Jay Feldman 0:05
If you're on Synthroid or levothyroxine for hypothyroidism, there's something you need to know that your doctor likely won't tell you. We're going to be going over exactly that in today's episode of the energy balanced podcast, a podcast where we dig into the physiology behind the bioenergetic view of health, and teach you everything you need to know to maximize your cellular energy. Today's episode is part five of our hypothyroidism series. This is the final episode of this series. And in this episode, we'll be discussing the problems with using T4 Only medications like Synthroid and levothyroxine. For hypothyroidism. We'll be going over when it makes sense to use thyroid hormone supplements, how to use T3 T4 and or desiccated thyroid or NDT for hypothyroidism, whether thyroid hormone should be taken away from food due to absorption concerns, and whether we should be concerned about thyroid hormone supplementation suppressing our own thyroid hormone production. As always to check out the show notes for today's episode, with all of the links to the studies and articles and anything else that we reference, head over to Jay Feldman wellness.com/podcast. And with that, let's get started.

So the last area of things I want to talk about is the supplement side of things for thyroid status. And within that talking about thyroid hormones, and issues with T4 monotherapy, which there's a lot of important things to dig into here. In terms of supplements outside of thyroid itself, we talked about the different nutrients that are involved in the art, hormone production and conversion. If you can't get those from your diet, for whatever reason, you need to supplement them in moderate amounts, there's a place for that. But we've talked about that enough times, I don't want to beat that dead horse any further in terms of the concerns there with over submitting, and all of that. So just keep that in mind. And as we've mentioned, this is rarely going to fix a thyroid hormone issue, unless you have a pretty severe deficiency in these things. But we want to make sure that we're getting enough of all that. And one important thing to consider is that as we're increasing our thyroid hormone activity, and our metabolism, if we have deficiencies of different nutrients, those can become more apparent and create issues, because we're basically going to exacerbate the usage of those vitamins and minerals, and therefore can exacerbate that deficiency in that short term as we increase our thyroid status. So we want to keep that in mind as well as the possible confounding variable. And maybe something to consider if you are having, you know, certain symptoms crop up either when using certain thyroid hormones, or doing other things that you know, increase your metabolism and support your thyroid status. So, yeah, it's important to consider in that short term basis, on the long term, and this is again, part of the reason why we don't want to go overboard with any concerns with the nutrients. In the long term when our metabolism is functioning well, and we're not dealing with chronic stress, we retain our vitamins and minerals much better. And we're going to lose them much less. And it makes it much easier to manage the status, we don't have to go to great lengths to do so. And so with that in mind, we don't want to get too hung up on nutrients. When in reality, the energy availability and our metabolic status is going to be the largest determinant here of our nutrient status and availability, among other things, so it's worth kind of citing in there, but it's kind of a similar point. Do you have anything you want to match it in those terms?

Mike 3:38
I just basic things, I would situate the diet first, see where your gaps are using chronometer something like that, start to fill in some of those gaps. And you can do that through specific foods like I call them the multivitamin foods, I guess your egg yolks or organ meats or seafood, things like that. And then if you have to do any exogenous supplementation, like a lot of people who live in the north, and who are, you know, slamming cod liver oil, maybe vitamin D would be helpful, but you know, and a lot of those, yeah, it's I would do diet first and then add things afterwards and try to build from the diet in the first place. And it's, it's, I would shock on the approach from in the beginning. And then kind of see where the chips fall before you do any massive amounts of testing again, because of expense and because you may also improve a lot of things without without necessarily needing to do like this matte like massive panels and whatnot.

Jay Feldman 4:33
So yeah, definitely. And just to clarify, on the color side, you were being facetious there. Yes, we have a recent episode where we're talking about issues with cod liver oil, there would not be a way that we recommend getting vitamin D. We'll link back to that

Mike 4:46
I have emphases is like quite a few times through here. So hopefully, evil people realize that like, I'm not serious about some of these things. It just some of them are so funny like the cod liver oil thing like the there's no cholesterol level that's too low. all type of stuff. What else? Did I say the temperatures thing. Whereas like you discriminate against people with low temperatures, things like that. They're all jokes. None of those are serious.

Jay Feldman 5:10
I think yeah, and I think we, we were laughing enough to make it clear that we weren't serious about those things. And I'll try to link to places where you've talked about that, in case anyone's unsure. Yeah. But that does bring us to a an important thing to discuss here, one of the more important ones, when it comes to sorting out the thyroid status, assuming that we've done all the prior things on the diet side and lifestyle side, we've really created a solid foundation where maybe we're ready for some extra supplementation, we want to and also considering the vast majority of people that are put on T4 From the beginning, what you know, by the doctor, whether diagnosis, hypothyroidism, hypothyroid, we want to dig into all of that, for context as well. I think the place where these where it can be helpful to supplement with thyroid hormone is a situation where we've got those foundations in place. But some of our symptoms have been resolved. And part of that could be due to the fact that over multiple years, whether it's a couple or 10 or decades, we have adapted to an environment that we've put ourselves in maybe thinking that it was a better environment, in a world where we're cutting calories and using lots of fish oil, and whatever else it is, you know, kind of carbohydrates. And that has cemented deeper deeper our adaptation to those things over time. And that can evolve lower thyroid activity and lower metabolism. And so in order to speed up the adaptation process to a thyroid supportive environment, it can help to use some thyroid hormones to kind of mimic that state and help getting things going a little quicker. Just for reference, we talked about this in terms of the fact that T3 has a positive feedback mechanism on its own production, increasing metabolism on its own is going to also lower stress hormones, because it's going to increase our energy production. And so that's also going to have some positive feed forward effects. So this can be a way to speed up our adaptation process when we're in a place where we can handle it. When we're in a well fed place, I've addressed all these other things. Or if we're having a lot of trouble adjusting his earlier things, sometimes using a bit of thyroid hormone, can help us get out of those and help us get through those so that we can then make other changes. So it's a, it's an area that can be really fruitful, it can be really, really beneficial when done properly and carefully. And we want to make sure it's in the right context. And also we'll talk now about what we want to do if we are in that place, and why the vast majority of times T4 monotherapy, meaning just using Synthroid or levothyroxine is a pretty bad idea and doesn't actually fix the issue. It just lowers TSH, which tells your doctor hey, things are okay, even when they're not. And there's quite a bit of literature and I'll share a few quotes that very clearly exemplified describe this. Yeah, go ahead. I,

Mike 7:50
I don't have too much to add to what you said I pretty much agree.

Unknown Speaker 7:52
Okay. So

Jay Feldman 7:54
just again, as a starting place, those people who are dealing with hypothyroidism, not only are they dealing with low thyroid hormone production, but they're also dealing with low conversion of T4 to active T3, high conversion for T4 to the inactive reverse T3. Not only inactive, but problematic, or suppressive reverse T3. So what that means is that if you add T4 to that system, not only will it not solve the problem, but it will often make it worse by increasing reverse T3, which has all of its own suppressive effects that we talked about where it competes for T3 for its activity for its binding sites. And it also competes with T4 with the D1 deiodinase enzyme, meaning that you're gonna have basically less conversion from T4 to T3 via D1, via deiodinase one, so that reverse T3 is pretty problematic, and can actually lead to reduced T3 production, just by supplementing with T4. So to say that in another way, if you just apply T4 to an already stressed system that's hypothyroid inactive for any T4 to T3. Well, it can actually lead to lower T3 production than you had prior along with suppressed TSH at the same time being another mechanism there as well as the elevated reverse T3 being the other part there. Yeah. And we see this in the evidence, you know, in the research and everything, where the T4 basically causes all these issues, and I'll share some of those quotes. But the important piece that we talked about earlier in terms of feedback is that the hypothalamus and pituitary deiodinase enzymes are not affected by the things that the DI only sensitives are affected by an all the other tissues. So that's why even when the rest of the body is low in T3, low and active thyroid hormone, taking the T4 can lead to local T3 Production inside of the hypothalamus and pituitary, which is the feedback mechanism today that they use, which is why you'll still result in a low TSH production despite the fact that the whole body is dealing with low T3 and hypothyroid state. So it can really lead to quite a bit of disruption and make things considerably worse than they were even prior. And with that in mind I don't know if I've seen anybody who has started from a hypothyroid state was given T3 Or sorry, given T4 by their doctor. Yep, yeah. And actually had a notable improvement in anything other than it changed TSH levels. And part of the reason for this as well, this is something that Ray peat had cited quite a bit, is what they were looking, they were comparing T4 to, for example, desiccated thyroid, they tested it at young, healthy males who are in their 20s. And that's the exact population that's going to have, for the most part, especially in that time, maybe not so much anymore, but at that time, that's the population is going to have at least issues with T4 have the least issues with conversion, and they are going to be dealing with all these problems. So to then state or assume that T4 is going to have a similar effect and somebody in a hypothyroid state is, is just irresponsible, I guess you could say. And that's what's happened. So I'm going to share a few quotes here unless you want to jump in first, right? And Mike,

Mike 10:55
yeah, so the only thing I want to jump in and discusses, or at least clarify is why you're seeing lower T3 as well, when you use the T4 monotherapy is when the T4 suppresses TSH, your own thyroid glands, production of T3 will be decreased. So usually your thyroid gland produces T4 and T3, obviously, the T3 component is going to be lower. But if you're suppressing that TSH value and you're in this hypothyroid state, now your thyroid gland production of both hormones is going to drop because you have this exogenous T4. And in that state, you're also going to have a ROS also going to have a, like an impaired conversion process of the T4 to T3. And you're going to have that elevated reverse T3. So you're going to a state where you're you're putting in the T4, it's suppressing TSH, so the suppression of TSH, that's probably a good thing overall, but you're also suppressing any T3 output that you had, and then that T4 is not being converted into the active hormone that you need. So overall, it's most people that I've seen, just to tag on to what you said on the end there that go on T4 therapy only with the hypothyroid state, I've seen them either feel absolutely nothing, or have some people actually feel a worse and their symptoms get worse. And they're like my TSH is depressed. But I actually feel worse overall. And they're I don't know if this these are the specific studies you quoted, but there are some studies looking at people's responses to nd t versus T4, or versus synthetic T3 T4. And they found that I think greater than 50% of the population you are I think it's even higher than that prefers actual therapy that contains T3 in it, not just T4. And I think one of the quotes maybe there I'm not sure. So we'll see what you have quoted there.

Jay Feldman 12:37
Yeah, yeah, there's quite a few studies showing that the combination therapy is needed to normalize tissue T3 levels to levels to normalize the metabolic rate, to normalize cholesterol and LDL levels, and mood and energy and body weight. And there's a ton of studies showing that people prefer it subjectively, they prefer to be in the combination therapy, it's pretty overwhelming. I've just started, just shared a couple of quotes here, just because they're very clear in their description of it. And talking about the mechanisms a little bit, and this to the general situation, but I'll link to or cite those other studies showing that that combination therapy is much more effective for those things in the

Unknown Speaker 13:15
shownotes. Yep. Awesome.

Jay Feldman 13:19
So And just to clarify, also, what you were saying is that with the suppressed TSH for T4, that means that pretty much any production of T3 you had from thyroid gland, which is a small portion of the total T3 is not going to be produced and that the other side, as you were saying is the other T3 into circulation that typically comes from the T4 to T3 conversion and delivering kidney, kidneys, that is also not going to happen due to the D1 deiodinase one suppression that's already going on. And that is made worse than the T4 state or the T4 monotherapy. Supplementation state. So yeah, all in all, it's basically at every angle making putting in a state of lower active thyroid hormone. Yep. So with that in mind, there's a couple of additional studies that were done in rats that showed this very clearly. And they they just did again, they were able to show it more clearly that has been shown in humans, even though we do have, as I said, all of the studies that show the benefits of of combination therapy to just a regular T for therapy in humans and with those parameters. I'll link to those but here's a couple of nice quotes. The first one is from a paper titled replacement therapy for hypothyroidism with thyroxine alone does not ensure euthyroid ism and all tissues as studied in thyroidectomy used rats and again in rats, it's much easier to measure thyroid hormone and all the different tissues and do biopsies and things like that. Yeah, so that's part of I can see it more clearly. So the quote here they state no single dose of T4 was able to restore normal plasma thyrotropin, which is TSH, T4 and T3, as well as T4 and T3. And all tissues or at least restore T3 simultaneously, and plasma and all tissues. Moreover, in most tissues the dose Have T4 needed to ensure normal T3 levels resulted in Super physiological T4 concentrations. And conclusion euthyroid ism is not restored, and plasma and all tissues have thyroid atomized rats on teeth on T4 alone, these results may well be pertinent to patients on T4 replacement therapy. So what we're essentially saying here, just to kind of put it clearly, in other words, a bunch of different things or measurement that different hormones, but essentially, you could not, or they cannot restore normal levels of T4, T3 and TSH in the tissues or in the plasma muscle, what's looked at in the blood using T4 alone. And if in order to get normal T3 levels, they had us massive levels of T4 dosing. And at that point, you had very, very high T4 concentrations, and probably super suppressed TSH. And again, this is not in a hypothyroid rat, which would have conversion issues. So this is an if you took this to you know, to a human This is a human who is not hypothyroid to start, but who has normal kind of thorough conversion and just doesn't have a thyroid. So this is our atomized rats where they took out their thyroid. If you'd like to consider a situation where the human has T4 to T3 conversion issues, then you still wouldn't be able to restore normal T3 levels with the super physiological T4 concentrations. So yeah, it's it's pretty damning here as far as T4 monotherapy goes, yep. Next one is from a paper titled only the combined treatment with thyroxin and triiodothyronine ensures you thyroidism and all tissues of the thyroid active mass wrap. So this is basically a follow up study looking at what happened when they spoke T3 and T4 together, and they state that circulating and tissue T4 levels were normal and all the groups infused with thyroid hormones are the country T3 In plasma and most tissues, and plasma TSH only reached normal levels what T3 was added to the T4 infusion to bind replacement therapy with T4 and T3 and proportions similar to those secreted by the normal rat thyroid completely restored euthyroid ism and thyroid optimized rats had much lower doses that T4 are much lower doses of T4 than those needed normalized T3. And most tissues when T4 alone was used, if pertinent to man, these results might well justify a change in the current therapy for hypothyroidism. So again, what we're seeing here is that we had these issues when we tried T4, only it didn't work very well. Why don't you do T3 with T4, and a thyroidectomy sized rat, that was able to completely restore normal T3 and T4 levels of tissue and in plasma. So that is again, a really important and clear finding here without the confounding variable of issues with T4 to T3, conversion, and so on may consider that that's even more of a reason to be careful about using T4, sometimes even at all, and we'll talk about that in a moment.

Mike 17:49
But Jay, how can you sell statins? If you use T4? T3 therapy?

Jay Feldman 17:53
That's a great question. I mean, the number one most prescribed medication in the states might might be undercut a little bit if you start using proper thyroid hormone replacement for hypothyroid state and obviously, that would not be something that benefited that industry. Yeah, of course.

Unknown Speaker 18:16
Alright, so last

Jay Feldman 18:18
quote I want to see it here is again from Holtorf. His paper titled thyroid hormone transport and to cellular tissue. The quote states that because the T4 transporter is much more energy dependent on the transporter for T3. It is also not surprising that T4 Preparations are generally ineffective, and the presence of such conditions, while T3 replacement is shown to be beneficial. He cites a bunch of papers in his his paper that are worth digging into as well. But what he's saying here is that if you're having an energy producing production problem, which of course, it's going to be the state of fear and hypothyroid state, or any, you know, if you're exposed to anything else that's inhibiting energy production, then you're not even going to your cells are not even going to be able to take up T4 Let alone converted to T3. And instead because T3 has much lower energy requirements for uptake, then it will be much more easily taken up and then be able to actually restore benefit or create some benefit. So it's just another aspect to consider here as far as why T3 might be particularly necessary compared to T4 supplementation.

Unknown Speaker 19:20
Yeah, I think I think

Mike 19:21
just across the board if you take all the evidence into consideration the rat studies some of the experimental studies in humans looking at T3 supplementation and use and effects of some of these different markers like cholesterol, body weight, etc. And then subjective feelings for people and and you also consider at least on our end, what we've seen with our clients when they've gone from T4 Only therapy to combination therapy, it I think it just makes sense that that it's like probably the best way to go. And I don't really see a place it particularly for people who are really having thyroid issues and are under stress or have conversion problems to use just a T4 monotherapy Yeah, it really looks like I know, it's not the standard of care. So I guess we have to be careful. But based on this, this, this level of data and like from what you're seeing in real life experience, like I've seen people who are on T4 monotherapy, switch to T3 and T3 for combination or to natural desiccated thyroid, and then immediately just thyroid symptom, their weight started, they start to lose the weight that they had a hard time losing their cholesterol levels drop, they feel significantly better, and a ton of tons of symptoms start to improve. And so the other thing that winds up happening is in when they're, they start to look at their labs, it's like, the doctor freaks out because TSH is lower, it's like that's now too low. And then it's you have to reduce the first thing all your T4 dose is too high. But yeah, I've seen a lot of people improve sick dramatically, just adding T3 to their T4 or to trying natural desiccated thyroid, whereas the T4 are on it and basically doing nothing for them. Even some people that TSH will just continue to rise even. And then they have to keep adjusting the T4 dose up. And even at like super high doses, they're not finding any necessarily significant change in symptom profile. So there's also some interesting studies where they actually look at the T3. I think one of the studies, they looked at the T3 and T4 concentrations in the tissues, and they basically show them on the different replacement levels. And you can see in like cerebellum versus muscle versus heart versus kidney versus liver, that is with a T shirt, like a regular control group versus a T four versus a T three T four T three, that the T four groups levels are def definitively like insufficient compared to what they were prior to think thyroidectomy and then thyroid hormone replacement. Yeah, yeah,

Jay Feldman 21:49
that's a great point. And the other thing too, is when you actually do proper replacement, including both T3 and T4, desiccated thyroid, not only do you see improvements and symptoms and everything, but you actually see improvements in those other thyroid hormone values in the serum. So you see the T3 value actually come up, sometimes T4 as well, depending on the dosing, and you actually see the reverse T3 Come down and you see the TSH staying low. And you'll also see cholesterol coming down and all of those things. So yeah, you actually when you're actually looking at the things that indicate that reset is much more effectively you see those shifts as well. Yeah. And so the important piece that we're getting at here is that if someone's dealing with hypothyroidism and they're in a place where they are ready for that supplementation based on what I described earlier, based on that larger context of already having addressed a lot of the foundations, then it can help to use some thyroid hormone. And when doing when doing that we would generally recommend not doing T4 Only, of course check with your doctor, all the disclaimers, you know, like all the medical disclaimers, but I would definitely consider using T3 or looking at to just accept T3 Either on his own or in addition to T4 or as we said he is he's a desiccated thyroid. And I often find that using desiccated thyroid is and I think you've found the same that using it desiccated thyroid tends to be easier and works better than trying to sort out doses between T3 and T4 because of a couple of reasons. One reason is that the because there aren't synthetic because the desiccated thyroid is not synthetic. I think there's slower digestion, some of the thyroid hormones are bound up with some other components like the thyroid globulin, which Amy's that you get those other like proteins like the thyroid globulin, but it also means that it will digest a little slower. And so because of that you have a slower trickle of thyroid hormone coming in which I think is easier to dose and handle relative to using the synthetic T3 and T4. You also get the benefits of some of the other thyroid proteins in addition to the thyroid globulin. So things like T one and T two. And T two has been shown to have some biological, physiological effects in terms of stimulating mitochondrial respiration, having benefits with fatty liver and with weight loss. So there can be some benefits there as well. So I do think that that's often a place to start for a lot of people. If you're looking to reverse your hypothyroidism with clear action steps and strategies, along with personalized guidance from me, head over to Jay Feldman wellness.com/solution where you can find all of the information for the energy balanced solution program. This program includes customized health coaching, a video library that includes a video that talks specifically about how to evaluate your thyroid status, using bloodwork and symptoms, as well as when you should supplement with thyroid hormones, how to properly dose them and how to pick the right product. It also includes resources like a sample meal plan and a supplement guide as well as a private community. So head over to Jay Feldman wellness.com/solution to check out all the details. And there's quite a bit of of different values that you'll see that are referenced for the T4 to T3 concentration and desiccated thyroid, the main one that's thrown around as nine to one. But when you look through the research, and this happens with research on pretty much any subject, one paper will come up with something sometimes it's based in reality of, of some paper they're citing. Sometimes it's a misinterpretation of a paper they're citing or whatever it is. And then that gets repeated throughout the literature. There are many, many more studies. And you trace back to this one first paper that was citing this one study that maybe was heavily flawed, or actually was saying something different, it was misquoted or something like that. And that's something I've seen with the ratio of T4 to T3, where most studies seem to show that with standard bovine thyroid, the, which also poor scientists use as well, like picked out, right. But when it comes to bovine and sheep, typically I've seen between a two and a half to four to one ratio of T4 to T3. I want to say that the poor sign thyroid is similar as well. But you'll see for whatever reason that a lot of people, or a lot of websites and things will say that it's nine to one, as far as the ratio of T4 to T3, for bovine thyroid. And, yeah, there was maybe one paper that was setting it. But again, it was kind of in contrast with all of the other papers that were showing that was actually a lower T4 to T3 ratio, which would generally be better, generally that, you know, two and a half to four to one of T4 to T3 is a pretty good ratio for most people and leads to pretty good outcomes, with the consideration of most people having the conversion issues and everything. And I'll be considering a similar ratio there when it comes to, you know, if you're using synthetic T3 and T4, individually, trying some somewhere that two and a half to four, two to four to one of two to four of T4 to one of T3. Now, there's a couple of other things that I would mention here, whenever you're dosing or supplementing with a thyroid supplement, if it's creating stress symptoms, that can often mean one of a couple things, it can mean that it might be too stimulating and too much for what you're able to handle due to a variety of reasons. And so with that in mind, you might need to reduce your dose or increase slower. Another thing as well is that if you were having severe conversion issues, sometimes any amount of T4 can be problematic. And so you might need a higher ratio on the T3 side, or maybe just sticking with very low amounts of T3 for a period of time, you know, and seeing how that goes before maybe bringing some T4 in or maybe not depending on what's necessary. There's a lot of nuances here. Again, check with your doctor or health practitioner. Don't do these things on your own all those disclaimers, but those are just some things that I would consider.

Mike 27:42
Yeah, my personal experience. I've personally worked with clients and also using thyroid myself, I found that MDTs easier to dose. These you can take it in terms of like half a grain or a grain and an Brodus bar proto barns work he was using natural desiccated thyroid. So I found that the easiest way to go the other thing is, and I think part of the reason why is because the the natural desiccated thyroid has both T4 and T3 present, as we discussed puts it as the other components, but it has both hormones. Whereas when you're using something like T4 and T3 only therapy like as in the form of synthetics, what I find is that if you just take them in the morning, the T3 Half Life is short. And so you wind up having to dose the T3 and other time and then maybe another time. And so and then getting that dose right and timing you with meals and stuff like that can be a little bit difficult. Because because of the effect of T3. So like with that half that short half life, what you'll find is that the T3 will have its effect for like a few hours, and then you'll kind of like start to feel that wear off. So I've seen quite a few people who've had that experience using T3. insulins like you, you're gonna have to dose it like multiple times. The other problem with the T3 only therapy or not T3 only, but like the synthetics is sometimes it's hard to get T3 doses or tablets that give you a smaller dose because sometimes like a massive dose of T3. So like I think some of the the sign ml tablets can be like 25 mics, which is quite a bit to do in one dose. And so I find that, like breaking that tablet down can be hard, especially because you usually want to usually we'll see that like maybe five mics is enough for that like program, by the way programs. Yeah. So you may find that that's like a better dosage overall. And it's kind of hard to split that type of up. So with the MDT it's just been easier than trying to micromanage the T4 and T3 amounts to just dose in terms of half a grain or grain. And then you can the way I usually have people do it if they're if that's something that they're interested in, and that's what they're trying like, a way that I recommend that they try it is maybe take if they're say they're on two grains, they could take one grain in the morning and then one grain at lunch or are one grain in the morning and one grain at dinner. And they just take it with those different meals. And other piece that I get asked a lot about thyroid is in terms of like how to take it. So thyroid hormone does interact with a lot of minerals and components of food and whatnot. So what I usually recommend people do is take it maybe like 2030 minutes before the meal, and then like have a meal afterwards, so that you you're not necessarily inhibiting or any too much of the absorption of the different components and whatnot. And the reason I want people to take it with the meal is because you're gonna press the gas pedal on metabolism, so you want to make sure that you have some substrate available. So now, in some cases, some people do like, the synthetics better. And, and in that case, I would, you know, it's kind of like mileage may vary on what works for the individual. So I'd really test out and see what you like do you like and natural, desiccated better, as if if natural desiccated is working, then you may not even have to try synthetics, if it's not working as well as you'd like, then maybe synthetic may be worthwhile. And I've had some people who like to take like a grain of natural desiccated thyroid in the morning, and then they want to dose T3 by itself later on in like, different spurts. So you can there's different ways to skin, the cat with the thyroid hormone as far as using both T3 and T4. And it's going to come down to making sure that you like that you're testing it out for yourself and seeing what works. And that's where symptoms and whatnot. And temperature also become really important to keep track of are these things working for you how you want them to work? And is this exactly is this dose appropriate for you. And so it's really important, again, to keep track of your temperature while you're using these different things, and then keep track of your symptoms. Another thing that I found and this is is that in certain people they made like for example, when I first tried thyroid, I tried T3 Only just to see the effect, and it absolutely like crashed my system like I had died to sleep for like 20 hours, I did not do very well with it. But I was better. I did much better with natural desiccated thyroid. So when I started using natural desiccated thyroid, I didn't get that effect. It did have a relaxing effect, a calming effect, but I was able to tolerate it much better. And then I you titrated it up appropriately, usually in two week increments on the dosing, which is what Broda Barnes had done and what Dr. Pete tends to recommend. And then I got my temperature I titrated according to the body temperature, and I got within that particular range. And I said at that dose, and I was doing well. Another thing is that the dosing can change depending on different factors, like stress levels, and then also season like seasonal changes and things along those lines. So it's important to keep those things in context, track your symptom profile, how you're feeling, etc. If you have lab values, you can look at your lab values. I think I mentioned at one point that I had changed my thyroid dosing, I had kept my thyroid dosing consistent, but I changed my my living environment like I moved to Florida. So I got out of the winter things along those lines, I changed some dietary components, and my dose actually wound up being a little bit too high for me, and I got to low cholesterol, things like that. So it's important to keep track of have to keep track of these, these different components test out which works for you. And the goal by symptoms, body temperature, things along those lines, take your thyroid with a meal, but maybe not act directly after a meal or directly before so that you don't impair some of the absorption and its effects. Yeah, those will be the main things that I recommend with playing around with thyroid. And I guess another really important one is I before I jumped right into thyroid, I would try to get the other areas right first with diet, lifestyle, supplementation, etc, for nutrients, different components and see if you can improve things without needing to use the thyroid. And the other things I find people's tolerance to thyroid is much better when those things are corrected, because as Jay kind of alluded to earlier, is if you're pressing on the gas pedal, and you don't have enough oil in the engine, say that's your B vitamins in the mitochondria, the engine isn't gonna run very well. And you may not really feel so great. So if you aren't, if you don't have enough gas in the tank, if you don't have enough oil in the engine, the car is not going to drive as how you want it despite no matter how hard you press on that gas pedal. So I'd be that's where it's like you can try to get those things right. And that doesn't mean that you can't use thyroid along that way. It's just if you're finding that you're not responding well to thyroid, then I would correct those things. And then you may not even need thyroid, if those things are corrected from the get go. Things might improve for you significantly. And you don't necessarily need to go in that direction. So, again, that your individual context is important to take into consideration as well.

Unknown Speaker 34:34
Yeah, absolutely.

Jay Feldman 34:35
Absolutely. There's a lot of great points there. I want to go back through a few as we wrap up here. One that you mentioned was the half life, which is an really important consideration when looking at T4 and T3 dosing. So as you were saying the half life for T3 is in our range when it's about six hours. The half life for T4 is much longer, maybe about seven days, 10 days or so 10 days. So with that Yeah. And so with that in mind, you won't, with the T3 dose, if you're just changing T3, you can recognize the full extent of that dose within a day. So maybe you know, within a couple days, you can make an adjustment for doing anything with T4. Whether it's T4, only or desiccated thyroid, you won't actually know the effect of your changes dose for a couple of weeks are normally about two weeks 10 to 14 days, because that level is going to either build up or decrease depending on what you changed over that period of time. So if you go from, let's say, 50 micrograms of T4, just to make it simple, 200 micrograms, you're going to continue accumulating T4 levels for the next 10 to 14 days. So you won't actually know what the effect is from that dose until 14 days later. So that's a really important consideration to keep in mind when adjusting your thyroid dosing. Again, the T4 contained in desiccated thyroid will be important there as well as the T4 if you're doing a synthetic T4. And that can also help you differentiate what effect is due to a T3 level versus a T3 T4 level, if you're taking a combination product, whether it's synthetic or desiccated. You know, changes that affects over the first few days are probably going to be more related to T3. Whereas changes after that point are going to be more related to the T4 level change. So you can use that to help adjust your dosing if you need. As far as the timing, so though the mettalic, the amount of the dose and the timing, most T3, synthetic T3 products are available at very high dose in like 25 microgram tablets. And that can cause a lot of issues. If you're taking that all at once, it's a pretty huge dose of T3, it's almost the amount of T3, we would produce an entire day, or you're getting it all at once, you're gonna get a huge spike in a short period of time, which could cause issues and that are going to have a much lower levels at later points. So that is going to be much less effective for replacing thyroid hormone compared to just doing lower doses spread out throughout the day. So that's a very important consideration. And the way that, you know, most doctors had been shut hot or told just you know, to prescribe T3, if they were to is just to do it on one dose, there's not really often a consideration of doing it throughout the day. So that is extremely important when it comes to using any sort of T3 supplement. Again, whether it's into desiccated product or a T3 only, you want to make sure you're spreading out that dose. And you mentioned concerns having it with food with absorption, which there are concerns in terms of absorption. And the things that are most often cited are calcium, also coffee as things that can inhibit the absorption. However, my preference is. So for one, looking at the literature there, the changes of absorption are relatively small, relative to like the total amount of power that gets absorbed, and often require large amounts of you know, whatever the substances to inhibit it. So I'll cite some of these but you know, a sub it requires really to get a good portion that's reduced. So there's a study is looking at calcium carbonate, it required two grams of calcium carbonate to reduce the T4 absorption from 83.7% to 57.9%. So it's you know, that's a decent decrease in percentage, that's with two grams of calcium carbonate taken at the same time. And so if you're looking at it in the context of a whole meal, I'm less concerned about that. The other thing, as well as there are other factors too, you know, like fibres can also reduce the absorption among other things. But the reason why I don't care as much is because even if you know at most meals, on average, you're only getting like you're getting, let's say, a 25% decrease in absorption, I would rather have that with a slower digestion and a slower absorption than to have you take the thyroid medication, especially the T3 containing one on its own, and have the possibility or the likelihood of stress induced stimulating effects, because you're taking it before a meal like when you're not fed. So that's my personal preference. I don't know what your thoughts are there, Mike. But I prefer to take that slightly less absorption and just maybe you take 25% more to have the same effect. But this way, at least it's digested and absorbed slower, as opposed to all at once.

Unknown Speaker 38:57
Yeah, I mean, I and I've usually

Mike 38:59
just had, personally I've usually just taken a little bit before a meal. So I haven't had necessarily a super stress effect from that. But I also eat consistently. So I'm not letting my I'm not like waiting six hours, seven hours, Tina meal, taking my T3 and then like not feeling well and then having the meal usually I'm like pretty decently well fed and I was dosing with the meal and just taking it like a couple minutes before I also wasn't using T3 Use MDT. Okay, and so I would take the MDT before and then I would have the meal and go from there. And only again it only be a couple minutes before and I guess it kind of goes with the dietary setup because I would usually have the way I set up the diet is like have the juice like juice and fruit first let that kind of digest a bit. So I will take the T3 then and then I would wait the the 20 minutes or whatnot and then I'd have like the main course which would be your protein, your fat and your vegetables so that may have all that may alter it as well considering there is carbohydrate available with the NDTV usage?

Jay Feldman 40:04
Yeah. And there's probably fiber there that will slow the absorption as well. And if you're talking on a few are you having like with this smoothie or a few minutes before it even?

Mike 40:12
Yeah, that's like a like right before I would start to drink the juice smoothie, I would just, I would have the MDT.

Jay Feldman 40:19
Yeah. And that's also different from the situation, which is, yeah, well, so and so I have clients who were, you know, taking T3 When they first woke up, and they were told to wait 30 to 45 minutes before they ate. And when you wake up, you're already in a low fuel, stress state, low energy stressed state. And then you're adding T3 On top of that, and then you're not eating for a while. And so I think that's much more likely to cause issues. And yeah, so there's kind of a big contrast there between what you were doing, which I think would be totally fine and not cause an issue versus what somebody might be typically told to do due to the concern about reduced absorption. Yeah,

Mike 40:55
and I usually, if people were on T three t 430. Therapy, I would usually have them like the T3, Jews would be dose, that of the T 43. In the morning, and T3 doses would be later on in the afternoon. So they would never be getting a massive dose of T3 right away in the morning, it'd be like spread out over time. Considering the half life and maybe like three doses in a day or two doses and day, depending on what they had going on. And always around. I think, whether you have it directly with a meal, you increase your dose, or you have it a couple of minutes before I ultimately always recommend having somewhat close to that meal, so that you're not like, again, pressing on the gas pedal without fuel in the tank.

Jay Feldman 41:35
Yep. Yeah, absolutely. And yeah, sometimes even doing very small T3 doses that are, you know, four to six times a day, while it's less convenient that sometimes works better for for people, you know, depends on your sensitivity and everything. A couple other things I wanted to mention when it comes to diet supplementation as a whole. One is just a small detail, which is that when looking at a desiccated thyroid product, you can generally estimate that about 100 milligrams is going to be the equivalent of one grain, which as far as the grain goes, which is just an awful measurement, but that's what's used with hormones. When you're looking at a desiccated thyroid grain. Normally you're talking about 38 micrograms of T3 and nine micrograms of T4

Mike 42:16
grams of T4, nine of T3. Yeah,

Jay Feldman 42:18
thank you. Yes, that's the Yeah, that's the standard when it comes to like the armorer thyroid and some most desiccated thyroid products are going to be about that when you're looking at about 100 milligrams just for reference.

Unknown Speaker 42:29
A couple other things. One is the

Jay Feldman 42:33
general thought process of thyroid hormone supplementation as a like hormone replacement versus even just something that we would have naturally been getting as a food source. So if we consider that we're, we would typically have eaten the entire animal that would often include all of the glands and different amounts and organs and things like that, and the thyroid gland being one of them. And so you do see some more traditional cultures that still consume some amount of thyroid in their normal diet. So fish head soup is a pretty common one. chicken necks are often consumed or used in soups and things like that. So there are situations where we would have naturally been getting some amount of thyroid hormone from our diet. And it also apparently used to be something that was used and sausages and hamburgers, anything with ground meats, they would also grind and use the thyroid gland in there. But there were some regulations introduced, I believe was in the 1980s, that led to a situation where it was the amount of thyroid in our, you know, was regulated in the, in the meat and supposedly some plant put a ton in there and supposedly led to some heart attacks or something like that. So a lot of kind of correlation. But as a result of that, it led to regulation where now that's not allowed to be included anymore, in like ground meat products, at least in the States, sausages, hamburgers, and things like that. So it's just a long way of saying that we would have been getting some amount of thyroid hormone from our food as well. And so, yes, we can look at it as a supplement or medication if you'd like. But I think we can also think about it more as, as some amount of it of it being a normal food source. So yeah, my just help kind of contextualize that in, in a different sense. And I still, you know, I do think of it as a supplement, but maybe one that would have been a normal part of our environment and might have been particularly supportive, or a particularly supportive part of our environment. Yeah. Last thing I wanted to mention, and I'll let you go ahead, Mike, as we as we close out is just that there is often a concern when it comes to using thyroid hormones that it will suppress our own thyroid hormone production. And it will do so and over suppressing our own TSH, or if we're providing a lot of T4 and T3. It will reduce our direct hormone production. And I would basically say that's totally fine. While we're supplementing with thyroid that's kind of the point is that we are providing the thyroid hormone or some amount of it, the exam And as Lisa, we don't, we don't need to produce an endogenously because we already we're not producing enough indigenously. However, if we're fixing the system, if we're restoring energy production, and reducing the stress hormones and all of that, it should really propel us forward to a point where then we can reduce our thyroid hormone usage at some point, and then our on thyroid hormone production will be restored and will be actually better than it was in the first place. So just because we're short term, suppressing our hormone production does not mean that that causes any issue long term, or that it wouldn't be a good idea.

Mike 45:33
I think that comes out of comparisons when people start using exogenous anabolic steroids, anabolic androgenic steroids and seeing that you get like a very strong shutdown of the hypothalamic pituitary gonadal axis. And it basically takes a while to come back in with the thyroid supplementation, something that I've seen is there is a period of time of a rebound, were following whether you're on thyroid supplementation, you will suppress TSH, and you will suppress your actual, like your own exogenous endogenous production because you're taking it exogenous ly. So when you stop, what you will find it what I've seen is that you can have like this temporary increase in TSH, where the body's trying to say, Hey, I'm going to say stop me and stop taking exogenous thyroid devising Hey, we need you to make thyroid now. But I haven't seen situations where they can put the thyroid axis gets completely suppressed, and like it doesn't recover. And the reason I think this is because like the thyroid hormone is so imperative. For bodily functions, it's not something that like just completely shuts down, I get, I've seen people recover pretty quickly, when they stop using thyroid hormone for whatever the reason was, and they just have this momentary period of time where TSH will bump up, and then it will come back down once the like normal production of thyroid hormone by the Klan resumes. So yeah, and for me, the biggest thing was never like is this because whether you classify it as a food supplement, or a drug or hormone replacement, for me that I, I never really was like, worried about what it was considered like it does the term the characterization of it, or the Yeah, the characterization of it didn't necessarily matter or categorization. It was more like that was something that I was more considered about, like, what is this? What is the long term ramification of using something like this, and essentially, what you see is, there's largely benefits to using thyroid, particularly if you have a low thyroid state, or if you're coming if you're, if you're using it to come out of some of these sub clinically, subclinical hypothyroid states and improve your overall thyroid function. And then with the lack of risk of suppression, it kind of minimizes the downside. So if you get the dose, right, you're using it appropriately, your diet and your nutrient status is built out appropriately, then there's a it's like one of those compounds where that's largely an upside. So for me, it's like it's kind of hard to it was kind of hard to say like, why not try to use it to come out of some of these problematic states, because if I stop, my thyroid production will resume, maybe I'll have an in this, this came later seeing that there was a period of time of adjustment, maybe I'll have a period of adjustment. But I'm already in the hypothyroid state from the beginning from all of this exercise and low carb and keto and whatever else I did. So if I can use that to kind of move the needle in the right direction in conjunction with these other things, it's another tool in the toolbox to get you the outcomes and get you where you need to be with mechanisms that actually make sense. Right? So minimal downside mechanisms that make sense. And get you the outcome. For me. I was like that was like the I was sold. That was the overall selling point. Because I know there are hang ups around the idea of drugs versus supplements versus herbs, or, or, or whatever the or hormonal replacement or whatever the deal is. But I think the big picture, at least, to some extent, at least in my circumstance was looking at what is the bet? What is the risk versus reward of this situation? And how is this compound actually working? What is it is it? What is the underlying mechanism? Does it make sense in this context that I'm looking at things through? And is there like, what is this huge downside and basically, that I think that there's very minimal downside to testing things out and seeing how you react now some people do get negative reactions to thyroid, that is definitely something that exists. But a lot of times I think that's a function of the state and other things that are going on and and I have seen people be able to have a negative reaction initially. And then down the road, when you correct a couple things. The their response to thyroid hormone improves dramatically. So yeah, that's the perspective that I like I discussed with clients and I also like to come at, fraught with the thyroid supplementation to get over this fear of whether it's hormonal support or things along those lines are natural or not natural or whatever the different concerns are. It's like, what are we are we moving the needle where you want to go and are we doing it in a way that actually makes sense. And is there really a heavy risk to moving it in this mech via this mechanism?

Jay Feldman 50:07
Yeah, absolutely. I think that that is a, like the best way to look at a substance that we're introducing. And as you were saying, some people just happen to have certain hangups run something that's considered a pharmaceutical. And so this might, you know, the idea that it's maybe also a food or more of a food or something we would have gotten in our diet compared to a pharmaceutical medication can eat some people's concerns. But you're right, that even if it were fully pharmaceutical medication, it doesn't inherently mean that it's problematic. And we want to evaluate it using those other sorts of parameters. And, yeah, that's kind of a separate conversation, but an important one that maybe we'll dig into another time. But, yeah, I think it's important to share and you're right, as far as the concern about, you know, the suppression of endogenous thyroid hormone production. It is, I think, normally coming from the equivalent concerns with anabolic steroids are just the use of testosterone replacement. And I often think that that is also a misplaced concern, where what's normally happening, they're happening there is either a, somebody who is already having low androgen production, is replenishing the androgens not fixing anything that led to it in the first place, and then finds that, yeah, when they get off of their androgen, their testosterone goes just magically where it was before, if not lower, right. I mean, of course, it's going to either naturally fix the system, the system or the situation. The other ones who was the other time when it's used largely is to get over, we're kind of force access, performance or muscle production, when you are creating a context that is not actually supportive of that, meaning excessive exercise, or just trying to push those things to extreme limits. In which case, yes, your normal signals are going to be trying to reduce thyroid hormone and reduce testosterone and all of that. And you're trying to override that with the hormone replacement. So of course, when you stopped the hormone replacement, those values are going to tank. So I think that that's largely a phenomenon of those issues, not a situation where there is something unique to the substance that actually like breaks your testosterone production or breaks your thyroid hormone production. It's just a normal part of the feedback mechanism in the larger context of what you're doing. So anyway, I think that it was just kind of trying to quell some of those concerns or fears for people who might have them. But as we're kind of saying these things can be extremely supportive when used in the right context. And that context involves also addressing the other aspects of diet and lifestyle and everything else, normally prior or to junction, depending on the details that are so certainly an important thing to consider when addressing hypothyroidism. Yeah,

Mike 52:39
and just to tail on to what you said, a lot of times dosage dosing within the body buildings here for these androgenic compounds are ridiculously high compared to what a physiologic level would be. And the same thing happens with thyroid hormones there, where it's like, I'm going to go on a cut, I'm going to eat low carbs and low calories and have higher protein intake, and then I'm going to exercise like high amounts, and then I'm going to take really high doses of T3 to lose weight, hence, like it, I'm sure it works. But the question is what is like the long term ramification of of doing something like that, and then they there are there are definitive problems like that, and you can see things along those lines. And then also, the lot of the comp, it's not like test base is something that or test, astor's or something that was recommended, but a lot of other compounds are added to the situation that have multitude of different effects besides just androgen or anabolic signaling. So yeah, that it's not an apples to apples comparison. You're

Unknown Speaker 53:38
right. Yeah, that's all right. I

Jay Feldman 53:43
hope you enjoyed that episode, and that hypothyroidism series. If you did, please leave a like or comment if you're watching on YouTube. And if you're listening elsewhere, please leave a review or a five star rating on iTunes. All those things really do a lot to help support the podcast and are very much appreciated. As always to check out the show notes for today's episode, head over to Jay Feldman wellness.com/podcast, where you can take a look at the studies and articles and anything else that we referenced throughout today's episode. And if you are dealing with any low energy symptoms or chronic health conditions, maybe these are caused by hypothyroidism or various other conditions that could be going on or other aspects of your environment. This could be symptoms like chronic cravings or hunger, low energy or fatigue, chronic pain, weight gain, digestive symptoms, brain fog, poor sleep, or hormonal imbalances, or again, any other chronic health issues, then head over to Jay Feldman wellness.com/energy, where you can sign up for a free energy balanced mini course, where I'll walk you through the main things that you can do from a diet and lifestyle perspective, to maximize your cellular energy and resolve these symptoms and conditions. So to sign up for that free energy Mellon's mini course, head over to Jay Feldman wellness.com/energy. And with that, I'll see you in the next episode.