I will be posting a readable transcript below this post as the videos can be hard to follow.
There was too much helpful information to not make a thread about it.
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Introduction
Hi, my name is Dr. Todd Lee. I am an MD, a biochemist, a medical doctor, and an IFBB professional bodybuilder. I’ve been a doctor for 15 years, competing in bodybuilding for 15 years, and coaching people for 15 years. The story has changed on the thyroid a number of times, and I’m going to try to go over what you need to know about the thyroid—not everything there is to know, because that would take forever. Honestly, after watching this, you’ll know more than most endocrinologists do about the thyroid.
Patient Scenario
Alright, let me paint you a picture. A woman goes to her doctor and says, “I’m fat.” She doesn’t put it that way; she says, “I’m chubby” or “I need to lose 20 pounds.” But I’m going to put it in Todd terms. I’m someone who does things in very black-and-white, clear-cut ways because I want to communicate information. Rather than saying things like, “Some women who are overweight do this, and some women don’t,” after every sentence, it would get obnoxious. If I make a generality, assume that it’s 51%.
Thyroid Basics
So, back to the thyroid. We have a lady who thinks she’s fat. She goes to her doctor and says, “I’m fat, I want thyroid medication.” What does he do? He orders TSH and that’s it. He says, “Oh, your TSH is high, you’re not making enough thyroid. We’re going to give you some Synthroid or some Armour,” and that’s it. She gets her thyroid medication, and then for the rest of her life, she’s trying to figure out what’s going on with her thyroid levels because it’s a total mess. This is not how you practice medicine. This is just how you do it in America.
In a world where you’re not incentivized to give people drugs, where you’re penalized for it, this is how medicine would be practiced. You would order a TSH, a free T4, a free T3, and a reverse T3. Based on that data, you’re able to determine a couple of things.
Understanding Hormones
In general, if someone’s overweight, their aromatase enzyme makes estrogen out of their available androgens, whether it’s androgens made from DHEA from the adrenal gland, or testosterone made from the testes or inside the ovaries. It doesn’t matter. The fatter you get, the more estrogenic you get. Estrogen is beneficial to a point, but that point is dependent on each individual person. Some people can get away with 100 units (or whatever the units are) of estradiol. Some people get issues with as little as 40.
The rule of thumb is, if you keep someone in the normal range, they’re healthy. There is an argument about whether or not in humans there is anabolism that occurs when the estrogen gets outside of this range, but that’s a topic for a different video.
The reason why I’m bringing up estrogen now is that as estrogen goes up, the function of the thyroid goes down. So, in most cases, the woman isn’t fat because she’s got a low thyroid; she’s got a low thyroid because she’s fat. The key would be fat loss and diet manipulation. You would provide her with magnesium before bed, zinc before bed, selenium, and iodine. This would upregulate the conversion of T4 to T3 because in obese people, stressed people, and people with a calorie deficiency (like when they’re undereating or undernutrition), the T4 doesn’t convert to T3; it converts to reverse T3.
Issues with Conventional Medicine
I’ve had a lot of people tell me that when they go to their endocrinologist, he’s never heard of reverse T3. That’s really scary because I’m not officially an endocrinologist. I’m not a fellow of the American College of Endocrinology. I did not specialize in endocrinology. However, from what I’ve seen, I am better at it than the average doctor in America that you would see with health insurance. Maybe out-of-pocket doctors are good because, I don’t know if you know this, but health insurance only pays 20 to 30 cents on the dollar. So any really good doctor isn’t going to take health insurance.
The reason why you work for an institution is you don’t have what it takes to do it on your own. In my experience, this isn’t specific to doctors, but there’s safety in numbers. Sheep like to travel in herds. So if you’re a bad doctor, you would work in a hospital because the hospital gives you a paycheck. You don’t have to earn your own money; you just have to earn a check. Usually, the way you earn a check in an institution is by saying what’s politically correct, keeping your head down, and not making any noise.
Obviously, I’m unemployable, thus I have to employ myself. I wouldn’t fit into any hierarchy. I have to do my own thing. So, I do things differently. I want to see what the reverse T3 is because most of the time, the reason why someone’s thyroid sucks isn’t because they don’t have enough T4; it’s because they’re not converting it into T3, they’re converting it to reverse T3.
Treatment and Supplements
So, with selenium, magnesium, zinc, and iodine, this should drive the equation to the T3, not the reverse T3. Also, if you reduce stress, whether it’s environmental stress or other types of stress, it will help this.
Normally, I start with the structure, but let’s be real, most people don’t care about the structure. Basically, some tyrosine molecules, an amino acid, when iodized, T4 is like two iodized tyrosines slapped together with four iodines, and T3 is when you remove one iodine to get three.
TBG is thyroid binding globulin. It binds to T4 in the bloodstream and prevents it from converting to T3. You’re like, “Why is that a good thing?” It just increases the lifespan of the and allows for more stability. It isn’t necessarily a bad thing. But I believe GH and I know Anavar decrease TBG, which will then drive up T4 to T3 conversion, which will speed up metabolism to some degree.
Hormone Replacement Therapy
The problem is if there’s too much of an imbalance between T3 and T4, then in theory, there’s a backward pathway called the D3 pathway or the di3 pathway, I don’t remember. That pathway is supposedly catabolic, so you could lose muscle that way. This is why if someone takes just T3 without having background T4, they could theoretically lose muscle, especially on a prep.
Doctors will either prescribe Synthroid, which is T4, and that usually doesn’t work because the woman isn’t converting her T4 into T3. You give her more T4, and she still isn’t going to convert it into T3; it’s just going to be more reverse T3. But since they don’t know what reverse T3 is and they don’t order it, they don’t even do that.
So, what they do is they order a TSH. They see that the TSH is high. TSH is thyroid stimulating hormone; it’s not thyroid hormone. It’s the hormone produced by the pituitary to stimulate the thyroid to release T4. That goes up because there isn’t enough T3. The T3 negatively inhibits the release of more TSH. So, if there’s enough T3, you don’t need more TSH. If there isn’t enough T3, more TSH is released.
The default setting is to pump out TSH. Because they’re converting the T4 into reverse T3, there isn’t enough free T3, so the T3 isn’t inhibiting the pituitary to release TSH, so the TSH is high. They see that the TSH is high, and they think the thyroid stimulating hormone is not efficiently stimulating the thyroid gland to make T4. So, they just give you synthetic T4. Most doctors do this. It’s scary that it’s so slipshod. It’s so weird that you wouldn’t just test the right hormone. If you’re going to test only one hormone, why wouldn’t you just test T3? Do you have the functional active metabolite? That’s the common sense approach, but they never do that.
Alternative Approaches
If you know why they don’t do that, please mention it in the comments section. Go up to your local endocrinologist and ask, “Hey, why do you order TSH, not reverse T3 or T3, to find out what’s actually going on?” They’ll be like, “Well, there’s no…” and that’s going to be their answer in that tone, which means they don’t know what they’re talking about.
My approach would be, find out if the person has enough T3, and then look to see if their reverse T3 is high. If it’s high, selenium, iodine, and stress reduction. That will increase the conversion from T4 to T3. Also, for example, if the person isn’t sleeping, if you get them to sleep 8 hours instead of 4, their thyroid function will go up. Sleep apnea will drop the conversion of T4 to T3.
Hormone Optimization
Once you’ve done that, a rational, thinking, intelligent, and caring doctor would take your current blood levels and prescribe enough thyroid hormone replacement to make up the difference. For example, let’s say the normal level of T4 is between 1 and 2, and let’s say the normal level of T3 is between 2.3 and 4.3. This isn’t exact; I’m just throwing numbers out. Let’s say you do your blood work, and your T3 is 2.3. You are at the bottom end of the range. A competent doctor would be like, “Well, you’re normal, but that’s not optimal.” An optimal level would be around 3.5 to 4.3.
So, you would start with a very low dose of thyroid medication, not a very high dose, because the thyroid hormone is pretty powerful. You would go with like 12.5 mcg of T3 and maybe 50 mcg of T4. You would see if that bumped the T3 up into the range of 3.5 to 4.3.
You would recheck the blood, and if it’s now at 3.5, you just continue with that dosage. If it’s still low, you would increase the dosage slightly. You don’t want to overdo it because too much thyroid medication can make you hyperthyroid, which can cause a whole bunch of problems, including heart problems and osteoporosis.
Practical Application and Contest Prep
If you’re doing a contest prep, a lot of people will use thyroid medication prophylactically to make sure their metabolism doesn’t slow down. They’ll start with a low dose and titrate up if needed based on blood work. They aim for optimal levels, not just normal levels.
Summarized Bloodwork and Thyroid Hormones:
- Key Hormones to Test:
- TSH (Thyroid Stimulating Hormone)
- Free T3 (Triiodothyronine)
- Free T4 (Thyroxine)
- Reverse T3
- Typical Medical Practice:
- Conventional doctors often only test TSH.
- High TSH usually results in prescribing synthetic T4 (e.g., Synthroid).
- This approach is often insufficient because it doesn’t account for how well T4 is converting to T3.
- Optimal Blood Levels:
- Free T3: Aim for 3.5 to 4.3
- Free T4: Over 1, probably less than 2
- TSH: Close to 1 is optimal, but not as critical
- Reverse T3: The lower, the better
- Understanding T3 and T4:
- T4 is converted into the active hormone T3.
- Reverse T3 is an inactive form, indicating poor conversion from T4 to T3.
- High Reverse T3 often means that T4 is not adequately converting to T3.
- Factors Affecting Thyroid Function:
- Stress and poor nutrition can hinder the conversion of T4 to T3, increasing Reverse T3.
- Supplements such as selenium, iodine, magnesium, and zinc can help improve conversion.
- Treatment Approach:
- Instead of only prescribing T4, a combination of T4 and T3 can be more effective.
- For instance, a combination dose like 50 mcg T4 and 12.5 mcg T3 can be a starting point.
- Bloodwork should be rechecked to adjust doses based on changes in hormone levels.
- Practical Tips:
- If Reverse T3 is high, addressing factors like selenium and iodine deficiency, and reducing stress can help.
- A balanced approach to hormone replacement therapy (HRT) includes careful monitoring and adjustments based on detailed blood tests.
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Tagging everyone who was involved in the last Thyroid thread I made.
@jshaving @Dani_Shugart @QuadQueen @FunkOdyssey @Meathead56
I found this video explained the concepts in that original thread to a much more simple, yet actionable, degree.
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