photo credits Brian Moss
So many women come into my office who are overweight seeking an evaluation of their thyroid, having heard that thyroid problems can cause weight gain. Similarly, many female bodybuilders and physique competitors want to use Cytomel to have an edge in their dieting. I think its important to address this important gland, especially if you are thinking about trying to hormonally manipulate it on your own.
The thyroid is an H-shaped gland located in the anterior neck. It is the master regulator of our metabolism. It functions by way of a complex feedback mechanism. The pituitary gland in the brain secretes a hormone which essentially tells the thyroid how to function. This neurochemical is called TSH (thyroid stimulating hormone) and it is monitoring the function of the thyroid gland. The thyroid gland produces a protein called thyroglobulin which has an inactive form which is then chemically changed through a process of adding iodine to the protein (T4) which then is converted in the gland to the active form of the hormone, T3. Proper functioning of the gland counts on the brain’s message reaching the receptors in the thyroid. If the thyroid production of T4 is low, then the brain speeds up its message to produce more. On a laboratory test, this would be represented by an increase in TSH. It would be stimulated by a low T4, also shown on a lab test (simple blood test). Occasionally, the gland has trouble converting T4 to T3, and this can also signal an increase of TSH to correct for it. All of these values are easily tested in a non-fasting blood test.
A thyroid that is hypofunctioning is called an underactive thyroid, or hypothyroidism. Labs show high TSH, and low T4 and probably low T3. If the gland is overactive, TSH would be low as the brain tries to slow production of the proteins of the thyroid, and a higher than normal T4 and probably T3. Treatment would be as follows: a hypothyroid patient would be prescribed artificial T4 (Synthroid) in order to allow the gland to convert T4 to the active hormone, T3. An overactive thyroid might require ablation, a process to stop the overproduction by stopping the gland from overfunctioning, but in so doing, renders the thyroid “hypo” thus requiring lifelong treatment with Synthroid.
Physique competitors and others desiring weight loss will often times want to make their thyroids act in a hyperactive manner. The reason? It speeds up weight loss. Just as a patient with an underactive thyroid is fatigued, constipated, lethargic and fat, just the opposite occurs with hyperfunctioning of the gland. So why would dieters, bodybuilders and physique competitors not just take Synthroid to activate the gland? If you take Synthroid and your thyroid is normal, the body would just discard the excess. It would not convert to T3 because the brain would be watching for hypofunction, and not sensing it, would not allow for the conversion. If you want to speed up the gland’s function, by taking T3 (Cytomel) you bypass the conversion and give the body the “final product” . The reason women try this is to make the thyroid hyperfunction, causing rapid weight loss. Unfortunately, it can also cause the other side effects of hyperthyroidism, like heart palpitations, sweating, diarrhea, hair loss and can cause a serious condition called thyrotoxicosis, which is life-threatening.
Taking small doses of Cytomel for short periods can still cause problems, but these are usually reversible when stopped. The problem is that most women don’t discontinue it correctly. If taken for more than one month, it takes two months to come off it. It requires a titration, or a reduction in milligram dosage over time so that the hormonal balance of the thyroid-pituitary axis can be re-established. Abruptly stopping Cytomel will shock the gland because while taking it, the pituitary shuts down TSH. In other words, the brain is reading that there is an over-abundance of the active hormone, and stops producing the hormone telling the thyroid to function. So no message is coming to the gland when you stop Cytomel and the thyroid no longer functions. This can result in lifelong hypothyroidism and requires taking Synthroid for life. Reducing it slowly will allow the brain to sense when a deficiency is occurring, and will kick-start the production of TSH, so the gland gets the signal to function again.
Hormonal manipulation is strongly discouraged by physicians, including myself, since we know the dangers. But since many women (and men as well) use Cytomel as part of their cutting cycle for contests without physician knowledge or approval, it is important to know a lot more than just what you hear in the gym.
It is unimportant in my opinion as a Nationally qualified female bodybuilder and a doctor to use Cytomel. The cutting cycle should be a balance of diet, exercise, and cardio to achieve your weight loss. In spite of the dangers, many may still choose to short-cut the dieting by using Cytomel and other drugs. Be well informed, and if you are going to take Cytomel, watch your dosage and the duration of the cycle, and most importantly, come off it very slowly. You have nothing to lose by a slow titration off, but everything to lose by abruptly stopping it.
If you have made the decision to try Cytomel, I suggest you begin by getting blood tests to see where your natural levels are before you begin. Make sure your thyroid is functioning properly. I can be of help if needed by faxing lab requisitions for these tests to be done at a lab near you. I will not prescribe Cytomel to anyone unless there is a medical condition requiring it, since this drug is looked at as performance enhancing and therefore unable to be prescribed for that purpose. However, if you are obtaining it illegally and taking it on your own, then it’s important to retest especially as you are discontinuing Cytomel. I offer telemedicine for athletes to help in this regard. My website is close to completion. The cost of an email consultation is $75.00 and I am able to have labs done very inexpensively through a lab I work with. I will publish my website address as soon as I am satisfied with it, probably within the next 30 days. Until then, my email address is glajoiemedical@cfl.rr.com and I can try to help you to make good choices and stay safe. Endocrinology is easy for an Internal Medicine doctor like myself, but really shouldn’t be attempted by someone without experience with this type of hormonal manipulation.
This topic is lengthy; there are a few other rare conditions like auto-immune thyroiditis and goiter that may also need to be evaluated. This can be done with additional labs and often with an ultrasound. Again, I can arrange for this via telemedicine. Let me know if I can be of help.
www.DrMarilynlajoie.com
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