Thyroid Question for Digital Surgeon
Sir - I read this in your Hormones101 Blog and have a few questions:
"The high cortisol also directly effects the HPA axis too. Cortisol directly blocks 5’ deiodinase enzyme that converts T4 to T3 (occurs in liver). Cortisol Releasing Hormone (CRH) ( seen in elevated in high cortisol production states) directly blocks TSH. The implication is huge because TSH and T3, the active thyroid hormone are inhibited quickly in this process. Immediately, any excess T4 is then shunted to reverse T3. Rev T3 is a COMPETITIVE inhibitor to T3 the active thyroid hormone. This basically turns off the thyroid! (Your welcome ladies) This is a biological switch needed to occur to shut metabolism off in starvation mode. This is precisely what happens in starvation or in anorexia. Once T3 is turned off no fat burning can occur at the muscles at UCP3. Remember UCP3 activation requires T4, T3 and leptin to be working well. With high cortisol it cannot. Shutting off these things could be good biologically if you’re starving bad or if you’re morbidly obese. CRH also directly inhibits TSH. This is why TSH is a horrible marker for thyroid status. If you do not know the cortisol status you can infer zero information from a thyroid panel. This is reason number one for many thyroid misdiagnosis"
Five years ago, I was a 40 year old male, 5'10, 240lbs. I'd put on 60lbs in about 10 years with SAD and little to no exercise. A Veteran's Administration doctor found my TSH was about 25 and put me on Synthroid. He adjusted the dosage over the next 3 years to .15mg and my TSH was around 5. I didn't change my diet or exercise habits and was eventually put on high blood pressure, high triglyceride, and gout medication and was told I'd soon need diabetes meds.
Two years ago I started diet and exercise (cardio/low fat). I got down to about 220lbs, then started eating more paleo about 12 months ago and Primal Blueprint 6 months ago. I'm now 180lbs, eating twice a day, IF'ing from 6pm til noon. Lifting weights, etc... I'm off all my medicine except the Sytnthroid. My TSH is now .5.
My questions: Can a thyroid heal? Can I stop the Sythroid? Should I have been on it in the first place?
I'm not looking for free medical advice, but I think there are a lot of people in this same predicament. The doctors just call it "Metabolic Syndrome" and medicate the heck out of it.
Yes it can heal. The real reason you were out of whack was the high cortisol level. Remember in the post I said LR leads to hypercortisolism all the time. When CRH is up is shuts down GNRH and T3 T4 and TSH and raises your rev T3. I bet your VA doc never checked your cortisol (blood is inaccurate salivary is the way to go) and never checked your rev T3 (would have been high). He could have made the diagnosis right away. Treating you with synthroid was not the best approach. He used the drug to falsely lower your TSH but I bet if he would have checked a simultaneous rev T3 it would have been astronomical. Reversing your metabolic syndrome was the better choice. Most thyroid disease is either autoimmune from a leaky gut (gluten) to cause Hashimoto's or due to high cortisol. Most docs never check the cortisol levels because they forgot about CRH effect on the thyroid from biochemistry. Most docs are clueless about thyroid physiology. They listen to the endocrinologist who tell them to just check a TSH and treat that alone. I have pointed out the effect of high cortisol to all my endocrine buds and they look at me like I did not know that. I told them if I know it you better know it.
Realize that your real issue was never the thyroid. It was LR and high cortisol.
Last edited by DigitalSurgeon; 06-16-2011 at 05:55 PM.
So Dr Kruse what is your protocol to get off thyroid meds? Do you just do cold turkey? First make sure cortisol and leptin correct? Does the thyroid just start doing its job again? If auto-immune thyroid would have to deal with that first.
I too was diagnosed with hypothyroidism during a period of high stress(law school)/high cortisol and put on Synthroid. I've seen several endocrinologists since then but have been told that my levels are normal now and that once you go on the Synth, you never get back off the Synth. I don't know enough to follow the technical language that you are using at the moment, but Dr. Kruse, if you could please let us know what tests to get done and what indicators to look for I think many of us would be very very very appreciative!
Could I stop the Synthroid, then?
I truly believe I have turned my Metabolic Sydrome around by eating PB and with primal fitness. I have been able to get off BP meds, high trig meds, and gout meds. The only thing I'm taking is Synthroid. I would love to just quit taking it, but the doctors around here say I will always need it. I've never been diagnosed with a thyroid condition, just high TSH level 7 years ago.
I guess I could cut the dosage in half and get bloodwork done after a couple months. Are there doctors that specialize in this sort of thing? How would one go about finding one?
otzi's story sure sounds familiar!
Originally Posted by DigitalSurgeon
I was on synthroid and just got bigger and sicker.
The doc that I went to in 2007 checked rT3 and found it really high. So were insulin and trigs. As far as cortisol, mine was actually low, but this is because my adrenals had fried by then and stopped making it. This was a huge mess.
The explanation I got was not leptin, but we got it sorted out. I got off the synthroid and switched to natural T3 instead. Synthroid is synthetic T4. I even took cortisol for a while, which is pretty rare. It's complex and most docs won't mess with it.
A year later, my rT3 was actually way lower than the test range instead of too high. I lost 120 lb, and everything else sorted out.
I didn't use natural T3, but used Cytomel for a year and I can say, my thyroid is better and that with have RAI. However, I didn't have a doctor, I had very smart Phd level friends that think today's doctors are stupid because they only medicate based on tests and not symptoms. Basically to get the T4 and T3 to work, you have to clear out the RT3.
Originally Posted by DFH
Clinical practice is 20 years behind the times.
Originally Posted by Rivercity
How would I go about finding a doctor who will help me with a thyroid issue? This synthroid plan I'm on seems ridiculous. The normal range of TSH is 1-5. I'm being treated with a small dose of synthroid, and my TSH is .55. The doc says, "looks like the synthroid is working great, keep taking it!"
Originally Posted by DFH
Back when my TSH was 30, I had no signs or symptoms--it was only a routine blood test after I had gained 60lbs a year after retiring from the military.
Keep in mind my doctors are VA or military. I'd pay out-of-pocket if I could find one smart enough to know how to figure out what I really need, or if I need anything at all.