help with thyroid meds

[roxanne]

Hi, I love this site. I am a 62 year old 3/4 female, compound hetero MRHFR. I have a question about thyroid meds. My FMD prescribed 5mcg liothyronine daily as my T3/Reverse T3 is not in line with the ideal ratio. I really would like not to take it as I think that when you are low carb your thyroid gets a little sluggish. So I suggested diet changes, but she didn't agree saying this can't be fixed with diet argh!!! not a good answer. I really like her but she's not perfect.

These are my numbers:

Before Supplementation After Supplementation
Free T3 3.2 3.6
TSH 2.510 0.83
Free T4 143 119
Total T3 113 133
Reverse T3 18.8 21.4

Please let me know your thoughts. I actually think that other that the TSH the other numbers are better without the supplementation.

I would like to understand this a little better.

[slacker]

Hi, I love this site. I am a 62 year old 3/4 female, compound hetero MRHFR. I have a question about thyroid meds. My FMD prescribed 5mcg liothyronine daily as my T3/Reverse T3 is not in line with the ideal ratio. I really would like not to take it as I think that when you are low carb your thyroid gets a little sluggish. So I suggested diet changes, but she didn't agree saying this can't be fixed with diet argh!!! not a good answer. I really like her but she's not perfect.

These are my numbers:

Before Supplementation After Supplementation
Free T3 3.2 3.6
TSH 2.510 0.83
Free T4 143 119
Total T3 113 133
Reverse T3 18.8 21.4

Please let me know your thoughts. I actually think that other that the TSH the other numbers are better without the supplementation.

I would like to understand this a little better.

Hi Roxanne;

First, I am not a thyroid expert. The functional medicine approach to thyroid is quite different than a conventional medicine approach. A strictly conventional provider will not order reverse T3 or be familiar with a T3/reverse T3 ratio. Your free T3 and TSH improved with the liothyronine prescription, which is expected since liothyronine is synthetic T3, the "active" thyroid hormone.

In his book "The End of Alzheimer's", Dr Bredesen lists optimal thyroid levels; I've attempted to add them to your lab chart, but the spacing has collapsed on itself! Oh well... If we use these recommendations, your TSH is now optimum, your free T3 was optimal both before and after treatment, your original reverse T3 was fine, and your free T3 to reverse T3 ratio is virtually the same. It's possible that your doctor is using different values for optimum.

Before Supplementation After Supplementation "optimal per Dr B"
Free T3 3.2 3.6 3.2 - 4.2 pg/ml
TSH 2.510 0.83 <2 microIU/ml
Free T4 143 119 1.3 - 1.8 ng/dL (must be different units)
Total T3 113 133
Reverse T3 18.8 21.4 < 20 ng/dL
T3/reverse T3 17 16.8 > 20

Second, what was your motivation for seeing the FM MD and getting your thyroid levels checked? Do you feel any different?

Third, why do you think one's thyroid gets sluggish with a low carb diet?

Here's a link to a FM MD's website on thyroid health and reverse T3. This will explain his approach, and possibly many functional medicine doctor's approach, to thyroid. It may answer some of your questions.

[roxanne]

Thank you for your answer Slacker. I have been seeing my FMD for over 20 years, even before she became a Functional Practitioner. I do not feel any different. This test was one of many we do to control for cholesterol, metals, minerals, glucose, etc. All is about right except for the Thyroid. My TSH without meds used to be 1.3 to 1.8 when my diet was higher carb. I have read research that I cannot quote offhand stating that TSH levels go higher on a low carb diet and figured that maybe without symptoms it would be better not to treat. Actually, my iodine levels were low and she has me taking 4 drops of liquid iodine which is 300 mcg.

In any case I will continue taking it, retest in 6 months and maybe stop and see if the numbers normalize.

[slacker]

My quick online search on low carb and thyroid yielded this kind of science-y blog with foot notes. Hope it helps. I learned something!

[roxanne]

Thanks Slacker. My diet is probably 50% or more goitrogenic foods, cooked. In addition, I do a green juice every morning that includes kale, bok choy, sometimes spinach, lemon, and other greens.

Also, when you asked if I felt any different with the medication, I said no, but it occurred to me that I am reacting to stress more emotionally than before, like my nerves are a little more on edge. I will have to mention that to my FMD.

[Karina52]

I have had Hashimotos for over 26 years and have also worked with a functional doctor, but the only way I finally got balanced was making my own adjustments while keeping a very close eye on symptoms, sleep quality, temperature and whether or not "brain fog" was present. I'm also homozygous APOE4. With Synthroid (Levothyroxine), I was forever in a fog and quite miserable. I switched to NDT about 12 years ago but still found myself making too much rT3 and thus continuing a level of brain fog. I would switch to Cytomel for a while (usually 3 months, titrate up to about 75 mcgs) which always eliminated the rT3...only to slowly have it creep up again a few months after I went back on NDT. I also have 2 copies of C677T gene variant which greatly reduces methylation and I'm sure this was a contributing factor to my repetitive rT3 buildup. Meanwhile, I am addressing the C677T issue with methyl folate and methyl B12 shots, and have reduced my NDT to 1.5 grains a day, taking 35 mcgs of Cytomel as well. This keeps the rT3 from being able to build back up since with only 1.5 grains of NDT, I'm not taking large amounts of T4 anymore. Sleep quality, for me, is greatly enhanced with T3. My diet is very low carbs, pescetarian.

[roxanne]

Karina, what is you T3/RT3 ratio? My ratio is almost the same even a little lower with the T3 than without it. Like I mentioned I also noticed I am responding more emotionally to stress than before supplementation.