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


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. Kim Storey says

    I have been battling with hypo for more than 20 yrs. In Dec 2014 my TSH was 4.28, June 2015 my TSH was 1.75. Today my TSH is .38 and my T3 is 3.34 and T4 is 1.39. Currently, I take 112 mcg 1xday. I feel so bad and don’t know what to do. Should I be concerned?

  2. Jalal says

    my t3 0.62,t4 is 4.90 and TSH 2.4 ug/dl…I have the symptoms of the hypothyroidism please let me know what type of treatments available for my condition. I am Male 29 years old.

  3. says

    Hello, I have almost nonextent TSH and rT3 with normal range of T3 and T4. I feel completely exhausted, like I could collapse just from standing up. I feel like it has effected my heart as well, I feel SOB at times and irregular tachycardia.

    Also, my sodium levels are slightly high too.

    Pls advise, I get no help from my current MD. I am taking 10 grains of Armour Thyroid and just starting taking 30 mcg of T3.

  4. Greg says

    The problem is too much RT3

    And taking T4 will make it worse

    You cannot see the high RT3 in the blood tests of TSH T4 T3

    Hashi will increase RT3 due to inflammation in the tissues, intestine or thyroid

    Sometimes you cannot see Hashi as its Antibodies to the Sodium Iodine Pump (35% of Hashi people have it) which is not tested.

    It is not “Emotional” stress, this is total BS. Its inflammation in the body due to an autoimmune disease. You can see it in the CD4:CD8 ratio and other markers like C3, C4.

    It probably needs NDT or T3 alone to clear the RT3 from the body.

  5. smfcherokee says

    I’ve seen a lot of postings of people who have symptoms of Hypothyroidism, have a normal thyroid tests, and don’t know what else to do. I was here a few months ago with the same exact symptom sets. Weight gain (for no reason), inability to lose weight, cold hands and feet, brain fog, memory loss, fatigue, mood swings, headaches, just to name a few! If you are a WOMAN you need to look into your hormone levels. Start looking into “Estrogen Dominance” and Natural Bio-identical Progesterone creams. Starting as early as 35 (or sooner) these a fore mentioned symptoms can start along with shorter/lighter or longer/heavier cycles, bloating, PMDD, migraines and a whole page of other symptoms. And yes you can have a low estrogen level and have estrogen dominance. Progesterone regulates your estrogen levels and if you aren’t producing enough you will get the above symptoms. Your estrogen will go out of control and this all will also mess with your thyroid and adrenal glands. All the glands are interconnected. When one of your hormone producing glands (Adrenals, Thyroid, or sex (Uterus) glands) aren’t working it will mess up the other glands. Read Dr. Lee’s book “What Your Doctor May Not Tell You About Premenopause.” If you are close to menopause age then read Dr. Lee’s book “What Your Doctor May Not Tell You About Menopause.” Do not let any doctor put you on Premarin (A progestin-synthetic). You will get worse! Maybe not at first, but it will happen. It causes breast and ovarian cancer! Bio-identical creams do not cause cancer. Just Google what Progesterone does, Dr. Lee’s website, and see for yourself.

  6. says

    My tsh was 5.9 and my b12 was 238. Started taking b12 shots and my b12 is good now but my tsh is 7.6 now and my t3 is 2.3. T4 was normal. My symptoms that sent me to the doctor were memory and concentration problems. Also my fingers started pruning up during the day without having been wet. Now my vertigo is bad. I haven’t experienced any other “new” symptoms. I am generally lethargic and cold because i tend to be anemic since childhood. I go to the doctor tuesday to go over lab results. Anyone else have the pruned fingers? I have read it is thyroid and diabetic related. I also am prediabetic. My a1c varies between 6- 6.8. Currently it is 6.6.

    • Robbie says

      Yes, when my hypothyroidism wasn’t being treated consistently I had Pruney fingers, blood sugar creeping up, A1c high but not ore diabetic. Since I’ve been back on levothyroxine for the past 5 weeks my fingers are no longer Pruney. My Doc is going to test blood sugar, bun creative, etc as he’ s very hopefully that these numbers will slowly move down as we get my TSH, free T4 and T3 in optimum range – which for him means TSH under 2, t4 mid, and t3 upper high but he says he’ll stop any where on these ranges where I feel good. Is doc treating you for hypothyroidism? My d was low and we got that to 43 in less than 45 days through sunshine and supplements and my b12 was 428 and I’ve been supplementing also. Hope my feedback gives you encouragement.

  7. silverstroke says

    Posted previously re; lack of improvement in symptoms despite ?? TSH and T4 NORMAL…. My leg pain became so severe I decided to again see my physician……the only thing she suggested was to decrease my Tirosint from 50 to 25mcg. Slight improvement in pain BUT other symptoms unchanged. One week ago I QUIT taking any thyroid med and today feel immensely better…. HOWEVER…..I am seeing an integrative medicine practitioner this Friday. I HAVE LITTLE TO NO FAITH IN TRADITIONAL WESTERN MEDICINE.

  8. ceasar1313 says

    have bottom scale low levels of tsh, t3 and t4 currently on .75 lithothyroxine and have classic signs and symtoms of hypothyroid. any one care to weigh in ?

  9. leah says

    Can low t3 syndrome cause anxiety and can other thyroid imbalances cause it also? If your tsh is low does that always mean that your t4 is going to be high?

    • Maddy says

      YES!!!! Both hypo and Hyper thyroid can cause anxiety for different reasons. For Hyper too much T3 causes Hugh metabolism and heart palpitations. For hypo, low metabolism can cause adrenals yo attempt to compensate and they produce too much adrenenalin.

  10. Renee says

    I have had thyroid issues for 32 years and it seems the last 10 years I always have to change my synthroid dosage because my test are either high or low. I am tried, on an off I have a sensitivity to cold, I eat well but cant lose the extra weight, I get headaches and I feel like I’m in a cloud. My last test results are:
    TSH 1.86, Thyroxine free 1.25 ng/dl, and my Triiodothyronine 57 ng/dl. My doctor said my TSH is normal so I should have nothing to be concerned about even if my T3 is low. Can there be other issues here?

    Thank you,

    • Alice Pritchett says

      My T4 levels were good; but, my T3 levels were low. No obvious health issues except tiredness and sleeplessness. I have stomach issues and decided to pursue that issue to see if it would help my thyroid levels. Raw, unfiltered apple cider vinegar, probiotics, extra iodine, pineapple and several herbs known to help stomach problems – my last test was within normal ranges. Don’t know if I have licked it; but, I am getting results.

    • Ms Moore says

      TSH within range. T4 within range. T3 low or low within range. Not good to me. If taking thyroid replacement hormone-TSH should be very low almost nonexistent ( we no longer have a need for the pituitary gland to give a TSH signal to make T4/T3), t4 at the upper end of the labs and t3 at about mid range, Dr’s currently have their gold standard to go by which is getting the TSH within range. If they allow the TsH to be out of range low it could mean potential law suits, so they are discouraged from prescribing higher levels of T4 or prescribing T3 for goodness sake. I started on T4 only (2007)and noticed my t4 was at the high end of the labs and T3 at the low end within range. Told my doc that I still didn’t Feel right and told him I thought my T3 should be better than low within range and he prescribed cytomel once a day. It is fast acting and short lived and should be divided into a minimum of 3doses/day….for me and most, you feel the effects…fast heart rate and extreme fatigue from it. I tried to stop taking t3 and was off of it for 2,5 years. I just started taking it again. While off of it my vitD levels became deficient, have ichthyosis vulgaris skin, brown patches appearing, tennis elbow that I have had since August 2014, my toe nails are dry, peeling, felt cold in air conditioning/72 degrees, bumps forming on the finger joints closest to my nails ….again(did this when I was undiagnosed for 3.5 years) also again… I was hearing crashing noises upon waking. Didn’t get the severe tinnitus back. Just started T3 again about 3weeks ago. Tennis elbow is not nearly as bad as it was, still waiting for my neck to stop crunching when I stretch, will get retested for vitD in a couple of months, don’t hear crashing sounds when waking, time heals. I would rather grow old gracefully on T3.
      Compounding pharmacies can tell you which dr’s are ordering time released t3 for their patients. It is the best way to find one that is willing to make you feel better instead of using the TSH as the gold standard. Does low t3 mean there is a not yet discovered disease in a patient in every case? I think it means that you are not getting enoug t3from the t4 you’re taking which is most common. It could mean we are not a good metabolizer of T4. Some are not good metabolizers of pain medicine…but there are tests for that to adjust meds. No test for genes that show low metabolizers of thyroid meds yet. Until the medical industry learns that the TSH is not a gold standard for those taking thyroid replacement, we will have other ailments, take more medications than needed and so one. Those who are informed have a chance to do something about it. I tried to find a dr close to where I liive and Fired 2 TSH gold standard physicians before going back to my dr that is across town.

  11. Sajad says

    Hi .
    I am 22 years old male. I have mild tremor, irritability, tingling of extremities, episodic palpitations, hot hands and feet, bounding pulsations (especially at finger tips). Last week i saw my doctor for these symptoms and he told me that this is just anxiety. I was advised to get my tsh, ft3 and ft4 checked to rule out hypERthyroidsm.. ECG was Normal. but Thyroid profile report shocked me because it showed high tsh level and low free T3, though T4 was normal.
    My TSH is 10.5 (high)
    FT3 is 2.0 (low)
    FT4 is normal.

    I was shocked because hypothroidsm was totally out of picture and i got my thyroid test done just to rule out hypERthyroidsm!! I have NO SIGN OR SYMPTOM OF HYPOTHYROIDISM!!!

    My doctor says it is subclinical hypothyroidsm. Im afraid because he is not able to find out the CAUSE of my hypothyroidism..

    What should I do next?? Shall I start taking Thyroxine daily or i shall wait and recheck my tsh after few months????

    Also, i had a tetanus booster 8 days back. Can this be, in any wat, the possible cause of my thyroid underfunctioning?????? (I somewhere on internet read that tetanus toxoid can induce autoimmune reactions in the body). Please help. Thank you

    • holly says

      I’d get thyroid antibodies checked. Dont let anyone (including doctors) push or scare you unto treatments that you are uncomfortable ith, especially any surgery. You may consider supporting your thyroid nutritionally. 200 mcg of selenium per day could be beneficial. Talk to a naturopath if you can.

    • Alice Pritchett says

      I’d try find the secondary problem. You may have some other health issues; my research indicates the whole body is involved in converting T4 to T3 in the body. I believe I have narrowed my problem down to my gut. I had H pylori that resulted in an ulcer. I take Nexium with magnesium supplements. I’ve been treating my stomach and have had my T3 levels back in normal ranges. This is just my personal treatment, my doctor doesn’t know why I had low T3. Regardless, taking care of my gut is a good thing.

    • Sonia says

      Your tsh is more than 3 times the norm?! I’ve hashimoto’s it’s an autoimmune disease they say levels should be between 0.4-4… Some Drs vary up to 5 but 10 is way too high
      My advice is always the same try going to see an endocrinologist they specialise in this area…

  12. Robin says

    I am taking 4 grains of armour a day. Tsh is great. Under 1 but T4, free T4 and free T3 are all low. What does this mean. I am not feeling so great either.

    • holly says

      You could try a liver detox to improve liver function. That might improve hormone conversion. Also, you can have low tsh production and hypothyroidism. Eat lots of kelp harvested from cold water around scandinavia to support thyroid nutrition.

  13. Maria says

    Hi ,
    I have had problems for years and just keep getting the disregard from my doctor and told my thyroid is normal.
    Had my numbers checked in 2013
    TSH was- 1.39
    My Free T3- 1.8 (Range1.4-3.8)
    My Free T4- .09 (Range.08-1.8)
    My doctor told me everything was normal, we’d check them again in a year, but I sure didn’t feel normal so took it upon myself to go see an endocronologist for some help was told I need to exercise more and watch what I was eating and drink more water, lol great advice doc, she totally made me feel like an idiot. Would love to workout if I wasn’t so darn tired everyday hard enough to pull myself out of bed, along with the aches and pains.

    Had my numbers checked again last year by my doctor 2014.
    My TSH was 1.87.
    My Free T3 was at 2.7 (range2.3-4.2)
    My Free T4 was at .09 (range.8-1.8)
    Still to be told Im in the normal range and shouldn’t worry about anything. Easy for him to say, bet he doesn’t feel like I do everyday, so I went to a holistic doctor, he told me that my adrenals were off to make me feel like this, so took his meds for a couple months and they helped, but its right back to the same old thing.

    I’m so tired of feeling crappy all the time, so hard to function, have all the typical symptoms and have had them for years. Its coming up on the time to check my numbers again, and I’m thinking of going a different route, just not sure which route that is. Don’t wanna be told its all in head when I know its not.

    Should I try finding another doctor or endo doctor.
    Im wondering if all of this may stem from my pituitary gland as Ive been reading online if my thyroid is normal.
    Wondering if I may need my hormones checked. I’m frustrated with all of this and dealing with people who cant understand what it feels like to go through life like this everyday. The worst part is not having anyone to turn to to get the help that’s needed.
    Anyone have any insight they could add I’d appreciate it.
    Thanks for letting me rant a bit!!!!

    • Alex says

      Hi Maria,

      I’m sorry to hear about your frustration. Consider reading/watching YouTube.com videos on adrenal health. When the adrenals are stressed, they will make us feel tired, fatigued and they will affect thyroid health. This book is supposed to be good: “Adrenal fatigue, the 21 Century Stress Syndrome”, by James Wilson. You may check your adrenals with a 4 point saliva cortisol. Maybe could be ordered at directlabs.com. Pituitary could also be a problem, they are all connected (hypothalamus, pituitary, thyroid, adrenal and gonads).

      • Maria says

        Thanks Alex, was thinking of purchasing some self testing kits online, and also thinking it be time to find a new doctor as well. I appreciate the response, not gonna give up till I get to the bottom of this. Im only 45 and have felt this way for years but was able to handle things better at a younger age, but cant imagine living the rest of my life feeling this way! The biggest challenge is actually finding a doctor who can help!

        • Alex says

          Hi Maria,
          You are welcome, if you are in South Florida, Dr. Blyweiss, David is awesome. As Jenniferlyn K. wrote, try finding a FM doc or at least a doc that is open to learn more about biochemistry and thyroid function. It is obvious yours is lost. To improve thyroid and adrenals, life style, nutrition, toxicity, yeast and gut must be considered, among others. The book by Isabella Wentz, a PhD in Pharmacy might help, it is an easy read and very comprehensive. Functional Medicine Docs are generally more expensive, but they will try to go to the root causes instead of focusing on symptoms and conventional lab ranges. The institute for Functional Medicine is a resource to locate practitioners like MD, Nutritionists, Health Coaches, Nurses and so on trained in this field. https://www.functionalmedicine.org/
          Last but not least, never give up, never, never…

          • Maria says

            Hi Alex,
            Thank you for the link on FM doctors. I am going to look into it. I live in Chicago and sometimes without a referral some of these doctors claiming to help turn out to be a big waste of time. I went to a holistic doctor who also practiced Chinese Medicine and accupuncture not too long ago his website claimed he could help with thyroid, hormones etc. and after a few visits it turned out to be a dead end. Its quite frustrating but I refuse to give up until I get to the bottom of all of this.
            Thank you again, my quest continues! :)

    • says

      Hello Maria,

      There is a difference between clinical ranges and functional ranges. Honestly – your Doctor seems to be just following what the clinical ranges say without much thought into your overall symptoms to see if something other than just thyrioid is involved. Unfortunately in allopathic care, we see this a lot. I would suggest finding a functional medicine doctor in your area who can help you determine if there are any other issues going on within the HPA(TG) axis, such as adrenals as Alex mentioned above.

      Good luck!

      Jenniferlyn, CHHC

      • Maria says

        Thank you Jenniferlyn, I appreciate the feedback! I’m going to look into finding an FM doctor as you and Alex suggested to help me get to the bottom of all this, as much as my doctor is telling me I’m ok my body is telling me otherwise. Thank you again!!!!

      • Rick June says

        I am a 61 yr old male who was reasonably healthy and physically active through to my 40’s with allergies through my whole life… within the past year and a half I had a mini stroke, (temporarily effecting speech) I have had 3 24hr urine test with higher protein results each time, at Christmas time through the first of the year I had major flu like symptoms chills, no fever… I have been having joint pain, more fatigue, depression, hand and face swelling and now I get low T4 results back from a simple blood test..
        I am concerned that taking more tests, or drug trial and error, (Dr’s with no real time to look into) that I have and underlying condition that resulted in the Low T4… Any suggestions?

    • Sarah says


      Just to say reading your comments it was like reading about me!! I had a total THYROIDECTOMY 11 years ago..since then on T4…never really feeling great but managing..last year I had an awful time of palpitations, I had to go private to get a result as the doctors just didn’t review my bloods..one of my readings was off the scale..I was told to reduce my meds to 75mcg..this helped the palpitations.

      On such a low dose however after time I really struggled particularly at work, as a carer doing a very physical job I was exhausted and most shifts felt crap..excuse that word but it best describes how we feel doesn’t it!

      I e mailed my oncologist who raised my dose to 100mcg…this appeared to help but in the last two weeks or so I have starts to feel awful…I was struggling at work on Sunday and had to leave early. I was very emotional as I couldn’t see how I could finish my shift.

      My oncologist has suggested adding T3 which I am awaiting..as she is away at present..it’s all a complete nightmare..I am dreading returning to work and feeling so ill.

      I am hear to chat and perhaps we can somehow support each other??

      In the UK T3 isn’t routinely prescribed and the oncologist suggesting it was quite a breakthrough…I hesitate to go to my GP as they appear to no next to nothing about what we are coping with.

      Best wishes to you


      • Anonymous says

        Hi I had my thyroid removed was on 200 mg levothyroxine lost 100 lbs was still on 200 when I weighed 169 I was having tremors ocd insomnia panic attacks no energy etc I had my labs done my endo said everything was normal and I said I’m not normal I’m finally reduced to 137 mg of synthroid but still have no energy ocd panic attacks and I got.my blood.work done and my t3 was .08 my t4 was 1.8 I have depression cry all the time this thyroid issue is all crappy I have a dctr apt and I still have panic attacks I have no energy I feel like I weight 1000 lbs. Hopefully today at apt they put me on armour or t3 medicine cause this is crazy. I have severe anxiety low progesterone and low vitamin d

    • Casey says

      Maria you sound exactly like me. My levels are the same as yours and I feel like crap everyday. Low energy, muscle aches, stomach problems and the list goes on. Don’t listen to the Dr regarding the weight loss thing… I’m 5’9 and only 130 pounds and I still have the same symptoms as yours. One thing I did find is that my Cortisol is low, so I’m starting to take Cortisol and progesterone supplement from wholefoods with the B vitamins and feeling a little better. I take it first thing in the morning. My whole family has thyroid issues, hypo and hashimotos and my Dr still says I’m fine. I’m also 42. So frustrated!!!!

  14. Leigh Santhuff says

    My levels are all low Tsh .007
    T4 Free 0.16
    T3 Free 2.09 been taking Cytomel for hypo thyroid for years but just had an episode with my heart rate soaring ended up in ER. Not sure what’s going on

  15. Melinda says

    The hypothalamus-pituitary-thyroid (HPT) axis will naturally respond to stresses in the body such as starvation, illness, etc. by slowing down metabolism to compensate for reduced food, or energy demands high enough to cause “wasting away”. As I understand (and several studies have suggested), the body will naturally start converting more T4 to Reverse T3 instead of active T3. I believe this process is seen in anorexics. As the active T3 plummets, the appetite can also plummet (so anorexics can end up “stuck” in low appetite mode and low metabolic syndrome). I believe the hypothalamus is somewhat responsible for appetite, and when T3 levels go back up to normal, so does the appetite. In fact, in Prader Willi syndrome there is a problem with the hypothalamus. If I understand correctly, some other mechanisms for low T3 or conversion problems of T4-T3 may be autoimmune in nature or perhaps antibodies which attack the particular deiodinases responsible for T4-T3 conversion (there are several diffferent of these, found in different tissues). By considering that antibodies can be found in almost any SPECIFIC step, this would account for why some hypothyroid patients will have more problems in their muscles (fibromyalgia), vs. others having other issues. Also, exogenous T4 supplementation (Synthroid) will naturally place excess demand on the pituitary gland to convert T4 to T3, which then artificially suppresses TSH production. The HPT axis acts a lot like an electrical circuit, or complex (mathematically) control system. By mathematically complex, we’re talking about its function being represented by a series of differential equations (CALCULUS!)– not the simpleton math formulas which most endocrinologists assume. In fact there have been a few studies representing parts of the thyroid or HPT axis as such. And problems can occur almost ANYWHERE.

    There are SO MANY problems with the current thinking in endocrinology it’s hard to detail them all here. Endocrinologists have over-simplified the HPT axis, under-appreciated the many subtleties of thyroid disease, and over-relied on TSH for disease maintenance, which is a disaster for many thyroid patients, including myself. By the time my THYROID levels are adequate (read — NORMAL) and most my symptoms resolved, my TSH will be very low. The knee jerk reaction by most physicians is to lower the dose and make me sick again. This approach is so simplistic, I could actually teach it to middle-school children. I actually have to hunt to find a physician more sophisticated in thyroid disease management. The longer a patient has been on thyroid meds, or more severely hypo (including removal of gland) the more problems they will have by the stupid approach of TSH management levels. Gone are the days when physicians treated the patient according to their symptoms. It’s just plain stupid how most physicians use TSH by itself to treat thyroid disorders.

    • trish says

      Boy did you peg this, like you by the time t3. And t4. Get to normal tsh very low and Dr took me off armor put me on 75% less equivalent dose of synthroid , severe symptoms within 7 days by 13 days calling office… I will say before these changes made Dr promised if I went south, she would put me back to what I was on…. My question, since happened to me more than once, when will the medical community get this one? And stop diagnosing and testing on tsh level alone… It has been a week and finally my bowels, heart and energy are feeling mire normal

    • laurie says

      Wow, melinda. Can you be my doctor? I don’t even see western doctors cause they still use the 1930’s mentality and want to put you on synthetics so eventually, the thyroid burns out. Still, integrative medicine approaches are hard to find but also vary so much, adding to their bad wrap. Overall, I seek holistic meds (armor, westhroid), in addition to same for hormone issues. Still, I’ve NEVER had anyone tell me my flare ups of muscle pain and joint pain are related to thyroid. You’re the first one. I live with the pain, but am desperate to be treated correctly and find the best medicine. WHERE SHOULD I GO???

    • Silverstroke says

      It is comforting to read these comments and personal experiences. I was diagnosed with Hashi’s over 4 yrs. ago and despite the different Drs.,and meds,etc.— I continue to struggle. If my TSH and T4 are WNL they assume their tx. plan is acceptable. I have come to question this as my S&S are not improved!!!!!!! I have textbook symptoms of low thyroid which are progressively worsening plus I now have severe arm and leg pain. (????related to Tirosint—-my latest med ). I am sick and tired of being sick and tired!!!!!! VERY weary of all this and I am losing hope of my life ever being NORMAL.

    • Mary says

      Melinda, can you provide more info/resources on why low TSH shouldn’t be the prime focus? I have this exact problem. The doctors jump to reduce my thyroid meds based on TSH. I was seeing a doc that didn’t test TSH once treatment stated and I was doing well, however, I moved out of state and my new doctor immediately reduced my meds based on my TSH level. It’s a recipe for disaster. I’d like to find some resources that explain this in more detail.

  16. Tasia says

    You, and every doctor (holistic or otherwise), are missing a HUGE factor in internal energy, cell, heart, brain, and organ (basically all METABOLIC) functioning… In addition to a huge environmental factor which alters how all medications are metabolized in the body. Electromagnetic radiation and fields, namely from microwave radiation (from cell towers, cell phones, wi FI, blue tooths, SATALLITE transmissions, and basically a thing that operates wirelessly with an antenna) which is emitted in ubiquitious and varying amounts throughout most modern living environments. In some national forests off the power grids and cellular phone network grids you can find some relief and stability withing these fields. The body is ELECTRIC, CONSTANTLY INTERACTING WITH NOT ONLY THE THINGS YOU PUT IN IT BUT THE EXTERNAL ENVIRONMENT. PLEASE RESEARCH THE HEALTH EFFECTS OF ELECTROMAGNETIC RADIATION AND FIELDS, ELECTROMAGNETIC HYPERSENSITIVITY, AND THE BOOK “The Body Electric”

    • LAHs says

      I agree with Tasia 100%. I avoid using a cell phone at all cost and only switch on my WiFi a couple of hours a day just to Google, e-mail, and research hypothyroidism – which I am doing now. If I see a mother handing a cell phone to a child (I’ve even seen them give one to a baby!) in the supermarket or on the street I go up to them and politely explain the dangers. I was a physics major so I have no fear of explaining the effects.
      Stay away from radiation guys – I recon that’s how I got thyroid cancer, but that’s impossible to prove.

  17. trish says

    I have been hypothyroid for 6 years. My tsh was high t3 free and t4 free were low..I am now on 120mg armor thyroid, 60 mg in am 60 mg in afternoon. My most recent labs show free t4 to be 0.77 free t3 to be 2.6 and tsh the lowest ever at 0.04. Dr mercola mentions when on armor thyroid it is not unusual to have a low reading on tsh and that if asymptomatic and free t3 and free t4 is within normal it means i am in the right dosage… Is this true?

    • JonGrant says

      I am not a doctor, but have experience as a hypothyroidism patient. I had to convince my doctor to do several things:

      1. Test for something other than just TSH. We looked into free T3, Free T4, reverse T3. So even though my TSH was in range, my active hormone was in the bottom 1/3 of range. I was very tired even though my TSH was in range.

      2. I asked the doctor if we could treat low FT3 symptomatically as long as we stayed in range.

      3. Asked the doc if we can ignore what might look like very low TSH as long as I felt good.

      This is working well for me.

      Another thing that has helped a lot is adding bioactive B vitamins as supplements. Do some research, and look into methylation protocols (essentially this is adding bioactive forms of B12, folate. The folic acid and cyano form of B12 don’t work for up to 50% of people due to mutations).

  18. Jane says

    Does anyone know the cause of high T4 AND high TSH? I am on Levothyroxine (I had a total thyroidectomy 14 years ago) and I am taking Vitamin D3 due to my low levels of VitaminD, low calcium and high phosphorus. Thanks

  19. Ms moore says

    Thyroid hormone replacement labs vs newly diagnosed thyroid problem labs
    So, if a patient has been on thyroid hormone replacement for 10 years and they go to a new physician, the physician sees a low TSH or nonexistent TSH. They tend to get a little upset and try to reduce The level of medication you’ve been taking for 10 years. If I were a patient that had never been diagnosed with a thyroid issue, and my TSH was nonexistent, I believe my T4 and T3 would probably be through the roof. If a patient has been on thyroid medication for 10 years and her TSH is nonexistent, is it possible that it is due to stuffing T4 down the throat every day and causing the pituitary gland to not make a request for T4. Therefore causing the TSH to be nonexistent. Do I have this process right? And, if the T4 causes the TSH to be nonexistent, then certainly the the thyroid gland is not producing T3 as it did when the thyroid gland was healthy. So the only T3 we get with replacement therapy is what we get from the conversion of the T4 pill. If we are very careful with how we administer the T4 pill, we can get a little T3 out of it. So, without the help of additional T3, it may be impossible to have optimal levels of T3 since our suppressed TSH is no help in providing the natural production of T3 as it once did. But, it is the oral T4’s fault that all this is the way it is. If I am thinking this through correctly, then why can’t the medical profession understand that it is unnecessary to try to bring the TSH within normal lab ranges. If the dr tries to bring a nonexistent TSH within range, the person would be in a vegetative state by the time that happened…or dead. So, no…low T3 is not about the thyroid. It seems possible that it could be about the T4 replacement causing the pituitary not to send a signal; therefore, no signal for T3 either- which makes us t3 deficient with only the replacement T4 to depend on for a minimal conversion to T3. Is it a mysterious unknown disease that causes the low T3 problem once we take thyroid replacement in the form of T4?
    I am venting and need to find a dr that doesn’t want to try to bring my nonexistent TSH within range. If they take me from 112mcg to 100 mcg-my TSH will still be nonexistent. I don’t want to be their guinea pig.

  20. Shauna says

    I am a 53 yo female that 2 years ago was diagnosed with cervical dystonia. Its been extremely painful and stressful. I get botox injections every 12 weeks, They have helped me to look better but I still am in extreme pain. I am a very active person, if I don’t exercise every day I cant move. I also am very careful with my diet. No pop, sugar breads etc. but every time I have lab work I am concerned with the numbers. This last week I had some blood work done and feel so discouraged with the results and really don’t know where to turn for help. My HbAiC is 5.70 and has been that high now for about a year.
    other labs that are out of range:
    Potassium 4.60 (4.0-4.50}
    Phosphorus 4.30{3.8-4.0}
    Globulin 2.3 (2.4-2.80}
    LDH 213.00(189.209.00}
    AST/SGOT 27.00(10.00-26.00}
    Serum iron 81.00(85.00-135.00)
    Triglycerides 204.00[75.01-99.99}
    Cholesterol 206.00(100.00-199.00}
    HDL 68.00{0.00-59.00}
    TSH 0.66 (1.80-3.00}
    T3U 25.00 (28.00-38.00}
    VLDL 41.00 (5.00-40.00)
    I suffer from extreme tiredness. I don’t sleep unless I take a sleeping med. I have no energy. I suffer from depression. I crave sugar so badly. I feel like I am in a down ward spiral that I cant escape. Can you please help me or at least give me some advise.

  21. Lonjezo Sawathi says

    hello sir,

    I am on 175 thyroxine for the past 5 months and tests 2 weeks ago were :-
    TSH 0.04 (0.3-5.6)
    T4 4.7 (4.8-11.7)
    T3 1.7 (0.8-2.0)

    feels sleepy especially mid morning despite having 7 hours of sleep at night.

    what do thinks



  22. Amanda Castellano says

    Good morning. I am wondering whether it is possible to have these kinds of issues if the thyroid has been completely removed, and if so how I would know or what tests would I ask for? I had my thyroid removed in 2005 for pre-cancerous cells and about 36 nodules, at the time it was alternating high/low/high/low. It’s been stable on medication but now my T3 is low and my weight has not changed. I’m just wondering if that’ a pure medication issue or possibly anything else should be considered? Thanks.

  23. Swathi says

    hello sir,
    this is swathi again…a dermatologist saw my reports and said that my blood levels are really very very very low….
    these are my thyroid test results
    T3,Total : 1.02 (Reference range 0.60 – 1.81)
    T4, Total : 12.80 (Ref range 5.01 – 12.45)
    TSH : 1.81 (0.55 – 4.78)
    by looking at this…he said that its..OK…there is not much problem..don’t need to worry…but better take second opinion from thyroid specialist…
    do i have to worry about this???
    i mean even if have problem , can it be cured or not???
    or else i have to take tablets forever??
    pls reply me…
    i am worrying a lot because of this…from past 3 weeks…

  24. Swathi says

    hello sir,
    this is swathi again…a dermatologist saw my reports and said that my blood levels are really very very very low….
    these are my thyroid test results
    T3,Total : 1.02 (Reference range 0.60 – 1.81)
    T4, Total : 12.80 (Ref range 5.01 – 12.45)
    TSH : 1.81 (0.55 – 4.78)
    by looking at this…he said that its..OK…there is not much problem..don’t need to worry…but better take second opinion from thyroid specialist…
    do i have to worry about this???
    i mean even if have problem , can it be cured or not???
    or else i have to take tablets forever??

  25. Swathi says

    yesterday i got my tests done…my haemoglobin levels are lower than ref range….but what i want to know is..
    these are my thyroid test results
    T3,Total : 1.02 (Reference range 0.60 – 1.81)
    T4, Total : 12.80 (Ref range 5.01 – 12.45)
    TSH : 1.81 (0.55 – 4.78)
    I just want to know, do i have thyroid problem ???
    do i have to , have those pills daily for lifelong????

  26. Veerle Deschuytter says

    Interesting article. If I read this,
    These are my lab results. My doc says they are ok but my free t3 is pretty low. I’m a celiac patient and I’m following the AIP diet since 6months (to get the gut inflammation down). My thyroid lab results are actually worse (lower free T3) in comparison with one year ago (at that time I was eating only gluten free then). Should I consider natural dessicated thyroid or not?
    Free T4: 1,16 (range 0.94-1.56ng/dL)
    Free T3: 2.41 (range 2.47-4.36 ng/dL)
    TSH: 1.84 (range 0.27-4.20 mU/L)
    Antithyroglobulin : 28 (<115 IU/mL)
    Anti-TPO: 18 (<34 IU/mL)

    • Jai says

      My T3 went down on AIP too. I read somewhere that can happen without enough starches/carbs. It is hard though because I seem to get stomach problems when I go off of AIP?

  27. Emma Brkic says

    My FT4 is 15.3 pmol/L (10.0 – 22.0)
    My FT3 is 4.6 pmol/L (3.1 – 6.8)
    My TSH is 4.16 mIU/L (0.30 – 4.20)
    I have a nodule in my thyroid and had a biopsy done and was told I have Hashimotos.
    I use to take 100mcg of oroxine and was told by my doctor to reduce it to 50mcg and add 5mcg of Liothyronine (T3) twice a day.
    My question is why such a drop in oroxine as my T4 was good, shouldn’t have I just added the T3 to help bring up the level which he would like to see at 5?
    Since dropping the T4 feeling worse.
    Any professional advice as I am thinking of returning to the 100 mcg of T4 and only adding 5mcg of T3 once a day to see if I feel better.

  28. says

    My name is Debbie read a lot of everyone’s complaints, been there been through a lot of the same symstems! I have Hashimotos, gluten intolerant, low T3 I’m on Liothyronine 10-MCG.per day. And Porcine thyroid75-MG. Never being able to lose weight ever to the understanding that if you have a Leptin issue, you more than likely are going to have a low T-3 leptin and t3 are interrelated! Long story, but I’ve had to be so proactive about my own health because most docs don’t get this stuff? ( not fun) but there is hope keep digging into your own health until you get your answers as like I did been through many a docs, but you have to or you will never fill right!

  29. Janine says

    I was diagnosed with hypothyroidism 4 years ago- I take armour thyroid- last month my tsh was 2.58 – it had gone up from 0.44. My dosage was increased to 90 mg.
    I paid cash for a comprehensive panel a month later –
    This is the reading Tsh 0.22 ; t4 10.10; T3 246; Fti 2.50 ; T3u 25.0 ; ft4 -1.44 Ft3 -6.80
    Rt3 – 19.60
    I never took the increased dose because the two days I took it I felt hot and uncomfortable.. I had in fact reduced my dose because I broke the pill in half.. I am confused how can these readings be all over the place.. I am at my wits end – any suggestions?

    • Rob says

      It takes.a few weeks for your levels to stabilize. Some natural thyroid hormones are not consistant doses and would cause fuctuations.


    Sir I am a 17 years male and have been experiencing high fatigue and cold intolerence lately..
    My doctor advised Thyroid Profile test which shows low levels of T3 & T4 while TSH lies in the normal range.
    Headache, drowsiness and muscle pain has also become a cause of worry.
    I am also suffering from constipation and experience twitching in my facial nerves at times..
    My test reports are as follows:
    T3,total: 0.43 ref. range:(0.80-2.10)
    T4,total: 2.20 ref. range:(5.01-12.45)
    TSH: 0.93 ref. range: (0.70-6.40)
    Vitamin D3: 58.2 ref. range: (75-250)
    Vitamin B12: 255 ref. range: (211.0-911.0)

    • Bernadette says

      Hi akshath singhal u need to b on meds get antibodies tested for Hashimoto ‘s. A hair analysis will tell u what minerals your lacking or have too much of have iodine & adrenals tested. U need to b on b12 vitamin d .u might need t3 meds if so magnesium & selenium & iodine but gets these checked as too much iodine will make symptoms worse. U will have to find root cause to fix. Going gluten free dairy & soy free helps. U wiil have to take control of your health as a lot of Dr ‘s don’t understand. Good luck

  31. 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.

    • kristin rizo says

      ow are you self medicating yourself with T3?? I also have Raynauds and supposedly a thyroid issue, however I dont lose weight on synthroid. I was able to lose weight on Armour bc it has T3. I can’t get a dr to prescribe me T3. im desperate, been to all endocrinologists in my city and no one has been able to help me lose weight again and I feel extremely bloated; almost pregnant-like but I’m not pregnant

  32. 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.
    [email protected]

    Thank you-Michele

    • Alex says

      Hi Michele,

      While TSH and T4 are within range, your T3 is out of range (75 Low). It should be around 120 ng/dl or a bit higher to be close to the optimal values. The T4 is also borderline low.

      Please find another doctor who at least can prescribe cytomel (T3) for you. Preferably a functional medicine doctor to understand thyroid labs and functional ranges and the root causes of your condition.

      I also have low T3, cold hands and slow reaction/thinking at times, etc. Used to feel much worse though, I feel much better now. The same will happen to you.

      You must also clean your diet. In a separate message I will send a simple handout of stuff that you might look into it. Diet and stress are fundamental, as well as toxins (mercury, lead, root canals, etc.)

      Wish you luck


  33. 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

  34. 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

    • Rita says

      Thank you so much for posting this. I have been struggling with my 17 yr old daughter. She has low T3, low vit D and high calcium. A few months ago she fell on her head thought concussion. Symptoms of dizzy, low concentration won’t go away they keep going back to concussion but I think something else. The concentration has been over a year but feel the fall did something else. Her pediatrition keeps saying eat better and drink more water. It’s making me crazy. Glad I just found new doctor to test the t3, maybe we can get some answers. Feeling overwhelmed

  35. Monique says

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

  36. 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

  37. 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.

    • LAHs says

      They are not vitamins they are enzymes which exist mainly in the liver. They “deiodinate” the thyroid hormones. Most mammals have three of them hence D1, D2, D3. More than that I do not understand but you can Google “What is D1…….etc” – but it’s a bit complicated!

  38. 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.

  39. 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

  40. 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?

  41. 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

  42. 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

  43. 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.

  44. 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!

    • Kathy says

      WOW! How did you get so much data? How much did you have to pay for all these tests? My insurance (Cigna) wouldn’t pay for all that testing and my PCP wouldn’t order it. I don’t even see these to check off on the blood work request sheet. Are you paying out of pocket to see a Naturopath? Good luck with your quest to find the truth!

  45. 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 :(

  46. 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…

  47. 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…..

  48. 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

  49. 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

  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. 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.

  52. 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!)

  53. 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.

  54. 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?

  55. 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.

  56. 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!

  57. 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

  58. 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.


    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!!!!


  60. 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

  61. 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?

    • teresa rose says

      I Know it’s been a while but did you have any luck figuring out if you have Wilson’s Temperature Syndrome? I think my daughter might have it. Seeing an endocrinologist tomorrow. Hope you are feeling better. Thanks, Teresa.

  62. 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..

  63. 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

  64. 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.

    • LAHs says

      Hi Lluke,
      I have Kaiser too and my Endo refused to treat my hypO symptoms because my T4 was pushing the high margin and my TSH was <.01. I am desperately trying to find another Endo, one who will look further than TSH and T4. I am now sleeping 11 hours per day and worried that I will eventually become too tired to help myself.

  65. 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.

  66. Raghu Iyer says


    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

  67. 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!

    • 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!

  68. 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:

  69. 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.

  70. 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.

    • sunny says

      Im pretty similar
      Tsh 1.6 t3 2.8

      I had low vit d …got it up to normal and hasn’t made a difference i cant lose the weight either. I’ve tried everything and so frustrated too :(

      The weird thing is my t3 was 3.1 and lowered after put in trearment armour

  71. 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.

    • 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!

  72. 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.

  73. 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?

  74. 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.

  75. 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.

  76. Kathy says







    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 )


    AST SERUM LEVEL 15 IU/L (0.0 – 30.0)
    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)



  77. 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.





    5.3mmol/L (2.5-6.1) PLASMA GLUCOSE,FASTING;-


  78. Julie says


    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!

  79. 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?

  80. 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.

  81. 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.

  82. 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.




    • 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!

  83. 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

      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.

  84. 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.

  85. 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.

  86. 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.

  87. 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!

  88. 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.

  89. 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.

  90. 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.

  91. 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.

  92. 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


            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

  93. 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.

  94. tess says

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

  95. 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?

  96. 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

  97. 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.

  98. 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.

  99. 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.

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