Fasting- A Cautionary Tale

If you have been diagnosed or suggested that you may have under active thyroid – READ THIS STORY.

Jason was a very successful personal trainer and like many others in the field, he was a self-experimenting. He had typical symptoms of Thyroid fatigue. He was practicing intermittent fasting and was also going through some very stressful times in his life.
Could these factors have been the cause of his symptoms and lab results? A little bit of fasting here and there shouldn’t cause this, but if you take it to the extreme, it’s definitely possible.

Our bodies sense starvation in times of extreme caloric deficit. When this perceived starvation happens, one way that the body protects itself and preserves energy is by lowering energy expenditure via the thyroid.
Normally, a healthy thyroid converts T4 hormone to T3 (which, again, is the active form of thyroid hormone). A sick thyroid often converts T4 to reverse T3 instead.
This might be happening to Jason.

To prove this was happening he stopped fasting and ate more, had lab tests while he was on the T3 (Cytomel) thyroid replacement. On the T3 replacement, his symptoms were variable, but overall better than they had been before replacement.
The tests and assessments
ordered the same thyroid panel as before.

Now, only T4 was abnormal. As expected, since normally a thyroid gland secretes mostly T4 (inactive compared to T3) with only some T3. The T4 is then converted to the active T3 in other parts of the body. Since Jason was taking exogenous T3 (Cytomel), his body wasn’t making the T4 anymore, which is why it shows as low.

Time to test the thyroid fatigue hypothesis.
The prescription
This would be the tough part. Cytomel (T3 – liothyronine) was the only thing during Jason’s illness that made him feel better.

I thought Jason’s problems were caused by low calories (and maybe even carbohydrates too). He needed to stop the long fasts and consistently eat at least his calculated caloric needs for the day.
We couldn’t fix the underlying problem without this step.

After 2 months, more labs tests.
While Jason was somewhat discouraged with these lab findings, He was going in the right direction. He continued to eat well and maybe even take it easy in the gym for the next month.
He took NO T3, no matter what. The next set of labs had to be accurate.
After 2 more months he had more lab tests.
Jason was off T3, and his symptoms were mostly resolved.

Jason was complaining of fatigue. He’d been to multiple doctors who diagnosed him with various conditions. He was inappropriately started on thyroid replacement without fixing the underlying cause.
By addressing the real problems — metabolic down-regulation because of stress and inadequate food intake — Jason was able to come off medication and on to a new, healthier path.

What can we learn from Jason’s story?
If you are constantly fatigued, see your doctor.

Hypothyroidism (low thyroid) may be a symptom of something else, and it doesn’t always have to be treated with thyroid replacement.

Find the actual problem.
In Jason’s case it wasn’t his thyroid, it was his low calorie intake.

Look at your allostatic load — the sum total of all the mental, physical, and emotional stressors in your life. You may be more stressed out than you realize — and if so, your body will give you clues.

Listen to your body..