DESSICATED THYROID CONTINUES HAVING ZERO EFFECT ON TSH; ELEVATED FT3, NORMAL FT4

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mcs

Member
All NP Thyroid seems to be doing is spiking my T3 and doing nothing for my TSH as evidenced on my latest thyroid function labs. Even worse, my TSH INCREASED despite taking my morning dose 4h prior to my lab draw. I do not have Hashimoto’s after having test TPO and TgAb several times over the last few years, so no reason to keep testing them.

Current dose @ 90mg q.d. I have been on every conceivable combination of thyroid replacement since 2010 and I’ve never been able to get a consistently suppressed TSH no matter what I’ve tried. I have been taking 90mg q.d. NP Thyroid now for 6 mos.

What causes I’m guessing at:

- Reduced pituitary/thyroxine signaling; High TSH; T3/T4 levels normal, but not getting into cells
- chronic LCHF diet > possible thyroid resistance and/or hormone suppression (ref: Paul Jaminet - Perfect Health Diet)
- SIBO/SIFO: I take betaine-HCL and pancreatin with meals, so I would think I got any possible malabsorption issues covered.
- under-dosed at 1.5 grains (90mg) according to this dose calculator by 10mcg T4 equivalent. Is that really enough to make a difference?

What possible actions to take:

1) Switch back to:
a) T4 monotherapy (this time with Tirosint-SOL) - based on successful past suppression of TSH with regular old levothyroxine (I realize that NDT is usually the better choice [contains T4, T3, T2, T1, calcitonin, iodine], but it simply isn’t suppressing TSH, and in my case, seems to be failing to make a difference). I had a good response early on trialing thyroid replacement meds and levo was the only med in which my TSH suppressed to <2.0. Unfortunately, the effect didn’t last for whatever reason.

b) compounded NDT (pure porcine powder from same supplier as the commercial brands with either sodium bicarbonate or ascorbic acid as filler); pre and post standardized (pharmacy will provide COA which shows T4/T3 ranges per batch) as opposed to reliance upon commercial brands, once the gold standard of reliable standardization and stability but have been recalled due to variations in potency, minor as it may be.

2) increase dose of NP Thyroid to 105mg which would give me 160.4mcg T4 equivalent/day, slightly over my limit of 150.2mcg.

3) Iodine intake - keeping in mind the advice from a naturopath. Until I can test correctly using UIC ratio, iodine intake will remain an open item.

Can you guys think of anything else that as to why NP Thyroid has failed me and what I can do for now?

It will take some time, effort and finagling to switch meds.
 
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Gman86

Member
Wow, A+ in regards to the effort u’ve put into trying to figure out this issue, and in regards to ur level of perseverance. Extremely impressive. The thyroid is arguably the hardest hormone system to dial in by far. So I feel ur pain and frustration.

So u said ur diet is low carb high fat, what exactly does ur diet look like? Would u be comfortable with increasing ur carbs a bit if it helped decrease ur TSH? Do u follow Dr Paul Saladino at all? He did strict carnivore for quite a while, as it’s very close to the optimal diet for humans, but he ended up figuring out that not only did he feel better with upping his carb intake a bit, his labs looked better when adding in the carbs as well. Here’s the most current video of what he eats in a day

How much iodine are u getting? Iodine, as I’m sure u know, is extremely important/ mandatory for proper thyroid function. Dr Westin childs is the top doc that I’ve found in regards to information about the thyroid. Here’s a good video where he talks about his iodine recommendations
And here’s a few videos where a guy went on iodine and had labs done before and after I believe.


And here’s a video of dr Westin childs talking about 3 supplements to take for ur thyroid. I have it saved, so must have some significant info I wanted to remember, and might help u out

 

Gman86

Member
And here’s a couple other videos on iodine dosage recommendations I have saved. They both recommend around 1-3mg/ day IIRC


 

Gman86

Member
Do u eat any organ meats, or take any desiccated organ supplements? Vitamin A (retinol) is very important for proper thyroid function, and most people don’t get near enough retinol in their diet

Also, are u getting enough selenium in ur diet? I’m sure u know that selenium is an extremely important cofactor for proper thyroid function
 

Vince

Super Moderator
Do u eat any organ meats, or take any desiccated organ supplements? Vitamin A (retinol) is very important for proper thyroid function, and most people don’t get near enough retinol in their diet

Also, are u getting enough selenium in ur diet? I’m sure u know that selenium is an extremely important cofactor for proper thyroid function
I may have missed it, what's level is your reverse t3 at?
 

mcs

Member
Do u eat any organ meats, or take any desiccated organ supplements? Vitamin A (retinol) is very important for proper thyroid function, and most people don’t get near enough retinol in their diet

Also, are u getting enough selenium in ur diet? I’m sure u know that selenium is an extremely important cofactor for proper thyroid function
I take selenium and take a raw spleen supplement as well as Vitamin A. As to iodine, too much is just as bad as too little and it's guesswork when you take as many supps as I do which may have trace amounts that add to an excess which is why I mentioned the UIC ratio test in my post. That's the only way to assess iodine status AFAIK. I don't think micronutrition is the issue.

As far as diet, here's the last few days from my Cronometer food diary (I do eat liver occasionally. I don't always include salads and veggies in my diary unless they are calorie-dense which most aren't):


 
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mcs

Member
You should post your complete thyroid panel. It would make it a lot easier for us to discuss your issues.
I posted my results in the link. The only marker missing was rT3. Up for debate as to whether it even has the value I once gave it after consulting with this endo (he doesn't even test for it): Reverse T3: The Four Top Causes of High Reverse T3 | Dr. Alan Christianson

Past rT3 levels here. Last one done in 05/20 was @ 18.0.

No reason for TPO or TgAb since I already tested for those many times in the past and was negative.
 
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Vince

Super Moderator
I posted my results in the link. The only marker missing was rT3. Up for debate as to whether it even has the value I once gave it after consulting with this endo (he doesn't even test for it): Reverse T3: The Four Top Causes of High Reverse T3 | Dr. Alan Christianson

Past rT3 levels here. Last one done in 05/20 was @ 18.0.

No reason for TPO or TgAb since I already tested for those many times in the past and was negative.
Okay, thanks. I see your labs. I wonder what your labs would look like, if you did labs before you took your thyroid meds. That's how I do my thyroid labs.
 

mcs

Member
Okay, thanks. I see your labs. I wonder what your labs would look like, if you did labs before you took your thyroid meds. That's how I do my thyroid labs.
My last labs were done 24h after my last dose as I posted in this historical chart (see 09/07/21 date). I periodically run labs soon after taking my dose to check how well it's working.

I'm now wondering if it's a problem with my pituitary/hypothalamus. Like a bad thermostat, I keep "adjusting the dial" (i.e. adding T3/T4) but the temperature (i.e. TSH) stays the same.

A partially-empty sella was found in my sella turcica as an incidental discovery on a brain MRI some years ago. I have mentioned this finding to just about every practitioner I can think of and the answer was always the same: you would know if you had ESS (empty sella syndrome) because most or all of your hormone levels would be out of range.

Maybe I should look into getting a TRH (Thyrotropin-releasing hormone, what the hypothalamus releases to get the pituitary to release TRH) drawn and see if it is unusually high.

If the TRH is good then it may be a "stuck" pituitary (i.e. hypothalamus properly senses T3/T4 but pituitary keeps pumping out TSH). If the TRH is unusually high it may signal that the hypothalamus is the issue. Despite proper levels of T3/T4 it continues to release too much TRH.

It may therefore be an exercise in futility, but to rule it out, neither Quest nor LabCorp offer TRH since it’s a stim test, so definitely haven’t had that done. Needs to be performed in a doc’s clinic or hospital. May also be a challenge to get the endo to do it since I have no other signs or sxs of ESS.

At the end of the day though, the treatment for that is usually T4 as indicated in this study. Re-trialing T4 was on my above list of possible actions to take anyways, so maybe give it a shot again to see if it corrects? My guess is that's what any endo would advise before subjecting myself to a TRH stim test.
 
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mcs

Member
Trying to find a pattern isolating my TSH levels from my historical chart over the last 7 1/2 years. This is what I came up with:

Average TSH level @ <2.50 (12 times): 2.04
Average daily NDT dose for each of those levels: approx. 1.25 grains (~75mg)
Average daily TSH levels for last 2.5 years (18 times): 3.48
Average daily NDT dose for each of those levels: approx. 1.64 grains (~98mg)


Cannot understand why the climb in TSH when the dose of NDT was increased. Only main difference: for the majority of the last 2 years I was taking NP Thyroid as my NDT.
 
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