Thyroid Hormone: Metabolism and Supplementation
Thyroid Hormone: Metabolism and Supplementation
"Keeping the metabolic rate up is the main thing, and there are lots of ways to do it." -Ray Peat (2015)
The thyroid gland regulates metabolism, which can really be seen as systemic energy production. If you aren’t producing energy efficiently, this is where we find all of the problems of life.
When your hormones are properly balanced and you have enough thyroid, this is when life comes natural, action comes from second nature and the flow of energy is not only maintained but expanded upon.
With adequate stimulation, thyroid is synthesized to increase the metabolic rate. In deprivation, stress hormones (cortisol, adrenaline, etc.) rise to oppose thyroid and lower the metabolic rate. This is an adaptive mechanism to preserve energy, but if upregulated chronically will lead to decay.
Ray Peat’s main thesis is that “energy and structure are interdependent at every level” and any time the production of energy is impaired, the structure of an organism or system decays. Essentially, low thyroid function can be seen as an impaired flow of energy at all levels of life.
The hypothalamus sends a message to the pituitary (TRH) and the pituitary sends a message to the thyroid to increase thyroid production (TSH).
When thyroid function is adequate TRH and TSH are kept low because the body is already producing enough thyroid. Upregulated TSH is a reliable sign of impaired thyroid function.
The thyroid gland produces approximately 80% of T4 (thyroxine, inactive thyroid hormone) and 20% of T3 (triiodothyronine, active thyroid hormone).
Thyroid is measured in grains:
One grain of thyroid: ~12.5mcg of T3 and ~50mcg of T4
One grain of natural desiccated thyroid (NDT): ~60mg
One grain of T3: 25mcg
Incredible tool to calculate thyroid measurements
The thyroid gland produces approximately four grains per day and since T4 is converted into T3 in local cells and tissues, Ray Peat approximated that about 3-4mcg of T3 is produced per hour.
What does thyroid do exactly?
The main role of thyroid is to allow your cells to convert glucose into ATP, CO2, heat, and water, in the presence of oxygen. (carbon dioxide allows our cells use oxygen and plays key roles in reinforcing metabolism)
Thyroid also helps to convert cholesterol into the downstream steroid hormones, most notably, pregnenolone, progesterone, and DHEA; three youth hormones that reinforce metabolism.
Thyroid is also involved in the synthesis of bile acids which support digestion and reinforce metabolism further by aiding the liver and gallbladder. T3 is vital to the production of stomach acid, and carbon dioxide (byproduct of metabolism) also helps support stomach acid.
Low stomach acid and low bile acids are two of the largest contributors to issues such as acid reflux/GERD, SIBO, and constipation/diarrhea.
When your hormones are properly balanced and you have enough thyroid, this is when life comes natural, action comes from second nature and the flow of energy is not only maintained but expanded upon.
When thyroid hormone and carbon dioxide are deficient, glucose isn’t efficiently oxidized, leading to inflammation, insulin resistance, buildup of cholesterol, soft tissue calcification, and an overall inability to oppose stress.
The most common symptoms of hypothyroidism:
fatigue or low energy
feeling cold (cold intolerance, cold extremities, etc.)
dry skin
brittle nails
hair loss
constipation or diarrhea
water retention
brain fog
anxiety
depression
weight gain
Diagnosis
Since the symptoms of hypothyroidism are so broad, this is one reason why hypothyroidism often goes undiagnosed.
Dr. Broda Barnes was one of the first physicians to recognize this and wrote about it in his book “Hypothyroidism: The Unsuspected Illness”. Barnes found that treating patients with supplemental thyroid hormone could often resolve nearly any of their health issues.
The diagnosis for hypothyroidism has faced a lot of controversy throughout the years, but Broda Barnes and Ray Peat both believed that the temperature and pulse are most accurate.
If temperature and pulse are consistently low or fall after eating, this is a sign that metabolism is low. Essentially temperature should be around 98°F (36.7°C) upon waking, and rise to around 98.6°F (37.0°C) in the middle of the day. Pulse should also rise and be anywhere from 60-100bpm.
Blood tests
Many times when people suspect that they could have thyroid issues their blood work comes back normal and even though the lab work can look normal, this can be much different at the cellular level.
This is known as subclinical hypothyroidism, and is another reason that hypothyroidism is not recognized nearly as much as it should be.
TSH is a common thyroid blood test and the normal range is around 0-5 but has changed a lot throughout the years. Ray Peat believed that under one and actually close to zero is optimal, but TSH can still appear low even if thyroid function is poor due to suppression from cortisol and adrenaline. This is why TSH is not a definitive test.
Total cholesterol is also a useful blood test for thyroid, as high cholesterol (usually in the mid to high 200s) is a reliable sign that the thyroid gland isn’t converting cholesterol into the downstream hormones. Low cholesterol can also be an issue, and is usually a sign of infection.
In all cases, evaluating thyroid function by temperature, pulse and symptoms is really the best way to get a useful view of metabolism.
What causes hypothyroidism?
Some of the main contributors to hypothyroidism are: stress, inadequate nutrition (most notably—consumption of polyunsaturated fats, consumption of indigestible foods, low carb diets and lack of macro and micronutrients), lack of stimulating experience, inadequate light exposure (deficiency of red light, excess of blue light), overtraining, environmental stressors (endocrine disruptors—heavy metals, fluoride, BPAs, phthalates, synthetic fragrances and fabrics, oral contraceptive)
Often times, many of these factors are inherited from the mother so ensuring adequate health at least 3 to 4 years prior to pregnancy is vital. Hypothyroidism is a generational condition, and takin all the steps that we can to correct this widespread issue is crucial to ensuring continued development of life.
Diet and lifestyle consideration
Before experimenting with supplemental thyroid I think making sure your nutrition is solid with adequate protein, carbohydrates from easily digestible sources, calcium, sodium, magnesium, potassium, B-vitamins (most notably, B1 and B3), vitamin C, fat soluble vitamins A, D, E, and K, gelatin from broth and or powdered form, and striving to improve digestion and liver function is vital.
Implementing things such as Ray’s carrot salad or well cooked white button mushrooms, vitamin D+K, magnesium, coffee, aspirin, coconut oil, vitamin B1 (thiamine), vitamin B3 (niacinamide), cascara sagrada, and other safe pro metabolic substances can be good places to start.
One of the most common issues for people in a low thyroid state is the conversion of T4 into T3 and taking steps to support this conversion can be highly therapeutic.
Some of the main inhibitors of the conversion of T4 into T3 are cortisol, estrogen, impaired liver function, polyunsaturated fats, and endotoxin (LPS).
In essence, all of these factors are interconnected to stress.
Activating the synthesis of bile acids is known to upregulate the conversion of T4 into T3. Taurine, pregnenolone, and progesterone are known to facilitate this and selenium and zinc are also involved in the T4 to T3 conversion, so seafood such as shrimp and oysters are beneficial for these nutrients.
Aiding the liver with things such as taurine, TUDCA and or ox bile, gelatin (glycine), vitamin K2 MK4, digestive bitters and bitter herbs, milk thistle, apple juice/apple cider vinegar, and vitamin C or citrus fruits can be things to consider.
For some individuals, these interventions can be enough but if improvement isn’t seen then a thyroid supplement should be considered.
Supplementation
"When doubt exists, a trial of thyroid supplementation may be the most useful diagnostic tool." -M.B. James
Almost anyone could benefit from thyroid, but it’s definitely not something to take haphazardly.
If a person doesn’t understand the context of how to properly support a thyroid supplement, issues can arise very easily, so ensuring that you have a solid understanding prior to beginning any supplementation is critical.
Natural desiccated thyroid or NDT comes from the thyroid gland of pigs or cows and is the traditional method of supplementing thyroid. NDT contains a ratio of T3 and T4 of around 1:4, and also contains cofactors such as T1, T2, calcitonin and iodine (in trace amounts).
One grain of NDT: ~60mg.
Two of the most reliable thyroid supplements are Cynoplus and Cynomel, which are synthetic T3 and T4 combination (in a ratio of 1:4) and T3 by itself.
One tablet of Cynoplus: 30mcg of T3 and 120mcg of T4
One tablet of Cynomel: 25mcg of T3.
Experimenting with different brands and different forms of thyroid can be useful but many often find that they do best with Cynoplus and Cynomel.
Supplementing a dose of around 1 mcg of active thyroid hormone or T3 chewed up with a meal can allow you to get a good clue of how you react to thyroid.
“…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.” -Ray Peat
Oftentimes with low metabolism, even a small amount thyroid can be stimulating, so staying aware of your temperature and pulse can be important.
Plenty of people can experience an adrenaline reaction from thyroid at least temporarily, so having something such as magnesium could help mitigate possible issues.
“Magnesium deficiency can cause those symptoms. Thyroid makes your cells able to use magnesium and take it up, but big organs like your skeletal muscles and bones can take up so much from your blood that your heart and brain have trouble getting the magnesium they need to respond to the thyroid and then you get an exaggerated stress of adrenaline. About 100mg of magnesium at a time as you take the 1 - 2 mcg Cytomel or Cynomel. 100mg will be enough for a few hours to respond the the dose of thyroid.” -Ray Peat
Usually a person will quickly adjust but if thyroid causes prolonged rapid heart beat or any other negative symptoms, the supplement should be stopped immediately and your gland will return to normal function over the course of several days or weeks.
Dosing
Thyroid doses should be split up throughout the day and chewed with meals. Doses of T3 with or without T4 should be no more than 10mcg and optimally, around 5mcg could be considered more physiological.
Many find benefit from using T3 by itself, since T3 is much faster acting than T4, but requires much more frequent dosing due to its short half life.
Taking consistent small doses of T3 throughout the day can be a good method to use. Often, many can find that temporary implementation of T3 monotherapy or even temporary T3 and T4 supplementation can have a noticeable impact in improving metabolism overall.
Tremendous benefit is often found from using thyroid long term.
Using a pill cutter and milligram scale is advised to properly split up thyroid doses. Measuring doses by breaking up a tablet without a scale can work but often this is extremely inconsistent.
T3 and T4 combination can be better than T3 alone long term because T4 builds up over time and acts as a reserve.
Starting with half a grain of thyroid (or approximately 5mcg of T3 and 20mcg of T4) and increasing by half a grain every 2 weeks (if improvement isn’t seen) until reaching optimal temperature is a good path to follow, tracking temperature and pulse along the way. Adding additional small doses of T3 can be very beneficial.
T4’s effects build up over the span of approximately two weeks, so it’s important to stay at the same dose for at least two weeks before judging results and adjusting supplementation.
When liver function is poor, which can be very common in hypothyroid individuals, supplementing with high amount of the inactive hormone T4 in relation to T3 can actually impair the thyroid further, since a burdened liver can’t as easily convert T4 into the active T3. The standard ratio of T3 to T4 is 1:4, but Ray Peat postulated that using a combination of T3 and T4 in a ratio of 1:3, 1:2 or even 1:1 may be more optimal or necessary to see improvement.
Supplementing thyroid is extremely dependent on a person’s context, and this is why it’s important to be very rational evaluating your current circumstance and history. Some individuals may thrive with half a grain in a warm stimulating environment but might need closer to one or two grains in a colder more stressful place especially with a deeper history of issues. According to Dr. Peat, most individuals won’t need much more than 2 grains of thyroid, but in words of William Blake, “The true method of knowledge is experiment.”
Some frequently asked questions regarding thyroid
Will supplemental thyroid suppress my natural production?
T4 suppresses the endogenous production of thyroid hormone, but thyroid gland activity actually returns to normal after a few weeks of ceasing supplementation. Many individuals have concerns about T4 suppressing their natural production, but in my opinion if thyroid function is extremely poor after exhausting other means, there should be no concern with using supplemental thyroid, since you can always cease supplementation if you choose, and supplemental thyroid can be used temporarily to facilitate improvement in your gland’s natural function. Many individuals do actually find tremendous benefit from using thyroid long term.
Isn’t supplemental thyroid unnatural?
According to Ray Peat, the idea that supplemental thyroid is “unnatural” is not entirely accurate. Before the 1940s, people would naturally consume thyroid hormone in the diet particularly from sources such as chicken or fish head soup, which would normally contain the thyroid glands of the animals. After 1942, laws changed, and it was no longer permitted to include thyroid in food, which led to the reliance on supplements to obtain thyroid hormone.
Also, due to the overconsumption of polyunsaturated fats from our food supply, Ray views supplemental thyroid as a rational measure to support the metabolism along with other interventions to combat the anti-thyroid effects of PUFA.
What happens if I take too much thyroid?
In the case of thyroid overdose (characterized by excessive temperature and rapid heartbeat) supplementation should be stopped immediately and avoided until the issue resolves. The gland will return to normal function with enough time, but if the symptoms are severely intolerable, consuming something such as a few cups of cruciferous vegetable juice over the course of a few days can impair thyroid function to speed the process of dealing with a hyperthyroid state. This is one of the reasons that titrating up thyroid dosage slowly is important.
My doctor had me take T4 but I saw no improvement or got worse, what should I do?
As I’ve mentioned, many people who have thyroid issues have a burdened liver which can’t as easily convert T4 into the active T3. This is one reason why T4 often causes more issues than it solves.
“If too much accumulates [T4], it competes with the T3 in the brain, lowering cell respiration, possibly increasing lactic acid and nitric oxide.” -Ray Peat
Slowly adding T3 to your dose of T4 could be therapeutic. Adding 5-25 mcg of T3 (split up throughout the day) every week or two weeks could be helpful and using the Thyroid Calculator to determine doses as you shift supplementation is extremely useful.
In the calculator, you can enter the dose of T4 and use this to gradually switch to an equivalent of synthetic T3 and T4 combination or NDT.
Thyroid supplementation alternatives
For individuals who don’t wish to use thyroid hormone or have an intolerance, supporting the thyroid with adequate nutrition, light exposure, a warm climate and stimulating environment is what I would focus on. Supporting liver health and digestion is often the most important focus to improve thyroid function.
High altitude is stimulating to thyroid function due to the retention of carbon dioxide, so moving to high altitude location could be therapeutic but of course this isn’t realistic in every situation.
Also, anything that activates mitochondrial uncoupling or thermogenesis can be beneficial for metabolism. Essentially uncoupling is a lower form of energy production, but due to the thermogenic or heat increasing effect, a person is able to see benefits to metabolism.
Things such as caffeine can increase mitochondrial uncoupling, so coffee or any other form of caffeine can provide several effects in raising metabolism. Ensuring to consume coffee with enough nutrients such as with a meal, milk, heavy cream, and or sugar is important.
DNP is a famous mitochondrial uncoupler and has been used to treat metabolic dysfunction, but it can be a dangerous substance to use and I recommend avoiding it for this reason.
Also, aspirin in the range of 1 to 1.5 grams with an additional 500 mg added every 4 to 6 hours can induce uncoupling and using 1mg of vitamin K2 per 325mg of aspirin is advised to offset aspirin’s blood thinning effects.
Further Resources:
Video form of this exact post
“Hypothyroidism: The Unsuspected Illness” by Dr. Broda Barnes
Thyroid sources (synthetic T3 and T4)
Ray Peat's Brain: Building a Foundation for Better Understanding
THYROID (DOSES/BRANDS) section
Synthetic V.S. Natural
Some people have concerns with the idea of synthetic thyroid but in my opinion, the debate between synthetic and natural misses the bigger context.
In the bioenergetic view, one can really look at everything in life in terms of pro metabolic VS anti metabolic. Many may know we’re being bombarded with countless stressors that lower our energy and impair our function.
Food, supplements, the environment you spend time around, and essentially anything that you consume through your senses each play a role in supporting or impairing your energy and structure.
Ray Peat thought that if there was one protocol, it would be “Perceive, think, act.” and in my view, this is the whole idea of intuition.
Maintaining awareness of your current environment, stressors, and trusting your senses no matter what is the whole point. I think that modern problems require modern solutions and in my view, anything that promotes energy and structure should be considered “natural” or evolutionarily appropriate.
I think things such as strict avoidance of polyunsaturated fats, consumption of sugar, pasteurized dairy, refined foods, bioidentical/synthetic substances are completely rational and warranted in today’s environment.
Temperature, pulse, and symptoms should be the ultimate determinant of the effects of any given thing, and I think anything that truly supports a person’s metabolism over a prolonged period of time should be implemented.
In my opinion, bioenergetics overrides the dogma of the “ancestral” or “primal” focus on avoiding something if it appears “unnatural”…
“Perception, combined with the discovery and invention of new patterns in the world, will be actively oriented toward the future, while the deductive, merely analytical, manner of thought will be tied to the past.” -Ray Peat
Coaching
If you’re interested in healing your thyroid, digestion, asking me any questions at all, or discussing any other bioenergetic ideas, I now offer one on one coaching and you can schedule a call by DMing me on Twitter/X or Instagram.
Thank you for reading… To more life and energy.
“The cistern contains; the fountain overflows.” -William Blake
One of the best easier explanations I’ve ever read on this. Thanks 😊
Incredible post, Nate!! So clear and detailed and actionable!! Thank you so much!