Effect of dietary composition on fasting-induced changes in serum thyroid hormones and thyrotropin.

To assess the effect of starvation and refeeding on serum thyroid hormones and thyrotropin (TSH) concentrations, 45 obese subjects were studied after 4 days of fasting and after refeeding with diets of varying composition. All subjects showed an increase in both serum total and free thyroxine (T₄), and a decrease in serum total and free triiodothyronine (T₃) following fasting. These changes were more striking in men then in women. The serum T₃ declined during fasting even when the subjects were given oral L-T₄, but not when given oral L-T₃. After fasting, the serum reverse T₃ (rT₃) rose, the serum TSH declined, and the TSH response to thyrotropin-releasing hormone (TRH) was blunted. Refeeding with either a mixed diet (n = 22) or a carbohydrate diet (n = 8) caused the fasting-induced changes in serum T₃, T₄, rT₃, and TSH to return to control values. In contrast, refeeding with protein (n = 6) did not cause an increase in serum T₃ or in serum TSH of fasted subjects, while it did cause a decline in serum rT₃ toward basal value.The present data suggest that: (1) dietary carbohydrate is an important factor in reversing the fall in serum T₃ caused by fasting; (2) production of rT₃ is not as dependent on carbohydrate as that of T₃; (3) men show more significant changes in serum thyroid hormone concentrations during fasting than women do, and (4) absorption of T₃ is not altered during fasting.