Paul,

I've been lurking on your blog for some time, as my probably obsessive search for the right maintenance diet has led me to the debate between you and Dr. Rosedale, then to your book and finally to your website.

I've been especially interested in the hypothyroid and low carbing discussion, as I'm something of a case study, as I think you'll agree. For the past 27 years I've been on replacement thyroid hormone as a result of Graves Disease and radioactive iodine ablation. I have no natural thyroid hormone at all, so whatever thyroid activity goes on is totally from the T4 (Synthroid) I have been taking all these years. Until recently, my TSH was controlled in normal range.

After gradually gaining weight for several years, I topped out at 218 three years ago, and decided that I could not go on that way. I began a "low glycemic" program and have gradually lost 75 pounds, down to 143 as of today. After hitting a plateau in the 150's I decided to go seriously low carb -- virtually no-carb-- and have taken off the last ten pounds that way, with considerable pain and angst over about 6 months. (I'm a 67 year old female, and apparently have to reduce my
calories below 1200 to lose anything, even with no-carb.) I've been on basically an extreme Paleo, even giving up my beloved homemade pastured whole milk yogurt. I function OK on the carb-less diet (Scandinavian stock), but have become absolutely paranoid about introducing carbs back into my diet, for fear of starting to gain weight, and your advice to eat up to 400 carb calories per day scares the living daylights out of me. I've been eating a ton of fat - cream, coconut oil, eggs, butter, meat -- at least 60% of calories.

In view of your blogs on low-carb and hypothyroid I thought you might be interested in my blood work results from about 1 month ago:

TSH .5 (normal range .5 - 5.5)
Free T3 69 (normal range 71-180)
rT3 324 (normal range 90-350)
T4 8.9 (normal 4.5 - 12) (I take that darn pill every day!)
Insulin 3.2 (normal 2.6 - 24.9)
Glucose 84 (non-fasting)
IGF1 90 (normal 69-200)
Creatinine .63 (normal .57 - 1.0)
LDL 160
Trigliceride 54
HDL 74

At my request, when my doctor tried to put me on statins, an analysis was done of the LDL particle size, which found that the vast majority of the LDL is large, fluffy, etc. That convinced her I could get by without statins, but she put me on 5 mg of T3!! That was a month ago. I don't know what my T3/T4/rT3 look like now.

After reading your posts I am very concerned about this T3 supplementation. But I'm also still paranoid about carbs. I am sure that I'm metabolically comprised to a sufficient extent that if I were to eat 200 calories per day of carbs I'd blimp up in no time. Years of counting calories have taught me the hard way that I can't eat more than 1400 tops, and that's if I'm exercising moderately every day. At 5'8" I'm pretty satisfied with my weight at 143, size 4-6 (although 138 sounds a little better), but the big dilemma is where to go from here on maintenance.

It's obvious from the above numbers, given my total euthyroid state, that no-carbing is dragging down my T4 to T3 processing, and hiking up my rT3. And it's a totally "pure" case, since I have no natural hormone clouding up the picture. However, I am aware that Dr. Rosedale recommends very low T3, low body temp, low insulin (yes, I read his book too -- hahaha) and wonder whether maybe I'm doing OK with the low T3, and should just stop taking that dang supplement and opt for low metabolism and longevity! I would appreciate any advice, comments, suggestions you may have about my situation.

Thanks,
Helen (aka MzTiny)