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3 Steps to Choosing the Right Thyroid Hormone


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

I often get comments and emails from people asking me which thyroid hormone I think is best. My answer is always the same: “It depends.” As much as some practitioners would like to make us believe, there is simply no “one size fits all” approach to thyroid hormone replacement.

Statements like “Synthroid is best” or “I prefer to use synthetic T4 with my patients” or “I only use bio-identical hormones” demonstrate a lack of understanding of thyroid pathology. Why? Because, as I’ve explained in this series, the underlying causes of thyroid dysfunction are diverse.

Giving all patients the same thyroid medication without understanding the mechanisms involved is analogous to not checking a patient’s blood type before doing a transfusion. Granted, the consequences may not be as severe, but the underlying principle is the same.

Before we continue, let me remind you that I’m not a doctor and I’m not offering you medical advice. My intent is to educate you about the various considerations that should be made when choosing a thyroid medication, so you can discuss them with your doctor. Understood? Great. Let’s move on.

Choosing the right thyroid medication requires answering the following three questions:

  1. What’s the mechanism that led to the need for medication in the first place?
  2. Are there any mechanisms that may interfere with the actions of the medication?
  3. Does the patient have sensitivities to the fillers used in the medications?

Let’s look at each of these in turn.

What’s the Mechanism That Led to the Need for Medication in the First Place?

If you’ve been following this series, you know that there’s no single cause for low thyroid function. Do you have an autoimmune disease (Hashimoto’s) causing destruction of your thyroid gland? Do you have high levels of estrogen causing an increase in thyroid binding proteins and a decrease in free thyroid hormone? Do you have a systemic inflammatory condition affecting your ability to convert T4 to T3, or decreasing the sensitivity of the cells in your body to thyroid hormone?

In order to choose the right hormone, you have to know what the underlying mechanism causing the dysfunction is. Let’s look at an example.

Say you have a problem converting T4 to T3. In this situation, your TSH may or may not be slightly elevated, but let’s say it is, and your doctor prescribes Synthroid. Synthroid is a synthetic T4 hormone. Will this help you?

No. It won’t help because your problem in this example isn’t a lack of T4, it’s an inability to convert T4 to the active T3 form. You could take T4 all day long, and it won’t do a thing unless your body can convert it.

The first step in this case would be to address the causes of the conversion problem (i.e. inflammation), in the hopes that you may not need replacement hormone. If that doesn’t work, though, what you’d need in this situation is either a so-called bio-identical hormone that has a combination of T4 and T3, or a synthetic T3 hormone (like Cytomel). These will deliver the T3 you need directly, bypassing the conversion problem.

Are There Any Mechanisms That May Interfere with the Actions of the Medication?

The vast majority of long-term hypothyroid patients that haven’t been properly managed find that they constantly need to increase the dose of their medication, or switch to new medications, to get the same effect.

There are several reasons for this. First, inflammation (which is characteristic of all autoimmune diseases, and Hashimoto’s is no exception) causes a decrease in thyroid receptor site sensitivity. This means that even though you may be taking a substantial dose of replacement hormone, your cells aren’t able to utilize it properly.

Second, elevations in either testosterone or estrogen (extremely common in hypothyroid patients) affect the levels of circulating free thyroid hormone. For example, high levels of estrogen will increase levels of thyroid binding protein. Thyroid hormone is inactive as long as it’s bound to this protein. If you take thyroid replacement, but you have too much binding protein, there won’t be enough of the active form to produce the desired effect.

Third, there are several medications that alter the absorption or activity of T4. These include commonly prescribed drugs like antibiotics & antifungals (i.e. sulfonamides, rifampin, keoconazole), anti-diabetics (Orinase, Diabinese), diuretics (Lasix), stimulants (amphetamines), cholesterol lowering medications (Colestid, Atromid, LoCholest, Questran, etc.), anti-arrhythmia medications (Cordarone, Inderal, Propanolol, Regitine, etc.), hormone replacement (Premarin, anabolic steroids, growth hormone, etc.), pain medication (morphine, Kadian, MS Contin, etc.), antacids (aluminum hydroxides like Mylanta, etc.) and psychoactive medications (Lithium, Thorazine, etc.).

All of these factors must be considered if a particular medication isn’t having the desired effect.

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Does the Patient Have Sensitivities to the Fillers Used in the Medications?

Another important consideration in choosing the right hormone is the fillers contained in each medication. Many popular thyroid medications contain common allergens such as cornstarch, lactose and even gluten. As I explained in a previous post, most hypothyroid patients have sensitivities to gluten, and many of them also react to corn and dairy (which contains lactose).

Synthroid, which is one of the most popular medications prescribed for hypothyroidism, has both cornstarch and lactose as a filler. Cytomel, which is a popular synthetic T3 hormone, has modified food starch – which contains gluten – as a filler.

Even the natural porcine products like Armour suffer from issues with fillers. In 2008, the manufacturers of Armour reformulated the product, reducing the amount of dextrose & increasing the amount of methylcellulose in the filler. This may explain the explosion of reports by patients on internet forums and in doctor’s offices that the new form of Armour was either “miraculous” or “horrible”. Those that had sensitivities to dextrose were reacting less to the new form, and experiencing better results, while those that had sensitivities to methylcellulose were reacting more, and experiencing worse results.

The best choice in these situations is to ask your doctor to have a compounding pharmacy fill the prescription using fillers you aren’t sensitive to. Unfortunately, insurance companies sometimes refuse to cover this.

Other Considerations

Another common question that is hotly debated is whether bio-identical or synthetic hormones are best. Once again, the answer is: “It depends.” In general I think bio-identical hormones are the best choice. A frequently perpetuated myth (in Synthroid marketing, for example) is that the dosages and ratio of T4:T3 in Armour aren’t consistent. Studies have shown this to be false. Armour contains a consistent dose of 38 mcg T4 and 9 mcg T3 in a ratio of 4.22:1.

However, in some cases patients do feel better with synthetic hormones. One reason for this is that a small subset of people with Hashimoto’s produce antibodies not only to their thyroid tissue (TPO and TG), but also to their own thyroid hormones (T4 and T3). These patients do worse with bio-identical sources because they increased the source of the autoimmune attack.

Another issue is the use of T3 hormones. As we’ve discussed, T3 is the active form and has the greatest metabolic effects. The flip side of this, however, is that it’s far easier to “overdose” on T3 than on T4. Patients with trouble converting T4 to T3 do well on synthetic T3 or bio-identical combination T4:T3 products. But for many patients with Hashimoto’s, which is can present with alternating hypo- and hyperthyroid symptoms, T3 can push them over the edge. They are generally better off with T4 based drugs.

As you can see, the best thyroid hormone for each patient can only be determined by a full thyroid work-up and exam, followed by trial and error of different types of replacement medications. Such a work-up would include not just an isolated TSH test, but also a more complete thyroid panel (including antibodies), other important blood markers (glucose, lipids, CBC with diff, urinary DPD, etc.) and possibly a hormone panel.

A history must be taken with particular attention paid to the patient’s subjective response to replacement hormones they may have tried in the past.

Unfortunately, this rarely happens in the conventional model, where the standard of care is to test only for TSH. If it’s elevated, the patient will get whatever hormone that particular practitioner is fond of using without any further investigation. And all too often, as many of you can attest, this simplified and incomplete approach is doomed to failure.

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Join the conversation

  1. Thank you so much for your article, I wondered why I couldn’t tolerate NDT and now I appear to have the answer. Unfortunately, I think I’m one of those subsets of Hashimoto’s patients that not only have antibodies to thyroid tissue but to the actual thyroid hormones themselves, as ANY thyroid medication makes the soreness in my throat worse. Is there a way to test this – what are the antibodies called, just anti-T4 and anti-T3? If anybody knows the names of all the antibodies associated with the thyroid, please can you let me know because I’m having a blood test this week and want to make sure I get the right tests!

    • Antibodies and their tests are:

      Hashimoto’s Disease:
      Thyroid Peroxidase Antibody (TPOab)
      Anti-Thyroglobulin (TgAb)

      Grave’s Disease:
      Thyroid Stimulating Immunoglobulin (TSI)
      Thyroid Receptor Antibody (TrAb)

      Again, any positive result is evidence of autoimmune disease.

      NDTs are, in general, better than a T4-only med, because of the T3 in them. What the famous thyroid advocates DON’T tell you is that a healthy thyroid secretes tiny bits of T3, all day every day, the synthetic version of T3 is called Cytomel, and those with antibodies, in general, won’t be able to tolerate an NDT (they need the synthetic T3).

      ThyroidLESS patients’ experiences PROVE that the T3 converted from T4 is not enough, precisely because they need and DESERVE replacement of the T3 not converted from T4. If you can’t convert T4 into FT3, you DESERVE 100% replacement of your T3.

      Ingesting T3 is different than ingesting T4; you can’t just take it once a day.

      • Thank you for your replies to my few postings on here, and your quick response, Barb. That’s so interesting about NDT, I wish I’d known that before reading Janie Bowthorpe’s book and spending over 200 quid (of money I couldn’t really spare) importing it to the UK! On my test last year a doctor told me I appeared to be a good converter of T4 to T3. I hope this is true. I’ve never had a Reserve T3 test as I was told it was a specialised test that wasn’t available to me due to me being bed/housebound (with a neurological disease not thyroid, although I think low thyroid might be contributing/overlapping with that.)

        What you said higher up in your other reply to me about increased heartrate/palpitations – so do these effects dissipate as your metabolism and body adjusts, meaning it’s worth persevering with the meds? I will be asking my GP about adding Cytomel then now if necessary when we know my latest results. Do you think it’s worth pursuing meds when I get this increased throat soreness – it feels like a double-edged sword: Increased energy, brain fog lifting, better sleep etc but increased soreness in thyroid and tendency of heartrate to increase. I don’t want to make matters worse by increasing the autoimmune attack, and I already have heart failure. Maybe I just need to go slowly and give my body time to adapt. Anyway, please don’t feel a need to respond as I don’t want to be an imposition! 🙂 You were already kind enough to answer the other questions.

        • You are NOT a bother!!!

          Ingesting T3 will teach your thyroid to shut down (suppressing your TSH), teach your body to depend on what you ingest. Ingesting thyroid hormones, even synthetic ones, is NOT a treatment for antibodies. Experimentation with low dose naltrexone is ongoing, but I decided against it, for me. Ingesting T3 “resolved” my congestive heart failure, within ten days of ingesting full replacement doses, not “supplemental” doses. IF you choose to ingest T3: Start low, build up. http://www.eaware.org suggests (not ingesting any T4), 12.5 mcg, twice a day, increasing by 12.5 mcg every 5-7 days. I increased every three days; a friend who still has his thyroid increased every eight days. We are ALL too individual for me to suggest what you should do; just know that considerable experimentation on yourself, by yourself, will be necessary. Read from the websites I listed; learn how a healthy thyroid works, so you can be your own thyroid from the outside in, if you so choose. Best wishes!!!

  2. Have found the protocols of NUTRI-SPEC.NET to be the most complete.Progesterone by mouth is useful ,as in PROGEST-E.
    The endocrine/immuno/neuro sisters are so interrelated that only chasing T: 3/4/glandular may be too focused .You probably need more saturated fat. The best gut flora supplement is FLORASTOR .Your body wants to heal.

    • Thank you!!! Most patients appreciate doctors who can still learn from patients (at least I do). What my doc found most interesting: it is a punishable CRIME (cruelty) to “practice” the “acceptable” standard of “care” on chimps. Yet the AACE continues to mandate that every doctor in every specialty “practice” this same cruelty on humans (at least one in every eight women). From my perspective, without a thyroid and being unable to convert T4 into FT3, this cruelty “practiced” on me is not only cruel, it is abusive, neglectFULL, and deadly. I sat in a wheelchair, dying of congestive heart failure, which cardiologists were unable to explain. Within ten days of ingesting replacement doses of T3, my wheelchair was gone and so was my CHF. Coroners are no longer trained to notice accumulated mucin in the heart due to INsufficient T3 at the CELLULAR level, so, now, one in three women dies of “heart disease”….

    • Doctor, I hope by interesting you also mean scary. Interesting in that I think there needs to be an internet presence of integrative and endocrine physician specialists and researchers willing to listen to the voices of thyroid sufferers and then more research needs to be done. This little gland is a powerhouse and really affects quality of life for many. There needs to be more attention paid and then there also needs to be a calming and authoritative voice from the people who dedicate their lives to endocrine research- not just a bunch of us sick from it pretending to be doctors. I am a nurse but I fully respect that I didn’t do 4 years medical, followed by residency and fellowship followed by lifetime of practice. There is too much CRAP advice on the internet regarding thyroid. With that said however, where there is smoke, there is fire…

      • I agree. A lot of the information I have found has caused (me personally) more harm than good. The NDT so heavily promoted on Janie Bowthorpe’s website and book and the T3 it contains was too much for me, I was soon having high heart rate and palpitations. This article finally explains why y I couldn’t tolerate that, even though NDT is so heavily promoted by some as being THE BEST choice for EVERYONE.

        • LOW thyroid:

          We get what appear to be hyPER symptoms when labs prove we are hyPO. What occurs is that when the body senses the metabolism slowing due to low thyroid hormones, in it’s effort to maintain homeostasis, the adrenals are given the signal to increase catecholamine output (adrenalin) which revs up the heart rate and BP, causing anxiety, heart racing and palps.

          NO thyroid:

          We get what appear to be hyPER symptoms AND lab results when we are hyPO. What occurs is that when the body senses the metabolism slowing due to low thyroid hormones, at the CELLULAR level (not in the bloodstream), in it’s effort to maintain homeostasis, the adrenals are given the signal to increase catecholamine output (adrenalin) which revs up the heart rate and BP, causing anxiety, heart racing and palps. Low T3 at the cellular level also stops production of progesterone (elevating estrogen unopposed by progesterone) and increases cortisol. Progesterone is a KNOWN component of converting T4 into FT3, and I notice my T3 works better when I use my OTC progesterone cream.

          • you sound like a fellow woman warrior as I was.. or am… I would like to talk to you about a few things… but im still recovering from thyroid cancer surgery and parathyroid surg… you wouldn’t believe my story.. my health issues that were ignored for years.. even when I presented them with info and test results.. I would love your insight if you get a chance.. thanks jackie

            • Thanks jackie. There are, literally, millions of us.

              When doctors remove the paras with the thyroid, you will need calcium replacement for “the rest of your life”. The thyroid makes calcitonin, which opposes PTH. So, PTH tells the body “make calcium” and calcitonin, from the thyroid you’re now missing, says “ok, but not too much”. Some surgeons are smart enough to leave paras intact; some patients adjust to not having calcitonin; and some don’t. I’m lucky: I “only” swallowed RAI, which destroyed my thyroid (literally, disintegrated it), and I adjusted to not having any calcitonin.

              The reference range for serum calcium is very narrow for a reason: too little or too much can kill you in just a few days.

              “Thyroid” problems can also CAUSE parathyroid problems, which is yet another story from someone I know that you “won’t” believe!!!

              I don’t have the internet at home or on my phone, but there are lots of groups on fb where you can gain info. I listed several websites above in other comments. On fb, FTPO has multiple groups, one for each problem encountered by most people with “thyroid” problems. There are very few groups for those of us withOUT a thyroid, but they do exist!

              I wish you a speedy recovery from surgery and a knowledgable doc who will be truthful (i.e., one who says “I don’t know” when they don’t know).

  3. I am having major Thyroid symptoms but normal tests…i believe I have estrogen dominance but have yet to find a doctor who diagnosis this let alone who cares! So frustrating!!

    • Sure is!!! 21st Century medical SCIENCE has PROVEN that progesterone is a known component of converting your own or ingested T4 into the Free T3 that every individual cell in the body and the brain NEEDS. I ingest T3 only and have proven that progesterone is also necessary for my cells to use my T3 (it works better). I use an OTC progesterone cream, because doctors don’t know how much prescription progesterone is absorbed, and they “think” it’s half life is “about 17 hours”. Estrogen, especially when elevated, but definitely when UNopposed by equally elevated progesterone, CAUSES excess stress (more frustration)! Stress uses up the supply of Free T3 quicker than any other drain, and a healthy thyroid even interprets food as stress. Left untreated, even a mild thyroid problem wreaks havoc on ALL other hormones, especially for women. Get a Free T3 test done from blood drawn at 3-4 Pm when it’s lowest, and know that healthy women who were tested created a reference range of 4.25-6.19. Of course, the lab won’t use that reference range, because they are basing their reference range on sick and suffering people. Then, find a doctor who treats symptoms, not lab results, and soon, because excess estrogen creates fibrous tumors in various parts of the body. I have one on my left adrenal gland, so I’m short more than just progesterone. Surgery to remove it would only replace the tumor with scar tissue and I’d still have the same problem: only one functioning adrenal. If you develop uterine fibroids, know they go away on their own once you start replacing your progesterone. YaY!!! You don’t “need” a hysterectomy OR “ablation”. If you develop one of these tumors in a breast and start getting radiated every year to “check it”, KNOW the radiation WILL eventually turn it into a malignant tumor. Mandate a sonogram and bypass the mammogram altogether. Radiation also destroys thyroids, but you won’t hear that from ANY radiologist or endocrinologist! They aren’t sufficiently educated about how women’s thyroids function or the connection between T3 and every other hormone, much less the connection between one in every eight women being radiated annually and being diagnosed with a “thyroid problem”. If you haven’t gotten “thyroid” antibodies tested, that’s a good idea as well. “Thyroid” antibodies aren’t evidence of thyroid disease; they are evidence of autoimmune disease that attacks your thyroid FIRST.

  4. Don’t you just love people who post articles like this, anticipating multiple comments and questions from the millions of people suffering? All so those suffering people can be ignored by the author of the article, and actual doctors, because the suffering people don’t have endless supplies of money??? SMH, and whoever moderates comments should be, too….

    There’s TONS of articles like this! They are all directed at people who still have their thyroid. If you are thyroidLESS, please understand you are NOT “hypothyroid” and you deserve 100% replacement of T3 for ALL your cells. IF you can convert T4 into FT3, great! You still need that T3 not converted from T4.

    • At last! Something that makes sense. Sheesh it’s so hard to find info on thyroidless people like myself!
      Thank You!

      • You’re welcome! Please know that labs’ reference ranges change every 2-3 years and they are based on the sick and suffering people that lab is testing; rigorously screened, healthy volunteers haven’t been tested since 2002. 🙁 Lab tests’ results become irrelevant once you are ingesting ANY version of T3, because 21st Century medical SCIENCE has PROVEN that you need to ingest more than a healthy thyroid would secrete, just because you are INGESTING it. If your doc doesn’t understand this, then your results will be compared to the labs’ reference ranges, based on those sick and suffering people who still have a thyroid that’s not working.

  5. Any advice would be helpful… Unfortunately at the beginning of the year I haven’t been able to see my doctor due to new insurance and I don’t even know where to go now… Trying to get him nominated on my new insurance but I’m not sure how long it will take

    • eaware.org, from Thyroid on the left
      21centurymed.com, Hypothyroidism tab

      .org sites are not-for-profit but may request donations
      .com sites are selling services, time, books, and/or products

  6. I’m so confused. I went to the doctor because my neck felt swollen and my ears have been ringing. My ears look okay but I have mild hearing loss got an MRI and my brain was okay… My doctor thought the swelling in my neck was an infection. Antibiotics took it away. Them I got an ultrasound of my neck I have a small cyst that’s beign on my thyroid. Doc checked my tsh level iodine and other things. Low levels of iodine so I went on iodine pills. Then next blood work check tsh levels again checked for that auto immune disease and t3 and t4. Don’t have any antibodies or immune disease. But after taking iodine for a little under 3 months my tsh got higher. It went from 2.8 to a little over 3 so he decided I was hypothyroid. Now that I’m taking armour thyroid my hair has increasingly started falling out my skin feels even drier. And he told me to keep taking iodine. I feel like everything he’s put me on has made my thyroid even slower I don’t get it. I’m about a couple days away from stopping the armour thyroid and just started going gluten free to try and see if that helps my thyroid. I’ve always had random spurts of weight gain and loss. Hair was falling out before the armour thyroid but now I can see my scalp and I lose a bunch of hair everyday to the point where my scalp is starting to feel weird. Can anyone suggest anything? I just want my hair to stop falling out, I can deal with feeling tired I’ve been like that since I hit pueberty.

    • Sounds like MAYBE, the T3 in the Armour isn’t enough, or you’re not ingesting enough Armour, or maybe(?) you’re allergic to a filler in the Armour, or maybe(?) you’re allergic to porcine or GMOs (Armour is made from pigs’ thyroids and the pigs are ingesting, exclusively GMO feed), or you’re not converting the T4 in the Armour into Free T3, but Reverse T3 instead, or you MAY have a pituitary problem. Pituitary tumors are rare, but they DO exist.

      Were the tests FREE T3 and FREE T4? Total T3 and Total T4 really, tell your doc nothing. You need copies of ALL your lab results in YOUR hands, always. Example: you may need to make copies of your copies for a different doc.

      Iron, B12, D3, Cortisol could all or individually be too high or too low, causing the T4 in the Armour to convert to RT3 instead of FT3.

      Read here: http://www.eaware.org, from Thyroid on the left. It has lists of symptoms, causes of conversion problems and treatments.

      You can order your own tests if you have an endless supply of money; you can order your own NDT made from range-fed cows in New Zealand if you have an endless supply of money. Insurance won’t reimburse you for either, usually. All NDTs are about 80% T4, so IF there is a conversion problem, you’ll need a T3-only med. There are ways to order that, as well, without a prescription, if you have endless supplies of money without insurance reimbursement. Unless you understand how a healthy thyroid works, I don’t suggest this means of self-treatment.

      It’s clear from your individual symptoms that the “cyst” on your thyroid is depleting the T3 available to your cells, and every individual cell NEEDS T3, converted and not. Congrats on getting your doc to prescribe an NDT!!! That indicates more knowledge of how a healthy thyroid works than most docs can demonstrate. 🙂 YaY! For you having no antibodies!!!!!!! Make sure all four antibodies were tested….

      Lists of symptoms are also here: http://www.21centurymed.com, Hypothyroidism tab and scroll down

      And here: http://www.hypothyroidmom.com.

      Hope you get in to see a doctor soon!

  7. What do you think is best for someone who doesn’t have a thyroid? I had a thyroidectomy 10 years ago and take Synthroid. I’m not sure if this is optimal, though. I’m wondering if perhaps something with T3 would be better?

    • Thyroidless patients’ experience proves that the T3 converted from a T4-only med (your Synthroid) is NOT enough. In most cases, ingesting a T4-only med, by itself, too long causes a Reverse T3 problem (the T4 gets converted to RT3 instead of/in addition to Free T3). Cells can’t use RT3, so massive, systemic illness is the result of cells not getting enough FT3, and the FT3 isn’t enough in the first place. Yes, please get either some Cytomel to ingest in addition to your Synthroid, or switch to an NDT. Neither Cytomel nor an NDT are ingested only once a day like your Synthroid, so, please educate yourself. 🙂

      • Barb, you are putting a lot of misinformation out here. You should know better than all this. No body is the same!!! Some people have hashi and do fine on T4, some need T3, some go well with Armour, some don’t. Not everyone has rT3… has the internet gone nuts?

        • She clearly states that she has NO thyroid. ThyroidLESS patients’ experiences (clinical outcomes) PROVE that the T3 converted from T4 is NOT enough.

          Even people with healthy thyroids convert their own T4 into RT3; the difference is, they HAVE A THYROID to make the T3 not converted from T4, AND the EXTRA T3 they need to clear their RT3. Again, she clearly stated she has NO thyroid.

          Just because a doctor can control a PITUITARY lab test result, even when there is no thyroid with which the pituitary can communicate, does NOT mean that a thyroidLESS patient is “optimal” when ingesting a T4-only med. It just means that ill-educated doctors can continue to blame “other causes”, refer us to multiple specialists who also “can’t figure out” what’s wrong, until, ultimately, we are all but bankrupted, and get referred to a psychiatrist who assures us WE are to blame for our “lifestyle” choices. ALL, 100% LIES, based on 20th century medical MYTH.

          The “practice” of 20th century medical MYTH is a punishable crime when applied to chimps; otherwise, we’d have gender-specific thyroid hormones’ (plural) replacements because we humans are so closely related to chimps. I think we humans deserve better than cruelty, so I share MY clinical outcome (among others’), not “misinformation”. Based on my experiences since 1998, doctors and the nurses they educate are spreading the “misinformation” provided to them by Big Pharma, whose sole goal is profit, and lots of it.

          I wish you, with Hashis, much better education, and continued health! I sincerely hope you learn what you need to know to take good care of you, an individual. Maybe you’re more likely to be treated as an individual human being (rather than as an individual, annual, pituitary lab test result once you have NO THYROID) than most, because you are a nurse? I don’t know….

  8. My experience is that my cells use whatever they will use (Cytomel), and any excess gets processed out as waste. There are NO “side effects” to taking “too much T3”. I can’t afford to waste my money or my Cytomel. I also have “thyroid antibodies” (yes, with NO thyroid). Ingesting thyroid hormones of any kind is NOT treatment for antibodies. Since I can’t convert T4 into T3, I NEED 100% replacement of my T3. I’m not gluten sensitive, dairy sensitive, etc. I AM processed foods sensitive, food-laced-with-chemicals sensitive, etc.

    • Barb,

      That’s NOT true. Excess T3 will make you go hyper and runs a risk of tachycardia and atrial fibrillation, panic attack and a bunch of other oddities… I should know, excess T3 landed me in hospital with both. 🙁 I was on 75 mcg T4 nd 18 mcg T3 when I went into sinus tachycardia followed by a-fib. I am 36 y/o female and VERY fit. Scary. Doctors took me off T3 and kept me on T4 at 75mcg only. 9 months later the T4 only stopped working at that dose and they had me alternating 88mcg and 75 mcg in a variety of combinations before trying me on 75 mcg T4 and 2.5 mcg T3. So far, so good. Really good. It’s been a week. Minimal to no palpitations on low dose T3 (a little morning jitter) and energy is good. Blood pressure immediately dropped 10 mmHg systolic. Fascinating isn’t it? Sign me Hashimoto Kris.

      • Sorry you were fed the same lies (and apparently believed them) as I was, Hashi Kris, but everything I state is 100% true, FOR ME. MY tachycardia, a-fib, and congestive heart failure were a direct result of NO T3 at the cellular level, precisely because I wasn’t converting the T4 into anything but RT3. RT3 is not the ONLY conversion problem, it’s just the most common.

        There is no blood test for how much T3 is actually making it INto the cells, only for how much is circulating in the bloodstream. There IS extensive “evidence” that the reference ranges being used by the labs are based on sick and suffering people with dysfunctional thyroids; there IS extensive “evidence” that once you are ingesting thyroid hormone(s), you will need more than what a healthy thyroid secretes; and when doctors in every specialty treat women who have no thyroid based on lab results compared to reference ranges established by testing sick and suffering people, there IS extensive “evidence” those thyroidless women have a shortened lifespan and die of “heart disease”, currently, one in three. (Coroners are no longer trained to detect accumulation of mucin at the cellular level, namely, in the heart, due to insufficient T3 AT the CELLULAR level.

        I wish you better education than you are being spoon-fed by, apparently, ill-educated doctors; especially if you have NO thyroid.

        I agree, we are all EXTREMELY individual!!! Unfortunately, doctors and the labs don’t distinguish between those who can successfully ingest only a storage hormone and those who need the active hormone, so they, essentially, know nothing about the active hormone when it’s ingested (as opposed to when it’s secreted).

  9. Hi Chris.

    I found the information very interesting. However, I have Hashimotos and have been on Levothyroxine for 1.5 years. I am so depressed and unwell still, its not working. I live in the Channel Islands and its so difficult to get a GP to entertain the idea of supplemental T3. I noted you also said that people with Hashimotos can fluctuate between hyper/hypo which I never knew, so T3 may not be helpful? However if the issue is a conversion problem from T4 to T3 then surely it would be necessary? Also, can your GP tell if your issue is not enough free T3 by your blood test results? It’s such a minefield of information that I feel a little lost…. Any ideas on how to approach my GP with all this would be really very helpful….. I just want to feel well again.

    Many thanks.


    • Fluctuating between hyper & hypo = antibodies are taking bites out of your thyroid, dumping large amounts of hormones into your bloodstream. Taking T3 suppresses your TSH, which will “teach” your thyroid to shut down and depend on the T3 you ingest instead. If there is a conversion to RT3 problem, yes, you will need to take T3-only, AND figure out what is causing the RT3, to resolve it. No, a Free T3 result ONLY tells what is AVAILABLE TO YOUR CELLS, not what is actually getting INto your cells. Thyroid hormone(s) are not a treatment for antibodies.

      • Do you know the names of the antibodies that attack the thyroid hormones themselves (that he discusses in the article) – are they just anti-T4 and anti-T3? You sound like you might know. Any chance you can let me know all antibodies associated with the thyroid as I’m having a blood test this week and want to make sure they test the right stuff!

        • Antibodies and their tests are:

          Hashimoto’s Disease:
          Thyroid Peroxidase Antibody (TPOab)
          Anti-Thyroglobulin (TgAb)

          Grave’s Disease:
          Thyroid Stimulating Immunoglobulin (TSI)
          Thyroid Receptor Antibody (TrAb)

          Again, any positive result is evidence of autoimmune disease.

  10. I was born with my thyroid gland not functioning. I have taken many different medicines and I have been increasing in weight all my life. I have considered Bariatric surgery which I really don’t want to do but I am at a loss as to being able to lose weight. The only time I lost weight easily was when my medicine was off and I was wired and full of energy, but happy. I have diabetes now as well as sleep apnea and I really want to lose weight in a healthy effective way. I am on many medications and I am wondering how to figure out if some medications are hindering my attempts at weight loss.

  11. Hi, Chris

    I have Hashimoto’s and gluten allergy, I take Synthroid 75mcg but I have some many side effects like my breasts hurts a lot my headaches are others make me kind funny feeling, I have foggy brain everyday and I honestly I see some of this other people say about if you take medication you are more at risk to have dementia and other mental illness someone told me why I just take iodine and thyrosine instead of all that stuff but I get so worry to do something like that because once in a while I get anxiety attacks too, I honestly I just want something to make me be here for some time I got pregnant in 2010 with hashi already and it was a miracle to have my son now I’m worry no to be here for him he is 2years 11 months by march 6 he will be 3 and have Autism spectrum disorder is so sad for me to see me at my age 41 and with my thyroid bad I have my others kids 26,22, 19, I didn’t have this sickness before can you give some advised what lab should ask to my dr. thank you


  12. Addendum
    I forgot to mention in previous email I also experience hairloss, muscle fatigue ana pain and joint pain. uric acid levels are normal. i also take Seacure aprocessed fish supplement for protein & Omega 3 and Methyl Protect by Xymogen with B12, Folate and Betaine.
    sorry my mind can’t stay on track these days to finish a thought.

  13. Hi Chris,
    I have chronic Fatigue Immune Dysfunction/Fibromyalgia. I was diagnosed in 1996. unable to work since 2000. I finally found a Dr after years of searching that specialized in FM/CFIDS/CFS treatment. I had <0 Cortisol level when tested and low thyroid. took Compounded Cortisol starting low an increasing to 20 mg BID then gradually decreasing over the years. i have been off the cortisol about a year now.Duriing that time and up till now she and my new Dr have tried every combination treatment of thyroid available including compounded T3 SR for those sensitive to fillers. Everytime I take any thryoid tx I feel better at first although the first time I took the compounded T3 we slowly worked up to 20 mcg BID and I felt normal for the first time ever in my life for about 3 months then I crashed and have never recovered. Now when I take thyroid meds I start having worsening symptoms of hypothyroidism if I increase or decrease the dose or leave it the same such as brittle hair /nails and intolerance to cold and just freeze all the time no matter how hot it is. I also I start developing painful (nodules??) in my abdominal area and have to eventually stop the thyroid tx because they become unbearable. no one can or wants to explain or find out what the reason is or what they are. I also start breaking out with pimple/boil type sores on my chin, groin and buttocks. I had one so severe on my chin I had to go to the ER and get IV antibiotics and have it lanced.
    Do you have any idea what is causing this when taking thyroid meds and any suggestions on how to be able to tolerate thyroid meds??? I can't sleep and am always exhausted and sleepy and pretty much spend most of my life in bed or on the couch these days
    My current meds are: Valium 8 mg poqhs, Vivelle Dot Patch 0.375 mg and GcMaf 0.05 mg every 7 days. Tried testosterone 200 ml 0.05 ml weekly but makes me feel even worse. Compounded Progesterone does the same to me as the thyroid medscausing the nodules.
    Please any help would be greatly appreciated. I am desperate to find someone that can help.

  14. Chris
    Thanks for all your fantastic information on Hashimoto’s Thyroiditis. After my insistence to be checked for Hashis, i was diagnosed in 2006. My doctor actually told me his specialty was diabetes and he didn’t know that much about the thyroid. After seven years under his care, I decided to change doctors. My new doctor immediately found a nodule through ultrasound and poor conversion from levothyroxine for my T3. She put me on Synthroid 75mg and scheduled a biopsy. I find that I have several things going on because of the Hashis. I wonder now if my adrenals are working normally. In 2006 I was also diagnosed with breast cancer. In 2009 had a double mastectomy. Estrogen related. Can I safely take a licorice supplement? My GYN has me on a grain-free diet and has given me natural progesterone 75mg for my sleep problems. I’m also on Spironolactone 50mg and 500 mg of Azithromycin for cystic acne. I’ve heard of something called low dose naltrexone that calms the AI but no one will prescribe it since it hasn’t been approved by FDA for Hashimoto’s treatment. I think the root cause of AI should be treated but guess we are all stuck with treating the devastating results of Hashimoto’s. Thanks again for your web site.

    • I have the all that you mention and finally went to a specialist that does the LDN route. So far so good but I will know more in one more month after blood tests. The specialist I found was Dr. Holtorf in Torrance – They push their supplements which is annoying BUT their website is LOADED with information for “us”.

  15. I am so happy that I found your site while searching for explanations of my husband’s cholesterol tests and results. My question, though is about my hypothyroid condition. I moved many states away while in the beginning stages of treatment for Adrenal Fatigue and thyroid issues. It took me 5 years to find a practitioner who actually knew more than I did on both issues, and I am far from being an expert. My practitioner added iodine and selenium to my regiment and increased my D3 intake and told me to take calcium – I actually lost 1 1/2″ in height over the last 5 years. Upon retest, my thyroid results (don’t remember which specifically) were higher than previous results. It was explained to me that this was due to the iodine and selenium and my thyroid meds were reduced. Is this an expected result of adding the selenium and iodine?
    Thank you for making your website available to the general public and for your great explanations of so many issues.

  16. I am such a loss. No one that I have seen seems to understand what is causing my inflammation. I am positive for tpo antibodies and I would like to not take any meds if possible. If hashimotos is an immune system problem wouldn’t it make sense to fix the malfunction in the immune system rather than take medications? If you lower your antibody levels doesn’t the immune system attack stop? Why not just focus on that and not take any meds?

    • I would suggest you research NUTRI-SPEC.NET for thyroid. He gives the most complete paradigm I’ve found in 24 years of natural medicine. Low progesterone /hi estrogen could be a problem (progesterone not progestin)…Chris’ diet suggestions also are key
      Dr Z

    • Sk, I have been under treated by an endocrinologist for Hashimoto’s thyroiditis about 20 years. In all that time my TSH would gradually inch up and the Synthroid would be increased about every two years. Not once did the doc try to get at the root of the problem (inflammation), or alternative treatments. I started seeing a functional internist and one of the first things he checked was a genetic marker MTHFR, which indicates an inability for the body to methylize certain B vitamins, such as B12. This can be causing systemic inflammation and everyone with an autoimmune disease should get this test.. Treatment: methalized B – complex vitamin supplements. Positive MTHFR can indicate problems with preterm pregnancy losses, as well as elevated homocysteine levels.

      I hope this helps!

  17. Great series of articles. In my practice I use the protocols of NUTRI-SPEC.NET, which see. This site seems to be very much in line and the above referenced site would be added info. Reverse T3 can also be a factor as well as the microsomal antibodies (TPO) mentioned. Another factor I’ve found useful is to use oral progesterone (not progestin ) in the form of PROGEST-E from the work of Dr. R. Peat…I don’t agree w/ everything Dr. Peat says but his progest-E product is great. Low thyroid is often caused by low progesterone &/or high estrogen. Finally, studies have been done on animals where the pituitary gland
    ( THE MASTER GLAND OF THE ENDOCRINE SYSTEM) was removed…as long as high doses of thyroid were given , the animal continued to function. The point being throwing enough thyroid substance as a mammal can cover as a lot of deficits. Am not recommending this as good medicine, just that putting women on thyroid can often give relief, yet at a high cost. Thanx again for a great site about truth in medicine.
    Ezra Edgerton, DC (ND) No. Carolina

  18. The “starch” in brand name Cytomel is from corn not gluten. Pfizer who now owns King / Monarch verified that none of the ingredients contain gluten. But they will not guarantee any cross contamination in manufacturing. But then again no pharmaceutical company guarantees that anymore in my experience. Hope that helps because there is a lot of disinformation out there on the Internet.

    • Not completely true. I verified this with Pfizer after getting an itchy, blistering DH rash from Cytomel. Cytomel contains trace gluten; the amount is below 20 ppm, so it is considered gluten free. Those of us that are sensitive to very low levels of gluten will react to it.

  19. k,

    My heart goes out to you. Although his bedside manner leaves something to be desired (I’ve seen him myself), were I in your shoes, I would definitely call/email Dr. Ted Friedman with the synopsis you wrote above, any lab data you can email or, and ask if there’s a way he’d be willing to treat you if you could find a way out to see him. Cushing’s is his specialty, so he’s very up on pituitary issues: http://www.goodhormonehealth.com/ (good hormone health dot com).

    Then, based on his response, and any feelings you have on whether he’d be of assistance to you, I’d get to borrowing funds, even selling off my belongings, until I could afford the airfare. Don’t give up! Keep reaching out everywhere you can, even though it gets exhausting and dispiriting. Eventually, you will find a good practitioner fit for your health issues and you will be back on the path to equilibrium. No use spending any more time with practitioners who aren’t giving you the help you deserve.

    Wishing you well,