Thyroid blood results while on low carb. Are my results normal?

[CROM]

I am currently on a low carb, calorie restricted diet to lose weight. I have a good amount of muscle mass as I have been lifting weights for 26 years. I have about 15 to 20 lbs more to lose. I am 45 years old.

When I am NOT dieting my TSH is about 3.40. When I am dieting my TSH goes up to 5.44.

My T3 & T4 is always in normal range on or off diet. My T3 reverse is usually high when ON a low carb diet.

Do my numbers look normal for someone on a low carb, calorie restricted diet? Should I leave it alone? Should I take any meds while dieting.

I had to go to my general doctor yesterday and he wrote me a script for 100 mcg of Synthroid (I didn’t ask him to). I wasn’t planning on taking any thyroid meds until I see my Endo in 5 days.

I thought I've heard people suggest using T3 when RT3 is high. Should I ask my doctor for it or just leave my thyroid alone?

 

[Sean Mosher]

Your RT3 is way up there.
TSH definitely elevated.
This has to be hampering your goals.
I'd pursue treatment for sure.

Probably low dose NDT with T3 or T3 exclusively.
Would be worth your while to examine the remainder of your hormone profile as well at this point.

 

[Vince]

I agree with Sean, your thyroid levels, especially you reverse T3. Will hurt your weight loss goals.

Your bad thyroid levels, could be from your low carb diet. Your body thinks you're in a fasting state, and it's slowing down your metabolism.

 

[MarkLA]

I agree with Sean, your thyroid levels, especially you reverse T3. Will hurt your weight loss goals.

Your bad thyroid levels, could be from your low carb diet. Your body thinks you're in a fasting state, and it's slowing down your metabolism.

Are you sure (re: fasting state slowing down metabolism)? I say that because Free T3 and Free T4 both look pretty good. The TSH is high which would seem to say the body is pushing the thyroid to make more hormone. Wouldn't we expect TSH, FT4, FT3 to be low if the metabolism was slowed?

IANAD. I'd think the doc would want to prescribe Cytomel (T3) not Synthroid (T4) as the former would push down RT3 and the latter would seem to make it worse.

I don't really know how to interpret the T3 uptake.

 

[CROM]

My metabolism seems to be at a crawl. Would T3 speed it up? I thought I’ve heard RT3 blocks T3 from doing its job. Is this not the case?

 

[Vince]

My metabolism seems to be at a crawl. Would T3 speed it up? I thought I’ve heard RT3 blocks T3 from doing its job. Is this not the case?

When you supplement with T3, it will lower your reverse T3.

 

[Vince]

Reverse T3 (also called Reverse Triiodothyronine) - Stop The Thyroid Madness

 

[apsjiml]

I agree with others. t3 can be lower and rt3 can be higher when doing low carb or calorie restriction. Some people leave that alone when they are dieting and some feel fine. However, that should not affect tsh. yours is elevated. That is telling me, your body wants more thyroid. I would be getting thyroid antibodies checked both of them. If I was going to add in thyroid, I would be adding in t3 only not t4 as rt3 is made from t4.

 

[CROM]

My doctor said he was going to give me Armor Thyroid. Should have it next week. I just want to speed up my metabolism. Will report if it works nor not.

 

[apsjiml]

I personally would not take anything with t4 in it,with a reverse t3 that elevated. I have been there, ndt, synthroid anything with t4 will increase reverse t3 because that is how reverse t3 is made from t4. That being said, let us know how you feel.

 

[MarcoFL]

You absolutely cannot take Armour with a RT3 of 30!!!! find a new doc and look at straight T3. With a FT4 of 1.5 you have enough T4 now and it is going to RT3.

 

[Vince Carter]

AS with all the others...straight T3 is what you should try, anything with T4 is more likely to not work as well or make it worse.

 

[apsjiml]

Now, I will tell you, I was in the same boat about 6 years ago , not from dieting my reverse t3 was always high 36, 50, 100 crazy high. The doctor insisted doing Dessicated thyroid. I felt terrible, a little better at first but terrible and hypothyroid. My rt3 levels certainly did not go down, it went up..

 

[CROM]

Now, I will tell you, I was in the same boat about 6 years ago , not from dieting my reverse t3 was always high 36, 50, 100 crazy high. The doctor insisted doing Dessicated thyroid. I felt terrible, a little better at first but terrible and hypothyroid. My rt3 levels certainly did not go down, it went up..

Where you overweight because of high RT3? Was your metabolism slow? When I diet my metabolism comes to a crawl. I got muscle. They say muscle speeds up your metabolism.

For me to lose weight I need to consume 1500 to 1600 calories per day (low carb). I do my VERY hard weight lifting workout for about 45 min to an hour 6 days/week. Then I go on a 4 mile walk (i jog a little of the way). And then sometimes I do heavy weight shrugs or lunges at home. I am @ 214 lbs I say that's about 800 to 1000 calories burned. Then I see people like athlean x who eats 3200 calories and is cut. I hope that maybe taking T3 might speed up my metabolism.

When I was younger I could easily eat 3200 calories per day and lots of pasta and lose weight.

 

[mcs]

I am dealing with a similar dilemma being on a LCHF diet for some time now, although I haven't been able to ascertain any difference in markers since my carb intake has remained static @ ~ 75g daily.

Your numbers are characteristic of Subclinical Hypothyroidism (see chart below) in which TSH is mildly elevated and FT3/FT4 are normal. To get a better overall clinical picture, you also need to check antibodies (TgAb and TPO).

Some questions:
1) Do you have thyroid labs before you started going LC and CR?
2) Are you on TRT?
3) What do your avg macros look like?
4) What are your symptoms, if any? I didn't see you post that, just that you feel your metabolism slows down.

It's long been known that low carb diet can definitely downregulate T3 (as well as testosterone). And LC + CR is like a double whammy! Studies are mixed as to whether such restriction directly affects TSH which is a pituitary hormone.

If what you say is true - that your TSH is still mildly elevated (high normal) + your frees are normal when you're not restricting cals or doing LC - then it seems such baseline levels are dead ringers for classic subclinical hypothyroidism and you should be on thyroid replacement.

I would start with 1 grain NDT (not Armour; it has too many crappy fillers that can cause reactions and absorption problems) and monitor rT3 levels before jumping on the T3 monotherapy bandwagon as others have suggested. If no problems, the titrate slowly 1/4 to 1/2 grain every 2-4 weeks.

Just because rT3 is elevated doesn't always equate to exogenous T3 as being the panacea. In fact, Barbara Lougheed's Tired Thyroid blog suggests a contrarian opinion: that too much T3 will be just as much a problem in shunting to rT3 as too much T4. It's all very individualized and the science is hazy when it comes to how valid rT3 is in the first place. We really don't know enough to suggest any real clinical significance, not to mention actionable protocols.

 

[apsjiml]

Where you overweight because of high RT3? Was your metabolism slow? When I diet my metabolism comes to a crawl. I got muscle. They say muscle speeds up your metabolism.

For me to lose weight I need to consume 1500 to 1600 calories per day (low carb). I do my VERY hard weight lifting workout for about 45 min to an hour 6 days/week. Then I go on a 4 mile walk (i jog a little of the way). And then sometimes I do heavy weight shrugs or lunges at home. I am @ 214 lbs I say that's about 800 to 1000 calories burned. Then I see people like athlean x who eats 3200 calories and is cut. I hope that maybe taking T3 might speed up my metabolism.

When I was younger I could easily eat 3200 calories per day and lots of pasta and lose weight.

So, that was part of it. I am secondary Hypogonadism. Long story short I am pan hypo pituitary. I also have a diodinase gene defect which is another reason why I cannot do t4 only or combination. I ended up not just on testosterone but I also am on hydrocortisone, fludro, Growth hormone, thyroid, testosterone, desmopressin. Once I was treated I got lean I lost 14" off my waist, with out dieting or anything. I didn't want to get into my story and take away from yours but you don't want to have a reverse t3 like that. It might or might not be from dieting either.

 

[CROM]

I am dealing with a similar dilemma being on a LCHF diet for some time now, although I haven't been able to ascertain any difference in markers since my carb intake has remained static @ ~ 75g daily.

Your numbers are characteristic of Subclinical Hypothyroidism (see chart below) in which TSH is mildly elevated and FT3/FT4 are normal. To get a better overall clinical picture, you also need to check antibodies (TgAb and TPO).

Some questions:
1) Do you have thyroid labs before you started going LC and CR?
2) Are you on TRT?
3) What do your avg macros look like?
4) What are your symptoms, if any? I didn't see you post that, just that you feel your metabolism slows down.

It's long been known that low carb diet can definitely downregulate T3 (as well as testosterone). And LC + CR is like a double whammy! Studies are mixed as to whether such restriction directly affects TSH which is a pituitary hormone.View attachment 8867

If what you say is true - that your TSH is still mildly elevated (high normal) + your frees are normal when you're not restricting cals or doing LC - then it seems such baseline levels are dead ringers for classic subclinical hypothyroidism and you should be on thyroid replacement.

I would start with 1 grain NDT (not Armour; it has too many crappy fillers that can cause reactions and absorption problems) and monitor rT3 levels before jumping on the T3 monotherapy bandwagon as others have suggested. If no problems, the titrate slowly 1/4 to 1/2 grain every 2-4 weeks.

Just because rT3 is elevated doesn't always equate to exogenous T3 as being the panacea. In fact, Barbara Lougheed's Tired Thyroid blog suggests a contrarian opinion: that too much T3 will be just as much a problem in shunting to rT3 as too much T4. It's all very individualized and the science is hazy when it comes to how valid rT3 is in the first place. We really don't know enough to suggest any real clinical significance, not to mention actionable protocols.

Here’s my past thyroid history…

2011 - TSH 0.780
2012 - TSH ? (started gaining weight slowly)
2014 - TSH 1.69 (gaining weight slowly)
2015 - TSH 2.63 (gaining weight slowly)
2016 - TSH ? (about 45 lbs heavier since 2011)
2017 - TSH ? (started dieting) Started TRT
2018 - TSH 5.19 (started yo yo dieting)
Mid 2018 - TSH 5.740 (yo yo dieting) Free T3, T4 in range
Late 2018 - TSH 5.060 (yo yo dieting) Free T3, T4 in rage RT3 19.9 (taking Cytomel)
Early 2019 - TSH 3.40 (not dieting)
Mid 2019 - TSH 4.120 (yo yo dieting) Free T3, T4 in range RT3 23.2
Late 2019 - TSH 5.44 (extreme low carb) Free T3, T4 in range RT3 30

Seems like when I started putting on weight my TSH stated rising. Low carb diets raised my TSH more, although T3 & T4 always stayed in range (but maybe not optimal). All TSH blood test above 5 were taken while dieting.

For a few years I was stuck in a cycle of yo yo dieting but this time I will not fail and I am sure I will reach my goal of about 196 lbs, which is where I was when my TSH was 0.780.

I don’t think I have Hypo symptoms except slow metabolism/weight gain. Actually with 7+ hours of sleep and low carb food consumption I feel great. Whenever I stop dieting for a short while my TSH starts dropping.

 

[apsjiml]

Here’s my past thyroid history…

2011 - TSH 0.780
2012 - TSH ? (started gaining weight slowly)
2014 - TSH 1.69 (gaining weight slowly)
2015 - TSH 2.63 (gaining weight slowly)
2016 - TSH ? (about 45 lbs heavier since 2011)
2017 - TSH ? (started dieting) Started TRT
2018 - TSH 5.19 (started yo yo dieting)
Mid 2018 - TSH 5.740 (yo yo dieting) Free T3, T4 in range
Late 2018 - TSH 5.060 (yo yo dieting) Free T3, T4 in rage RT3 19.9 (taking Cytomel)
Early 2019 - TSH 3.40 (not dieting)
Mid 2019 - TSH 4.120 (yo yo dieting) Free T3, T4 in range RT3 23.2
Late 2019 - TSH 5.44 (extreme low carb) Free T3, T4 in range RT3 30

Seems like when I started putting on weight my TSH stated rising. Low carb diets raised my TSH more, although T3 & T4 always stayed in range (but maybe not optimal). All TSH blood test above 5 were taken while dieting.

For a few years I was stuck in a cycle of yo yo dieting but this time I will not fail and I am sure I will reach my goal of about 196 lbs, which is where I was when my TSH was 0.780.

I don’t think I have Hypo symptoms except slow metabolism/weight gain. Actually with 7+ hours of sleep and low carb food consumption I feel great. Whenever I stop dieting for a short while my TSH starts dropping.

TSH is not a thyroid hormone and it in itself does not mean a whole lot. Free t3 is the active hormone that we can use. Low Carbohydrate and diets in general can cause changes in t3 and reverse t3 but I am not sure about tsh levels, as dieting in itself would not necessarily affect production but probably conversion from t4 into the active hormone free t3. The average healthy person really does have a free t3 somewhere in that upper portion of range. 2 to 4.2 range 3.5 to 3.8 is about average. If it were me, I would be checking out to see if I had any Hashimoto's antibodies. When people say in range you do realize that a free t3 at the bottom of the range probably represents not a healthy person but rather a sick person in the hospital. I would want to know how low it really is.

 

[Another Great Day]

Where you overweight because of high RT3? Was your metabolism slow? When I diet my metabolism comes to a crawl. I got muscle. They say muscle speeds up your metabolism.

For me to lose weight I need to consume 1500 to 1600 calories per day (low carb). I do my VERY hard weight lifting workout for about 45 min to an hour 6 days/week. Then I go on a 4 mile walk (i jog a little of the way). And then sometimes I do heavy weight shrugs or lunges at home. I am @ 214 lbs I say that's about 800 to 1000 calories burned. Then I see people like athlean x who eats 3200 calories and is cut. I hope that maybe taking T3 might speed up my metabolism.

When I was younger I could easily eat 3200 calories per day and lots of pasta and lose weight.

We must have a similar issue. I have tracked my caloric intake and calories burned via FitBit. over 30 days I had a 50,000 caloric deficit and lost no weight. My reverse T3 was at 20. After a few months of titrating liothyronine up to 50mcg my reverse T3 is now 7.7. However, still no weight loss. Very frustrating. I too lift weights. 5 days a week for 45 to 80 minutes. The issue with that is it lowers cortisol, which makes it harder to lose weight. I stopped lifting for a month. I have not done that in 20 years. It was a good break but it made no difference. It has been suggested that my cortisol levels are too low. I had them tested about a year ago a defy (saliva), they were low but no treatment was suggested. I am testing them again next week (saliva). Still searching for an answer. I am sure it is metabolically related, possibly low cortisol? Please let me know if you find any answers.

 

[slicktop]

We must have a similar issue. I have tracked my caloric intake and calories burned via FitBit. over 30 days I had a 50,000 caloric deficit and lost no weight. My reverse T3 was at 20. After a few months of titrating liothyronine up to 50mcg my reverse T3 is now 7.7. However, still no weight loss. Very frustrating. I too lift weights. 5 days a week for 45 to 80 minutes. The issue with that is it lowers cortisol, which makes it harder to lose weight. I stopped lifting for a month. I have not done that in 20 years. It was a good break but it made no difference. It has been suggested that my cortisol levels are too low. I had them tested about a year ago a defy (saliva), they were low but no treatment was suggested. I am testing them again next week (saliva). Still searching for an answer. I am sure it is metabolically related, possibly low cortisol? Please let me know if you find any answers.

I just want to verify: you had a 50,000 calorie deficit over 30 days... that's a 1666 deficit per day, correct? So you're eating less than a thousand calories a day?