On Optimal Metabolism

A Sane Take On Hypothyroidism

This is one of the more interesting papers published on hypothyroidism in recent years.

It described treating patients with T3 and T4 to optimize the reverse T3 to T3 ratio, under the assumption that this would correct the metabolic rate and low thyroid hormone activity.

Here are some of the improvements observed in patients who achieved this target, expressed as percentage improvements from baseline.

Improvements in hypothyroid symptoms when dosing to optimise the T3:rT3 ⬇

100% Temporal Arteritis

100% Trigeminal Neuralgia

100% Burning leg syndrome

100% Rashes

96% Dizziness

94% Blepharitis

92% Chronic Bronchitis

92% Neuropathies

90% Vertigo reduction

90% Migraine

89% Meniere's Disease

83% Brittle nails

82% Excessive coldness

81% Excessive Tiredness

80% Neurology

80% Urticaria

78% Hives

78% Hives API

77% Headaches

75% Chronic Sinusitis

75% Chronic Oral Aphthae

72% Infections

72% Constipation

71% Dry Skin

70% Dermatology

67% Reduced antidepressant meds

65% Excessive hair loss [women]

63% Asthma

63% Immune System

56% Allergic Rhinitis

53% Eczema

52% Eustachian Tube Dysfunction

50% Raynaud's Disease

46% Depression

44% Food Allergies

35% Chronic Pharyngitis

34% Allergy medicines decreased

33% Chronic Laryngitis

20% Chronic Fatigue/Fibromyalgia

The standard treatment of hypothyroidism involves dosing T4 until TSH reaches a certain range. This leaves a lot of people with hypothyroid symptoms because it does not address the underlying problem of low T3 activity, either through the test or the treatment (usually).

T4 alone often cannot replenish tissue levels of the active thyroid hormone T3. A "normal" TSH level does not necessarily mean you have sufficient thyroid hormone T3. TSH is lowered in "stress," and it reflects T3 in the pituitary only - the pituitary is exceptionally efficient at making T3 from T4 - this means that the pituitary can have plenty of thyroid hormone (T3) while other tissues can be severely hypothyroid.

"Hypothyroidism must be defined physiologically as insufficient T3 effect in some or all tissues… The TSH level is not a reliable indicator of T3 status in the untreated state and is oversuppressed by the peak levels that occur with once-daily oral T4 and/or T3. Normalizing an elevated TSH or low FT4 with T4 usually does not produce sufficient, let alone optimal, T3 effect and can leave some patients markedly hypothyroid. T4/T3 combination therapy is more physiological and effective than T4 monotherapy and must be guided by clinical criteria, not the TSH."

— Clinical thyroidology: beyond the 1970s' TSH/T4 Paradigm

D. Levine, an ENT doctor, outlined a better strategy in a paper titled The definition of Optimal Metabolism and its association with large reductions in chronic diseases.

He started with 658 patients at his practice who had been diagnosed with hypothyroidism.

From those, he selected likely prospects:

"based on the following:

A) one chronic ENT complaint with sub-optimal response to standard medical treatments,

B) two or more general hypothyroid symptoms, and

C) a sub-optimal thyroid profile. "

370 patients were considered candidates for Optimizing Metabolism, and 165 eventually hit the targeted ranges. Those 165 were then used to assess the changes in symptoms from treatment that I listed above.

His target labs were:

FT3 (free T3) in the upper 20% of the normal range,

TT3/RT3 ratio (total T3/reverse T3) between 10-15

FT4 above 0.6

Yes, that would put the minimum FT4 below the normal range.

The patients were given T4 and T3 in increasing doses until the targets were met.

T3 was dosed twice daily, and tests were done every 3 weeks. The starting dose of T3 was 5 mcg - that's 2 x 2.5 mcg.

"To account for T3's 6hr half-life the T3 dosages are halved, given twice a day, with repeat blood testing 6hrs after the last dose after allowing 3 weeks for equilibration."

After 3 weeks and testing, the dose was recalibrated. First, adding another 2.5 mcg in the AM if indicated, then, after the next test, adding the same to the PM dose.

T4 was given so that FT4 stayed above 0.6 g/dl.

Once the targets were hit, if there were no significant side effects, it was continued, and the testing period was gradually extended to every 5 months.

Dr Levine addressed the concerns with the very likely suppression of TSH that would alarm most doctors:

"Resistance from endocrinologists and general medical doctors is significant because the TSH becomes suppressed both with Optimization and in hyperthyroidism. However, unlike Optimization, hyperthyroidism is a hypermetabolic state that can aggravate osteoporosis and arrhythmias. If the bones are experiencing a net loss, then treating that problem directly is necessary with vitamin D3, vitamin K2, Ca++, exercise, and/or bone-stimulating drugs. I have not seen accelerated deterioration of osteoporosis or osteopenia on serial bone density studies due to Optimization. Patient L.C. whose metabolism was Optimized over the last three years, reported an increase in bone density on serial bone densitometry despite her TSH continually suppressed (current - 0.022). TSH is a poor indicator of metabolic status. It can be high, normal or low in patients with low metabolism."

Hyperthyroidism is a concern; it is to be avoided, but it is not a certainty just because TSH is suppressed.

He reported a few case reports, too.

1]

"He presented with perennial allergies, recurrent sinusitis and bronchitis in spite of repeated antibiotics and steroids... He had many primary doctor visits and was frequently out of work. He was also excessively tired and depressed and on klonopin (a benzodiazepine sedative)."

After optimizing metabolism:

"His immune and nervous systems improved greatly. His allergies are mostly gone -rarely using azelastine. He no longer gets sick and is back to work. His excessive tiredness is 100% gone. His depression is 100% gone. He is no longer on klonopin."

2]

"A 55 year-old female complaining of ear problems with tinnitus, fullness, and itching in the left ear; frequent vertigo treated with meclizine; seasonal allergies treated with Benadryl. She had frequent sinus headaches triggering migraine headaches. She also reported recurrent bronchial infections. She was on multiple psychotropic medications for anxiety, depression, and ADD. She was premenopausal with hot flashes. She was excessively cold and also suffered from dry skin and severe constipation. Audiometry confirmed mild Eustachian tube congestion in the left ear."

After treatment:

"Her migraines, headaches, vertigo, aural fullness, itching, bronchitis, and allergies have completely resolved (off azelastine)."

3]

"71-year-old female who complained of headaches, vertigo, dizziness, left aural fullness, pain and "thyroid issues" with dry skin, severe constipation, hair loss and brittle nails. GERD with gas... I treated her acute sinusitis and otitis media with clarithromycin, medrol dospak, and ordered my thyroid profile. On follow-up, the patient reported only mild improvements."

After optimization:

"Her dizziness was 100% gone; dry skin 100% gone; constipation 80% better, hair loss 90% better, brittle nails 100% better."

Then she stopped treatment and got worse on the "equivalent" dose of T4. (T3 and T4 are not equivalent.)

"She didn't follow up and ran out of medication. Her internist refilled it instead with levothyroxine 50mcg. (reported to be equivalent)! When I saw her again she reported she couldn't sleep for the last four months, her hair was falling out, her dizziness was returning; and despite stopping the levothyroxine she was only marginally better. I restarted liothyronine 5mcg bid. With her thyroid profile Optimized she became asymptomatic again."

I think this paper really drives home the amount of hypothyroid symptoms that are now not recognised as such, the unnecessary and inappropriate treatments of these symptoms as other unrelated diseases, and the improvement that can be seen when T3 activity, rather than TSH level, is addressed.

There was also some weight loss and huge improvements in energy levels.

"Optimizing Metabolism can help with weight loss by eliminating excessive tiredness that often prevents exercise and dieting. In this study, 93 patients had an improvement of 82% eliminating excessive tiredness. Now these patients have the mental energy to exercise and diet when they did not before.

There were 48 patients who were overweight and "dieting" and had reached the Optimal Metabolism. They reported an average weight loss of 7 pounds without changing their current dieting habits. Some of these patients were not dieting too seriously where others had been stymied despite multiple diets with exercise.

One particular patient - C. M. - lost 48 pounds. Also her depression improved 100% and she stopped all her psychotropic medications. She was no longer excessively tired and her allergies improved by 60% as well."

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Thanks for reading.

If you need more help understanding hypothyrodism the loin my video course + support group.

👉 skool.com/thyroid

We cover:

➥ Hypothyroid Symptoms

➥ Causes of Hypothyroidism

➥ Thyroid, Energy, and Health

➥ Diseases Caused by Low Thyroid

➥ Problems Caused by TSH

➥ The Thyroid System

➥ Thyroid Blood Tests

➥ The Problems with Blood Tests

➥ Pulse and Temperature

➥ Testing T3 Activity

➥ Thyroid Autoimmunity

➥ Thyroid Hormone Conversion

➥ Reverse T3

➥ Thyroid Hormone Transport

➥ Supplementing Thyroid Hormones (T4, NDT and T3)

➥ Stress

➥ Iron, Iodine, and Selenium

➥ Calories

➥ Macronutrients

➥ Thyroid Threats

➥ Polyunsaturated Fatty Acids (PUFA) and Free Fatty Acids (FFA)

➥ Pro-Thyroid Substances

➥ A Pro-Thyroid Diet

➥ Drugs That Affect Thyroid Hormones