Chronically elevated TSH but normal FT3 and FT4, despite Peating for years - ideas?

[PxD]

Intro
Have been Peating since April 2018. Prior, I used to eat a lot of meat, relatively little carbs (50-100g a day), and a higher amount of fats as well as plenty of vegetables/salads. Fruit intake was limited and dairy intake was very restricted. After starting Peating, dairy intake has increased a lot, fruit intake is high, and about half my muscle meat intake has been displaced by gelatin/broth , liver, and low-fat seafood. Vegetable consumption has fallen and consists of a serving or two of something raw per day, e.g. a carrot and a bell pepper. My PUFA intake is maximum around 5-7g per day, but often less, on a 2500 calorie diet. I've added coffee as well, which I can tolerate since I started eating more carbs. Prior to 2018 I limited myself to one cup of coffee a week for social occasions and it would make me jittery/tired but wired for the rest of the day.

Started supplementing with Vit E in 2017. Started taking half a tab of aspirin a couple of months ago. Take 5,000 IU of Vit D 3-4 times a week since 2017. I've been taking Vit K2 since last year. I shine a red light on myself 4-5 times a month for 15-20 mins. I also was taking Umzu's TestroX supplement from 2016 up until a couple of months ago. Did Intermittent Fasting from 2017-2020.

I've noticed positive changes since starting Peating. My skin doesn't sunburn any more. I wake up with adequate energy on 7-8 hours of sleep, and I sleep deeper. I recover much faster from weight lifting (within a day or two max). Prior to 2017, I needed 8+ hours of sleep just to be functional and would still crave naps, and it would take me 3 full days to recover from a squat or deadlift workout. My mood and disposition has improved as well.

I'm 5' 10" and 180lbs. BF is probably around 14-15% (can faintly see my abs), with a fairly muscular build. Libido is good and always has been, including pre-Peating. I weight lift with weights or bodyweight 3-4x a week and go for walks a couple of times a week.

The issue
My blood test results changed significantly after starting Peating. Most of the markers have improved, but TSH remains stubbornly elevated (between 3.5 and 4.5). I've spent 3 years trying to tackle it but I'm out of ideas. Looking for input and ideas from the RPF community. Maybe someone else has had a similar issue. My FT3 and FT4 are OK, although ideally they could be a bit higher. I just had my annual physical a week ago and my doctor is now recommending a visit to an endo because of the chronically borderline high TSH and because total T4 fell below the range this year. Note that cholesterol has also increased a lot since starting Peating, although I've not a strong opinion on whether or not that's good or bad. My TC/HDL and LDL/HDL ratios are still in the normal ranges.

Either way, based on these labs, my thesis is that I should turn over more of my cholesterol into hormones, but am not doing so because my thyroid isn't quite up to the job. After 3 years of Peating, I feel like I'm out of ideas on what to try next to accomplish this. The only Peaty thing I haven't tried yet is taking supplemental thyroid, but I view this as an artificial crutch and not a long term sustainable solution, so I haven't tried that (yet). Or maybe these blood markers are all fine and I should not be concerned over it?

The attached image has a progression of bloodwork markers over time since 2016. Below the numbers are notes on the various supplements and dietary tweaks I was trying at the time. There is a period from mid 2019 to mid 2020 where I was testing some of my thyroid markers frequently while trying different supplements. There weren't any meaningful changes in that one-year period.

 

[Risingfire]

Have you taken thyroid?

 

[PxD]

Have you taken thyroid?

No, never. I'm hesitant to do so because I view it as a sort of permanent crutch (maybe I'm wrong about that) and want to exhaust all other avenues first.

 

[Vileplume]

With the high cholesterol and high TSH, thyroid seems the most likely to help. I understand your reluctance, but if it improves your life, it might be worth it.

 

[PxD]

With the high cholesterol and high TSH, thyroid seems the most likely to help. I understand your reluctance, but if it improves your life, it might be worth it.

Any recommendations on brand and what to look for?

 

[Risingfire]

No, never. I'm hesitant to do so because I view it as a sort of permanent crutch (maybe I'm wrong about that) and want to exhaust all other avenues first.

You very well may be on thyroid for the rest of your life. Or at least during the winter.

Here's cynoplus. This is what Ray recommends. I tend to agree as it's the best thyroid I've taken. Don't start with a full tablet:

Cynoplus (levothyroxine / LIOTHYRONINE) 30 mcg 120 Mcg 50 TAB

Consumption of this product is responsibility of the person who uses and recommends, consult your doctor before taking any medication, prescription required. PLEASE CHECK IF YOUR PRODUCT IS IN STOCK BEFORE YOU DO YOUR PAYMENT.

mystore.mx

Do you test your pulse and temperature?

 

[PxD]

You very well may be on thyroid for the rest of your life. Or at least during the winter.

Here's cynoplus. This is what Ray recommends. I tend to agree as it's the best thyroid I've taken. Don't start with a full tablet:

Cynoplus (levothyroxine / LIOTHYRONINE) 30 mcg 120 Mcg 50 TAB

Consumption of this product is responsibility of the person who uses and recommends, consult your doctor before taking any medication, prescription required. PLEASE CHECK IF YOUR PRODUCT IS IN STOCK BEFORE YOU DO YOUR PAYMENT.

mystore.mx

Do you test your pulse and temperature?

I don't, but at the Doc's office on my most recent visit a week ago my pulse was 62bpm. BP was 116/62. I don't test temperatures but hands/feet are always warm and I'm more prone to feeling hot and stuffy than cold.

 

[Nemo]

I don't, but at the Doc's office on my most recent visit a week ago my pulse was 62bpm. BP was 116/62. I don't test temperatures but hands/feet are always warm and I'm more prone to feeling hot and stuffy than cold.

Heart rate of 62 bpm is low, PxD, and suggests you're hypothyroid. You'd like to be at 85 bpm at the doctor's office. The rising cholesterol level basically confirms.

It would be interesting to know your resting heart rate before you get out of bed in the morning.

I wouldn't regard thyroid supplementation as a crutch. I'd regard it as something to keep you from getting cardiovascular disease or cancer. Read Broda Barnes' book on hypothyroidism to learn why you'd want to supplement.

You might give one last thing a try before supplementing. I would try an aspirin and niacinamide crackdown for a week. This means you take 2-3 adult aspirin or 25 to 50 mg of niacinamide every 2-3 hours while you're awake. That will bring down your free fatty acids, high levels of which keep thyroid hormones from working.

If you see a distinct difference from that, like a significantly improved heart rate, then continuing those therapies at some lower level may be all you need.

Or you may get a boost but not enough of one to get you where you really need to be. At that point, you could still try going really strict Peat. Replace all starches with sugar. Keep muscle meat to 2 oz a day. Zero vegetables. If that doesn't take care of it, or if you don't want to be on that strict of a diet, I would supplement thyroid because it's dangerous not to.

I like Idealabs thyroid products because they are easy to adjust to the exact dose you need (including microdoses) and digestive issues don't interfere with absorption. Why don't you try the free fatty acid flush and see where you're at before going further into brands or doses?

 

[5a-DHP]

No, never. I'm hesitant to do so because I view it as a sort of permanent crutch (maybe I'm wrong about that) and want to exhaust all other avenues first.

Almost half the western population above the age of 50 are on levothyroxine - this isn't as big a deal as your comment suggests you're interpreting it to be.

 

[Risingfire]

I don't, but at the Doc's office on my most recent visit a week ago my pulse was 62bpm. BP was 116/62. I don't test temperatures but hands/feet are always warm and I'm more prone to feeling hot and stuffy than cold.

Seems like you not fully taking on Peat's advice

 

[Kozak]

Test antibodies and always do the test at the same time of the day. Thyroid follows circadian rhythm.

 

[PxD]

Heart rate of 62 bpm is low, PxD, and suggests you're hypothyroid. You'd like to be at 85 bpm at the doctor's office. The rising cholesterol level basically confirms.

It would be interesting to know your resting heart rate before you get out of bed in the morning.

I wouldn't regard thyroid supplementation as a crutch. I'd regard it as something to keep you from getting cardiovascular disease or cancer. Read Broda Barnes' book on hypothyroidism to learn why you'd want to supplement.

You might give one last thing a try before supplementing. I would try an aspirin and niacinamide crackdown for a week. This means you take 2-3 adult aspirin or 25 to 50 mg of niacinamide every 2-3 hours while you're awake. That will bring down your free fatty acids, high levels of which keep thyroid hormones from working.

If you see a distinct difference from that, like a significantly improved heart rate, then continuing those therapies at some lower level may be all you need.

Or you may get a boost but not enough of one to get you where you really need to be. At that point, you could still try going really strict Peat. Replace all starches with sugar. Keep muscle meat to 2 oz a day. Zero vegetables. If that doesn't take care of it, or if you don't want to be on that strict of a diet, I would supplement thyroid because it's dangerous not to.

I like Idealabs thyroid products because they are easy to adjust to the exact dose you need (including microdoses) and digestive issues don't interfere with absorption. Why don't you try the free fatty acid flush and see where you're at before going further into brands or doses?

I already went and ordered a NDT product before realizing Haidut makes a thyroid product too. Would have rather given him the money...

I will try the aspirin crackdown you suggested. That would be about 650mg every 3 hours, or 3.25g per day for me. Sounds like a lot.

I’ll think about a FFA flush diet but that’s pretty restrictive and I’m not sure how long that would take to show results. I’d probably have to end up eating nothing but skim milk, oranges/fruit, and gelatin if I want to be really strict about it. I don’t think that would be easy to sustain.

I’ll do the aspirin for a week and report back.

 

[PxD]

Update: I ordered a bovine NDT product and have been taking 1 65mg capsule daily since May 8.

I've also been taking 2 or 3 aspirin tablets 5 days a week since then.

Got some thyroid bloodwork done yesterday and it came back as follows:
TSH dropped from 4.409 to 2.64 in those three weeks (40% decline).
Free T3 remained roughly the same (3.1 to 3.0)
Free T4 dropped (1.19 to 1.0)

One difference is that yesterday's blood was drawn a couple of hours after breakfast, whereas the prior bloodwork a month ago was done in a fasted state, and I know that post-prandial TSH can be 20-25% lower than fasted TSH. Nonetheless, this is the lowest TSH reading I've had since July 2018, and between then and now I have had non-fasted TSH tests with results of 3.0 or higher anyway. So, I do think most of the decline in TSH over the past 3 weeks is likely due to the NDT and aspirin.

One thing I'm wondering about is why my free T3 and T4 numbers decreased slightly, in conjunction with a decrease in TSH. One would think they would have increased. Is it possible that the serum free T3/T4 results don't accurately reflect thyroid status under certain conditions?

 

[Kozak]

Update: I ordered a bovine NDT product and have been taking 1 65mg capsule daily since May 8.

I've also been taking 2 or 3 aspirin tablets 5 days a week since then.

Got some thyroid bloodwork done yesterday and it came back as follows:
TSH dropped from 4.409 to 2.64 in those three weeks (40% decline).
Free T3 remained roughly the same (3.1 to 3.0)
Free T4 dropped (1.19 to 1.0)

One difference is that yesterday's blood was drawn a couple of hours after breakfast, whereas the prior bloodwork a month ago was done in a fasted state, and I know that post-prandial TSH can be 20-25% lower than fasted TSH. Nonetheless, this is the lowest TSH reading I've had since July 2018, and between then and now I have had non-fasted TSH tests with results of 3.0 or higher anyway. So, I do think most of the decline in TSH over the past 3 weeks is likely due to the NDT and aspirin.

One thing I'm wondering about is why my free T3 and T4 numbers decreased slightly, in conjunction with a decrease in TSH. One would think they would have increased. Is it possible that the serum free T3/T4 results don't accurately reflect thyroid status under certain conditions?

Test antibodies and always do the test at the same time of the day. Thyroid follows circadian rhythm.

 

[BestSinceDAYONE]

Almost half the western population above the age of 50 are on levothyroxine - this isn't as big a deal as your comment suggests you're interpreting it to be.

Sauce?