T Nation

Thyroid Worse on TRT. Going to Self Prescribe T3


#1

So my thyroid is dicky, doc keeps saying he may treat it but is reluctant to give life long thyroid treatment when i have no direct symptoms bar low metabolism and slight tiredness.

ENDOCRINOLOGY
Thyroid Function
THYROID STIMULATING HORMONE 5.74 mIU/L 0.27 - 4.2
FREE THYROXINE * 10.7 pmol/l 12.0 - 22.0
TOTAL THYROXINE(T4) * 30 nmol/L 59 - 154
FREE T3 * 1.9 pmol/L 3.1 - 6.8
Thyroid Antibodies
Thyroglobulin Antibody 14.5 IU/mL 0-115(Negative)
Method used for Anti-Tg: Roche Modular
Thyroid Peroxidase Antibodies 7.5 IU/mL 0 - 34
Method used for Anti-TPO: Roche Modular

As you can see, its all pretty dim and in my opinion is a pain in the ass as i can only eat 23-500 calories before gaining weight and it makes me overtrain (2 hours most days) to keep the weight off...

Would a sensible dose of T3 (25mg) be okay to try? Iv read rebound is minimal and your back to normal within a few days...

thanks


#2

Same thing happened to me. I’ve been fighting with my doctor for almost three years now since I started TRT that my thyroid levels dropped, feel shitty, etc., but says “normal.”

T3 is easier to get, no one wants to take T4 (I looked and had a hard time finding it, only to buy it from a site who emailed saying they were out), the problem is you need BOTH.

In what I’ve found and researched, “Armour Thyroid” is the best as it’s a combination of T4 and T3.

Self prescribing T3 may backfire, I’d try alternative routes first, even if it means going to another doctor. Tell them your symptoms, that you are having trouble concentrating, unmotivated, tired, etc., and that you want to try thyroid therapy – make sure to tell them you are on TRT and feel that it has effected your T3/T4 levels. May take some time, but long term use on T3 may not be what your body needs and could be worse in the long run.


#3

Your TSH is very poor (far too high, indicating inefficient thyroid function: the pituitary is having to produce large amounts of thyroid stimulating hormone to try to regulate thyroid hormone levels) and the free T3 also very poor.

The doctor has no good reason to be sitting on his hands.

I would find another doctor.

As a long time member and poster, you already know about iodized salt so no need to mention again. I hope you have not used iodine overdosing; if you were considering it please don’t as there is plenty of evidence of thyroid harm from iodine overdose, and dietary-level restoration such as at 1-2 mg/day works fine. (Two mg/day shouldn’t be sustained indefinitely, but a few weeks is fine.) However, as you’ve posted on this before most likely the iodine issue is taken care of. I mention it only for completeness.

25 mg/day T3 as a self-administered protocol would be better than nothing and will not be unsafe, but as Tommy79 mentions, tailored combination therapy would be better.

A different doctor should have no reluctance prescribing with those values.


#4

Thyroid harm from iodized salt introduction to populations was determined to be uncovering existing thyroid condition. Normal thyroid activity can be toxic if one is selenium deficient.

Is your thyroid enlarged, lumpy, sore or asymmetrical?

Tell doc that if he does not prescribe, that you will find another doctor who will.

Body temperatures?

Iodized salt history?


#5

Determined by whom?

As to what I say, here’s who determined it, and how they determined it:

Consequences of excess iodine. Nat Rev Endocrinol. 2014 Mar; 10(3): 136-142.

More than adequate iodine intake may increase subclinical hypothyroidism and autoimmune thyroiditis. European Journal of Endocrinology (2011) 164 943-950

Iodine intake as a determinant of thyroid disorders in populations. Best Pract Res Clin Encocrinol Metab. 2010 Feb;24(1):13-27

Iodine toxicity from soy milk and seaweed ingestion is associated with serious thyroid dysfunction. Med J Aust. 2010 Oct 4;193(7):413-5.

Iodine Excess as an Environmental Risk Factor for Autoimmune Thyroid Disease. Int J Mol Sci. 2014 Jul; 15(7): 12895-12912.

Element Analysis of Biological Samples: Principles and Practices, Volume II. CRC Press. 1997

Iodine-deficiency disorders. Lancet. 2008 Oct 4;372(9645):1251-1262

Scientific Opinion on Dietary Reference Values for iodine. EFSA Journal 2014;12(5):36-60

Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. National Academy of Sciences. 2000: 265-289

Tolerable Upper Intake Levels for Vitamins and Minerals. EFSA Scientific Committee on Food. 2006: 142-147

By the way, the Weston A Price website is not a primary source.

On a related matter, claims that the human body contains or should contain hundreds of milligrams of iodine have absolutely zero basis in the scientific literature and are refuted multiple times. As I’ve told you before, the measured total iodine content of the human body averages not more than roughly 20 mg. Grand total, the entire body. It does not take hundreds of milligrams of dosing to replenish, and extreme dosing can harm the thyroid.

The things I’ve said are thoroughly backed up, and by that I don’t mean from a health website. I’m sure you find your sources credible enough to you, but they are not at the same level of showing anything. There comes a time to update one’s information. Plenty of update is available above.


#6

I still have seen articles that support my statements. Many supporting your point of view may be citing old conclusions.


This supports the idea that total store are small. But contradicts iodine as a cause of the pathologies that you are worried about. Correcting iodine deficiencies can expose underlying conditions, some of which are caused by iodine deficiencies and some by selenium deficiencies. I do advice that IR should have identified selenium intake.

“”“
Traditional food of Japanese contains significant amounts of dietary iodine, possibly consuming at least 7000 mcg of iodine daily from kombu alone (23). It has been estimated that the Japanese consumption of dietary iodine exceeds the upper safety limit of 1 mg by approximately 5-14 times 5). These higher levels appear to have no suppressive effect on the thyroid function in normal individuals, yet intake of excess of iodine could cause problems in patients with thyroid nodules, hyperthyroidism and autoimmune thyroid disease (5). On the contrary it has been interestingly observed that Japanese women who consume a high iodine content diet have a low incidence of benign and malignant breast disease; however, this protective advantage is lost in the same ethnic group once they immigrate to other countries (24?26). Japan also has a low incidence of autoimmune thyroiditis (27). Stadel has postulated that given the geographical distribution of iodine deficiency, there is low incidence of cancers of the prostate, endometrium, ovary and breast in populations consuming diets with high iodine content (28).
”""

So why are iodine doses for use in nuclear accidents so huge at 100mg during the period of threat when total iodine stores are so low? For children, doses are smaller, but repeated every day of risk. Adults are less prone to developing cancers do repeated doses are not deemed necessary from an epidemiological perspective but who wants to fall outside of that bell curve. Also see http://en.wikipedia.org/wiki/Potassium_iodide#Thyroid_protection_due_to_nuclear_accidents_and_emergencies

50mg cited here: https://books.google.com/books?id=Q2MrAAAAYAAJ&pg=PA16&lpg=PA16&dq=total+iodine+stored+in+humans#v=onepage&q=total%20iodine%20stored%20in%20humans&f=false

http://www.fao.org/docrep/004/y2809e/y2809e0i.htm
Excess iodine intake

Excess iodine intake is more difficult to define. Many people regularly ingest huge amounts of iodine - in the range 10-200 mg/day - without apparent adverse effects. Common sources are medicines (e.g., amiodarone contains 75 mg iodine per 200-mg capsule), foods (particularly dairy products), kelp (eaten in large amounts in Japan), and iodine-containing dyes (for radiologic procedures). Excess consumption of salt has never been documented to be responsible for excess iodine intake. Occasionally each of these may have significant thyroid effects, but generally they are tolerated without difficulty. Braverman et al. (35) showed that people without evidence of underlying thyroid disease almost always remain euthyroid in the face of large amounts of excess iodine and escape the acute inhibitory effects of excess intra-thyroidal iodide on the organification (i.e., attachment of ´oxidized iodine’ species to throsyl residues in the thyroid gland for the synthesis of thyroid hormones) of iodide and on subsequent hormone synthesis (escape from or adaptation to the acute Wolff-Chaikoff effect). This adaptation most likely involves a decrease in thyroid iodide trapping, perhaps corresponding to a decrease in the thyroid sodium-iodide transporter recently cloned (36). Some people, especially those with long-standing nodular goitre who live in iodine-deficient regions and are generally ages 40 years or older, may develop iodine-induced hyperthyroidism after ingestion of excess iodine in a short period of time.


cites 1500mg

http://www.westonaprice.org/modern-diseases/the-great-iodine-debate/
This is a huge read!

“Many require 50 mg per day for several months before they will excrete 90 percent of it. His studies indicate that, given a sufficient amount, the body will retain much more iodine than originally thought, 1,500 mg, with only 3 percent of that amount held in the thyroid gland.”

So it seems that one can load 1500mg into the body. 1500mg is a peak saturation and is not a normal amount if iodine.
50mg for two weeks would seem to be a fraction of that.


#7

I’m going to leave it at this:

You cite Weston A Price, Mercola, and Wikipedia. Really.

You also cite some other sources that don’t in any way disprove a single thing I said. There is an entirely different reason for high dosages used with exposure to radioactivity, as a first example. It in no way refutes anything I said. In a second example, your FAO document is sloppy with units, confusing mg with mcg at least once and it looks like more: for example, it gives American iodine intake as 500 “mg” per day which, as mg, is not correct. Far more seriously than that, however, is your selective citation of the document that you present to counter what I’ve posted.

In this document that you cite, you selectively omit that it gives 30 mcg/kg/day as the probable safe upper limit for adults. For an 80 kg man that would be 2.4 mg. Way below 50 mg!

So, since you cited that one as authoritative, do you now acknowledge that as a reasonable value for probable safe upper limit? Or do you pick and choose: you don’t like that part so you throw it out, but the parts you select to support you, you keep? (I don’t know, it’s an honest question. Perhaps you’ll spot that your document gives that as a probable safe upper limit and accordingly revise your recommendations.) I don’t think too much of selective citation.

You assert, without having checked, that what I’m saying might be out of date. If you had checked you’d know differently.

I’m citing primary research, which I have the education and experience to understand, and citing world-recognized panels of scientists publishing under peer review, as well as individual such articles. I’m not citing Weston A Price, Mercola, and Wikipedia.

I’ve read what you’ve read, plus what I’ve read.

It appears you’ve read only the types of sources you’ve given and obviously have not read what I’ve provided for you. Instead you assume, wrongly, it “might” be out of date.

You are absolutely in an alternate reality with any claim of the body holding anything like 1500 mg of iodine. The human body has been chemically analyzed. Repeatedly. What you say is categorically false and proven so repeatedly in the scientific literature. You cite the Weston A Price website as attempted support. (Gee, why don’t I cite Livestrong and then we can have a really super quality discussion.) That’s fantasy to think that their extrapolation, which is what that one is, outranks actual measurement.

It’s simple fact: the amounts you recommend are shown dangerous with continued intake, are based on completely false theory of amount that should be in the body that you get from an alternative-health website, and which amounts have never been shown by comparison to give better effect for replenishment than more normal intake.

I have given absolutely thorough substantiation already and have no desire to keep repeating myself with it and won’t. If you want to know, go read what I cited in the primary literature, not Weston A Price, Mercola, and Wikipedia. Standards should be higher than that. If you had read and understood the references from the previous post, even the first few, I would not have needed to post the above.

Your choice as to whether to accept evidence-founded knowledge on this matter or to continue believing and propagating myth, and worse, myth that a ton of evidence says can harm.


#8

I don’t know all of the answers. I did find a source that indicated that the 1500mg number is the saturation point for long term high iodine intake and is not by any means a normal occurrence. So the 750mg/2 week rational no longer has the basis that I thought. Also note that absorption rates via the gut are limited [unknown] and that a large amount of any dose is excreted in urine, increasing over time with continued dosing.

So what to you recommend for IR. We have many guys who are iodine deficient with low body temperatures and lethargy etc. Many are recovering body temperatures and vitality with IR; proving that IR has merit. We have had couple of cases of obvious bromine purging on higher IR dosing and I suspect that low dose IR might not flush bromines out of the body. So that remains a concern as well.

If you reject IR out of hand, you are dismissing the demonstrated benefits that have been enthusiastically reported here.

I see that you are upset that high dose IR [insert selenium details] can lead to thyroid problems. I point out that these events seem to be the outcome of the thyroid with hidden pathologies even when only iodized salt is introduced; which implies that perhaps you should be discouraging use of iodized salt in a situation where one has been deficient. [Iodine deficiency leads to some thyroid pathologies beyond TSH driven enlargement].

I did not make up these suggested IR doses, but adopted after reading on several sources [that you would reject out of hand].

You seem to be willing to take a lot of time exploring this issue with me. Please suggest something else for the symptomatic iodine deficient.


#9

In the sources I provided, absorption information is there. As well as the information on risk.

Absorption is very good. It’s not an issue.

I have posted here many times what people can do for replenishment. 2 mg/day via iodized salt, or if a person desires kelp, works within a couple of weeks. Even 1 mg/day works in a few weeks. Many have done this. I have been helping people with their hormones for 17 years now. This area is not new to me.

Continued improvement in thyroid function can occur after the replenishment: as with most disorders, full health on fixing the direct cause often doesn’t restore instantly but has some gradualness to it.

As mentioned, there’s no comparison study showing higher dose to work better than that, nor any reasonable reason why it should. The body only holds so much, and it’s not very much.

It’s not a question of being upset. It’s a question of facts as established by repeated studies. It’s not factual that there are huge stores needing to be replaced (if true, then of course huge total amounts would be needed) and it’s not factual that such doses have no risk of harm.

I appreciate that you absolutely did have reasonable reason to think such large stores existed, based on the information you had.

Just as an aside, that general type of study (elemental balance) is typically problematic. That’s because it’s difficult to account for all losses of material. Nitrogen balance, often of interest in bodybuilding, is an example of one that is notorious for deceptive conclusions. This is because elements are lost not only in urine, but also feces, sweat, and lost skin. In the study ( http://www.optimox.com/pics/Iodine/pdfs/IOD05.pdf ) you mention, Abraham measured only urine. It’s almost astounding, because it’s well established that sweat is a significant route for excretion of iodine. Further, if less than 100% was absorbed in the first place, then less than 100% can be found in the urine. So amount found in urine didn’t equal dosage? That didn’t prove that the body needed still more iodine, not at all. It just proved he wasn’t looking at the other places it logically could be (feces and sweat in particular.)

It’s for reasons like this that that sort of study makes it to alternative health websites but not to any peer-reviewed journal.

It’s true, I’m not going to replace the findings in the references I cited with the teachings of the Weston A Price or Mercola sites, etc, and should not. These are other people’s versions, opinions of, and selected accounts from other sources. And without (in my opinion) proper care to examine those sources, such as their having overlooked that completely-invalidating flaw in the Abraham study. The original sources themselves are where to go.

If the references I provided are difficult to find for any reason, I’d be glad to provide links, though usually Googling the title should do it. Most are free full text. There are only a couple that I had to read at a library and couldn’t presently give copies for, but nothing is depending on that.


#10

Bill, I added the following to the thyroid basics sticky and this is what I have in a few minutes … for now:


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.



#11

Thank you KSman, that’s top notch of you.

It could be worth considering however that when the body of evidence is enormous, most of the researchers involved are not MD’s (if one has a bias there), the researchers are from around the world, and the results are all consistent, then turning away on a prejudice just could be leaving valuable knowledge on the table for no real reason.

I do disagree that recommending intake of 50 mg/day for cumulative doses in the hundreds of milligrams, and some follow this advice indefinitely into the thousands of milligrams, isn’t “extreme” when the human body only holds 20 mg and there is powerful evidence of increased risk of induced hypothyroidism from chronic dosing starting at doses far below that.

I do call 25 times higher than what’s effective to get the job done in 2 weeks, 25 times higher than what your own cited source gave as the probable safe upper limit, and double the body’s entire store every day for weeks on end “extreme.”

If someone’s gas tank can hold 20 gallons and he drives only 10 miles a day but pumps 50 gallons of gas every day, that’s extreme. There ought to be a reason to do such a thing versus just filling the tank and being happy with that, or if not don’t do it. At least there it has no potential to harm anything except the environment by a touch.

Why overkill? Why assume more is better when having not a single comparison to show it.

And as a final minor point, by no means do I advise people that most or all of what they might find with web searches is worthless. Trying a search on iodine supplementation now, not counting ads I find the great majority of search results to be in accord with what I’m saying. You did cite Mercola above, and I see Mercola as hit #2.

I’ll end with some of his article, as you’ve cited him:

[quote]There are potentially serious risks to taking too much iodine, however, which is why I generally do not advise taking iodine supplements like Lugol’s or Ioderol. Your thyroid only transports iodine in its ionized form (i.e. iodide).

Your thyroid reduces iodide (I-) into iodine (I2) for use in formation of thyroglobulin. Your body doesn’t utilize iodine directly. It has to split the I2 into two I- ions, which is an oxidative reaction that causes oxidative stress.

Further, taking too much iodine may also lead to subclinical hypothyroidism, which occurs when your thyroid produces too little thyroid hormone. It’s an ironic association, since hypothyroidism is often linked to iodine deficiency.

But research published in the American Journal of Clinical Nutrition revealed that study participants taking relatively higher doses of supplemental iodine at 400 micrograms a day and more paradoxically began developing subclinical hypothyroidism. [note: supplemental being on top of existing intake, rather than 400 mcg total.]

I would recommend taking a large dose iodine supplement in the event of some type of nuclear fallout. In this case, if you’re iodine deficient, taking a potassium iodide (a stable form of iodine) supplement can protect your thyroid by “flooding” your system with iodine so your thyroid has no need to take in the radioactive form.[/quote]

By no means am I saying regarding Web searches for iodine supplementation that “none/most of what you will find has any merit.” Rather I’m saying that not all of it is right, and in particular, not the fraction of websites advocating extreme dosing.


#12

Great stuff guys !


#13

Two giants of information, for me at least, going at it. I see points on both sides. Bill Roberts, research scientist, comfortable with statistical analysis and peer-reviewed journal articles- “show me the science”. KSman, engineer, science-based but also not afraid to apply empirical knowledge, extrapolate, and make judgment calls- “you can’t argue with results”.

Both far superior to the stuck-in-the mud doctors most of us have been dealing with, that’s for sure.

Carry on, gentlemen!


#14

This is great. Thank you both.


#15

You’re very welcome! And as it looks like the thread is of some interest, here’s some further information:

Of course, virtually no food provides iodine in such high quantity as to make possible double-digit milligram intakes per day. The vast majority of people around the world don’t get amounts like this. However, some Japanese eat large amounts of seaweed, and sometimes, seaweed that contains very large amounts of iodine (most types are not so high.)

Now to the point: websites advocating such iodine dosing, or even higher, often claim that the Japanese typically consume double-digit milligram amounts of iodine daily, to their benefit.

First, is it true they typically consume so much?

As mentioned in earlier posts, sometimes some web sources are more than a little shoddy on their representation of facts.

From Assessment of Japanese iodine intake based on seaweed consumption in Japan: A literature-based analysis (Thyroid Research 2011, 4:14 , http://www.thyroidresearchjournal.com/content/4/1/14 ) looks like it is not true as a generalization of Japanese intake:

(in the full text they discuss how they determined this.)

Second, is it true that where Japanese do have really high iodine intake, that this is not associated with resulting hypothyroidism from overdosing?

That does not appear true either:

Excerpts, with emphasis added, from In J Clin Endocrinol Metab 1994 Feb;78(2):393-7:

So: among the Japanese, those with higher intake have greater incidence of hypothyroidism.

And, from Thyroid 2009 Sep;19(9):937-44, it was found that nearly 10% of Japanese had thyroid dysfunction, of which hypothyroidism was much more common than hyperthyroidism.

More is not always better.


#16

If we can get some guys who have low body temps who have not been using iodized salt long term or multi-vits that list iodine who report good results with 2mg/day, we are good to go. Meanwhile I am susceptible until we can get some significant anecdotal evidence ;}

If the body only stores the amount of iodine that you suggest, the excess gets excreted/sweated out. Also, I don’t know what the replenishment/saturation times are either way.


#17

There are huge problems with this drug. It interferes with thyroid function and worse: