T4 Trials & Tribulations

Ten days ago I treated myself to yet another round of blood tests.

TSH shot up to 2.88 from 0.11, so definitely 25 mcg is too little daily T4 supplementation for me. If 50 mcg was too much, then I guess I need 37.5? I’ll be cutting up pills every night then. Fine.

Magnesium was at the bottom of the acceptable range and calcium was at the top! That’s got to be bad news, right? Maybe that plays a role in the return of my pain and tiredness?

Estrogen doubled yet again. Progesterone increased as well, four times the amount I had when I wrote the “Perfect Ten Progesterone” posting,  however, it is now only twice as much as my estrogen, from ten times the amount. So that’s another piece of bad news.

Anti-TPO’s are falling again, 611 from over 700 (so, still a heck of a lot, they should be below 6!), so moderately good news there, although… I’m not even sure I should bother checking them anymore.

The CA-125 (an ovarian cancer marker) is higher than last year, 45 instead of <35.  I don’t like seeing it progress, needless to say, the more so as my estrogen is rising as well, steadily, if you catch my drift…

Total cholesterol at an all time high: 225, with an LDL of 67. So, still good ratio, but it was 190 five weeks ago… Vacationing in Eastern Europe increases cholesterol, who knew…

For the first time, I did Free T4, Free T3, Total T4, Total T3 and TSH, like so:

The real downer was Total T4, which was under the lower limit! Not by a whole lot, but still! What was that supposed to mean? Lab proof of hypothyroidism?  Or was my body adjusting to the lower dose of supplementation? I can't wait to check it again and to talk to someone about this.

Well, on the other hand, I just read today "Levothyroxine And Lung Cancer In Females: The Importance Of Oxidative Stress", by Umberto Cornelli, Gianni Belcaro, Martino Recchia and Annarosa Finco a very credible study suggesting that too much T4 can cause serious issues as well and that one cannot monitor its amounts carefully enough. I see lots of people living with undetectable TSH levels and that cannot be right either. Inducing hyperthyroidism iatrogenically apparently can cause lung cancer in women.

"During the therapy with LT4 even at the steady state condition a peak of the hormone is evident a couple of hours after the administration and may cause a temporary condition of hyperthyroidism and a further increase of oxidative stress.

Oxidative stress is well documented in hypothyroidism [22-24] and is even worsened through treatment with LT4 [1,2]. The difference between the two conditions is that, in case of hypothyroidisms, oxidative stress is due to the reduction of AO [4], whereas, after the LT4 treatment it stems from overproduction of ROS from mitochondria [5,6].

A very simple method that can be used to measure oxidative stress is related to hydroperoxides content in plasma which is considered a very reliable test compared to other common methods since it shows very limited coefficient of variation [25].

An inverse association with fruit and vegetables consumption and lung cancer recently has been documented recently in the EPIC study for 50 to 59 age group, without an effect on specific histological subtypes [26]."

 So I should start measuring the hydroperoxide levels as well while I fiddle with this dangerous stuff. Also, increase antioxidants intake. I am not so sure about vegetables, finding clean veggies is an ordeal in itself.  I will look into supplements.

How to decrease calcium and estrogen and increase progesterone, magnesium and T4, make CA-125 and Anti-TPOs go away and be happy?

That’s all I’d like to know.

P.S. on August 17, 2013: Actually, the above sounds outdated. Just an old Peatian "reflex".  I no longer believe progesterone is good and estrogen is bad, so I take that back.  I will stop caring about the progesterone/estrogen ratio and worry instead about the level of hydroperoxide in my blood. It sounds like a fair trade-off..:)

Plus, the study I mention gave me a nightmare last night. So maybe I should withdraw a bit from worrying about these things altogether, like the doctor said. Just find the time and organize another seaside session...

P.P.S. I just came across a study that supports my decision to stop considering progesterone such a good guy, a study linking it to the emission of hydrogen peroxide: "Progesterone increases skeletal muscle mitochondrial H2O2 emission in nonmenopausal women". Yep. :( And guess what, estrogen is counteracting it, according to the authors. That makes progesterone less than a hypothyroid woman's best friend, because it promotes oxidative stress. Taking this one step further: maybe it was an excess of my natural progesterone which launched the H2O2 destructive festival which may have brought about my Hashimoto's.


 

Reality Check Feat. Dr. Coculescu

In a posh part of Bucharest, at a luxury clinic where everyone on staff had sheer reverence towards "The Professor", I had this consultation with Dr. Mihail Coculescu, the President of the Romanian Society of Endocrinology. To my surprise, we had a rather extensive chat, by my standards, and by the looks of the still waiting patients. 

As expected, Dr. Coculescu had never heard of Dr. Peat, whose books I had brought along, in the hope that they might capture his interest. Granted, I was not given the opportunity to pitch them properly as Dr. Coculescu had interventions and pointers for me at every step. However, something tells me that he would eventually check out Dr. Peat's work and theories. 

To summarize, he recommended that I simplified my life and quit the path of excessive intellectualization I had embarked upon. Decrypting PubMed articles and becoming fluent in the theories behind Hashimoto's would accomplish nothing. I should be thankful for the easy form of the disease I experience and for its simple (perhaps not even necessary, judging from my last set of blood tests) treatment. 

I could see that Dr. Coculescu was barely registering my suffering and I cannot blame him for one second. I myself felt kind of guilty for insisting on seeing him, when other people, with far more serious problems, were waiting in line by his door. But the harm is done. Refreshingly, he didn't mind this aspect, he even indicated that he would accept my "case", if I decided to switch endocrinologists, so no discrimination there on his side. 

He laughed when I mentioned that I didn't believe Anti-TPOs and Anti-TGOs were killing thyroid tissue and mentioned the "firemen at the place of the fire" analogy. He freely admitted that the science doesn't have all the answers, but refused to admit that I should complicate my life and allow myself to be affected by THAT, i.e. the proverbial things I could not change. 

He insisted that the thyroid, no matter in what shape, whether shredded or inflamed, can still accomplish its function, and that I seemed to have been in that situation.  It is OK if I feel better under T4 treatment, it is just that I should determine the optimal amount of supplementation, because it looks like even 50 mcg is too much for me. 

As to the concept of improper nutrition undoing thyroids, he mentioned the endemic lack of iodine in some places, and how entire populations develop huge goiters -- however, all those thyroid glands do keep working... They huff and they puff but... they do their jobs. So?.. At this point in the conversation, I felt kind of ashamed -- I didn't even have a goiter to complain about... 

I felt like coming out of a tunnel.  Minor twists of perspective performed by "authoritarian figures", to use a Peatism, can work wonders. In that sense, Dr. Coculescu was a tremendous doctor -- and I am convinced that he performed knowingly his "tricks".

They were what I needed and he was too experienced a practitioner not to know it the minute I took out of my purse Dr. Peat's books and my stacks of blood test results...

Whose Hormones Are These?!?

        I just came back from my doctor’s office. 

        The news is intriguing. 

        Luckily, I will see Dr. Coculescu (”the Great”) soon enough. I hope he can explain these developments and advise me accordingly.

        Three weeks have passed since my previous lab tests. My TSH was a nice 1.9, down from 5.21, under 50 mcg of T4 for a few weeks. I was entertaining hopes of going up to 75 mcg of T4 (Levothyrox), an amount not exaggerated for a Hashimoto’s patient of my size. My doctor had opposed the idea (see previous post), although she had wondered about the accuracy of the tests, thinking that they showed too little TSH for such a small amount of supplementation. 

         Lucky me that she didn’t increase my T4 dose, because even continuing with the 50 mcg for these extra three weeks, my TSH is now at a bewildering 0.11!  My T4 is higher than it has ever been, bordering the upper acceptable limit.  Again, lucky me that “mymexicandrugstore” didn’t deliver my T3 on time — I would have headed for a thyroid storm, without a doubt, with T3 supplementation on top of what my body is already producing!

        I didn’t check T3 this time around, but I’d be curious about the TPO antibodies, because, unless they are really high, marking another episode of thyroid destruction and subsequent hormonal flooding, I am not sure what to make of this! 

         Is my thyroid increasing its function of its own accord? Is the Peat diet working wonders on me, with some delays? Am I possessed by a higher metabolic self? 

        The latter option would be in sync with another surprise: a high estrogen level, ten times higher than three weeks ago. I didn’t check progesterone, but I doubt it went 10 times higher as well, so as to keep the Peat favored ratio… But who knows, after all, who would have guessed the thyroid development? 

        Cholesterol is down, but it was never bothersome. Vitamin D3 is hovering on the lower admissible range, so my doctor offered 100.000 units of supplementation — that is how they like to do it in France, with vials of potent liquid stuff, called “Uvedose”. When I was in Cannes last year, I bought them without a prescription from a pharmacy. In Alsace, no such luck.

        She also directed me to decrease my T4 supplements to 25 mcg… 

        I am wondering if my recent hair loss was connected to the exaggeratedly low TSH, rather than the Synthroid type medication or some previous hypothyroid moments that were never captured on lab results.
 
       I could have sworn I would never again see that level of estrogen, let alone that TSH or the T4, but here we go… Maybe with the increased amount of calories, came increased titers of hormones, across the board. Could it be that my body is waking up? Restarting? With all the good and the bad hormonal developments? So...
 
       IS PEAT RIGHT?

What Kills A Thyroid Gland?

Today is International Thyroid Awareness Day.

I am celebrating by posting a few thoughts on the current views of Hashimoto's Thyroiditis.

Many people out there will tell you that autoimmune thyroiditis comes from the thyroid gland being attacked by antibodies. People measure those and try to evaluate their degree of thyroid health by them.

My endocrinologist advised me to stop measuring those things. "Once you have them, they're there for life. Genetics plays a big role. At some point, a stress related event may have triggered them and they would exist in your body, once in a while getting to your thyroid, until they destroy it and render it incapable of doing its job". So, according to her, there is no way to go but down and measuring antibodies levels is not constructive or conducive to any worthwhile conclusions. I have to admit, despite my continuing efforts and gluten free diet, the results of my own lab tests indicate she might have a point... Unfortunately...

Dr. Datis Kharazzian, who has a best selling book on Hashimoto's, thinks one can balance the immune system and thus stop the killing of the thyroid. He says Th1 and Th2 cells are out of balance in Hashimoto's and that all the patient has to do is bring them back into the desired equilibrium. He offers combinations of nutrients that would boost either Th1 or Th2.

Dimitry Chistiacov's study, "Immunogenetics of Hashimoto's thyroiditis", published in the "Journal of Autoimmune Diseases" in March, 2005, seems to indicate that it is only the Th1 cells that are to blame for the said destruction. So, if you believe in Dr. Kharazzian's balancing of the immune system you may combine it with the results of this study and go for increasing Th2 right off the bat.

Dr. Alexander Haskell (link to the right) thinks that autoantibodies (Anti-TPO and Anti-TGO) are not the culprits in this scenario. He says they are simply there to clean the thyroid cell debris and that lack of specific nutrients is the culprit for the destruction that does occur at the thyroid gland level. He isolates iodine among those and this has caused some serious rebuttals of his vision (as iodine deficiency is hardly a problem in the US.) If he hadn't emphasize iodine, his theory would have actually sounded a lot more credible - and it is my favorite, still...

Like Dr. Haskell, Ray Peat does not believe in "autoimmune diseases" and the body's feasting on itself via antibodies, like those described above. He thinks that the thyroid does get destroyed (like many other organs) and that this is a process of degeneration, a result of insufficient supply of energy at the cell level. A nutrition blunder, if you will.

His view is consistent with the symptoms I have had after my Paleo time -- and, apparently, more and more people come out of their low carb experiments with damaged thyroid glands.

But let us go back to D. Chistiacov's study mentioned above, from which I have stolen the graphic above (I am giving it back if there are any complaints). His description of how things go wrong in Hashimoto's is representative for the scientific community's viewpoint. Indeed, my own doctor told me about the "strong genetic component" to Hashimoto's, to which environmental triggers are added.

Incorrect nutrition is not considered a factor in this study. However, infection and pregnancy are...

A key phrase in D. Chistiacov's paper remains:

 "The mechanisms, whereby autoreactive T cells escape deletion and anergy, and become activated, remain uncertain. "

This leaves the field still open to many interpretations, in my mind, including that of Dr. Peat and Dr. Haskell -- that the said breakdowns of cells are primarily caused by issues other than our own cells gone crazy and that we can stop or even reverse that destruction through a combination of nutrition, lifestyle and supplementation. I will attempt in full Dr. Haskell's protocol (described in his video series) once I have the necessary ingredients and let you know how it goes.

Perfect 10 Progesterone & Other Curious Findings

I finished reading Dr. Raymond Peat’s book “From PMS to Menopause. Female Hormones In Context” and I am now (re)reading the articles collected in "Nutrition For Women". I will soon write review those. For now, I will just comment on my test results.

In his book, Ray Peat recommends a ratio from five to ten times more progesterone than estrogen in serum levels. He does, on several occasions, mention the possibility of progesterone’s turning into “other hormones”, but he never takes this idea to its full consequence, namely, natural progesterone's possible final transformation into Public Enemy No. 1, estrogen. I think that, sooner or later, he should address this, because it is an important part of the hormonal equation, one that has not received the necessary focus up to now.

Drum rolls, please, as my progesterone levels were exactly TEN TIMES the amount of my estrogen, many weeks after my short Progest-E experiment, when I felt things had returned back to normal. Not five, not six, not seven... Perfect 10 me! 

(So, well, I was right all along, and those who tried to tell me my symptoms stemmed from a potential “liver issue” better learn that their imaginary knowledge of how hormones can affect one would be best not shared out there. Also, if a woman describes previously non-existent symptoms of estrogen and cortisol spikes after taking natural progesterone, you can believe her, although Dr. Peat and other proponents of natural progesterone never explicitly discuss the possibility.)

I also had good levels of DHEAs. I am sorry I didn't check my pregnenolone, I forgot, but I soon will.

Now, for the thyroid part of my labs: despite supplementation of 50 mcg of T4 for almost a month, my levels of T3 and T4 are only slightly changed. That is, T3 decreased a tiny bit, but it was already in mid-range, from 2.55 to 2.43, in a range of 1.71-3.71 pg/ml. T4 went from 13.4 to 13.52 in a range of 12-22 pmol/l, so it’s still lagging towards the lower part of the admissible spectrum, Levothyroxine or no Levothyroxine. TSH was the only one that took a spectacular dive, from 5.21 to 1.90, on range of 0.21 to 4.60 mui/l. This made my GP happy, albeit a bit mistrusting of the Romanian labs, so I will repeat them here in two weeks or so. I wanted to move up to 75 mcg of T4, but she said that would not be warranted and that raising my metabolism was not what she had in mind, to begin with — just getting rid of the TSH, while settling in the thyroid range my body chooses, as long as that is within what is considered normal.

I can understand her wish to tamper with key metabolic things as little as possible. However, if I ever receive my T3 supplements (I ordered them online at mymexicandrugstore.mx), I will try to supplement a little bit of that and see how I feel.

For the bad news of the day, after one year of constant and considerable decline, my TPO antibodies rose again, from 535 to 731 (normal: below 5.61!) The TGO antibodies have decreased (could this be due to the Anatabloc supplementation?) and are now within acceptable limits — but they were never that high to begin with (from 4.25 to 3.52, they should be below 4.11.)

Anyway, I do feel better with this (loosely) Peatian diet and the little T4 I am taking. I have more zest for life, more energy and my circadian rhythms are excellent — at night, there is this magnificent tired feeling, like when I was a child and I would drop in the evening, brain foggy, muscles tired, to only wake up in the morning, refreshed and ready to take on a new day. This is in itself a superb achievement and might bring with it a lot of good.

Let me not forget my “pre-diabetic” story. It turns out one should never buy cheap blood sugar monitors. After so much worrying about it, the serum glucose lab test revealed a nice 84 in a range of 60 to 105 mg/dl. My home measurement that morning: over 110. So I stopped DIY-ing in this department. 

Heart: curiously high diastolic pressure, more often than not, and a puny pulse pressure.

You can see from the upper part of the graph above that I am trying my hardest to push my calories intake and my body reacts, by packing on pounds. I fight back by reducing calories, only to start again pushing my luck. I am curious if I changed anything after all this effort, if I went past 1600 calories a day while maintaining my weight -- I shall soon check on Cronometer. 

And finally, in the ears department: another infection, this time in the right ear. I took cyprofloxacine. The otolaryngologist said I should maybe consider a CT scan or an X-ray. I said no way. She insisted, maybe at least an ultrasound? I already did that and they found nothing, just some inflamed lymph nodes. She still seemed worried. I told her about my progesterone and pregnenolone supplementation and the ear pains and now the repetitive infections — she said she would not be surprised if those played a role, because the ears are lined with mucous tissue and they react to hormones.

Thyroid Gland Physiology, Musings, Gadgets...

...by Dr. Adeleke Adesina. More videos like this on http://www.ftplectures.com/:

-- a subscription is required, free for the first three days. Another free video on "Thyroid Storm" can be found on YouTube.

Can a thyroid gland ever come back from Hashimoto's? My ultrasound shows that destruction of the gland has happened. It is not clear to me whether it is still going on. I do have some moments when I feel BETTER, as in almost hyperthyroid... So that would be consistent either with continued destruction and cleaning of debris by antibodies (which have considerably diminished in the past year) or with slow regaining of function and improvement. It will be interesting to have the same doctor perform an ultrasound in the near future and compare the results with the previous ones.

A few studies out there let me believe that the thyroid can indeed be destroyed by incorrect nutrition and rebuilt in the presence of high TSH and low T4.  I have both, as well as normal T3.  My doctor said I should not supplement with thyroid hormones unless I reach a TSH of 10 (I am currently at 7) or I run into serious symptoms.

Since I started eating Peat style, I can say that my energy has increased a whole lot.

I have also had a series of bacterial infections, in my left ear, the last of which has been extremely virulent, to the point that surgery was considered an option. I had very high fever and then...

And then, I don't know if this is temporary or not, but I have been pretty much walking on air! I am still trying to understand how this happened and what is it that makes me feel not good, but GREAT! Again, I hope it was not an episode of thyroid destruction that released lots of T3 and T4 into the bloodstream.

If my next thyroid numbers are awesome, I will attribute this to the Peat lifestyle, without a doubt.

If the antibodies have increased, I will not be too happy -- that means that further destruction has occurred.

But I want to get to the bottom of this diet experience by following Dr. Georgia Ede's example, namely doing readings of blood glucose and frequent blood tests and pulse and tension and recording properly everything that happens to me. I should also keep a serious diary with all this, but I am reluctant to do it here, it might make this blog too messy with a mix of personal experience and science and thoughts about diets and what not. Maybe I should start a separate blog for the daily diet experience, connected here in the upper tabs...

I need to round up some equipment in order to do this. I had set my eyes on the Withings smart body analyzer and their blood pressure monitor. I could do some mean graphs without even trying using those... Besides, I needed a good excuse to get them.

So, lots of work ahead, but that's alright, 'cuz now I've got the energy!