Location 167:TSH is a pituitary hormone and TSH levels only indicate to us how loud or soft the signal being sent to the thyroid is. What truly matters is how the thyroid gland interprets that TSH signal…meaning whether or not the thyroid gland dispenses enough thyroid hormones to the body after receiving the TSH signal.Tags: blue
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Approximately 80% of T4 is released by the thyroid. Approximately 7–20% of T3 is released by the thyroid.
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FOUR PROCESSES OF FAT-BURNING METABOLISM 1. The thyroid gland outputting T4 and T3 (or you taking thyroid hormone replacement) 2. Your body converts the T4 into T3 3. The T3 arriving at work (the cells) 4. The T3 “punching in” to work (enter/affects the cells) Why doesn’t the thyroid gland just pump T3 directly into our system, if that’s what our bodies ultimately need? Why does the thyroid bother with this “middleman” T4 and this whole conversion process? T3 is the biologically active, most important thyroid hormone to human health, and as a result, it’s a very powerful energy hormone. T3 has such immediate and powerful effects that our bodies sort of have a built-in time-release process, where T3 is wisely dispensed to our bodies via T4 throughout the day when our bodies need it. The biologically inactive T4 converts into the biologically active T3. The leftover T4 that was not converted into T3 will convert, instead, into a biologically inactive form of T3 called Reverse T3 (RT3), as a way of clearing out excess T4 from the body that goes unused/unconverted.
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THYROID HORMONE FUNCTION On a daily basis, the thyroid gland releases: T4, T3, T2, T1 & calcitonin. • T4: 80–93% of what your thyroid produces. Its main function is to convert into the biologically active hormone T3. Of the T4 produced by the thyroid gland, 40–50% converts into T3. • T3: 7–20% of total production by thyroid. Most of the T3 in your body makes its appearance when T4 loses one of its molecules to become T3—a peripheral (that is, away from thyroid gland) conversion of T4 to T3 in the body. • T2: May play a role in production of an enzyme called deiodinase that helps covert T4 to T3. • T1: May play a role in keeping thyroid function in check. • Calcitonin: Primarily secreted by thyroid, calcitonin responds to too-high levels of calcium in the blood and inhibits the release of more calcium from your bones to the blood.
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some in the gut, and through the action of a specific enzyme called the D1 deiodinase. A small portion of the conversion from T4 to T3 happens within the gastrointestinal tract, but only if the gut is healthy and has the right level of friendly gut bacteria. Some conversion also occurs within the cells of the brain, bones, muscles, through the action of another specific enzyme called the D2 deiodinase. The mineral selenium also plays a key role in the conversion of T4 to T3.
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There are a variety of factors that can cause T4 to T3 conversion issues, such as a sluggish or unhealthy liver, poor diet, adrenal dysfunction, vitamin/mineral deficiencies, low iron storage, and blood sugar imbalances.
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Doing chronic cardio (a pattern of frequent workouts where you exceed 75% of your max heart rate for a sustained period of time) can negatively affect thyroid hormone metabolism by skewing the output
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and balance of adrenal hormones and glucose metabolism, both of which are connected to thyroid health.
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Hypothyroidism generally stems from one (or more) of these categories: 1. The pituitary gland does not produce enough TSH. 2. The thyroid gland does not release enough T4 and T3 in response to the TSH. 3. T4 is not converting into enough T3. 4. T4 is converting into the inactive Reverse T3. 5. Hashimoto’s disease is an autoimmune disease whereby the immune system creates antibodies that attack the thyroid gland (attempting to destroy it). Sometimes a combination of both hypothyroidism and hyperthyroidism can occur. Hyperthyroidism generally stems from: 1. Graves’ disease is an autoimmune disease whereby the immune system creates antibodies (proteins produced by the body to protect against a virus or bacteria) called thyroid-stimulating immunoglobulin (TSI). These antibodies turn on the thyroid and cause it to grow and secrete more thyroid hormones than your body needs. This is by far the most common cause of hyperthyroidism. 2. Excessive thyroid hormones produced for other reasons, such as nodules in the thyroid gland or too much iodine. 3. Ingesting too high a dosage of thyroid replacement hormones.
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The true kryptonite of the human species is anything anti-thyroid. These are external influences such as food glutens, environmental chemicals (chlorine, bromine, fluoride), certain medications, soybeans and soy products, nuclear radiation, and even adverse health practices like too much stress, overexercising, poor diet, nutrient deficiencies, adrenal imbalances, blood sugar instability, and not enough sleep—all of which can throw off the delicate hormonal interactions that support optimal thyroid function and metabolism.
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Selenium deficiency
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Carbohydrate dependency/sugar addiction
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RECOMMENDED THYROID TESTS • Free T3 • Free T4 • TSH (This is not a test your doctor should rely on as a sole measurement in assessing hypothyroidism; nor should a doctor use this test on its own to prescribe or alter doses of T4, NDT, T4/T3 combination, or T3-only.) • TPOAb (thyroid peroxidase antibody for Hashimoto’s detection) • TgAb (thyroglobulin antibody for Hashimoto’s detection) • Reverse T3 (must be taken in the same blood draw as Free T3) RECOMMENDED THYROID-RELATED TESTS • Vitamin D, 25-hydroxy • Homocysteine • B12 • Ferritin • DHEA-sulfate • Morning cortisol or twenty-four-hour saliva cortisol test • Sex hormones for both sexes: free testosterone, progesterone, estradiol
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Why Test Free T4? If Free T3 is really the ultimate marker of how well someone is doing and feeling, then why test Free T4? • A very high T4 on a blood test when someone is on thyroid hormone replacement—or the natural over-production of T4 in someone who is not taking thyroid hormones—can indicate an overactive thyroid, hyperthyroidism. • A high Free T4 on a blood test of someone on NDT could partially indicate a Reverse T3 problem (T4 to T3 conversion issue).
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Free T3/Reverse T3 Ratio: 20 or higher is considered healthy. Total T3/Reverse T3 Ratio: 10 and higher is considered healthy.
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Most Popular Brands of NDT NP Thyroid (Acella Pharmaceuticals) A generic brand of desiccated thyroid. You can take the pills sublingually, which is an option patients like; I preferred it when I took NDT. Nature-Throid (RLC Labs) Patients might want to chew up the tablets before swallowing them, as it may assist in breaking down the cellulose filler in the pills. WP Thyroid (RLC Labs) Considered the option for chemically sensitive patients, RLC Labs claims that WP Thyroid is gluten-free and contains NDT (porcine) with only three fillers. Others NDT brands Armour Thyroid (USA)
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NDT Dosing Protocols The typical starting dose for desiccated thyroid is one grain (60–65 mg). A lot of people find it beneficial to increase every two weeks in 1/2-grain increments, because the feedback loop of suppression that starts when you commence thyroid hormone replacement can cause further hypothyroid symptoms. One of the biggest mistakes doctors and patients make is that they wait too long in between increases, and sometimes patients experience more hypothyroid symptoms because they are on too low a dose for too long. Once a patient reaches the 2 grain mark, it is wise to increase by 1/4 grain increments, until the optimal dose is reached.
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However, if you do swallow your thyroid hormone replacement, then you need to avoid taking estrogen, calcium, or iron at the same time, because they can bind to the thyroid hormones and cancel them out, so to speak.
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A two to one ratio works well when multi-dosing T4/T3 combo and NDT. For example, if a person is on 3 grains per day, a dosing strategy could be 2 grains in the morning and 1 grain around 3:30 p.m./4:00 p.m. There are other people who do well on split even-dose scenarios (1.5 grains in the morning and 1.5 grains in the afternoon). There are some patients who multi-dose NDT three times a day. In my opinion, it might make a little more sense to take a larger dose in the morning to prepare the body for a day’s worth of activity, and also because cortisol output is reliant on adequate levels of T3 in the blood. (Our largest surge of cortisol happens in the few hours preceding our rise from sleep.) Since direct T3 peaks within a few hours of ingesting it, multi-dosing prevents big spikes of T3 in the system. Again, this process is not only individual but it can always be altered and adjusted as time goes on.
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T3-ONLY (DIRECT T3) In the case of people on T3-only (like myself), dosing three to five times a day is common. T3 spikes within two hours and reaches tissue saturation within four hours, so dosing three to five times a day is most optimal. I currently dose my T3 four times a day.
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I not only prefer to dose sublingually (which you can’t do with sustained-release T3), but I also have a sense of overall control with direct T3 because of its rapid release. I don’t have to worry about mismanaged T3 levels in my body by trusting the sustained-release component to act synergistically with my fluctuating T3 needs.
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Do Not Take Your T4/T3 Combo, NDT, or T3-Only Dose the Morning of a Blood Test!
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The reason we test Free T3 is to see what is unbound and available in the blood, not what we just sent coursing through our veins by ingesting T3 thyroid hormones an hour before a morning blood test. Free T3 results are most in line with how the patient is feeling.
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Consuming grains on a regular basis can also inhibit the absorption of nutrients like selenium.
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Supplements: Selenomethionine is the form found in plants. Selenocysteine is found in animals.
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Dosage A safe supplemental dose appears to be 200–400 mcg per day,
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Dosage The daily minimum dose is 400 mg. You can ingest magnesium in pill form, but there are also a variety of chelated magnesium drinks on the market. My favorite is Natural Calm by Natural Vitality company.
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Why Might Deficiency Occur? Because hypothyroidism negatively affects digestion, often hypothyroid patients have issues absorbing nutrients like B vitamins, B12 in particular. The body needs adequate thyroid hormones to absorb and “hold onto” B12. Consuming grains on a regular basis can also inhibit the absorption of nutrients like B12. Even people who eat plenty of the richest sources of B12 (animals) can have a deficiency.
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Healthy MTHFR Gene Benefits: • MTHFR enzyme works with and breaks down folate vitamins. • Those folate vitamins help convert homocysteine to another amino acid called methionine. • The body uses methionine to make proteins, process fats, maintain and repair cells, along with creating and breaking down brain chemicals. • Methionine helps with inflammation. Defective/Mutated MTHFR Gene Downsides: • MTHFR enzyme functions perform sluggishly, which can affect the breakdown of toxins or heavy metals. • MTHFR enzyme won’t break down folate vitamins properly, which can cause high homocysteine (high homocysteine can increase risk of heart disease and more). • Homocysteine is scantily converted to glutathione (your body’s main antioxidant and detoxifier).
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Methylation is a vitamin-requiring process in the body that is critical for supporting various aspects of physical and mental health, including normalizing gene expression. Methylation occurs constantly and helps the body to repair DNA regularly. However, when methylation processes slow down, an increase in the breakage of DNA strands occurs. Poor methylation can promote inflammation and poor detoxification in the body.
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Supplements: For B12, methylcobalamin is probably the best. If you are recovering from hypothyroidism and adrenal issues, taking a B-complex supplement one to two times a day can help improve skin quality/tone, repair the adrenals, improve immunity, assist metabolism, and improve emotional health.
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vitamin D deficiency, which can significantly increase cancer risk by compromising the function of the p53 “spell-checker”
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Reverse T3 issues happen when, due to a variety of factors, the T4 converts into too much Reverse T3, which is the inactive form of T3 (thus making the person hypothyroid). Hypothyroid symptoms show up despite the fact that Free T3 blood levels may look optimal or even high.
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of chronic dieting, if one is over-restricting calories, the body thinks it is in a state of starvation and so the body will convert T4 into RT3 in an attempt to lower metabolic rate (fat-burning) because the body wants to hold onto the fat you currently have until you are out of “starvation” mode and can fuel the body with enough nutrition to turn off the RT3 alarm.
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Selenium/Milk Thistle/Liver Support: Cleansing and supporting the liver is essential, because much of the RT3 is produced in the liver. Milk thistle is the standard go-to choice for liver support, but there are other, more complex, adrenal support options too. Low selenium levels can contribute to high RT3 levels. Making sure that your selenium intake is adequate can assist in correcting RT3 issues (see page 55 for more on selenium).
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Thyroid hormones need cortisol (an adrenal hormone) in order to work in the cells, so a decline in cortisol production reduces the metabolism of thyroid hormones, which then places more pressure on the adrenal glands to produce more cortisol. This loop can push you down a spiral staircase into more adrenal issues. Some scientists believe that the entrance of thyroid hormones into the cells is delegated by adrenal hormones. (More on adrenals and cortisol in chapter 6.)
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MY CURRENT T3 DOSING SCHEDULE: 56.25 MCG OF T3 PER DAY TIME DOSAGE 5:45/6:00 a.m. 25 mcg 11:00 a.m. 18.75 mcg 4:00 p.m. 6.25 mcg 10:00/10:30 p.m. 6.25 mcg
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One grain (or 60 mg) of desiccated thyroid (NDT) equals about 25 mcg of T3.
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After going paleo, I was able to lower my dosage of T3 by half, likely the result of optimal blood glucose management, healthy adrenals, and optimal thyroid hormone metabolism, which a paleo/primal lifestyle promotes.
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The key is to clear out all the excess T4 in the body so that it can no longer convert into RT3, which is causing the problem in the first place. Only T4 converts into RT3; T3 does not make RT3. It can take between eight and twelve weeks before you start to feel well and until the T3 finally gets out of the parking lot, into the office, and punches in to work (because production of RT3 dissipated and RT3 finally stopped blocking the T3 receptor). For me, it took about ten weeks after starting on T3 to feel major symptom relief, but I felt some relief in just hours after my first T3 dose.
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Reverse T3 exists to protect us from increasing metabolism in stressful situations. Perceived stress can stem from nutrient deficiencies, inadequate caloric intake, chronic exercising, blood sugar imbalances, infections, and adrenal issues.
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RT3 and Stressors If you are an athlete engaged in excessive running, your body interprets that as a stress and assumes you are in danger. So it’s going to respond by helping you keep your fat reserves until perceived danger goes away. If you are living a low-fat, high-carbohydrate existence (or low-fat/low-carbohydrate) and chronically doing cardio exercise on top of having very low body fat and low weight, then your body thinks you’re starving and stressed and it’s not going to let you burn the very little fat you have left on your body until it senses the perceived danger is clear. Hence, people who overtrain, who chronically limit caloric intake, or have a lot of stress in their lives are susceptible to Reverse T3 issues. The diet and lifestyle aspects of the Paleo Thyroid Solution have a critical role in RT3, as we shall see.
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• Gastrointestinal issues: Gut issues can cause problems with the absorption of minerals, which can lead to low nutrient levels that might ignite an RT3 problem. Even if you don’t have deficiencies in selenium or zinc, suboptimal digestion or more serious conditions like leaky gut syndrome, candida infections, or IBS can all contribute to low T3 levels. Inflammation in the gut can reduce T3 by raising levels of cortisol, which can contribute to more RT3 production.
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Brain cells have more T3 receptors than any other tissues, and adequate amounts of T3 (whether through conversion or direct T3 dosing) are critical to proper brain function and the development of both newborns’ and adults’ brains.
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the cause is inadequate levels of T3 (or too much T3). T3 thyroid hormone is used for treating depression! T3 interacts with brain receptors and crafts the brain’s sensitivity to neurotransmitters involved with memory, alertness, focus, emotions, and disposition.
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“T3 is found in large quantities in the limbic system of the brain, the area that is important for emotions such as joy, panic, anger, and fear. If you don’t have enough T3, or if its action is blocked, an entire cascade of neurotransmitter abnormalities may ensue and can lead to mood and energy changes, including depression. Hypothyroidism and depression are related on many levels. The main building block for the neurotransmitter serotonin and for thyroid hormone (both T3 and T4) is the amino acid tryptophan, the same amino acid needed for the neurotransmitter norepinephrine, which stabilizes mood and anxiety. This means it is quite possible that low thyroid function can deplete your body of serotonin and other mood-stabilizing neurotransmitters. It also means that chronic depression and sadness may deplete your body of tyrosine stores and T3, which is also necessary to maintain healthy mood and energy.” —Christiane Northrup, MD, drnorthrup.com
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T3 plays a very important role not only in normalizing cholesterol levels, but also in affecting healthy blood pressure and a healthy heart rate.
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The earliest mention of thyroid issues dates back to around 12,000 years ago in China. Coincidentally, wheat and barley were introduced to China from the Middle East during that time, reflected in the name of the mythical Chinese emperor “Emperor of the Five Grains.” I will go into depth later in this chapter as to why grains are toxic and need to be eliminated from our diets in order to achieve optimal thyroid health and metabolism; however, suffice to say for now glutens (present in grains) are the biggest known triggers for autoimmune Hashimoto’s disease (an autoimmune disorder that affects the thyroid gland). I find it interesting that the first recorded occurrences of thyroid issues in China coincided with the introduction of grains into their society.
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Insulin was one of the first hormones to evolve in living things. Virtually all animals secrete insulin as a means of storing excess nutrients. It makes perfect sense that in a world where food was often scarce or non-existent for long periods of time, our bodies would become so incredibly efficient. How ironic, though, that it’s not fat that gets stored as fat—it’s sugar. And that’s where insulin insensitivity and this whole type 2 diabetes issue get confusing for most people, including our very own government.
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In fact, some paleo-anthropologists suggest that our ancestors consumed, on average, only about 80 grams of carbohydrate a day. Compare that to the 350–600 grams a day in the typical American diet today.
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there was so little carbohydrate/glucose in our ancestor’s diet that we evolved four ways of making extra glucose ourselves and only one way of getting rid of the excess we consume.
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eat too many carbohydrates, the pancreas pumps out insulin exactly as the DNA blueprint tells it to, but if the liver and muscle cells are already filled with glycogen, those cells start to become resistant to the call of insulin. The insulin “receptor sites” on the surface of those cells start to decrease in number as well as in efficiency. The term is called “down regulation.” Since the glucose can’t get into the muscle or liver cells, it remains in the bloodstream. Now the pancreas senses there’s still too much toxic glucose in the blood, so it frantically pumps out even more insulin, which causes the insulin receptors on the surface of those cells to become even more resistant, because excess insulin is also toxic! Eventually, the insulin helps the glucose find its way into your fat cells, where it is stored as fat.
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Just as insulin resistance prevents sugar from entering muscle cells, it also prevents amino acids from entering. So now you can’t build or maintain your muscles. To make matters worse, other parts of your body think there’s not enough stored sugar in the cells, so they send signals to start to cannibalize your precious muscle tissue to make more—you guessed it—sugar. You get fatter and you lose muscle.
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When your liver becomes insulin resistant, it can’t convert thyroid hormone T4 into the T3, so you get those mysterious and stubborn “thyroid problems,” which further slow your metabolism.
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While alcohol is being burned or converted into acetate, metabolism of other fuels is put on hold. Hence, alcohol calories are known as the “first to burn.” Not only is fat burning put on hold while the alcohol calories are burned, but any carbohydrate calories consumed with alcohol are more likely to be converted into fat and stored instead of burned.
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Since alcohol inhibits lipolysis (fat burning) and glycolysis (glucose burning) being the first to burn, studies correlate frequent consumption with hypoglycemia (low blood sugar).
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Dr. Foresman: Stress in our society (physical/mental), and poor diet. You can assess the degree of a person’s severity of congestive heart failure by measuring Reverse T3-it’s one of the best measures–it is a marker of severe mitochondrial dysfunction at the level of the heart. So, it’s a good marker of disease activity. It’s a non-specific marker for wellness. I read a study where it was a marker for hyperemesis gravidarum (vomiting during pregnancy). You can tell when a woman is really struggling with that because her Reverse T3 is going way up. Elle: And that is happening as a natural protection mechanism in the body? Dr. Foresman: Right. The theory is that the body thinks it is starving, so the body slows down metabolism, so you don’t become hypermetabolic. I’m not saying we have to treat Reverse T3 to treat vomiting during pregnancy, but if you treated the vomiting, then the Reverse T3 gets better. That’s why in so many of our patients we have to make sure that we treat all of the underlying disorders, because a high Reverse T3 is a marker for chronic stress of some kind, whether that’s physiologically as well as psychologically.
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Dr. Foresman: Yes I do. The ratio value of 15 and above is usually okay in most people that I see, but 20 and higher is healthier.
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desiccated (T4/T3 combo), and I mostly use Nature-Throid, which is my preferred brand of desiccated, except some chemically sensitive patients do better on WP Thyroid
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because every grain (one 60 mg pill) of desiccated thyroid has 38 mcg of T4 and 9 mcg of T3,
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Do you divide the medication equally between the two doses? Dr. Foresman: No. Usually it’s two to one. So if a patient were on 3 grains a day, they would take 2 grains in the morning and 1 grain in the afternoon.
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Elle: If a patient comes back after four weeks of being on 1 grain, and they are still not doing well, and it’s clear that they need a dose increase, how do you raise desiccated from there? Do you raise by 1 grain or a 1/2 grain, or…? Dr. Foresman: I would probably not increase the prescription by more than 1/2 grain from there on out. Also, sometimes 1/4-grain dose increases can make all the difference for a patient. So usually I increase by either 1/4 or 1/2 grain about four weeks after the initial 1-grain starting dose (if called for). The first parameter is how the patient feels, which is more important to me than labs.
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The majority of my patients, if you correct the selenium, give them 200 mcg twice a day (I use the methyl selenocysteine form these days), you will find improvements in autoimmunity, and that’s a sign that you’re having improved thyroid hormone metabolism and less reactivity to the cell.
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selenium, appropriately used, 200–400 mcg a day seems to be so important for decreasing Reverse T3, improving Free T3, improving energy levels, decreasing thyroid autoimmunity.
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Dr. Foresman: In treating autoimmune thyroid disease, I have found the three most vital treatments. Incorporating a paleo/primal lifestyle, combined with correcting vitamin D (levels 70–90), and providing methylselenocysteine (selenium) at 200 mcg twice daily, will usually cause thyroid antibodies to drop. If I am convinced the patient has been compliant with these recommendations, and yet antibodies are not falling appropriately, the addition of low-dose naltrexone (LDN) could help significantly. The website http://www.lowdosenaltrexone.org serves as a good reference. Obtained from a compounding pharmacy with a doctor’s prescription, at a dose of 4.5 mg nightly, naltrexone boosts natural endorphin levels and can serve as a significant immunomodulator, helping reduce thyroid antibodies.
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Keto Clarity by Jimmy Moore with Eric C. Westman, MD
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Recovering with T3 by Paul Robinson
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PALEO/PRIMAL/LOW-CARB WEBSITES AND BLOGS MarksDailyApple.com (The most comprehensive daily blog on primal living!) FatBurningMan.com LivingLaVidaLowCarb.com
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