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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. hi chris, I had complain of fatigue for almost 6 years and tender points all over my body. chronic aches increase after exertion , sometimes rest may help sometime not. I had workup for thyroid,SLE,addiosons,connective tissue disorder. hypothyroid diagnosed 4years back ,m on thyroxin 75mcg since 3 years in past on 50mcg for one year. bt still have all the symptoms.
    recent labs are
    serum tsh= 2.517ulU/ml
    ft3= 2.61 pg/ml
    ft4= 0.97 ng/dl
    cholestrol= 338mg/dl
    uric acid 7.8mg/dl
    anti TPO= 0.65 lU/ml
    TG= (not done yet)
    HBA1c= 6.18 (a/c tp lab 18 is normal.
    u/s shows lipid deposition in right kidney uper pole.
    Also having pcos (hormones derranged LH,insulin,prolactin).
    facing difficulty to conceve (married since 8 months)
    In past= having vitiligo, tonselectomy..
    i thinks its more than enough for disturbing u, feeling sorry for such a long post. please help..! God bless u

  2. I am on Naturethroid. Before that, Synthroid. For years my doctors have been unable to stabilize my thyroid results. I’m either extremely hypo or hyper, never normal. I had RAI in the 80’s. Recent results show a high T3, so doc is having me reduce the dose again. Any thoughts?

    • Hi Nancy. I’m having the same problem as you. I was on Synthroid for hypo and it made me hyper and extremely ill. So, I went off the Synthroid for 2 months and I became super hypothyroid. My TSH shot up to 95. My new doctor put me on WP thyroid and now I am hyperthyroid again. Had blood work done on August 10 and results showed my TSH is 0.13 and my Free T3 is high. My thyroid peroxidase antibodies are also High at 112. I ended up in a cardiologist’s office last week due to heart palpitations and chest and back pain. Had an EKG and I have Premature Ventricular Contractions. I am having chest tightness and fullness, sharp shooting pain behind my eyes, anxiety through the roof, interrupted sleep, my pulse is up to 83 and resting blood pressure has gone up from 112/78 to 142/90. My doctor can’t seem to get my levels to normal range and is going to lower the dose again. I’m either hypo or hyper. I am also looking for answers. I hope we can find one soon. I can’t take this. It’s really taking its toll on my body, not to mention my psyche!

    • I kept looking for answers to WHY my body could not convert T4 to T3? This conversion happens primarily in the liver. I’m still unraveling the puzzle. Getting genetic testing done may help to determine if you have a metabolic issue (like MTHFR – estimated 30-40% of the population has a genetic polymorphism in this area) or you’re missing an essential nutrient causing the metabolic issue. What this means iSync are either not getting a specific nutrient OR somewhere in the body, the intake level of the nutrient can’t be converted into the level your cells need to do their job.

      I strongly believe if anyone with hypothyroidism isn’t on a stable dose of T4, the doctors need to start looking at micronutrient levels.

      There are a lot of documents on the NCBI website related to hypothyroidism.

  3. I am having my thyroid completely removed and will be on medication for the rest of my life. I am definitely swaying towards natural medication. Amour in particular. Do you know if I can get this easily in England. UK

    • Hi Valerie, it’s unlikely you’ll get this through an NHS G.P. because they only prescribe T4 Levothyroxine, unless you’re lucky and they’re willing to prescribe NDT, which is rare as it’s ‘off-licence’ in the UK (frustrating!). The charity Thyroid UK have a private doctors and practitioners list, where you may have more success in finding a medic who will prescribe natural desiccated thyroid hormone in the UK. Armour is the most expensive to buy, there are lots of other brands of NDT that you may get on just as well with e.g. (Erfa, NatureThroid, WP Thyroid, NP Thyroid), that work out a bit cheaper. Information about these other brands can also be found through Thyroid UK. Good luck and hope you find the right thyroid medication for you.

  4. I have Hashi’s and RA. I am in the process of getting the Adrenal/Cortisol and Stool profiles to assess leaky gut. My thyroid values are: T4 direct 1.45, T4 9.1, Free Thyroxine index 28, T3 free serum 2.6, T3 90, T3 uptake 28, Reverse T3 serum 18.6, TSH 1.28, Thyroglobulin Antibody 1363.4 and TPO 63. Any advise on supplementation to calm the thyroid antibodies and immune system would be awesome! I have been Hypo 40 years and never knew about Hashi’s until I was diagnosed with RA!

    • Hi Diana,
      The very fact that you have a complete thyroid panel tells me that perhaps you are seeing a good doctor already?
      Perhaps, Chris Kresser has already responded to you. However, I’m a Clinical Nutritionist and wanted to make one suggestion. Your very high level of Thyroglobulin Antibodies indicates that your thyroid tissue is being destroyed. Go Gluten-free and you will see that number go down quickly! It’s helped many of my patients. Apple Cider Vinegar may help your gut and RA. RA has many factors but usually starts with poor digestion, the Apple Cider Vinegar is a good start. If you get burning in your gut from this vinegar you may have an ulcer. So test it with a small amt. (1-2tsp.)and have a glass of water ready!

      • Thank you Ellen! I am AIP so no gluten, grains or dairy for me since the beginning of April. I cannot seem to drive those antibodies down. I started taking LDN and selenium and still nothing. I just thought I might get an outsider opinion, since I am not having any success, and thought that possibly changing to a natural thyroid might help. I am going to a Naturopath and treating some gut bugs, but nothing that seemed extremely bad. My stool tests did not indicate incomplete digestion, so I stopped the ACV.

        • Hi
          Maybe it’s a late info but it helped me to lower my thyroid antibody level from aug (265), to nov (175)- not significantly I guess it takes time but it’s moving (!). I am gluten, dairy, soy, corn free, no nightshade veggies, detoxed liver with supplements and vitamins, reinforced gut lining, installed water filter, removed silver teeth fillings, take ashwaganda, selenium, vitamins with iron, extra b-vitamins, no thyroid medicine yet still looking for a good match- I’m a borderline Hashimoto. Hope this helps!

      • Stool test reveled (dr data) 3+ for: Citrobacter freundii, Enterobacter cloacae, Enterobacter cloacae isolate 2 and Klibsiella pneumoniae ssp pneumonie. The yeast culture came in with 1+ for Candida orthopsilosis. I have been on Silvercillin and Designs for Health GI Microb-x for the last 3 months. But the labs are not changing much. I am on an AIP diet.

  5. Savvy suggestions – I was enlightened by the information , Does anyone know if my business could possibly find a blank FRB 500 Form URLA PE version to use ?

  6. I was diagnosed with Medullary Thyroid Carcinoma, Multiple Endocrine Neoplasa type IIb in 2007. Two surgeries to remove my thyroid and 3 parathyroids, 152 lymphnodes. I am on Levothyroxine 112 , I feel like crap all the time. I am trying to get into Dr. Kenneth Ain in the University of Kentucky’s Markey Cancer center, (I am having a difficult time getting an appt.) What do I need to be asking him when I get in there? Is Armour the solution? I have read so many articles that it all a blur to me now. Help!!! Please!!!

      • I have been on Tirosent now for 8 weeks. My hair has stopped falling out, some of my brain fog is gone. I have tried every med out there for my thyroid issues, this by far is the best. But my joint pain has gotten much worse. I am going to ask my doctor to try a T3 med along with my current treatment.

        • Yayyyy!!! Good for you!!! It certainly was the answer to my prayers!!! Live life again!!!

      • Greetings
        Tirosint may work for some but I had very bad side effects. Developed severe muscle spasm a month after starting on it and still struggle to get rid of them.
        Each person needs to find what works for their bodies.

        • I’m so sorry it didn’t work for you. 🙁 I hope you can get this ongoing issue resolved soon!!! It is such a bummer! Blessing to you!

  7. I have graves disease with RAI 15 years ago. I have been taking only cytomel for approx 13 years, prior to that time I tried all T-4 synthetics plus armour thyroid but they did not work for me found a new endo who prescribed just cytomel to me. This worked great for me 2014. At that time, I began having strange hyper symptoms. I backed down some on my cytomel which worked for awhile but progressively returned. Approx. 8 weeks ago, I awoke (after feeling quite strange for a few weeks prior) to my face being so swollen I didn’t recognize myself. I had absolutely no idea what what going on at that time. The only other meds I was taken at that time what certain vitamins, D, C, Zinc and calcium plus testosterone/estrogen hormone replacement. Endo was on vacation and internist told me to wean myself off of cytomel some because I was having hyper symptoms till endo returned and I could talk to him. After a few days, my face swelling went down. I have had a past history with other meds becoming toxic in my system due to hereditary fatty liver disease although the test results are only slightly elevated and not really outside the higher range on my test. When endo came back he pulled me COMPLETELY OFF of cytomel and told me to get my numbers down to 0 to start over and quite frankly I though I was dying at this point. BP skyrocketed, anxiety thru the roof and just a mess. I now am on BP meds and anti-anxiety meds to try to alleviate these two issues. He started me back on cytomel at lowest dosage possible 5mcg 3x/day. By 7 day mark having allergic reactions again. Even the 1st day I started it I could feel that something was not right with it. Itching inside, freezing to death all major hypo symptoms possible and just weird feelings I had not ever experienced before.

    So I called him and requested to try Armour…..I was willing to try anything at this point. Began Armour and by second day the old familiar feeling started again with the weird itching feeling, brain fog, insomnia and whole list of bad side effects could only tolerate it for almost 3 weeks till the itch eyes, fuzzy brain, itchy upper body became unbearable. Before Armour, I even went to allergist and had 72 different allergy tests and was negative for all of them. Now endo is trying me once again on Cytomel. Today is 1st day, took 1/2 of a 5 mcg in the am and within minutes the symptoms again started, weird feelings tingling upper body, brain fog and 1 1/2 hours the itching eyes/upper body started. I do not have any test numbers as I am still starting over. Unable to even tell him what I should tell him to test because I have read so much on different sites, I do not know where to being. I am ready to lose it at this point. Could I just be allergic to t-3 period or what??? Any help anyone can give me would be greatly appreciated, I am at my wit’s end.

    • Hi Jannette,

      I too am going through this, can you tell me if your endo has come up with a solution, because life is hell? I have been to every doctor and they tell me this is impossible, I have had shakes and body feels like poison acid is running through it, severly anxious which I have never suffered from in my life!

      • I strongly suggest you go on the thyroid med called Tirosint. I had the very same symptoms you had. I wish I wasn’t taking any thyroid meds but it is what it is. Tirosint helped me feel much more normal and human!!!

    • Donna,
      Please report this adverse reaction. I did when my BP skyrocketed with generic T3. I hope that if more of us do this, we might eventually get an answer.

      Since that reaction, I’m moving forward on two theories – an allergic reaction to microcrystalline cellulose and HPMC (so I take a survival dose of Tirosint) and insufficient cortisol that is not yet Addison’s (IMHO, adrenal fatigue and I’m looking for solutions).

      My TSH is low-normal, so no conventional doc will address obvious hypothyroid symptoms and declining health. I currently supplement with one quarter of a tablet of Nutri-Meds thyroid to protect myself from being hospitalized.

      My serum AM cortisol has always been low, so I asked my conventional doc to test serum ATCH – it flagged Low. Doc claims that the subsequent Stim test is “normal” so I’m stuck without a next step forward.

      Trying not to mess with cortisol until I can find a good doc to help me monitor. I paid cash to see a functional doc, but disagreed with the diagnosis and approach.

      Hoping to find a diagnostician – an endocrinologist/HPA doc who is more interested in “mapping” and testing the related hormones to figure out the disruption.

      • Jane, have you been tested by MRI or CT Scan for an adrenal adenoma? If not, you should. And if you have one get it taken out too. It’s why your ACTH is low and cortisol is low. If not you might have something going on w/pituitary.

    • I feel your pain! I have just recently experienced hormone thyroid toxicity myself with Levothyroxine 125mg. I was experiencing all the symptoms of a heart attack and stroke. The left side of my body went numb, facial numbness, headaches, unbalanced, walking side ways…what a mess! I am now two weeks off the medicine and luckily most of the symptoms have gone away. Currently I am researching new medicines to take myself. I have discovered that the levothyroxine has maize starch in in which I have a reaction to corn and wheat. From what I have read cytomel which is T3 has gluten in it so medications that have that in it will be no good for me. I have recently found a medication called WP thyroid that shows no gluten or corn in it and very few inactivie ingredients. My doctor and I are actually going to look into this after the detox period. Good Luck!

      • I was also poisoned by Synthroid 125mcg. I was super hyperthyroid on it. Thought I was having a heart attack too! Joint pain and stiffness. Scintillating scotomas, migraines, premature ventricular contractions, and full on panic attacks just to name a few. I was so sick. I am 48 and felt like 84. I finally found a functional medicine doctor who prescribed WP thyroid for me. It took a bit for my body to acclimate to it. My body was a wreck. But, after some fussing around with the dosage and going through a 10 day healing crisis where I couldn’t get out of bed, I am actually tolerating WP quite well. I’ve been on it now (1.25 grains) for a little over two months. My only complaint is that my hair is falling out a LOT, but I’ve started taking Biotin 8 by Thorne twice per day. But since getting on WP, I lost 12 pounds in a month and still losing. The joint pain is gone and the massive inflammation in my body is subsiding. I don’t feel poisoned anymore. I hope it works for you too. My best thoughts and hopes for everyone who is suffering with this horrible disease!

  8. Please tell me if ACELLA’S N.P. THYROID would be a good choice for me. I try to stay away from gluten, corn and GMOs.
    After the radioactive treatment for grave’s disease I took 3. mcg Synthroid with good results. Now they have dropped the dose to 1.12 mcg for two years and i’m on the generic. I’ not feeling to well and would like to switch to a natural thyroid replacement. Any advice would be appreciated.
    Thank you, jeannette

    • I was on the 3. Mcg for 20 years. Is it common to reduce the dose to 1.12 after that many years? Can you explain how this works if my thyroid is not active due to the radioactive treatment for Graves disease? Thank you.

  9. My problem is I’m literally allergic to Synthroid and other synthetic thyroid meds. My t4 and tsh are low but my t3 has always been fine. I started taking Naturethoid to bring up my t4 which it did however, now my t3 has gone high making my tsh almost non existant. So I don’t know what to do. The docs want me to take a synthetic but I can’t and don’t know of a med I can take with just t4 that I’m not allergic to. It’s not just the fillers but I’m also allergic to dyes, the gluten, etc. This really is hard, especially when you have a doc that states he doesn’t know what to tell me. And I’m a vet going to the VA hospital, I can’t really go to another doc.

    • Cheryelle,
      Can you talk your doc into trying Tirosint? It’s a gelcap with synthetic T4. I was so desperate I paid for 7 gelcaps at my pharmacy to try it, before i asked my doc’s office to advocate for it to be covered. Still tough to get to the right dose. I’m considering adding a quality NDT supplement after I find a professional to help me understand and monitor test results and symptoms.

    • Are you a 100% disabled veteran or retired? If you are retired or medically retired you can choose to go out in town and terminate in the VA Dr. They do not like to tell you this but that was absolutely the case. Good luck.

    • A low or none existent TSH means your body is satisfied with the level of thyroid hormone, therefore you don’t need to make your own. Patients with a 0 TSH are doing much better than patients with active TSH, the later still having symptoms. I was at 0 TSH and perfectly healthy, now my TSH is 1.5 and I’be gained 25 pounds in one year. I’m an autoimmune patient for two decades including Hashimoto’s. I think I need a gluten free T3.

      Anyone with high thyroid antibodies is autoimmune. Read Datis Kharazzian and Dr Perlmutters books. You shpc gf off gluten immediately.

    • You sound like me – I am the hot potato of all hot potatoes – v stressful actually when you are also dealing with a major problem and coming up with all sorts of allergies and sensitivities making medications very difficult.

    • Hi, Can you tell me how you knew you were allergic to Synthroid? My Dr. has never mentioned this possibility. After 20 years of taking it, I started having tremors, heart palpatations and signs of heart trouble. The zDr. lowered dose ffor six months from 1.38 to .50 wdith no results. Still had tremors etc. I stopped totally and my TSH is34. I am scared to take anything. The Dr. insist it is not the medication and is sending me to a Cardiologist. Thanks for any info.

  10. Hello,
    I just had blood tests done.
    Free T4 within norms but on the high side
    Thyroidperoxidase antibody – within norms
    TSH within norms but on the low side 0.86 (norm 0.2 – 4.00)
    What puzzles me is: thyroglobulin antibodies high at 375.5 (norm 0-115)
    What does it mean. I have to go for a ultrasound and i have palpitations, severe anxiety and some other symptoms consistent with both Hiperthyroism and Grave’s but the doctor does not think it is graves.
    She was vague and i am worried.
    Can somebody tell me these results might mean.

    • LOW thyroid (from a nurse who still has her 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 (from my experiences):

      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 T3 (the active thyroid hormone), 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.

      • Best answer I’ve read on here, thank you!!!

        Not in menopause, but was going to talk to a Naturopath about Wild Yam cream and progesterone cream to use for depleting hormones. Understanding the connection between progesterone and FT3 is an important point and my endo has never bothered to run a sex hormone panel. Of course I also had to talk him in to prescribing me T3. He thought the answer to all my problems would be to take me off T3 and switch me from Synthroid to Tirosint. I did at his insistence and almost crashed my car I was so tired driving into work. I fell asleep at the office every afternoon- he finally wrote me a script for T3 and I felt better but the few pounds I gained while on Tirosint only, have been practically impossible to lose again despite a rigid diet a exercises daily including HIIT, walking, yoga, pilates and interval trail running.

        Hard to know how much is the thyroid issue and how much is being in perimenopause.

      • Oh my gosh this is exactly what is happening to me. I constantly shake like a leaf but how do I increase my thyroid hormone to prevent the adrenaline surge.

        On 75 mcg Levoxyl and a 1/4 grain of Nature Throid. Nature Throid alone kept my T4 levels way bottom. I now take 50 mcg of Levoxyl at 6am after breakfast the Nature Throid and another 25 mcg of Levoxyl at 3 pm as this is the only way I am able to keep my temperature around 36.4 degrees C. I try to increase my Nature Throid but due to adrenal issues my legs swell when I use more than above. I have low levels of cortisol all the time bar around 3
        1-4 am. Had the Dutch urine test done. Will progesterone help?

        Thanks for any advice as most of all am trying to rid myself of the adrenaline rushes

    • Your dr needs to test ft3 ft4 rt3 and tsh your antibodies r high which means u have hashimotos u need to treat adrenal fatigue and leaky gut.

  11. I have suffered with digestive issues and hormonal issues for as long as I can remember. I was working with a functional dr who helped most of my digestive issues, and SIBO. I was feeling so much better, but still fighting with fatigue. I found out I was hypo and was put on a compounded natural thyroid 30 mg. Since I started taking it in May, my fatigue, anxiety and bloating has been getting worse and worse each day. My drs suspect my sibo came back so I started another round of herbal antibiotics. I was also just put on a compounded progesterone to help with my cycle. My dr has decided to take me off of they thyroid medicine and seems to think that I am sensitive to it. I honestly feel better today not taking it than I have in months. We are retesting next month, but is it possible that I may not need medicine again or possibly need to try another kind? Or is it possible that once my hormones get balanced out, I wont need any medicine? I have been eating a super strict SCD and recently AIP diet

    • I was in your shoes 2 years ago! Found out the doctor didn’t Know how to dose natural desiccated thyroid medication correctly! I found a book called Stop The Thyroid Madness(or STTM).Explains everything you need to know the doctors don’t tell you. I also joined the natural thyroid hormone group in Yahoo groups. They follow a lot of the information in the stop the thyroid madness book. They also periodically print articles from Chris Kesser and Doctor Axe. Being diagnosed properly getting the correct medication for your situation and supplementation can be the key. I have been on WP thyroid for a year and a half and I’m doing really well hope this helps.

  12. Great article Chris thanks. I haven’t gone on medication for this reason. I feel that after 2-3 years on AIP I am still foggy & exhausted so I need medication but am afraid of being given the wrong one by my primary care physician or an end that doesn’t understand what you wrote. I know you aren’t available for patients so who do I see in Los Angeles to be prescribed or advised of the right thyroid hormone replacement for me?

    • Lee, did Chris ever reply to you? Did you find a good doctor in LA? I am in the same boat and I’m also looking for a doctor in LA to work with who has a deep understanding of this stuff. Thanks

  13. My enlarged thyroid was removed three years ago. Levothyoxine did not work for me, so my doctor switched me to Synthroid. Since reading an article that contained numerous photos of deformed piglets from sows fed GMO feed, I’m horrified that all thyroid medication in the U.S. is made with dessicated porcine thyroid. In other words, even if we avoid GMOs in our own food, thyroid extract replacement comes from pigs fed GMOs. Regardless of Monsanto’s lies and even the “approval” of the U.S. corrupt FDA agency, I do not want GMOs in my body. Unfortunately, I must take a thyroid extract. Is there any thyroid replacement medication made from organic porcine thyroid?

    • Synthroid IS levothyroxine (synthetic T4), and is just one of many brand names. You may have been taking a brand name or a generic version of levothyroxine with fillers that you reacted to, but you were and are still taking levothyroxine. Is it better than a hormone from a pig fed GMO’s? I don’t have the answer to that, but I would say your choice should depend on which makes you feel better in the long run. Pick your poison!

    • In my searches for the same, one comment from a man, gave a link to the following product:
      Thyroid Glandular (Thyroxin-Free)
      Look for thyroid glandular (bovine) made from New Zealand cattle. I believe I read, they are 1 in 2 places in the world that have a non-GMO standard for feed for their cattle and pigs.

      Hope this helps. Good luck on your journey to health.

  14. Hi-
    I have celiac, crohns, and will have no thyroid soon due to thyroid cancer. Can anyone suggest a thyroid medication? I’m leaning towards Natural Thyroid, but levothyroxine is also a possibility. Does anyone else with these diseases take a thyroid medication that works for them? I’m very worried about the fillers in thyroid medications (like gluten and dairy) that will trigger autoimmune responses in me and make me very sick. Seems like the perfect storm waiting to happen.

    • I also had Thyroid Cancer in 2010. I have been on Synthroid since then. It never made me feel like myself. I am finally seeing a doc who is willing to see if I have issues converting t4 to t3 or what is going on. I am still exhausted just on t4. It has been this way for the last 5 years. Feel free to contact me if you have any questions.

      • Hello Doris, I also had thyroid cancer in 2010 and have been on synthroid and feel like crap. I’m 55 and don’t expect to be 135 pounds anymore but I’m pushing 200. My current endocrinologist will not try cytomel in addition to synthroid. Apparently, it can cause heart problems…like the 60 extra pounds I’m carrying is healthy for my heart…frustrating!! I know chances are slim that your doctor is in Pittsburgh, but perhaps he/she may be able to recommend someone that will either do further testing, or try a combination of Synthroid and Cytomel. I was on cytomel prior to my radiation and I never felt better!

      • Hi ive been on levothyroxine tirosint, 75mcg for 3 months now! My tsh was 25 while back and now went down to 6.65 which is close to the desire range, but i heard that this gel-medication, its a fast realease and soon while im taking the med, 1 hour after, i have terible palpitations and anxiety, so i have to take propranolol and clonazepam, to lower my heartbeats! After taking these meds, my heart rate its fine and no more anxiety!! Pls help me out, could the thyroid med, has anything to do with my palpitations and anxiety?
        Thanks, Madalina!

        • Wow Madalina!! You are the first person that I’ve read about that is on Tirosint! I too am on Tirosint 88mcg. I couldn’t take the generic thyroid meds. Tirosint seem to be the all and all for me. However I have noticed severe palpitations if I don’t eat in a timely manner. I also have anxiety!! Hmmm….I wonder if this could be due to the Tirosint. Maybe I should go back on the generic??? I just wish I felt NORMAL!!!!!!!!

          • I have had a reasonable amount of success with Tirosint however am bloated and have continued to gain weight…I started Armour two weeks ago.I am less bloated but feel slightly hyperthyroid.I am trying to stick it out at least a month before I give up 🙁

    • Hi. M, sorry to hear you’r having your thyroid removed. I too had mine removed due to cancer about 7 years ago and was on thyroxine until April this year when I switched over to compounded thyroid extract. The best thing I ever did. I had a reverse t3 blood test revealing I wasn’t converting t4 (thyroxine or Levothyroxine) to the active form of t3 which your body must have. Years of that caused many more health conditions for me. I am now getting my life and my body back. Lost 10 kgs. My brain works again, skin clear, eyes sparkle, metabolism works, energy is consistent throughout the day. I eat paleo and very clean, never smoked, don’t take alcohol or drugs, have done for a long time, but not matter what I did I was a mess. Obviously my body needed direct t3 included and I’m finding so far that porcine gland (Armour or thyroid extract as they call it), has been life changing for me and my young family. Getting a good Dr who understands how to dose correctly and transition whilst being able to go by symptoms foremost rather than just blood tests and ranges is probably also the biggest contributing factor to my health. Starting of low and raising your dose around day 7 then around day 10 according to symptoms worked well for me. Holding for 4 weeks from then till blood tests. T3 needs to be high in the range or at the top. T4 needs to be mid range. TSH is to be low. If post Thyca, supressed is great and thyroid extract does a great job at doing this. You do however need to keep an eye on your antibodies. If symptoms are good and your looking after your immune system via all methods (diet and nutrients, selenium, iodine, vitamins etc.) I find my immunity is really good, no lethargy or glandular issues. I’m a sceptic of being on a t4 only medication. A human thyroid gland does not just have t4. It has 5 hormones not just 1, so why would a medication that has only 1 be sufficient for us? Your body must work so hard to convert all the time and not get any direct hormones. This is difficult for someone suffering from cancer, autoimmune diseases etc. I can’t understand why its expected. I’ll never go back to T4 Thyroxine ever again.

      • Melanie,
        You are very smart girl. You have understand perfectly the thyroid philosophy. I’m happy for you doing very well. I have a question. I’m in the same situation like you and I’m still on Synthroid T4 mono therapy. I still have some problems. Did you tried taking selenium, zinc, vitamin D3, B12 and other natural elements in order to help converting T4 to T3?
        Wish you all the best.
        Thank you for posting,

        • Hi Sam
          Thank you. Yes I take 200mcg selenium picolinate daily, high zinc picolinate, just finished a few months of boosting my D3 with K2 after winter months it wasnt optimal but still ok & I take Methylcobalamin B12 x 1000mg daily as my B12 was not optimal but in range. I do have problems storing iron (ferritin) & this maybe one contribution to my conversion of t4 to t3 issues. I take an iron supplement at night. I have also worked hard to reduce hormone disruptors in the environment from chlorine, flouride and bromide to also plastics esp. BPA. Since my last post I have made good progress and awaiting latest blood test results to see if my rt3 is still high. I also have mo antibodies and have been taking Lugols iodine about 12mg daily for a few months. I’m also working on my cortisol/adrenals and have made huge progress there. Theres been allot to learn through my health journey this year & I was very scared to change meds however I’m glad I did. I don’t need to have afternoon nanna naps anymore which makes life so much easier especially when caring for young children! Happy to share my experience & answer any questions. Take care. Melanie

      • Hello Melanie. You speak an awful lot of sense! Are you by any chance in the UK? I wondered with you using the name Thyroxine instead of Synthroid. I’m curious to know because I am based in the UK and should like to get Armour but cannot find a source. If you could let me have the name of your supplier I’d be more than grateful. I took Armour many years ago through an enlightened doc but had to stop when I moved from the district. I’m desperate to get back on to it because I felt sooooo much better when I was taking it. Looking forward to your reply.

        • Thank you. Yes I know what you mean as I feel noticabley better since I switched. I live in Australia so we call the synthetic T4 thyroid medication Thyroxine here. Theres a couple of pharmacy brands but they’re all Thyroxine based which is the same as Synthroid in the USA.

          Here in Australia you can only get natural thyroid extract (& natural bio identical hormones) via a prescribing Dr on a script. Then its only supplied by a compounding pharmacist.

          There are a few Drs affiliated with the USA and can order a commercial brand from there but its rare.

          The TGA here only really allow compounded thyroid extract therefore its expensive and leaving many people unable to access it.

          The benefit of compounded for me is that I have my pharmacist make up my medication with vegetable capsules and I can have the filler anything I want. I chose vitamin c and glutamine as the only fillers. This is wonderful as I know I’m not reacting to anything and know what I get.

          I have heard that thyroid extract is difficult in the UK. I believe there are parts of Europe where its been banned so not sure if UK is the same.

          Although I don’t recommend it, there is a company in Thailand where some people here can purchase Thyroid-S which is apparently the similar to Armour. Its cheap and has lots of fillers and colours etc. I wouldn’t take it myself but I hear of others on facebook groups who do and find it ok.

          Can ask what have you done to address underlying issues? How is your Iron, B12, gut, magnesium, other sex hormones, adrenals/cortisol?

          Are you taking selenium, iodine & zinc? How is your liver?

          Have you had a reverse t3 blood test at the same time as a ft3? Have you had your Antibodies tested for Hashimotos or Graves?

    • Hi
      I have celiac and no thyroid. My doc keeps me on synthroid meds which have gluten an lactose in it…the doc has tried cytomel which has no gluten and lactose…which i thought was awesome cuz i had not side affects…but my t4 reading dropped and they put me back on snythroid which i keep telling the doctors I cant take it…makes me sick. But I guess I have no choice as I need something. Let me know what you find out if any

      • Hi Patricia,

        I’m pretty sure Synthroid was cross contaminated with gluten. I switch to levoxyl and have had far fewer digestive issues than I did when taking synthroid. I am also celiac.

  15. Hi I was wondering if any one could help me
    I’m 22 years old and have had hashimoto’s thyroid, type 1 diabetes and aloepecia since I was daignosed in 2002 at the age of 9. I was on synthroid for years but 2 years ago switched to armour because my TSH levels were always high. I have adapted a more lower carb diet to manage my diabetes better, but have lost a significant amount of weight. I’m at 105 pounds for 5’7 height. For the past couple months been having trouble sleeping at more recently severe insomnia. I was originally on 3 grains of armour a year ago, since then I have lowered to 1 & 1/2/2 grains every other day in the past 3-4 months. My last test results were :

    T4,Free(Direct) 1.09
    TSH 0.014 Low uIU/mL 0.450 – 4.500 01
    Antithyroglobulin Ab
    Thyroglobulin, Antibody 113.7 High IU/mL 0.0 – 0.9 01
    Reverse T3, Serum 9.1
    Ferritin, Serum 32 ng/mL 15 – 150 01
    Thyroid Peroxidase (TPO) Ab 770 High IU/mL 0 – 34 01
    Triiodothyronine,Free,Serum 2.0

    I have compounded cytomel, should I add that to the armour or switch back to synthroid and cytomel?

    • Hi i would say looking at your lab report, you are hyperthyrid. your symptoms portray that too. jo

    • Your antibodies are through the roof; antibodies prevent the Free T3 from getting INTO your cells. Antibodies are evidence of autoimmune disease that eats away at your thyroid gland FIRST; then it moves on to other organs/ glands /systems (like your Pancreas and Adrenals–usually other glands that secrete other hormones). 21st Century Medical SCIENCE is slowly proving that ingesting an NDT (your Armour) WHEN you have antibodies is NOT a good idea (because it increases the antibodies, because it’s made from pigs’ thyroids and the pigs are confined to GMO feed, and GMOs are KNOWN endocrine disruptors). Healthy women with healthy thyroids test between 4.25 when blood is drawn in the late afternoon and 6.19 when blood is drawn first thing in the morning, for a Free T3 test; your 2.0 = you are hypOthyroid (INsufficient Free T3 at the CELLULAR level, not in the bloodstream from where they test it). IF I were you, I’d stop ingesting the Armour and ingest ONLY T3. To do that, you need to ingest the T3 you would convert from the T4 in the Armour AND the T3 that’s in the Armour, multiple times per day (for instance, I’m thyroidLESS and ingesting 25 mcg T3 six times a day). If you don’t know how to make these calculations for yourself, to know how much to ingest when (because we are all very individual), then find the help to figure it out elsewhere, because Chris clearly isn’t answering questions unless he gets paid….

    • First of all I cant see all the lab ranges for your results. Secondly, I can’t seem to find your Free T3 result which is essential. You need this done at the same time as your Reverse T3 so you can work out the ratio that you are getting. FT3 measures the active thyroid hormone your body uses. Reverse T3 will show the excess. You need to see how well you are converting your T4 to T3. Many don’t convert well. Your antibodies are high. Are you taking any iodine (Lugols) and selenium? Your Ferritin levels are too low. Did you get a complete iron panel blood test? You need to be at least 70 to be optimum. Have you had a 4 point salivia test done to measure your cortisol and DHEA’s? This will show how well your adrenal glands are functioning. Have you had B12 tested? Optimum is at least 500+. Really need to see your T4 range. T4 should be mid range and T3 top of range.

      • Hi, My 9 year old also has Type 1 Diabetes, he was DX 8/14/13.
        He was recently DX with Hashitomo and his doctor wasnts to take a “wait and see” approach but I am very uncomfortable with that. I cannot seem to fins much information on children with T1D and Hashimotos.
        Can anyone give me advice?
        Here is his lab reports:
        TPO AB: 514 high
        TSH: 6.6 high
        The others were normal range.

    • Do you have lab ranges for these results? Ideally t4 should be mid range, t3 top of range, tsh low <2 & reverse t3 down around 150 or so. Have you had your cortisol/ Adrenals, DHEAs & SHBG checked? Are you taking any thyroid supporting supplements such as selenium and zinc?

  16. I am desperate to find a Dr. in AL or TN that will treat hypothyroidism with Armor or Cytomel. I have made an appointment with Dr. Doekel in Birmingham, AL but he is unable to see me until August. The Dr. I am seeing now is freaking out about my TSH levels and wants me to see someone as fast as possible. Of course she wants me back on Synthroid. Any suggestions?

  17. Hi,

    I just found out that I am low on ft4 which might be the cause for my symptoms like constant nervousness, fatigue and constipation.
    Now if I have to choose between Armour and a T4-only medication, what would it be?

    TSH 2.00 (0.27 – 4.20)
    fT4 0.80 (0.70 – 1.48 ng/dl)
    fT3 2.96 (1.71 – 3.71 ng/l)

    Will Armour work or has it the potential of pushing fT3 over the range?

    Thanks, guys!

    • Are you currently on any medication when you had this test done? If so, how long was it before the test that you took your last tablet? Have you found out the underlying reason for your T4 being so low? Your symptoms sound Hypo though. Did you get a reverse T3 test done at the same time as these? Did you get any other thyroid tests, Iron (ferretin needs to be 70 min), selenium, saliva test for your cortisol (adrenal)? These can all effect your thyroid and conversion. Are you on any selenium or iodine? Your T3 is ok but I suspect you are actually pooling, meaning that you could have a high reverse T3 result. Its an extra blood test that must be done at the same time as your fT3 and TSH. Then you can work out the ratio to see how much you are actually able to use vs. how much is just pooling sitting out in your blood doing nothing but causing horrible symptoms.

  18. Hello all – am seeking informed advice if possible…
    Am currently on Levothyroxine (Synthroid) 75mcg for past 9 months or so. Had been on compounded low dose T3/T4 for about a year. Very bad symptoms started occurring & labs came up clinically hypo so was then put on T3 (in a rising amount to 100 mcg compounded in a private clinic) which caused the horrible symptoms to continue (symptoms that that could only be described as of someone who is HyPER.) A hideous year where that Dr did no investigation of my situation whatsoever. I switched to a Naturopath who tried me on NDT – same thing happened. He then tried me on Synthroid…et voila. Symptoms went away & my labs stabilized. Have recently tested (TSH, T3, T4 all good) but came up slightly anemic. Also have bad tummy. Irritable, gassy, can get very bloaty & continues to grow fat on it like some alien creature as taken up residence. (The rest of me is perfectly normal & responds in a healthy way to my diet & exercise habits the way you might predict. I’m in good shape in other words) Cannot seem to tackle this belly though. Either the discomfort or the alien.

    So my question is; should i be looking at the “Synthroid” as being a culprit here? Am I someone who is permanently “sensitive” to T3 and can never take it – should – never take it? Would I be wise to push on & try to get back to it as it might be a better choice than Synthroid in the long run – & I’ve also heard its sometimes possible to even get off it altogether…Is this anemia thing a red flag that should lead my investigation in a particular direction…

    Ok that was more than one question. But you know it goes…
    I’d appreciate any thoughts from folks who might have them.
    Be Well:)

    • First, my disclaimer: I’m not a doctor or a nurse. I’ve been surviving without a thyroid while ingesting ONLY T3 for the past six years. For the 8 years before that, I was confined to T4-only and mostly-T4 meds and I was barely existing. I’m one of those people who can’t convert T4 into Free T3, who was then repeatedly abused with T4-only and mostly-T4 meds by doctors who didn’t believe I needed T3 at all.

      Ask yourself: Is the compound sustained release? If not, were you ingesting a dose every 3-6 hours when the T3 in it would have worn off? If it is, do you understand now, from your own experiences, that SRT3 doesn’t work?

      T4-only meds cause “early menopause”. Menopause is more about fluctuating hormones than dramatic declines, tho levels decline over time. Testosterone decreases fastest, then progesterone, then estrogens. Adrenals pick up the slack as ovaries shut down. Adrenals, when they notice INsufficient FT3 at the CELLULAR level (not in the bloodstream from where they test it) STOP picking up slack for the ovaries and focus on survival–secreting adrenalin and cortisol to keep the heart pumping, causing symptoms that appear to be hypER, but which are, in reality, hypO. Adrenals also deny women the progesterone they need to oppose their now “excess” estrogens (estrogen dominance). Estrogens store in fat. Get some OTC progesterone cream with USP progesterone in it and apply it where you have “fat”.

      Estrogens unopposed by progesterone make whatever Free T3 you have INactive, it gets bound and processed out as waste. So, just because you have “good numbers” on an FT3 lab test result doesn’t mean that FT3 is getting INto your cells. Progesterone is a KNOWN component of converting T4 into Free T3 (even for men). I’m thyroidlESS and ingest ONLY T3, and my T3 doses work better when I use progesterone cream. Even if you are “post menopausal”, or you’ve had a hysterectomy, you still have a monthly cycle that helps maintain your circadian rhythm; you just don’t have the outward evidence that cycle is happening.

      INsufficient T3 at the cellular level = low body temp, usually. Low body temp = low stomach acids. Food doesn’t get digested enough before leaving the stomach and rips the lining of the duodenum, causing ULCERS. Ingesting acid reducers, protein pump inhibitors, etc. only exaggerate the problems.

      Low stomach acids also cause red blood cell problems, including anemia. Those red blood cell problems also cause air hunger, because red blood cells carry oxygen.

      When food isn’t being digested appropriately, malabsorption can result, depriving your cells of nutrients necessary to use whatever T3 you ingest. Malabsorption also negatively affects your immune system, since your immune system is in your gut.

      Synthroid/Levo are T4-only meds. T4 is a STORAGE hormone; the body and brain can’t use it unless it gets converted into Free T3. Supposedly, 60% is converted in your liver, 20% is converted in your gut, and 20% gets processed out as waste. So, take 80% of the T4 dose you’re ingesting and that’s how much Free T3 you have available for your cells because you’re not ingesting any T3. T3 is the ACTIVE hormone, needed by every individual cell in the body AND the brain. Your Free T3 lab result, currently, reflects what you’re converting from your T4-only med, AND the T3 your thyroid is secreting (if any).

      21st century medical science has proven that the Free T3 converted from T4 (whether secreted by a healthy thyroid or ingested) is NOT enough, so, yes, I’d advise returning to a med that has T3 in it over ingesting a T4-only med by itself. I do NOT recommend ingesting T3 once a day! So, you need to know how much T4 and how much T3 was in the compound, and get it divided up into smaller doses. “Most people” find they need 3-4 doses a day, some more.

      Your reaction to the NDT is common: women need more T3 than men. NDTs were made by men, for men, based on studies of men, by men. The women I know who ingest an NDT at least three times a day (the T3 in an NDT only lasts 3-6 hours as well), AND who feel well, are ALSO ingesting T3 separately, at least three times a day.

      IF you have thyroid antibodies, an NDT is the wrong med. NDTs are made from pigs’ thyroids. The pigs are ingesting, exclusively, GMO feed, and GMOs are known endocrine disruptors. “Thyroid” antibodies are evidence of autoimmune disease, not thyroid disease, which I know because I have NO thyroid gland and yet I have “thyroid” antibodies.

      Get a copy of your actual lab report, and check the reference ranges against those created by testing healthy volunteers with healthy thyroids. My guess is your numbers are not as good as you think, because the labs are using reference ranges based on the sick and suffering people they are testing. Healthy people aren’t being tested. Since you have to ingest more than a healthy thyroid secretes to get the same effect at the cellular level, your FT3, when ingesting enough T3 for YOU, will be lots higher than the lab’s reference range. Ingesting enough T3 for you also suppresses your TSH, indicating your PITUITARY is HEALTHY. Over time, suppressing your TSH teaches your thyroid to shut down, however, and it’s very difficult to “revive” it. I’ve listed reference ranges for various tests in other replies to other comments.

      IF you have antibodies, you can get them “into remission”, but you’ll always have them (they fluctuate). IF the antibodies have already caused damage to your thyroid gland, you’ll probably need to ingest replacements (plural) for “the rest of your life”. IF there’s NO damage, yes, you can, sometimes, heal your thyroid gland and not need to ingest anything from the outside in.

      Hope this helps! Get some progesterone cream, go back to a compound and/OR add T3 separately to any med containing T4, and don’t ingest T3 only once a day. If iron is low, ingest replacements. I drink food-grade aloe vera juice to heal my gut from the inside. I also ingest acidophilus before bed every night (adding the good bacteria my immune system needs to function). Since every individual cell in the body and the brain needs T3, any cell that doesn’t get it will be “impaired”. The longer the impairment continues, the more damage occurs….

      Reverse T3 “occupies” T3 receptors, preventing Free T3 from getting through the receptor and into the cell. Antibodies block the opening to T3 receptors in the bloodstream, preventing the Free T3 in your bloodstream from even getting into the receptors. There is NO test for how much T3 is actually getting into your cells, only RT3 and antibody tests to indicate problems, which we know as SYMPTOMS. In other words, you’re the only one who can know how much T3 you need at any given time on any given day. Lab tests can tell IF you’re converting T4 into Free T3 or Reverse T3, but 21st century medical science has proven that the Free T3 converted from T4 is NOT enough, so I’d encourage you to give T3 another trial, treating symptoms instead of lab tests’ results, whether as contained in a compounded med or ingested separately with your T4-only med (T4-only meds can be ingested just once a day; T3 will need to be ingested every however-many-hours your doses last FOR YOU. Experimentation required! Treat symptoms’ relief (or lack thereof), not lab tests’ results.

      • Thank you so much for your incredible reply.
        So much info to chew on.

        I have been using Progesterone regularly, so thanks for the confirmation.

        When you say “treating symptoms” in instead of labs, in the case of someone who comes up clinically HyPO are those symptoms generally pretty consistent with a lack of thyroid being ingested, produced or converted such as fatigue, weight gain, foggy etc etc or would you consider HyPER symptoms in someone clinically HyPO also a sign of not enough T3 being ingested, produced or converted? Any ideas there?

        When I seek help the general assumption (certainly amongst those I consider enlightened beyond mainstream medicine) is that T3, however often it is ingested is usually the answer & I was convinced of that myself and sought out a Dr who would put me on it rather than jump on the “Standard of Care” bandwagon & throw T4 at me, smack me on the back and send me on my way not minding how I felt…However, when I was switched from a compounded T4/T3 (having experienced an onset of rotten extremely HyPER-ish symptoms on that compound) & put on pure (yes! Sustained Release) T3 for a year, I suffered a continuous stream of the same hideous and alarming symptoms – only worse, much worse. I was taking one SR-T3 pill a day, but it certainly didn’t seem like it wasn’t “enough”. That Dr kept raising it up, till i was on 100mcg. I would call the Dr and inquire as to whether I might just be ingesting too much since as someone clinically HyPO I was feeling symptoms rather more in line with HyPER in my estimation. After a while, I felt like was, trapped in an “alternative” medicine bubble as narrow minded as the mainstream since this Dr seemed not remotely interested in investigating my suffering, but continued to slap me on the back and send me on my way not caring much about my symptoms which I reported to him each and every appt. & beyond.

        These symptoms would often come on violently strongly in the pm (around 11pm), a full 12 hours after ingesting SR-T3 and usually keep me up nightly till very late & often all night wondering if I was having a heart attack/stroke/would I pass out..that sort of thing- palpitations, dry mouth & a head & body feeling like it was experiencing one extremely long adrenaline rush, tingling in hands and arms…and on and on. It wasn’t until I was taken off medication containing any type of T3 & put on T4 that those symptoms abated.

        I had to get away from a “T3 is the only answer for everybody” Doctor in order (in my opinion) to save my life. It was a Naturopath who, at first tested me on NDT (Armour) and then when the HyPER symptoms continued switched me to T4 with finally, some relief. (ie I can sleep, I don’t have palps every night, my brain came back, my daytime energy feels more normal – ie I have enough to do my somewhat demanding job & more, my head & body don’t feel like I am experiencing one long vibrational scream etc etc etc). Real relief.

        Now I know most of you out there are beating your heads against a system that insists that T4-only is the “Standard” and for most of you, it isn’t. But I have found that T3-only has not been my answer. At least not so far & I’m somewhat confused by that. (…antibodies were tested, I never had Hashi’s…)

        But I’d like to know if anyone might have an idea for reasons why or if there’s possibly some reason standing in the way of me being able to successfully use T3 instead. OR does it matter? I feel mostly well on T4. I am though, concerned now about the slight case of anemia (which I had experienced also 15 years ago briefly) & excess belly fat that seems unassailable & quite separate & from the rest of my body which responds well to diet and exercise.

        I agree totally about the digestion issues, low stomach acid & the need to take care of the liver since its working so very hard & I do what I can there. Aloe Vera is wonderful & good probiotics part of my life also.

        • Becca,

          I know it’s been a while since you posted, but for whatever it’s worth, I have had a similar experience with T3. Although I have hypothyroidism, when I take T3 I get many of the same hyper symptoms you described as well as a terrible, itchy rash, usually on my shins.

          I was diagnosed with Hashimoto’s about half a year ago and it’s been a roller coaster getting to the right medication. Two different doctors have tried T3 and both times I tried it, I ended up feeling like I was going to explode. As soon as the T3 starts to leave my system, I feel better. I’m still not on the right dosage yet, but I’m advocating for finding it without added T3.

          I’m no expert, but as I understand it: If you don’t have a conversion problem, you don’t need T3. In fact, if you are successfully converting T4 into T3 and then you add T3, you actually flood your body with too much. This causes your body to down-regulate. Check out this video, he explains it well:

          As for your belly fat, you might talk with your doctor (endo is better than OB/GYN in my opinion, but either will work) about Polycystic Ovarian Syndrome (PCOS). There is a well-documented relationship between Hypothyroidism and PCOS and the symptoms of the two are quite similar. Women with PCOS often hold excess weight in their abdominal region and it makes losing weight extremely difficult, even with proper diet and exercise.

          In the meantime, you might try a super low-carb (50-100g/day) diet and also try going gluten-free, if you haven’t already. Weight-bearing exercise also helps more than cardio. I’m an avid runner, so it was hard for me to adjust to not running every single day–but varying between running and hot power vinyasa, for me, has really helped.

          If none of that makes any sense or seems to matter, then I just want to say I validate your experience on T3. Listen to your body above all others!!

      • Please help me. I feel like I’m slowly being walked off a very long pier. Had a TT 3/15/2013 due to follicular cancer. No RAI. My endo was insistent Synthroid was the only way for me to go. I gained 20 lbs within 10 days (half that time I was hardly able to eat real food). He kept bumping up my dose. Added Cytomel. I continued to say at the 1 yr mark- I feel awful. He kept giving me referrals to primary drs. I refused. Instead I fired him & moved on to a Dr focused on well being & easier approaches. Immediately she offered to put me on Armour. Right before my 1st visit with her I had sent off for hormone saliva testing, full panel, because my prior endo kept saying it wasn’t the Synthroid, I must be in menopause. (I was 40). It did come back that my cortisol was barely registering in the AM & stayed low the entire day. My new Dr explained my adrenals kicked in & were hardly functioning. I was given an adrenal glandular. I kept saying no no no. It’s not working. Now It’s 3/2015. My B12 is under 175. Vit D is 18. Ferritin is 16. And I had the awesome pleasure of wearing a cardiac monitor for 30 days to be told oh, it’s just sinus tachycardia- no big deal. Probably just the medication you’re on.
        Now I beg you. Tell me how to begin dosing with Cytomel only. As I sit here & type this I have a full bottle of 25 mcg & 5 mcg. If you’re saying you have no thyroid (like me) & you’ve managed this barely existing existence on T3 only- I’m desperate to try.
        How much should I take to start. First dose, etc. And how often.
        How bad will the effects be of getting the T4 out of my body.
        How long before I feel any kind of difference.
        I see my endo on the 16th but I want to start now. She needs to follow my lead. I have done it everyone’s way but mine. Tired of being told my TSH is perfect but my Reverse T3 is too high. I’m not converting the T4!
        And on a final note. I was put on 200 mg of oral Progesterone 1 month ago because my estrogen was so high it registered as though I was in 1st stages of pregnancy.
        Maybe based on what I’ve read here, the estrogen dominance is due to the T3 not reaching what it needs to.
        Please help me. I’m done being at the mercy of Drs who are either in big pharma pockets or not inclined to connect the dots.
        Thank you.

        • Your story sounds like mine. I was on T4 only for 7 years after having my first daughter I was diagnosed with Folicular carcinoma thyroid cancer. Had a TT and rai. 7 years of the same rubbish like you have experienced. Fat, fatigued & ugly. I didn’t know who I became. I had enough and fired my Endo. I started reading and learning how to improve my health (already never smoked, alcohol, drugs and ate paleo, so I knew it was my thyroid meds). I started compounded thyroid extract (Armour) in April this year and have lost 10 kgs, feel energetic, happy, stable, enjoying life again. My skin has softened and my eyes are sparkling again. People comment all the time and cant believe the transformation in such a short time. Can I ask did you try Armour? You should check out this website and join their facebook groups for lots of info and support. If you are determined to get well, you can. http://www.stopthethyroidmadness.com/

      • Thank you so much for all this important information! I recently had my thyroid removed and put on levothyroxine. It was like being on methamphetmines for me, bringing back all the hyperthyroid symptoms I thought the surgery would end. It was a terrible 7 weeks until I called my holistic doctor and he suggested Armour. Hearing about the importance of T3 and understanding the effects a deficit can have on the system really explains what I went through. My last blood lab with my holistic doctor showed my T3 at 1.6, no wonder why I felt that way! My endocrinologist who had me on the levothyroxine doesn’t even test for T3! When I told her I had switched to Armour she was very upset and says it doesn’t work. I feel a ton better after only being on it for 5 days and will continue to feel better I hope.Needless to say, I am no longer with that endocrinologist, and sticking with my holistic doc. Since this hypothyroid thing is all new to me I really thank you for your reserach and sharing with us…knowledge is power

      • Hi Barb,
        I know it’s been a year since you posted this comment, but I just had to write to you in the hopes that you get this.
        I just started WP thyroid about 2 weeks ago. I had been on 125mcg Synthroid but not doing well. Dr. started me on 1 1/4 grain of WP. For about 4-5 days I did great, and then after that I noticed that about 6 hours after I took the pill I started having HYPER symptoms. Chest pain, palps, anxiety. Dr. took me down to half a pill once per day in the morning. Same thing. I felt fine for about six hours and then WHAM….anxiety through the roof, chest pain. Dr. took me down to 1/4 pill. Again…same thing. I feel okay for the first six hours and then I start getting anxiety.
        What is wrong with me? Should I be taking the WP in several doses throughout the day? My doctor is lowering the dose while everything I’m reading says the dose should be increased. But, why am I having anxiety and chest pain 6 hours after I take the meds? I hope you see this message. Any advice would be greatly appreciated.

    • You might try Tirosint.
      It doesn’t have conventional fillers.
      Just water, glycerin and gelatin… and the active…. T4(levothyroxine sodium).

      You might also want to start at a lower dosage, being as it tends to be more bio-available due to the lack of fillers.

  19. I have been on thyroid for 20 yrs. I cant take synthroid because real bad gerd and nothing I take helps . I am on armour thyroid and I cant get the numbers right,what do I do? Thank you
    Also my hair is falling out so bad. My TSH is .69 and T4 is low.

    • Women’s bodies change over the course of 20 years! Maybe you need to ingest more than one dose a day of your Armour? Maybe you need more Armour than you’re already ingesting? If T4 is low, my guess is Free T4 is even lower, and your Free T3 will be below the reference range provided by your lab, indicating you’re nearing your deathbed.

      Stopthethyroidmadness.com has multiple pages you’ll find of interest, for free. There’s an answer for almost every question you can think of, for free. Janie is selling her time as well as books, but she knows how to help someone ingest Armour.; it seems pretty clear your doctor(s) hasn’t educated themself(ves) about Armour, even though you’ve been able to get a prescription for it. Getting a prescription for it IS commendable!!!

  20. To thyroidless barb:
    Dec20 13 my general doc found that my right thyroid was enlarged; she ordered an ultrasound. Having over and underactive thyroid since the age of 12( I am 55 now), didn’t scare me. I knew enough to ask if she would run TPO and TgAb along with the TSH she was going to order. My TPO was in the 900 range and my TgAB was also elevated…can’t remember right now, and TSH was low normal. She suggested I see a ENDO. She suspected Hashi. I traveled 100 miles to see a good ENDO. She ordered a FNA biopsy; lymphocytes and normal Hurthle cells; diagnosis Hashis, put on levothyroxine…I felt better within a few weeks. followed up at 3 mos, 6mos, 6mos each repeating Ultrasound…supression therapy not keeping down the main nodule; it is now the size of an egg and has pushed my esophagus over to one side….it is time to come out. I am and have been gluten free since my brother was diagnosed with Celiac’s 3 yrs. ago, even though my testing came back that I don’t have it. I have not had my Antibodies checked again, but I am going to ask my general doc to order them before I have surgery. The 2nd biopsy was similar to the 1st, however they told me there are false negatives. The surgeon also felt another hard nodule on the base of my left lobe, so I am going to have a total thyroidectomy. I know this will not be a picnic. Thank you for posting that you still have Antibodies even though you have no thyroid. My surgeon will do everything he can to save all the parathyroids, which he suspects are fine because my calcium levels are good. My endo wants me to continue on levothyroxine until I see her 6wks post op. Thanks again for the input from everyone.

    • Good luck on your surgery. Suppression therapy never works with a T4-only med like Levo. KNOW that people with healthy thyroids, following any surgery, “normally” convert their own secreted T4 into Reverse T3, which their cells can’t use (this occurs in the liver for seven to ten days after your last INGESTED T4-only dose), so their HEALTHY thyroid STOPS SECRETING T4 and dramatically increases secretion of direct T3 (not the converted kind). Since you’ll have NO thyroid, you’ll need to ingest T3-only (Cytomel), starting the day of your surgery (dissolved in your mouth once you’re awake), because the T4 you’ve been ingesting every day prior to surgery will get converted into Reverse T3, for seven to ten days from your last T4-only ingested dose, which your cells can’t use. You don’t ingest T3 just once a day: It takes 30-45 minutes to get to work after dissolving it in your mouth, then it “wears off” 3-6 hours later. Instructions for starting ingestion of T3, and ONLY T3, are at eaware.org, from Thyroid on the left, from RT3 under Thyroid. Once ingesting T3, you must be treated based on symptom relief or lack thereof, NOT based on ANY lab test result. Your TSH will be suppressed by the T3, and that’s an indication your PITUITARY is HEALTHY, responding EXACTLY as it’s supposed to respond to the T3 you ingest. Most thyroidLESS humans ingesting ONLY T3 need 100-175 mcg per day in multiple doses, once they taper onto the T3 and reach a maintenance dose. Ingesting T3 and ONLY T3 is NOT dangerous! 21st century medical SCIENCE has proven that the Free T3 converted from T4 is NOT enough, precisely because there are times you’ll need an extra dose of T3, and there are times when you’ll need to ingest ONLY T3, like immediately following your surgery. I’m so very sorry your doctors allowed your thyroid’s growth to progress to a point where you have no choice about removing it, but you DO have a choice about which med to ingest and when!!! Get some Cytomel, in your hand, BEFORE you have surgery, and take it with you to the hospital!!! IF they find cancer and try to talk you into swallowing radioactive iodine (RAI or I-131), don’t “assume” you need it–that’s nuclear waste that WILL give you cancer when your thyroid grows back, especially if you’re denied the Cytomel you definitely need. Thyroids grow back, more often than not. When you had cancer or swallowed RAI, they grow back, more often than not, malignant. If your TSH registers when your thyroid grows back malignant, your PITUITARY will be telling your malignant thyroid to secrete malignant T4 to your liver (giving you liver cancer), and malignant T3 to every individual cell in the body and the brain (usually resulting in brain cancer). 21st century medical SCIENCE: EVERY INDIVIDUAL CELL IN THE BODY AND THE BRAIN NEEDS T3 NOT T4. Just because your PITUITARY has enough T3 doesn’t mean every individual cell in the rest of your body and brain has enough T3. ThyroidLESS humans shouldn’t have to pay for Thyroid Stimulating Hormone (TSH) tests!!! Anything else is 20th century medical MYTH…. You’ll be in my prayers, too.

      • Thyroidless Barb
        Thank-you for taking the time to reply. I really appreciate it. I will order some Cytomel. and have it with me when I go to the hospital. Should I expect any side affects from the T3?

      • Thyroidless Barb,
        Funny thing is endo wants me to stay on the same dose of levothyroxine(25ug/day) until I see her 6wks. post op. and surgeon will put me on Synthroid immediately after surgery. Kind of a conflict here. Surgeon specializes in endocrine surgery. From everything that I have read so far in this conversation; Levo(T4 only) sounds like a really bad idea.

        • ok, I am an idiot. I just realized Synthroid and Levo. are both T4 only. Sorry everyone. I also need a reputable Pharmacy that I can order Cytomel. Anyone willing to share that info with me?

          • In my experience, there are no side effects to T3. Whatever your cells can’t use gets processed out just like any other waste. I ingest the brand, which is expensive, so I can’t afford to ingest “too much”. There are, sometimes, allergic reactions to the fillers, but rarely to the T3 itself. Yes, there are contradictions between 20th century medical MYTH and 21st century medical SCIENCE. Your endo surgeon doesn’t have the follow up with patients to understand that there have, in fact, been advances made in his field of specialty since he was taught his medical myth in medical school. That’s why I suggested you read the instructions for tapering onto the T3 at eaware.org, from Thyroid on the left, from RT3 under Thyroid. I increased every third day (because the T3 is completely gone from your body in two days). Start with two doses of 12.5 mcg each. On the third day, add a third dose of 12.5 mcg. You will experience SYMPTOMS of insufficient T3 at the CELLULAR level that doctors interpret as “hyper” symptoms, but they’re NOT “hyper”! They are your adrenals cranking out adrenalin to keep your heart pumping because your adrenals know you’re not yet ingesting enough T3 for every individual cell in your body and your brain. IF, once you get to maintenance doses, each dose lasts six hours for you, then you’ll know you’ll need to ingest a dose at least three times a day while you’re awake.

            The only place I know to get T3 without a prescription right now isn’t responding to the people I know who order it that way. Hopefully this will change soon! In the interim, show your ent/surgeon AND your doc the text at eaware.org, there’s more at recoveringwitht3.com, a list of systemic symptoms is at 21centurymed.com, Hypothyroidism tab and scroll down. It prints on one page.

            • Thank-you so much for your input. I will definitely show these articles to my endo. and surgeon. Hopefully they will be open to treatment with T3.

        • If you’re on Facebook, I’m “Barb Shultz (Barb Boston)” there. I post lots of stuff for Thyroid Awareness Month (January), set for “Public” view so you don’t have to be my friend on Facebook to read them. No “c” in my last name; I’m easy to find. Current profile pic reflects that I’m an Army B.R.A.T. Again, good luck with your surgery, and your (not your doctors’) choices, for YOU, an individual who will be thyroidless. Remember, you’re not “hypothyroid”; you’re thyroidLESS. “Hypothyroid” humans need supplementation; some need replacement and don’t get what they need. ThyroidLESS humans need and deserve 100% replacement, not just supplementation. 25 mcg of a T4-only med when you’re thyroidLESS is NOT replacement. Even if only kept on that dose for six weeks, you will be ingesting supplementation, not replacement, for those six weeks, and you will develop symptoms of INsufficient Free T3 at the CELLULAR level, regardless of your PITUITARY (TSH) lab test result.