#### General Questions > [IDEAL SERUM RATIO OF TOTAL T4 AND T3] The serum T3/T4 ratio decreases with age and sickness. I think dose of a supplement should be based entirely on the signs of metabolic response. > [Ratio of T4 to T3, which is sometimes suggested to be wrong in NDT] Pigs' and cows' thyroids are very similar to people's, with a ratio usually between 3:1 and 4:1. The blood serum of hypothyroid people can have a ratio of 50:1 or 100:1, when the liver is failing to convert thyroxin. Maybe the authors of the book are physicians, educated by pharmaceutical advertisements. > [Lack of hormones like calcitonin, T2 etc. in synthetic T4/T3 combo a problem?] The old Armour thyroid, made from beef and pork glands before 1990, did contain other components that were probably valuable, but when T3 is absorbed by mitochondria it's immediately changed into T2, so the synthetic T3's effects can't be distinguished from those of a mixture of T3 and T2. The company that now makes Armour thyroid started removing the calcitonin in the 1990s, to sell as a separate product. > [IMPROVING T4->T3 CONVERSION] If you were deficient in selenium, the correcting effect would be quick, but if there was a problem with intestinal flora, that would have to be taken care of before conversion was good. Other nutritional deficiencies could be involved. Daily raw [[carrot]], weekly [[seafood]] and liver, enough sunlight and [[vitamin D]], a good ratio of [[calcium]] to phosphate, are often helpful. > [[Calcium]] (two liters of [[milk]]), [[vitamin D]] and plenty of orange juice sometimes help to regulate things by balancing the minerals. A daily [[carrot]] salad should keep the small intestine fairly sterile. > [Reverse T3] Yes, it's probably induced by stress, with cortisol inducing the type of deiodinase that makes the inactive rT3. A low [[sugar]] diet can cause chronically high cortisol. If you are eating enough [[fruit]] and protein, I think the T3 of natural thyroid will help to correct the stress/inflammatory metabolism that is connected with the reverse T3. > There isn't any natural T3 product, in the sense of biologically created, but the activity of T3 is so great that the effective dose, of a few micrograms, couldn't introduce a significant amount of industrial junk; the excipients are the main concern, and whether the people making the tablets understand what they are doing. Cytomel and Cynomel, so far, have been very well made, and there isn't any other T3 product that I trust. > [THINGS INHIBITING T3 FROM ENTERING CELLS] It isn't a matter of T3 entering cells, it's assuring that it is either made by conversion from the T4, or taken as a supplement. > [Question about T2 mentioning 150mcg-capsules] Mitochondria have the enzyme for converting T3 to T2. The potency seems crazy, the body needs only about 4 mcg per hour. > [Less neuropathy and body pains when alternating Armour and Synthroid, low cholesterol] T4 suppresses the pro-inflammatory TSH, without activating the metabolism, so probably spares the cholesterol and other antiinflammatory things. Does she eat enough [[sugar]]? Starches and irritating, bacteria-supporting foods increase [[inflammation]] and probably interfere with cholesterol synthesis. Custards, sweet fruits, and Haagen Dazs ice cream are safe ways to increase cholesterol. > [On hypothyroid headaches and finding a good doctor] Mary Shomon’s list of doctors by city includes some comments about their attitude toward prescribing thyroid. Hypothyroid headaches often result from the intestinal inflammation associated with the hormone deficiency, and avoidance of starches (most [[vegetables]], nuts, grains) and unsaturated oils, and using an anti inflammatory laxative such as cascara, or fiber such as shredded carrots, boiled bamboo shoots, or boiled white button mushrooms, will often relieve headaches until the thyroid is corrected. The most important things about supplementing thyroid, that most doctors ignore, are that it should be taken in small divided amounts with meals, and that the temperature and pulse rate should be measured at waking, midday, and afternoon, to watch the effects. The active hormone, T3, acts quickly, within a few minutes, and leaves the body quickly (half of it in a day), while the precursor thyroxine is hormonally inactive, and accumulates in the body with a half life of two weeks. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-211467) #### Starting Thyroid Supplementation > Sometimes it takes many months to get the metabolic rate stable at a higher level, and it's often necessary to use a thyroid supplement. > Thyroid is the only thing that safely lowers cholesterol, but when your stress hormones are very high, you shouldn't take more than about one microgram of Cytomel at a time, and should accompany it with things like [[milk]] and orange juice. > With your TSH so high, you should probably add a thyroid supplement, until you get it down to about 1.0, or less. (The normal range, according to the American Association of Clinical Endocrinologists, is from 0.3 to 3.0.) > A starting dose of about 1 mcg can produce a noticeable effect, and can be repeated at intervals according to the effect. 5 mcg with a meal is another way to start it. Thyroid tends to lower cholesterol by converting it into [[pregnenolone]] and other steroids, and yours is high enough to easily improve your steroid hormone balance. > Cynoplus (www.farmaciadelnino.com has a good price) is cheaper than Armour, and an eighth to a fourth of a tablet would be a reasonable amount to start with; thyroxine's half-life in the body is two weeks, so the effect is cumulative, and if you get the desired effects in less than two weeks the dose should probably be reduced. > At the beginning, once a day, but if your temperature and [[pulse]] and symptoms aren't just right after two weeks you could add another dose at a different time of day. Change of seasons affects the amount of thyroid you need, sometimes it isn't needed after using it for a while, but it's always good to watch for signs of change. > When you are hypothyroid, there’s usually an increase of stress hormones in compensation, and they hold up the pulse rate and temperature, especially in the early morning. T4 builds up in the body in the first few weeks, so it’s good to stay on a certain dose for at least two or three weeks, watching its effects, then adding a little to the dose, and watching for gradual reduction of stress (lower morning numbers, higher midday numbers) and increase of metabolic rate. It’s best to absorb it slowly, to imitate the normal pattern of secretion, and food helps to slow the absorption. In the evening a little milk, rather than a whole meal, is usually enough. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-230414) #### Thyroid Supplementation Doesn't Help / Causes Issues > T3, by lowering stress, sometimes reveals a low basal metabolic rate, that was hidden by high stress hormones. The body produces about 4 mcg of T3 per hour, so taking more than that can interfere with regulatory processes. It's helpful to use the resting [[pulse]] rate, and the 24 hour temperature curve, along with other signs, such as mood, appearance of veins on the hands, etc. The peak temperature should be in the afternoon. > The temperature rise during the day is the most important thing, since nocturnal stress hormones can give a misleading impression in the morning. Resting [[pulse]] rate is another good indicator. [[Milk]] and cheese are the best [[calcium]] sources. > If you are eating enough protein, about 100 grams, and [[salt]] and thyroid, then I would consider the steroids--something might be interfering with your production of [[pregnenolone]] and [[DHEA]]. Things that could do that would be very low cholesterol, or a deficiency of [[vitamin A]] (retinol), or possibly other deficiencies. > If your cholesterol is above 200, and the thyroid [[supplements]] didn't warm you up, it's possible that something is interfering with your steroid synthesis, which might be a deficiency of something like [[vitamin A]], or interference from something like [[iron]] or carotene. Have you tried a supplement of [[pregnenolone]] or [[DHEA]]? Were any other hormones, such as [[prolactin]], measured? If you are taking the [[aspirin]] regularly, you should make sure to get [[vitamin K]], from kale, liver, or a supplement. Anemia, like cold feet, is a common sign of low thyroid function. > I occasionally see that happen [T3 WILL CAUSE LOW TEMP/[[PULSE]]]; sometimes people have had their [[pulse]] rate decrease 40 or 50 beats per minute. The temperature of your fingers, toes, and nose helps to interpret the balance between stress and thyroid; your fingers should be less cold as your metabolic rate comes up. In extreme [[hypothyroidism]], the hands and feet can be very cold while the oral temperature looks o.k.; then as the metabolic rate increases, the difference between fingers and mouth decreases. > When I used only Cytomel, any little stress would make me suddenly hypothyroid, and my [[heart]] would stop several times in a minute; when I started using some thyroid, USP, that contained both T4 and T3 it stopped happening. > [BRAIN FOG] The body makes up to about 4 mcg of T3 in an hour, so each dose should be small, with food to delay absorption. Are you having orange juice and [[milk]] in your diet? Sometimes a B vitamin deficiency, especially B1, can cause the fog. A supplement of 10 mg. is often enough to improve focus and prevent [[fatigue]]. > When you take T3 without food, it enters the blood stream very suddenly, and the liver is likely to detect an excessive amount, causing it to produce enzymes to eliminate it. The result can be a decrease in T3 for the rest of the day, especially at night if you took it in the morning. Have you tried rebreathing into a paper bag, to see if the increased CO2 affects the fog? > [HIGH [[HEART]] RATE AFTER T3] I think regular use of the [[pregnenolone]] might help. Are you getting enough [[milk]], and salting your food to taste? Do you have some sea food regularly? (For trace minerals.) Have you tried taking the small amounts of T3 at different intervals, sooner until the symptoms are gone, then longer intervals until they return? TSH is likely to be high early in the morning, and as it subsides during the day the amount of T3 needed might decrease. > [HIGH STRESS HORMONES ON THYROID INCREASES SENSITIVITY TO THEM?] Not necessarily, but it's something to watch for. The daily temperature cycle is helpful, if stress is low, there will be a strong cycle, lowest at night, early morning. > [THYROID NOT ENOUGH TO LOWER STRESS HORMONES] Yes, the diet is an essential part of normalizing them. The climate is important, too. > [TEMPERATURE CYCLE - DIFFERENCE BETWEEN LOWEST AND HIGHEST TEMPERATURE] It depends on when you wake up, but anything from 0.6 to 1 degree Fahrenheit can be normal. > [HYPOTHYROID SYMPTOMS RETURN DESPITE SAME DOSAGE] During the first week or two of supplementing thyroid, there is usually an intensification of the effect of adrenaline. It’s necessary to watch a variety of signs, especially the temperature of hands and feet and the amount of water evaporated, to judge the actual effect of thyroid. The effect of thyroid after the level of adrenaline has normalized is to increase the depth of relaxation. > [THYROID ACTING LIKE [[CAFFEINE]]] Not like [[caffeine]], but if too much is taken suddenly, a person who has been deficient in thyroid is likely to experience an excess of adrenaline. Since the body normally produces about 4 mcg of T3 in an hour, taking 10 or 20 mcg at once is unphysiological. > [You mention a period of 2-3 weeks for adrenaline to come down from thyroid. During this time, should the person suspend the thyroid dose or continue taking it?] If you start with a small dose, you can usually increase it slightly at intervals of about two weeks while keeping the pulse fairly steady. Other things that improve glucose metabolism help to lower the stress hormones. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-261461) #### Long Term Effects > [HOW TO STOP THYROID] If a person's thyroid gland has been inhibited by very high doses of a supplement, it takes only 2 or 3 days for the gland to resume full activity, and because it takes time for the hormone to be excreted, suddenly stopping a supplement shouldn't be noticeable, when the gland isn't being inhibited or malfunctioning. > Experimenters using isotopes gave large doses of thyroid until the subjects' glands were completely shut off, and when they stopped giving the doses, everyone's gland returned to normal activity in just 2 or 3 days. The gland is extremely quick to adjust its activity, both up and down, except when it's inhibited by stress, or [[PUFA]], or estrogen, etc. [TAKING THYROID WILL HAVE LONG-TERM EFFECTS] > Recording pulse and temperature at a certain time of day is helpful. When the thyroid gland is suppressed by taking too much of a supplement it recovers as soon as the dose is reduced. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-209523) #### Brands/Dosage > The working thyroid gland produces about the equivalent of 4 grains of desiccated thyroid per day, and that is about 70% thyroxine, T4, which allows the liver to make as much of the active T3 hormone as needed (if it is well nourished, and not blocked by [[PUFA]] or estrogen or other inhibitor). So taking that amount makes up for what your gland would be producing; by suppressing TSH, which stimulates the growth and activity of the thyroid, it also protects against the recurrence of [[cancer]] if it wasn't all removed (some types of [[cancer]] were treated just by supplementing thyroid, without [[surgery]]). Since the desiccated thyroid is made available by being digested, it's best to divide the day's dose, with some at each meal and at bedtime, so that the amount of active hormone entering the blood isn't too high at any time. > It's important to remember that it's cumulative, and the effect of any daily dose increases with time, and is affected by many things, so it's important to keep a chart [of temperature and [[pulse]]], watching for changes during a period of about two weeks. > An eighth of a tablet of either [Cynoplus/Cynomel] is a good starting dose. The difference is that T3 has a short half-life, and so can be repeated more often, while watching the [[pulse]] rate, so it's possible to get a quicker response. > Sensitivities and requirements vary widely. I've known people who temporarily needed 500 mg of Armour even in the summer, but usually the summer requirement is a fourth of the winter requirement. For some people, 15 mg of Armour was enough, and for some 1 mcg of Cytomel was an effective dose. > [Type 1 diabetic] The cynoplus tablets can be divided into pieces so that each dose of T3 is similar to the amount you were taking in cytomel. In [[diabetes]], when cells aren't getting enough glucose, T4 can't be converted to the active T3, and so it can build up in the body to levels that interfere with metabolism, but the advantage of a combination is that T4 inhibits TSH, and TSH is responsible for many of the symptoms.  > [WINTER RECOVERY] The end of winter is the worst time, because of the cumulative stress injury. Small amounts of T3, just 2 to 4 mcg at a time, along with good nutrition, including plenty of [[calcium]] (e.g., two quarts of [[milk]]), helps to recover from winter. > T3 has a short half-life in the body, and by adding small amounts of it you could feel quickly whether it was having the right effects. I don't know how reliable the Erfa is in composition. Mood is a good indicator, and the temperature of the toes and fingers usually changes quickly with thyroid changes. > The liver has to convert T4 to T3 for it to be effective. It needs glucose and selenium to make the conversion. Adequate protein, at least 80 grams per day, is necessary. Sea food, once a week will provide selenium, two quarts of [[milk]] and a quart of orange juice would provide many of the other essential nutrients. Taking T4 at bedtime sometimes is helpful. Most people feel best on a ratio of T4:T3 of 4:1 or less. Checking the relaxation rate of the Achilles reflex is a quick way to check the effect of the thyroid on your nerves and muscles; the relaxation should be instantaneous, loose and floppy. > Are there any combination products, such as Thyrolar or Cynoplus, that you can get in Spain? It's good to start with a small amount, such as 5 mcg of T3 twice a day, while watching for changes in your [[pulse]] rate, temperature, and ability to [[sleep]]. Half a grain of Armour, or about 30 mcg of T4 and 7.5 mcg of T3, is traditionally a common starting dose; it should be taken with a meal, so that it absorbs slowly. Taking a very small amount at bedtime usually helps with insomnia. > Try a sixth of a 25 mcg cynomel tablet at first, and watch for the effects in the first two hours. According to what you notice, you could continue that once a day, or twice a day, for about 10 days, then you could try some with each meal, for another week. #2 and #3: when you find out how the T3 affects you, you could change to the combination (Armour or Thyrolar or Cynoplus); the amounts I mentioned would be similar to 12 mcg of T3 per day. > It depends on what you notice from taking a small amount with meals. If it makes you feel pleasant, calm, confident, then trying it at bedtime would be right. > 25 mcg of T3 has approximately the activity of a grain (65 mg) of thyroid gland; is ERFA the only one available? A synthetic thyroxine could be combined with the Cynomel. Since the European products aren't necessarily the same as those made elsewhere, and a person's requirements are variable, it's essential to start with small amounts, watching for the effects, including [[pulse]] rate and temperature. T4 builds up slowly in the tissues, over about 14 days, but the T3 acts immediately. With any product, a single dose of T3 of about 4 mcg is close to the physiological range; sometimes a smaller amount is enough. > As long as it's divided so that you don't get a big dose of T3 all at once it should be o.k. to take a total of 25 mcg T3 and 100 of T4.That would be similar to the traditional 2 grain dose of Armour thyroid. A healthy person should produce the equivalent of about four grains per day, so with 2 grains of supplement, or the equivalent, there isn't a risk of over-dosing. > I use Cynomel and Cynoplus mostly, but they come in only one size, so I cut the tablets into about ten parts. > Twice a day should be o.k., [CYTOMEL] but every day you should make a note of your [[pulse]] rate and temperature, and in a week or ten days you should be able to see a progression. > It [CYTOMEL] improves the retention of [[magnesium]], and cellular relaxation, and some people want to have a nap in the afternoon when their thyroid is good. > If you use some T3 (such as Cytomel or Cynomel) it's important to keep each dose small, while watching for changes in your [[pulse]] and temperature. Usually 4 or 5 mcg at a time is o.k. (the body makes about 4 mcg per hour). I don't think there's likely to be any problem using desiccated thyroid if the product is good, but because of changing manufacturing methods, that's largely a matter of trial and error. Low ferritin is often a result of [[hypothyroidism]]. The need for thyroid increases greatly during the winter in high latitudes, for example when I needed half a grain in the summer, I had to increase it to two grains during the winter. When cholesterol is high, that can make it easier to adapt to a thyroid supplement, since the thyroid will stimulate the conversion of cholesterol into [[progesterone]] and the adrenal hormones. > I have heard from a few people using it, one thinks it doesn't work , but I haven't heard enough details to form an opinion yet. [THIROYD by Greater Pharma] > I use Cynoplus (contains T4 and T3) and Cynomel (T3 only) that I usually get from www.mymexicandrugstore.mx. There is only one size tablet, and a fourth of a tablet is a typical starting dose. > Several of the commercially available products aren't well formulated, some are completely inactive. Cytomel's formulation has changed recently, so I'm not sure of its present potency. In areas with fluoridated water, taking a tablet with water can inactivate it. With good Cytomel, once a person has taken a very big dose, the liver produces enzymes to inactivate it quickly, so after 12 hours the blood level will become too low, and another big dose will be needed. Stress hormones are responsible for raising reverse T3, and just supplementing T3 is seldom enough to normalize the stress hormones, so continued use of large doses can maintain improved functioning, but at the risk of developing problems from the continued excess of those hormones. > I think Triyotex is T3, 75 mcg, which would be three times as much as Cynomel, but I haven’t tried it, and don’t know how effective it is. Usually, a 5 mcg dose of T3 with each meal is effective. Anti-aging Systems in England has a large variety of thyroid products. > [T3 for someone who's been chronically running on adrenaline?] When T3 is used in small doses, such as 3 or 4 mcg at a time, it can be very effective for lowering adrenalin by letting glucose be more fully oxidized. It’s helpful to keep a chart of your waking and midday temperature and [[pulse]] rate to watch the cumulative effects of the T3, so you can adjust the dose. A dose at bedtime typically makes it possible to go to [[sleep]] quickly; it should be supported by things like orange juice, cheese, and [[milk]]. A natural desiccated thyroid product, in the long run, is a convenient way to keep your metabolic rate where it should be. Cytomel is the only T3 product that I’m confident of, at present. > [Giving 3mcg Cynomel/hour to 84-year-old grandmother with dementia] If someone is in a precarious condition, even smaller amounts at a time might be better. For example, a man in the hospital right after a [[heart]] attack started taking one mcg per hour; the doctors had said that at the rate his enzymes were rising they would be expected to keep rising for another day, but they started decreasing exactly when he started the small doses, and they had decreased the next day when he left the hospital, without symptoms. T3, [[sugar]], and [[aspirin]] are the most [[heart]]-protective things. > [NDT RECOMMENDATIONS] I haven't seen anything that compares well with the original Armour. > Armour thyroid, USP, was the standard thyroid used widely for about 80 years. Since ownership of the product name was bought by Revlon and then a series of other companies, I'm not sure anything of the simple original formula remains; maybe [[magnesium]] stearate, I haven't looked lately. > A few years ago I had some communication from a pharmacist at Forest Pharmaceutical, and he said that over ten years ago they began having thyrocalcitonin extracted from the pig thyroid powder to sell separately as a new drug. I think that left stearic acid as the only ingredient the current product might have in common with traditional Armour thyroid, USP. I don't use any product containing fumed or colloidal silica, or titanium, or various novel polymers, or coloring agents > [TOPICAL T3] Using it topically doesn't do anything for systemic metabolism, just the [[skin]], at least at the concentrations I'm familiar with. > [Liquid T3, concerns?] Trace impurities can inactivate it, but some liquid forms have worked. > [200 mcg T4 pill] During the first week, every day would be o.k., then I think once or twice a week is enough. > I think it’s fairly customary for thyroid supplements to be compounded by crooks, morons, and pharmacists, so it’s good to be very watchful when trying out any specific product. An extremely simplified diet for a few days without supplements makes it easier to see the effects of a particular food or drug. In the 1970s, someone bought 10 products sold in US drugstores as 'thyroid, USP,' and found (by immuno-assay) that only 2 of them contained any thyroid glandular tissue. After I had bought a kilo of 'thyroid USP' that was 99% gelatin, people at USP told me that anything which contains a certain amount of iodine meets their standard. It was then that I started to understand that there’s probably no point in trying to distinguish stupidity from criminality. > I always take my cynoplus at night, to go to sleep faster; it has an antiinflammatory effect. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-230414) > [With 5 days of work stress, would the T4 cause hyperthyroidism on the weekends when stress is lower, or would you recommend T3-only to combat the stress (I know you don't usually)?] I think a combination or natural thyroid such as Thyrolar, Cynoplus, or Armour is usually best. A basic antistress action of thyroid is to convert cholesterol into pregnenolone, progesterone, and DHEA, but that requires adequate cholesterol, and a good mixed diet helps to maintain that. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-234884) #### Cancer > [On studies like [this](https://archive.ph/o/OJZkW/www.ncbi.nlm.nih.gov/pubmed/988872), suggesting that thyroid supplementation could increase [[cancer]] risk] Two background facts are needed to interpret the JAMA article. The first is that [[hypothyroidism]] is a major cause of breast [[cancer]], because of the chronic excess of estrogen and deficiency of [[progesterone]]. The second is that US doctors don't correct [[hypothyroidism]], because they don't prescribe the active hormone T3, only the precursor T4, which fails to be converted because hypothyroid women's livers aren't efficient. T3 is needed for the storage of glycogen and the efficient use of glucose, and glucose is needed to form T3. Therefore, women in the US who "are treated for [[hypothyroidism]]" are still hypothyroid, and hypothyroid women are much more likely to get [[cancer]]. #### Eye Drops > [In a previous discussion you said: " For topical use (T3), I think about a tenth of a microgram per milliliter is effective." Do you mind sharing why such a dilution is necessary?] I think that was referring to its use as eye drops, where it’s extremely well absorbed. [Source](https://lowtoxinforum.com/threads/ray-peat-email-advice-depository.1035/post-244263)