In the article I mentioned my severely depressed TSH and rising T4 and antibodies. According to my former endocrinologist, I was becoming clinically hyperactive and my meds needed to be reduced. Thinking that less medicine is always better, I saw this as good news. Boy was I wrong!
After this visit, my doses were reduced two more times over the next 18 months after finding my TSH still hovering near zero and my T4 and antibodies were increasing. There was never a discussion on what could be causing this. My doctor knew I was practicing daily intermittent fasting (no food for 14-16 hours a day) as I asked him on multiple occasions whether that could be causing this - for better or for worse. He simply shrugged.
Fast forward to October 2012. I found an MD with a heavy slant toward naturopathy. I don't know why naturopaths seem to be the only physicians who give a shit about actually healing people, but it's certainly true in my case.
She spent almost an hour with me on our first visit taking a detailed history and ordered the most complete metabolic blood work to date - not just thyroid, but adrenals, pregnenelone, testosterone, estrogen, cortisol, DHEA, vitamin D, etc. When the labs came back, guess what? My TSH was STILL almost zero - I'm talking 0.04 when it should be between 1.0 - 4.0 area. My cortisol was also quite high. Still not clued in to what was going on, she reduced my Synthroid one more time and put me on adrenal support and a number of vitamins to reduce my cortisol.
I felt better for a few weeks, but then things started to dive. I gained more weight. I was falling asleep on the couch at 8 pm for no reason. My appetite was gone. I was cold all the time.
I started doing more in-depth research after a woman in my FFF facebook group suggested I have my reverse T3 (RT3) tested. What the hell is that, I asked? I've been dealing with thyroid issues since I was in high school and this is the first time I'd ever even heard of RT3.
So what is it?
When our thyroid makes T4 - a storage hormone - (or, as in my case, when I take T4 medication like Synthroid), our body must convert the T4 primarily into the active T3 hormone that our cells desperately need. Since our bodies are wonderfully resilient and have an amazing capacity for homeostasis, our bodies are also able to convert T4 into the mirror of T3 - called RT3. In a nutshell, RT3 binds to any excess T3 in the body, rendering it inert or unusable so as to keep our hormones in balance.
What I didn't know at the time is that the conversion of T4 to RT3 is increases under the following circumstances:
- high cortisol
- iron deficiency
- fasting / extreme dieting
- ultra low-carb diets
So, I asked my doctor to add RT3 to my most recent labs and she thankfully obliged. When the labs came back I plugged my numbers into this handy converter and found my ratio was 9.1 when it should have been well over 20! My TSH and T4 were also elevated (though it's important to know both were still within what is considered 'normal' range.) Thyroid Antibodies were lower, but still considered 'high.' The only good news is that my cortisol dropped, but now it looks like my DHEA is a bit low.
Well, well, well...turns out that our bodies run great when we don't f*#@ with them. Because of my little experiment with IF, it would seem that my body fought back by overproducing RT3 over the past two years, cutting back production of Free T3, slowing my metabolism so I will survive the artificial famine I had created for myself. At least that's my theory. We haven't checked iron yet - that's in the next round.
Why blame IF when it RT3 dominance has other causes? Well, let's take a look at the facts:
1999 - Papillary Carcinoma diagnosed; entire thyroid removed and I-131 treatment ensued. Rx .150 mcg Synthroid to suppress any potential thyroid function.
1999-2010 no change in labs tested every 7 months. Meds remain at .150 mcg.
2011, Jan/Feb - Start intermittent fasting and heavy weight training a la Leangains. No other changes other than lifting heavy weights and eating a lot of animal protein. Weight 130 lbs (skinny fat, no strength at all).
2011, March - Labs show TSH near zero, T4 and antibodies climbing. Meds reduced to .137 mcg. Weight 120 lbs.
2011, August - tried a 14-day PSMF experiment (basically all protein and green veggie fat-loss diet). Lost a few pounds. Resumed IF/Leangains. Weight 115 lbs. Doing weighted chin-ups; deadlifting 205 lbs.
2011, October - Labs show same problems, suffering from cold sweats at night. Meds reduced to .125 mcg. 5 lb weight gain ensues.
2012, January - worked with Andy Morgan for a couple of months to try to lose the 5 lbs I had mysterious gained, but the calories were way too low and I was basically passing out every time I tried to sit up. Gained a few pounds despite ridiculously low calories. Resume IF/Leangains.
2012, March - TSH slightly better, dose kept at .125. Doc tells me to live with it and get lipo if I want a flat stomach. Never prescribes labs for anything but TSH, T4, T3 and antibodies. Strength still high. deadlift 245 lbs for reps at bodyweight of 120 lbs.
2012, March - I start search for a doctor who actually cares about helping me. Stop powerlifting and start more intense cross-fit style training trying to lose the weight.
2012, October - See new doctor who finds elevated cortisol, TSH still near zero. Antibodies high. T4 high. Reduces meds to .100 mcg, prescribes natural supplements for cortisol issue. 5 lb weight gain with no major change in diet or exercise habits.
2012, November - I tried a few weeks on Carb Nite Solutions diet, weight seemed to be coming off slowly, but then went on vacation and enjoyed Christmas and New Year's. I didn't eat in excess, but I wasn't counting calories either. Weight gain resumed. Exhausted every night by 8-9 pm despite sleeping in.
2013, January - Now almost back to 130 lbs. I ask for RT3 test in addition to follow-up blood work. Find out that my RT3:Free T3 ratio is well out of wack. I have RT3 dominance and my body is not getting enough T3 - SURPRISE!!! Doc prescribes Cytomel (T3 only medication). Why? Well, T3 cannot be changed by the body into RT3. Without a thyroid gland and without T4 medication, my body will no longer be able to manufacture RT3. We are currently working to increase my T3 dose until my body temp rises 98.6 and my pulse resembles that of a living person. This probably won't happen until the RT3 decays completely over the next 2-3 months.
A sudden rise in T4 when I don't have a thyroid should have been his first clue that something was changing. It meant my body was suddenly not converting as much. Did he ask why? Hell no. My rising antibodies meant my cells weren't getting enough T3 even though it appeared I had too much because of my very low TSH. Did he ask why? Hell no.
So here I am. It's almost two years later and I have regained most of the 15 pounds I originally lost. Granted, I am hella stronger than I had been, so it's not all fat. But I am still nowhere near sub 20% bodyfat I was aiming for and seem to be going backwards. I'm hoping that my doctor and I are finally on the right track and the T3 treatment will put me back into balance. I've obviously also stopped fasting and eat when I'm hungry - smaller meals, more carbs and protein isolate shakes throughout the day. My strength has temporarily dipped, but I'm hoping it will come back as my T3 dose is increased.
I know this was a long post, but I'm hoping it will serve to help others out there who may be struggling with their own metabolic issues. Unfortunately, you have to insist on the tests you feel you need. If your doctor refuses to help you, then you need to keep looking until you find one who will. There are many resources regarding thyroid and adrenal problems here.
And though I started the FFF facebook group for women who want to learn about and practice IF and heavy weight training, I no longer recommend fasting on a daily basis. (I'm still active in the group because we discuss dozens of issues facing women who train hard.) I have to stress that, like any 'diet,' IF needs to be undertaken with great care and consideration. If after reading my tale you still want to try it, do so at your own risk. It seems to work for most people, sadly I am just not one of them.