Low T3 Syndrome I: It’s Not About the Thyroid!

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This article is part of a special report on Thyroid Disorders. To see the other articles in this series, click here.

Hypothyroidism involves high levels of thyroid stimulating hormone (TSH) and low levels of the thyroid hormones T4 and T3.

However, in my clinical practice I frequently see people with low levels of T3 with normal T4 and either low or normal TSH. This condition has been reported on in the medical literature for years but it is rarely acknowledged or discussed in conventional medical settings. Most doctors (even endocrinologists) do not seem to know what causes it, or what to do about it. (I know this because I always ask my patients with this syndrome what their doctors said about it, and my patients’ response is almost always some variation of “not much”).

This particular pattern goes by three different names in the medical literature: Euthyroid Sick Syndrome (ESS), Non-thyroidal Illness Syndrome (NTIS), and Low T3 Syndrome.

NTIS has become the term of choice in the literature. However, I’m going to use Low T3 Syndrome in these articles because it’s more descriptive and accessible to the layperson.

What’s most important to understand about this condition is that, although it does involve low levels of T3 (the most active form of thyroid hormone), it is not caused by a problem with the thyroid gland. This is a crucial distinction and it’s what distinguishes Low T3 Syndrome from “garden-variety” hypothyroidism.

In this series we’re going to discuss 1) what causes Low T3 Syndrome, 2) it’s clinical significance, and 3) if it should be treated, and if so, how.

But first we need to lay the foundation with a little basic thyroid physiology.

Basic thyroid physiology

In order to understand Low T3 Syndrome, you’ll need a basic understanding of thyroid physiology. Regulation of thyroid metabolism can be broken down into the following five steps:

  1. The hypothalamus (a pea-sized gland in the brain) monitors the levels of thyroid hormone in the body and produces thyrotropin releasing hormone (TRH).
  2. TRH acts on the anterior pituitary (directly below the hypothalamus, but outside of the blood-brain barrier) to produce thyrotropin, a.k.a. thyroid stimulating hormone (TSH).
  3. TSH acts on the thyroid gland, which produces thyroxine (T4) and triiodothyronine (T3), the primary circulating thyroid hormones. The thyroid produces T4 in significantly greater quantities (in a ratio of 17:1) than T3, which is approximately 5x more biologically active than T4.
  4. T4 is converted into the more active T3 by the deiodinase system (D1, D2, D3) in multiple tissues and organs, but especially in the liver, gut, skeletal muscle, brain and the thyroid gland itself. D3 converts T3 into an inactive form of thyroid hormone in the liver.
  5. Transport proteins produced by the liver – thyroid binding globulin (TBG), transthretin and albumin – carry T4 and T3 to the tissues, where they are cleaved from their protein-carriers to become free T4 and free T3 and bind to thyroid hormone receptors (THRs) and exert their metabolic effect.

Mechanisms of Low T3 Syndrome

As you can see, the production, distribution and activation of thyroid hormone is complex and involves several other organs and tissues other than the thyroid gland itself.

Hypothyroidism is a defect in step #3, because it typically involves a dysfunction of the thyroid gland itself – most often caused by autoimmune disease (Hashimoto’s, Ord’s, Graves’) and/or iodine deficiency.

However, in Low T3 Syndrome, the problem generally occurs in steps #1, #2, #4 and #5. None of those steps are directly related to the function of the thyroid gland itself.

More specifically, Low T3 Syndrome can include the following mechanisms:

  • Modifications to the hypothalamic-pituitary axis
  • Altered binding of thyroid hormone to carrier proteins
  • Modified entry of thyroid hormone into tissue
  • Changes in thyroid hormone metabolism due to modified expression of the deiodinases
  • Changes in thyroid hormone receptor (THR) expression or function

Low T3 Syndrome in acute and chronic illness

Most of the studies on Low T3 Syndrome have been done on people suffering from acute, life-threatening illness. In the intensive care unit, the prevalence of abnormal thyroid function tests is remarkably high. More than 70% of patients show low T3 and around 50% have low T4.

Many of these studies have indicated a direct relationship between Low T3 Syndrome the severity and both short- and long-term outcome of disease. The lower the T3 level in critically ill patients, the worse the outcome tends to be.

However, studies examining thyroid hormone replacement in these situations have shown mixed results. In most cases – with the exception of cardiovascular disease – taking thyroid hormone did not improve outcomes. We’ll discuss this in more detail later.

Recently, more attention has been given to Low T3 Syndrome in non-critical, chronic illness. Specifically, the question on everyone’s mind (including mine) is whether thyroid hormone replacement is useful in this situation, or if – as some have suggested – it could even be harmful.

In emotional, psychological or physiological stress, the body will convert excess T4 to reverse T3 (rT3) as a means of conserving energy for healing and repair. It is at least possible, therefore, that replacing thyroid hormone in these cases may not be beneficial.

On the other hand, in those suffering from long-term chronic illness, Low T3 Syndrome may be more reflective of pathology than adaptation, and this group may benefit from T4 or T3 supplementation.

We’ll explore all of these questions in more detail in the articles to follow, and I’ll also share some of my observations from my clinical practice. Stay tuned!

Articles in this series:

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Comments Join the Conversation

  1. says

    Always enjoy your articles, Chris and am already looking forward to this one, although my own research into this topic tells me that we (or rather the pharma-financed medical research) knows nothing about NTIS beyond its clinical manifestation in really critically ill patients – part of the establishment even still deny its existence and exacerbate the problem of hundredthousands of patients by propagating T4 treatment and TSH diagnostics as the treatment and diagnosis techniques of choice.

  2. says

    Thanks for this article, Chris! This is exactly the problem I have been facing. Even with T3 supplementation in addition to Armour, my T3 levels continue to go down and my TSH is below range. I have been working on eliminating candida and healing my gut in hope that my thyroid function will improve. Do you know how iron plays into this as I have difficulty getting my iron levels where they need to be. Thanks!

    • Alixe says

      Iron needs adequate thyroid hormone in order to “hold/stick”, and the thyroid needs adequate iron so it can be taken into the cells, versus pooling in the blood. Armour contains T4 and it may be that you have a reverse T3 issue blocking thyroid hormone from getting into the receptors and need to be on a T3-only medication should there be too much T4 being converted into reverse T3. It may be that you would do better “ramping up” iron and T3 together, slowly. Candida should greatly improve once your body temp comes up to normal (ie, you are treating your hypothyroidism adequately). Candida thrives in a low-temp body and will be hard to eliminate while actively hypothyroid.

  3. Tierney says

    I would also love to know the relationship with iron. The STTM group says low iron will make you unable to tolerate Armour or any synthetic T3. In my experience, Synthroid gets me to about 90% of where I want to be. When I add in T3, I have some issues and have to go super slow (but it’s the only thing that will budge my weight.) My iron is very low (although I am never anemic) and I’ve been taking so much iron for almost a year now, but my iron levels hardly move. To give you an idea, I take about 200 mg iron bisglycinate and 10 mg ferritin each day and my ferritin has gone from a 22 to a 36. Why would it be so hard to raise iron? I want to take my T3! Thanks so much for this series!

    • Rhonda says

      B-12 shots have kept my iron at a normal level. Without them my iron goes way down. Drs believe I have connective tissue autoimmune disorder. T3 is half of what it should be, but others ok with 88 mg levothyroxine daily.

    • Ana says

      Wow, It seems like you are talking about me. I was given by my doctor some T3 pills. I have to admit i did not take my iron for whole month and now it has been very hard to make it go up. I cut the T3 dosis in half just because of my schedule, could it be possible that it also affects the iron in your body? Scary. I am losing weight with all the treatment the doctor gave me.

  4. Paul says

    Looking forward to learning more. BTW, I am a hypothyroid whose T3 dropped badly (with TSH <1) when I switched to low-carb approach. I have remained substantially low-carb, but have increased my T4 & T3.

    I am interested in the Broda Barnes / William McK Jefferies view that the conversion of T4 to T3 and the uptake of the T3 in the cell is, to some extent, dependent on adequate cortisol levels – levels of which can become depressed in a chronically un(nder)treated hypothyroid.

    I have noticed some papers showing some benefit from supplemental T3 in heart failure patients. The most recent (a review) being: Thyroid Replacement Therapy and Heart Failure http://bit.ly/rsAaNN

  5. says

    Awe…..way to leave us hanging!!! I am extremely interested in this topic because I have been on Armour Thyroid for 2 years after my alternative healthcare practitioner found my Triiodothyronine, Free Serum levels to be at 2.5pg.mL. The “lab limits” were 2.3-4.2 but she said the level was low and could be causing some of the nervous system disturbances I was experiencing. This view concurred with a very informative article by Dr. Joe Mercola in which he promoted the use of Amour Thyroid for low T3. However, I later went to an ND who wasn’t thrilled to know I was taking it. So now I’m confused and waiting on the edge of my seat for the rest of this article!

    • Randle says

      My T3 was tested twice and I reported 2.6 and 3.0, with lab ranges from 2.0-4.4. (My TSH is between 0.5-0.8, and T4 1.1-1.7. Never tested me for Rev T3, even though I show very obvious clinical hypothyroid symptoms). I didn’t realize these number could be interpreted as “low”. Just curious, what kind of nervous system disturbance are you experiencing?

  6. tess says

    excellently clear description of the various places “thyroid” problems can happen! i look forward to the rest of this series!

  7. Robert Jacobs says

    At the end of your article you bring up rT3, which is most interesting. I have been looking into rT3 dominance and its ability to shut down even normal levels of T3. The point about stress is very important, as we are talking about emotional, as well as physical stress. I have read that even a lack of exercise – strenuous exercise – can also apparently result in higher rT3 levels.

    Looking forward to your future articles.

  8. Alixe says

    The problem for a lot of people – including myself – is in taking thyroid medication with any T4 in it whatsoever. Those with a poor free T3/reverse T3 ratio need to be on T3-only medication. Many cannot simply add T3 to their T4 regimen or take dessicated thyroid as it will make their problem worse due to the T4 converting to reverse T3 instead of T3 and thereby blocking the thyroid hormone receptors. They are then hypothyroid on a cellular level.

    All doctors should be running a free T3 along with a reverse T3 test and understanding what to do with the resulting ratio of free T3 to reverse T3. It will catch many with thyroid hormone resistance that will never be diagnosed through the TSH, free T4 and free T3 alone.

    • Randle says

      Excellent comment. I wish every doctor would test Rev T3. But it’s hard enough to get T3 and T4, along with TSH, tested.

      • Alixe says

        You can get your own reverse T3 tested if you are having trouble finding a doctor who will order it. There are online labs you can pay for, print out the lab order, and take the sheet to your nearest lab for a blood draw.
        Also, I would fire a doctor that refuses to order it and find one who will. Even if he/she isn’t sure how to interpret it. Unfortunately, most doctors do not order the reverse T3 as part of the standard thyroid panel as, surprisingly, they are not up-to-date on thyroid disease diagnosis, testing, and treatment. The free T3/reverse T3 ratio is key to have done if you have any chronic health issues. The TSH indicates thyroid hormone levels in the pituitary, but does not indicate whether one has hypothyroidism in the rest of the bodies’ tissues and is therefore quite far from a gold standard test. Free T3 and Free T4 alone do not show what is going on in the tissue level. People with fibromyalgia, chronic fatigue syndrome, leptin/insulin resistance, depression, dieting, obesity, and other chronic health issues should be checking this ratio. If the ratio is off, one will need T3 only treatment in most cases. Even Armour will not cut it, as the T4 will convert to too much reverse T3 and block the thyroid hormone receptors, keeping one hypothyroid.

        • andrea says

          great information thankyou so much. I have suffered with depression,severe fatigue ,trouble sleeping, muscles aches ect. im on synthroid and think thats what is making me sick. what do u think about natural hormones. I will know check with my Dr abut mt t-3 level is and make sure a reverse t3 was done. what ussually is the cause of depresssion and sever fatique ,any ideas. thank you so very much andrea

          • keo says

            andrea,

            T3 is key in depression and muscle aches. When I got off T4 and went onto dessicated thyroid, the muscles in my neck and back that had been stiff released within a day. There are also more and more studies to say that brain fog is cleared by T3 therapy. Look into dessicated or synthetic T4/T3 therapy.

    • Rob says

      I am 56 and had hashimoto’s as well as papillary thyroid cancer with follicular and small area of tall cell variant.
      My thyroidectomy was in 2011. I am on synthroid 137 mcg and atenolol 50 mg. i recently started on cymbalta. I went on it a few months after my thyroidectomy and then went off and two months ago back on 30 mg. i had never in the past suffered depression although i woukd have periods of anxiousness. When i get the low feelings, my sense of smell gets incredibly heightened.
      I also have leg and muscle cramps. My tsh was last 0.13 total t4 11.4 free t4 3.2. T3 total 123. T3 uptake 28. Thyroglobulin <0.2

      Are these labs a bit off. Would i feel better if my t3 were higher?
      I am startimg with a new doc at cleveland clinic and looked at the lab orders and he is not even requesting t3
      I want to feel normal, lose 15 pounds and stop having muscle spasms and cramps. Calcium and magnesium have always been normal as have K levels

  9. John Calhoun says

    Thank you for addressing T3 issue. I have been diagnosed with “Reverse T3 Dominance”, and I hope you will be addressing this as well, especially how keep in in check/ preventing reoccurances.

  10. Sue says

    The rT3 that you bring up very popular subject at the moment especially in regards to leptin resistance. If you have high rT3 usually marker for leptin resistant (as per Dr Kruse). Hopefully you address leptin when talking about rT3. High rT3 from calorie restriction.

  11. Debra B. says

    Chris, How does one know what kind of Hypothyroid autoimmune disease they have (Hashimoto’s, Ord’s, Graves’) and/or iodine deficiency)? I was diagnosed a year after I gave birth to my one and only child was born, in Dec. 1983, (my was then age 36). I was put on Synthyroid & never felt normal until I asked my Dr. to prescribe me ARMOR in Nov. 2010 & also started eating Paleo Diet Feb. 2011, now I finally feel the most normal for me since I was in my mid 20′s. I am looking forward to learning more about this topic! Thank you so much for expanding on thyroid disease.

    • Chris Kresser says

      You get your thyroid antibodies tested: thyroid peroxidase (TPO) & thyroglobulin (TG) if you suspect Hashimoto’s or Ord’s and Thyroid Stimulating Immunoglobulins (TSI) if you suspect Graves’

        • Chris Kresser says

          The antibody tests are not 100% accurate. If my patients have signs and symptoms of Hashimoto’s, I treat them as if they do have it and watch how they respond.

          • Rhonda says

            I am also on Plaquenil 200 2/d. Could carbs make my T3 drop? Will it hurt if my T3 is low when the other thyroid markers are ok?

        • dsgreen5 says

          Hi Sheila,

          Initially, Graves is related to hyperthyroidism. However, after medication treatment, many of us end up hypothyroid with the FT4 and FT3 looking “normal” but being too low to feel good, and the TSH on they very low end. Unfortunately the doctors look at the TSH and label us as hyper, when in fact you are hypo if you look at the thyroid hormones. I’m finding it next to impossible to find a doctor who is really knowledgeable about treating Graves.

  12. says

    I’m SO looking forward to the rest of the series since this might directly fit to my case… Been on a thyroid medication now for six months (recently switched from T4 to Thyroid) but I suspect this kind of scenario talked about this post might be the case. It’s subclinical but the symptoms are obvious. It’s not autoimmune either and my other blood work is really quite excellent (including ferritin, B12).

    So please, please get the next ones out soon! I’m feeling hopeful :-)

    Ps. About the carbs&thyroid issue; I read Nora Gedgaudas’ book Primal Body Primal Mind in February 2010 after which I ditched the rest of my already low carb diet’s carbs. She really recommends like a zero carb, just leafy greens and “the less insulin we secrete the longer and healthier we live”. Well, that didn’t seem to do me any good (also started eating with just three times a day and did IF regularly). My problems started couple of months after and they’ve only now, over a year later started to get a bit better with the mentioned thyroid medication, adding carbs (berries, fruit, a little sweet potato – still very, very moderate since it’s not easy to go from a almost zero carb to eating more carbs, mentally) and some other stuff like herbal support.

    Anyway, just received Nora’s new version of Primal body primal mind and skimmed trough it; it still recommends a very low carb diet and I’m just wondering whether it’s me or is it really the best thing for everybody… Don’t really know what to do. I just do a lot better eating more often, a bit more carbs, no IF.

    • Paul says

      My T3 crashed too after going low carb. But, was it less carbs, more protein or more fat? Is rushing back to carbs the best approach – I did and I gained weight. I have upped my T4 and T3 and am trying vlc again – checking T3 later this month.

  13. says

    Hi Paul,
    yep, you are right: correlation doesn’t equal causation. But I didn’t rush back to carbs, only after a year after the symptoms started and after gaining those 15kgs I increased some carbs and subjectively I feel better. Also I haven’t put on weight since adding carbs. I also read the post written by Paul Jaminet (http://perfecthealthdiet.com/?p=4383) and I get even a stronger feeling that I shouldn’t go zero carb. But, time will tell, I guess. Since no one else will… ;-)

    Hope you’re getting better, Paul!

  14. Jennifer says

    I began researching Low T3 syndrome after coming home from the doctor today. My blood work results were received by my doctor and we met to review the findings. My TSH and T4 numbers all fell within the normal range. However, my T3 came back 0.00. I am a healthy 30-year old woman, somewhat overweight, but I do not have any known chronic disease. I’m interested to see the changes I experience once I begin treatment for this condition.

  15. Sherry says

    Is it safe to take iodine supplements of 12.5 mg with synthroid to raise free T3? I was thinking I may have iodine deficiency and ordered it. Then, my lab tests came back showing TSH and T4 normal, but the free T 3 lower which prompted my dr to increase my synthroid dosage.
    your article is very well written.looking forward to next follow up.
    Oh and I realized that I,too, was on a low carb diet before I took the lab tests. Makes you wonder about the metabolism effects.

  16. Kimberlie says

    Hello, Doc

    I have been on Tirosint for almost 9 months… raising the dosage from 25 to 75mcg as my levels had wavered and I kept hitting the wall of fatigue! I am at that point again with my TSH and T4 at good levels but T3 very low now. I exercise intensely every other day (lifting, boxing, boot camp) and walk/cycle/jog all alternate days. I eat really healthily…perhaps not enough calories actually…and have one hellova time just losing a few pounds! My Doc wants to add another med to help raise the T3 and I am not game. Any thoughts about how to help the T3 go up, how to boost my energy, and how my exercise and eating can actually result in weight loss? Thanks for any insight in advance!!

    • Robert Jacobs says

      Just some ideas from my recent reading. If your TSH and T4 are at good levels, and the T3 is low, then why not just take a T4/T3 supplement? If that works, then you were having difficulty making T3. It is also possible your body could be reverse T3 dominant or for some other reason have problems making the T3. Have you had total and free T4/T3 tests? A thyroid microsomal antibody test? Tirosint seems to be just T4. I have heard that high stress (high cortisol – perhaps overtraining?) can inhibit T4 conversion to T3.

  17. Katie says

    Hi Doc,
    I’m a 30 year old female that has been On synthroid for seven years. This past July I got extremely tired for weeks straight and saw my endo . My tsh on .112 was .8 and my t3 was 71. she increased my synthroid from .112mg to .125mg. In sept I got my levels checked again and my tsh was 1.5 and t3 was 76. Tidies the opposite of what we expected to happen, but I was feeling better and had more energy. In dec I got sick and my pcp thought I had bronchitis, I got a dose of steroids and antibiotics. I felt better after a few weeks, however since then my anxiety levels have been worse than ever. I have had several panic attacks and went to my psychiatrist. Although I have been on zoloft for 10+ yers she recommended I increase it to 125mg QD. For the last two months I have been taking 125mg zoloft and .125mg of synthroid. My panic and anxiety is still frequent. Have you ever seen or heard of anyone’s TSH levels going up by increasing synthroid? Or seen any patients T3 levels go down with increased synthroid? Do you think I should get another opinion?
    Also, I started taking singular in dec. Do you think that may effect my anxiety levels?

    • says

      Katie,
      I would! I’ve been dealing with all of this since I got Mono a few years ago. You can read my story on my website. Keep in my site isn’t fully developed yet.

  18. Jennifer says

    I am a 42 yo female who had a complete thyroidectomy (hasimoto’s thyroiditis) in 2003. Had a total hysterectomy in 2009. Wow, my life/health have never been the same. I have read, researched, experimented with everything I can find and pay for.

    Question: I have tried compounded slow release T3, cytomel, along with Armour. I do not seem to tolerate cytomel well (nervousness, heart palpitations, etc.) even in very small doses (2.5mcg) yet cannot really tell a difference with compounded SR T3 (even at 12.5mcg). I am currently experimenting with adjusting my Armour dose between 2 – 3 grains along with following Dr. Wilson’s Adrenal Fatigue protocol. I am also on BHRT. It is convoluted to be attacking all aspects of this hormonal trinity but nothing seems to be working and I can’t tell what is creating the symptoms.

    Ok, question: my TSH is still super suppressed, my free T3 is low, my free T4 is low. My FSH is high, my estrogen, progesterone, testosterone is low! Not sure what to do. Recently added some Tyrosine and Phenylalanine and Glutamine for energy and to decrease depression.

    Any suggestion? Should I even look at my TSH since I don’t have a thyroid gland. should I keep increasing my Armour dose to increase T3 and T4? Yet why do I have hyper like symptoms when I do? Adrenal Fatigue creating that? What about female hormones as they interplay into the whole hormonal orchestra. Help!

    • Kim says

      Hello Jennifer and Chris:

      Here are a few resources that I have found helpful; I am about to begin a protocol with LDN. Each of these resources may lead to more questions as well as some answers, such as the role of adrenals, in stabilizing on synthetic hormones, bio-identical hormones, or NDT. I have Hashimoto’s. I am currently on a T3 replacement only as years of Synthyroid at 200 mcg as well as Armour never alleviated the disabling symptoms of autoimmune disease.

      http://www.hormonerestoration.com/index.html

      http://www.stopthethyroidmadness.com/adrenal-info/

      http://recoveringwitht3.com/

    • timothy says

      Jennifer Im here because Im trying to learn more about t3 ( I had thyroid cancer so now have no thyroid. 200mcg synthroid and I feel depressed, tired, weak..36y.o. male)
      I was having constant anxiety/depression/brain fog and I asked my Dr to test my testosterone. He said it was in the “normal” range. So I took it to a hormone specialist and he laughed and said “ya its normal if you were in your 70′s”
      I went on testosterone injections and in two weeks everything changed.
      Im telling you this because he even prescribed my wife testosterone cream and I couldnt believe the change in her.
      She went from being tired, no energy, no sex drive etc to being happy, energetic, fat loss, always wanting sex lol…..
      I havent been on trt for a few years now because I couldnt afford it anymore and Im back to having no energy, memory problems, brain fog, lack of focus, no sex drive….
      You might want to look into it, but you need to find a hormone replacement clinic as your normal DR most likely wont prescribe a woman testosterone

    • Debbie says

      you should read the books from Stop the Thyroid madness to gather some important information for your symptoms and what to treat first. The sttm website is also a very good source of info online and a way to get help fast!

  19. Donnie says

    i was diagnosed hypothyroid based ‘only’ on high tsh back in 07 when menopuase hit, only symptoms then were severe hot flashes but i was put on synthroid and i took it until about a year ago when i started feeling sick and i had hair changes, skin, muscle loss, eyebrows, you name it, i was a ‘fit’ 57 yr. old but felt like i was dying slowly. i decided to quit taking the med. and some things felt better but symptoms remained so went and had new labs and all numbers are within range except free t3 and i’m hoping some one here can help me? free t3 is183 ref. 210-440. dr. tried me on armour, i had a bad reaction so synthroid and cytomel, bad reaction, and then, just cytomel, i can’t take it so????? i don’t know what to do now. thanks.

  20. Shaina Goyal says

    Hi Doc!
    I am suffering from Vitiligo, I was told that one auto-immune disease puts you at the risk of developing other auto-immune diseases so I got my Thyroid profile done and it came out as :
    T3,Total 0.60 ng/ml (Reference Range 0.60-1.81)
    T4,Total 8.20 ug/dl (Reference Range 5.01-12.45)
    TSH 3.99 uIU/ml (Reference Range 0.35-5.50)
    Do I need to worry? Looking forward to your advice. Thanks!

    • Chris Kresser says

      A TSH of 4 indicates thyroid hypofunction, and you’re at the bottom of the range for T3. My guess is you’re having trouble converting T4 to T3; I covered the possible reasons for that in this article and elsewhere.

      • Shaina Goyal says

        Thanks for getting back to me,Sir!
        I’m really worried. If you could please suggest me what should I do next.
        Thanks!

  21. Donnie says

    hi, i was hoping for a reply to my post, why my free T3 is 183 ref. range 210 to 440 and all the rest are within range. thank you. taking small dose of cytomel but it gives me strange side affects. ANY advice or reason free t3 is so low?

  22. Julie says

    Chris,

    Could you please clarify what do you consider normal for TSH, Free T3, Free T4
    I think my Free T3 is low (3.7) but it’s within the lab range…(2.8-7.1 pmol/L)
    Thank you!

  23. Kathy says

    Dear Dr.Kresser,

    I would very much apprceciate if you would look in to the symptoms /blood test results in my email and give me your opinion of what I should do.Thank you so much.
    Kathy
    I WAS DIAGNOSED WITH UNDERACTIVE THYROID AT THE AGE OF 26 – NOT TREATED
    HAD MY SON AT 28, DAUGHTER AT 31 WITH BOTH PREGNANCIES PUT AROUND 5 STONES IN WEIGHT – LOST THE WEIGHT AFTER BOTH BIRTHS WITH STRICT DIET AND EXERCISE .

    AT THE AGE OF 33 HAD SPINAL OP.(REMOVAL OF2 DISCS) SINCE THEN SEVERE OSTEOARTHRITIS -SCIATICA FALLEN ARCHES TORN LIGAMENT IN THE HEEL.

    AT 37 DIAGNOSED WITH M.E , SLEEP APNOA ( SLEEP WITH OXYGEN) AND PCOS MIGRAINE ALLERGIC RHINITIS PUT LOTS OF WEIGHT ON AND NO AMOUNT OF DIET OR EXERCISE CAN SHIFT IT. AT 40 HAD COMPLICATED HYSTERECTOMY WITH BLOOD TRANSFUSION.

    ALWAYS COLD- LOW MORNING TEMP.BETWEEN 35.9 AND 36.9 DEG. NOW I THINK I HAVE ALMOST EVERY SYMPTOM OF UNDERACTIVE THYROID BUT I’VE BEEN TOLD THE BLOOD TESTS ARE NORMAL

    FEMALE 61 Y OLD

    5.3mmol/L (2.5-6.1) PLASMA GLUCOSE,FASTING;-
    IMPAIRED FASTING GLYCAEMIA: 6.1 – 6.9
    DIABETES MELLITUS : >7.0
    PLASMA GLUCOSE, 2HOURS POST GLUCOSE LOAD: -
    IMPAIRED GLUCOSE TOLERANCE: 7.8 – 11.0
    DIABETES MELLITUS: >11.1

    THYROID ANTIBODIES
    THYROGLOBULIN AUTOANTIBODIES (XA1D4) < 20 IU/ML (0.0 – 20.0)
    THYROID PEROXIDASE ANTIBODY LEVEL (XADVU) = 0.9 )
    CALCULATED LDL CHOLESTEROL LEVEL 4.53 MMOL/L (0.0-3.35)-ABOVE RANGE
    SERUM CHOLESTEROL /HDL RATIO 6.5 (0.0 – 4.3) ABOVE RANGE

  24. Kathy says

    I WAS DIAGNOSED WITH UNDERACTIVE THYROID AT THE AGE OF 26 – NOT TREATED
    HAD MY SON AT 28, DAUGHTER AT 31 WITH BOTH PREGNANCIES PUT AROUND 5 STONES IN WEIGHT – LOST THE WEIGHT AFTER BOTH BIRTHS WITH STRICT DIET AND EXERCISE .

    AT THE AGE OF 33 HAD SPINAL OP.(REMOVAL OF2 DISCS) SINCE THEN SEVERE OSTEOARTHRITIS -SCIATICA FALLEN ARCHES TORN LIGAMENT IN THE HEEL.

    AT 37 DIAGNOSED WITH M.E , SLEEP APNOA ( SLEEP WITH OXYGEN) AND PCOS MIGRAINE ALLERGIC RHINITIS PUT LOTS OF WEIGHT ON AND NO AMOUNT OF DIET OR EXERCISE CAN SHIFT IT. AT 40 HAD COMPLICATED HYSTERECTOMY WITH BLOOD TRANSFUSION.

    ALWAYS COLD- LOW MORNING TEMP.BETWEEN 35.9 AND 36.9 DEG. NOW I THINK I HAVE ALMOST EVERY SYMPTOM OF UNDERACTIVE THYROID BUT I’VE BEEN TOLD THE BLOOD TESTS ARE NORMAL

    FEMALE 61 Y OLD

    SERUM FREE TRIIODOTHYRONINE LEVEL (XAERQ ) 3.6 PMO/ L ( 3.5 – 6.5)

    SERUM FREE T4 LEVEL (XAERR) 15.2 PMOL/L (10.3 -23.2 )
    SERUM TSH LEVEL (XAELV) 3.25 MLU/ L (0.4 – 5.5 )

    LIVER FUNCTION TEST FASTING

    SERUM TOTAL BILIRUBIN LEVEL BELOW RANGE 4 UMOL/L (5.0 – 21.0 ) BELOW LOW REF
    SERUM ALKALINE PHOSPHATASE LEVEL 45 IU/L (30.0 – 120.0)
    AST SERUM LEVEL 15 IU/L (0.0 – 30.0)
    SERUM ALANINE AMINOTRANSFERASE LEVEL 16 IU/L (0.0 – 34.0)
    SERUM GAMA-GLUTAMYL TRANSFERASE LEVEL 87 IU/L (0.0 – 37.0)ABOVE RANGE HIGH
    SERUM TOTAL PROTEIN LEVEL 71 G/L (66.0 – 83.0)
    SERUM ALBUMIN LEVEL 44 G/L (35.0 – 52.0)
    SERUM GLOBULIN LEVEL 27 G/L (22.0 -42.0)

    SERUM LIPID LEVELS

    SERUM TOTAL CHOLESTEROL LEVEL 6.91 MMOL/L (0.0 – 5.19) -ABOVE RANGE
    SERUM TRIGLYCERIDE LEVELS 2.90 MMOL/L (0.0 – 2.23) -ABOVE RANGE
    SERUM HDL CHOLESTEROL LEVEL 1.06 MMOL/L (>= 0.9 )
    CALCULATED LDL CHOLESTEROL LEVEL 4.53 MMOL/L (0.0-3.35)-ABOVE RANGE
    SERUM CHOLESTEROL /HDL RATIO 6.5 (0.0 – 4.3) ABOVE RANGE

  25. Jamie says

    Any advice would be greatly appreciated. I am a 41 year old female with hypothyrodism. I curently take 75mcg levothyroxine, TSH level is 3.28. However, my T3 level is 28. I continue to have symptoms of hypothrodism. My doctor says that everything is ok because my TSH is within range, however, I am tried of freezing all the time and tring to lose weight with no success.

    • Chris Kresser says

      That’s one of the lowest T3 levels I’ve ever even heard of. Definitely not okay or normal. I would seek out a second opinion.

  26. Jane Hudkins says

    I have a low RT3 ratio 3.2. I have a doc who knows the right labs to draw and kindly agreed to prescribe ERFA Thyroid even tho he hadn’t known of it, at my suggestion. However, 2 wks on the med I started having fairly severe chest pain, so I stopped it. I had 2 office visits, $120 ea to get the ERFA Rx and now doc will only talk to me if I pay another $120, which seems exploitive to me. I asked stopthethyroidmadness folks who said I had to have an iron test and a saliva test for accurate cortisol level, correct these levels and then start an NDT. Otherwise I’d always have a reaction to NDT. I need help and support in order to navigate these hoops. Can you recommend a doc in my area Morgantown WV 26501 -1-1/2 hrs from Pittsburgh, PA who really understands this issue?

    My worse symptoms are depression/hopelessness, brain fog and dryyy skin. I was diagnosed with a goiter, tho fairly normal TSH in ’95, Synthroid 5 yrs, Naturethroid 5 yrs (great), reformated westhroid and naturethroid didn’t work, severe hair loss. Quickly became hyper on Armour…no med for last year, TSH 3.8 and have depression and progressive brain fog.

    • Michele says

      Did u get an answer about a dr to go to for thyroid in morgantown or Pittsburgh area?? I have been looking also.

      • Heather says

        I would love to know of a doctor in the Morgantown, WV area as well. Or if you could share the name of the doctor that is willing to prescribe Nature Throid or Armour as I’ve not had success in finding one who is willing to do so. Thanks!!

    • Debbie says

      The Stop the thyroid madness people know their stuff and have helped a lot of people. You should spend some time on their website and educate yourself well. Sadly there are not enough doctors or endo’s who are educated to help you. Dr. Kessler is the exception, this site is very good.

  27. Christine says

    On Synthroid only, my tsh is 1.5, ft4 1.8 (lab range 0.7-2.5), and ft3 2.5 (lab range 2.5-6.5). I feel good enough relative to the misery before treatment, but only if I live like 70, taking it easy. If I try to exercise, I have days of rough recovery, feel hypo again. I used to be very fit and ran, now I can only stroll. I want to exercise again – could the addition of a little Cytomel help? If so, do I adjust my Synthroid down at all? If I drop down or go up by even a little, I don’t sleep well and get the “fuzzy” feeling.

    Another question – I faint from needles, so I’ve been using blood spot mail-in lab. The numbers have correlated well to how I felt finding my way to the best Synthroid dose. Are these results valid and reliable, and do they correlate well to venous draw?

  28. Honora says

    Hi Christine

    Good luck with your tinkering of the thyroid meds. As a phlebotomist, I just want to reassure you that if you lie down flat, you shouldn’t faint when you have your blood drawn. All the best.

    • Christine says

      That is a brilliant monster! The hospitals where I go have only a short little bed, or a recliner which doesn’t help enough. The shortie bed is ok because it makes me raise my legs which actually helps. I think that’s why I’ve also not fainted (so far) at the dentist – the bed tilts the head down below the legs.

    • Honora says

      yeah, and the weird thing was the outpatients department where the Blood Test Centre is sited paid for it, not the lab…Don’t know how we got that lucky!

  29. Alka Kapadia says

    My daughter is 18 and was diagnosed with PCOS and insulin resistant at 16 and asked to reduce weight ASAP. We tried everything from high protein diet to 1200 cal diet but were not successful in droppint even 1 pound. Then we came across a natural diet which guaranteed weight loss even for PCOS patients. It was totally natural no medications just diet restrictions. We saw no harm in doing it just willpower as it was very strict. She lost 40 pounds on that diet in 3 months and then was on transition. Her T3 was fine before the diet. But since then she has been feeling Very Cold, hands turn blue and very weak. At first we thought it was because she lost so much weight but now her T3 was tested and was low. TSH and T4 are in normal range. T3 is going more down but endocronologist did all the testing and as all glands are normal they are refusing to treat her T3. She is alwasys tired, depressed, cold, brain fog, cannot concentrate in college etc. Natropathy suggested Cytomel or Armor Thyroid but nobody is willing to prescribe Armor Thyroid and with Cytomel 5 mg her heart beats go up. The endo suggested to stop Cytomel as it will be harmful BUT he has no solution for her low T3 and her other symtoms. What is your suggestion and since her T3 most probably got messed up because of the diet which was in August 2010 two years ago. How do we correct that problem.

  30. Debra Pike says

    Hi, I used to have Cushing’s disease and had to have the entire pituitary removed in 2003. I am on all pituitary replacements and produce no TSH now. My T3 is 2.7, and Free T4 is 1.10…this month. I cannot seem to loose all the weight nor gain all my muscle back after Cushings. I want to try Armour instead of Synthroid but doctor will not prescribe. Am I producing enough T3?? For several years prior to this year I produced hardly any T3. Not sure but I was low on Vit. D, and have been told to supplement, and now have it at 38. Any advise would be helpful.

  31. Ghalia says

    Hello, I’m here cause I honestly feel that I cannot trust nor respect doctors in my country anymore… Im a 30 yr old female and was diagnosed with hypothyroidism since I was 14 yrs old. I was like a guinea pig each doctor giving me different dosages and different comments and I have lost hope on getting back my beautiful hair nor slim body or high energy..Im embarrassed even to admit that I feel stupid and my comprehension is slow.
    Im constantly emotional, depressed and sensitive and it causes me embarrassment public. I have been taking thyroxine and recently changed to euthyrox (levothyroxine sodium).
    In the 16 years I started from 50mcg and went up to 175mcg. Then 150mcg 5days 175mcg 2days and gradually decreased now I have been on 100mcg for the past 6 months and gained 8kg while I have been on a moderate diet/moderate activity..
    Just found out about RT3! I will try to see if I can have it checked.. What other medicines equivalent to cytomel because it’s not available in my country. Today’s lab results confused me so if u can help me please
    TSH 0.29 mlu/l (lab Normal value 0.27-4.20)
    FT3 3.1 pmol/l (lab Normal value 3.0-7.8)
    FT4 17.2 pmol/l (lab Normal value 9.1-19.2)
    In my understanding this means my doctor would lower my dosage but it still doesn’t make sense to me since I’m so tired, constipated and feeling Depressed the whole time let alone the weight gain and hair loss with every brush and shower..
    Are there lab tests u recommend that my doctors are neglecting?
    Would really appreciate the help.. Until I find a doctor who treats patients like humans and not just numbers on a piece of paper..
    Thank you

    • Tanja Guven says

      I would just stop fighting the doctors and get my hands on Cytomel, Cynomel, Tiromel or some such thing from mymexicandrugstore, and twiddle the dosage until you feel good.

  32. Honora says

    Having the reverse T3 tested looks like a good idea. Other co-factors for conversion from T4 to T3 need to be at the right levels. A good site to learn about this stuff is “Stop the Thyroid Madness”. From memory it may be things such as ferritin, selenium and the B vitamins such as B12 and folate in particular as they are necessary for methylation. One of the basic starting points is being gluten-free. This site below explains why:
    http://www.direct-ms.org/molecularmimicry.html

  33. laura says

    Hi Doc!
    I live in Phoenix Az. Had a total thyroidectomy in september 2012. I am currently on 137m Synthroid and absolutely miserable. I have seen 4 doctors (2 of which are endo) and they ALL refuse to accept t3 as an excuse for my inability to tolerate my medication. They refuse to test for t3 levels and will not change my meds. Can you refer a doctor in Phoenix who shares your views? My TSH is in range as well as my t4.Thank you so much and have a great day!
    Laura

    • erika Huyck says

      Just saw your post and wasn’t sure if you still need a doctor in Phoenix. I see a Naturopath in Scottsdale named Dr. Yu Rhee Hyun. She is great and was referred to me by three separate people. Hope this helps!

  34. Raghu Iyer says

    Hi,

    A year back, my wife was diagnosed as having papillary carcinoma of thyroid.

    The oncology doctors (surgeons) were/are of the opinion that the complete thyroid gland needs to be removed.
    But, there is no pain whatsoever, there is no problem in breathing/voice/swallowing.

    she prefers natural/alternate therapy to any kind of surgery. she has been taking wheat grass juice, Green Tea, grapes juice, etc. regularly in her diet.
    the recent sonography of the throat does not show any deterioration in the condition.
    Even the prominent swelling on her throat has now visibly reduced.
    But, still the onco-surgeons are sticking with their decision to operate at the earliest.

    the recent blood test (TSH) for thyroid shows TSH: 0.98, T3: 4.55 & T4: 6.66, her haemoglobin count is also always low (8.4).
    is this due to papillary carcinoma of thyroid ?

    Thanks & Regards,
    Raghu Iyer
    India

  35. Renee says

    Low TSH, Low t3 Normal free t4 I’m so confused! Please help!

    ——————————————————————————–

    Hi and thanks for reading. I am hoping for some insight on where to go from here. These are my past 2 labs.

    Oct 19,12

    TSH- (5.800) Range-(0.300-4.700) Total T3-(42) Range-(60-80) Free thyroxine (ft4)- (1.3) Range-(0.8-1.8)

    I was instructed by my family phys to take one more (Levothyroxine 125mcg) on W and Sun. Check in 8 weeks, below.
    I also started low carb high protien under 15 carbs a day on Nov 15th. When I do this diet, I notice my thyroid goes wacky.

    Re-check,different lab.
    Jan 17,13

    TSH-(0.06) Range-(0.35-5.50) Total T3-(58) Range-(60-181) Free T4(1.02) Range-(0.59-1.17)

    Doc now says to take 2 less pills of Levo on Wen / Sun.

    I have not been back for a re-check, as I really don’t know at this point if I trust my docs opinion on treatment.

    Backround info.

    I am a 56 year yr. old female in Post Meno. (I had the blood work done also in Oct. for meno) I started on Synthroid when I was 17. I stopped on my own at 20 (couldn’t afford doctors or meds)
    Checked at 22, no problems.

    Checked yearly. Not Hypo again till 1991, put on 88mcg synthroid and increased the next 10 years till up to 175mcg. In 2000, switched to Armour by alternative doc. Felt the worst ever for an entire year and my t3 was just not improving. Switched doc again. (one I have now) she gives me script for 175mcg synthroid. It’s been a rollercoaster since. Up and down. 2006 labs shows thymoglobin antibodies (83)and thyroid peroxidase is (238) Hashimotos, I was told. Never been retested for it.

    So present day I again am so confused. The past two weeks, I am sweating off and on, hot than cold, heart pounding, shaky, anxious and my hair is falling out. Thought maybe, female hormones but my labs show I am post menopausal.
    Also, I noticed going through my labs the past 12 years that every single one, I have a low rbc and was never addressed?

    Any suggestions would be really appreciated. Thanks so much for reading this. Renee

    • neeters says

      first of all, you need to make sure your Ferritin levels are good, like over 100 if possible, but I bet yours is bottomed out. if you need iron, try Ferramax or Proferrin. AND you probably need to take some Progesterone, get some good quality cream such as Emerita Pro gest and take 20 mgs twice a day. your symptoms sound like mine , which ended up being Estrogen dominance (zero progesterone) this will help you tremendously, especially with the anxiety and energy. and it will help your thyroid hormones work better. I was able to reduce my meds by 1 full grain.

  36. LLuke says

    Drs. I have normal TSH, T3 uptake%, low within reference range of free T3 and free T4 but a Total T3 of 0.88. What would my next step to take, please advise. I have many symptoms since 2006 but docto would mot treatr at Kaiser because normal valu of FreeT4 and TSH.

  37. Dave says

    I’m 80 yrs male.
    Recent labs:

    TSH: 0.86 (0.40-4.50)
    T4 Total: 3.5 (4.5-12.0)
    T3 Total: 36 (76-181)

    Presently taking Armour 45 mg in the AM and 30mg in the afternoon.

    Recently took 2 Dosepaks plus had injection of Methylol Prednisolone for pinched nerver.
    Could this have affected my T4 and T3 readings?
    Prior to Dosepaks and injection TSH, T3 and T4 were all within normal ranges.

    Please advise

  38. Mimi says

    I have .014 TSH level. T4 (free) is 1.05. I still suffer from hypo symptoms.. Any suggestions on what I need to do??
    I am 44 years old. I have had my progesterone tested (which was low and have increased my dosage). Cortisol levels are good except a little high at night. I take vitamins. I workout daily..

  39. Deanna says

    I have low T3. I started taking Armour and experienced improvement in my symptoms for about 2 weeks. I have been taking Armour at a stable dose for 6 weeks now and just had blood testing done. My labs come back with both T4 and T3 on the “normal” range, but TSH is very low (as was expected). I am having quite a few thyroid symptoms, though. My naturopath mentioned that she wondered if I have Wilson’s Temperatue Syndrome. What are your thoughts on Wilson’s Temperature Syndrome? And do you think it is possible to have both low T3 syndrome AND Wilson’s Temperature Syndrome or do you think this is just inadequate treatment for my personal symptoms?

  40. Becky says

    I have been in 0.25 of tirinosint and levels have been ok. The last blood test my tsh was up to 3,35 so dr increased by 0.13 sob taking a 13 and 25 pill. I seem to have now developed terrible muscle aches achilues tendon problems and keg aches. The last blood test tsh was still 3,35. Free t4 was 1.15 and free t3 was 2.68. That was the thing I noticed most it was usually around 3,36. I asked dr she said t3 is not a test she looks at only for hyper
    Could this be causing my aches? I also have rheumatoid arthritis that is not doing well too
    Thanks

  41. CHRISTINA CROSS says

    I had some blood work done, the DR said it was normal but it says out of range on the T3 the range is 76-181 and mine says 67 L I’m confused. I have been having muscle aches, pains, dry skin, tried all them time, sleepy, kids say i’m cranky, and the list goes on.Should I got to another doctor and have him look at this blood work? Help I’m confused!!!!

    Thanks

  42. Danielle says

    I’m very confused. I also feel pretty sick. My labs have been showing a TSH of 0.64 Low, Free T4 0.55 low with low vit D and elevated RBC. THEY HAVE BEEN LOOKING LIKE THAT FOR THE LAST YEAR! I’m so frustrated that I am seeing a Endo. Spcialist and he won’t supplement my thyroid hormones. He seems to think I Have some virus attacking my thyroid or my immune system is attacking my thyroid/enfocrine system. The plan… labs every month just to monitor. Until I croak?? I’m fatigued, sick and very depressed.

  43. Pam says

    Hi I am struggling with my TSH levels being extremly low, my T4 and T3 and all other blood work is great, the doctors think I have hyperthyroidism, but I don’t have one syptoms other then my TSH being very low, if anything I feel I have HYPO syptoms. I did have a virus in my hpyothalamus years ago but that is now gone, I have been taking selemium, 2 times a day 400 mcg total daily, L-carnitine, and one lemon balm a day, I keep putting on weight and I eat gluten free organic and exercise a lot, i need suggestions
    Thanks
    Pam

  44. Erica says

    Hi Chris, Love all the info you have on your site. I just got my results back and I am showing slightly low T3 (.49, where normal is .58-1.59) and slightly low T4 (.70, where normal is .71-1.48) and a normal TSH of 3.91. Do you think this is enough to consider T3 syndrome? My doctor said to get more iodine and retest in a few months. I am in Korea and am not sure how much my doc knows about this condition and the language barrier makes it difficult to ask all my questions. Thanks so much!

  45. Mahena says

    Hello Chris,
    I am trying to understand my blood results and have not had a great response from the doc who ordered them. I have high TSH (5.05), low T3, Free (2.0) and mid range T4, Free (1.0). Would you kindly explain? Any light you can shed would be appreciated. Thank you.

  46. Jacqui says

    I have all hypo symptoms. No eyelashes on one eye, dry course hair that has all changed in last 6 month. Fatigue, moods. TSH is 2.5 but T3 is on low end.. Dr put me on synthroid.. Does this sound right?

  47. s kaplan says

    My teen started three years ago with all the symptoms of hypothyroid and chronic migraine following a severe flu-like illness. At that time she had normal TSH and normal free T3 but free T4 =.78 – This continued for a few years as her TSH gradually got higher – peeking at 6.75 with a free T4 of 1.15 and an ‘ok’ T3.

    There was a short respite that occurred when she went on an anti-inflammatory diet. At that time her free T4 went to 1.3 and free T3 to 3.5. She felt really good. Since then however, she’s regressed.

    About 6 months ago, she started taking Armour thyroid – beginning with a slow dose and increasing very slowly. At first she felt better – but since then her T3 and T4 have actually gotten worse. Currently, her TSH is very low. Free T4 = .83 and Free T3 = 2.5. She tests negative for Hashimotos. Reverse T3 is 9.4. So, what could be wrong? She’s on 2 grains of Armour. She takes iron (but not at the same time). She recently started taking iodine drops – at 3 x the Daily Requirement…but no improvement.

    Please help. She is totally missing out on her teen years.

  48. Jennifer Goldberg says

    Can you recommend a doctor who is willing to prescribe t3 or consider combination therapy in Zurich Switzerland? Many thanks, Jennifer (Hypo since 1999 and consistently had lower t3 levels, that doctors continually ignore!)

  49. angela says

    I too have low levels of T3, and other hormones. I had a gastric by-pass last year and have not had a period in over a year, do you know if these levels will have an impact on me getting pregnant? I am at the stage where me and my husband would like another child, but its just not happening.

  50. Sanja says

    I am 48 year old and have under active Thyroid last 15 years. I have been taking Synthroid 125mcg over 10 years… I did the test in November and my results were T4 1.20 ; TSH 4.75 and total T3 was 0.67 . After that my doctor decided to increase my dose to 150mcg. The last test we did 30 days after I started the new dose was T4 1.38 ; TSH 0.65 and Total T3 was 0.86. My doctor told me to continue with the same dose and redo the test in 3 months… What is your opinion based on the listed results? One more question would you recommend I take Ashwagandha Root pill in addition to my Synthriod? Thank you for your time I apperceive it very much

  51. michelle says

    So for years I have battled my thyroid and I am so confused. I have been on synthroid for years and in the last years an endocrinogist put me on cytomel. My blood work always shows my tsh is low and my t3 and t4 low. It is confusing because my symptoms are weight gain and exaustion! My recent labs show 0.55 t4, free: 0.40 tsh: 2.7 t3, free: and a normal t3 total. I am so tired of going to the doctor and not getting any answers. I feel better on my current dose of meds but wish I had more energy to get rid of this weight I have put on over the past few years. Any imput would be greatly appreciated. Michelle

  52. debbie says

    i had a bad case of hives to start with doctor did a blood test and found that my thyroid was off ( low thyroid ) so started off on 75 then 100 112 now on 125 my last reading was TSH 5.75 range .034-5.60 free T4 0.79 range 0.50-1.60 and lately been having hive issues again not as bad as the first time i was completely covered in them i saw a nutristist at the health food store and put me on a gluten free diet which helped also with a regimen of vitamins and taking adreal health i feel so so just not sure if i should take iodine i guess i am lost in all this as i do not understand the the ranges and i have noticed that my aniexty levels are out of control i get very nervous when i have to go see the doc at times it feels like my heart is gonna pop put of my chest ….HELP

  53. Esther says

    Hi Chris, I remain confused…. Maybe you can clarify a few things for me? After the birth of my 7th child I developed all the classic signs of hypothyroidism. THS got up to 29, TPO was over 1000 for a year, body aches, brain fog ect, ect. With homeopathy, acupuncture and lot of diet and stress changes I have gotten my TSH down to 5.6 and my TPO under 500 but I have stopped making progress. How do I keep progressing without taking drugs? Is it possible? I do cheat with diet occasionally eating gulten and dairy…..

  54. ANONYMOUS says

    I want to know what happens if at the age of 27 approx a male having both T3 and T4 low but having high TSH about 253.32..
    Is it a thing to worry or can be medicated as early as possible…

  55. Sharon Katz says

    I have Hashimoto’s as well as Epstein Barr. I ran some tests couple weeks back. Results: TSH 1.72 (0.45-4.5); FREE T4 1.43 (.82-1.77); FREE T3 2.2 (2.0-4.4). With the exception of Free T3, My labs are within optimal however my symptoms were terrible. I was taking Synthroid 88 mcg but had to lower it. But my question regards my mysterious Iron lab results from December:My FERRITIN was 25 (15-150) which I believe is considered too Low for Hashimoto’s patients (it’s recommended that we have 60 or higher) while my IRON SERUM was 160 (35-155) which is high. TIBC was 316 (250-450) and Iron Saturation was 51 (15-55). What could cause Low Ferritin with High Iron Serum? Could this be Epstein Barr feasting on Ferritin? I changed my thyroid medication last summer from Naturethroid to Synthroid (my ND actually instructed this change). Could it be the T3 in the Naturethroid (if it was too much) was depleting my ferritin? Would love to hear your thoughts on this. Because I can’t tell if I should be careful with my iron intake or if I need more.
    Thank You.

    • sunny says

      Hi sorry this doesn’t answer your question but i was just wondering if you experienced any weight gain with Free T3 of 2.2 .I got labs done and only my Free t3 was considered low I got 2.2 like yours but I’ve put on 8 lbs just in this month despite working out.I go tired to the gym wake up tired its depressing :(

  56. Michele says

    Hi everyone I’m a 37 year old female & I got my blood work back and here are my levels. Please help me understand it, Quest labs did it:
    tsh 1.95 reference ranges (1.5-2.5)
    t4, total 5.4 (4.5-12.0)
    t4, free .9 (.8-1.8)
    t3, free 2.3 (2.3-4.2)
    thyroglobulin antibodies <20 (<20)
    Rt3 .7 (8-25) (But I know you go by the ratio of Free t3 divided by Rt3 and if it's lower than 20 then there is a Rt3 issue, correct)
    Iron and total iron
    Total: 139 (40-175)
    iron binding capacity: 353 (250-450)
    % saturation: 39 (15-50%)
    Ferritin: 16 (10-154) Doctor says I have low Ferritin, which can cause a problem with the convertion of t4 to t3, correct? He wants me to take iron pills

    progesterone: .7 (follicular phase: < = 2.7 Luteal Phase 3.0-31.4)
    testosterone, total: 15 (2-45)
    Free testosterone: 1.6 (0.1-6.4)
    Waiting on the Estrogen (which usually is on the ower end)

    .. why are my levels soooo low already, I'm only 37?
    And what is the difference between blood levels and urine levels, bc I just did a hormone urine test and it showed my progesteron and estroge were high but on the blood work it shows they are low?

    Anyways my doctor wants me on t4 & t3 and I'm afraid because of the rt3 issue.. but when you look at my numbers is it justified to put me on t4 & t3 since both numbers are low?
    He wants me on t4 33.3 & t3 10.1 Sustained release for 15 days then up it to t4 50.4 & T3 15.2… if I can take t4 and t3 together does that sound about right?

    He wants me to up my 25mg of progesteron pill to 75mg pill and he wants me to take 1mg of testosterone.
    Once we get my esterogen I may have to be on estrogen too.

    My urine levels showed that I had high cortisol later in the day but my Am and PM blood cortisol showed I was in the normal range.

    Oh yeah my DHEA levels weren't ideal either, on the lower side. so he wants me to take 10mg of DHEA each day. What do you think about that?

    Please help me sort all this stuff out and thanks!
    I just want to live anxiety free and feel great everyday! Sometimes I have no anxiety and sometimes I'm not sure where my anxiety comes from, but it is present and I know it is bc of this hormonal imbalance.

    Hugs and thanks for helping!

  57. Tammy says

    I’m currently on compounded liothyronine and feel so miserable I can’t stand it. For a time, the liothyronine seemed to be doing a great job. I also take vit d, b, c, fish oil, calcium, magnesium and compounded progesterone that I’m nearly out of and estrogen. I had a full hysterectomy 1.5 yrs ago and it seems to have made me feels worse than ever and I’ve hit a brick wall. We recently moved to Europe from the U.S. and I don’t have access to my compounded meds once I run out, like I did before and the docs here don’t seem to have the same forward thinking mentality as my doc in the U.S. I don’t think I’ve been this desperate for help in quite awhile. It’s all I can do to get out of bed in the morning. People tell me I need to exercise and I would feel better but no one seems to understand how absolutely exhausted I am because I look great. I’ve gained 25 lbs in the 1.5 yrs since my hysterectomy and was already 70 lbs overweight prior to that. Desperate doesn’t even come close to how I feel right now. I had a lot of stress with the move but for the past few months have a little to no stress so that doesn’t seem to be the problem. I don’t know where to turn. I don’t know what to do. I start work at a physical job the beginning of April 2014 and am scared to death that I won’t be able to hack it. I had my blood work done last October and for the most part things seemed ok….but it’s hard for me to read because of being in Europe. Does anyone know where I can get help? I really, really need it. Should I go back and see the doc and see if he can put me back on Armour again. That is what I used to take up until about 3.5 yrs ago. I just don’t know where to turn for help but I honestly can’t live in such misery. Thanks for any help that anyone can provide.

  58. julie says

    all my thyroid and part of my parathyroid has been completely removed about ten yrsago, I had my bloods taken yesterday and I had a phone call today saying that my t3 was low and the doctor wanted to see me on Monday, what is t3 exactly and how will this effect my health thank you

  59. Lorraine Lauer says

    I am 64yo…had postpartum hyperthyroidism at 34yo (never told it was Graves), with heart failure and extreme weight loss (92lbs). Treated with Radioactive iodine. In 2013 was diagnosed with parathyroid adenoma and had surgery for that in January 2014. I am a registered nurse for 35 years and have done extensive reading/research to better understand the relationship between the two. My labs today (4/23) are TSH 0.12 – t3 1.4 – t4 8.2 – Ca 9.5 (the best I have had in over a year) – Vit D 30 (also good for me). Have been taking Synthroid since approx. 3 months after the radioactive iodine treatment in 1983. Just wondering if these levels may indicate to you (although I understand without prior recent labs for comparison that may not be easy). Thank you

  60. Alice says

    I have been diagnosed with low T3 while my T4 levels are normal. I have diverticulosis and have been treated for H Pylori. I take medicine for my stomach ulcers caused by the infection off and on. My doctor prescribed 25 mg synthroid. Is there something I can do to boost the T3 levels? If my stomach issues improve should my levels even out?

  61. says

    When you say

    “D3 converts T3 into an inactive form of thyroid hormone in the liver.”

    Do you mean Vitamin D3 or something else in the body-I’m confused

  62. Lisa says

    I was put on WP Throid NDT 3 months ago. I was started on 3 16.25 mg a day. My endo would not up my does in the req 2 weeks so I stayed on the starting does for 3 months. I was doing good till 6 weeks or so ago I started to feel awful.

    I Feb 2014 TSH: 2.34, FT4 1.08, FT3 3.1
    March 2014 (took my NDT before bloodwork by mistake TSH: 4.6, FT4 1.08, Ft3 4.6.
    April: Blood test in the afternoon TSH 1.44, FT4 0.8, FT3 4.6.

    I was getting dry skin again and the red dots on my legs, I had problems sleeping nausia, headaches, anxious and wieght gain. It got worse and I actually stated to feel sick.

    My Endo did not want to raise my starting dose. I called back again to tell him I was still sick and he said raise my NDT from 3 16.25 to 4 everyother day. I did 4 pills on Wed and Thurs on 4/30 and 5/1, 2 days in a row and on the 3rd day 5/2 took 3 and felt worse. I went back on 4 day on 5/3 and have been it ever since. I noticed in a few days my skin on my legs arms was soft and the red dots were gone. I started to get some relief on being so sick.

    On May 3rd I had my GP call in blood work for reverese T3, FT3 and FT4 and TSh. This is the results.

    Reverse T3 7.0, FT4 0.9, FT3 2.9, TSH 3rd generation 3.25.

    I know my RT3 should be in the 20 range. I never have had my T4 under 1 or 1.08 in 3 years and I feel good with my FT3 at 3.1 or 3.3.

    I spoke to my ENDO today and said reverse T3 is never used it has nothing to do with the Thyroid I was shocked. He also said my T3 is normal which for me it is not and my T4 is a little low. He does not like the idea I raised my NDT to 1 grain.

    Now I have to find another ENDO that treats with NDT.

  63. SK8GR8JO says

    Out of one side of your mouth you said that you are going to use terms the lay person can understand, but then you start using terms without defining them. What are D1, D2, and D3? The only D3 I know of is a vitamin, are you speaking of vitamins and minerals or are you talking about other hormones that we just weren’t introduced to? I am going to try to finish reading the rest of the article now, but it is already confusing.

  64. nickoli says

    Hi there I had my thyroid removed a total thyroidectomy 12 years now. I take 150 eltroxin daily. I am 50 now and I am beginning to worry about the affects of having no thyroid now that I get older. I get a blood test done once yearly to check all function except T3. Due to having papilliary carcinoma my levels have to stay at a certain state even though the tumor on my neck was cancer none showed up. I suppose now that I have got the all clear I am conscious how important the thyroid is. Is there anything u woulf advise me to do. Thank u

  65. Monique says

    I have had hyperthyroid for 16 years and I’m still struggling last test shows low t3 and I feel horrible everyday …

  66. jadunton says

    great article!!!!! just happened to stumble upon it while reading up on thyroid stuff. really like how you tie in the connection to the hypothalamic-pituitary axis. have known this for some time but it validates me and what I have had to go through. I took a blow to the head (right in the face, badly broken nose) a little over 5 years ago. it felt like an explosion had gone off in the center of my head and then I felt the shock wave rip through the rest of my brain, resulting in a tbi. i never had thyroid issues before, i instantly started having lots of endocrine issues due to the injury to the hypothalamic-pituitary axis and thyroid malfunction!!! because all the tests were “normal” it was very difficult to get the doctors to believe there was anything wrong. finally when I had gained over 70 # and my hair was falling out by the handful, and I was sleeping almost 12- 16 hours per day they tried me on thyroid meds. voila’, what a difference it started to make. I eventually switched to a doctor that understood the connection btwn tbi and thyroid issues he put me on both T3 and T4 meds. the T3 was the key!!! my hair stopped falling out, I had more energy and it helped stabilize my anxiety/ptsd, mood fluxuations, etc that all went along with the tbi! it was very frustrating that the professionals that I had gone to (one was even a specialist in brain injury and endocrine issues) couldn’t look beyond the numbers on the paper from the tests. they also wouldn’t take into account the blow to my head. duh, the pituitary and hypothalamus is right behind the nose and the bridge of my nose, septum and right eye orbit had been broken or had hairline fractures. I never been told that I have low T3 but what a difference it has made in my life taking it. recently I’ve had to switch to a new endocrinologist who knows nothing about tbi and thyroid issues and he is not a big proponent of prescribing T3, but I am hoping to educate him on how vitally important it is for me ( and other patients) and maybe he’ll give it a second look. :) and maybe he will also not just look at the numbers on the page from the blood tests! thanks for a great article! can’t wait to read your other articles. cheers jennifer

  67. Maria Bacchin says

    I am hypothyroid on porcine compound thyroid meds 105mg a day lately I have very low Tsh, low Free T3, normal Free T4 not sure if I am hypo , hyper or Hasi or graves I have simptoms of shakes, 3hrs of sleep only, sweat a lot, tired ,I get sometime head acke on top of my head I am on gluten free and a very gentle diet. 5years since I had my right thyroid gland removed and have not been able to get the correct dose because of my
    up and down range of mt t4 and t3 ( they used to be high now free t3 is low so my tsh please help thanks
    Maria

  68. Michele says

    Hi There –

    I was wondering if anyone could help me. I am 24yo/F. For a very long time I have felt extreme exhaustion/fatigue (there is not one point I am awake that I do not feel tired – I can also sleep for 15+ hours). I have really bad concentration/brain fog (which has gotten worse recently) and I most always feel dizzy/nauseous. I also have sensitivity to the cold.

    My dad has the same problems, and my mom has hypothyroidism. I have gotten numerous blood tests done which have all come back “normal”

    Here is my most recent test results:
    TSH .57 (.40-4.50 mIU/L)
    T4, FREE 1.0 (.8-1.8 ng/dL)
    T3, TOTAL 75L (76-181 ng/dL) *Out of range

    My doctor told me this was normal but I am certain there is something wrong with me. Having to feel like this everyday has caused me depression and thinking of having to live my life like this everyday is a terrible, terrible feeling.

    Please help me – thank you so much in advance.
    mmpaolel@gmail.com

    Thank you-Michele

  69. Tanya says

    I’m sure you’re right Chris – there’s something else going on, forcing our thyroid into slowing…still working, just not at full steam. That said – it took me 15 years to find the answer to my Raynaud’s (cold fingers) was a temperature that never climbing above 96 degrees, it’s just resolved, period, when my temp is above 98. Mainstream and alternative healthcare providers offered me nothing but calcium channel blockers (which I refused) or iron for my accompanying anemia. Neither of which is THE PROBLEM. When I go to see the doctor today, they don’t even take my temperature anymore!!! lol
    I’ve done all the right things, and yet continue to suffer from low temps – one day, at a normal temp, feeling fantastic and energetic, the next day, at a low temp, unable to see an end to the doldrums, unable to look for work, much less actually keep a job! It’s infuriating. The mind/mood connection to that temperature is FASCINATING!
    At this point, I’m unwilling to spend the rest of my life unemployed and unable to cope with life. So I’m self-medicating with T3, two days on/two days off – it keeps my temp up and me functioning as a productive member of our society, rather than living off unemployment benefits and food stamps.
    I agree with you, it’s probably not the RIGHT answer, but it is a better answer than calcium channel blockers, the best answer I’ve found – and frankly, after 15 years of searching for the right answer, I’m willing to accept a word-around. I’ve done all the right things, and I only got worse when I suffered some extreme stress. And when I let carbs back in my life for the heat they create, I gained 25 pounds.
    T3 makes me feel like a human being again, and I’m able to function and lose weight and have actual interest in life again. If there is an underlying health issue that has not presented itself fully that my body is fighting, it’s just going to have to do it while I’m being a productive human being. I’ve had enough of 96 degrees and lying on the couch.

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