Tag Archives: genetics

Viral Infection and the Thyroid in the Age of Covid-19


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By Gary M. Pepper, M.D.
(This article is for educational purposes only and is not intended as medical advice or treatment)

During the Covid-19 pandemic my medical practice has been operating as normally as possible. The other day a young woman arrived wearing a surgical mask with a stack of medical records in hand, for a new patient appointment. Her difficulties began 6 weeks prior with intense tenderness in the right side of her neck just above the clavicle (collarbone) which varied in intensity over the course of about 10 days. Evaluation by her primary care physician uncovered newly elevated thyroid hormone levels. During our discussion she recalled a respiratory tract infection starting a week before the neck pain developed.  Still complaining of lung congestion she denied fever or shortness of breath.  Sitting comfortably, the thyroid was no longer tender but was slightly enlarged and unusually firm.  Reading on it will become clear why my preliminary diagnosis is sub-acute thyroiditis, an inflammation of the thyroid following a viral respiratory tract infection, possibly Covid-19. Continue reading →

Suzi’s Amazing Blood Pressure Response to Cytomel (t3)


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Suzi has hypothyroidism and high blood pressure. She sends the following story describing how t3 treatment appeared to help normalize her blood pressure. This is the first time I have come across this effect and thought it would be helpful to share her story on the main blog. Does anyone else have a similar (or contradictory) experience?

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Hi Dr. Pepper,

I was diagnosed hypothyroid 2 years ago and given levothyroxine. On diagnosis I had lots of symptoms and my BP was 175/115 despite my whole family having low BP. After some months on T4 I did feel an improvement in a lot of ways and my BP got better. Then after a year, things started going wrong, as if my body didn’t like T4.

I tried reducing my dose of T4 back down to 75µg but went hypo. But each time I increased above 75µg my BP increased again, then on 112µg it became a serious problem, especially the diastolic. I still had fatigue, constipation, red eyes, swollen legs and so on.

About 3 weeks ago I started on 10µg T3 and reduced my T4 from 112 to 75µg and pretty much immediately felt clearer headed and more energy, the constipation went etc….. My BP has gone down by an average of 20, which I know because I check it regularly myself. I’m doing a 24-hour BP monitor this week too, because my doctor put me on Amlopidine 6 weeks ago after being shocked by the monitor results from then while on 112µg T4 (only took Amlopidine for 2 weeks after terrible side-effects incl. overwhelming fatigue and massively swollen legs).

So, it looks as though my body goes weird on T4 tablets when the dose is above 75µg, but if I stuck to that dose I’d be really hypothyroid. The T3 has changed my life completely!!

Now I’m wondering what the ideal balance T4 / T3 tablets would be? Is that possible to say or does it depend on each individual body and genetics? My typical BP now is around 120/ 95; it goes down after eating, and gets worse when I’m hungry or tired. The T3 reduced my BP so much more than the Amlopidine did, and on T3 I feel great whereas on Amlopidine I felt half dead. I’d like to get my BP back to before I got hypo, so that’d be 110/70.

All I need to do now is find my ideal dose of T4 and T3, could you possibly advise me on that? If I started 20µg T3 instead of 10µg, would you advise a reduction in T4 from 75µg? ( I’ll be doing a TSH, fT3 and fT4 test in about 5 weeks’ time, maybe I should wait till then?).

Thank you so much!

Diet Success May Be Genetic


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Diet Success May be Genetic

A few years ago the book, Eat Right for Your (Blood) Type, was published by Dr. Peter D’Adamo with the premise that our present day nutritional needs are dependent on the types of food available to our genetic ancestors. For example, if your ancient ancestors evolved in a region of the world where protein was plentiful, then your body now requires a protein rich diet to stay healthy. According to the author your blood “type” is the clue to determining your nutritional heritage and your ideal diet type. I was never convinced of the usefulness of this blood type theory but agree that genetics strongly influences the way an individual stores fat and what constitutes their optimal nutritional requirements.

Along these lines recent research points to a connection between success with various weight loss diets and genetic differences between individuals. This was the conclusion of a study known as the A to Z Weight Loss Study. This study compared the results of 300 women who followed one of four possible diets ranging from those low in carbs (Adkins diet) to those low in fats (Ornish diet) to those high in protein (Zone diet). The women were then screened for genetic differences in specific genes that control fat metabolism.

Found was that some participants needed low carbs to lose weight while others required a diet low in fat to achieve weight loss. Analysis of the fat metabolizing genes showed that a specific favorable genetic profile was associated with up to a 6 fold increase in the amount of weight loss achieved with a particular diet. A participant was much more likely to lose weight if they were on the diet that harmonized with their particular genetic type.

How can you tell in advance if you are a carb sensitive or a fat sensitive dieter? For those with access to these experimental genetic tests (conducted by Interleukin Genetics) you could conceivable get the information you need. For the rest of us, starting with one type of diet and switching to the other type if weight loss isn’t achieved seems like a common sense approach.

Gary Pepper, M.D.
Editor-in-Chief, Metabolism.com

Wondering if t4 (Synthroid) Treatment of Hypothyroidism is the Answer


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Prosanta asks metabolism.com if her thyroid blood test results indicate that treatment with t4 is required. I suspect that she is also wondering if other forms of treatment might be better (Armour Thyroid for example).

Here is what Prosanta writes:

Iamsuffering from Diabetes type2.recently on routine Blood test—
FT3(ECLIA) 2.33pg/ml
FT4 1.07ng/ml
TSH 9.32microIU/ml
AntiThyroid Peroxidase 37.02IU/ml
Do I need to take only Levothyroxine

In response to her question I offer my thoughts on whether someone beginning with thyroid hormone replacement therapy should start with t4.

Hi Prosanta

You know I can’t recommend medical therapy in this forum. I can make some general comments, however.

There is debate among endocrinologists about what level of TSH indicates a clinical degree of thyroid deficiency, but there is no doubt that a TSH of 9 is abnormally high. Since elevated TSH almost always indicates that the pituitary gland is releasing excessive TSH in response to thyroid hormone deficiency, unless there is a pituitary tumor (exceedingly rare), replacement therapy with thyroid hormone is indicated.

Thyroid hormone replacement therapy in the U.S. usually consists of taking a pure t4 product such as Synthroid or levothyroxine (generic t4). On this website you will notice extensive posting about treating hypothyroidism with alternative forms of thyroid hormone replacement, particularly desiccated thyroid products such as Armour Thyroid. An appropriate concern in a situation like yours is whether to take t4 only or to use desiccated thyroid or t4 plus t3 therapy.

If you are like most people in this country being treated with t4, you will wonder why someone might need alternative forms of thyroid hormone replacement. In the past year or so researchers have discovered that a portion of the population lacks the ability to normally metabolize t4 into the highly biologically active t3. This means that affected individuals may continue to experience symptoms of thyroid hormone deficiency when treated with conventional t4 therapy [https://www.metabolism.com/2009/11/07/breakthrough-discovery-thyroid-hormone-therapy-part-2/ ]. How does a person know if they won’t respond to t4? The simpliest approach is to try t4 and see how you feel. Then you and your doctor can decide whether you are a t4 responder or not.

You may be aware that Armour Thyroid and similar products are in very short supply in the U.S. Even if some advocates of desiccated thyroid therapy for hypothyroidism argue that only desiccated thyroid can result in a full return to normal, in my opinion the present shortage makes t4 therapy the clear initial choice. If symptoms of hypothyroidism persist even after a full course of t4 has been tried, then you may be forced to join the ranks of those struggling with the pharma industry to get desiccated thyroid products.

Please discuss these ideas with your own physician.

The disclaimer and terms of service of metabolism.com applies to this and all my posts on this website.