower body temperatures. We take advantage of this as a simple diagnostic tool. That method cuts through the complexities or ambiguous results of lab results, other symptoms and the blocking effects of rT3.
If one’s thyroid hormones are low, or body temperature is low, one has hypothyroidism. If the problems are slight, it is called subclinical. Subclinical basically means that your doctor will not do anything. You have to remember that doctors are trained to deal with disease management, not health management. If you want to optimize your state of health, a doctor does not have any interest because you do not have a disease and associated diagnostic code that can be used for insurance billing.
So how does one interpret thyroid lab results? The range for Thyroid Stimulating Hormone [TSH] is 0.5 - 5. The range varies slightly from lab to lab. Fall in that range and many docs will say that you are normal and dismiss your concerns. So for those docs, a 10:1 range in this hormone is OK. In reality, you want to be somewhere close to 1.0. An endocrinologist professional group recommended that the range be changed to 0.5 - 3.0. However, labs have not change the ranges and effectively, hardly any doctors are aware of this change. You need to know that the normal range is from data fitting to a “normal” statistical variation which captures 95% of the sample group. So one normally finds 95% of the sample group falls within that “normal range”. But that range captures a lot of people who are not well and the reason that their thyroid hormones not right.
We talk about optimal levels for hormones. But if you are in range, your doctor will probably tell you that you are normal. Those doctors have confused lab normal ranges with normal health function. This is the big problem. With thyroid hormones, optimal T3/T4 seems to be at the middle of the lab ranges.
TSH is released by the pituitary gland, the master gland. By varying TSH levels, the pituitary is able to control the output from the thyroid gland. The thyroid produces two thyroid hormones, T3 and T4. These hormones are a protein complex that includes 3 or 4 iodine atoms. Iodine is a trace element in nature, but it is so important for survival, that 1.0 to 1.5 grams can be stored in the human body. Evolution selected for that. Most iodine is stored in the thyroid gland. Women store more as iodine is also stored in breast tissue; with implications for increased breast cancer if one is iodine deficient and the obvious implication that breast milk can deliver iodine.
Hormones T3 and T4 are mostly carried in blood [serum is the medical term] bound to proteins and is not readily bio-available. T3 and T4 that are not bound are termed free and referred to as fT3 and fT4.
T4 is really a reservoir and it not so much bioactive. It is T3 that directs the metabolic rate of cells, and specifically fT3. T4 is converted to T3 [T4–>T3] inside the thyroid gland and also in other tissues [referred to as peripheral conversion. As we will see later, some people seem to have less ability for peripheral T4–>T3. If you give a T4 thyroid medication to those people, they will be T3 starved and they are still symptomatic. And surprise, most doctors are also clueless about that.
Your body has a feedback loop that compares T3/T4 in circulation with a “set point”. If the serum levels are below the set point, more TSH is released to promote more action from the thyroid gland. If serum levels are above the set point, less TSH is produced and thyroid output falls. You can make an analogy with your home thermostat. Do you have a set-back furnace/heater thermostat that allows the temperature to drop at night during the heating season? Guess what, the same thing happens to your body temperature. The body temperature set point drops at night and your body cools down when you are sleeping.
Your pituitary gland is not fully in control. The hypothalamus monitors serum thyroid levels and it controls the pituitary gland by signaling with TRH.
You can read more here: http://en.wikipedia.org/wiki/Thyroid
So that is the quick and dirty introduction. Now we need the practical information.
We will focus on hypothyroidism: http://en.wikipedia.org/wiki/Thyroid#Hypothyroidism
Hypothyroidism is a state of low thyroid hormone levels [T3, T4, fT3, fT3 are low and TSH the pituitary hormone is higher] and in this sticky we will extend that broadly to include sub-optimal levels. We need to be more concerned with functional hypothyroidism as you will see later.
So what causes hypothyroidism? Things can go wrong, auto immune disease etc. But often there is not a disease state. We see that low testosterone levels, hypogonadism, often can create a degree of hypothyroidism and visa versa. So we often see guys who come here with hypogonadism issues having thyroid problems. And sometimes hypothyroidism causes hypogonadism.
It is also important to note that most of the symptoms of hypogonadism are also common to hypothyroidism. So you do not want either one, let alone the compound effects of both!
But back to basics - iodine.
Iodine is needed to make thyroid hormones and you would die without it. Low iodine can cause goiter http://en.wikipedia.org/wiki/Goitre. When there is an iodine deficiency, the pituitary gland releases more TSH, to make the thyroid gland more active. High TSH levels have the effect of making the thyroid gland grow larger and that can lead to nodules inside the gland that might become cancerous. These nodules can also start to make T4 and T3 without the control of the TSH hormone. When that starts to happen, the serum hormone levels will rise, but TSH levels are reduced in compensation. If the nodules produce all of the hormones that your body needs, TSH is shut off [TSH–>0] and one is on the edge of hyperthyroidism. If the nodules produce more than that, TSH cannot go negative and serum thyroid hormones can go to high and now one has hypothyroidism, which is a serious problem.
So back to iodine. Many places in the world, perhaps most places, do not have enough iodine in the soil to work its way up through the food change to provide the levels that we need [iodine deficiency ID]. For this reason, iodine has been added to salt and that is iodized salt. That eliminated goiter in most cases. And there also used to be iodine in bread, but that is no longer the case.
The iodized salt method of delivering iodine has two weak points. One is that sea salt has become popular. There is iodine in sea water. During the crystallization of salt from sea water, iodine is lost, not captured in the crystals. Sea salt is the big reason why iodine intake has dropped in many societies. Note that restaurants mostly do not used iodized salt. And prepared foods do not use iodized salt. So even if one has iodized salt at home, if one is not cooking most of their own meals, they have a limited opportunity to get iodine. The fancy “rock salts” that claim to have many trace elements are also very low in iodine and are not a source.
The second problem is that doctors tell people with high blood pressure to stop using salt. Sooner or later those people will suffer from the effects of iodine deficiency. This is a pathology directly caused by ignorant doctors.
I know someone well who used to cook for her grandmother who was told to get off of salt. So she learned to cook without salt and got used to that. Her grandmother was long gone, but she still did not use any salt. She ended up with goiter and nodules and is now border line hyper with TSH=0. She has been hospitalized twice as a result of high thyroid hormone levels, otherwise, she gets along fine is this state. She has nodules producing thyroid hormones without needing TSH. Her thyroid gland was visibly “thick” looking and asymmetrical. And there were lumps. Her doctor should have been picking that up by feeling [palpating] around her larynx. FAIL!
We now ask guys to have TSH, fT3 and fT4 lab work. Often this is not conclusive. But if their body temperatures are low, whatever the labs say, we can conclude that there is a state of functional hypothyroidism.
Testing your body temperature: Get an oral “fever” thermometer. Do not test in your arm pit. Do not test soon after you have been talking, panting, drinking, eating, screwing, training etc. Check your temperature when you wake up, before you get out of bed. 97.3 F or lower is definitely a problem indicator. Ideal would be near 97.7 F and could be higher. We have guys who are below 97! I have added to this a check during the mid afternoon to see if you are getting to 98.6; if you can’t get there, that is a problem indication.
How many times to I need to ask a guy here before he checks his temperatures? Very often three times. Maybe there is a learning disability as a symptom of hypothyroidism.
Some people say that they have always had low body temperatures. I think that many times we are been told that they have low iodine intake!
If your thyroid hormones are suspect and body temperatures are low, one can take iodine supplements [iodine replenishment IR] to treat the presumed ID. If IR normalizes one’s body temperatures, then that is diagnostic. If that does not work, you have more serious problems to consider.
I went trough ID, my wife started to buy the “dirty” rock salt about one year earlier with all of the nice trace minerals. My body temperature was low in the AM and I was close to 98 in the afternoon. IR fixed that. I had started to feel run done, depressed, no energy. That was resolved with iodine. All of my thyroid labs would have been “normal”.
The amount of iodine in iodized salt, is really only enough to tread water. And the 150 mcg RDA in some vitamins is no better. Those amounts are useful if one has a good existing level of iodine. RDA is recommended daily allowance and mcg actually means micro-grams. .
IMPORTANT: You must have selenium in your diet or vitamins to prevent possible auto immune thyroid damage
So lets say one needed to take in 0.75 grams if iodine for IR. How many days would it take to intake 0.75 grams with the RDA of 150mcg. Simple, 0.75 grams /0.00015 grams per day = 5000 days. But over 5000 days you would loose most of that and for all intents and purposes, the RDA will never fix ID.
For IR you can take up to 50 mg iodine per day and get .75 grams in two weeks. I did that and started to feel better in 2-3 days. Some health food stores will have high potency iodine supplements. Many get a product called Iodoral from internet stores which is 12.5 mg iodine. Iodine was a common disinfectant in every home years ago. Rarely seen now. It was applied to cuts etc. But that stung and fell out of favour. So in large doses such as 50mg, it starts to kill of some of the bacteria in your gut. That can cause some disturbances for some, farting and loose stools etc. After a while I had that problem and skipped the iodine for a day then went on with a lower dose. So you can do something similar as needed.
More IR: Element bromine is related to iodine and in the body it can get stored where iodine would otherwise be stored. You can slowly build up bromine in your system and it is not good for you. Bromine is introduce in foods and medicines: http://en.wikipedia.org/wiki/Bromine#Applications When you do IR, it will displace bromine in your body that is then excreted. However, serum levels of bromine can make one feel sick during the phase and people will feel that the iodine is making them sick. Those who have such levels of bromine should not abandon IR but should understand what is happening and why. They can also reduce their IR dose to see if things are more tolerable. Bromine stinks. Someone shedding bromine may smell bad or fishy and may have a metallic taste sensation. If this is happening, there would be some comfort in knowing that they removing toxins. If one feels that the bromine displacement is over, they could increase IR dose if that makes sense.
I have read a few comprehensive medical guides to thyroid lab interpretation for cases where the labs do not make any sense, describing various problems like cancer, medicine interference, various genetic abnormalities, T4 higher and T3 lower, vice versa etc. Not a single word about iodine, iodine deficiency, iodized salt or the fact that the GP may have taken the patient to a salt free diet. So you have these very high end endocrinologists who are thyroid specialized and publish about thyroid problems and lab interpretation who are blind to the central role of iodine. Unforgivable.
The cynical side of me wants to point out that if iodine was patented drug, then drug reps would ‘detail’ this to doctors and they would be aware and alert for iodine deficiencies.
So the complicator: rT3. Reverse T3 is almost the same as T3, except that the molecule is twisted the wrong/reverse way. It fits into T3 receptors and just parks there and does nothing, while not allowing T3 to activate the effected receptors. One could have perfect TSH, T4, T3, fT3, fT3 labs and not have any markers for autoimmune diseased of the thyroid, thyroid would be normal size, symmetric and smooth. But if rT3 is elevated, one can have hypothyroid symptoms. In this case, one can do rT3 lab work, or take your temperature. If temperatures [AM and PM] are low, then you can assume that you have a functional hypothyroid state then test rT3 to see if that is the reason.
So what can cause rT3 levels to be elevated? We do see this with adrenal fatigue, where high stress levels and/or events have exhausted the adrenal glands. The causes can be job stress, relationship stress, job loss, death of a loved one, accidents, injuries, infections acute or chronic, parasites etc. Dealing with adrenal fatigue is difficult and takes time. You can’t fix that with a pill. We do see guys with this problem; some have hypogonadism, hypothyroidism and adrenal fatigue. If you want to know more, Google Wilson’s book on “adrenal fatigue”. It does require a book, not a sticky.
Note that starvation can increase rT3, so I will add starvation diets to that. You can get the same result from over-training, you need recovery days. We see guys here who have totally messed up their hormone systems with starvation diet or diets that are extreme low fat.
But why do we worry about these things in a TRT context? Both hypothyroidism and adrenal fatigue undermine your metabolic capacity. TRT often restores one’s metabolism to a youthful state. However, if your adrenals and thyroid levels cannot support that restored metabolic state, you hit the wall, crash or whatever you want to call it. In these cases, guys go on TRT and do not do as well as they should, or simply feel unwell or worse than before they started TRT. So TRT finds these weak links, and surprise! Doctors do not get understand this. So again, you need to be the expert and find a doctor who is not an idiot.
Symptoms: - there are others…
Low body temperatures
General hair loss [not MPB]
Thinning of outer eyebrows
Doctors: There are few who are great and really understand these issues, I have trained a few ;). Unfortunately, most doctors are a deep disappointment. You guys can understand these issues and all of the details that we discuss about TRT. But the doctors typically are clueless. So you are on your own. You have to manage your own health care and be proactive. It is really very rare that a guy will be in any way like that. Most people are totally ignorant about any level of health care issues, and they want to stay that way [passive]. That may sound surprising, but you have to understand that the process of guys using Google and hitting the page content here selects for guys who are trying to learn and find something better than their current state of health or standard of medical care. So these forums select for guys who are already proactive.
I am an old engineer and not a medical professional in any capacity. These issues simply make sense to me as just another system.
02/21/2013 - deep info on rT3
10/15/2014 See this concerning iodine and related issues:
Update: You should not do thyroid labs soon after your thyroid gland is palpated. That can be from a doc or your own exam. This can increase serum thyroid hormone levels and make the lab results inaccurate. See: http://onlinelibrary.wiley.com/doi/10.1002/lary.20959/abstract;jsessionid=EE1951A93270B63ACC0467A06304BB70.d04t02
Parallel to the above, you should not do lab work that includes PSA soon after a DRE prostate exam.
EDIT 01-10-2016: ------------
My body temps were down again and iodine supplementation did not work and 1.0-1.5 grains of T4+T3 did not work. T3 alone seems to be helping. rT3 suspected. Found this great article that gets quite deep, but practical. It discusses some of the odd things that make some thyroid work difficult. Introduces hypometabolism:
Wrote this is a post, also dropping it here:
With low thyroid function, mitochondria are slow, body temps fall, energy levels are down, every system in the body is affected, brain and libido for sure. Mitochondria burn less sugars and lipids/cholesterol from blood stream, insulin resistance and weight gain are expected and cholesterol increases. Our bodies are not perfect, we need to make sure that we avoid things that allow decline. Vit-D3 converts to Vit-D25 an essential steroid type hormone that has many effects as it is needed for proper gene expression. While fT3 directs mitochondria, CoQ10 enables and it made in the liver, some who take statin drugs to reduce cholesterol can have a resulting CoQ10 deficiency. Mitochondria make oxygen free radicals as a bi product of making thyroid hormones. The enzymes that clean the free radicals up have selenium as catalytic reaction sites in their structure. A lack of selenium leads to tissue damage and the immune system cleans up the wreckage but can mis-imprint the mess as foreign and then you have an auto-immune disease. High TSH+time+selenium_deficiency is a bad combo. Low iodine leads to high TSH. High TSH can lead to thyroid nodules that make thyroid hormones freely, not controlled by TSH feedback loop. So over time low iodine presents as hypothyroid but can progress to hyperthyroid. Very few doctors understand this progression and triggers.
When hypo from low/inadequate iodine, when introducing more iodine, this appears to be a period of high vulnerability if selenium deficient.
The medical community has forgotten the lessons of iodized salt from 95 years ago. The thyroid lab ranges mean that they do nothing until the pathology is really horrible. The thyroid lab ranges represent the base level of thyroid pathology in the community that was used to establish the ‘normal’ ranges and that process automatically determines that only 5% of the population can be considered unhealthy. If 100% of the population had cancer, that method would consider that cancer was normal.