Low T3 Syndrome V: Should It Be Treated with Thyroid Hormone? | Chris Kresser
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Low T3 Syndrome V: Should It Be Treated with Thyroid Hormone?

by Chris Kresser

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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.

In this final article in the series on Low T3 Syndrome, we’ll discuss whether thyroid hormone replacement therapy is an appropriate treatment in these cases.

Why T3 Levels Are Low

Unfortunately, there are few studies that have examined this question specifically, and even fewer that have explored the question of whether T4 or T3 (and which type of each) would be the best choice.

As a clinician, my primary concern is always primum non nocere, or “first, do no harm.” From this perspective it’s important to recognize that the changes seen in Low T3 Syndrome may represent a restorative physiological adaptation by the body to chronic illness.

In other words, T3 levels are low because the body is attempting to conserve energy and resources to better cope with the challenges it is facing. Increasing thyroid hormone levels in this situation could conceivably have adverse effects.

For example, the changes observed in the thyroid axis in acute illness are similar to those observed in fasting, which can be interpreted as an attempt to reduce energy expenditure and protein wasting. (1) Giving fasting subjects thyroid hormone results in increased catabolism (breakdown). (2)

In cases of chronic illness, however, it is less clear what effect thyroid hormone replacement has. The few studies that have been done produced mixed results. (3)

Some studies show that treatment causes harm, others show no change, and still others show an improvement. After reviewing the literature on this, I’ve come to the following tentative conclusions:

  • T4 is rarely, if ever, effective in Low T3 Syndrome and may even cause harm. This is probably due to the decreased conversion of T4 to T3 that is seen in chronic illness.
  • T3 replacement has been shown to be consistently beneficial only in cardiac patients who’ve recently had surgery, heart failure or a transplant.

That said, I’ve heard anecdotal reports of improvement from people who have taken replacement T3 hormone for a condition called “Wilson’s Syndrome” (which does not exist in the scientific literature or according to any mainstream medical organizations). Wilson’s Syndrome refers to low basal body temperature and other nonspecific symptoms occurring in the presence of normal thyroid hormones.

I’ll be the first to admit that “lack of evidence is not evidence against,” and as I mentioned earlier, there’s not a lot of research on the effectiveness of T4 and T3 replacement therapy in Low T3 Syndrome. It may be that as we look into this further, we’ll discover a role for thyroid hormone replacement in these conditions.

That said, I think caution is warranted.

Taking T3 when you don’t need it is potentially dangerous. It can significantly upregulate the metabolic rate and lead to cardiovascular complications in some patients.

And, if the changes seen in Low T3 Syndrome are a compensatory adaptation of the body in response to chronic illness, increasing T3 levels artificially may have undesirable effects.

In the majority of cases of Low T3 Syndrome, I think it’s preferable to identify the underlying cause and treat that. As I discussed in articles #3 and #4 in this series, those causes most often include infections, autoimmunity and inflammation.

Have any of you tried thyroid replacement for Low T3 Syndrome? If so, what was your experience? Please let us know in the comments section.

Articles in this series:


Join the conversation

  1. In all the articles, it was never quite clear just what the numbers are for low T3; I think that would be helpful. My daughter’s free T3 is 3.1. the doc said this is sub optimal and wants to put her on a natural thyroid med with T4 and T3. From your article, I agree that i’d like to know what is causing this first. She has no chronic illness, eats healthy, very fit and loves to exercise, but is low in vit D (29) and is tired at times (but aren’t we all?). That is the only course of action I am going to take right now and see if getting the D corrected might help. I’ll then retest to see where she’s at. Other than that, I’d love to know if there is anything else we should do. Thank you!

  2. Being of southern italian descent and supposedly thyroid problems on both italian and english sides of family..my blood thyroid..,(routine tests) and cortisols are normal i have high cholesterol and bad reflux..some bowel prob. I dont have food allergies some arthritis. Good cardiac function(according to ekg and pre op cardiac stress test altho calcium test was abnml. Low to nml bp low pulse. Some signs of insulin resistance. I try to eat right..paleo/meterrain.But i have little energy now to just get thru daily chores/work as nurse(recently retired)
    But i do have symptoms of hypothyroidism…excessive wt gain 198#(5’3″) bmi 35 total body fat 29% low energy some hair loss dry skin cold lethargic/low energy/ sleepy but dont sleep well( no apnea).
    Could this be results of low free t3….HOW can i find someone to test and treat ..when my doctors say nothing is wrong you just need diet and exercise
    Chris can you please advisr

  3. Just read the series of articles – great information!! I was diagnosed as hypothyroid 20+ years ago – have been taking levothyroxine since then – now reduced to 75 mcg/day. Only “standard” thyroid testing done in the past – recently tested for antibodies – confirmed I don’t have Hashimoto’s thyroiditis. Apparently I have low T3. Also have annulare granuloma -(autoimmune/inflammatory?). Recently stopped all nightshades, gluten/wheat and have limited dairy. Have been off soy for a long time. Have started supplements to improve conversion of T4 to T3 – will undergo further testing in about a month. Since stopping all nightshades annulare granuloma has improved – maybe if this gets under control – T4 conversion might improve(?). Aside from losing hair (shampooing/brushing) and difficulty losing weight (5-10 lbs) – don’t have typical number of symptoms/problems associated with hypothyroid. Could the levothyroxine be part of the problem?

  4. If hypothyroid people have tried T4/T3 combo therapy and it doesn’t make them feel better, a trial of T3-only (or T3-only combined with NatureThroid) should be given. You never know if T3-only can help until you try it, and if it works for you it can be life-changing.

    There are only so many ways to treat a hypo condition with thyroid hormone: T4-only, T4/T3 combo synthetic, T4/T3 combo natural desiccated, T4/T3 combo with added T3, or T3-only. All hypo patients should have access to trials of *all* of the above until they find the one(s) that help their symptoms.

    It doesn’t matter what the labs say, because, as Chris points out in these articles, the labs don’t always show what’s really happening in the body, and normal/abnormal lab values can vary so much from person to person.

    Once a hypo person starts to feel better on whatever type of thyroid hormone works best for him/her, then he/she can better address underlying causes of inflammation. It’s hard to make big changes in lifestyle and diet and start complex treatment protocols for chronic infections when you don’t even have the motivation to get dressed in the morning.

    What I’ve seen from many holistic practitioners is that they try to solve the problem through diet, supplements, detox, etc., instead of giving people what they really need: *replacement* thyroid hormone.

    When you lose a lot of blood in an accident, you replace it. You don’t say: oh, I’ll just build this blood back up through diet and supplements. Thyroid hormone is as essential as blood. If you don’t have enough, it’s hard to build your body back up through food and supplements alone. It’s hard to fight any chronic infections you might have, and it’s hard for the immune system to come back online and fully function again without adequate thyroid hormone.

    Some people do *really* need T3-only, there are many personal stories on the internet about it, books about it, and doctors who Rx it who see it work miracles for some people. It doesn’t really matter what their labs say or what the underlying cause of their hypo condition is if the T3-only makes them feel better and doesn’t cause adverse side effects.

    I personally know people who feel their best on T3-only. I’m one of those people who improved only after T3 was added to my NatureThroid protocol. LDN didn’t improve my thyroid function. Going after underlying causes of inflammation didn’t improve my thyroid, it just continued to get worse, even after treating Lyme & co-infections, H. pylori, SIBO, doing detox for heavy metals, dietary changes, etc.

    I believe that sometimes the thyroid gland itself *and* the whole chain of events that occur in the thyroid hormone production & conversion cycle have somehow been INJURED and simply removing underlying causes of inflammation isn’t enough to get this complex cycle going again. Replacement thyroid hormone is oftentimes necessary, and in whatever form works best for the individual, including T3-only, no matter what the research says.

    • Those of us that used the time release T3 years ago know that it does work; it’s just not a permanent fix. As the dose goes up the body temperature also goes up. I used to do a five minute temperature check every morning, so I know. The problem is that it’s not a permanent fix, and it’s not covered by insurance. Also, the thyroid “industry” was then and is now on a vigorous anti Wilson’s Thyroid crusade which has lasted to this day. It’s obvious to me that this “crusade” has effectively stopped any meaningful study of the issue: The body produces the active T3 and the relatively inactive T4 which is converted by receptor sites elsewhere in the body to T3. Meanwhile I’m living with a low body temperature: at the gym I wear a long sleeve shirt with an undershirt; on other occasions I wear a woolen vest to keep warm. I have no hope that the industry will stand up and deal with this problem, in my lifetime (I’m 83 years old). It’s a good conversation though and I appreciate it. Also, Dr. Wlson had to learn the hard way: To really be effective the T3 has to be in a time release capsul.

  5. I used Cytomel for a total of 2 weeks for low T3. At 5mcg. I started to wake up in the middle of the night, unable to get back to sleep. Because it started a couple of days after beginning, I did not at first connect the two. At the two week mark, I was to increase to 10mcg. That night, I was completely unable to fall asleep. I stopped immediately, but that was 7 years ago, and I have never again recovered the ability to fall asleep naturally. My endocrine system is in chaos. My immune system is a mess. I have allergies and autoimmune disease, which I never had before. Any tickling of my immune system results in complete lack of sleep. Oh, and I went directly into menopause like putting your car in reverse on the highway, even though my FSH just months before was equivalent to that of a 30yo. I was a nutritionist before this happened, and my joyful life has never returned since my two-week course of Cytomel, low dose. BEWARE Cytomel.

  6. I was treated for low free T-3. For over a decade, multiple doctors had checked my TSH and T4 levels, because I was presenting with malaise, low temp, depression, irregular menses, infertility, PCOS and fatigue. Every single time the results showed euthyroid and my symptoms were shrugged off. I was told to get more exercise and stop sleeping so much.

    I finally came across a PCP that immediately recognized my symptoms and for the first time in my life, ordered free T4 and T3 to be tested. The results showed that my free T3 was very low. She explained that the treatment could be short or long term depending on the cause.

    I was started on liothyronin and levothyroxine. I had my labs checked monthly and my doses titrated. She tried armour thyroid and also compounding to get me the best result.

    After years of infertility, I finally became pregnant. After my second miscarriage, it was found that I also produced anti-phospholipid antibodies during pregnancy.

    My free T3 levels kept improving and I was eventually weaned off the replacement therapy.

    I became pregnant again shortly after and immediately was started on lovenox and low dose ASA for the entire pregnancy. My baby was born healthy.

    3 years have passed and I am experiencing symptoms very similar to how I felt before I was started on the thyroid hormones. I’m concerned that the problem has returned and wondering if I’ll find a practitioner that is willing to help.

    • Do some research on Iodine. Dr. David Brownstein has two books that might help: “Iodine why you need it” “Overcoming Thyroid Disorders”

    • Suzanne, I feel like I wrote exactly what you stated. I have been suffering with severe fatigue since giving childbirth 5 years ago. Everything comes back “normal” and I gained the diagnoses of CFS and a small degree of PCOS. I have been trying to get pregnant again with no success. Which at this point in my life I feel so bad that I don’t even feel as if I could care for another child.
      I would love to talk to you more if you wouldn’t mind. I am desperate at this point. I’m will to travel to get help, whatever it takes.

  7. Hi
    I had a partital thyroidectomy in the beginning of March this year and I’m not taking any meds. I felt fine at first but the past 3 weeks or so I’ve been very tired (even as soon as I wake up). I went for blood work and everything was in normal range even if my free T3 is on the lower end and my TSH increased from 0.73 to 2.44. The endocrinologist told me that being tired has nothing to do with my thyroid (?!) and that I should redo my labs and come in for another check up in December. Is there anything I can do to naturally increase the free T3? Would that help or should I just find another endocrinologist?

    • Hi Jennifer, I have Graves Disease and had my thyroid removed (radiated) 20 years ago. I feel best when my TSH is around 1.0 to 1.5 and my free T3 is in the upper half of the range (usually above 3.0). And you are right…your energy levels are affected by your thyroid! Best of luck!

  8. My wife has been treated for hypothyroidism for 30 years. first with Levothyroxine and now with Armour Thyroid and T3. and a lot of supplements. Some symptoms have gotten better , i.e. hair falling out, cold body temp etc. Labs are good according to doctor TSH, T3, free T3 and T4, Reverse T3 all normal. Chief symptoms are extreme difficulty losing weight despite on 1500 to 1600 balanced calories a day. constant body pain on a 7 or 8 scale. Doctor says she has adrenal Fatigue. She does show Hashimoto anti bodies. How can she be tested for LAH? Do you know any doctors in Georgia?

  9. Hi, i gave birth 7 months ago, with complications right after, with heavy bleeding and super bombarded with iv antibiotics. I got bloodwork done and my results indicate my free t3 is 2.0, which according to my doc is “mildly low, but not cause for concern”. She wants to recheck it in 3 months.
    Please can someone help me and tell me if this is bad? Thank you thank you!

  10. Doctor told me i was slow on the gas and hard on the brakes! Low T3 and high reverse T3. Was on levothyroxine for three months with natural thyroid hormone as well. Stopped the thyroid hormone for next three months but stayed on T3. At this point, my numbers are way off with exceedingly low TSH and high T4. So the doctor is mystified and has me off everything now. Symptoms haven’t changed noticeably.

  11. I was prescribed T4 after going off the pill 5 years ago. I never took it and instead pushed for more tests. I had and MRI and was told I had an 8mm tumor on my pituitary glad that had most likely hemorrhaged. I have another MRI coming up to check on that… in the mean time my new doctor is prescribing me a T3 for low T3 (all other numbers were about normal but she did not test RT3).
    ANY suggestions?!? I have not taken any thyroid medication as of yet, I am 30 and people assume I am the healthiest person they have met. I of course have mood disorders and low sex drive but everything looks fine on the outside.
    Why did my doc not want to see my RT3? How important is that?
    Should I try the drugs or hold out for more tests and answers?
    I am hoping to have a baby in the next year or two and I am trying to make sure my health is optimal.
    Any personal suggestions is greatly appreciated! This stuff can be confusing!

    • Was your MRI “WITH Gadolinium Contrast” to detect change? Please check out http://www.gadoliniumtoxicity.com many patients even those with no known kidney disease are retaining gadolinium in their bodies, it is causing fibrosis. Fibrosis is scarring within veins, arteries and organs! This has happened in my ownbody and I am suffering horribly from it and want to warn others before it is too late. Please check out this informative site.

      It is also known that the A committee of the European Medicines Agency (EMA) has recommended the suspension of the marketing authorizations for four linear gadolinium-based contrast agents (GBCAs) used for MRI scans because of concerns about small amounts of gadolinium from administered GBCAs being deposited in the brain.
      (for right now they will only be speaking to the collection of gadolinium in the brain, because in order to test for that you would have to die for them to biopsy you, but there are blood and urine tests to determine how much is within the body. I am STILL emitting HIGH amounts of Gadolinium from my body post last MRIs by seven years tiem frame, a drug that is supposed to clear the body within 96 hours…
      European Medicines agency is going to be removing *four of the Gadolinium contrast agents in June, why not now and why not in the USA and entire world, is beyond me! IT infuriates me to no end that a drug can harm us and they are not yet held accountable! TO be continued…So please NO MORE MRIs with gadolinium contrast!


      * those being by name:
      Linear agents recommended for suspension by the PRAC are:
      Gadobenic acid, marketed as MultiHance by Bracco Diagnostics Inc.
      Gadodiamide, marketed as Omniscan by GE Healthcare
      Gadopentetic acid, marketed as Magnevist by Bayer HealthCare Pharmaceuticals
      Gadoversetamide, marketed as OptiMARK by Mallinckrodt Inc.

      There is testing info available at the Gadolinium toxicity site. Good luck with your medical issues. I am post ablation (2005) post double thryoidectomy (HRAS codeon 61) styloidectomy (eagle syndrome-elongated and calcified Left styloid bone) awaiting surgery to right styloid, but after removal of BOTH upper ribs for NTOS (Neurogenic thoracic outlet syndrome) yes it’s complicated…at present TSH 0.229 (Low) and some new nodules have shown up, seeing Endocrinologist this Tuesday

    • The short answer however is that the rT3 test is very expensive and the result does not change the treatment.

      My understanding of the rT3 mechanism is that it is not biologically available but does interfere with the negative feedback loop. The body recognizes rT3 the same as it does T3 and does not produce more thyroid hormone. This is apparently why people with this problem have normal TSH and T4 levels. It was explained to me that in some cases the rT3 needs to be flushed out to allow for the active T3 to be made available. This is all dependent on the mechanism of the underlying issue of course.

  12. Hi,
    I’m only 27 years old and i was diagnosed with hypothyroidism about a year and half ago.. my TSH was a bit high T4 was normal and T3 was a bit low… doctor started treating me with levothyroxine 25mcg 6 months later TSH was still a bit high T4 was normal and T3 was a bit low so she increased my dose to 50mcg.. 3 months later she ran some blood work again, TSH came back normal T4 was normal but T3 was still low. She decided to give me Liothyronine 5mcg twice a day.. 3 months later (this past weekend) my TSH came back VERY LOW, T4 was high & T3 STILL low… any ideas of what could be happening? Before i was diagnosed i did have symptoms of hypothyroidism, i was always tired, and gained quite a good amount of weight about 100lbs since i went with this untreated for about 3 years, constipation, dry skin, my hair got very curly (didnt expect that).. ever since my doctor has been giving me levothyroxine i have lost about 60lbs.. and now everything seems to be off balance… i feel tired all the time again, my appetite has increased a lot and im still losing weight but she says it has nothing to do with my thyroid. She referred me to an endocrinologist which i should be going to this week.. i feel like my lab results have been all over the place since i started taking medication and my numbers have never been awful until NOW… they were always SLIGHTLY off and now they’re totally off.. i feel like i was over medicated just trying to bring my T3 to a normal level and now the rest is out of whack.. is there any reasons why my body is still not producing enough T3? i dont know if this helps my but testosterone levels have been abnormal as well which my OBGYN wants to start treating soon i just havent given her an answer yet on that. Any advice would help, could something else be wrong with me? a few of my family members have already had their thyroid or part of their thyroid removed and i dont want to go through that. Thanks

  13. I have been off work now for over half a year. I have Hashimoto’s, my T4 is at the very top of normal range (occasionally higher), T3 at the very bottom of normal range, TSH is normal. On a lower dose of Levothyroxin the T4 came down slightly and the T3 went below normal range, TSH was at upper normal. My functional, integrative doctor has deplored the ratio between T4 and T3 and believes it’s a conversion problem, the Endo says everything is perfect and laughs at the various supplements given to me by the functional doctor. My GP says I have fibromyalgia. I sometimes have muscle pain, am always completely exhausted, have heart palpitations, can not sleep well (much better on lower T4), get dizzy unexpectedly (have fallen down the stair and broke my foot), have no appetite, vision, concentration and speech problems, tinnitus and a whole host of minor other problems. Having had a history of undiagnosed thyroid problems, which presented in very similar but not as pronounced ways, I tend to side with the functional doctor. He wants me on the supplements for 4 months and then take it from there. In the meantime I’m at home alone developing symptoms of depression and really sometimes wanting to give up (on everything). Any thoughts on that? Not that it matters in the sense that the docs will still do whatever they do, regardless. Still, it would be nice to hear some opinion on the matter.

    • Hi,
      I have Hoshimotos. Not sure how I got it or when. I was diagnosed at 4yrs old. My mother and grandfather also have it. I’ve had symptoms my whole life. The drs would never give me medication because, while my antibodies were so high the test couldn’t measure them, and my thyroid was always swollen, my actual thyroid levels were within range, for Western medicine anyways. Long story short, meds helped minutely. It wasn’t until I started a 6 month program with a holistic/functional?? Dr. I ate a completely clean diet and for the first 2 months an autoimmune diet. I stopped the meds and a couple months later rechecked my levels. Everything was normal. The tinnitus was gone, the weird pain in my ears, the tachycardia, sleeping much better, not getting up all night to pee. The list goes on. Not all my symptoms were gone as I had other health issues to deal with, like Lyme disease. I continue to take different supplements to heal different parts of my body. Dont expect a quick fix. Healing takes time. Im 11 months in (minus the bad eating) I have been eating bad off and on the last couple months. My tsh is crazy high, of course my dr (VA) didn’t bother with t3 or rt3. And many of my symptoms are back. I cannot stress enough, before you start taking pharmaceuticals to try the holistic approach. Heal your body, not treat your symptoms. Since I started the program I am off all my meds. Mood stabilizer, antidepressants, metformin, blood pressure meds for my tachycardia, thyroid meds. I do still struggle with anxiety but nothing like before. Good luck and don’t lose hope. God brilliantly made our bodies, and when we treat them how he intended, they work brilliantly.

      • Thank you so much, Elisabeth. I have had Hashimoto’s for at least 40 years. When I was diagnosed with it, my thyroid had atrophied severely and I was terribly hypo. Since my thyroid is completely destroyed I will unfortunately have to supply my body with the missing hormones. I have found an integrative/functional doctor, who stated that the ratio of T3 to T4 is completely off. He believes that my body is so run down at this point that giving me the T3 will damage my organs. So he did the same as you suggest as the very first step…….he gave me a food plan. Now, the food plan is identical to my usual diet, so I did not have to change much. But he also recommended a whole number of supplements to boost my mitochondrial health, which I have been taking for 4 weeks now and they seem to slowly start to kick in. I have refused to take the antidepressants and neuropathic pain medications (stepping on doctors’ toes big time) and am glad I have, because while I’m still very, very exhausted the pain is starting to subside and my concentration is getting better as is my vision. The incidents of speech problems occur only towards the end of the day when the exhaustion reaches its peak. Some other things have not improved…….yet. My hope is that by the end of April, when I go back to see the functional doctor (unfortunately I have to fly out to see him) everything has improved quite a bit as it will be 2 more months of supplements until then.
        I really appreciate your encouragement, Elisabeth. It is not easy to upset doctors and my insurance has refused disability payments on the grounds of me not taking the recommended medications. But just like you I feel that putting chemicals into my body for no good reason will do more harm than good…….better poor and healthy than not exactly rich and ill. 😉 I just needed to hear this from somebody when I was getting pretty desperate and came within a hair of agreeing to take the prescription drugs (there had been no discernible improvements at that time at all). So your words and the recent small improvements encourage me to stay the course and……..to heck with the doctors here and the insurance company. And good luck to you, as well, with losing your anxiety and having your health restored to the fullest.

      • I just realized that I have other low thyroid symptoms besides low body temperature: tinnitus and depression. Also I have to sleep with a mattress warmer.

      • There is a group I found through StopTheThyroidMadness that discusses correct levels and how to get there. It’s a natural desiccated thyroid group, but there is a list of thyroid groups that have experienced moderators that likely may be able to point you in the right direction

    • Adrenals. A saliva test can determine how they are functioning.
      Go to the stop the thyroid madness site. They have tests you can order yourself, if your physician won’t. You may also have hashimoto’s thyroiditis, an autoimmune disease. You should have your thyroid peroxidase, and antibodies checked along with Reverse T3/T4. I also have had your symptoms; ginger has helped me, it doesn’t work for everyone. I bring about an inch of ginger root sliced up in 4 quarts of water to a boil, then simmer for 20 minutes and drink at least four cups daily. It takes a couple of weeks to build up, lemon helps with the taste if you do not like it, some honey also, if you do sugars, I don’t, coconut oil helps also. I also use magnesium oil. You don’t have the effects as you do by taking it orally. I was plesantly surprised at how this has helped with joint, muscle, and nerve pain. I also use homeopathic remedies for nerve pain and helping sleep. Passionflower is a nice evening tea. Hope some of these help you out.

  14. I have high RT3, low T3 and T4. I have been on 81.25 mg of NDT & 15 mcg of compounded T3 . My numbers do not get any better – and my TSH is at .01, of which I was under impression NDT suppressed TSH? I have severe constipation, insomnia, cold hands and feet (hands will get so cold feels like they are in ice water) and thinning hair. Dr and I decided to try just compounded T3. I switched straight over to 75 mcg of compounded T3. Now I have night sweats, still constipated and my insomnia is worse.
    My iron is low, taking desiccated beef liver capsules with vitamin c and bio flavonoids. I eat a lchf diet, exercise and strength train daily plus walk 2 miles a day. Very little to go off of, I know – but any thoughts?

    • Have you had both circulating iron and ferritin checked? Ferritin is iron storage. If it is low, your thyroid will not improve and you will always be cold and have cold limbs because your blood is not oxygenated and healthy. You also need to make sure your adrenal glands are being treated. You need to make sure you have proper levels of adrenal hormones as well for your thyroid to be utilized properly.

      I had to have intravenous iron treatments for 4 years during which time no one would address my thyroid issues but now that my blood is healthy, I don’t experience as much coldness. Still have cold feet but not so much in summer. I take bovine adrenal glandular supplements and prenenelone and DHEA in addition to sex hormones and am now experimenting with thyroid as I have Hashi’s and a RT3 issue also. I still have constipation but mostly when I eat something that is high carb or contains an allergen.

      I follow a Paleo/Ketogenic diet and if I stick to eating ‘high fat’ then I lose weight and feel great. If I let too many grains in or sugar, everything stagnates. I avoid gluten and I try really hard to avoid dairy so I cheat sometimes b/c it’s my favorite and avoiding just breaks my heart. I probably only have one serving a week in a meal where I can’t help it.

      You may also have some systemic illness affecting your immune system. I was treated for intestinal bugs and am still fighting candida and mold illness.

      I hope you feel better. Good Luck!

  15. I have been feeling a whole host of issues, I’ve been tired, dizzy, weak, joint pain, painful heartburn, etc. I’m in my early forties so I suspected it was hormonal. I just got a my blood work done and My estrogen is really high, my naturopath says I’m “estrogen dominant” , but i was surprised to find my cholesterol was super high and my T3 was low (1.9) . My T4 was normal.My naturopath believes in Wilson Syndrome and due to my low basal temp and T3 wants to put me on a round of free T3 therapy. It lasts for about a month and a half. It supposed to boost our T3 levels back up. I’m worried after reading this article that maybe it can cause more harm than good. Any thoughts?

  16. I’ve been to numerous doctors trying to diagnose my eczema, dizziness and short/irregular cycle and the most recent doctor ran a panel of blood work and said that my T3 was just below range. My TSH and T4 levels are normal. The T3/R2….. was just below range (1.79). In addition my billirubin is high. They suggested putting me on a slow release T3 hormone but are not certain I have a thyroid issue. Everything else related to my liver function is normal. Do you have any thoughts or suggestions for additional testing?

  17. Couple of questions to add to the conversation:
    – Any benefit to observing/acting on fT3/rT3 ratios?
    – If fT3 levels continue to fall despite increasing dosage of T4, is it sufficient to just add T3 therapy, or should we be looking into whether chronic or acute illness could be causing this drop in fT3?
    – Does ferritin / iron play into T4/T3 conversion?

    I’ve been on T4 (Synthroid/levothyroxine) for over 2 decades, but my TSH levels were rarely stable, and in the last few years started widely fluctuating. In the last 12 months, my TSH was normal, fT4 slightly elevated, and I began experiencing palpitations that did not subside even when T4 dose was reduced and TSH/fT4 came back to normal. I finally convinced my PC to refer to an endocrinologist, especially since she refused to test anything but TSH and fT4 (and only would test fT4 if I practically begged) and couldn’t get those labs to stay stable for more than 90-120 days at a time.
    The endo ran a full screen that included antibody tests for both Hashi’s/Grave’s, gluten and other sensitivities, and found I am definitely Hashi’s. Over the 120 days I’ve been working with my endo, we’ve also tested everything in the HPA axis.
    Key Findings:
    Cortisol normal – While my morning cortisol numbers were slightly below normal range, they respond appropriately to both ACTH and dex stimulation tests – doc says everything there is normal. I’m curious why my morning levels would be outside reference ranges and that’s considered normal…… have to investigate that later as right now T3 is the priority.

    Thyroid – TSH and fT4 respond to T4 treatment, but fT3 does not
    150mcg levothyroxine for 1.5 years until the above episode, lowered to 134mcg. 3 months in (when I met my endo), switched to brand Synthroid, 134mcg. 6 months after dose was lowered, began to feel typical ‘thyroid tired’ and brain fog. It continued to worsen, I gained 25lbs in 2 months, could barely stay awake through the work day, and despite adding in 13K steps per day and morning workouts 5 days a week, saw zero lean muscle gains, experienced facial inflammation, Shjogrens, pitting ankle edema, kidney pain, and a very strange heavy feeling in my limbs. In the 20 years of being hypothyroid/on T4 treatment, symptoms had never been this severe. Doc increased Synthroid to 150mcg, with no symptom relief. after 90 days, 2 rounds of serum tests showed TSH had increased on both rounds, fT4 remained normal/stable, but fT3 was dramatically decreasing. Doc ran an rT3 recently and it came back in the high end of reference ranges. This creates an fT3/rT3 ratio of 10.2 – I’ve seen sites indicating a ratio of 20 or above is ideal – but I’m not finding much in the way of medical literature or studies to support ratio consideration. If anyone has anything that could support ratio as a consideration I’d be quite grateful….
    Doc added 5mcg Cytomel – she was concerned about the palpitations so started me on a very low dose. Ironically I self-treated with increased iron-rich diet and iron supplement, although a recent ferritin test (for telogen effluvium) turned up in the very bottom of reference ranges. Palpitations are gone after supplementing, thank goodness.
    Adding just 5mcg of cytomel had a dramatic effect after just 5 days. Saw significant improvement in fatigue, brain fog, aches, kindey pain, and heavy limb feeling dissipated. Didn’t realize that my hair had become limp and lifeless (in addition to the hair loss that I DID notice, yikes!) but this low does of T3 has brought back the normal body and shine (yay!)
    However, after 2 weeks the fatigue and kidney pain are starting to return. I’ve asked my endo if we can test serum levels of fT3- we’ll see what she says. It seems her pattern is to add or make therapy changes based on abnormal or suboptimal labs, but then not order follow up labs for 90-120 days. Most literature I’ve found indicates appropriate follow up for T4 changes is 30-45 days, and for T3, 2-4 weeks. Thus far she’s responsive if I press issues, but ideally I’d like to work with a practitioner who provides education and follow up, without patient having to drive that 100%.

    So – to respond to the request from this article – T3 therapy seems to be having significant positive effect on my symptoms, but its probably too soon to say whether I’m optimized, and what, if any effect adding T3 will have on my fT4, rT3 and TSH labs. I’m concerned as to whether we should be investigating anything outside of HPA to determine the cause of plummeting fT3 but don’t know where to start (CBC and BMP/CMP show nothing outside reference ranges, but do see increasing WBC and a few other indicators at the ‘edge (high/low)’ of reference ranges).



    • Taking t4 only in close to 100% replacement for 20 y, is out of balance therapy but you coped well now when getting older you get t3 lvl low, you need to add just a tiny amount of t3 to it and it will make wonders, if your ferritin is bad this is clear sign your thyroid hormones are not balanced for a longer period of time probably more then 10y, add some real vit A to help iron building and add a bit of t3 , to it and you will be fixed in 2 years time……looking at rt3 is futile business and i so wonder who made that stupid thing up! Its so irrelevant

      • To the commenter on checking rt3, no, it is not stupid. I’ve seen a couple comments to that effect and I can’t help thinking how uninformed and ignorant that is. If your doc doesn’t know how to check reverse t3, how to correct the ratio, then find a doc that does.

        • amen daniel,,,wow how uninformed people are and making statements knowing nothing about what they are talking about,,the ft3 to rt3 ratio is what cured my wife and lost 50 pounds of belly fat just correcting that ratio,,going fro 10.3 to 24.7 gave her life back

      • Hi Ivy,

        I appreciate your response although most of the comments don’t relate to questions posed. As for the rT3 being a stupid made up irrelevant thing, you couldn’t be further from correct.
        I’m not a medical practitioner, hence I asked the questions I did. I am however, in possession of a degree in biochemistry (albeit more than a few years old lol). The chem geek in me shares this: the deiodination process cleaves an iodine molecule from T4 – if it cleaves it from the outer carbon ring, active T3 is produced. If it cleaves it from the inner ring, inactive (or rT3) is produced. If a majority of the deiodination process creates inactive T3, or rT3, and that is what binds to receptor sites of tissue, then the rT3 is causing a serious problem at the cellular level by blocking cells from receiving active T3. So, you can see rT3 is not a stupid made up thing, and it can be VERY relevant to hypothyroidism.

  18. I was an idiot. A reproductive endocrinologist said my t3 was a little low and put me on synthroid. I became pregnant and he increased it in my 7th month. I became anxious and unable to sleep, but chalked it up to pregnancy. I took that medicine for 13 years, was anxious, depressed, and couldn’t sleep the entire time, but attributed it to stress and inability to cope. I began losing my memory. I quit my job. I went to Dr after Dr trying to find out what was wrong with me. I told one Dr I felt horrible within 15 minutes of taking synthroid. He switched me to armour. I told another Dr that I felt so much better when I forgot to take my thyroid meds out was like a happy mania. Poor choice of words because he suggested I see a psychiatrist. Finally, a friend who started thyroid meds asked me if it made me feel worse to start. That’s when it all clicked. I never was clinically hypothyroid and yes, I’ve felt like crap for 13 years. The last year I thought I had dementia and had sensations of my brain shaking like a flexed muscle inside my head. I’ve been off thyroid meds for 4 months and don’t experience that anymore. My memory is much better, but I still have moments, sometimes days when I feel drunk. My thyroid levels were perfect while on thyroid meds and they are perfect now that I’m not. Very strange, but god knows what damage I’ve done to my brain.

    • I really sympathize with you, the brain is very plastic and it has ability to recover ,but it will take you probably 3 years at least to recover that damage from t3..and its not only brain…..so be patient and eat foods good for brain, take quality omega 3 oil supplemets every day, dont overdose on anything, and go early to sleep….i sympathize with all the people who take wrong therapy, its sufficient to take just 10% more or less then needed to be out of balance….and its 50% of people who are on wrong therpay this is data that usa endocronology association said in their own reports! So sad when things are basically very simple…..too si ple that in 2017 people still cant figure out what is balanced thyroid hormone replacement! And its not t3 only!it never will be

    • Oh yes taking 134 t4 is little too much, it should be 120 or so…..134 is just 10% too much, the balance must be in -+ 2% of ideal 10% more and you are overdosed! And pushing t3 lower…..the ideal dose for you is based on absorption but if thats not good also work on your gut! And reduce that t4 it cant work otherwise

  19. I recently found an excellent 2015 article focusing on the phenomenon of “poor conversion” from T4 to T3 thyroid hormones in hypothyroid patients treated with thyroxine (T4, Synthroid).


    Their study was based on 353 subjects on T4-only therapy who had reached a stable “euthyroid” status (defined as TSH 10pmol/l). Their subjects were divided into three categories:

    1. patients who had had carcinoma (who had had thyroid surgery and were taking a large dose of T4 in order to suppress TSH),
    2. patients with “AIT” (autoimmune thyroiditis), and
    3. patients who had had non-cancerous “Goitre” (after surgery to remove thyroid nodules).

    The results showed that people with less of a functioning thyroid gland had the lower conversion rates. The carcinoma group had the poorest conversion rate.

    They also showed that if AIT or Goitre patients take higher and higher doses of L-T4 per kg of body weight, they risk depressing their T3 levels further if they are a “poor converter.”

    Wow. The authors openly blame T4-only therapy for poor conversion status:

    “While acknowledging the role of genetically determined differences in deiodinase activity affecting conversion rates, the poor converter status described here appears to emerge mainly as a consequence of the T4 monotherapy itself, induced by the mechanisms discussed above (42, 43, 44, 45). Compared to untreated subjects, deiodinase activity and conversion efficiency tend to be diminished in L-T4 treatment (20, 22).” (p. 203)

    The authors also emphasize “the inhibitory actions of … reverse T3 (rT3) on deiodinase type 2 activity (27).” (p. 202)

    • Because deiodinase activity is governed by tsh lvl, surpressing tsh with so much t4:-) just 10% more of t4 and you get low t3 thats why people who take large t4 dose (100% )……must be getting small amounts of t3 with it…you cant have low tsh , bad thyroid and have enough t3 its impossible!….t4 above 65 mcg is supressing tsh in sick patients too much to produce enough of t3 by thyroid
      Gland itself!…but this is funny that someone did not figure that out in 2017, its all known, how much of t4 and t3 body produces, and thyroid, so dont get it that so many people still cant do 2+2

  20. I recently started taking Cytolmel for low T3. After about two months my T3 has not significantly changed, but my reverse T3 has increased markedly.
    The numbers below show a couple of years history from the current lab, but do not show other data that I have on file from several years ago when my T3 ranged from 4 to as high as 7.

    T3 Free

    2.4 pg/mL
    Date: Dec 07, 2016 04:30 p.m. PST
    Reference Range:2.0-4.4

    2.3 pg/mL
    Date: Sep 29, 2016 12:56 p.m. PDT
    Reference Range:2.3-4.2

    2.4 pg/mL
    Date: Sep 06, 2016 08:17 a.m. PDT
    Reference Range:2.3-4.2

    2.6 pg/mL
    Date: Sep 22, 2015 11:17 a.m. PDT
    Reference Range:2.3-4.2

    2.6 pg/mL
    Date: Apr 06, 2015 04:38 p.m. PDT
    Reference Range:2.3-4.2

    Reverse T3

    26.4 ng/dL
    Date: Dec 07, 2016 04:30 p.m. PST
    Reference Range:9.0-27.0

    15.4 ng/dL
    Date: Sep 06, 2016 08:17 a.m. PDT
    Reference Range:9.0-27.0


    5.32 uIU/mL (High)
    Date: Dec 07, 2016 04:30 p.m. PST
    Reference Range:0.40 uIU/mL – 5.00 uIU/mL

    5.69 uIU/mL (High)
    Date: Sep 29, 2016 12:56 p.m. PDT
    Reference Range:0.40 uIU/mL – 5.00 uIU/mL

    7.39 uIU/mL (High)
    Date: Sep 06, 2016 08:17 a.m. PDT
    Reference Range:0.40 uIU/mL – 5.00 uIU/mL

    3.15 uIU/mL
    Date: Sep 22, 2015 11:17 a.m. PDT
    Reference Range:0.40 uIU/mL – 5.00 uIU/mL
    3.53 uIU/mL
    Date: Apr 06, 2015 04:38 p.m. PDT
    Reference Range:0.40 uIU/mL – 5.00 uIU/mL

    T4 Free

    1.56 ng/dL
    Date: Dec 07, 2016 04:30 p.m. PST
    Reference Range:0.60 ng/dL – 1.60 ng/dL

    1.51 ng/dL
    Date: Sep 29, 2016 12:56 p.m. PDT
    Reference Range:0.60 ng/dL – 1.60 ng/dL

    1.38 ng/dL
    Date: Sep 06, 2016 08:17 a.m. PDT
    Reference Range:0.60 ng/dL – 1.60 ng/dL

    1.18 ng/dL
    Date: Sep 22, 2015 11:17 a.m. PDT
    Reference Range:0.60 ng/dL – 1.60 ng/dL

    1.11 ng/dL
    Date: Apr 06, 2015 04:38 p.m. PDT

      • Since Kresser’s 2011 article series appeared, this excellent 2014 article has come out: “Defending plasma T3 is a biological priority” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4699302/ In a nutshell, if you have a thyroid that is physically damaged and unable to produce enough T3 directly into your blood plasma, then your body can’t effectively “defend its plasma T3” levels at all times. Defending your plasma Free T3 levels is important because certain organs don’t have the ability to locally convert T4 to T3. You may find yourself in a health situation where your T3 is being broken down by a dysregulated enzyme at a faster rate than your thyroid gland can produce or your other enzymes can convert. The article explains that “Deiodinase type 3” is responsible for both converting T4 into Reverse T3 and deactivating Free T3 into inert T2 before it reaches your cell nucleus. It is almost always the cause of Low T3 syndrome. Normally, Deiodinase type 3 is supposed to protect your brain or a pregnant mother’s fetus from thyrotoxicosis if T4 levels go too high. But if your Deiodinase Type 3 has become oversensitive to T4 and has become overactive, it can overwhelm all your best efforts to aid your glandular T3 production or T4-T3 conversion with an excellent diet and supplements, etc. In addition to taking T3 meds to supply more direct T3, you may need to reduce or slowly eliminate your intake and/or production of T4, since T4 is the only thing that can be converted into Reverse T3. You have to take away the building blocks of Reverse T3 at the same time as giving your body the sufficient Free T3 it lacks. I did this switch from T4 to T3 and it was effective in restoring my overall health from a horrible crisis.

        • Thanks for the reference Tania. I am only taking supplemental T3, Liothyronine, not Armour or any other T4. I started two months ago on 5 mcg T3 and now I’m up to 25 mcg spread over the day. I also take iodine and selenium.
          Several years ago I was taking 25 mg per day of iodine and my T3 was between 4-6. My doc thought that might be high, so I cut back and more or less forgot about it. Recently I was advised that I should get my T3 between 4-6 to reduce coronary calcium that has been increasing for five years. Iodine didn’t increase T3 this time. It only increased my TSH. So I have resorted to T3, but the significant change has been the increase in Reverse T3. My ratio of T3:RT3 went from 15 to 9. The research indicates that a ratio of about 20 is minimal or heart disease is a risk.

          • You are taking completely crazy therapy and you will do damage to your heart and adrenal glands with that t3 therapy, read what i wrote above! Dont try to invent hot water its allready invented:-) ……i know guys who did not want to listen to me u til having heart racing every night during the sleep on same 25 t3…..no human should take that! Your thyroid makes only 3_4 mcg of t3 so you should not give more !

    • Mike, why has your FT4 increased over time? Are you on a T4 drug? That can cause your RT3 to increase. Cytomel should not increase RT3. Also, check your cortisol, vitamin D3, vitamin B12, ferritin and also check both thyroid antibodies, TPO and Antithyroglobin. Your TSH is really high long term. Check DNA for gluten issues. As Chris says, inflammation is such a contributor, and gluten, dairy and other dietary allergens can cause all your many vitamins and minerals to be unable to absorb via small bowel. When this happens, it effects the ability of thyroid hormone to work at the cellular level.

      • Lisa,
        I think my TSH is high due to iodine supplementation, but T4 has not increased. I’m taking a generic Lyothronine T3: now 25 mcg per day. My B12 tests above normal and Ferritin has been about 70. D3 about 70. We have been non-gluten diet and non dairy for several years.
        Thyroid antibodies may be a factor. I have not been tested, but I do not have hypothyroid symptoms. I exercise strenuously and work full time. At 67 years of age, I feel fine, very fit, and I’m not obese.

  21. Hi friends,

    Any advice please? I have felt awful for over a year now. Pretty much every symptom of hypothyroidism.

    In October:
    TSH 1.29
    Free T4: .87
    Free T3: 2.8

    I was concerned about low T3 levels and talked to MD. I started taking 50 MCG Levothyroxine (synthroid) 1 month ago.

    TSH: .49 (.45-4.67)
    Free T4: 1.09 (.71-1.85)
    Free T3: 2.4 (2.4-4.2)

    It bothers me that my T3 went down. I feel worse too. Could that be the cause? Is adding 5 MCG Cytomel a good course? Should I decrease my Synthroid when I add Cytomel? It seems it is doing a lot for everything but T3 levels.

    • Did they check your reverse T3? Could be adding T4 is just pushing more to rT3 and not to T3, based on your numbers. Also, did you get your thyroid antibodies tested? They may be having an impact, too.

      My doctors put me on T3 only, and I’ve done well with it, at 25-37.5 mcg a day. T4 didn’t help me. I know what Chris and some of the other folks here say, but this is what works for me.

      Have you had your adrenals checked? Also, you may want to try a gluten free diet. And be asking why your thyroid is unhappy in the first place, which is what Chris is encouraging. Likely, something is causing your hypothyroidism.

      In the short term, if it were me, I’d try adding T3 in 5mcg increments, a couple days at a time, and see if you can find some combo that works for you.

    • 50 mcgs of levo is not nearlh enough to raise your T3 your not converting you t4 into t3, I was on 100mcgs of levo and my T3 was too low. I had to start T3 alone..no more levo as it was not converting its T4 into T3, you’ll never get you levels up on that small amount of T4 which is what you are taking..My opinion

  22. Anyone interested in finding a physician open to testing and prescribing combination T4 and T3 might want to check out the website: thyroidchange.org

    This is a non-profit dedicated to improving the diagnosis and treatment of thyroid issues. I found my endo on their “find a doctor” listing who is open to adding cytomel (T3) to my synthroid (T4)…and he even accepts my insurance (BCBS PPO).

  23. So is there a treatment? I have off the charts low tt3 and higer normal rt3 but tsh and t4 is perfect. My doctor seems to think that estrogen is binding and blocking t3. We are going to try a low dose progesterone to balance the estrogen dominance. But I would love to hear if there are other effective treatments. I don’t have a chronic illness that I know of.

  24. I’ve been on levothyroxine for several years for high TSH (5.5) which is now normal, but still exhausted, achey, memory issues and 30 lbs heavier than before I took cipro 4 years ago. been to many doctors, most of whom treated me like a psych case and tried to put me on antidepressants, which I refused due to serotonin syndrome when they put me on them 8 years ago.

    my latest doc (who I can’t see anymore so I don’t know what I’ll do) just tested my T3 because the endo didn’t. started 5 mcg levothyronine in addition to the levothyroxine 3 days ago and already feeling better. night sweats gone, and today I had the sudden urge to take a walk, for no reason except the joy of moving. I’d forgotten what that felt like. I do have a bit of a headache though. don’t know if it’s related but I have to find someone who can continue my care who isn’t an idiot.

  25. Dr Evans, at Holtorf in L. A. is amazing!

    I was given the wrong ratio of meds (high at4, Low T3-bioidentical) for two years and gained 60 pounds! My doctor ignored my complaints.

    I have hypothyroidism, and can’t convert T4-T3, from a thyroid injury. I almost broke my neck surfing.

    My reverse T3, was the highest they had seen, as all the T4 converted to reverse T3

    Dr. Evans had me figured out immediately and reversed the ratio of bioidentical Meds to 25 T4, 65 T3, abd I’ve lost 52 pounds in two years without dieting.

    She’s extremely knowledgable and treats the individual.

    Most doctors are ignorant of thyroid injuries! Often they occur due to the treatment of OB Gyns when babies are born. They crank the neck and injure the thyroid. Whiplash can damage the thyroid as well.

    Injury can be a cause of low T3…

  26. My 15 year old daughter was diagnosed with Gastroparesis and SIBO. Her blood work shows low T3. I pointed this out to her GI specialist and asked him if the T3 level will rise after the bacteria in the small intestine are eradicated. He stated that there is no correlation between the SIBO and T3 level and the the low T3 was not clinically significant. In the past 8 months my daughter has lost 20 lbs, her hair is thinning and her body temp is 97. I’m just looking for any insight. I’m not convinced that the SIBO and low T3 are not related.

    • People with hashimotos which is an autoimmune disease whereby the body attacks the thyroid gland, have a higher percent than non hashimotos people with sibo. You need to get thyroid antibodies score from bloodwork tpo and tg. I have hashimotos and a low amount of thyroid antibodies but it has been enough to destroy some of my gland making me have low body temperature, cold hands and hair loss. My tsh has held at 2.5 and my t4 is good but my t3 was not in the optimal upper percent of the range. Recently the t3 fell to the lowest number on the range. Read hashimotos root cause by dr wentz. You will see food intolerances, sibo, parasites etc are the root cause of triggering an autoimmune disease like hashimotos. A leaky guy must be present as well and sibo contributes to leaky gut as do food intolerances. People with hashimotos have gluten intolerance. I stopped eating gluten and my thyroid antibody scores dropped over 10 months to now being within range. I did an Igg antibodies test and found i have extreme antibody levels to dairy and egg which means in addition to a food intolrance to gluten, i have a food intolerance to these foods When i cut out these foods my joint and muscle pains went away in 4 weeks. To fully stop these antibody attacks i need to now restore my gut and seal it. First step is to get rid of the sibo. I have done three rounds over the last year of antibotics followed by antimicrobials which has not worked to get a negative breath test My sibo breath test shows extreme for hydrogen. I am now about to start elemental diet followed by a sibo diet (siboinfo.com) that combines a prokinetic drug and iberogast prokinetic so that i do not get a recurrence once they are killed. My body will keep leaking foods and toxins into my blood causing my hashimotos to continue and put me at risk of triggering more autoimmune diseaes until i seal the gut. Eating the foods i am intolerant to and not getting rid of sibo are preventing me from sealing the gut. I have found betaine with pepsin increases the acid in my stomach and i have no bloating at the end of the day anymore. I take 6 per meal. You can look up how to test for low stomach acid. Low stomach acid and slow motility are two of the most common root causes of sibo. I take iberogast 20 drops at bed and will add in a prokinetic drug to further help my motiity. Back to my t 3 being low. I will wait and see impact on this score once i get rid of sibo. My doctor did offer natiral dessicated thyroid hormone at a very low dose but i will only take if my low thyroid symptoms of cold hands and hair shed continue after the sibo is gone

      • thank you for this input. We have since discovered that my daughter has hashimoto’s. She is scheduled for a breathe test in two weeks. We have eliminated gluten and dairy and are following a low FODMOP diet. Her diet is very limited at this point but she has done better since eliminating these trigger foods. The difficult part now is trying to get the weight that she lost back on her (25 lbs) with such a limited diet. She is determined to stay active, plays varsity field hockey. The endocrinologist we saw only said he would be willing to put her on low dose synthroid and never mentioned altering her diet. That was something we determined to do on our own after researching ways to treat low thyroid. I am hesitant to put her on Synthroid since her T4 is not low. It is her T3 that is low and from what I understand Synthroid only replaces T4 which her body in turn needs to convert to T3. He was not convinced that it was her thyroid causing her issues since most patients that have hashimoto’s gain weight, not lose it. I mentioned that I felt it was due to her slowed motility and her gastroparesis which were potentially caused by the hashimoto’s. He said he had never come across that before.

        Sorry to ramble on so much it’s just that I feel I have really started to put the pieces of this puzzle together and yet the doctors don’t seem open to the Hashimoto’s,SIBO, weight loss connection. Thank you for sharing your experience and best of luck with treating the SIBO.

  27. I was diagnosed with having low T3 (but nothing else) in April of this year. I have been taking 5 MCG of Liothyronine 2 times a day since then. I have seen some improvements in my peripheral neuropathy. My feet, specifically my toes used to burn and turn bright red if they got too hot. I could not go out in the sun, in a hot tub, or even get my heart rate up through exercise without having my feet go up in flames and my hands get really hot. I do still have the peripheral neuropathy as well as neuropathic pain in other parts of my body, but it is not as severe. In recent months, however, the pain when walking has increased as well as pain in my lower back and hips. No doctor has ever mentioned low t3 syndrome. I am still looking for answers and would love to know if anyone else has found anything to help.

    • Did you take cipro, levaquin, avelox antibiotics? I had burning too from the peripheral neuropathy, which was from those antibiotics. Thyroid went bonkers after first dose of levaquin. Feet burning has subsided but did a lot of things that helped, like sun chlorella and magnesium citrate, and magnesium threonate, both powdered to avoid fillers.

      • I didn’t take any medication during the time when the burning started.
        I took Gabapentin and Cymbalta to help with the burning, but it didn’t go away until I started taking Liothyronine. Unfortunately, it feels like it is starting to come back again. My doctor is testing for a vitamin D deficiency and having me start Alpha Lipoic Acid R. Has something worked really well for you in regards to the burning? I haven’t found anyone else who has had this symptom.

        • I was given those antibiotics months before the burning. Some people get the burning and neuropathy right away, some many months later. regardless, the most common thing to help has been magnesium, usually citrate. Alpha lipoic acid has also helped some. A good quality vitamin c ( powdered, if possible), resveratrol. Although I still have neuropathy, the burning has stopped. If I were you, I would check my medical records for at least a year prior to the neuropathy/foot burning to see what medications were prescribed. If it turns out you were prescribed any fluoroquinalones, I can recommend a Facebook group where the members have narrowed down things that help. Good luck

  28. I waa just researching T3 because after 5 yrs on Armour my doc changed me to Tyrosint. No T3. After a month, I have a brain fog and cannot put sentences together. My research found that if you do not have the binding proteins available then your body cannot convert T4 to T3. One thing that caught my attention was D3. I have low vit D even though I supplement 50,000 to 100, 000 ius weekly. I also have osteoporosis and autoimmunity. Chances are Vit D plays a significant role in the T3 problem too. Any one know more Vit D defiency and Low T3?

  29. Help!
    I am at my wits end almost suicidal. I am 70 now but when I was 16 I had a goiter removed (my grandmother died of this)
    They said they took too much out and I have been on thyroid replacement medicine (All my Life). So it has been a journey for me and I am still a basket case with NO help from any DR.
    Now I am gaining weight at a high speed, very depressed (told my Dr that and he wanted to give me pills), DO NOT SLEEP at night, constipated, bloating, puffy eyes, hardly any eyebrows, now skin problems.
    I cannot take it anymore and I am tired and unhappy, miserable and put my poor husband through so much, he cries because he cannot help me and he has seen my life go through HELL for the past 45 years we have been married all due to my thyroid.
    Is there ANYONE out there that can help me?

    • Please don’t despair! You are not the only one. I am finally starting to get some sleep with a combination of de-stressing, inositol, tryptophan, melatonin, magnesium, TMG, phosphatidyl serine, magnolia bark (the last two for high cortisol) – and my doctor actually supports me taking all these things! Everyone is different, but I pray that you can find a good functional medicine or holistic doctor lines who will take the time to get to the bottom of things and figure out what you need for your thyroid. Good doctors are out there, it just takes a little searching. And all the suggestions about an auto-immune and anti-inflammatory diet really do help. It’s a lot of work, but I have seen a difference with it. God bless you!

    • Collen. Please call dr. Edward Pearson at the New Medicine Foundation in Jupiter, FL. This man is a brilliant chemist when it comes to thyroid numbers and levels. You don’t have to suffer. I have sent so many people there and they ALL get better. Including myself when I thought there was no hope. I will be praying for you.

    • Dear Colleen, I have been on T4 only (synthroid or levoxyl) for 20 years after radioactive iodine treatment from Graves Disease. For much of these 20 years I have felt horrible. One month ago, I tested low in free T3 and convinced my doctor to add 5mcg of cytomel. OMG…such a small change is increasing my energy and changing my life! Don’t give up! Find a doctor…such as a functional medicine doc…who believes in the importance of both T4 AND T3! Hugs and best wishes, Caryn

  30. Thank you for this insightful article. I have been using T3 hormone replacement for 5 months now (under supervision of my dr) – he velieves I have Wilsons syndrome – I have been following the protocol for this – he starts me off with a dose of 7.5 gradually making my way up to 97.5 – and then I stay there for about 10 days then we gradually come down again. Simce taking this – which was suppose to make me feel and look better – I have only gained weight amd have extrme water retention. All my clothes that used to fit perfectly is now too small and so tight. I feel amd look awful. My skin is also bad. I also have a vit D deficiency and am taking vit D oil for this. I am so frustrated as I am eating a 100% clean diet almost entirely whole foods. I do yoga daily and exercise regularly. I am a 25 year old female, way around 75kg and im 6.5m – ie arounf 15kg overweight. I am tired of being overweight and having bad skin. I dont know what to do anymore and I have been to several doctors. I dont know who to trust anymore. Any advice would be helpful.

    • Alesha,

      Sounds like you need to stay at a particular dose for a while, 6-8 weeks. I’m in the USA so we use mcg as a measurement. So, perhaps 60 mcg 3x a day for 6-8 weeks. Make sure to take a daily vitamin, Iron and Folate/ Folic acid EVERYDAY while you are on T3.

    • From what I read, when you’re in that protocol, you will get worse before you get better. Do what your doctor asks you.

  31. I have recently, fallen into a deep depression. The realization that after fighting whatever is wrong with me for 13 years, the only relief I ever got, and the best I ever felt was from taking CYTOMEL which is T-3.

    I do not understand why a doctor cannot work with me long enough to see if that works again. I am at the point of complete despair. I have spent $$ Over and over for Drs, Naturopaths, Blood Tests, and Appointment Fees to no avail. Now I fell there is absolutely NO HOPE for me.

  32. Chris,

    These articles have been very interesting. My family has a history of autoimmunity, and I have MTHFR mutation, double HLA DR dreaded haplotypes, high biotoxin/inflammation markers, high lead during provocation, high measured inflammation (up to 6 inches at the waist in one day), and a past CMV infection. With what you said about “infections, autoimmunity, and inflammation”, sounds like I’m a poster child.

    When I started on naturethroid, I experience uncontrollable weight gain (40-lbs in 1 year on a paleo diet while working out 5 times per week) and sudden vision decline – both which continue to get worse and worse with no end in sight. What were the typical bad effects from taking thyroid hormone when the underlying issue was infection, autoimmunity, and/or inflammation instead of the thyroid? I am very tempted to stop the thyroid hormone and see if things improve. Since taking the thyroid hormone, my TSH came down, but my t3 free and t4 free *never* changed, and my reverse t3 has always been 11 or 12, with that t3 to reverse t3 ratio being around 25.

    I have been taking LDN for two months now, so hopefully this will help, but my doctor said that it can take up to 6 months to see any benefits. Why does it take 6 months? I feel very skeptical of this medicine, but I hope that I’m wrong since nothing else is working.


    • Camille, I’ve been on 4.5 mg LDN for 2 years for autoimmune issues. It’s been a miracle. Elevated my energy and mood within days, then took 12 weeks to get my autoimmune disease into remission.

      • Just curios Viv, my doctor is suggesting LDN for autoimmune issues, did/do you have any side effects from taking it?

        • Deb, I had brain fog, slight headache and grogginess for the first 3-4 days, then the cloud lifted and I felt great. I lost some weight, especially water weight, and I notice I have to get up to pee about 2-3 hours after I take it. Some people do experience insomnia, but others sleep better than before. I notice if I take the pill and don;t go to bed right away, it can delay my ability to fall asleep.

          • Thanks for your reply Vi, I will have to check it out. I have had so many bad side effects from traditional drugs that it’s hard to want to take anything!

            • On LDN, I had really weird dreams and slight insomnia for about two weeks and then that went away. I feel a bit more energetic in general, but I don’t feel a huge change. My doctor said it can take up to 6 months to see any benefit.

  33. I have mild dermatomyositis and have long had signs of “clinical hypothyroidism” — low BP, low HR, low body temp, cold intolerance, etc. TSH and antibody tests were always normal but TSH started to creep to higher than “optimal” range and T3 was low. Integrative medicine doc prescribed 5, then 10 mg Cytomel, which made me feel much better, then switched to 1 grain Armour Thyroid. Thyroid tests came back slightly high, so she switched me to 3/4 grain Naturethyroid and I’m feeling great. I did have a moderate flare of the DM after I started the thyroid meds, but I had an EBV relapse and gluten exposure to blame it on, so I’m not sure the thyroid meds contributed. Doc called it Wilson’s Syndrome.

    • I was told several years ago I had Wilsons Syndrome, but try to get anyone to treat it properly. The only thing I had good results from was T-3, in the form of a Px called Cytomel. The integrative Dr. also then put me on Armour Thyroid, and it did not do well.
      I am so worn down from no one finding out what is wrong with me I just keep chasing symptoms. Sigh

  34. Good Morning . . . I’m sure my story is an old one, but it’s certainly new to me. This whole thing started a couple of years ago – subtle weight gain. Honestly, I was baffled by it. After being a woman who had dropped 115 lbs in 4 years, I had embraced my new life fully. My eating went from disastrous to healthy, and my activity went from couch potato to athlete/personal trainer/coach. I never “fell off the wagon” because my changes were life changes. Anyway, little by little I was gaining weight. No matter what I did, nothing seemed to make a difference. I visited numerous docs, and oh wow, what a depressing time. I’ve been told to eat less and exercise more. I’ve been told that obviously I’m depressed. LOL! I was also handed a script for weight loss pills and then asked “Will that make you happy?” Last August, I was hit between the eyes with a fatigue and brain fog that I had never experienced before. I had begun to lose hair, struggle with constipation, and felt easily chilled. My husband made an appointment for me to see a sports med doc that we both respected. He truly was so validating. He KNEW that I did not feel well. He began to run a myriad of blood tests to try and find out what was going on. The only test that came back grossly abnormal was the RA Factor. Among many other tests, he did run a thyroid panel which included TSH (middle normal), T4 (high normal), and T3 (low normal). At the time, the focus was on the RA Factor. Honestly, I thought it was a false positive, as I really had no joint issues to speak of. Still, he referred me to a Rheumatologist to get things checked out. In the 6 weeks that I had to wait for my appointment, I woke up one morning to my hands/fingers looking like sausages – stiff, swollen, and red. I was mortified, but the blood test result became more real to me. I since found out that my grandmother had RA also. Since the end of September, I have taken Plaquenil (did not help at all), and Methotrexate which I took for almost 5 months. In the beginning, it seemed to help, but then it didn’t. Actually, the side effects became unbearable. Now, I’ve just started taking Enbril – TNF inhibitor. Still, I continue to exhibit hypothyroid symptoms. My weight gain has been around 30 lbs since this all started. I’m so so sad and frustrated. I continue to eat clean and I exercise, even when it doesn’t feel good, yet my body weight never drops. Chris, when I was reading these articles on inflammation, I was drawn to your information on TNF and Interleukin-6 receptors. Enbril is a TNF inhibitor. My last appointment with the Endo, I told him about my continued issues with hypothyroid type symptoms. He looked at my blood work and told me that he did agree that my T3 was quite low, especially compared to the TSH & FT4. He referred me to a ENDO which only resulted in getting a prescription for weight loss pills. Truly, the guy did not care. Sigh . . . I decided to take matters into my own hands and pay out of pocket, on my own, for some thyroid blood tests. The results were TSH: 2.750 (.450-4.500), FT4: 1.30 (.82-1.77), FT3: 2.6 (2.0-4.4), Reverse T3: 21.8 (9.2-24.1) with a FT3/Reverse T3 ratio of 12%. Bingo! Autoimmunity antibodies were surprisingly negative. I think I found the answer to my hypothyroid symptoms and weight gain. Then, I read your running articles on low T3 and found it interesting that high levels of Interleukin-6 would cause an elevated Reverse T3. I started wondering if Enbril is not the appropriate RA med for me – maybe a IL-6 inhibitor instead. I’m also debating on working with taking some T3 as well. There just has to be something that will help me. Thanks so much for your insight and articles.

  35. When I was 35 years old I began to have symptoms of low thyroid. (I have no idea at that time what my problem could be.) I went to a well know internist who did TSH level and told me my thyroid is fine and asked me if I was having trouble at work, or with my husband, or anything else. I continued to have the following symptoms for YEARS: difficulty concentrating and staying awake, continuous pain in my legs 24/7 unresolved by pain meds or elevating my legs, severe constipation, and other more subtle symptoms. I moved to California, and when my father visited he said he had never seen anyone so tired as I was. A friend gave me Armour Thyroid to try. After one week all my symptoms when away! I continued on Armour until I had to change physicians, and my new physician said I only needed Synthroid. That was a disaster. My symptoms came back plus racing irregular heart rate, urinated 4-6 times a night, and severe difficulty concentrating. After several years another doctor gave me cytomel and I have been fine since them. My TSH and T4 levels are always almost non-existent, and my T3 is a little below normal, but I feel fine.

    • I have had the same results. Awful symptoms for 3 years, countless doctors, no answers or improvement. Finally my doctor tried Cytomel. Within 2 weeks I could tell improvement and after 6 weeks it was amazing! However, after 12 weeks, my levels started falling so they decreased the dosage. Withing 3 days symptoms had returned! I asked to go back to higher dose and was told to go ahead. However, he referred me to an endocrinologist who poo-pahed the use of Cytomel and didn’t seem to believe me. Felt more harm than good would come from using it. After the tears started to fall because I told him this was the ONLY thing in 3 years that had made me feel better, he agreed to continue but on a lower dose. 1-1/2 days in to lower does, symptoms returning! So frustrating. My TSH, Free thyroxine and T3 uptake are all almost non existent – yet I feel good.

  36. I am posting this again at the bottom of this board as people tent not to go back & read replies to old post:

    I have followed this diatribe and argumentation between IVY & Faith since the top of this tread & I feel like at the beginning of it, it was more of a misunderstanding than anything. The first thing that ticked me off was when Ivy said, “Faith is very educated but her condition is so unique that you should not follow her therapy.” Funny thing is that Faith said, everyone’s condition is different & should be treated on an individual basis (which, is very true but I cannot find her original post with her exact words). She was totally right. But then after seemingly being harrassed she said, “Vit D and Thyroid are NOT connected (nor do I view adrenal hormones and thyroid as being connected), OTHER THAN they share a receptor, and the hypothalamus as a control. Each endocrine hormone has its own chemical/biological pathway, and are controlled by completely separate chemical/biological markers. I have often suggested that people may have issues with hypothalamus or pituitary IF they have more than one endo hormone issue. But no, individual hormones, have no bearing, biologically, on other hormones…they are for all practical purposes, unrelated..” This statement is just plain false. What Ivy has said over * over again is that if one hormone &/or essential nutrient gets out of the normal range, many more usually started getting abnormal, as well. But Ivy when you responded to Mohamed, I think I began to see a little but of what Faith was talking about, your responses became manic & never-ending. This comment section was entitled “Have any of you tried thyroid replacement for Low T3 Syndrome? If so, what was your experience? Please let us know in the comments section.” Ivy, although, I feel you mean well, you are not a doctor. and you do not know why Mohamed was taking psychotropic medications & I hope to God that he has not committed suicide or attempted to commit suicide or some other horrible psychiatric problem has happen to him as a result of your irresponsible admonishmement for him to get off of them because he has of Low T3. It is not your place to suggest that anyone to get off psychiatric medications, for any reason WHATSOEVER, especially, in order, to raise their T3. Also, Mohamed posts is about having hypothyroidism & these comments are supposed to be about people who only have Low T3. Ivy, you obviously have a lot of personal experience with hormone imbalance & you have seemingly overcome a lot, if not all of it & you feel wonderful about it & did a lot to help yourself overcome your situation. You have a lot of helpful advice to give & you need to keep giving it. But when someone’s passion overcome’s their ability to be rational & responsible then that person begins to lose their credibility & their arguments just stop holding water. I feel at this point the author of this article, Chris Kresser needs to jump in & correct some major misstatements that have been made on here & reign this comment section in & think about posting a date when this board will be discontinued or brought down as it is getting out of control.

  37. I was diagnosed with very low TSH and T3 a year ago, after gaining 15 pounds in a very short period of time with no change in diet – I have eaten no sugar or any other refined carbs for years and eat all organic – or exercise regimen, after being a lifelong normal weight person. The worst of my symptoms was inability to maintain normal body heat and I spent the most excruciatingly cold winter of my life. I was put on ArmourThyroid and continued to be cold all the time and the weight gain never budged. I then spent considerable time educating myself on everything there is to know about the thyroid, from a lay person’s perspective, and came to the tentative conclusion that I may be converting too much of the T4 in the medication to rT3. I also suspected some level of leptin resistance as a result of the recent weight gain. I requested that my doctor order the relevant blood tests, which he did. In addition, I requested the tests for thyroid antibodies to rule out Hashimoto’s and I am also am aware of the inflammation issue and put myself through an elimination diet to determine whether I was intolerant of any foodstuffs, which I am apparently not. As it turned out I have no thyroid antibodies, my TSH was normal to slightly high again but my T3 to rT3 ration was off, as in, too much rT3. My leptin was normal. I have now been on compounded T3 for three months, starting with a very low but steadily increasing dose of time release T3, and carefully monitoring my basal temperature and other symptons, and have topped out at 44 mcg per day, taken in three doses, the largest being in the morning. As of about a month ago, I am, for the first time in a very long time, no longer cold. That in itself is just the most wonderful thing I have experienced in a while. Aside from being able to maintain normal body temperature my weight is slowly coming down, emphasis on slowly, I have lots of energy and my mood is more stable as well. So this is my story. Feel free to contact me for more detail on blood test results or any other questions.

    • What should the free t3 /rt3 ratio be? I started tirosent 4 months ago. I had tsh bouncing around 2-4, borderline low t4 and low t3. My rt3 has gone from 13 – 25 during this time. Tsh almost nonexistent, t4 a little high and ft3 a little higher. I actually feel pretty good but concerns I’m over medicated or should be taking t3 med. I am gluten free, celiac. Any advice?

    • I have been struggling with hypothyroidism and Low T3 Syndrome for many years and no endocrinologists are able to find a solution to my problems. Recently an eminent functional Doctor put me on cytomel and after a week or so I began to feel as if I was literally going to explode. He then changed me to a porcine glandular T3 and after taking it for two days I felt so terrible, I thought I would have to go to the hospital. Clearly my body rejected T3 replacement but I have extremely low free T3 and am exhausted all the time, unable to think. Does anyone have any ideas???

      • Hi Barbara
        I am really sorry that you have these symptoms, I know them from my own experience and still have them.
        However, I came across a book called “Recovering with T3” in which there is an abundance of information regarding all sorts of problems in the thyroid metabolism pathway, and you symptoms for instance could perhaps be low cortisol.
        I can only recommend reading this book, even if it is rather difficult to comprehend or grasp all at once. But at least this is very good information if you (like I) have to find out diagnosis and treatment on your own, because no doctor or endocrinologist is able (or willing) to help.
        Kind regards

      • Hi Barbara,

        Is there any chance you could be allergic to any of the “inert” ingredients in either med?

        I had bad reactions to Mylan T3, which contains corn, but do fine with Paddock/Perrigo, which has cellulose as a filler. I can’t take NDTs as they all have allergens and must have T4 compounded.

        I’ve been utterly amazed reading drug ingredient lists to find carcinogens, allergens, sugar, and other stuff that shouldn’t go into our bodies.

        Maybe try a different generic if what you tried didn’t work.

      • Is it possible that you were given too much T3 to start? I think it is best to start very slowly and increase over time if necessary. Two months ago, I convinced my doc to add 5mcg of cytomel to my regular synthroid dose after my Free T3 test results were low. I take half a pill (2.5 mcg) in the morning, and the other half before I go to bed. I feel so much better…both increased energy and emotionally. Don’t give up!

  38. I gained a significant amount of fluid after taking Methimazole 3 yrs ago for graves disease. Now, I can’t get rid of the tremendous amount of fluid I gained (70lbs). Doctors are absolutely USELESS! .

    I’ve been told that T3 is the way to go with returning to normal size.

    Is that the case, I have tried EVERYTHING else (diet, exercise, etc). Nothing works, absolutely NOTHING.

  39. You all seem very knowledgeable and I am desperately hoping for some insight. I was on levothyroxine for eight years without issue. I was then diagnosed with Lyme disease and became very sensitive. I am on a very strict AIP diet and switched to Armour thyroid because I wanted something more “natural”. After three months on Armour I was having heart palpitations, racing, anxiety and insomnia (not something I had ever experienced before}. I stopped all thyroid 8 weeks ago and my levels are TSH 60 Free T4 0.3 Free T3 100 T3 47 Reverse T3 <5 Thyroglobulin Antibody 531. I have tried to start a compounded T4 and then Synthroid but each time my BP, Heart rate insomnia increase too much that I cannot tolerate it and stop all medication. I know I have to begin therapy and was wondering if maybe compounded T3 alone would be tolerated. Any suggestions would be sincerely appreciated. Thank you!!!

    • Ive also had lyme disease and it messes with all your hormones. See a llmd *lyme literate dr* or an *nd* naturopath to help you heal the lyme. You need to start there to get your immune system back into shape

    • You may be reacting to the armour? From what I understand, because of molecular mimicry, taking natural dessicated thyroid when you have elevated thyroglobulin antibodies may make the problem worse…

    • Disclaimers First – I am not a Dr but do have an excellent Endo (Dr. Kadambi – Ft Wayne, IN). My thoughts to help you are as follows: (1) The symptoms seem to be very consistent with a thyroid meds overdose (TELL YOUR DOC!). Thyroid meds overdose can be life threatening (think Thyroid Storm). (2) Too much thyroid med can happen for many reasons (your script was right and your stress level drops – warmer weather – lot-to-lot variation – change in your weight – change in when and with what you take the meds (milk/coffee/calcium vitamins can all interfere) – your own thyroid kicking in and creating havoc – etc). (3) The specific med that works for you is specific to your condition – and as frustrating as it is – the docs need to move slowly and carefully when trying to get you to the right place for your situation. (4) Switching from one med to another (Levothyroxine-Armour-Synthroid) is absolutely NOT like going from Walmart Aspirin to Kroger Aspirin. Many of my friends with Thyroid issues (I have several who I confer with on their experiences) have experienced this issue courtesy of the benighted yahoos at their various health care insurances flipping them. They all work for someone – but they may not work for you specifically. (5) There is a pretty good network of help in the blogoshpere – read up and don’t lose hope. (Also – depression goes with the hypothyroid territory – please remember that it is not REAL – it is your body trying to get you to pay attention – don’t do anything rash! – it may take awhile but you can get the right help.)

  40. I’ve been on Nature-Throid for several years. T4 alone didn’t work. T4 & T3 compounded didn’t work. To treat my symptoms, my NT dosage has to be high enough to raise T3 to the top of the normal range. That puts T4 above the high end of the range and TSH close to zero. I feel good, but my doctors hate my labwork. Any thoughts on how to do better?

    • I understand COMPLETELY!! The definition of insanity is doing the same thing over and over and expecting a different result. I have been through this with 3 endocrinologists and 4 primary care drs. The give me Synthroid, I feel sick, my joints hurt, I have brain fog, severe constipation, weight gain, insomnia, the list goes on. I get Cytomel and everything goes away. Literally. These 7 doctors are responsible for the 50 lbs I am overweight. One doctor didn’t believe any of this until I showed him a fresh bag of poop in which you could see that half the food was NOT digested. Then he started treating ME and not the piece of paper from the lab.

    • Dr Levine in nyack. I know it’s not in the city, but he’s the only thyroid doc I’ve met that knows how to test the thyroid, including reverse t3 and proper ratio. He’s also the only one that put me on cytomel. Worth the trip. His number is 845-358-1700

  41. i create test on lab and this is my results
    T3: 2.2, T4: 1, TSH: 1.11
    Vit D: 18 ( i take 5000 per day from 3 months after this result )

    should i take cytomel? how much mcg per day and for how much time should i take it ?

    • you should take no t3 for now..only t4…t3 is not for everyone and not to be taken as sole therapy, Faith is very educated but her condition is so unique that you should not follow her therapy…she says that herself many times, you should take t4 but its normal that your ft3 is low becasue you can not convert properly without good vit D lvls and your lvls are very low

      • With all due respect, I said no such thing.

        Many people live very well on T3 only. Just because you have an opinion on need for T4 does not mean that is a shared view. I do not normally suggest T3 only (unless there is cause to) simply because it is more challenging to get a doctor to rx it, and opens you up to commentary from doctors who have no clue. Why put anyone through that? That said, if doctors were widely educated and it was widely available, why bother with T4?

        Vit D and Thyroid are NOT connected (nor do I view adrenal hormones and thyroid as being connected), OTHER THAN they share a receptor, and the hypothalamus as a control. Each endocrine hormone has its own chemical/biological pathway, and are controlled by completely separate chemical/biological markers. I have often suggested that people may have issues with hypothalamus or pituitary IF they have more than one endo hormone issue. But no, individual hormones, have no bearing, biologically, on other hormones…they are for all practical purposes, unrelated.

        I get that there are often internet fads out there, and I get that some well meaning practitioners sometimes capitalize on these fads in thinking…but I do not contend myself with any of that. I only look at how the actual biological pathway works. Because for me, I need real answers that really work, not things to try for the sake of trying something or supplements that don’t ultimately work. I don’t fault anyone who does do those things, I just personally don’t have time or health to waste on that.

        Never can man, no matter how much he tries, reproduce what nature created in us. Meaning, in that YOU could never, ever know what anyone’s ratio for anything should be, ever…because not only would it change throughout the day and seasons, it would be different in each person.

        There is no one right way. There is just the way we each choose, and in sharing the ways we have found, arm others with more information to make their own choices.

        I hope that clarifies.

        • hi Faith, ok i wanted to say you said yourself that people should not follow your therapy….

          as a person who is suffering hypo state i think i am called to say several of my observations that are written in the literature , and i have felt them on my skin too and these are:
          vitmain D and thyroid ARE connected, we just dont know yet how…

          and adrenals and Thyroid ARE VERY much connected….it goes like this:
          when you dont have enough of t4 or t3 you lack energy, adrenals pump to get energy …which is not there, your adrenals are constantly under attack due to lack of thyroid hormons, i know this very much becasue i have experimented with all possible doses, and I FEEL HEALTHY now so i can tell very well the difference between bad state and good state….and this is what i discovered by trying to lower my perfect therapy which includes 98.5% of t4 and 1.5% t3, this is by the way something that is called physiological dose….

          beeing on t3 only is not proper for majority of people, only for very sick who have no other way to fix their healt, also, beeing on a good therapy wont cure you instantly , the healing process may take 1-2 years when on a good therapy!

          • Ivy,

            I am not sure what your issue is today, but there were like 60 emails in my inbox today from you, and almost as many yesterday…or why you feel the need to say anything about what I say.

            My information is spot on accurate if you would pick up some medical texts or run it by a knowledgeable doctor you will find they agree with me.

            While I am glad you fixed your thyroid issue please be aware of the one guiding rule of this forum – EVERYONE IS DIFFERENT…and…WHAT WORKED FOR YOU WILL NOT NECESSARILY WORK FOR ANYONE ELSE.

            So please, take a rest from the forum today and let things go.

              • i came here to give some light into the matter , and we can join the forces…but i see you want to be the doc here….so be it 🙂 ….i am not interested in that……..did you hear about people in india who look at the sun and dont eat anything! for months……did you ever ask yourself why is that so?….its such a pitty we know so little…do you know that t3 plays role in ATP? mabye thats why t3 and vit d have the same receptor casue they are interchangable?

                • Ivy,

                  Attacking people is not the way you “join forces” with them…and it is not “lightness” either. It is negative, and hurtful.

                  I am very glad you feel you helped yourself. I would be very interested to hear your story. But to insist that your story is right and everyone else and their doctors are wrong, tends to rub people negatively.

                • Ivy,

                  I am very glad you feel you helped yourself. I would be very interested to hear your story. But to insist that your story is right and everyone else and their doctors are wrong, tends to rub people negatively.

        • i really think you help people by your advices but i also notice that your knowledge is just half time true, becasue you are no MD, neither am i, but as a person who was very sick, and now cured….i give myself right to say something i am SURE of and what i lived through, also i read many medical books researches too….but most important i learnt it from MY BODY! my body is not lying, and i know that vitamin D and thyroid are connected, all 80 hormones are connected in a way if you lack one the other will be exploited more, thats why….when someone has metabolic problems: either diabetes, autoimune disease…it has to be tackled from 10 different points not just one, becasue all of this is like an orchestra, and this is something i found out very clearly recently, i finally understand how adrenals are connected with thyroid! ….you get anxious and depressed for the same reasons, when you lack energy….you go in the state of fear….panick attack is sudden onset of fear for life, while depression is ongoing state where you dont have enough energy for life…all of this can be healed ONLY by adresssing metabolis problem….
          also taking t3 only will mess up with your insulin lvls! this is proven too….measuring sugar blood after every meal

          so as long as i like what you say, allow that someone maybe has more knowledge of a certain matter then you do, becasue the truth doesnt lie with you.

          i hope my experience can help somone. i spent 4 years trying to figure out my condition! and whats the best of all it worked out!

          • Again, Ivy

            You are manically posting and you really are not making much sense.

            I have other emails I need to get to and it is really hard to weight through all these repetitive posts from you.

            I am glad you fixed your thyroid. Please consider taking a walk and enjoying the weather.

            • i am sorry you see no good in my info, read all of the posts, where i explain why its better to give a try on physiological doses of hormones, then jumping into the t3 quick fix…….i hope you dont mind that some other people can say how things work just as you do this EVERY single day 🙂

            • Hi everyone! This is my first time here and my question and comment will be lengthy so I apolize ahead of time. My problems have been going on for about three years, initially diagnosed because I had many complaints of extreme fatigue to my primary care doc who of course goes right off the TSH and no other tests. My TSH came back at 3.9 and I asked if I could at least try a small dose ? She put me on the lowest dose of Levothyroxine which did not nothing. Three months passed I asked for more blood tests, and once again she only did TSH and it was now 4.9 so she increased it to 50mcg. After six months of no change I wouldn’t leave the office until she promised me more tests. I wore her down I guess and she ran the TSH which now was 6.230, the free T4 which was 1.0 and the free T3 was 1.0. She thought maybe she could increase it to 75mcg which I knew wasn’t going to change anything, so I had to say goodbye to her!!!! A week later I found another doctor and brought all my labs which he refused to look at. Had me do some sit up/sit down exercises, checked my neck, asked me how I felt and then prescribed two grains of Naturethroid without taking any blood work and for to come back in 3 months. When I came back to see him after my labs came in I waited 3 hours and 45 minutes to see him. He looks at me, says your really strange, and then accuses me of taking meds incorrectly. His labs were TSH of 0.03, free T4 0.7 and free T 3 of 2.0. So he upped my dosage to 3 grains of Naturethyroid. His attitude put a bad taste in my mouth so I threw the prescription in the trash on the way out. It took me a week to find a doc that spent a long time going over and explaining everything to me and he said that the last doc was right to up my dosage. I just got his labs back yesterday and after 7 days without any meds my TSH went back up to 7.0 and my free T4 went further down to 0.6 and my free T3 down to 1.8. My reverse T3 and estrogen and testosterone levels won’t be back until later this week. He changed from Naturethyroid to Armour thyroid at 3 grains. I go back in two months. Since my brain fog is just so overpowering, I can’t seem to remember how he explained how all these things are connected and work together. You all sound so very knowledgable, could you look at my numbers and how and why they changed and rell me what you see? Sorry again for the length of the post.
              Thanks so much

              • Hi Laurie,

                How frustrating. I am so sorry that you are going through all that. If the current doc doesn’t work, might I suggest an integrative doctor? They are good about wanting to get to the bottom of things.

                There are two things I think about with lab patterns like yours, either classic low thyroid or Hashis, which would cause your TSH to go up and down.

                When you are truly low thyroid, like you were (high TSH, low T4, low T3 (which is what I think your numbers were since you didn’t include the lab normal)…you want to look into why you are not making enough. Assuming that you still have a thyroid.

                Sometimes people truly don’t have enough iodine. It is rare in our modern world, but not unheard of. Be cautious about taking it…but you might want to look into that and consider trying it.

                It may have gotten too much thyroid because you were taking thyroid (low TSH high T4). But it may also have been a Hashi’s swing, I believe in hashi’s it goes up and down. If Hashi’s you would want to be cautious in taking natural thyroids because that would have the same thyroid matter that causes the immune attack. It is not unheard of that people can take it with that condition, but it is something I wouldn’t do.

                None of the so called natural thyroid rx’s are as natural as they seem. Armour comes from Armour pigs, aka Amour Hot Dogs. Slaughter animals are fed excess endocrine hormone causing premature death. Some people do really great on it, just that I think it helps to have all the information. Also, they often use fillers, like soy, that inhibits the thyroid.

                You may also want to look into your diet and match that with what is known as “goitergens” these are foods that inhibit thyroid function. Soy and walnuts top the list, but there are many others as well. This might be playing a role.

                As well, antidepressants (not that you are on any) can inhibit thyroid as well. Something to think about if that is an issue.

                Hang in there. Keep walking towards your answers and you will eventually find them. I know it can be a frustrating long slow process. I really hope you find someone that can help you with this soon. And I hope you will come back and let us know how it goes.

              • Laurie, The ups and downs in your thyroid levels all make sense based on your increases, throwing it in the garbage and being without for days and so on. I liked the way your levels of T4&3 came up with the increase to 2-grains and the tsh went all the way down to .03. The increase to 3 grains is needed based on the inadequate t3&4 levels. The tsh should be low or nonexistent-.03. My tsh is always very low at .03 or .04. This last DR sounds like a keeper as long as he doesn’t believe the tsh is the gold standard. In the event you take other meds daily, a t4/t3 combo like armor is the best choice due to the effect other meds can have on t4 only. The first dr that dosed you based on tsh only…sorry you had to go through that.

          • I 100% agree with you! Thyroid, but D & adrenals are all connected, what I’ve read Ivy post is not accurate. This coming from someone (myself) who is suffering from all of the above. Regular doctors are clueless to how everything works!

    • i was diagnosed by Hyperparathyroidism from 6 month after 12 years of Suffering from symptoms
      PTH: 207 ( 10-75 )
      after taking 5000 UI Vitamin D for 3 months and 1200 MG Calcium per day now it decreased fro 207 to 52

      i still have osteoporosis and my doctor tell me it will take more than 2 years to get my bone density back to normal

      i think i have vitamin D in range now after taking it for 3 months and still take it.
      is my FT3 Low ?
      And what should i do now because we haven’t T3 in Egypt
      we have T4 only but i can get T3 online
      i get (Now Foods Thyroid Energy ) online and will start on it after it arrived to me
      i increased 18 lbs in last 2 months by eating less that 2000 calories per day and exercise 5 days per week (Length: 180 CM)
      i have cold hands and legs, taking depression medical from 6 months with Hypnotic (follow Psychiatrist)

      • hello Mohamed,

        1st of all i am no MD, so no doctor, i have fixed my thyroid problem, that was going on for a decade before beeing aware of it…and all i know comes from experience + researching……+ doctor.
        1. you have to have good doctor, that is very knowledgable of the matter
        2. i know that vitmain D FROM THE SUN is not the same thing as the one you take orally, its of MUCH better quality, the synthesis of it follows completely different path, through skin and not throuigh liver….we have limited capacity, with aging we can not use that much of the sun as when young…..so you have to get vit D from the SUN! not orally! it may not have all the benefits…..
        3. parat hormone regulates calcium which must be held in a very tight range this much i know, and thyroid hormones also affects metabolism of electrolites and minerals….its in the esssence of metabolic process….you ft3 looks low, you have to provied lab ranges,,,in my country all below 3 is VERY low, i had once 2.9 and i felt really bad!…..

        i cant help more, then warn that WHATEVER you put in your mouth you must know why and what you are doing……taking calcium only and not magnesium as well, doesnt sond balanced, the best would be you drink milk eat fresh cheese and let body recover in natural way but you have to fix PARAT hormon levels, i dont know how is that done! you HAVE to talk to a doctor

        low t3 is beneficial in your condition becasue higher t3 would melt your bones even faster so …you have to adress your FIRST problem with help of doctor…and BY NO MEANS TAKE T3 before you know why you need it!

      • oh yes your low ft3 is giving you all the symptoms:weight gain, depression, but you should not take t3 now! only t4 ……becasue this way you can not make much of mistake, so try with small dose like 12.5 or 25 t4 if needed

        so your condition is improving and your doctor is right! if you suffered 12 years undiagnosed it must take time to heal, the body NEVER heals overnight! its a healing process…i would only suggest you go in the sun 30 mins every day at least you have plenty of the sun there….but must be the strongest sun…your vit d would go up ……thats what i would do….
        and i would try with t4 to help your metabolism…try very small dose like 25 mcg t4 and see if you feel any improvement after 4-5 days….
        and you must wait for 6-12 months for this to start working out…..also pls dont restrict yourself from the food!!
        you have to eat….but try to eat only healthy food, and no sugars becasue when your enegry is low, i.e. thyroid not working ok then you have sugar cravings and eating sugar aggravates the situation even more…..
        i hope t4 will help you! t3 can be taken only as a part of therapy never alone!

      • taking psychiatric drugs can lower ft3!! its VERY bad to take them for a long time…after better readign your problem i am sure you must take therapy for thyroid too, and that t4 start with 25 mcg for 5 days if you feel improvement keep taking it ……and then see if the dose must be upped, on higher t4 doses you have to take a tiny bit of t3…..but you must be sure you dont take too much of t4 as well……it can surpress ft3 as well
        yes all of your symptoms come from very low ft3 and you should seek doctor for thyroid hormone replacement!

      • you are young and you should fight for yourself…..you have to avoid any pshyciatric drugs! and seek ways to fix metabolic problems , becasue those problems are at the CORE of psychiatric issues……search until you find…i always knew my panick attacks are coming from the bad heath and i would never take psychiatric drugs….and i had probably like 1000 panick attacks….had 2 of them every single day! and i would never give up…..fixing my health fixed all the problems that somone would describe as head problems, i could not drive a car!…..when your health is very bad and CALCIUM is the most essential mineral that builds muscless and electrical impulses in your head!……when you have calcium problem you cant fix it by taking some drugs that will throw you even more out of balance!

        remember everything you take will afect something else in the body! the question is only if body will find the balance with it….naturally or it will create imbalances in some other arrea…….give yourself a chance…and try to kick out psychiatric drugs…t4 may help you…..and if needed a tiny bit of t3! by no means more then 1-2 or 3 mcg!!COMBINED with t4 never alone. most of people here take like 5 times over this….let me know after 5 days how you felt on t4 and yes ask for a doctor for thyroid, you will feel much better you cant cure yourself alone

        • i was taking aside from my hormon therapy a little bit of zinc, selenium, magnesium oil over skin…..and good b complex…. this helped somwhat, also vit C! yes it must be taken so 1-2 lemons after going in the sun, without sugar vit C is very importan….everything is important but i can not elaborate here forever :)…..be happy with tiny improvements becasue big improvements come only after 1 month-2-3-6-12 month time…..

          • what is that now foods? no you should not take t3 first! NO NO , read my posts 🙂

            you should go in the sun and consider taking t4 only so levothyroxin t4…….i dont know what company you have there, and ask for a doctor!…..dont do it yourself…believe me! you can tweak from what docs say a bit but not take all on your own….i tested things on my skin and its hard way! and you can get lost.
            if your doctor doesnt see your ft3 is low search for a GOOD doctor that knows what is low ft3!

            • what all sick people want is to fix themselves over night, with one pill only, unfortunately it never goes that way….it so much better to give body to heal itself properly on a physiological doses and uses of hormone….so replicating what thyroid is doing a lot of t4 and just a tiny bit of t3! then jumping on the “FEEL GOOD overnight” that you can get from t3 , this is like taking the shortcut, thats why i wanted to warn people they can go 2 ways! but if you are observable you will see that t3 shortcut is not that nice one!…i was there taking 25 mcgt3 for 15 days! and it is brain drug…and i sensed what effects it produces, it messes a lot with insulin! hear, puls rate etc….you have to go out of the problem the same way you fell into it! you should do a lot of thinking about your life, your habits…and healing process is collaboration with your doctor, noone can cure himself alone, going t3 only by reading it on some forum, internet whatever….. and another wrong step in your life….unless YOU KNOW what you are doing…..

          • what all sick people want is to fix themselves over night, with one pill only, unfortunately it never goes that way….it so much better to give body to heal itself properly on a physiological doses and uses of hormone….so replicating what thyroid is doing a lot of t4 and just a tiny bit of t3! then jumping on the “FEEL GOOD overnight” that you can get from t3 , this is like taking the shortcut, thats why i wanted to warn people they can go 2 ways! but if you are observable you will see that t3 shortcut is not that nice one!…i was there taking 25 mcgt3 for 15 days! and it is brain drug…and i sensed what effects it produces, it messes a lot with insulin! hear, puls rate etc….you have to go out of the problem the same way you fell into it! you should do a lot of thinking about your life, your habits…and healing process is colaboration with your doctor, noone can cure himself alone, going t3 only by reading it on some forum, interent whatever…..is suicidal! and another wrong step in your life….

        • hey ivy,
          its an astonishingly bad idea to tell people who are taking psychiatric medication that they shouldn’t be taking them (long term or otherwise). you are not qualified, in any sense of the word to recommend something like that. 1. you have no personal knowledge of the person, what they are taking, or why. 2. you are not an MD, psychiatrist, etc. and i highly doubt even remotely close, 3. if someone was taking such meds, and decided to follow your haphazard advise, there could be DIRE repercussions.
          you need to exercise responsibility and common sense when doling out advise, or just dont.

      • Sounds very like Wilson’s Temp Syndrome but you need to take your waking temps at least for a few days to see if low [below 36C] and also later on in the day ti check rise [may not happen]
        I’m on T3 and worked up to 45mcgs a day split two doses. It’s not a bad drug at all but needs to a) be needed correctly and b) increases ultra slow with monitoring of BP Pulse and temps daily.
        Mine was Rx by a clinical pathologist in the end and he is open minded enough to let me get on with it.
        To answer the main post article, T3 is very useful in cases of Wilson’s. Read Paul Robinsons book on it- ‘Recovering with T3’ – and get wised up.
        T3’s not for everyone- but then neither is the awful, unconvertible by many, Levo T4.
        Vit D is best via sun -or Cod Liver Oil of the best quality.
        Hormones DO affect each other.
        T4 conversion involves Testosterone for a start and vice versa.
        We are complex organisms, indeed!

    • oh your vit D lvls are still low! should be 25 at least..if i remember numbers correctly….those numbers come in units 🙂 noone talks of units here hehe

    • oh your vit D lvls are still low! should be 25 at least..if i remember numbers correctly….those numbers come in units 🙂 noone talks of units here hehe…maybe thats why your ft3 went low casue you were taking vit D orally……so Faith is right about receptors….etc….

      i tell you sun sun sun sun……

    • Mohammed, you need a doctors to answer here. not the general public. While I believe many if not all of us on this site have T3 Syndrome, it is not for us to tell you what you should take.

      That said, the only thing I take it T3. becuase it is low. I don’t need T4. My T4 is fine, so I don’t take anything for it. The T3 works great for me. It helps me so much.

    • after trying (Now Foods Thyroid Energy) for 4 months i create another lab test and here is my results
      TSH 1.85 ulU/ml (0.3-5.5)
      Free T3 3.1 pg/ml (2-4.4)
      Free T4 1.1 ng/dl (0.7-1.8)

      i went to Endocrinology and he told my my both tests inside normal range and he have nothing to do with my
      then i went to my Psychologist from 5 days and after some argument with him he write Eltroxin 50 to me and i start to take it
      i will create a new thyroid test after 6 weeks and write here the results

  42. i very much like what faith says here, vit d is a hormone! its not vitamin….and it is very important as t3 there is some huge connection between vit d and hypothiroid status…..i know that beeing in the sun helped me tremendously with hypo symptoms that no homrones could cure only the sun, oral vit d is completely different thing then the one taken in the sun….it may help to improve depression somewhat but its limited compared to the sun…..

  43. your vit d is too low….only this is a sign of serious imbalances….you have to go in the sun for 2 months , but summer sun, not winter….

  44. Hello, I just received my lab results from my PCP. She has put me on 5mcg of cytomel. She said I am hypo and my T3 is low. My labs are as follows…. TSH 1.4 ,(normal) T4 free .99 (normal) and T3 free 2.93 (low) . I also have a low vit d25 hydroxyl of 19.4…….. Everything else was normal except my bili total and bili direct which were high by .1 I am 30years old and have no other issues that I know of. I was wondering if anyone had any advice for me. I don’t want to take meds unless absolutely necessary. Should I be looking for underlying diseases ? I do have stymptoms of fatigue, hair loss and intermittent heart palps. Any feed back is appreciated. Thanks in advance

    • Hi, and I am sorry that you are going through this.

      It is true, Vit D is another endocrine hormone, like thyroid. Unfortunately, they tested the wrong Vit D levels…they tested your storage Vit D. You need the 1,25 D test to test the active Vit D.

      The reason you cannot trust the other Vit D test, is about half the population has a genetic defect (that doesn’t bother them) where they over make the enzyme that converts storage D to active D…so will ALWAYS test low on the wrong test. Only by testing the active 1,25 D will you be able to know what your real levels are.

      Now, that does not account for why you have low T3, which does look like a classic sign of some other underlying condition. Heart palps are generally considered to be a sign of too much thyroid so I am kinda wondering if maybe you fluctuate from high to low? But I think your TSH would be wonky (over time) if that were the case.

      The body normally lowers T3 when it is trying to recover from things. I think the logic is to make you tired so you will rest so the body can better recover. This, however, does not help much in chronic illness.

      Sometimes a bit of T3 can really help…sometimes it doesn’t work well. T3 is something your body makes, so it is unlike a drug that is foreign to your body…if that helps.

      The trouble with the Vit D…is all endocrine hormones share the same receptor…and the receptors have a preference for Vit D over T3…so as to create a situation (when people take Vit D) of being low thyroid because the thyroid cannot get into the receptors, but having plenty thyroid in their blood on tests…making it hard to get an rx for it.

      This is why I suggest getting the 1,25 D test before taking Vit D. If the 1,25 D test is also low…they you will likely feel better with some Vit D.

      The other cause of low the wrong test and high or normal the 1,25 D test…besides genetic, is bacterial infection.

      On the side of screening for what else may be wrong, I suggest these tests:
      ANA or FANA (autoimmune screen)
      RA Factor (autoimmune screen)
      SED Rate (inflammation)
      C-Reactive Protein or CRP (inflammation)
      CBC with Differential (tells you what white blood cells are active)
      Along with, of course, the
      1,25 D test….(I like to get both the 25,D and the 1,25 D at the same time)

      Hope that helps.

      • hi Faith, is that your pic on? 🙂 looks beautiful

        heart palps mild one come from shift in hormones up down, what basically happens people who have sick or slow thyroid….dont get t4 or t3 in time, either there is lack of hormones or the conversion is not smooth…so one can feel heart palps, either from lack or too much, it has to be looked within the context.

        ft3 must be constant, this is why body created this perfect mechanism that t4 is storage and t3 active and must be kept in very small variation, so when there are fluctuations that you notice in heart, thats a sign you have imbalances…becasue body is trying its best to keep ft3 in constant flow!….and heart muscle is especially sensitive to that, thats why people who have low thyroid hormones over many years develope shortness of breath, and dyastolic heart problems….

      • and on vit D, vit D is not in competition with T3…..becasue t3 will be much better with your vit D lvls as they should be, i know it since i had severe hypo status for probably 6-7 years before i discovered it…..and beeing in the sun over 2 summers helped me tremendously, the vit D researches show that comes from sun is of much better quality, so taking vit D oraly will compete with t3 becasue it must be processed through liver the same as t3 but the one that comes from sun is VERY BENEFICIAL, and everyone with low vit D must be worried…..we all generaly lack sun exposre, and we can not live without the sun, it has huge role for our health!…….

        • Hi Ivy,

          Not meaning to argue, but they do compete in the receptor…as the receptor is one for all endo hormones, and prefers Vit D to T3. One study even stated that Vit D will “displace” T3 from the receptor.

          The normal lab test done is 25,D…that is the storage form and to understand it, compare that to the T4 test. Half the population will LOOK low on that test, but are not truly low.

          People need to do the 1,25 D test, which is comparable to the FT3 test, to see if they are truly low.

          Sun and supplement alike will help us make the storage form of Vit D or 25,D…which we will later convert, or some will over-convert, into 1,25 D the ACTIVE form.

          The problem for thyroid patients in 1) trusting the wrong D test, which for some will ALWAYS look low when true Vit D levels are not low; and then 2) supplementing…is that they may unknowingly be creating excess ACTIVE Vit D (1,25 D)…and the excess will bump T3 out of the receptors leaving one’s body LOW thyroid even though there is plenty of T3 in serum levels.

          This is not a problem for most people…but with the advent of the Vit D fad, and the misinformation from study after study that used the WRONG Vit D test…is that more people were taking Vit D than ever should have been.

          So again, the walk away should be to always insist on both tests, the 25,D that they always run and the 1,25 D that will really tell you what you need to know.

          Hope that helps clarify.

          • hi Faith, you are repeating this thing over and over again for a year that i know of, but probably for several years, you take this place as your private MD office 🙂 i dont intend to spend any more of my time here, if you got several mails it must be becasue of bad servers becasue i posted only about 10 replys to Mohamed mainly…..dont make out problems over that 🙂 i dont have time to spend living here on this page

            this is why i say to people to go in the sun only and not take oral vit D there are studies that show its not the same thing, i also dont have time to go into details how it all works, cause docs dont know as well…but i do know that if you are low on vit D compared to your best posssible vit D status you will not have energy! you cant convert t4 into t3….and this is why it takes time for hypo patinets to recover….vit D is crucial for life, its also very very logical…..all these problems people have come from lyfestyle chnages, most of these people work in the office…..there is no study done about thyroid status of people like farmers……this would put some light into the matter….also saying that body is compartment of organs, or compartment of individual hormons tells that you dont undrstand the core of life, i.e. metabolism and this all looks like blind leading the blind

            enjoy in your online MD office 🙂

      • and on vit D, vit D is not in competition with T3…..becasue t3 will be much better with your vit D lvls as they should be, i know it since i had severe hypo status for probably 6-7 years before i discovered it…..and beeing in the sun over 2 summers helped me tremendously, the vit D researches show that comes from sun is of much better quality, so taking vit D oraly will compete with t3 becasue it must be processed through liver the same as t3 but the one that comes from sun is VERY BENEFICIAL, and everyone with low vit D must be worried…..we all generally lack sun exposure, and we can not live without the sun, it has huge role for our health!…….

    • can you speak arabic?
      i create test on lab and this is my results
      T3: 2.2, T4: 1, TSH: 1.11
      Vit D: 18 ( i take 5000 per day from 3 months after this result )

      should i take cytomel? how much mcg per day and for how much time should i take it ?

      • mohamed? you come from the area where people cover too much of the body and is known for the lowest vit d lvls (middle east), your vit D lvls are too low to function normal, you must get 30 mins of sun exposure in the strongest sun light every day for 2 months to recover your vit d status!

    • Hi Nadia. I had heart flutters/palps with HYPOthyroidism. I had them during an undiagnosed 3.5 yr period of time. I did not fluctuate between hyper an hypo- my heart rate was a consistent low 55-60bpm. Cytomel 5mcg is what I am currently taking along with 112mcg Levoxyl. I have to divide my Cytomel into 3 doses per day. If I take 5 one time a day it makes my heart rate increase to an uncomfortable rate for a couple of hours. T3 is fast acting and has very short half life so it is better to divide and take throughout the day. The other alternative is to have it prescribed compounded and time released for a once a day dose-avg $40/mo no insurance coverage. Since you are not taking t4, you may find that you need more T3.

      • hello Becky no you should decrease your t3 to 3 mg max! you are taking too much of t3 , on a good therapy you should have 0 heart palpls!

        i fixed my condition over the 4 years time, it took me 6 months of extensive reseaching, and now after 1 year from educating myself i can say i am healthy person, with proper therapy , ofcourse, i can not live without my 106mgt4+ 1.5 mgt3……i chopp my 25 mg tablet, dont ask me how 🙂 but i nopticed that body doesnt mind if you take 2 or 1.2 mg even 3 mg is ok, all above those doses is too much and you get various issues……..read the book from dr blanchard its the BEST book on thyroid i have read….and i can prove you its all true whats written there

        • Ivy, I don’t have heart palpitations while taking my T3 and never did – even when I was taking seven twice a day. I had heart pabitations when I was low hypo thyroid undiagnosed. At that time-2002 to 2006 -my heart rate was consistently below 60 bpm and my blood pressure was somewhere at 90/60. Doctor never thought to run a thyroid lab eve with all the visits I made bc my body and mind were breaking down. Of course, I had to fire him. I was myxedema coma pre-coma and started losing weight after back to back bladder infections. He then put me on narcotics for add. Bad stuff for hypo undiagnosed.

          • i am so sorry Becky to hear that!! you were in a serious situation, your situation maybe does need quick fix by the help of t3…becasue you had no time to wait for a healing process, but in general i would always thrive to try to replicate the nature , becasue then you will be more healthy if thats possible ofcourse! its not possible for every single person! i also think Faith maybe can be on normal therapy..i dont know such things, i just want to say….that i was severely hypo..and my therapy could not work instantly it took me several years before the body started to work properly……but one should give a try with that physiological doses therapy for few years before jumping on a t3 quick fix…i read several books that helped me there….i know how t4 and t3 affect heart, its mainly t3 that casues heart palps, yes either when you lack it then you have low blood pressure and low HB or when you are overdosed, thats why i say heart palps can be from either too uch or too little hormons! one can get lost easily in those symptoms

            • Ivy writes: ” i also think Faith maybe can be on normal therapy”

              Ivy, again, with all due respect – I am under the care of a competent doctor who knows better what is the best treatment for me, than some person on the internet.

              I am starting to realize that you do not realize how you are coming off. To sit back and judge me and my doctors based on what worked for you is insulting and rude.

              Please, just let it go. Find what works for you, share your story…but don’t cross the line and start judging others, not if you hope to keep friendships with them. Please take in my words…and understand then in the spirit in which they are given.

              It is also overwhelming to check one’s email and have umpteen emails all essentially saying how right you are and wrong everyone else is, it is sort of insufferable. I am not sure what is going on for you, and I am a bit concerned…and thinking you maybe are not doing near as well as you see yourself to be doing.

              No one is trying to fight with you, I am hoping to just help you see yourself a bit…to understand how you may be impacting people here…which may not be the way you wanted to impact people here.

              Please take a step back and think about what I am saying.

            • Ivy writes: ” i also think Faith maybe can be on normal therapy”

              Ivy, again, with all due respect – I am under the care of a competent doctor who knows better what is the best treatment for me, than some person on the internet.

              I am starting to realize that you do not realize how you are coming off. To sit back and judge me and my beloved doctors based on what worked for you is insulting and rude.

              No one is trying to fight with you, I am hoping to just help you see yourself a bit…to understand how you may be impacting people here…which may not be the way you wanted to impact people here.

              Please take a step back and think about what I am saying.

              • it was typo, i replied later but the answer did not went through…..i wanted to say you CAN not…but you will see later when my answer wil be released…i said too many good things…..

              • yes i also think you should take a step back from this site, becasue it turned out into your private practise, and your knowledge is way below that…..

                • you missinform people presenting yourself, on vit d, on thyroid hormons you know very little….and especially on other hormones which you dont even consider in equasion, and yes they are very important…..adrenals will never be normal without good thyroid, insulin will also spike on too much t3, and on lack of thyroid hormones, this is why thyroid problem can lead to diabetes in some cases….its an onset of metabolic problems, and head is just one organ that suffers under metabolic issues….so people get depressed and all sorts of issues….and most of young woman have too low progesterone if their thyroid was not doign well, etc etc…..its always 3 homrones that are in imbalance when thyroid is not working well…etc etc…you dont know anything about this….so please take step back and alow that somone else has more insight into these topics …..this is me helping to see yourself a bit.

                • *Sighs* I am not even sure how to respond to you at this point.

                  The last couple of days you have been posting manically, and you are clearly not aware of the number of posts you are making or that each time it generates an email for people following Chris’s blog.

                  You seem to have some need to bait me, which is weird. When you put words in my mouth, I corrected you and clarified my words, and then you went on attack mode.

                  I am not sure what kind of response you are looking for or expect to get from all this, but the response you are evoking in me is one where I am thinking you have some kind of mental health issue.

                  You may not realize this, but I have some serious health issues going on with my mom right now and need to be attending to emails back and forth between her doctors. Amid everything going on right now with my mom, it is beyond hurtful and yuk to have to wade through umpteen emails of your posts to get to the ones from her doctors.

                  I have tried being nice, but that is clearly not working…so I am regulating posts from this site to my spam folder.. I do not think you are as healthy as you are saying, but the sounds of your posts…and I am concerned for you. Whatever you feel helps you, please get help.

                  Take care Ivy.

              • wanted to say that F. maybe can not be on normal therapy…becasue she will jump on my neck casue i made typo…also you notice english is not my native language and i want to say as much as possible in shortest time….casue i go out now 🙂 in the sun hehehe…..try to read some books, dr b. is genious if you ask me, he figured out soo well thyroid therapy that i wonder why docs still cant understand how it is all simple for majority of patients and still insist on wrong things like all t4 all t3 and such nonsense…..sooooo little knowledge is in the medicine compared to quantum physics and other areas….that i wonder why is that still so, and i know how much of suffer it is when your thyroid doesnt work only 10% from the optimal

            • Vit D….I was within range until I stopped taking t3 for 2years. At the end of the first year without t3 is when a D test was done that was low. My t3 lab went back down as well to within range but barely.
              At the end of the 2nd yr I had been on vitD for a full year and my t3 was still low barely within range.
              Also during those 2 yrs my legs have been scaley dry and my ankles more filled with what I thought was spider veins. My legs will not tan like my arms. So, I put my legs in the sun for a full hour this summer and they didn’t even burn.
              I have read that sun exposure of a large area of the body is needed to soak up vitD so I guess since my legs won’t tan I only soak up sun and D via my arms.
              Showed my ankles to the doc and he said they were varicose! I don’t have obvious varicose veins in my legs. He sent me to the vein center for a leg ultrasound and they found that I have sever reflux of the sephonous veins in both legs-bad circulation. Now I understand the dryness, pooling of blood at the ankles, no tan and possibly low D. I’m having the sephons ablated in January after the required 3-months of compression socks. The ankle veins started after 2002 when I started my 3 1/2 yr undiagnosed hypo period of time. They have gotten worse with time. But the dryness and no tan since the lack of t3. Will be interesting to see if D changes next summer. Back on t3 for 7 months but definitely not reversing the dryness or tanning ability. Also read that long standing hypo and pregnancy can cause sephon vein reflux.

              • hi Becky….yes i can confirm this with my own experience too!, this summer my ability to tan was the best in the last 15 years, my TSH before summer was 2.77 but i was on a good therapy and i felt good so i did not chnage anything, after the summer it fell to 0.7, and i never felt better in my life, also everyone noticed my tanned skin and i was really not doing much different then before, becasue if you would be too long in the sun you would get burnt…..so yes its true when you are hypo , you can not tan!…..also i completely chnaged into much happier person, now i tried to lower my t4 by only 10% and it did not work out, i was thinking that TSH at 0.7 is a bit hyperish but it looks like….TSH is not the definitive guide when you are on a therapy……yes this is what i understood even 2 summers ago, that every summer raises my health, so to sruvive winter time its best to be loaded and not defficient in anything let alone vit D, after 5-10 years of vit D defficiency i think people can develop all sorts of health issues…..thats why people get sick in the spring when their vit D lvls are lowest, hence this spring tiredness…etc…..this is why vit d is so important but as you noticed the ability to produce it falls with age! so its like any other hormone, as we age we loose it….unfortunately…..

              • i think taking too much t3 is not good as well, i tried it…..it must be balanced therpay i understood that you are on a combined therapy t4+t3, but you take too much of t3 i di dnot feel that good on the same therapy as i take now, but it improves gradually over time, also you must get the feeling of rested body…and never push it too much into exhaustion, we who have these problems should never exhaust ourselves….this is as important as taking good therapy…..if you take too much t3 the body knows it and reduces t4 in the body also makes tsh going lower! so that the process of conversion from t4 into t3 is lowered….unf there is no other way to heal that mechanism unless filling up the gaps in minerals, in other homrones..the body needs support from various sides……i took progesterone , but very small doses not the one like 20 mg, 2 mg per skin was enough….i did mistakes there taking 30 mg for 35 days….etc i did every single mistake….but how the body works with t4 and t3? body must be soaked with t4…..then in converst into t3…if there is enough ingredients..if there is not…you have to wait , rest, eat well, do all the good things for yourself…and go in the SUN! during the summer…..and miracle may happen! it happened to me, and i was not even aware how good i am doing….the same as i was not aware for 8 years that i have problem :)…..i wish you find your way…it takes a lot of thinking about your life ….i dont eat glutens , but eat all the rest, one can get easily lost in all the various info that you get to….but try to think how you lvied last time when you were healthy…..and how you felt….this is where you should aim…and go in the sun it helps in t4 to t3 conversion! so much that i start breathing properly in only 3-4 minutes in the sun, but the zenit sun not late afternoon

                • yes exposing all the body is the best, i take break from the office sit on a bench and sun my legs and arms….even belly :)….its that good, and take vit C if its summer! becasue it must go together, vit C is also great energy booster! sun can make you feel exhausted then take vit C and you will see the miracle happening!…i tried all possible suplements, spent so much money….nothing worked except few logical things like, a little bit of zinc, magensium, selenium, b complex….everything else you should take from fruits, vegetables, meat cheese fish….whatever you like to eat….no restrictions except sugars…and gluten stuff….if you eat live food you will thrive :)…grains are not live they can be stored for 2 years! all seasonal and you will see miracles, also i reduced exercising increased salt a bit this was tremendous help……little by little, it doesnt happen over night! but do all the good and thats all you can do….and be patient….dont obsess over therapy…beeing on too much t3 gives you a feeling of beeing healthy quickly, but …….try not to go above 5 t3 at least if you can not live without it….i never went above 3t3 this was enough …although my doc siad i can take 6 mg t3 🙂 i had tinitus when i was taking 6 t3…on 3 t3 it was perfect…now i am on a 2 t3 and its even better :)….i dont even feel if i take 2 or 3 i just get tinitus if i take too much…..i learnt my body, we all have to learn about our body!

            • Fluctuating T3 while consistently hypo undiagnosed makes sense for my hypo palps! I get that if the lab minimum is 78, I could have been at 55 low and food, sugar caffeine intake could cause a jump to 65 (if a lab could track that…). Then I would get a flutter from the increase-although still low -not “hyper”. I only remember having the palps whil hypo. Even when I went through thyroid storm when I was given prednisone for 3 to 4 weeks for tennis elbow – this is what brought me out of my severe stages of hypothyroidism. – I didn’t get palps. But, I felt like my body was going into shock and had to lay down for fear that my body was going to shut down . And then the doctor put me on thyroid medicine without listening to me. I asked him if there was a chance I could be hyper he said no there is no way. The reason I ask is because the uptake test technician came out before I left and asked me why I was there. I said hypo. He said I will get that rechecked. I looked at the test long after the doctor gave me my thyroid medicine and I was producing very healthy amounts of thyroid hormone. Nevertheless, I did with my doctor told me to do and I started with 25 µg and ramped up to 100. About a week to two weeks after taking 100 I start feeling symptoms of hyper- faster heart rate and hot. So what the doctor should’ve done is tested me again or at least taking my pulse before he gave me thyroid medicine. So of course I stop taking thyroid medicine altogether for about three months thinking that I did not need it. While I was coming down off the thyroid medicine I had pounding heart palpitations that started with a jabbing feeling in the back. My thought is that it was due to excessive release of adrenal cortisol. I say this because they ran cortisol test at about three months off thyroid med and I was in the Cushing’s range. At that point it was time to start squeezing thyroid into my body again. Armor with active T3 was killing me at the lowest amount I could take. So I eventually switched back to levoxyl and found out I need to add time released to t3 at 14 µg per day. Stop drinking tap water and I had to reduce my T4 to 112 from 125. Also on my own reduced myself to 1 T3 7 µg pill per day. Then on a trip in Jamaica my T3 which had to be refrigerated found a itself in a dead refrigerator. That ruined the T3. So I just stop taking t3 altogether -thought maybe I can do it now since not drinking tap water increased my t4 and the doc reduces to 112. It didn’t work and I was at the very lowest within range on T3 labs again, so I’m back on T3 for 7 months now. 5mcg split for 3 doses. No heart palp/ flutters.

              • oh yes yes yes i know it all!! i was on a wrong therapy for 3 years , was upped to 150mcgt4!!…it is disaster to push hypo people and push their TSH in 6 months let alone in several weeks, its total disater and not understanding of metabolism!…..if i could go back i would stayed on 65 mcg for a year before upping it and adding like 1 mcg of t3……becasue just like you my adrenals were under great stress when i was on 150 and my body was not able to produce that energy thyroid is gass peddal! if you dont have fuel you cant produce energy!….fuel is progesterone..and all the things you misss in the body….you should have taken progesterone for elbow!! progesterone works tremendously antiinflamatory! a little bit 2mg not 20 daily….and it is not a lifelong hormone it can be stopped ….its miraculous, i put it on my knee….i was taking larger doses at the begining because i was experimenting 🙂 and it felt soo good….until i got issues becasue taking too much……

              • you have to find a therapy that you can take for a year….without changing, if your t3 goes low it means that there is too much of t4…….the best for you would be to be on t4+t3 in this 98%t4 and 2%t3….try like this…112+3 sounds like possible maybe it will be 120…or 107….you will know it in a month time……..unf i dont know your thyroid ultrasound…and everything about you to be able to say…but i trust doctor who did that for 50 years and he said he is sure of this that the above t4+t3 ratio is the only way to go……t4 is just for few …..t3 alone i wont even mention…..if you thyroid is sick, then do what that gland is doing not something else….if you are sick elswhere try to fix that…and not take t3 shortcut, t3 creates ATP, so it gives energy..but why body created t4 and every organ has its own way of converting t4 to t3….this is why taking t3 in doses larger then your thyroid makes to me makes no sense

                • maybe you need 65 t4+1 t3….dont know your numbers…, you should aim for t3 to be above 4! thats enough! mine is 4.1 and i have enough of energy!……if your ft3 is 5 this is defo sign you take too much of t3….when i was on 6 mcgt3 i had my ft3 5.1! and this felt good, but i had tinitus, and i did not want to go above physiological doses…now after a year i feel soo well 🙂 so its not all about thyroid only! there is much more to it all, and to the numbers!…..

              • you have to know what kind of an energy person you were before, i knew when i was on 5-6 mcg t3 that its not me! that it was false!….i di dnot want to take shortcuts…and today i am so grateful for beeing logical! it payed off.—–yes your blood numbers can guide you when you dont feel well…..but try to find some therapy that you can stick to for a whole year before changing!…..if your thyroid is very damaged then you need 100% of hormones …so 100t4.3t3 sort of lvl…..if its 20% damaged then you probably dont need that much but maybe half….my thyroid is like 40% damaged and 100% replacement i need! i cant go lower …..for now…and probably for another 10 years 🙂

  45. Perhaps someone can suggest a protocol to help me. For over15 years, I have been having 3 month cycles of hair loss and sleepless notes, only to be followed , 3 months later, with normalcy. I have had every endocrine and blood test and all fall within normal ranges, but, consistently, my total T3 is low, 100; and my TSH is low, -837; my free T4 is 1.2; and my free T3 is 2.72. My Pituitary tests are mid range. No one can seem to suggest what my problem is. One day, I took a half a tablet of porcine thyroid extract and I never felt better, but I don’t wish to self medicate without advice of a medical professional, but every one I go to refuses to accept that I have a problem. One even suggested I see a psychiatrist! Any suggestions?

    • So free T3 is supposed to be in the range of 3.5 to 6.5? Yours is 2.72. T4 max is 1.8 and yours is 1.2. Ask your doctor if he thinks it would kill you to take the next level of t4 above what you’re taking. And add 5mcg time released t3 to start. If he is not agreeable then you could try calling a compounding pharmacy near you to ask them what physicians prescribe compounded T3.- preferably the Doctor Who prescribes the most. That doctor may be more open to helping you by adding T3 at least or prescribing armor if you think that will make you feel better. They are his best taken in at least two doses per day. So whatever is prescribed break the pill in half and take it morning and night. I couldn’t handle armor. I use time released t3 and have my t4 near the top of the range. Tsh stays around .05(nonexistent- 8 years ). Psychiatrist? Not until the thyroid is right.

    • I was just reading yesterday about Non-24, a sleep disorder. Read the second paragraph in particular below:

      From the website http://www.sleepreviewmag.com/2015/05/need-know-non-24/

      Instead of sleeping at roughly the same time every day, persons with free-running non-24 will typically find their sleep time gradually delaying by minutes to hours every day. They will sleep at later and later clock times until their sleep periods go all the way around the clock. Patients’ cycles of body temperature and hormone rhythms also follow a non-24-hour rhythm. This is the characteristic symptom in sighted non-24 patients, but also occurs in many blind patients.

      Other patients maintain a sleep cycle linked to the 24-hour clock, but their underlying circadian rhythms, as reflected in body temperature and hormone levels, continue to cycle with a non-24-hour period. As a result, these patients experience a periodic form of insomnia. When their body clock is aligned with their sleep cycle, they sleep normally. When the body clock is out of sync with the sleep cycle, they experience severe insomnia and daytime sleepiness. The periods of normal sleep and insomnia alternate in a periodic fashion over weeks or months. This pattern occurs mainly in blind persons with non-24 but is sometimes seen in sighted patients.

      Since the abnormal circadian function in non-24 affects not only the sleep cycle but also multiple cellular and hormonal rhythms (melatonin, cortisol, testosterone, TSH, etc), other symptoms such as severe fatigue and digestive and metabolic disturbances are common.

    • I was just reading about a sleep disorder called Non-24. I may have it because, like you, I have periods of relatively normal sleep followed by long periods of insomnia. I would recommend seeing a sleep specialist who understands circadian rhythm disorders.

      Below is an excerpt from the website

      Take note of SECOND PARAGRAPH in particular.

      “Instead of sleeping at roughly the same time every day, persons with free-running non-24 will typically find their sleep time gradually delaying by minutes to hours every day. They will sleep at later and later clock times until their sleep periods go all the way around the clock. Patients’ cycles of body temperature and hormone rhythms also follow a non-24-hour rhythm. This is the characteristic symptom in sighted non-24 patients, but also occurs in many blind patients.

      Other patients maintain a sleep cycle linked to the 24-hour clock, but their underlying circadian rhythms, as reflected in body temperature and hormone levels, continue to cycle with a non-24-hour period. As a result, these patients experience a periodic form of insomnia. When their body clock is aligned with their sleep cycle, they sleep normally. When the body clock is out of sync with the sleep cycle, they experience severe insomnia and daytime sleepiness. The periods of normal sleep and insomnia alternate in a periodic fashion over weeks or months. This pattern occurs mainly in blind persons with non-24 but is sometimes seen in sighted patients.

      Since the abnormal circadian function in non-24 affects not only the sleep cycle but also multiple cellular and hormonal rhythms (melatonin, cortisol, testosterone, TSH, etc), other symptoms such as severe fatigue and digestive and metabolic disturbances are common.”

    • Basal body temperature is the only way I am able to regulate my thyroid. I started with 30mg of dessicated thyroid (Armour, West throid, ERFA, etc). I monitor my temperature first thing in morning. If its 97.8-98.6, then I’m in a good range. If temp drops to 97.6 or lower, I increase by 30mg. Very few doctors are up on thyroid, so prepare to do battle to get the amounts you will need. I now take 390mg of West throid in a.m. and again in p.m. Most Dr’s are quite ignorant on correct dosage. Therefore, carry a thermometer with you. That’s the only help you’ll get.

    • Have you had your thyroid antibodies checked for Hashimoto’s disease? It can cause thinning hair and can cause your thyroid labs to look normal at times. It can also cause those fluctuating sleep cycles as the thyroid fluctuates between hypo and hyper. Good luck.

    • you have endocrine problem thats for sure, your symptoms tell this, dont ignore it and who ever sends you to psychiatrist for hair loss, needs to loose job,cause thats a sign that person has 0 knowledge.

      do you take any meds? you should check also progesterone lvl, vit d lvl ,ferritin, b12….to see where you stand …..and then take proper hormonal therapy

  46. I’m at my wits end! I just got my newest labs back … I am currently on NDT but the day of the labs I didn’t take my pill and my numbers came back still lower than they should. TSH 0.57, free t4 0.9 and free t3 2.3.

    Sigh. I have microscopic colitis and celiac and spent all of last year getting MRIs done because every single hormone in my body was low. I am 34 year old female. My estrogen at one point sat at 23 yet fsh, lh, progesterone- all of them were significantly low. No pituitary tumor was found and at this point no one can offer an explanation or how to fix it. Last year I was pretty sick w colitis and by August I started putting on weight very quickly- 5 lbs a month until I hit about 25 lbs. I can’t lose a pound to save my life regardless of what j do. I am on nature throid (which has been doubled and tripled over the course of the year) and I still feel depleted and exhausted. I follow a strict Paleo diet and I also take LDN. Any ideas? If it isn’t the thyroid that’s the problem/ how do I fix this? HPS axis issue… Obviously with the pituitary gland this may make sense but I just don’t know how to solve it. Do I up my thyroid medication? Thank you!!

    • Hi Tori,

      Assuming that your only medications are thyroid replacement and low dose naltrexone, your low FSH and LH makes one wonder about pituitary malfunction caused by something other than a pituitary tumour. Pituitary underfunctioning is called hypopituitarism – here’s a link to the Mayo Clinic handout on it – http://www.mayoclinic.org/diseases-conditions/hypopituitarism/basics/definition/con-20019292 . Pituitary inflammation is one of the causes of hypopituitarism and is called hypophysitis.

      Given that you have celiac disease, the papers below on the association between celiac disease and hypopituitarism/hypophysitis may be worth discussing with your doctor?

      I hope you find the answers you need soon . . . .

      Best wishes,

      http://www.ncbi.nlm.nih.gov/pubmed/18463048 (abstract only)
      Endocr Pract. 2008 Apr;14(3):381-8. Celiac disease and the endocrinologist: a diagnostic opportunity. Fisher AH1, Lomasky SJ, Fisher MJ, Oppenheim YL.
      1 Endocrinology and Diabetes Associates of Long Island, Rockville Centre, New York 11570, USA.
      (excerpt from abstract) Celiac disease has been associated with numerous disorders, including several conditions treated by endocrinologists-type 1 diabetes mellitus, autoimmune thyroid disease, Addison disease, osteomalacia, secondary hyperparathyroidism, vitamin D or iron deficiency, fertility problems, hypogonadism in men, and autoimmune hypopituitarism.

      http://www.researchgate.net/profile/Barbara_Predieri/publication/6889850_Growth_hormone_impaired_secretion_and_antipituitary_antibodies_in_patients_with_coeliac_disease_and_poor_catch-up_growth_after_a_long_gluten-free_diet_period_a_causal_association/links/0912f511fa0de4915c000000.pdf (full text)
      Eur J Pediatr. 2006 Dec;165(12):897-903. Epub 2006 Aug 3. Growth hormone impaired secretion and antipituitary antibodies in patients with coeliac disease and poor catch-up growth after a long gluten-free diet period: a causal association? Iughetti L1, De Bellis A, Predieri B, Bizzarro A, De Simone M, Balli F, Bellastella A, Bernasconi S.

      http://press.endocrine.org/doi/full/10.1210/er.2001-0035 (full text)
      Endocr Rev. 2002 Aug;23(4):464-83. Endocrinological disorders and celiac disease. Collin P1, Kaukinen K, Välimäki M, Salmi J.
      (excerpt from abstract) The endocrinologist, especially, should maintain high suspicion and alertness to celiac disease, which is to be found in 2-5% of patients with insulin-dependent diabetes mellitus or autoimmune thyroid disease. Patients with multiple endocrine disorders, Addison’s disease, alopecia, or hypophysitis may also have concomitant celiac disease. Similar heredity and proneness to autoimmune conditions are considered to be explanations for these associations

      http://pathology2.jhu.edu/hypophysitis/pdf/483_2000_Collin.pdf (full text)
      Scand J Gastroenterol. 2001 May;36(5):558-60. Autoimmune hypopituitarism in patients with coeliac disease: symptoms confusingly similar. Collin P1, Hakanen M, Salmi J, Mäki M, Kaukinen K.

      • Gillian!

        Thank you for the reply. Yes I have had an MRI checking for pituitary tumor which wasn’t found… I believe some of my other hormones have come up a bit? But definitely not optimal by any means. Every doctor and endocrinologist seems to be baffled and no one can give me a way to fix it! I will look into the article that you have linked! Thank you kindly for that. It’s very frustating to have an issue that no one seems to have a grasp on! I’m not sure which direction to move next. Between the thyroid and celiac and colitis I also have a genetic mutation called MTHFR -(677 homogenous) and I’m not sure how it all relates together. Sigh. Thank you again for taking the time!

    • Hi Tori. If my levels were at the low end within range I personally would feel bad too. I was on my 5th day of augmentin for a tooth abscess when I had a 6 month check up scheduled for thyroid. My T4 went down to the mid point within range and it took 3 weeks to feel better. My cholesterol also went up 30 points and the results also showed I went through menopause(haven’t had the symptoms though so I am very suspicious). I take levoxyl 112mcg and it keeps my free t4 at the top of the range. My Tsh is always about .05 (non-existent basically). I do better with the T3close to the middle within range. By topping out t4 I get best t3 conversion I can get. If I add 5mcg of t3 it is enough. I prefer time released t3 once a day. I tried not taking t3 for 2.5 years and there is a tremendous difference in my skin, joints,etc. I feel better. My doctor told me last visit that there is a definite correlation between thyroid and other hormones. Tried armor years ago and it was too inconsistent. Might want to focus on improving thyroid labs. Don’t give up.

    • Take your temp! Odds are your temp is below 97.6. Your body cannot heal anything if it’s fighting just to keep your vital organs warm. T4 won’t help you. Most people cannot convert synthetic T4 to the necessary T3. Can’t get your doctor to get past his paperwork to look at his patient? You can get dessicated thyroid without a scrip at pharmaoffshore.com. But read my previous post concerning how to regulate your body temperature. I am a multi generational hypothyroid. Family members have hypo, hyper, Graves, goiter, etc. We all prefer natural to synthetic.

    • NDT has bad ratio of t4 to t3 ….the ideal one 98% t4-2% t3…so if you take 100 t4 you should not take more then 2 mcg t3…….for majority people…..your NDT has way too much t3 in it….also you will never feel better if you dont balance out all hormones: progesterone, vit d, ……only then your problems will fade away slowly….

  47. I have been getting full hormone replacement therapy for 16 years. I had two pituitary surgeries and lost the gland in the second one, I still have the stalk. I am still sluggish and have to force myself forward. I take 150 mcg of synthroid, 15 mg of
    Hydrocortisone, .04 mg of genatrophin (5x week), 100 mg test (per week). Is the T3, T4, TSH covered by the synthroid? Yes, it is very low.

    • Hi Anthony,

      The pituitary regulates more than growth hormone and testosterone, I am a bit surprised that you are not on some kind of replacement for the other things the pituitary does. You have probably already looked into the other hormones it regulates, but just in case:

      If the TSH and T4 are low, then you probably need to increase the synthroid. If just the T3 is low, that suggests that your body has some other illness pattern going on (and is normal).

      I cannot imagine, without a pituitary that you would feel good at all. Losing my thyroid, made me intimately aware, that we do not have adequate replacements. And it can be a fine art to get the replacements right. For me, my thyroid needs shift…sometimes I need more, sometimes less…and any deviation from what I need makes me feel yukky.

      I wish I had more to offer in the way of ideas. Keep looking, because eventually you really will find your answers.

      • she needs to replicate thyroid secretion in physiological doses so something aroudn 100 t4 and 2-3 t3 for a start….i was taking 106 t4 and 3 t3 for a year it helped me a lot…..i feel healthy again!

  48. So, I am new to this.. i have been feeling like i have all of the symptoms of something wrong with my thyroid so i went and got a panel done on my own. My mom and older sister both have hypothyroidism. My results came back as the following. ..
    T4 : 8.9 which is normal
    Free thyroxine index: 1.8 which is normal
    Tsh: 1.84 which is normal
    Then T3 uptake: 20 which is low.
    I haven’t shown it to my doctor yet but, im going to. Now I’m trying to figure out whats wrong with me???

    • I just thought of something else. I am also vitamin b12 deficient and was diagnosed with irritable bowel syndrome over 12 yrs ago. I can’t drink beer without it getting me sick. People have said that i may have celiacs but ive never looked into it. Now that i have low t3 and b12 those both can be signs of celiacs? Now, i think that i may finally ask about it with my doctor.

    • Hi Katie,

      T3 uptake and T3 levels are different things. You will want to test FT3 (Free T3) to check T3 levels.

      That said, in cases of normal TSH, normal T4, and low T3 is usually a sign that another disease process is going on. This is a normal thyroid response to other illness…so, not a thyroid issue per se.

      B12 will mess with all kinds of things. My doctors recommends Adeno-B12, which works very well…or hydroxyl-B12 which is a liquid. Again, not that adding B12 doesn’t go a long way in helping you feel better…to me is suggestive of another disease process taking hold in you.

      The question is what? And unfortunately, western medicine is not set up to help people figure out what is wrong, and they really fail us when it comes to things like this.

      If you have access to testing, I would recommend these:
      CBC w/ Differential
      RA Factor
      C-Reactive Protein
      SED Rate

      These will give you a good idea what is going on. The CBC with differential will tell you what white blood cells are doing…you have different ones for allergies, for bacteria, for viruses, etc. The ANA and RA Factor are standard auto-immune tests. The CRP and SED Rate are inflammation tests.

      They also might be fine, and that does not mean you are fine…it just helps you know where you are in the disease process.

      If these tests are fine, the next factor to consider is diet. Diet can really affect how we feel, low energy and brain fog, and overall yukkiness. When diet does this, it creates the hot bed for disease processes to take root and grow.

      Ignoring what the “experts” say, because everyone and their brothers think they know…I personally have had the greatest success in trialing an elimination of all dairy and all grains. This is not easy to do for long without making major adjustments…but within a week if you can keep at it, you should see some improvement…and then after a week when eating it again, a reaction…and then you will know for yourself how you might be contributing to a bad out come for yourself.

      That is what steps I’d take next.

      Best of luck, and I hope you feel better soon.

      • Faith,

        I hope you don’t mind me butting in hear but that response is so informative. I have low-normal T3 and have severe CFS and Fibromyalgia. I’d love to get a better understanding of my illness. My GP said, “Just let me know what tests you want” and I didn’t have a clue. The Open Medicine Institute gave me tons of blood tests, but most of the tests you mentioned weren’t among them. Are you accepting new patients by chance….?

        Also, I have never had GI issues. Dr. Kaufman at the OMI gave me what I think was a rather dubious test for SIBO (the lactulose hydrogen breath test). It suggested that I had SIBO, so I went through two weeks of hell on Rifaxan and Neomycin. They didn’t do anything except make me feel even more horrible than I already do.

        So, my question to you is: If a person with CFS and Fibro has no GI symptoms, would she benefit from the diet you suggested above?

        Thanks again!

  49. This is a very interesting article. I was put on synthroid for just being borderline hypothyroid. It really helped for a short time as they said it was post partum. Unfortunately I was kept on it too long and now I’m suffering from heart palpitations and OCD and a menstral cycle that lasts up to 14 days . All of this is hormonal related and I have had no help from Drs except saying I need to see a psychiatrist and also put on birth control to regulate periods . I eat a paleo diet I’m active for the most part . now these heart palpitations happen right before a menstral cycle. No dr believes me that this is from being treated with a thyroid medication. They all say it’s a coincidence. I can’t afford to go to a naturopathic dr and all the Drs want to do are more meds and I refuse . I tried taking serotonin drugs for the OCD /anxiety and everything made it worse so I stopped. I would rather deal with the anxiety then have it worse. I went to a cardiologist and I do have mild mitral valve prolapse but I have never had any of these issues till after taking synthroid . Now I’m on birth control pills because a dr says I’m peri menopause at 35 years old. This is getting ridiculous. I know the synthroid have done something to my hormones but blood test come back normal and everything normal . Is this truly a coincidence or has the synthroid really messed up something?

    • Hi Tasca,

      I am sorry that you are going thru all this. Too much thyroid does cause heart palps as a symptom. However, it shouldn’t cause an actual problem with your heart.

      Most doctors do not run all the tests, and depending on your personality and the doctor you are dealing with you might be able to argue for the full body of labs.

      TSH is the pituitary’s request for thyroid
      T4 is the storage form of thyroid and is what Synthroid is
      T3 is the active form, your body has to convert T4 to T3
      RT3 is the inactive form

      If you had the T3 test and is normal, then I would suspect your heart palps are due to the heart issue. But chances are, even if the T3 is in the normal range, yours is too high for you. Some swear to only feel good when T3 is at the top of the range, others only feel good when it is at the lower end of the range.

      Good news, you do not need a nutrapath…look instead for an “integrative” doctor, most large clinic systems have them. They combine western medicine with alternative things and supplements….and they are covered by insurance.

      In a normal body, even taking too much thyroid should cause your thyroid to make less. Stopping the thyroid should cause everything to return to normal. Your did not.

      The bad news is, that despite all our wonderful research in the world…doctors really do not know much about the body. They don’t know why it goes wrong…95% haven’t a clue what was in their books from med school. The last two years of medical school is ONLY matching symptoms to medicines (hence, the practice of medicine). That is pretty much all they can do for you. They even say diagnoses that they don’t really think you have because they have to put a diagnostic code in for billing to justify the medication they gave you.

      Now we, the patients…we need them to know. We need them to tell us what our body is doing and why…and we need them to fix it. They cannot do this.

      I know that doesn’t help you get your answer much, but I hope it helps you get some perspective. It is sad for me to think of all the millions of people out there suffering, needing answers, and all the doctors that just shrug their shoulders…and I am sorry that you have become one of them.

      I sincerely hope that you find your answers…please don’t give up. Sorry I didn’t have a better answer for you.

    • Hi Tasca. Low thyroid can cause a lot of the symptoms you have-anxiety, long menstraltrial cycles, heart palps. I had all of these when I was undiagnosed. I ended up getting a noninvasive ablasion to end my cycle because it was so painful and lasted so long. I did not do well on synthroid once diagnosed so since 2007 I still take Levoxyl. Synthroid caused some unusual symptoms for me. Check your heart rate and body temp. If you of are taking too much your body temp will be a title elevated and heart rate too fast. I found the best way to take my temp is under the arm and add 2degrees. I had heart palps until I was adjusted on thyroid replacement. I was hyperthyroid at one point and did not have palps-just a fast heart rate. Do you feel cold when most others are comfortable? Just because you are within range on thyroid tests doesn’t mean you are taking enough. Look at your labs and see if you are within range low or in the middle on T4. You may need more to get the anxiety and heart palps to settle down.

      • Hi Becky,
        I’m thought that anxiety and heart palms were due to too much thyroid hormone and not too little? I’ve always thought that was the “norm”??

        • I was undiagnosed for three and half years. My symptoms where much worse towards the end. In the beginning when I was going down I was extremely anxious. When I got really really bad I didn’t have the energy to be anxious. I had never had palps before and I thought I just had cough and clear my lungs. When I talk to my endocrinologist after I was diagnosed he asked me if I had palpitations during that time. I told him maybe that was what the feeling was when I thought I needed to cough. My heart rate was about 58, body temperature was low and my blood pressure was about 90/55 at that time. When I was hyper thyroid I would just get tired really easy from walking up the driveway to get the mail or trimming a couple of branches off of the fig tree. It didn’t take much but I didn’t have palpitations I just had a fast heart rate. Not to say that hyper could not cause palpitations and anxiety too, but body temp and heart rate is a pretty good indicator of if you are too low or too high.

        • When I was undiagnosed hypothyroid, my heart palpitations felt like flutters. After I was diagnosed I decided I was going to stop taking thyroid medicine and I had pounding palpitations bad enough that I had my 18 year old take me to the emergency room.

          Abnormal thyroid function
          An underactive (hypothyroid) or overactive thyroid (hyperthyroid) intensify heart palpitations at rest. Palpitations combined with rapid heart rate (>100 bpm) are typical signs of hyperthyroidism. Get a thyroid (TSP) test and if your thyroid is not functioning correctly, that could be the cause. A beta blocker like atenolol or propanolol usually helps relieve the palpitations. Heart flutters when lying down from uncontrollable anxiety or abnormal thyroid level usually can be controlled with a very benign dose of prescription toprol XL which will slow your heart rate and thereby decrease the number of palpitations you feel. Related reading: Complete Symptoms of Hypothyroid / Low Thyroid Functioning.

  50. I suffered fatigue. My immune system was scanned and determined to be hyperactive. I was diagnosed with chronic fatigue immune dysfunction syndrome based on a 42-page immune scan.

    I have suffered low red cells for decades. In the mid-90s, my red cells fell to 3.9. I started Epogen alfa to stimulate my red cells. It brought my count back to 4.5. But I ran out money could not buy the drug. I went to an older doctor and he told me T-3 would boost my red cells. I started taking 10 mcg day and worked up to 25 mcg day and with in 3 months my red cells were up to 5.2. I stayed on low dose t-3 for the next 10 years. I would skip a couple of days every week and go off every 2-3 months for 2-3 weeks and then start back again at 10 mcg. But in 2005 I could no longer get a prescription because I am in the Philippines where t-3 is not sold.

    My red cells and hemoglobin started falling. By 2010, I was down to 3.4 and hemoglobin was under 10.

    I was finally diagnosed with myelodysplastic syndrome (5q syndrome). The latest research indicates that 5q syndrome is as likely as not caused by inflammation. My red cells are not down to 2.7 and my hemoglobin under 10. I tried Epogen again, but started getting small numbers of nucleated red cells in my blood


    I find Dr. CHRIS KRESSER’s connection with inflammation and low T-3 to apply perfectly to my situation. My inflammation has been proven. My MDS has been officially diagnosed by bone marrow examine. I felt so much better on low dose T-3. The problem is that main stream medicine has been scared away from this hormone by over abuse by diet doctors.

    I think inflammation-induced low t-3 might be associated with anemia far more than doctors even know or care to talk about.

    I need to find a new supply.

    Thanks, Dr. Chris.

    [email protected]

    • Hi David,

      Wow, I am impressed by all the work you have done to figure out your illness. My daughter also has low red blood cell count and some abnormal blood cell shapes…so it touches close to home.

      I cannot explain, medically, why your numbers improved on the T-3, but I can say that often when people are sick with something (as you are), our convert less T-4 into T-3 (labs look like normal TSH, normal T4, low T3)…and when sick our bodies may even over-convert T-4 into unusable RT-3 (labs look like normal TSH, normal T4, low or normal T3 and high RT3). By taking T-3 you bypass your body’s need to convert it and it makes up the difference of what was probably already low T3 numbers, helping your body work better and helping you feel better.

      What I do know about the low hemoglobin and blood cell numbers is that the body needs all three things: iron, folate, and B12.

      Hope that helps, hope you feel better soon…

    • I agree on your inflammation point! I’ve had Hashimoto’s for 14 years, and for several years, I took VERY large amounts of curcumin daily (2,000 – 3,000 mg, sometimes more) to reduce inflammation from an inner ear condition (Meniere’s Disease). I think the high doses of curcumin MUST have reduced inflammation and been helping me to avoid Hashimoto’s depression. Because, in May 2014 I was in the hospital for 3 weeks, and then stopped taking the curcumin. When I got out, there was a lot to deal with, and I did not take the curcumin any more, because my ear condition disappeared (because I stopped taking porcine thyroid meds.) BUT, depression started like I HAD NEVER EXPERIENCED IN MY LIFE and I am STILL grappling with the depression. I am going to start taking 3000 mg daily of curcumin and see if it helps the depression. Before May 2014, I was careless with my diet, ate gluten, sugar, drank fluoridated water, alcohol, didn’t supplement vitamins and minerals, didn’t use progesterone cream, but STILL DID NOT have depression! I think it MUST HAVE BEEN BECAUSE I WAS TAKING SO MUCH CURCUMIN!! (Now, I very carefully address all areas to help the Hashimoto’s – clean diet, vitamins, minerals, no chemicals, progesterone cream, but I still have the depression).

    • I have researched T-3 and red blood cells for years. A lot of weight lifters take T-3 to build muscle mass. The big side effect for them is excessive red blood cells. It is recommended that they donate blood every two months. Wow… I would like to have this side-effect. If you are not aware of T-3 and increased red cells I suggest you take a quick look at PubMed. And look at some of the body-builder website. Anyway, Thanks for a great website.

      • hi i always had bit larger amount of red blood cells…..for a female on the top of the range, after i started taking thyroid supplements it fell not significantly…but i suffered anemia! if you have iron problem there is no way…that you will feel better on any hormones…..anemic people must avoid all exercising! do a lot of rest and take thyroid supplements….only then your iron may slowly improve…..with improved iron you will be able to use t4 better and convert to t3……this is my example! my ferritin was always below 35! its 36 now for the first time ever and i am not supplementing iron…..for a year now! it improved only becasue i am on a good thyroid therapy, i imporved my other hormons progesterone, vit d, and most important! i stopped swetaing and exercising! and taking a bit more salt then before…….and results are miraculous for me becasue i was not able to improve my ferritin for 7 years!

  51. You asked for feedback from anyone with experience with supplementing thyroid meds with T3. Well, I suffered with hypothyroidism for years because doctors kept telling me that my TSH was fine, so it could not be a thyroid problem. Finally I read Dr. Barnes” info on basal temperature as an indicator of thyroid issues. I finally convinced by doctor to prescribe thyroid med, Synthroid. Over the next 15 years I was increased up to over 200 mcg of T4 and still never got rid of my lingering hypo symptoms.

    Only after finding out about the importance of Free T3, and that it correlated best with hypo symptoms, I was able to convince my current doctor to test for it. I was very low in the range, even though my Free T4 was at the top of its range. I convinced my doctor to switch me to NDT med in order to raise my Free T3 level, and after some tweaking I felt better than I could even remember.

    Then several years ago when Armour was not available and the doctor put me back on T4 med, without changing anything else, I gained 18 pounds over about 9 months. I also came up with bad acid reflux, and also carpal tunnel syndrome. Needless to say I also had little energy and had to sleep a lot.

    As soon as Armour was available again I switched back and in just 3 days the acid reflux was gone. Within a week the carpal tunnel issue was gone. I started to have more energy, and over the next 8-9 months the 18 pounds went away, with no other change to my diet and exercise.

    I cannot fathom why doctors continue to be taught in med school that TSH is basically all that is needed to diagnose and treat a hypo patient (with T4 meds of course). Even the professional thyroid organizations preach the same. Yet there is much scientific evidence that TSH doesn’t correlate well with either of the biologically active thyroid hormones, Free T4 or Free T3, much less correlate with symptoms, which is why we go to see doctors in the first place. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as necessary to relieve symptoms, without being constrained by resultant TSH levels.

    I went through 40 years of frustration with being told that all my symptoms were not thyroid related because my TSH and Free T4 were within the “normal” range. Finally I learned differently from an internet Forum and got my doctor to reconsider my treatment, and add a source of T3 to my med, with great success. Now that I know this, I hear from people every day with similar stories of inadequate testing and treatment. I have written to the AACE and the ATA about this and basically been ignored. There seems to be little hope of any significant change in the foreseeable future.

    • Good to hear that someone else is doing well on a combination. I’m on a very small dose of WP Thyroid and find it very effective. Too bad the medical community seems to be lagging behind on this.

  52. Ok, I could really use some help right now. I have battled a chronic bacterial infection for the past 6 years. I have finally got my immune system up but now its attacking me. My labs never show anything and my levels are usually good. Last time i checked them my TSH was about .5 or so. I’ve done the conversion from FT3 and RT3 and it was ok too. (except they were from diff labs). Anyway, my doc thinks i have hashi’s along with another autoimmune disease and he put me on the Wilson’s protocol to see if it would help. I did 2 cycles on it and my temp would be stable at 75mcg and then drop. So finally he just put me on compounded instant release T3 (cytomel made me sick). My dose was 25mcg twice a day. That didn’t work very well so I had some compounded sustained release left over from the Wilson’s protocol so I have been adding that as well. This is what i take daily:
    Morning-30mcg SR T3 and 25mcg T3
    Noon-25mcg T3
    3:30pm-25mcg T3
    Night-30mcg SR T3
    This to me seems like a WHOLE LOT. A few times throughout the day I do feel better and the fog has lifted and my temp goes up to about 98.3. But then it drops and i have to take a nap. I have a 3 year old i have to take care of. Can someone help me?? I thought that much T3 would have side effects like heart palps, energy, insomnia, etc. I have NONE of those. It does give me a little bit of help with my hypo symptoms but I’m not sure what it going on. Should I add T4?

    • HI, Jess. My doc (nutritional) just told me to take Lauricidin –little tiny pills you swallow with cold drink 3 x daily (start with 1/4 cap and work up to one cap daily) to fight all kinds of virus, fungus, bacteria in your system. (Long story–the point is this may help with my autoimmune problems.) Luaricidin is an “oldie” that is somehow related to the anti-virals in mother’s milk and has no (wow–really?) side effects, but it takes the tummy a while to get used to it. I’m just starting–but hopeful.

    • Sorry no one answered you right away…I just saw it…and I don’t have much to say as I am not a big believer of the Wilson’s thing (for many reasons). What I can do is to restore some logic to the things you are dealing with.

      Core body temp is 100% controlled by the hypothalamus…and no where else. It is what raises our temps to give us fevers and lowers core body temp in certain disorders. I am not sure which chronic bacterial infection you are talking about, but if it is Lyme…I suspect that Lyme purposefully causes inflammation in the hypothalamus in order to reduce core body temp in order to not allow that many white blood cells to be made to attack it. If that is so, then no amount of T3 or adrenal whatnots will raise the body temp no matter what. The thing to address is inflammation. Regarding feeling hot and having low body temp…that is generally a sign of adrenal issues IF coupled with needing to eat all the time or losing it (which is the sure sign of adrenal involvement).

      That said…pretty much ALL illnesses, esp chronic, will throw off the body’s levels of things…that does not mean that the individual things are wrong, or that they need correcting…just that is what the picture of the illness looks like…if that makes sense? I know it can be hard when one doesn’t know exactly what is wrong and all they have is thyroid numbers (that is how my journey started out too, so I am very sympathetic), I often encourage people to keep looking for what is wrong.

      You ask about thyroid resistant…it is a hard call and more voodoo philosophies out there on the subject, however…one thing you should become aware of is what is called Vitamin D Reversal Pattern…many people have either a genetic defect (that they would never know) or a bacterial infection (like you)…this causes the over-making of the enzyme that converts active D (not D3, but the true active D) so as to over-convert it to the active form. Doctors (for whatever illogical reason) only ever test the storage form of vit D and for these two types of people, they will ALWAYS look low…but in fact and either not low or too high in the truly active D.

      This only becomes a problem when someone has normal thyroid numbers, but still feels low…because Vit D is an endo hormone and not a vitamin (despite its name)…and as an endo hormone uses the same receptor as the thyroid…and is more dominant than T3…so it boots the T3 out of the receptor.

      The test they run is the 25 D (it tests D3 and D2)…D3 needs to be converted twice to become truly active…you can think of D2 and D3 like T4. The truly active D is tested with the 1,25 D test…you might have to argue for the test, and is best to test both together. This 1,25 D test tests the truly active form. My personal opinion is that having a bacterial infection could cause a problem of too much 1,25 D and thus a thyroid type issue…but that is just my opinion and if the cost is not an issue, it might be worthwhile to get the test.

      Have you had an ANA or FANA test run?? That is a better way to determine if you have an immune issue. Immunology can get complicated, but a super good book on the subject is Dr. Datis K’s, Why Do I Still Have Thyroid Symptoms When My Lab Results Are Normal? which you might find worthwhile. My ANA, Anti SM, RA Factor, and something else I forget is positive. It is also well known that Lyme can cause autoimmune conditions…generally, Rheumatologists are the ones to see. Don’t stop looking into this if you have anything positive…it can be a real challenge to find an answer and a treatment…and don’t go by the internet stuff. For me, it took 6 years…1.5 of which I was made so much worse on antibiotics…to come up with Myastenia Gravis and an actual treatment that is helping! I wish someone could have told me back then that it would take a while and not to stop looking…which is why I say that.

      So called natural doctors and naturpaths can seem like a nice thing at first…but just as often as not they scan these sites and take their ideas from patients trying to figure things out and give us whatever we will buy into…even if it makes us sicker. Too much T3 can cause heart issues, even heart attacks and death…as well as bone loss…I have never heard of Wilson’s practitioners testing or monitoring those things which to me is dangerous and illogical and makes me doubt their practice…your health is worth more than the latest fad out there. The only people it might possibly make sense for is people with excessive RT3…however, people with chronic health conditions will have high RT3 anyways. I did, but for me I just switched to T3 only and have done well.

      Hope something I said helps in someway, sorry that I did not have more helpful info.

      • Hi Faith
        thanks for that insight -one of the things I have been chasing down for a while is the significance of the D enzyme mutation you talk about(which I have) and have not heard of its effect on T3 receptor site-most interesting.Can you recommend any other reading on this-I am specifically wondering how to supplement D with this mutation(I live in scotland so sunbathing is a rare treat!)
        Congratulations on your perseverance – I too am struggling to find answers for symptoms and it is hard but endlessly worthwhile.

        • Hi Judith,

          If you have the Vit D enzyme mutation (not sure there was an identified mutation or that it is picked up on the 23andMe.com test)…then you have likely discovered this by having run both Vit D tests (the standard 25,D and the 1,25 D test). The way you determine that there is an issue is that while your standard 25,D test was low…the 1,25 D test was either normal, ideal, or high. In such a case…if your active Vit D is high…why would you want to supplement????

          The standard 25,D test that doctors routinely run is for the storage form of Vit D…comparable to T4 for thyroid. 25,D…also known as D3 and D2 must undergo 2 conversions to become usable. Any medical book dealing with the subject should suffice to convey this information. The 1,25 D test is for the only active form of Vit D…comparable to T3. Just like you would not supplement additional thyroid hormone if T3 is over range…nor would you on the Vit D issue, so I am a bit confused.

          The other investigative resource is again, the medical books and studies that deal specifically with how exactly the body does things…in this case, how the endocrine receptors work. As well, what endocrine hormonal function Vit D has in the body…again, should be standard medical knowledge.

          Not everyone wants to take their research to the nth degree like I have…or cares to get that technical so I try to make it easier to understand. The area where this is an issue…the only area where this is an issue is with people who have normal thyroid serum levels, but who have solely hypo symptoms…in which case there are only two known causes: excess RT3 (likely because they have some underlying illness and the symptoms are most likely explained by the illness and not thyroid) or they are taking Vit D when they do not “truly” need it as evidenced by the dual Vit D testing. It is illogical to continue supping Vit D when one’s active levels are ideal or high.

          The problem is, because all the subsequent studies on Vit D never test the active form of the hormone (and because public perception is, oddly, that D3 is active when it is not) the studies are invalid on their faces. From there, each individual will have to make up their own minds about what they care to do.

          Hope that helps.

    • Go to Stop the Thyroid Madness website. they explain about how to take T3-only meds. I have the book and have joined the “For Thyroid Patients Only” Facebook group. Lots of good discussions there. The administrators will help guide you at the group. Elaine is one of them, and she is on T3-only and NDT together.

  53. Hi,

    I am a Hashi’s patient. I take 130 mcg of WP Thyroid and 13 mcg of Tirosint daily. I just had my blood work done and my TSH was .61, Free T4 .85, Free T32.6, Reverse T3 13. Although all the labs are considered to in the normal range, they’re all on the low side of normal. I have been feeling fatigued lately, have had headaches and insomnia. My basal temps range between 96.6 – 97.6. Any suggestions?


    • Hi Kim, I appreciated reading your comment. I am struggling with finding the right dose of thyroid hormone and do not feel well either. I don’t know your age or how long you have been diagnosed, but I started adding 5mcg T3 (generic cytomel) to my 88mcg T4 (synthroid) and my symptoms are no better even though my blood work “numbers” are now in range but on the low side of normal. I have been reading another post where it is suggested to take the T3 at night, so I am going to try that. Then maybe adjust the amounts of the T4 and the T3. If I could get my doc to Rx Armour or Naturethroid I would try that as well. Good luck to you!

      • hi i always had bit larger amount of red blood cells…..for a female on the top of the range, after i started taking thyroid supplements it fell not significantly…but i suffered anemia! if you have iron problem there is no way…that you will feel better on any hormones…..anemic people must avoid all exercising! do a lot of rest and take thyroid supplements….only then your iron may slowly improve…..with improved iron you will be able to use t4 better and convert to t3……this is my example! my ferritin was always below 35! its 36 now for the first time ever and i am not supplementing iron…..for a year now! it improved only becasue i am on a good thyroid therapy, i imporved my other hormons progesterone, vit d, and most important! i stopped swetaing and exercising! and taking a bit more salt then before…….and results are miraculous for me becasue i was not able to improve my ferritin for 7 years!

    • Hi Kim & Kathy,

      It can be a struggle to get to the right doses for you. T4 is a storage hormone and so anywhere in the normal range is fine. TSH is just the request for thyroid hormone, so anywhere in normal…or even lower than normal is good (if you have no thyroid). T3 is the active hormone and the number that you need to concern yourselves with mostly.

      RT3 comes into play if your TSH, T4, and T3 is normal and you still feel hypo…it is possible to over-convert T4 into RT3 which is not usable and thereby fill up the thyroid receptors.

      T3 being low is common when one’s body is struggling in some way, such as chronic inflammation or illness.

      Core body temps (despite what odd people on the internet believe) is 100% controlled by the hypothalamus (which incidentally also controls the thyroid). Inflammation in the hypothalamus is what causes the body to set its core operating temps lower. On the flip side, it is the hypothalamus that also causes the core body temp to rise and gives us a fever when we are sick. Unfortunately, doctors are not real keen on testing whether one’s hypothalamus is working correctly…instead just sup hormones to cover the problem.

      Insomnia is a symptom of too much thyroid hormone, rather than too little. Ironically, you can get the same fatigue and weight gain with high thyroid as you can with low.

      Doctors are probably not keen on increasing your thyroid dose slightly, so one thing you can do is to pay attention to avoiding foods that reduce its effectiveness. Walnuts and Soy is listed on the Synthroid sheet, but I found pretty much all “goitergen” foods caused me a problem on T4. Some people with thyroid issues insist that one can eat broccoli and the like, but I couldn’t and would become miserably symptomatic…bottom line is everyone is different and it is one thing you can have control over.

      Vitamin D is a nothing thing I have found interfers with thyroid. Your blood levels can be fine, but at the receptor level, Vit D dominates and doesn’t let T3 in.

      Lastly, it is possible to have genetic defects with your thyroid receptor. There is a test readily available on 23andMe.com for 99$ and you can search your code. I found I had a lot of defects with my thyroid B receptor which may account for why I need higher levels of thyroid in my system to be able to use it.

      As well, I did a stool test and found I was very low in something that helps you process endocrine hormones…also might explain my need for higher levels.

      Although all these tests can give an amount of insight, doctors do not know what to do with them or how to help so they are of limited personal value.

      Part of autoimmune conditions is inflammation, so the best recommend for body temp and overall function is reducing inflammation where you can.

      Hope some of that helps.

      • Thanks Faith, your post was very informative. I am trying to soak up as much information as possible before my Dr appointment on Saturday. I am also thinking that maybe I need to get rid of the Tirosint and just take the WP Thyroid. I also take magnesium, selenium and Vitamin E supplements, and a progesterone cream at night. I am 51 and in full blown menopause. It’s odd because I am hot all the time, yet my basal temps are low. I have read recently about Wilson’s Syndrome and that is why I am starting to track my temps. I know for sure I need to work harder at getting gluten out of my diet as well.

        Thanks again for your insight Faith.

        • FWIW, my sister and I (we both have Hashi’s) have found WP Thyroid so effective, that we’ve had to reduce our dosages due to hyperthyroid symptoms. If you try it, I hope you have similar success.

    • Hi Kim. My t3 was low within rang( 82& 78-181 is normal) I added 5mcg T3 to bring my body temp up and alleviate other hypo symptoms. TSH is .04-if this was brought within range I would be in bad shape- normal low is .5. With undiagnosed Hypo, I had horrible insomnia. Tirosent is a great choice. I am wondering why you are taking only 13 mcg when you could take more and possibly do away with the WP. I thought Tirosent was too expensive so I take 112 mcg levoxyl now with 5 mcg T3. When I took 112 mcg Tirosent I didn’t need T3. If you are willing to pay the price, I think Tirosent would benefit you greatly!

  54. Thanks for the informative articles!

    I had a total thyroidectomy just over three years ago, because I was diagnosed with cancer, but it ended up being nothing which I’m very grateful for, but also annoyed as you might imagine. But anyway, it is what it is. So, since then I have been on a roller coaster of trying to manage my hypothyroid symptoms even when my TSH is normal. To cut a long story short, over a year ago, I changed to T3 only medication because I believed that I had high level reverse T3. It really did help a lot, but after about 9 months, other issues arose like very high BP. I did some tests: my T3 was at the top of the range, and T4 at the bottom, and TSH in the bottom of the range, so, I slowly changed back to a combination of sythyroid 150mg and 12.5 of T3. And then, when I ran out of T3, I went back to 200mg of sythyroid. (Oh, I forgot to mention that I’m living in Jordan where the only thyroid treatment is synthyroid, and many of the tests are unavailable eg: RT3, cotisol saliva etc, and also Dr. Google is a safer bet than the doctors here who say things like…’there’s no such thing as T3′!). At the same time, my AM cortisol was very low at 4.2 (range 6-20). I got the ACTH test done and my adrenals were making the right amount of cortisol, so the cause of the low cortisol still remains a mystery. I started on a very low dose of cortisol 5mg twice a day. That helped a lot too, and I kept taking that until my BP started going up again (I also had my heart checked and everything was fine and my high BP was symptomatic, even though they couldn’t tell me what from). So, I stopped the cortisol. I have made sure to take a range of vitamins and minerals daily (Multi B, D 5000, zinc, magnesium 400, selenium, krill oil). In the last few weeks I have been feeling unwell again: shortness of breathe, dizzy, more aches than usual, hair falling, very tired. My BP is fine, sugar is normal, and so I did the usual blood tests: TSH 0.442 (0.27-4.20), FT3 2.92 (2.2-4.4), FT4 21.52 (12-22), AM cortisol 9.65 (6.2-19.4), PM cortisol 8.56 (1.8-6.5). My T3 is in the low range which is much lower than last time, and T4 is in the top range much higher than last time. So, I have reduced synthyroid to 150mg and added T3 at 12.5 again. But that was only yesterday, so I’m not sure if this will help. Oh, one last thing to add. I have always had a very low temperature, between 35.5 and 36. When I take T3, or cortisol it goes up a bit, but never to the normal range. Any ideas or suggestions would be greatly appreciated 🙂

    • Hi Lucy,

      You have done remarkably well treating yourself given your resources in Jordan, I don’t have much to add but a few things.

      One is to understand that Vitamin D is not a true vitamin, but rather another endocrine hormone (like thyroid and cortisol)…and being another endocrine hormone, shares the same receptors as the thyroid hormone does. In addition, it appears that the body has a preference for vitamin D over the thyroid’s T3…and so will prevent and even at time boot the T3 out of the receptor.

      As you know, blood tests only show what is circulating…and not what you are using. T4 is the storage form, so it is good being near the top of the range. I would not worry about the T3 being near the low end of the range, unless you feel crappy (which I suspect). That said, that might be explained by your taking Vit D. There are other reasons for symptoms of low thyroid and that might be possibilities too.

      Despite what it says all over the internet, the thyroid and adrenals have NOTHING to do with body temp. The body’s temp is controlled exclusively by the hypothalamus and inflammation in the hypothalamus can result in a lowered core body temp. low body temp is also found in many illness conditions like Lyme disease for one example. The hypothalamus ALSO determines and controls how much endocrine hormones one produces. But, again despite all the beliefs on the internet, adrenal hormones and thyroid hormones are signaled by very separate chemicals in the body…again, the signaler being the hypothalamus. I suspect that the body lowers its temp as a protective devise. it is also the hypothalamus that increases body temp (fever) when we are sick…and it does this because a higher temp is needed for white blood cells to attack whatever we are sick with.

      To me, your thyroid levels look great…even ideal. However, many doctors say it is more important how you feel. I am sorry that I don’t have many answers for you. My only suggestion would be to maybe try stopping the Vit D and see if you don’t feel better…or to slightly increase the T3 level??? Again, you have done an awesome job figuring this all out, hope something I said might help further your search.


      • Hi Faith

        Thanks for much for your input! I didn’t understand that about Vit D. So, if I stop it, I know my Vit D level will dramatically drop again which also makes me feel crappy, so is there another way to maintain a healthy Vit D level?

        I have been feeling slightly better since I started taking the T3 a few days ago, but I still feel like someone is sitting on my chest, and light headed – the kind when you hold your breathe.

        One other thing….whenever I test CRP in my body, it’s always above the range, but where to look after that, I do not know. I have moderate arthritis in my knee, and I’m suspecting in my feet now, but I haven’t checked that yet.

        I’m actually leaving work in two weeks time to concentrate on my health and go to the gym daily, mostly to swim and do weight training. Hopefully that will pick me up a lot, and I’ll lose some of this weight, that doesn’t shift with good diet, even low carb.

        Thanks again for your comments!

        • Hi Lucy,

          As you probably know, elevated CRP is inflammation…which could explain the low body temp. The suffocating feeling and knee issues sounds like Lyme disease…although there is no really good test for it. The standard test only has a 35% of picking it up. And there are no real good answers for Lyme disease either.

          Here is the funny thing about Vit D tests…the 25,D test which they run is similar to a T4 test…it is the storage form of Vit D and not the actual usable form. The 1,25 D test is the one people want, but are not given unless you argue for it. The 1,25 D is the active form, like T3. When they only test the 25,D…it is like dosing thyroid only testing T4 levels. It makes sense on one hand, but when one is having problems then it probably should be looked into more deeply.

          Oddly, people with bacterial infections and people with a genetic defect (that would not be noticed normally), over-make the enzyme called CYP27B1 that over-converts 25,D into 1,25 D…so that they will ALWAYS look low on the standard Vit D test, but are in fact normal or high active 1,25 D. I am one of those people. My standard test was 6, but the 1,25 D test was 50, right in the middle of the range.

          When I tried taking D, I felt great for a while…then not so great. Another little known fact about Vit D is that it is also a steroid and immune suppressor.

          I would never hope to imagine what anyone should do regarding this issue with Vit D, but I do think it helps to understand it before deciding whether to take it, especially considering that it competes with thyroid hormone in the receptor.

          Again, not a problem for most people…however, it is something to consider when thyroid levels are normal and one still feels hypo-thyroid as a possible explanation.

          I don’t have much to say on the diet front largely because no one seems to know much. I have had really great success with going grain free. I thought to try it for a month, but felt so much better within a few days. That said, not only do I not digest grains (and most other things), but just found out from a stool test that I don’t have the bacteria to break down complex carbs. either way, I lost a pound or two a day just not eating grains.

          I hope your time off helps you feel better. 🙂

          • Hi Faith

            Thanks for all this great info. I will see if the 1.25 test is available here. I’ve stopped taking it for now to see if I notice any difference. In regards to diet, since the thyroidectomy, I have become gluten intolerant which I think is a blessing in disguise because over here, all the flour is GM so its probably not good anyway. After I leave work, I am also going to try and get off all grains, and try low carb again. I went really well on it a few years back. Hopefully all these changes will make a difference. Many thanks, and all the best 🙂

    • Hi Lucy
      Good to know that there other other patients in Jordan suffering from what I suffer.
      I’m a Hashimoto’s patient and have been searching for a long time for a progressive doctor in Jordan who might consider T3 or Armour. Do you know any? It is not easy to get meds into the country. Can you advise me on what to do and is there a Dr. who you recommend?

  55. So much information here to absorb and I know that Drs don’t know either. Or at least the ones I have seen for 20 years. I have been on synthroid that long. Am overweight/obese, tired, achy most days & pain in various body parts. Jumps around from shoulders to hip to lower back. Bruised feeling when I touch the locations.

    Last week I went to a new dr who I hoped could make me feel better. I talked about Armour and that I would like to try it given that I have been on synthroid forever. He did not agree & said the American Association (or college of) Endocrynologists have not found any studies to prove it works better than synthroid. He said he has had 3 patients that insisted they wanted to try Armour. He said none of them showed improvement. As for what I told him I have read about his response was “you’re not going to get accurate info in chat rooms “. UGH!!! I didn’t push it. These are my test results;

    TSH: 1.65
    T3: 2.8
    T4: 1.15

    What is really interesting is the last time my TSH was high at 4.5. I take 75 mcg of synthroid.

    There is an ongoing issue with my Vit D. The last 2 times it has been checked it was low (22 then 25) The first time I ever had it done it was a 9. I’ve been taking 50,000 units one per week for about 2 years.

    I got my results online and have t heard what dr will advise. All other blood tests in normal range except cholesterol. But triglycerides were good. Checked for any muscular problems, that test also normal. All the chemistries normal.

    Any ideas from anyone? Will ck back in once I hear from dr. Sure wish I could find the right doctor. To think there is something to make a big difference & they are standing in the way!!

    • Brends, You gave values for your thyroid lab results but didn’t tell the minimum and maximum for the lab. If you are on the low-end of the labs with your thyroid results and you probably need to be taken a higher level T4 for max conversion to T3. Taking t4 with purified or distilled water will also help,to maximize. Levoxyl is more effective than Synthroid.you will likely feel healthy when TSH is non-existent or very low…not within range. Doctors believe the TSH is the gold standard for determining thyroid health. If you call some compounding pharmacies in your area and ask the which doctors are prescribing compounded T3 for their patients, you will have a better idea of what doctors to employ. My TsH is very low out of range and has been since taking thyroid meds. My t3 labs without t3splement is 82 with a lab range of 78-181. T4 Is at the max-18…so can’t take any more t4. When taking t3, my tennis elbow, etc heals. I just started taking t3 again after a 2.5 year break realizing that I couldn’t make t4 alone work. Armor has to be divided and taken a few times a day-same with Cytomel t3. Compounded t3 is the best since it is time released.

  56. Hey everyone, reaching out to see if anyone can provide me with any advice or experience. I’m a 25 year old male with a long history of bulimia (10 years) and anorexic tendencies that led to that. I’m still struggling, but somehow am managing a bit better in terms of frequency than I have in the past. Over the past year, I’ve begun trying to sort out my health issues, specifically related to my thyroid. I am essentially broke so seeing a quality practitioner regularly is not possible for me. I have had some blood work done recently, which confirmed that I have low T3, borderline low t4, and normal TSH. Even after a long stint in treatment (refraining from bingeing and purging), I had these same results several years ago. I’ve been taking 1 capsule of Thyrogold daily for the past few weeks but have felt no difference. I’m going to try increasing to 2 capsules tomorrow. I’m normal weight (120 lbs. at 5’7″) although I have gained a solid (taking fluctuations into account) 3-4 pounds over the last month. Any feedback anyone might be able to provide would be so unbelievably appreciated. Thanks in advance and let me know if you have anything that I should clarify.

    • Josh, have you looked into the book and website, Stop the Thyroid Madness? or Why do I Still Have Thyroid Symptoms? The former has many self-help suggestions. Read up and gain the knowledge you need, while you are saving up for testing and treatment. You could also consider joining Life Extension, they have a blood test sale annually in May, if you live in MD or NY it’s a bit tricky but elsewhere you can order your own tests. Best of luck.

  57. I have a strong family history of thyroid problems. I felt mine was not right by the end of my twenties and struggled with weight loss after each of my kids even though I only gained 22-30 pounds with each. At 35 I went on phentermine, ate well and jogged 3 times a week. Lost weight and felt good. I was diagnosed with Hashimotos at 42 when they accidentally found nodules in my thyroid. Two years later they put me on levothyroxin 50 then 75 then 88. In one year I gained 30 pounds and felt worse than ever. Constipated, fatigue, hair falling out, extreme cold all the time, do not sleep well and can’t lose weight no matter what. Tsh is .371, t4 1.62, T3 3.57, cortisol 24/urine 47.9. Endo placed me on phentermine last September to help me stop gaining. It did but NO weight loss this time. I keep my calories around 1,200 because I gain very quickly if I don’t. Now he’s put me on Belviq which I feel like both are a band aide and do not address why I’m struggling to lose weight. I have a BS in dietetics and fully understand the nutrition side but I am struggling with what to do. Help!

    • You could be describing my life, exactly. To a “T.” I think our pregnancies kicked off an “autoimmune” response. (Common.) We developed autoimmune disorders. I have hashimotos (that is an autoimmune disorder. Now I think I have autoimmune pituitary. (One cause of Low T3.) This article was informative, but it didn’t REALLY say how to treat it, did it? Confused.

  58. I had a total thyroidectomy 15 years ago, my parathyroid glands were traumatized. I have Graves’ disease, diagnosed when I was 14, and now hypoparathyroidism and I’m hypocalcemic. I’ve been on Levothroid, Cytomel and Calcitriol since my surgery and have experienced long periods of great health with euthyroid tests (especially during pregnancy). I have had chronic sinus infections over the past year, a myomectomy 2 years ago, and a lot of stress.

    My last test had my free T3 at 268 and my TSH at 0.46 and free T4 at 1.1, needless to say it’s been a rough few months. My Endo has reduced my Cytomel to 12.5 mcg daily (from 25), and increased my Levothroid to 112mg 7.5 pills per week (from 112mg 7 pills per week).

    In the last year I’ve gained 15 pounds, even though I eat well and exercise regularly.

    What now? I know I need something to change. I’ve had fluctuations for the first time in 8 years and I just feel off. Always tired, palpitations, slow metabolism, insomnia, immunosuppressed, headaches, shakes in my hands, body pain…. What do I test? Do I modify my diet? Are there herbs or natural protocs I should look in to?

    I’m a single mom of two little girls and I need my health back. I’m 35 and starting to feel old again, the way I did when I was finally diagnosed.

    Any direction is appreciated!

    • Hi Roaya,

      I can so sympathize with your need to get your life back. Unfortunately, I don’t have much to offer.

      Palpitations are generally a sign of too much thyroid hormone…adding as an FYI.

      There is a member of the thyroid groups that only feels well when her T3 is near the top of the range…I wanted to add that so you can know that not everyone’s situation fits into some “typical” anything.

      I do believe graves sends you up and down thyroid-wise, although without a thyroid that is a challenge to explain. That said, I do know from experience (I also do not have a thyroid and take T3 only), that too much thyroid can also cause you to gain weight. Most people do not know that, but as I have experienced that I try to share it.

      Sometimes the fillers in thyroid meds cause issues too. There is a kind of T4 called Tirosint that has no fillers and may help you. Unfortunately, it is a brand name drug so you may have to work with your doc to give them some kind of justification for ordering it to get insurance to cover it. For me, it was because I wasn’t processing any other T4’s right and was a last resort. I have to say, it was the only thyroid med that I didn’t feel ishy after taking.

      For many years, I just felt like I wasn’t able to use the thyroid hormone well…despite my numbers. Two things I did, but weren’t really helpful for any reason other than explaining things to me, is to take the 23andMe.com genetic test. This allowed me to realize that I have many defects in my thyroid b receptor. There is no treatment, but it allowed things to make some sense.

      The other thing was, I studied the Vit D pathway…oddly enough, Vit D is also an endo hormone…and it shares the receptor with thyroid. Indeed, an excess of Vit D will boot T3 out of the receptor. This wasn’t the end of story for me, but should have been…but my labs consistently showed low D. So I studied further and realized that 2 kinds of people will ALWAYS look low on the Vit D test they run which is, incidentally, the storage form of Vit D (sort of like only testing T4). Those with bacterial infections and those with a certain genetic defect (that wouldn’t cause them any problem) over-make the enzyme that turns storage D into active D (the one they do not test). So I got both my 25,D and 1,25 D tests done and found that indeed I had plenty of 1,25 D (the active form). So I stopped taking Vit D and did much better on thyroid hormone.

      Also, I take T3 only 10x a day…which is a little much for most people…for me it is great because I seem to benefit from it only for a short time and by taking so often allows me to feel great (thyroid wise) throughout the day.

      Lastly, my suggest is to find an “integrative” doctor…they combine western medicine and supplements and generally (unlike normal drs who just want to rx something) actually try to get to the bottom of things and fix it. It is just a much more logical approach when ones symptoms are hard to pin down.

      Hope that helps.

      Oh, and another possibility…shaking and palps can also be too much adrenaline (different endo gland) as well as the weight gain from the body trying to metabolize the adrenaline. The very best test I know for reading that is Pharmasan’s Neurotransmitter Test…insurance covered mine, not sure if it will everyone’s…but is good to find an Integrative doc that uses these send out tests, better chance of getting it covered.

  59. Hi Faith! I have a question regarding autoimmune and thyroid medication I have heard the same as you that taking desecrated pig hormone or armor is contraindicated in autoimmune disorders. I have Graves’ disease and I am currently taking Synthroid and have currently added T3 as well because for some reason I have stopped converting. not really sure why? May I ask why you are taking T3 only and if you loved Cairo sent why aren’t you taking that currently? I do have friends of mine who take nature thyroid who have autoimmune Hashimoto’s and do very well on it I am trying to decide whether or not to switch over I have been on this protocol for 20 years now and feel that I have had enough of synthetic hormone and would like to try something more natural

    • I’ve been taking WP Thyroid for a few months now, and I feel good with stable Reverse T3 numbers, and I have Hashimoto’s, so maybe Dr. Christianson is right about NDT and Hashimoto’s? I’m going to stick with it for a while longer. I like the idea of supplementing T4, T3 and even T2, which NDT allows you to do.

    • Hi Sam,

      I am on T3 only because I massively over-convert to RT3 (I have other health issues that are behind the RT3 abundance). My labs get up to over 150 points over range and I start collapsing when they are 100 over range. So until I can get the other worked out, I am doing well on the T3 only.

      Everyone has to weigh whether slaughter pig thyroid is “natural” enough, I guess. The same people who tend to think of it as natural, tend to also think hotdogs are not good for our health…and it is likely that the hotdog is cleaner than the thyroid, imho. I do think some people need some of the other stuff in the pig thyroid and do well on it. And I do think that everyone should find what works for them.

      That said, there are issues with each thyroid hormone out there. Desiccated thyroid tends to go thru times when it is not available, they tend to change fillers…sometimes using soy which inhibits it. But those who swear by it, swear by it.

      To me it is the fillers, rather than the synthetic part, that seems the most difficult. I have to get a special brand of the T3 because the one pharmacies carry give me hives. I liked the tirosint because it was the only one that I didn’t feel yukky after taking.

      Hope that helps.

  60. Thank you for this series Chris. We see some very complicated Hashimotos and thyroid cases at my clinic, and at times it is quite confusing.
    I think I understand the relationship you are talking about when Reverse T3 remains low despite Total T4 increasing due to supplementation, but I have a patient currently that has Hashimotos with low free T3, low T4 and low reverse T3.
    My strategy with her so far has been decreasing AI inflammation, building Qi and blood and a very low dose of WP Thyroid (T4/T3) just to help her feel better while we work on the underlying issues. After 6 weeks of having her on 1/4 grain per day, her numbers remained practically static – even the T4 – and her TSH dropped functionally low. Symptomatically she felt better than ever though.
    Is this a pattern you’ve seen?
    Thank you.

    • Hi Julia,

      The general problem with giving hashi’s patients desiccated thyroid gland is that it also contains the very things the person’s immune system is attacking.

      Low T4, if clinically low and low T3, if clinically low is fairly classic hypothyroidism and would warrant supplementation.

      Have you heard of a product called, Tirosint? It is a T4 with no fillers, people often do well on it. And there shouldn’t be anything for hashi’s immune system to attack.

      • Faith, I’m a Hashi’s patient who is taking a small (1/2 grain equivalent) dose of WP Thyroid. My TSH has improved a bit in the 6 weeks or so since I changed the dose from 1/4 grain to 1/2 grain (from 1.5 to 1.4); my T4 is normal, about in the middle of the range, my Reverse T3 is also normal, about in the middle of the range, but my T3 is still low, just slightly under the low end of the normal range (67, when the low end of my lab’s range is 71). Should I switch to Tyrosint? If so, how would you do the transition, and to what dose? I definitely don’t want to make my Hashimoto’s worse! If you have a link to any references about what ingredients in WP Thyroid could make my Hashi’s worse, I’d love to take a look. Thanks for chiming in here. I was just diagnosed in December, and I feel like I’m trying to get a PhD just to decide what to ask my Dr. for!

        • I just wanted to add that I did have both of the blood samples (6-7 weeks ago, and then 1 week ago) drawn fasting, before taking meds, in the morning. So I had already decided to not increase the WP Thyroid further at this point, on the idea that I would work on putting the Hashi’s into remission. But I would hate if I was taking the wrong med, and impeding my progress!

        • Hi Amy. I saw your mention of Tirosent. It is an excellent thyroid med with a high price. Discounts are offered for the first few months and the price continues to go up. Over $100 for 28 pills. It is definitely more effective than the Levoxyl I take. I tried it when Levoxyl was discontinued for about a year. I keep my t4 labs at the maximum within range and my t3 is within range on the low end. TSH is always nearly nonexistent since starting thyroid replacement in 2007. I tried armor and cytomel too but they were too fast acting for my system. For a consistent feeling of well being, compounded t3 is great added to t4 if needed. Some Walgreens compound for a reasonable price and it doesn’t have to be refrigerated.

        • Hi Amy,

          When they dx you with Hashi’s, it is usually because your TPO Antibodies, or TG Antibodies came back high. TPO is short for Thyroid Peroxidase, the enzyme that breaks down iodine from food or supplements and renders it bioavailable (T4 and T3 are 1 thyroid and 4 or 3 iodine). TG is short for Thyroglobulin, the thing that adds or binds the 3 or 4 iodine onto the back of a thyroid molecule.

          In hashi’s your immune system attacks one or both TPO or TG.

          Desiccated (or dehydrated) animal thyroid (usually pig) has TPO and TG in it (just like your thyroid has them in it). Because hashi’s immune systems attack those things…it is generally not wise to take it.

          That said, some people may be low in some other of the things in desiccated thyroid and thus may benefit despite the immune issues. Me personally, I wouldn’t want to continually antagonize my immune system if I could avoid it…but that is just me.

          The same issue arises with taking iodine for the same reasons.

          Also, not to mention that slaughter pigs (Armor Thyroid = Armor Hotdogs) are generally fed so much endocrine hormones that they die prematurely at 1.5 years old (slaughter age is 2 years). That in itself is a reason to remain leery of desiccated thyroid products. Again, just me personally, some think it is more natural…even though the same people would probably think hotdogs were not-natural or not good for them. So again, this is just a matter of personal preference and you will have to decide for yourself how you feel about it.

          There is a really fantastic book regarding hashi’s and trying to balance the autoimmune immune system called, Why Do I Still Have Thyroid Symptoms When My Lab Results Are Normal, by Dr. Datis K…

          I have autoimmune issues, not thyroid related, however when I tried desiccated thyroid my RT3 skyrocketed and my inflammation went up. That was enough for me. I loved the Tirosint, it is dosed the same as any T4…and there are conversion tables for desiccated to T4. My insurance covered it, so I can’t speak to cost…but it is a brand name drug. It helped that I had a series of labs from all the trials my doctor was doing trying the different thyroid meds, so she could have made the argument for why the brand name was necessary.

          Hope that helps. 🙂

          • My RT3 is good/stable. What other tests would you do to determine if I’m having an inflammatory reaction to the WP Thyroid? Thanks!

            • Actually, my reverse T3 has *decreased* since I increased my WP Thyroid dose from 1/4 grain to 1/2 grain. It was 19.9 and is now, most recently, 13.6. Same lab, same testing conditions.

            • Hi Amy,

              The general inflammation labs are C-Reactive Protein (or CRP), and SED Rate.

              But, for me, I would keep up on the antibody testing.

              As always, if it is working for you, use it.

          • Faith,
            Very helpful info you shared that includes details of your personal journey. Sharing experiences on our thyroid journeys is the one thing that makes the suffering more tolerable.

  61. I have low T3 & T4 and low body temp. (under 98 degrees most days). I suffer from Renyards symptoms and can say I “never” feel warm. I just finished the “Wilson’s Protocol” which is starting at a low dose of T3 and working up to a high dose and then back down to the low dose over 4 weeks. On the way back down, I felt great. My temp was up over 98 (still not normal) and my Renyards symptoms were reduced. Two days after the protocol everything seems to be back the way it was.

    The only adverse effects that I had were increased heart rate (from 80 to 100) – this made me have to be very careful with coffee and I would have to take breaks during my workouts to get my heart rate down.

    A little history: I am 44, eat very clean, exercise some every day, do extreme workouts 3 days a week. Other than broken bones I have no health history to speak of. There is no autoimmune disease in my family history

    • I would try T4 first and a little bit of T3 compounded and Time released if you think you need it. So I am 114 pounds, I take 112 µg of T4-Levoxyl, and I would like to have my T3 back. Based on my previous experience with T4 and T3 together I felt like about 5 µg of T3 would have been perfect. (Was taking 7mcg twice a day and cut myself back to 7once a day because it felt like too much. Felt like 7 was a bit much over time-I cut out tap water and anything but purified water without minerals added for the first hour after taking T4. Took t3 at night-can be with food) Temp is 98, t4 is near the top at 1.7 on labs (1.8 is the highest lab within range) and t3 is 87 (78-181). I keep the t4 at the top for maximum t3 conversion and need to add t3 at some point-I think skin, joint health and other things would be better if the t3 were better than at the bottom of lab results.

    • Hi Shannon,

      Low T4 and Low T3 is classic low or hypo-thyroid. I agree with Ms. Moore, in that the first step is to increase T4 and get those numbers up.

      If, when your T4 is normal, you still have low T3, then you need to figure out why.

      (I am on T3 only, so please take this in the spirit it is offered), excess T3 is not good for your body. It will demineralize your bones and as you mentioned the heart palps, it is not good for your heart. So my best recommend is to figure out WHY the low T3 before taking it…because, like Chris says in the article, if you fix the underlying cause of the low T3, the body will correct itself on its own. That said, we do not know if low T3 is your problem yet…gotta get the T4 up there first.

      Hope that helps. 🙂

  62. I tried T3 for 6 mos, gave up and then tried again after a yr for another yr. Neither time did ANYthing.
    5mcg 2x a day. i would give myself 15mcg sometimes tho and never tolerated it.
    Then I got my RT3 tested FINALLY. Well after I had been off the T3. Waddya know–its high; my ratio’s not good either. Well that’s where all the T3 went. I’m not just resistant, I also convert it to RT3 and shoot it out the bod. I could take tons; I’d just get rid of it, not use it so I could MAKE ENERGY.
    I hate my body.
    T3 is the only thing that would probably work, but sometimes it don’t work neither. Well *I* think, ALOTTA times it doesn’t.
    Be thankful, those of you that IF you can get on it, it will make a difference.

    • Hi Hélène,

      Sorry to hear that you have a lot of RT3.

      T3 = 1 Thyroid Hormone + 3 Iodine (and T4, 4 Iodine). T4 is converted to T3 (or RT3) when it cleaves 1 iodine off. T3 is one corner, and RT3 is the other corner. The only way to get RT3 is from T4.

      RT3 can happen in excess when you have too much T4 (which may have been the case when you started taking T3 that you didn’t need as much T4), or when you have other health conditions. The hallmark of whether it is a health condition or too much T4 is if you have low T3. Low T3 (with normal T4) is generally a sign of some other health condition.

      It can be really hard to pinpoint what is going on within our bodies and just how to help them…and you are right, T3 is not for everyone. T4 to T3 (and RT3) conversion primarily take place within the liver…so sometimes attending to liver health is enough to help. By that I mean, resting it from time to time…the liver both processes the foods we eat and balances our hormones…giving it time to balance our hormones can be very beneficial. And yet sometimes, we just make lots of RT3…I know I do.

      Also, everyone’s “ideal” numbers are different…some need T3 on the low side and others on the high side in order to feel well.

      Best of luck.

      • Hi Faith, let me first say thank you. I have been reading all the Q&A’s and i found them very informative. Now my questions concerns my wife’s health. She has been overweight for many years even though she doesn’t over eat. Her T3 is been low (2 labs in 1 year period), T4 & TSH were normal. She has been doing a no carb diet with MIC injections for about 7 weeks and lost about a lb. a week since she started. Now last week all her labs results normal again except for the T3 and she is feeling helthier than ever before. My questions are: Can she have an undetected underlying condition (because her T3 was low before the no carb diet) or is it her body not producing/conserving T3 for energy and we should do more tests. Also her Thyroid ultra sound came back normal. Please help.

        • Hi José Luis,

          First of all, I am sorry about your wife’s health.

          Low T3 with normal TSH and normal T4 has two possibilities. One, she is not converting enough T4 into T3…or, two, she has other underlying health issues.

          The best test to see which it might be is to try supplementing a small amount of T3 and see what happens. If her levels go up and she feels great, then is probably a conversion issue. If her levels stay low or if she continues to feel poorly, then is likely something else.

          No one knows why the body reduces T3 conversion when sick…they only know that the body does. In critically ill people in the hospital, T3 is often very low. However, this corrects itself so that is why mainstream doctors do not treat it. And, that sort of makes sense since despite all our scientific knowledge, we still don’t really understand how the body works.

          Also, and I might be the only one around saying this, NO ONE understands weight gain or why it happens. Yes, I know the beliefs…however, 100% of hospital diet and exercise clinics fail…so it is not diet and exercise. I personally believe that weight gain is a symptom…like a sore throat is…especially given that fat cells only contain three molecules…none of which is food, water, sugar, or pollutants.

          If weight gain is linked to low thyroid, then supplementing with thyroid will correct it…and that does work for some. Too much thyroid can also cause paradoxical weight gain as well. However, for most there is no explanation as of yet.

          Kudos to your and your wife for trying those injections…however, I might add that she might want to do the 23andMe.com genetic test…and then run that thru the online software of Genetic Genie or Livewello to get a methylation report. What I have learned from my own experiences with that is that NO supplement is as safe as anyone once thought, especially those.

          The reports give you info on defects that one may have in the various ways we make and unmake nutrients. For example, I don’t process folate well…so I do well avoiding eating many greens (something most would consider good for one).

          My suggestion would be to consider trying a small amount of T3 and see how she feels.

          Hope that helps,

    • I have Hashimoto’s, have an autoimmune reaction to American porcine NDT (tried 5 different compounding pharmacies). I have CFS and depression. I am currently taking 6 OTC bovine thyroid capsules at 9 a.m., 6 caps at noon, and 6 caps at 3 p.m., with one L-Tyrosine cap at 9 a.m. and 3 p.m. Also take 10 mcg Cytomel at 9 a.m. and 5 mcg. at 3 p.m. PLUS 125 mcg of Levothyroxine at 9 a.m. (This regimen is about 70 percent effective). Haven’t been tested for RT3, but FT3 “falls within lab range.” I take ALL recommended Hashi’s vitamins and minerals; gluten free, sugar-free diet; low stress, spring water only. I’ve gotten some comments that I need right balance of T3 and T4; OR maybe I’m taking too much T4 (doctor prescribed the 125 mcg. levothyroxine is appropriate. I think I need T3 only based on Paul Robinson book “Healing with T3.” After $10,000 worth of testing they haven’t found any other illnesses or conditions.

      • Ms Klagh, with all that you are currently taking, what are your T3 & T4 on your labs? Concerning water, I recommend aquafina or the equivalent (distilled or something purified without minerals added-nothing but water or nothing for the first hour after taking T4-allows for better absorption and effectiveness-My levels improved with purified reverse osmosis and distilled.)

  63. After trying only T4 for a couple years and realizing little improvement, I noticed a pattern of consistently low T3 levels in my lab tests. After reviewing the literature (including an important article addressing low T3 levels in the brain, Bianco, MD and Casula, MD), I made my case with my MD. Just 5 mcg T3 per day literally made me feel as though I’d emerged from a fog. 10mcg/day allowed for even more relief of symptoms but caused cardiac/chest discomfort. I have spoken with several physicians and patients who hear/say the same thing: feel so much better with a little T3. Hope this helps someone.

    • That person could very well be me.

      What form of T3 do you take? I’d be very interested in knowing that.

      And may I ask who prescribed the T3 to you? Man, I can’t find anyone in the San Francisco Bay Area who will even consider prescribing it.

      There’s one doctor, but he charges $1000 for the initial visit. The bully.

      Thanks so much, Claire.

      • Hi Kim,

        Endos generally will not give you T3 because it is outside of the “standard of care,” however, you can often get integrative doctors to…providing you can make a good argument for it.

      • Kim, if you are considering compounded t3, call the compounding pharmacies in your area and ask which doctors prescribe T3 for their Customers. Some Walgreens also make compounded t3.

      • Claire,

        I live in the SF Bay Area and I’ve heard Dr. Richard Shames in San Rafael is a good resource. He’s written several books on thyroid function, which discuss the importance of individuality in treatment (aka not everyone responds favorably to the same brand of thyroid hormone). I would definitely check him out!


  64. Hi,
    I would really appreciate comments on my situation. I am a hashimoto patient with with consistent low FT3 if on previous dose of (T4 Levo) 112 mcg and 5 mcg(T3 cytomel). I also have a suppressed TSH. In November 2014, testing confirmed too much RT3 (4 to 1 ratio) and my physician switched me to time release T3 (15 mcg x2) and T4 dosis of 112 mcg. A month later she dropped my t4 to 100 mcg. I still developed a slight fever and weakness on the third month. I am assuming due too much hormone and she dropped T4 meds to 75 mcg. I have not been able to take the t4 prescribed due to temp rising to 99.2 still. My physician suggested I switch to t3 only meds. I am otherwise healthy, have no cholesterol, normal BP, good weight, etc. I have been on this treatment for 4 months and before the temp increased to over 99, I was doing great and had lots of energy. Now I am back to feeling tired all the time. My temps used to be very low on previous meds (96.3-97.8), I had fatigue, cold all the time, constipation, dry skin, etc. Now temps fluctuates between 97.8-99.2, I feel fatigued when I have 99.2 temps. I am assuming I still have too much T4. I haven’t taken (t4) levo for two weeks. Should I have my doctor switch me to T3 only meds as she suggested or wait until my t4 levels drop enough to begin my new dosage of 75 mcg? Could I still be on a hyperthyroid state? Thank you

    • Hi Marcy. Sounds like your doctor should have started you out on less compounded T3. Are you taking two doses per day? If so try taking just one of those pills each day and see if you feel better. I have nonexistent TSH. I think that for most that are adjusted properly on thyroid medicine-TSH should have nothing to do with your thyroid gland. If you’re ingesting thyroid hormone there is no need for a TSH signal from your pituitary gland. My T3 and T4 are within range and the TsH has been .04 since 2007. Less t3 may have worked fine with 112t4. I used to take compounded t3. I am very familiar with the higher temp and not being able to do anything without the heart rate elevating-exhaustion….

      • HI Ms. Moore:
        Thank you for your reply. I think she should have dropped my T4 when she increased switched me to SRT3. She did start me with 7.5 mcg twice a day and she left me with 112mcg of T4. My second appoint was 4 wks later, and she dropped the dosage to 100 mcg T4 and upped my SRT3 to 15 mcg x2 a day. I think I have too much t4 on my system and the moment I try to take my two dosages or SRT3 my temps go up to over 99. I tried not taking anything and my temps began to come down a bit. I am still not taking the 75 mcg of T4 for over a week now. I am going to start up with one dose a day of SRT3 and see how it goes. Thank you,

    • Hi Marcy,

      Let me start out by saying that I am by no means an expert in hashis…but I do know a bit about autoimmune.

      My thoughts are that it is unlikely that the raise in temp is due to taking thyroid, however, I don’t know about taking thyroid hormone in hashis.

      Raising temps is an immune function, so I am more likely to attribute the temp issue as a sign of immune attack…and feeling yuk also due to immune attack. Just my thoughts. Hopefully you are not taking iodine since that can cause immune attack in hashis.

      There is a very good book by Dr. Datis K. called Why Do I still Have Thyroid Symptoms…he has a compelling idea for how to balance the immune system that is worth a look at if you haven’t already.

      Any chance you have other autoimmune issues? That might explain the chronically low T3.

      Years ago, people used to believe that TSH was only responsive to T4, but I am inclined to think it is more responsive to T3. I take T3 only and general have a less than 0 TSH so I only follow my T3 levels. Again, I don’t know anything of the mechanics of hashis treatment…or whether taking T4 is done to suppress the thyroid.

      Anyways, I am not much help, sorry.

      • HI Faith:
        Thank you for your reply. It is possible that it is a hashi immune reaction. I have had very high antibodies and positive ANA tests in the past. However, when my doctor runs a battery of tests, it always comes down to TPOAb. No lupus, RA or Sjogrens. Perhaps I had an autoimmune attack on my thyroid due to excess hormones. I do think my T4’s were probably too high and it caused the temp increase. I’ve dropped all meds until my temp drops a bit. I will start with one SRT3 pill a day and see how I feel. I tried taking half my 100 mcg pills of t4, but that also raised the temps. It took about two months for my temps to normalize on SRT3, and then another month for the higher than 99 numbers to show up. My temps were ok today, but I took no meds yesterday or today. Thank you for your reply

        • Hi Marcy,

          TPO is Thyroid Peroxidase, an enzyme, that oxidizes iodine so that we can use iodine. TPOAb is the antibody against this enzyme. http://en.wikipedia.org/wiki/Thyroid_peroxidase

          There is iodine in your T3 and T4, however, it is already bound onto the thyroid hormone (T4 = 1 Thyroid and 4 oxidized iodine) so it wouldn’t/couldn’t be sparking a TPO attack.

          Using iodized salt, taking iodine supplements, or eating foods high in iodine could trigger an attack…however, anything that runs your body down could also cause your immune system to amp up.

          There is no known biological pathway for excess thyroid hormone to increase body temp. Body temp is controlled by the hypothalamus…and is generally raised in an effort to increase white blood cells which need a higher temp. This is why the body’s temp increases (fever) when we are sick. Inflammation IN the hypothalamus can also increase body temp.

          The hypothalamus (TRH, thyroid releasing hormone) tells the pituitary (TSH, thyroid stimulating hormone) which tells the thyroid…not the other way around. High TSH might increase TPO production and thus cause an attack, but that is not at issue here.

          There is a false belief rampant on the internet regarding the adrenals and thyroid, and between adrenals and body temp, but these are not connected other than the hypothalamus (CRH, corticotropin releasing hormone) and pituitary (ACTH, adrenocorticotropic hormone) also control the adrenals, but does so with completely different chemicals through different chains of communication.

          Anyways, I am not much help…best of luck finding your answers, and I hope the other med helps.

        • Hi Marcy,

          I can’t help but reply, as I moticed 2 key things. 1 is that SR is not recommended… Straight T3 is much better regulated by the body. My ND started me on SR and after not feeling well still and doing a lot of reading I found that per patient experience straight T3 is a much better experience. I noticed an immediate difference when I switched!!!! 2nd thing is I think you are raising your T3 too fast, which is causing the elevated temp and fatigue. Patient experience shows that it’s best to raise 5mcg every few days as vitals dictate … For some that could be every 3 days, for others, every week. You dose based on vitals that you take upon rising, and multiple other times throughput the day. I joined the Facebook thyroid groups and have learned an incredible amount & received endless support!!! I hope some of that was helpful!

    • Marcy, you are right. Elevated temp is definitely a symptom of too much hormone. I went from 3.5 yrs undiagnosed and freezing…to hyper without replacement therapy. I remember taking my winter coat off when the temps were in the 20’s because I was warm. My doc also warned me to check heart rate and temp if needed.

      • I want to thank all the comments made to my posts. I couldn’t find my post and I have been busy with grad school. I am currently doing much better. After all the SRT3, I ended up not tolerating any T3 replacement at all for about 3 months. My doctor rechecked and noticed my thyroid was making enough hormones, but I still had elevated RT3. Since I couldn’t tolerate time release t3, I started on regular cytomel 5 mcg. I was doing great until the winter came and I felt hypo again. By then, my doctor no longer was taking insurance. I went to my GP and she prescribed Levo 25 mcg. I have been stable since. My RT3 is 19 (20 and above is normal) which is the closest to normal it has ever been. My doctor now tests Reverse T3 on a regular basis. I made a mistake in previous posts, I had elevated anti thyroglobulin in the past not AbTPO, very high, but I haven’t had it tested since. I avoid iodine as much as I can b/c I don’t want to have autoimmune reactions. Mymom’s endo and my doctor suspect we have a problem with the deiodinase enzyme from the pituitary. We also have hashimoto and she has been placed on T3 supplementation as well.

  65. Thanks for the informative series of articles.

    I have low T3 (2.1) and normal T4 and TSH. I also have moderate to severe Chronic Fatigue Syndrome and Fibromyalgia. I’m wondering if there is a correlation, and if my low T3 is simply a byproduct of having CFS/Fibro . Or, could low T3 be worsening my already intolerable exhaustion and weakness?

    Alas, there is no way to treat the underlying condition. Might I benefit from some treatment for the low T3? If so, what is it?

    • Kim, where is your T4 on the labs? Low, middle or at the high within range? Ask your doc to increase T4 if you are low or mid range normal. Only have purified or distilled water with your pill for the first hour.(no minerals added for flavor-aquafina is good. I stopped tap water and my T4 labs went out of range high but I was already close to the max. Your TSH should be suppressed out of range low to get the T3 within range and feel better. Don’t express to your doc that you want your tsh to be nonexistent. There will more than likely be resistance. If that doesn’t help, and your doc won’t prescribe T3, call your local compounding pharmacy to find out what Drs are prescribing t3. I was on T3 &T4 at first but now only take T4. It is much easier. I don’t have to take any other meds…just vitamin D. If you take your thyroid in the AM, take any other med or vitamins about 4hours later. I went back to my doc 30-min from my home because he doesn’t get excited about tsh being nonexistent. I tried 2docs near where I live and they wanted to reduce my thyroid med to 100mcg because of the tsh. Not gonna happen!!! I would have my Veterinarian significant other prescribe what I know I need before I would reduce the mcg and make myself sick again.

    • PS….your low t3 is causing CFS & Fibro. I had this in addition to cholesterol of 300+, digestive problems, eczema, etc when I was undiagnosed.

      • And, cytomel can be a pain since you have to divide the pill-compounded t3 is so much easier on your quality of life. Levoxyl is more effective than Synthroid.

        • Thank you Ms. Moore. You provided so much information that I can take to a good, out-of-the-box-thinking Endochronologist.

          My T4 is 1.3 – right smack in the middle range. I’m scared to treat the T3 because it could backfire on me. But, I am terribly ill, and am willing to take a few risks.

          You say you got rid of CFS by treating your low T3. Did you have “post exertion fatigue”, which is a hallmark symptom of the illness? I know some people who experience debilitating fatigue think they have CFS, but they actually don’t.

          In any case, it is great to know you got better. I’m going to buy some purified water.

          • I didn’t really do anything or push myself. Kept a heating pad on the couch and in bed. Tried to walk around the block and made it to the corner and went back inside. I was divorced and my children were in high school. Feel guilty because of lost time with them. Wish I was up making breakfast before school and taking them to events. Anyway, Sounds like you are in a perfect position to request the next higher T4 level. Request Levoxyl if your doc doesn’t disagree. My neighbor switched from Synthroid to Levoxyl and said she felt much better. My pharmacist told me she understood Levoxyl is more effective. Studies show it is more effective. The water helped. The nurses called me and was alarmed because my T4 was over the max. I told them not to worry because I had an appt with the doc the next day and that I felt fine. (My T3 was within range…it is the most important thyroid hormone) I hope you do well! I look forward to hearing back after you make some changes. Even though the docs say it takes 2-weeks…you should feel the changes immediately. I have accidentally taken 2-doses in the past and could definitely feel it. Couldn’t remember if I took it. That was before I nixed everything but water for the first hour. I put my water pill and phone beside the bed so I’ll know what time I took it….coffee with creamer within an hour!!! Always better if I wake at 5 or so and go back to sleep.

  66. Hello Chris. I want to thank you, great site, so much information. I have Peripheral Resistance to Thyroid Hormone and take T3 only, and my thyroid gland was removed. When thyroid gland was still there, my tests looked just like that: very low TSH, very low FT4 and FT3. I have to take very high amounts of T3 just to be able to think and not swell more than usual (not 50lbs, but 20 is a blessing). However, I am extremely ill, fully disabled, and get dangerously lethargic, always freezing to the point of emergency situations, have super low body temperature, dry painful skin, lost most of my hair so bad that we (my hubby and I ) are saving for a wig again, have myxedema of the face and overall body swelling, very high blood pressure, lost all my teeth, and in a catabolic state as well by the blood tests despite the symptoms. We are kind of caught between a rock and a hard place-I can’t be without large doses of T3, can’t be with them. I was actually diagnosed with a strange form of unmanageable Hypothyroidism first, did not respond to T4 or Armour Thyroid and developed very high levels of reverse T3 on them, responded only partially to T3, then was inaccurately treated for Adrenal Insufficiency with too much Hydrocortizone over almost a year, and I suspect that’s why my then high TSH became permanently supressed. T3 helps a little with some symptoms, and makes others worse. I also have an extreme Potassium Deficiency (Hypokalaemia) that we treat with Slow K, and chronic inflammation, both of which we think started in my childhood; and that doesn’t help. We are at our wit’s end, I’m homebound and doctor who diagnosed me long ago is not a doctor anymore so hospital staff and doctors don’t believe us, think I’m nuts fot taking large amounts of T3 but without it I get worse. What fun…I had inflammation for as long as I know it, nearly died of Mono as a child (strange as it is commonly a mild disease; I was given HUGE amounts of antibiotics before they found out it was Mono, too), and was exposed to radiation and malnutrition in my early teens, plus hiked all over the Sierras in my youth and was bitten by many ticks (add possible Lyme disease to that), so figuring out what caused the illness is like looking for a needle in a haystack-considering we are so poor that we could never afford to explore all the causes.. I don’t even have a doctor. We periodically call long distance to my most recent, nice and sweet but not knowing what to do practitioner to refill my Cytomel. I just detiriorate at home. After reading a bunch of your articles I firmly believe any of these things could have contributed to the current situation; however, I truly wish there was a way to find out which one did. Even if there was no way to treat it. 🙁

    • Hi Maria,

      My heart goes out to you. Like you, I take very high doses of T3 only due to too much RT3 on the other options.

      You sound very much like you have a health condition driving the RT3…the question is what.

      I am not sure where you live, but if you are in the United States, you likely qualify for medical assistance…and could get some testing for free or very low cost.

      You probably already got tested for autoimmune, but if not, you might try getting an ANA or FANA and RA Factor. The other test, probably through Quest Labs, is the C3a and C4a…that will let you know whether it could be Lyme or something else.

      You might try an Integrative doctor…they do whole body regular medicine and alternative supplements etc. They are also more used to having patients that other doctors can’t seem to help. Whatever you do, please don’t give up trying to find someone to help. I say that knowing that trying doctor after doctor really sucks, I am right along with you on that one.

      In the effort to say time, money, and energy…I have learned to be leery of doctors who are so sure they know what is wrong and you just have to take X,Y, Z supplement…all the hottest rage and all. Those ones tend to just follow whatever is the hot trend on the internet and seem to know nothing (nothing personal to those doctors). Best to find the one that is open to really listening and working with you over time. They are out there, took me nearly six years to find one.

      The Lyme test, if you wanted it, is Igenex…it is $260 dollars upfront. If you have any insurance other than state aid, they will reimburse you…if not, there is a program (so forgetting the name, but I think is called) Lyme Aid…anyways, they will reimburse you if you can show you are low income. The upfront part is hard…I would go for the insurance covered C4a test first, if that is low or normal you can pretty much rule out Lyme and not bother with the Igenex.

      Hope that helps. Hang in there.

  67. I’ve struggled with weight my whole life, starting at around 10 years old. Despite dieting pretty much the whole time, I have slowly gained weight over the years. Of course, the natural response of all doctors is basically to accuse you of lying about how much you eat instead of looking at the thyroid or actually measuring your metabolism.

    I started measuring my morning temperature a few weeks ago, and it was consistently low (high 95Fs to low 96Fs). I went in and paid for a thyroid panel including TSH, Free T4, Free T3 and TPO. TPO was negative for Hashimoto’s, TSH was high-normal, and Free T3 was low. Free T4 was about mid range.

    Since I also had problems with energy and feeling cold all the time, I convinced my doctor to let my try Cytomel for a few weeks to see how I feel. The difference after even 2 days was relatively astounding – I felt like I had more energy and didn’t need 5 cups of coffee to make it through the day. I have also been measuring my average daily temperature, and it’s slowly been climbing, over a few weeks, from around 97F to about 98.2F currently. I’ve also lost 7 lbs, even though I’m not really doing much different.

    So at least for me, treatment with T3 is making a big difference. I went to lab and had my metabolism (via indirect calorimetry) measured after taking it for two weeks, and it showed my RMR around 2500. I didn’t measure it before, but I was eating about 1400 calories a day and not losing weight, so it must have been lower than that.

      • Hi Duane,

        I take T3 only (my thyroid has been removed). My dose is .5 mcg, I take x2 pills 10x a day.

        The problem with T3 is that it is the active form, which means that as soon as your body processes it, it is gone. Unlike T4 which is the storage form is available for a long time until you convert it to T3 and use it.

        The other downside to T3, beyond multiple doses a day, is that you can never forget and skip a day.

        The info with the rx does not say anything about food affecting it, and I often take it when I have food in my stomach and do not notice any difference.

        However, T4 has on the insert to avoid soy and walnuts. I found issues converting worse when eating ANY goitergen in my diet. Others do not notice this, but for me it was a big problem. I do not know if it affects T3 users…I haven’t had any issues.

        T3 is outside of the established medical care that doctors are allowed to do. Despite their poor treatment of you, they risk their jobs and license to give you T3…even with a clear chain of labwork that establishes the need. So, unfortunately, you will likely have a difficult time finding one. People often say to keep rolling the dice until you do find one, but that is easier said than done. You might try looking for an “integrative” doctor…they blend western medicine with natural. You also may have better luck with doctors in private practice than in big clinics.

        The other thing to note, the general reason docs add T3 is for mental health issues…so when you mention it, the doctor’s mind will likely attribute it to your being a mental health patient. Just know that walking in.

        How I got to T3 only treatment was through a year long intensive trialing of all the T4’s…my labwork clearly shows that I over convert to RT3…to the point that I collapse. Mine gets around 200 points over range. Thankfully, my doctor is in agreement with the T3 only…I think I’d be dead without it. That said, I have other health issues that drives the massive RT3 conversion.

        I hope that helps you in your quest. Sometimes it helps to ask your dr to consider trying it, to see how it goes, with new testing in 30-60 days…sometimes they will do that.

        Another thing you might consider is Tirosint. It is a T4 only with no fillers.

        • Faith, question….why do you say that you can’t forget or skip a day? I am on 15mcg of time release T3 and the pharmacist told me I could try taking it every other day and see if that helped my side effects….?

          • Hi CJ,

            What might explain the differences…if you on T3 as a supplement to T4 or if you still have your thyroid gland.

            I have no thyroid gland, nor do I take any T4. T3 does not hang around the body in the same way T4 does.

            Hope that helps.

            • Faith,
              yes, that makes sense. I do still have my thyroid. Would you mind taking a look at my numbers I posted down a few days ago on this thread and give me your thoughts? I am still trying to determine if I want to keep on this T3, and/or try the Lugols iodide/iodine, or just skip it all and try and figure out my autoimmune stuff.

              Backstory- I took antibiotics for about 2-3 years for acne as a teen…later developed an allergy to that abx and also chronic urticaria which I have to this day (managed by daily zyrtec).

              • Hi CJ,

                I looked at the labs, however, you did not offer the lab’s normal ranges. That said…two thoughts.

                Most people coming to this article have normalT4 and low T3 (if you haven’t read the article above, you may find it helpful). The general reason for this is another health issue unrelated to the thyroid. You mention autoimmune, so that would likely be the cause of low T3. The operating theory is that when you resolve the other health issue the T3 will return to normal on its own.

                As to iodine, I would be against it…at least until you do more research. MANY practitioners do not understand iodine and just spit out internet crap about it and thyroid. We cannot use any thyroid we take in UNTIL the thyroid digests it and makes it bio-available. The thyroid does so with 2 things, Thyroid-Peroxidase (TPO) which breaks it down, and TG which binds it to a thyroid molecule. BOTH of these things are the prime subjects of attack in thyroid autoimmune (that said, yours was negative). Taking iodine whenever there is a possibility of thyroid autoimmune will just subject one’s body to attack, which can become medical quite serious and even life threatening.

                The other important part of thyroid function to understand is that T4 (yours is presumably normal) is one thyroid hormone with four iodine molecules attached. We convert to T3 by liberating one iodine molecule. If you have normal T4 you have ALL the iodine you need.

                The only true cases of iodine def are when people cannot make enough T4.

                Hope that helps.

                No one has a solid answer on whether to sup T3 when it is low due to health issues. I think the answer should depend on the individual person – if it helps, do it…if not, don’t.

                • Thank you. That does help.
                  I decided against the iodine, I stopped taking my T3 for now and am trying to heal my autoimmune issues and see if that changes my low T3. If my TPO was negative, can that be a false negative or is there another explanation there? I KNOW I have autoimmune issues. Does this test simply show if the issues are affecting the thyroid?

                • Hi CJ,

                  Yea, the TPO is one aspect of the thyroid…Thyroid Peroxidase, an enzyme that breaks down iodine so that we can use it.

                  In general autoimmune is tested by the ANA or FANA, then there are more specific antibody tests as well. Also, the inflammation tests are C-Reactive Protein, and SED Rate tests.

                  Hope that helps. 🙂

                • -Thyroid Stimulating Hormone (TSH)
                  1.210 uIU/mL
                  0.270-4.200 uIU/mL
                  Hi Faith. I copied down my latest labs, from a few weeks ago (plus the ref. range). I did end up asking for testing for the other antibody, which was also negative. So I am pretty confident this is not Hashi’s. I went off the T3 almost 2 months ago. Felt ok for awhile and have developed terrible fatigue. I am seeing a functional med practitioner now (I didn’t like how the other doc pushed T3 and high iodine). She has me on a supp. called thyrosil which does have iodine but only 150 mcg daily. I see her again next week to go over my labs and get the results of IGG testing for food sensitivity. Anything else you can think of that I should request or ask? It is a conversion problem, apparently, and I can’t seem to get the right balance. Reverse T3 is all too high as you can see.
                  As always. I appreciate your knowledge and input.

                  -Free Thyroxine
                  1.42 ng/dL
                  0.65-2.00 ng/dL

                  -Free Triiodothyronine
                  3.2 pg/mL
                  1.8-4.6 pg/mL

                  -Reverse Triiodothyronine (T3)
                  25.8 ng/dL
                  9.0-27.0 ng/dL

    • Duane, do you take it on an empty stomach? I think my stomach is never empty. I.e., it’s slow, slow to empty. So taking 4 doses a day seems hard.

      Formerly an overdosed Armour patient, and briefly a Levothyroxine patient, which exacerbated my insomnia, I’m now on an OTC, Swanson’s Thyroxine-free Bovine Thyroid Glandular. I’m alternating 1 a day, 2 the next day, then 1 again, etc. Swanson’s isn’t allowed to make claims, so they won’t answer my question does food interfere with this supplement; but I assume it is T3, so I assume yes.

      I read stories like yours and want to try a more quantified approach to how much and what timing works for me. But as it is, two doses requires that I pay way too much attention to what I eat and when.

      Here in Tennessee, we alternative patients have to do most of our own thinking; holistic practitioners are rare and out-of-network.

      • Well, I’m in Canada, and the situation isn’t much better. I’ve been told at least some of your holistic doctors can write prescriptions – ours can’t. So either way you have to convince a family doctor of your issues, and that’s not always easy since most of them assume you are a hypochondriac with access to Google!

        I usually take the first dose on an empty stomach when I wake up and then take a shower. I’ll eat about 30 minutes after that.

        Then usually another dose around 11am, which is usually an hour or so before eating.

        Next one is usually around 3pm or so, usually between meals.

        Last one is usually around 7pm, or so, so typically after dinner.

        I don’t find food much interferes with it for me. I read something about calcium blocking the effects, and that seems plausible, since if I have milk in my stomach I don’t normally feel that subtle warmth that happens about 15 minutes after taking a pill. But I’ve been tracking my temperatures and they have consistently trended upwards since starting, so it appears to be working at least.

  68. I took a T3 replacement for about 3 weeks. I become so swollen I could barely walk. Could hardly bend my fingers. My hips ached and knees were extremely sore and could barely bend them. I was out of town and returned to my doctor telling me to stop immediately. I had a severe reaction to the medication. He advised me to start again at 1/2 dose, however, I simply cannot bring myself to begin on it again.

    • My uneducated opinion is that the problem with L-T3 is that the smallest possible dose is way too high. My doctor gave me a free rein to take up to 2 pills per day as I felt I needed it.

      I started on it, but after the first dose of 1/2 pill, I could tell it was too much, so I decreased it to 1/4 pill every other day. Eventually I figured out how to split it into eighths and took one a day for a week then advanced to 1/4, then another week took 3/8 etc. until I was stabilized.

      I am off of it now but I am convinced it was good for me at the time.

      • Fern, the lowest dose of T3 was too much for me too whether armor or cytomel. Time released compounded T3 was the only solution. I am not on T3 now either but have made the T4 work for me. I am sure the addition of about 3mcg T3 would be just right for over all physical well being and bring my level to something more acceptable than lower 10% of the labs. At this time I am having a hard time finding a healthcare provider that will even allow me to stay on my current 112T4 since they see my nonexistent TSH as a threat. That’s what get for trying to find a dr near home I guess. At this point I will either end up traveling to my old dr or get what I have been using-112 from my sig other who is a veterinarian (not sure that is going to work…)

  69. Hello,
    I could really use some advice. I am 37…healthy and of normal weight. I am so confused with all this conflicting thyroid information and am thisclose to just chucking all the meds in the trash!!

    Here was my initial blood work results:
    TPO- NEG
    TSH- .99
    Rev T3- 22
    Free T3- 2.8
    T4 1.2

    Vitamin D was a bit low, and ferritin was very low, 18!

    I have been taking a T3 compound called Triiodo-l-Thyronine Sodium S.R. I started at 10 mcg, went to 20, it wa a bit high so I am not taking 15.
    My integrative Dr. wants me to be taking Lugols Iodide/Iodine. I have not been tested but she maintains she is 99% sure I am deficient. I am just really unsure about it. Reading about the issues with taking only T3 make me more unsure about taking that compound as well.

    I will say I feel great. I have more energy and feel happier and more like myself than I have in years. BUT I do not want to take any chances with causing a more severe health issue. I can GET BY without the meds if need be.

    I know I have some autoimmune issues after taking antibiotics for a few years as a teen (acne). I have chronic itching and rash that I take zyrtec for. But my TPO was neg, so no Hashi’s?

    Please please help me understand this better!

  70. Diagnosed with Hashimoto’s mid 2013. Fatigue, depression, consistent weight gain, loss of hair. Primary doctor told me to exercise more and eat less. On the way out the door my comment about my swollen throat caught his attention. He ordered a THS which can back 98.8. I went on levothyroxine but 2 days later had swollen tongue and difficult breathing. Dr said that it must be an allergy even though you can’t really be allergic to thyroid medicine because of its integrity to the natural compound. Sent me to an endocrinologist who did several tests for autoimmune and said no Graves, etc. Switched me to Synthroid. We messed with dosage for 8-9 months and then stayed at 150 daily and 2 xtra 125’s on weekend. Some symptoms have gotten a little better but still loss of hair , weight gain, lack of energy…but the stuff that really bothers me is the lack of desire for about anything…and the fog. I am definitely not my dual-tasking self. Everything takes so much energy both physically (which could be the weight) and psychologically. I miss the old me…and everyone else around me does too. Today my results were TSH 2.22, T4 FREE 1.3, T3 FREE 2.2. Any suggestions with what I could talk to my doctor about?

  71. I was placed on armour thyroid 30 mg daily along with compounded estrogen and progesterone cream for severe hot flashes and night sweats. My TSH, free T3 and free T4 were within normal limits but doctor thought thyroid was “low functioning” and could be playing a role in my menopausal symptoms. My free t3 initially increased from 2.56 to 3.12 after 2 months but after 3 more months fell to 2.2(lowest ever for me). Free T4 dropped from baseline of 1.06 to 1.08 and then to 0.86. TSH baseline was .743 then .277 and then .537. I’m wondering what could cause my T3 and T4 to drop while taking armor thyroid. My doctor kept asking me was I taking it correctly. I am, first thing upon waking at least one hour before eating anything. She wants me to increase to 60 mg daily. My hot flashes and night sweats are greatly improved. I have stopped taking it. I am seeing another doctor this week for second opinion and also because I now feel like I have a lump in my throat.

  72. I was diagnosed with Low T3 syndrome about a 1 1/2 years ago. After going through a few thyroid meds that did not work, my Dr. put me on taking a compounded C-T3 10 mg capsules last May. I started to feel better over the summer and by September We dropped it to 5 mg a day unless I felt fatigued. Most of my fatigue was gone, even with the 5 mg. and my mind was out of the fog it had been in for so long. Also, I lost a few pounds, the vertigo I’ve struggles with for years virtually gone, and the depression and mood swings I used to have went away. My hair still falls out and I have really bad dry skin, but those are easy to manage.

    However, I waited to long to refill my last prescription. There was a mistake at the pharmacy, resulting in no pills for 5 days. By day 2 I was shaking, and had chest pains and felt weepy. By day three Vertigo kicked in big time and the left side of my body was not functioning, meaning my fingers on my left hand would work right, pains going down my left arm, walking… my left leg kept giving out. and by day five I was suicidally depressed, sobbing and unable to get out of bed. I’ve now been back on my C-T3 for 4 days. Yesterday was the best day, but my mental clarity is off. I cannot get words out of my mouth well and my mind is scattered. I’m not shaking anymore but my left side is weak and my left fingers still struggle to work correctly.

    All symptoms of stopping my C-T3? I’ve not been diagnosed with any long-term or life threatening illnesses. I was told by my Dr. when first diagnosed that low T3 is often associated with serious illness, but I don’t have the money right now to keep getting tests done to see…

    What is clear to me is that my vertigo is a direct correlation to the Thyroid, as I was thoroughly tested for the vertigo and diagnosed with the vertigo coming from my central nervous system, not my ears. but they cannot figure out where… not tumor, no ms….

    • I am sorry to hear you are suffering so. I was able to be treated with up to 7.5 mcg Cytomel (L-T3) for a while and it was also very hard for me to go off it. It was hard to hear the doctors insist that I should not ever take it or allow any other doctor to give it to me. They insisted that my problem “was not the thyroid” and they downplayed the role of “simple” bladder infections, chronic sinusitis, or depression short of major depression as a cause of Low T3 with normal or low TSH.

      When I was diagnosed with depression, though, I found out that Wellbutrin would address most of the issues I had associated with low thyroid. I could never tolerate SSRI’s though. You may want to ask your doctor about that.

      I can’t say I have ever had vertigo, though.

      • Thank you Fern. If the vertigo would go away I would feel a lot better I think. I spoke to my Dr. today. She wants me to see a cardiologist for the chest pain and take a few more blood test. Crashing off your Thyroid medicine… not good

      • I think it’s a crying shame that doctors will hand out anti-depressants like candy, but often refuse to give patients T3, or enough to help their problem. Paul Robinson, author of “Recovering with T3,” accurately summarizes it: “It is the progress in how a patient actually feels that doctors should be primarily using to assess the quality of their treatment.”

  73. Hi All.
    My blood test are:
    T3 1.13 (1.20-2.80) !!!!
    T4 117.66 (78,38-157,4)
    TSH 1,59 (0,34-5,60)
    TgAt 2,1 (<4)
    TPOAt 77,9 (<9) !!!!!
    fT3 4,85 (3,84-5,99)
    fT4 11,35 (7,85-14,42)
    Am I "Low 3 Syndrom" case.
    In your opinion what are priorities-should I start to take some suplement, or start with food diet to lower inflamation, and test blood again before start taking any T4 or T3 ?
    Please help and thanks in advanced

    • Doesn’t look like low t3 syndrome since you have room to improve the other lab values-not maxed out. If you feel bad, tired, etc take thyroid replacement. I tried kelp + supplements instead of taking thyroid med and it didn’t work. I needed replacement but fought it…and ended up taking it anyway. Don’t wait- get better. You just have to wait to complete the thyroid scan and uptake test of ordered.

    • These are the test results that I received yesterday and immediately went to search for information and I forgot to write the other symptoms that I have: digestive problems (waiting for for the Food intolerance Test results ), I am always cold, low blood pressure, low body temperature, feeling of the heart palpitations , fatigue, anxiety, depression, tingling sensation all over my body, frequent headaches, hair loss, inability to get pregnant for last 9 years. Most of these symptoms I have for several years now.
      A few years ago my GP doctor sent me to thyroid hormone test but only T3, T4 and TSH and they were all within the normal range.
      Generally, I feel pretty bad.

      • It is typical for one to have symptoms and the labs are still normal so we don’t get any help. I had all of your symptoms except the inability to get pregnant. I was in my 40’s and prevented it by that time. Heart palps are also a hypo symptom. When I felt them during that time I just thought I had to cough and realized after talking to an endo that it was palps. I’m glad you are able to get help now that the labs show you need it. You will feel so much better. I recommend Levoxyl rather than Synthroid. I have tried armor, generic, Synthroid. I feel much better with Levoxyl -for 7years.

      • Hi Vana,

        I am sorry that you feel yukky.

        It is my understanding that in thyroid autoimmune that the thyroid levels go from too high to too low. Heart palps are generally a sign of too high.

        It is possible that thyroid autoimmune can explain all your symptoms…you may want to search “Hashi’s”.

        Some basic panel tests you might want to consider are:
        CRP(C-Reactive Protein) for inflammation;
        SED Rate for inflammation
        ANA/FANA (Anti-Nuclear Antibody) for other autoimmune
        RA-Factor for autoimmune

        These are a great place to start.

        Hope that helps, hope you find some answers, and deeply hope you feel better soon.

    • Hi Vana,

      Your TPO Antibodies are positive. TPO is Thyroidperoxidase…in other words, the enzyme that processes iodine that you take in into bioavailable iodine. I would NOT take ANY iodine supplements if I were you.

      I would also suggest the wonderful book by Dr. Datis K called Why Do I Still Have Thyroid Symptoms When My Lab Results Are Normal.


      It is not like what it sounds, Dr. K goes into detail about the autoimmune condition of the thyroid and gives a very wonderful premise on how to treat it.

      Hope that helps,

      • PS…that means that your immune system is attacking the TPO enzyme. Therefore, taking iodine would cause an increase in TPO and thus an increase in attack.

    • Thank you all for your help.
      Also have low B12 and D. I am on AIP diet now, taking fermented cod liver oil, selenium, B12, magnesium. Generally, feeling a lot better. Still have sort of heart palps/shaking in the nights and sometimes during the day.

  74. Hi All – I normally wouldn’t ask for advice on this type of format but it seems there are a lot of supportive people here who have some experience. I have chronic Lyme disease that was diagnosed in May. I was about to start treatment in August and then found out I was pregnant. (I’m 30). As far as thyroid, my doctor started me on Armour about 2 years ago 60mg 2x/day due to high reverse T3 and low free T3. He said the ratio was off. Things were good until about halfway through my pregnancy. I’ve had difficult symptoms, and the cause has been hard to pinpoint. Some of it is fast resting heartbeat – bouts of beating around 110 when laying down, palpitations/flutters, pounding.. nausea, anxiety, many other other things. I also have pretty severe adrenal fatigue. I’m now being treated for that with a physiologic dose of hydrocortisone which is definitely helping. I’m having trouble eating enough for myself and the baby and I don’t want to do anything with thyroid treatment that would cause weight loss.

    My most recent labs showed:
    free T3: 3.5
    reverse T3: 26
    T4: .9

    My doctor says the ratio is off again and wants me to try lowering Armour to 15mg 2x/day and Cytomel 10mcg 2x/day.

    After reading on this page the responses people have had to Cytomel (namely fast heart rate) I am not feeling comfortable about trying it.

    Does anyone have insight for me? Thanks 🙂

    • Hi Ashley,

      I am so sorry about the Lyme disease (I also have Lyme, as does my daughter who just gave birth).

      One possibility for the heart palps is too much thyroid hormone…it is a common sign of it.

      The hard part about Lyme and the thyroid is that your numbers are just going to be off…esp normal T4 and low T3. There is no correct “ratio”…although some will argue. You don’t need T4…it is a storage form that you must covert to T3 to use. The T3 number is the important one.

      The other hard part is determining whether your Lyme is a new/active form or a late stage form. The reason I say this has to do with the cortef you are taking…because, as you know, it is an immune suppressant…sort of opposite what you want when treating Lyme. That said, late stage Lyme often starts creating auto-immune issues in which immune suppression is beneficial. For what it is worth, I also take cortef.

      Anyways, I hope you feel better.

      • Thanks Faith!

        The Lyme is late stage. My Lyme doc is also the one who put me on Cortef and Armour.

        Do you have any experience with Cytomel? It sounds like the right thing to do (cutting down T4 and boosting T3). I’m just nervous because so many people on this page have mentioned getting a fast heart rate from it.

        • I have been prescribed cytomel before . It was a while ago and I think it was only 5 mg once a day. At the time I was also taking armour thyroid 2 60 mg tablets at morning and noon. My reverse T3 was three times what it should have been and T3 was low. When I added the cytomel I began having terrible anxiety. I was a mess. I took it for the month and stopped. I changed my thyroid med to NatureThroid and that seems to have helped. (Armour’s ingredients had changed after they were bought by a large corp. and I felt like I was regressing which is why the doc gave me the added cytomel) I also had no adrenals and was post menopausal because all of my hormones were gone (the doctor said I was robbed…I wonder if that is why some of you were unable to conceive a baby?) so I was absolutely exhausted. Possibly all of this caused by years of gut problems…My alternative doctors really helped me. There was a point when I felt fabulous because I ate the paleo diet, took my supplements, avoided the 24 foods I tested (blood test) allergic to, and took my thyroid meds. I also detoxified and I have to take supplements to digest proteins since I can’t do that and eventually it affects my liver and kidneys. I can’t imagine lymes and a pregnancy on top of it all… But there is hope! 🙂 You have to find a really knowledgable doctor. Mine was at Progressive Medical Center in Atlanta, Ga. Dr. Victor Buoquette, MD.

    • Ashley, I have pulled a couple of ticks off of areas and had the bullseye developed but quickly went to the doc for the antibiotic needed, so I don’t feel like I am suffering any adverse effects from the bites months later. As far as armor and cytomel are concerned, I have tried both and it was a very uncomfortable experience with racing heart rate if I tried to do much of anything. I had to sit down and rest. I discovered time released t3 and it worked great with Levoxyl. Since then I have found that if for the first hour after I take my T4 pill, I only drink aquafina (with no minerals added for taste), my levels are fine and I feel great. I think all the chemicals in tap water unfiltered and water from the frig as well disrupt the full absorption of the t4 and it conversion to t3. The proof in in the labs. After I started drinking the right water the doctors office called and acted as if there was an emergency to handle because my t4 went high. I told them I felt fine and had an appt to discuss with the doctor the next day. The splitting of the pills throughout the day was to try to feel good at the right time was too much guess work and never helped. I wouldn’t add cytomel if I had a racing heart rate. The armor and cytomel being t3 products would be over effective for the first 2–3 hours and I would sink after until the next daily dose. That is why I went to time released t3. Glad I found a way to only take t4 though. Many time when you change brands or level of thyroid medicine, you will feel tired for about the first week though.

  75. My tsh has been low to non-existent with t4 high within range and t3 low within range since 2007. I feel that if I take less T4 to try to increase the TsH, my T3 will be out of range low.

    Should I be concerned about my low TSH? Current Dr is; others weren’t.

    When first diagnosed with Hypo, my tsh was very high and T4 was very low(between 0 and the minimum lab value-so if the minimum was 4, mine was 2)

    • Hi Ms. Moore,

      My guess is that the doctors are not concerned about your TSH (the pituitary’s request for thyroid hormone) because your T4 is in the top end of the range.

      It is the low T3 that is more of a concern…and your labs put you in a strong position to request to add some T3.

      If you are in a position to do so (and haven’t already) you might also request an RT3 lab…sometimes we over-convert T4 into RT3 rather than into T3. One big reason we do this is from having too much T4.

      Hope that helps,

      • Faith, My new (older-60’s)) Dr is concerned and wants me to reduce from 112 to 100mg T4 because TSH is .044 (range .4-4-5)Do you think that T4 (1.3; range .08-1.8) is really close enough to the upper range to believe that I’m getting too much T4? (This is really in the middle of range looking at it again.)
        T3 is 89; range 71-180.
        Sounds like you are saying that if the RT3 is even high within range that I could take less T4 and there is a chance that the free T3would actually increase on the labs (and RT3 would go down). If that’s the case, maybe the doc is right. If not…need compounded time released T3

        • Hi Ms. Moore,

          The low TSH (pituitary’s request) means that your body wants less thyroid hormone than it currently has.

          The T4 in the upper end of the range could be deceptive…meaning, you could have much more T4 than the range, but that your body is simply converting it to RT3 to try to save you.

          The problem with excess RT3 (some is good) is that it binds in the receptors keeping T3 from getting in. I am not sure that this is the case here…the usual is normal T3 and yet hypo symptoms.

          You have low T3…and that is the problem. That said, your body does not want any more T4. I think you have a strong case for more T3 rx. You could ask if they will try you on more, just to see.

          Regarding time released T3, I am not really a big fan just on the logic alone…but I am sure some will swear by it. The logic being that things move through your gut and are only absorbable at certain places along the way…at some point, you wouldn’t absorb any more. That said, if they would give you a second dose of T3, you could take that at night or in the afternoon…might be all you need.

          Lowering the T4, which you should if you add more T3, will not help you make more T3 if you haven’t added more…and, like you, I would be concerned. I’d argue for an additional dose of T3 with the lowering of the T4.

          Hope that helps,

          • Thanks Faith! At one time, before I stop drinking tap water. I was taking 125 µg in the morning and T4 and 7mcg T3 time released twice a day. My T4 went over the maximum lab value and my T3 was okay on the labs; however,I felt like I needed to cut back on T3 so I cut back to one 7 µg pill in the morning with 112. Went to Jamaica, the refrigerator died , so did my T3. (Found out more recently that some Walgreen stores makes time released T3 that does not need to stay in the refrigerator.) since my T3 was ruined I stopped completely. I have been fine in terms of energy exercise & endurance. I have noticed that I have pretty dry skin on my legs which could just be age. I have told my doctor that I am inclined to take 3 µg of t3 even though he is fighting me to reduce my T4 because of the low tsh. My previous dr asked me if it would be ok for me to come back in the afternoon to test my levels to see how the levels were compared to morning. The levels were basically the same. He was curious about how the t3 was doing with time released. I took cytomegalovirus in the beginning and could not tolerate it even when dividing for 4doses per day. Feelings of hyper… Armor was the same at 25mg. I had to take breaks during a walk around the block. Took it after my walk one morning and the walk was a normal walk. The limitation I found with time released T3 was that I could not ride a bike for 25 miles unless I wanted to lay down for the next 2days and experience edema again at about the 48th hour.
            In this conversation I was actually looking for your take on the TSH level being low to nonexistent with T3 and T4 being within range for one that is on thyroid replacement. I am inclined to think it doesn’t mater if the tsh is low in this case. Dr thinks it is hard in the skeletal system. I would thing it would be hard on the bones if the T3 was high…

            • Hi Ms. Moore,

              My take is this, high T3 (active thyroid) can and often does cause bone loss. However, doctors also seem to have a very difficult time thinking things out.

              In general, TSH is the pituitary’s request for thyroid hormone. It is also possible (and I think this is the case with many people) that either the pituitary or hypothalamus (which instructs the pituitary) may be what is out of whack. They do not routinely test this, as you know, when you have weird numbers…I think they should.

              I take T3 only, and my TSH is less than zero. I don’t know how that relates exactly. Some people on these boards used to say that TSH only responds to T4, but that hasn’t seemed the case to me. I personally ignore my TSH because it is always so weird…I have had less than zero; less than zero; 9; 14; less than zero; and 17 all on the same dose. For whatever reason, I had been under the impression that wonky TSH is usually in T3 only cases.

              The best advice I have gotten from my integrative doctors is to dose T3 based on how you feel. If you have energy and are doing well at a certain dose…then that is where you should be…and whatever the numbers are, they are your numbers.

              Also, lab norms are determined by the average results for the people tested in that lab…which says to me that they are only rough guidelines at best.

              Hope that helps,

              • I was reading about the 3 forms of deiodinases enzymes that are responsible for conversion of T4 to T3 and in the case of the third form, D3, converts T4 to RT3. The one in the hypothalamus is D2. So TSH levels are determined in response to the level of this enzyme. Or as the article says – “deiodinase enzymes are essential control points of cellular thyroid activity that determine intracellular activation and deactivation of thyroid hormones. serum thyroid hormone levels may not necessarily predict tissue thyroid levels under a variety of physiologic conditions.”


                This form of deiodinase (D2) allows for the phenomenon of tissue hypothyroidism whereas the pituitary tissue being in the normal range will result in a TSH level in the normal range.

                Also…”In addition to having a unique make-up of deiodinases, the pituitary also contains unique membrane thyroid transporters and thyroid receptors.”

                There is more: good idea to read the article.

              • Faith, i tried 2new Drs close to where I live and both were unnecessarily concerned about my nonexistent TSH. Back to my more knowledgable doc across town. I asked The second new doc what she was going to do if my T3 went out of range low if I were to take less T4. She couldn’t even respond. My old doc did run reverse T3. No problems. I just think that if you’re taking replacement hormone, the TSH Has no purpose. Since it has no purpose, the thyroid gland does not produce T3 as it used to either. So with replacement we only get what converts from the replacement t4 which leaves us a little short. If for the first hour after T4, we leave out food chlorine bromide, fluoride, caffeine, juice,…all but purified or distilled water, we do better.

            • It is my understanding that it is important to keep the TSH being produced from time to time. If the TSH is always at or near zero the thyroid will suffer by not having the natural stimulation of the TSH.

              Interestingly, though, was that when I was taking small amounts of Cytomel (L-T3), 1/4 of 5mcg tablet once every other day or 1/8 tablet every day, my TSH actually rose from borderline low to mid-range. My Free T3 levels remained borderline low, but I felt much better as far as my symptoms went.

              The human body is very complicated, though. I read scientific journal articles that gave me the impression that the Methyl cycle is important in converting T4 to T3, and my DNA report seemed to indicate I may have some problem in my Methyl cycle, so I take Methyl B12 and Methyl-folate instead of regular B12 and Folic Acid.

              I am no longer allowed to take Cytomel, but I am on Wellbutrin which makes me feel just as good.

  76. I’m 60, and have Hashimoto’s; I take 125 mcg of levothyroxine and 5 mcg of liothyronine daily. My fatigue has worsened dramatically since May 2014 when I switched from popular pig thyroid med to the current regimen (I was allergic to pig thyroid). I’ve also had depression since May 2014. I have to consume huge quantities of naturopathic supplements daily to try to control the depression. I have read that T3 only (40-50 mg. daily) alleviates fatigue and depression, but my doctors will only agree to 5 mcg of T3 daily. I have no other illnesses and follow a strictly healthy lifestyle (regarding food, liquids, etc.), and have no other terrible stresses or problems. Can anyone recommend a physician in northern VA (U.S.) who will prescribe me larger quantities of T3 without another $1000 or $2000 in testing? I just had $1500 in tests in November to verify that I have no other diseases (AIDs, diabetes, Lupus, etc.)

    • Ms klagh, I assume you take your T4 first thing in the morning and only consume reverse osmosis (without minerals added) or distilled water for the first hour after taking your pill. (I keep mine by the bedside just in case I wake up anywhere between 3 and 5 AM and then go back to sleep so when I get up I can have my coffee if I want-otherwise I have to wait an hour and just drink water). If you take vitamins or any other medication you should take it in the afternoon sometime. I am 56. I started with a 125 µg of T4 in the morning and 7 µg of T3 compounded/time released twice a day in 2006. I only take 112 µg now. So much easier!

    • Hi Ms. Klagh, and welcome.

      You did not mention whether you had both T4 and T3 tested…I am assuming that your T4 was fine and T3 a little low (why they would consent to 5 mcg of T3).

      For what it is worth, 5 mcg of T3 is what psychiatrists give for depression in some cases. As you know, low thyroid can cause depression…esp the kind that is made worse by antidepressants. And, as you also clearly realize, doctors are woefully behind in how they still treat people.

      Low T3 with normal T4 is often a sign that something else is going wrong with your health…even if you are unaware of what that might be. Being tired all the time is also a sign that something else could be going wrong. Just a though for what it is worth.

      There is no one set dose…or average dose of T3 because unlike T4 (which you have to convert so is safe to take larger amounts), T3 is active and so must be more precisely dosed. Dosing of T3 is generally done by trial and error…starting lower and slowly increasing. Some people can only tolerate tiny amounts, whereas I take what many would consider large amounts. Another variable is how fast your body processes and gets rid of it. In general, T3 is taken numerous times a day (I take mine 10-12x a day).

      Another side of T3 is that being the active form, you are in danger if you forget a dose or say get in a car accident and are not conscious for a few days…if the hospital doesn’t know you are on T3 your body could deplete. This danger is why the medical system does not, as a general rule, use T3 only.

      I see an integrative doctor…they are a bit different from the mainstream doctors and you might appreciate those differences. However, that said, my doctor justified using T3 only by a year of trialing T4’s and my numerous lab results showing that I was over-converting into RT3. I was very sick from the thyroid trialing and often collapsed. You say that you don’t want to do a lot of testing, and I hear you on that, but that is what is often what is required.

      Once on T3, you need to be tested often to see what your pituitary (TSH) and T3 levels are…and it is so easy to go over and under.

      I can say, that there is no thyroid rx out there that operates like a healthy thyroid does…each kind has its own problems.

      I wish you luck in the effort to get T3 only.

      • Hi and thanks for talking about T3. What dose are you on?

        I’m on 5 mcg cytomel, twice a day plus125 mg dessicated thyroid in Canada, brand is called Thyroid. Do you know if this pig medication is known to exacerbate autoimmunity? curious why you don’t use any t4?

        also curious if you looked into old infections as a cause of inflammation. eg my epstein barr VCA IgG test was reactive, as was cytomegalovirus IgG EIA test. it just shows I was exposed in the past, but I’m confused if this explains inflammation and if it warrants treatment?

        after being ill for 45 years, my symptoms are finally improving. the big improvement came in 2004 from getting off synthroid and using natural hormone, although it put me into adrenal crisis. pretty scary but good to know i had to address that. its been a very complicated thing to recover from. but i have. it involved getting many things into balance…its all connected…

        after testing, going on BHRT plus myomin, to lower bad estrogen helped massively with adrenals. it also cured pms migraine i was on so much medication for… since i was a teen. I’m 50 now. It also cured the massively heavy periods, and incontinence the docs were going to do surgery to correct. wow. no thanks.

        iron supplements to get ferritin up to 80 now seemed to cure fatigue and weakness and finally stop my hair from falling out and its growing back now.

        going on cytomel finally helped me get out of lifetime of depression. it took my ten years to find a doc to prescribe cytomel. i’m off all the other psych meds. i attempted suicide age 5. i really haven’t ever been well…until now…

        I also got 23 and me testing and am on methyl b12 and folate for genetic defects. i also use potassium, magnesium, lithium orotate and iodine. prior to adding iodine, testing showed deficiency and bromine toxicity – hair dye? i got rid of fluoride and chlorine in my world, and every other chemical i can avoid…

        today, my health is good, my labs all in normal range except thyroid antibodies. i take no meds except hormones herbs supplements. i have energy to do my life all day every day. I grieve the 45 years I had “wanting to die” and various levels of fatigue and well, you surely know the myriad symptoms we can have. i never got any traction in my life, and now its kinda late to start. but here I am.

        my anti-TPO and anti-TG levels came down dramatically in 2004 when i got off synthroid and went on dessicated, and they are coming down again slowly, now that i’m on cytomel in the last few months,but hard to say what helped antibodies come down? have you heard of others with antibodies lowering once they went on t3? curious.

        have you looked into LDN? curious. Thanks so much from Ruthie in Ontario Canada.

    • Hi Ms. Klagh,

      You did not mention whether you had both T4 and T3 tested…I am assuming that your T4 was fine and T3 a little low (likely why they would do 5 mcg of T3).

      I am very sorry that you are suffering depression. For what it is worth, 5 mcg of T3 is what psychiatrists give for depression in some cases. As you know, low thyroid can cause depression…esp the kind that is made worse by antidepressants (which further suppress the thyroid).

      Low T3 with normal T4 is often a sign that something else is going wrong with your health…even if you are unaware of what that might be. Being tired all the time is also a sign that something else could be going wrong. Just a though for what it is worth. Sometimes when our health first starts failing it is subtle and the only signs we have are an odd lab result. Sometimes, the odd thyroid lab is all some people have to go on at first. Often times, we can think it is the thyroid and nothing else…in the hopes of fixing the thyroid and everything else will get better (I am speaking here from personal experience).

      Regarding T3 dosing, unfortunately, there is no standard dose, or even a common dose, of T3 because, unlike T4 (which you have to convert so is safe to take larger amounts), T3 is active and so must be more precisely dosed for the individual person. Dosing of T3 is generally done by trial and error…starting lower and slowly increasing and testing all the while. Even on this board, some people here can only tolerate the most tiny amounts, whereas I take what many here would consider large amounts. Another variable in dosing is how fast your body processes and gets rid of it. That said, in general, T3 is taken numerous times a day (I take mine 10-12x a day).

      Another side of T3 is that being the active form, it does not stick around in your body like T4 does…this adds an element of danger if you forget or are unable to take it on your own, which is my guess why most doctors will not rx it.

      I see an integrative doctor…they are a bit different from the mainstream doctors and you might appreciate those differences. However, that said, my doctor justified (to insurance and her associates) using T3 only by a year of trialing the different T4’s and my numerous lab results showing that I was over-converting into RT3. I was very sick and miserable from the thyroid trialing and often collapsed when RT3 levels got around 100 points over range. You say that you don’t want to do a lot of testing, and I hear you on that, unfortunately that is what is often what is required to both get on T3 only and to find the best dose for you…sorry about that.

      That said, I can say that there is no thyroid rx out there that operates like a healthy thyroid does…each kind has its own problems.

      On a different note, there is a product called Tirosint…it is a T4, but has no fillers…it is the only one I felt good on (aside from the RT3 issue), just offering this tidbit on the off chance it might help you too.

      I wish you luck in the effort to get T3 only.

      Hope this helps,

  77. Is it possible hypothyroidism is one of the body’s many self preserving mechanisms? A type of cold thermogenesis? And that replenishing depleted stores of anything will actually do more harm than good? Lifestyle changed are a lot more difficult than adding a supplement/script but I’m beginning to think that’s the wisest option. For those for whom that’s not an option, maybe a script/supp is necessary.

  78. I’m so glad to find your studies I’m a good sample of everything you have said I had feel like I do have hypothyroidisms for all the symptoms until I decide to request levothyroxine for treatment and it actually works at the beginning but the side effects I had did not worth the treatment now I’m under treatment prophylactic for TB because I had the TB test positive and never treated before I will let you know if my T3 rise when I finish the treatment to confirm your theory of long chronic disease wasting

  79. I got partial results of the blood work I got last week. My free T4 is HIGH while my free T3 is normal. Also, my rT3 is HIGH. Lastly, my white blood cell count is low and neutrophils measurement is low, implying low count wbc. I am not sure what’s going on. Can somebody please give me some advice.?

    • Hi David,

      First of all, it is normal to make some RT3…in other words, to convert excess T4 into unusable RT3.

      In situations where one has normal T4 and low T3 and high RT3, then illness is usually behind this.

      However, in situations of high T4 and high Rt3, then one could easily theorize that the excess RT3 is explained by the body trying to get rid of excess T4. If you have no underlying condition, then this may be a likely explanation.

      Hope that helps

      • Thanks for the response Faith. I got most of the recommended blood work that I’ve researched, which includes zinc RBC, magnesium RBC, free T3, free T4, rT3, vitamin D 25, ferritin, iron level, selenium, vit B12, and a few others. I did not get vit D 1.25 test, but ask for one. I do not have any base reference for hormone levels.

        The red flags I have are low vit D level (low 20’s ng/mL), low WBC count (3 x 10^3/uL), a little high MCV (98 fL, some consider this as within the range), low absolute neutrophils (0.9 x 10^3/uL), high free T4 (1.91 ng/dL), and high rT3 (30.8 ng/dL). Test for Antithyroglobulin Ab and TPO were normal.

        Also, TSH was normal, but on the lower end (1.86 uIU/mL) and T3 was normal (3.0 pg/mL).

        Zinc and selenium levels were normal on the higher end while magnesium level was normal on the lower end. This is because I’ve been supplementing with zinc piccolinate and carnosine for past few months along with selenium and Brazilian nuts.

        One last thing to keep in mind is that I had two surgeries last year that were 9 months apart and had a lot of antibiotics afterward, which killed my gut health. I have a leaky gut syndrome for sure because I started getting rashes on my body everywhere along with itchiness. I’ve had 4 surgeries with general anesthesia/antibiotics in total, which is enough to kill healthy bacteria in the gut.

        I am kind of confused by the blood work results. I know that I have leaky gut -> compromised immune system -> onset of other medical conditions. Is there anything I can do to boost my immune system so that my body starts functioning properly? If anybody has good advice, please feel free to share. I am desperate and my hair is still shedding a lot :[

        • Hi David,
          Besides fixing your low vitamin D, I wonder if looking at your copper might be a possibility?
          High red blood cell MCV (aka high mean cellular volume, aka macrocytosis) usually makes one think of low B12 and/or low folate, but you had your B12 tested, so I’m assuming that was normal. (You don’t mention folate.)
          Because you’re taking zinc and you mention gut issues, I thought about low copper as a possible culprit.
          Both zinc supplementation and malabsorption, among other things, can cause low absorption of copper, and low copper can cause low levels of white blood cells (aka leukopenia) with low neutrophils (aka neutropenia). I’ve pasted in a few links below with more information, in case any of this is useful in talking with your doctor(s).
          (Apparently low copper is also associated with osteoporosis, greying of hair, and nerve problems that can cause symptoms like trouble with balance.)
          Hope some of this might be helpful in your search for answers –

          http://www.cancer.org/treatment/treatmentsandsideeffects/complementaryandalternativemedicine/herbsvitaminsandminerals/copper (excerpt)
          Some people may not get enough copper from foods, especially if they take zinc supplements, which can partly block copper absorption. Large doses of vitamin C supplements can also block copper uptake. People who take zinc supplements or large doses of vitamin C may need to take extra copper to absorb enough. Those with malabsorption diseases or malnutrition may also need extra copper.

          http://lpi.oregonstate.edu/infocenter/minerals/zinc/#safety (excerpt)
          The major consequence of long-term consumption of excessive zinc is copper deficiency. Total zinc intakes of 60 mg/day (50 mg supplemental and 10 mg dietary zinc) have been found to result in signs of copper deficiency. Copper deficiency has also been reported following chronic use of excessive amounts of zinc-containing denture creams (>2 tubes per week containing 17-34 mg/g of zinc; (100)). In order to prevent copper deficiency, the U.S. Food and Nutrition Board set the tolerable upper intake level (UL) for adults at 40 mg/day, including dietary and supplemental zinc (5).

          https://en.wikipedia.org/wiki/Copper_deficiency (excerpts)
          The deficiency in copper can cause many hematological manifestations, such as myelodysplasia, anemia, leukopenia (low white blood cell count) and neutropenia (low count of neutrophils) . . . .
          . . . . The characteristic hematological (blood) effects of copper deficiency are anemia (which may be microcytic, normocytic or macrocytic) and neutropenia.[6]
          . . . . Anemia and neutropenia typically resolve within six weeks of copper replacement.[8]

          http://www.jabfm.org/content/19/2/191.full (Note: high methylmalonic acid makes one think of low B12 and high homocysteine makes one think of low B12 and/or low folic acid, but this woman wasn’t low on either – she was low on copper.)
          Wu J et al. Copper Deficiency as Cause of Unexplained Hematologic and Neurologic Deficits in Patient with Prior Gastrointestinal Surgery J Am Board Fam Med 2006:191-194
          Copper is a trace mineral essential to hematopoiesis and to the structure and function of the nervous system. Copper deficiency is a rare cause of anemia, leukopenia, and myeloneuropathy, but should be considered in the differential diagnosis in a patient with prior gastrointestinal surgery. We report the case of a 51-year-old woman admitted for nonspecific neurologic symptoms ultimately found to be due to copper malabsorption.
          The patient’s neurological and laboratory findings were initially attributed to vitamin B12 or folate deficiency . . . . However, her vitamin B12 and folate levels were available by the third day of hospitalization, with a vitamin B12 level of 738 pg/mL (normal range, 200 to 950 pg/mL) and folate level greater than 24 ng/mL (normal level, >0.9 ng/mL). Methylmalonic acid was 0.77 μmol/L (normal level, <0.4 μmol/L) and homocysteine was 4.7 μmol/L (normal range, 4 to 12 μmol/L). . . . . Serum iron, ferritin, and transferrin levels were normal, at 122 μg/dL (normal range, 40 to 150 μg/dL), 259 ng/mL (normal range, 10 to 291 ng/mL), and 220 mg/dL (normal range, 200 to 400 mg/dL), respectively. Other laboratory findings included a white blood cell count of 2,000/mm3 (normal range, 4400 to 11,000/mm3), with 40% neutrophils. . . . .

 (Note: these three men all had very high zinc levels)
          Willis MS et al. Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination. Am J Clin Pathol. 2005:125-31.
          Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. . . . . Excess zinc ingestion is among the causes of copper deficiency. We present 3 cases of zinc-induced copper deficiency . . . . The first patient was a 47-year-old man with a debilitating peripheral neuropathy that had progressed during the previous 18 months, mild anemia, and severe neutropenia. The second was a 21-year-old man receiving zinc supplementation for acrodermatitis enteropathica in whom moderate normocytic anemia and neutropenia developed. The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. . . . .

          • Gillian,

            Thanks for your insight. My result for vitamin B12 was normal, actually on the higher end. I was tested for folate too, but the result has not been released yet. I was supplementing with B12 in the past for about 6 months, so I think that explains why my B12 level is normal.

            I suspected copper might be a problem as well. I’ve taken zinc supplements for a long time without taking copper supplements. Copper from food source is not easy to get as they are abundant in shelled seafood. My hair loss symptoms actually worsened when I switched from zinc piccolinate to zinc carnosine. I’ve dropped zinc supplements altogether and have been taking copper supplements for 6 days now.

            I have not had a chance to read the articles you posted, but I really find your idea convincing because it suits my case perfectly. I will talk to my physician about it.

        • Hi David,

          The normal T3 (the only one that truly matters), high T4 and high RT3…especially in light of the normal to low TSH (the pituitary’s request for thyroid) all suggest that the RT3 is a result of the body trying to rid itself of the excess T4.

          While one would like to think that the TSH should be lower with excess T4 (as it was originally believed to respond to T4 only), it is normal as is your T3 (the one you use).

          The clear antibody tests mean that they will not be dx’ing hashi’s.

          All that suggests that the thyroid is not your issue.

          Regarding everything else, you cannot (truly) tell if your Vit D (also an endo hormone) is low without the 1,25 D test…as what is tested on the 25,D test is the inactive hormone (similar to testing T4 only). MANY people have low 25,D who have normal, even ideal, 1,25 D. Unfortunately, no one seems to want to understand the Vit D process enough to end the fad or realize that the endless studies are thus invalid…I suspect that the fad will remain another 10 years. Sorry that you could not get your test.

          You will have to decide what you do re the low inactive D.

          White blood cells are measured in percents…so some will appear high and some low to non-existent…that is all perfectly normal. Each kind of white blood cell has its own function. Neutrophils destroy bacteria and fungus…so, unless they are suspecting AIDs, you were not having an issue with bacteria, fungus, parasites when your labs were drawn.

          The one of interest is the MCV…or Mean Corpusul Volume…it just means that your cells are larger than normal. If this is coupled with low blood cell count (you did not mention) and low hemoglobin (also did not mention), then it could be a form of anemia. Since it is likely that those two other labs were normal, it is unlikely this is the case. They can also be big when you are making fresher new blood…as may be the case after surgeries. Also, likely not the case, they can be big if you drink alcohol fairly often.

          The vits (zinc/selenium/etc) have nothing to do with thyroid use and function (although, the bulk of people on here will disagree). What I do know is that the need for selenium is very low (in the body, in general) and that the symptoms of too much are the exact same as for too little. Unlike vitamins (that one can take and take and simply excrete), minerals are needed in precious balance in minute amounts…and too much or too little can quickly put our health (and life) in jeapordy.

          I know gut health is a huge topic these days…but (trying to add some logic and reason here) if you had a truly leaky gut (first off, one would get sepsis), then you would be having an immune response…which you are not. My doc had a great suggestion for testing your probiotic (most on the market don’t work), by putting it in a half cup of milk and seeing if it curdles overnight. The major problem you would experience from antibiotic use is the inability to digest food…and the inability to fight yeast. Trusting that you do not have thrush or a yeast infection…and that you are still digesting food, likely the antibiotics you took are not an issue.

          I was on 2-4 antibiotics solid of 1.5 years. Not only for myself, but for a surprising number of people I know, digesting food has become an issue. Like corn had been for most people, more foods are becoming. However, you did not mention that was your issue.

          Lastly, the thyroid numbers fluctuate over time…and change slightly when you have a cold…all this is normal. And just because the lab has a so-called “normal” range, does not make it your normal. The best suggestion I can make is to look up the body function behind each thing being tested…rather than the “theories” out there…for example, what cells use zinc…and in what way? What is the step by step body process of thyroid hormone, or Vit D??? What makes what, when and how?

          I wish I had better answers…the labs look good. They probably told you to take Vit D…and it probably wouldn’t hurt as you are not having a bacteria issue, but may not be needed.

          The hair thing…that is other hormones. I wish I could remember which ones, I deeply feel for you.

          Hope that helps.

          • Faith,

            Thanks for a thorough response. My red blood cell counts are normal and same for hemoglobin level. MCV was a little high, but my vitamin B12 level was fine, so I do not think MCV matters. My liver enzymes are all normal and kidney is normal as well.

            The reason why I think I have poor gut health is because of many reasons. First, as I stated above, I’ve had 4 surgeries with general anesthesia, followed up by megadoses of antibiotics afterward. I had two surgeries as a kid when I was 7 yrs and 9 yrs old respectively, and I do not recall eating yogurt or probiotic rich food afterward. In addition, I was prescribed with Accutane twice in my life (20-30mg/day for 300 days, total 6000-9000mg) and also had doxycycline for acne. All these are possible causes of compromised gut.

            Furthermore, I used to drink non-organic pasteurized milk all the time, probably 1 gallon every week. I also ate a lot of canned tuna in the past, at least 3-4 cans/week. My all time favorite meal was sausage, the cheap ones you can find at Walmart. I have stopped eating all of them, but I think the damage is already done.

            After receiving the last surgery in March 2014, my body has been functioning strangely. I’ve been suffering from eczema, pityriasis rosea, seborrheic dermatitis, and dandruffs. I have never had pityriasis rosea in the past and my body always felt itchy.

            Food intolerance has become prominent. Whenever I consume dairy or fruits with high fructose, my shedding becomes more severe. I cannot even have a sip of alcohol as it turns my entire body red, hot, and itchy. Processed foods are hard to eat as well. Common salad dressing and a lot of raw veggies lead to same reaction, increased shedding.

            Adrenal fatigue is another thing. I do not feel as refreshed even after sleeping for 9-10 hours of sleep. I have difficult times concentrating and thinking.

            I know that a lot of hair loss sufferers focus on hormone DHT. I’ve tried finasteride and other alternative supplements that lower DHT, but they all increase shedding and create more rashes on my body. I do not think DHT is the sole culprit of hair loss in my case. There is a bigger piece of puzzle that I need to figure out, but I still have not found the true answer yet.

            So far, my conclusion is leaky gut (poor gut health) -> autoimmune response resulting in food intolerance -> compromised immune system (low WBC, neutrophil counts) -> infection (pityriasis rosea, eczema, SD) -> hair loss. Does this seem plausible? My physician just thinks this is telogen effluvium, but it’s been 9 months already and I shouldn’t have gotten other skin conditions in that case.

  80. I got partial results back from blood work I got last week. My free T4 level is HIGH, but T3 level is low. Also, rT3 level is high. I am not even sure what condition I have. Has anybody seen a condition like this? What should I do about this condition? I would appreciate your feedback.

  81. I tried 1/4th a tab of 5mg of generic Cytomel for low T3 for 3 days in a row. I could not tolerate it, I felt horrible. My HR was elevated (120), dull headache, nausea, couldn’t eat, incredibly sleepy; I couldn’t function. My current symptoms of fatigue and anxiety seemed like heaven compared to how the Cytomel made me feel.

    • Lori,

      When I started on cytomel I didn’t have much anxiety, but the first dose, 1/2 of 5 mg tablet was great for me for the first day, but I knew it was way too much, so I didn’t take another one for a couple of days and then decreased to 1/4 tablet but not two days in a row. Eventually I figured out how to split it down to 1/8th and that worked for me for a while. As my body adjusted I could take more without my HR rising above 80 or my BP being high. That was the sign to me that my level was right, and I began to function better on a regular basis.

      About a year ago, I had a low TSH test, although neither my Free T4 or T3 were high.

      I was forced to go off the Cytomel then, and had terrible fatigue, drowsiness, and sensitivity to the cold until I was told I may be depressed and I was put on Wellbutrin, which seemed to help a great deal, even with the cold intolerance.

      I also started taking Acetyl-L-Carnetine which seems to have helped somewhat with muscle weakness, especially fine muscles like the eyes (relaxing my severe double vision) and for bladder control.

      • Fern,
        I switched to 1/2 tab of lowest dose of Synthroid to see if it can boost my T3. I am not really tolerating it either. It is giving me insomnia and nervousness; only 5 days into it. I took Wellbutrin 4 years ago for weight loss and I felt really good on it. I have read that it’s not always necessary to try to correct low T3 but address the underlying problem, I am also peri-menopausal. I have considered trying Wellbutrin again to see if it can help with my mood and fatigue. How are you doing on it?

        • If I understand correctly, 5 mg is the lowest dose of Cytomel and it was way too much for me until I chopped the pill into 8 pieces… but even the Synthroid lowest dose, 25 mcg, I believe… if you get a bad reaction to that, then you are probably converting the thyroxine to triiodothyronine well enough. I suspect it doesn’t happen very well with me.

          Even though my endocrinologist told me that my labs may indicate that I could be having a “non-thyroidal illness” [or Low T3] and it may have caused my TSH level to drop without the FT4 rising, he has also said that no condition that I know I have could have caused it. It might be caused by severe depression or severe psychosis, or at least something more severe than chronic sinusitis.

          I don’t think my depression is that severe, especially when on the Wellbutrin. Yes, it is working well for me but the doctor had to increase the dose so I am taking 450 mg for half the day and 300 for the other half. [I take the 300 extended release (24-hour) tablet once a day and the 12 hour, 150 mg tablet for the other half day being careful not to overlap the times so much that I ever have more than 450 mg in my system at a time.]

          I was having a terrible time with depression even on Wellbutrin when I started using estrogen and especially when my OB/gyn had me use it 3 times in a week instead of just once. That was when my regular doctor tried me on 300 mg Wellbutrin plus some Zoloft. I didn’t do well on that combination so he had me do the 300-450 mg Wellbutrin that I am doing now. I also stopped the estrogen because it was obvious to me that it had the worst effect on me.

          Anyway, I understand the necessity of finding the illness that is responsible for the Low T3 Syndrome, but the doctors seem to believe I am just perfectly healthy other than having auto-antibodies that could cause either Hashimoto’s Thyroiditis or Graves’ Disease. So they say it’s depression but the low energy and inability to function well, remain with me.

  82. I’m 62. Diagnosed with hypothyroidism at 28 at the onset of myxedema coma. Prescribed 200 mg Synthroid. Over the years I tried natural thyroid medications, but they made my heart race while not helping symptoms very much. Darn. I wanted to be on something “natural.” Oh well. Eventually went back on Synthroid 110 mg as I aged – but suffered symptoms all my adult life. Had a Thermography Test done 10 years ago – it did report a “severe viral infection” that I can’t seem to shake off entirely. I’m ok if I keep on high doses of Vitamin C, etc. and don’t overwork my body. But if I let myself get run down or stressed too much emotionally, the upper respiratory suffers and I cough up a little stuff. I don’t know who to go to find out what kind of virus is causing this, and how to destroy it so I do the best I can. I betcha the thyroid problems are connected to that virus, but can’t prove it right now. So then – a few years ago, symptoms worsened, so I experimented and increased the T4 Synthroid which caused diarrhea, but did make me feel a bit better. I knew something was wrong so went to MD and asked that my thyroid be checked. He told me nothing was wrong with my thyroid and tried to push Zoloft into me! I changed MD’s immediately. Found an out of town alternative MD who did all the tests, including Reverse T3 – and that was way out of range at 425. I had done my homework and showed him research on T3 Cytomel. He prescribed a low dose, breaking up the tabs which I took sublingually. I monitored my pulse 3X day. I did start to feel better. I increased the dose gradually and still take Cytomel 2-3X a day. It helps me more than any other medications I’ve used. I’m not symptom free but function better. I do half a dozen cleanses a year followed by colonics to keep toxins down, which also by the way, stopped the 8 years of horrible migraine suffering after just 1 liver cleanse and 2 colonics! What a relief! I grow veggies, flower, don’t smoke, drink clean well water, breathe fresh air except on “spray-days” and actually feel and look better today than I did 10 years ago. Its a lot of work to take care of self but its better than being sick!

    • Vicky,
      Can you tell me how much Cytomel you take at each dosing daily? I want to take 15 mg 3 times daily to alleviate my Hashimoto’s, and I’m looking for a doctor in northern Virginia who will agree to that.

  83. Recently diagnosis with low T-3 in the absence of any obvious illness. I am 61 and take no medications other than Topamax for migraine control and vacated. Just a couple of bad disc in my back. I am at loss for this. I do have trouble keeping my iron level up. Not sure what if anything to do about this.

  84. Hello hipifiggy,
    Insomnia is either caused by hyperthyroidism, or hypo…

    It means you dont take right dose of t4, t3 combo

    Try with smaller dose of t4 then add just tiny amounts of t3 and this fixes majority of people who have thyroid issues only

  85. Hi. Has anyone ever taken one of those OTC “thyroid glandular” supplements with success?

    I was on Armour 60mg. A natural health practitioner (via electrodermal screening) found that Armour was causing stress to my body so I switched to Levothyroxine, which ramped up my moderate insomnia until it was nightly severe insomnia. So I wondered if the plain old glandular would help me.

    (Anyway, the Levo was not increasing my low fT3, I learned when I replaced my old MD, seeking answers to the insomnia.)

    any experience with the glandular type supplements?

  86. yes you should eat bone broth every day or as much as possible to fix the gut!…if you dont have good gut, you get malnutrishioned, and no way you can function properly ……

    this is the nature of things first gut then everything else, but to achieve it you have to get balanced hormons in blood, and maybe take thyroid therapy

  87. I lost a lot of weight (+100 lbs) in a short period of time (<10 months) about 7 years ago. I did so by cutting down a lot on food consumption and exercising as much as I can. I believe this increased cortisol level in my body significantly and it must have stayed that way ever since then. I managed to maintain my weight for 7 years, but I do feel fatigued all the time.

    In addition, I had a major surgery in June of 2013 and March of 2014 that required general anesthesia. I took antibodies and narcotics after each surgery, which I assume destroyed my gut health (flora). I've been experiencing hair shedding since March of 2014 and it just does not stop. My hairline receded a bit when I am in mid 20's.

    I've tried all iodine supplement (potassium iodine, kelp, and Lugol's), but all of them created massive shedding after a day of taking the supplement and I felt jittery. I supposed I am very sensitive to hormone/thyroid level and something is severely messed up in my body.

    Furthermore, massive shedding also happened when I took DHT inhibitors (finasteride, saw palmetto, and beta sitosterol), which substantiates my theory about hyper-sensitivity to hormone/thyroid level further.

    Lastly, I have cold hands, feet and sensitivity to cold, but at the same time I sweat really easily and have large pores, which are contradictory.

    I have not done a blood test yet, but I think my rT3 will be high and free T3 will be low due to prolonged high cortisol levels from diet/surgeries and gut problems from antibodies. I do not think I have any other medical conditions that's causing thyroid/hormone problems.

    I just want to fix sensitivity to coldness and hair shedding. What should I do? Does anybody have any suggestions? Your input would be greatly appreciated.

    • did you check your thyroid? hormon levels as well ultrasound?

      it may well be that you are malnutritioned in some way..or your thyroid hormones not balanced,

      hair loss can come from low ferritin, low vitamin d3…..you should check those, esp if you avoid sun, or have no possibility to get tanned….then b12 you could check just in case…becasue all of 3 can contribute to feeling fatigue

      then you should start eating real food, kick out as much as sugars as you can…not 0 but make sure you eat good proteins, versatile food, liver, organ meat..not just lean…maybe fresh milk, not pastereuzed…

      and dont think about rt3! you are too young for that…unless you are not infected somehow?…anyway rt3 is not something TO FIGHT AGAINST but to think about why it happens….but i would save that money for the above….which is more relevant for your case

      your symptoms point to underactive thyroid…esp avoid adding iodine! and you should test for thyroid antibodies too

      • Ivy,

        Thank you for your response. Unfortunately, I have never done a blood test for my thyroid, testosterone, vit D or ferratin levels.

        I did avoid sunlight unintentionally in the past because I had difficulties moving due to surgeries I had. Starting June 2014, I started jogging outside to get as much exposure to sunlight as possible. On the other hand, I’ve been on vitamin D supplement since January. I am not sure if getting sunlight has different effect on the body compared to consuming vitamin D supplements.

        I’ve been eating vit B12 supplements for 2 months, but I do not see significant improvement yet. Also, I took Ferrets Furmarate (106 mg of elemental iron) for 3.5 months, but it had no effect on hair loss what so ever. My iron level was 14.8g/dl last time I donated blood. FYI, I do not donate blood frequently.

        The reason why I considered rT3 being a problem was because I read numerous posts saying that severe constraint on food intake (from diet) causes body’s cortisol level to rise and conserve energy by reducing the amount of active thyroid T3. Since T4 is converted to either T3 or rT3, to decrease T3 amount, body has to convert T4 into more rT3, causing imbalance. Am I missing something here? How would I go about getting my thyroid level balanced in a natural way? Iodine supplements definitely do not work at this moment especially because I can’t stand more hair shedding. Any feedback would appreciated.

        • I didn’t read this post until I had already posted. Yes…here is your answer!

          The Vit D.

          Vitamin D is grossly misunderstood…even by the medical community(sorry).

          Vitamin D is a endocrine hormone…just like the thyroid is an endocrine hormone. Although there is often talk about different receptors, the endocrine system shares the same receptor…the receptor has different functions. Vit D shares the same receptor with T3. The issue is, Vit D is dominate and will boot the T3 out.

          However, to understand this issue deeper you need (and everyone needs, and most especially the researchers and medical community needs) to understand that D3 is NOT usable. It must be converted twice in order to be used. Therefore tests of Vit D (the 25,D) are as false and misleading as endos who only test T4 for thyroid! This is crucial to understand, imho.

          D3 is “CHOLECALCIFEROL” (everyone can look at their bottles and see this for themselves. D3 is animal based and IS absorbed ever so slightly better than D2 which is plant based…but not so significantly that vegetarians need concern themselves. The most obvious and grossest mistake well meaning, but unthinking, practioners make is to call D3 “active”…it is not, and is not any more than T4 is. D2 is “ergocalciferol.”

          The body converts CHOLECALCIFEROL (aka D3) into “CALCIDIOL” in our bloodstream. Then our body converts CALCIDIOL into “CALCITRIOL” in our kidneys. CALCITRIOL is the ONLY usable form of the hormone known as Vitamin D. In other words, CALCITRIOL is the ONLY active form of Vitamin D.

          CALCITRIOL is tested with the 1,25 D test. The doctors, and all the researchers on all those numerous studies, have erringly tested the 25,D…the non-active D3 and D2. This invaildates all those studies on their face…unfortunately.

          The reason this is important…and it is very improtant…is MANY people, maybe even half, have a non-harmful genetic defect in the enzyme known as CYP27B1 that over-converts the D3 you take (CHOLECALCIFEROL) into the D you use (CALCITRIOL). This is not an issue for one’s health or wellbeing…but it does mean that these people will ALWAYS test low on the 25,D test that doctors run. Always.

          In addition, anyone with a bacterial infection will also over-make the enzyme CYP27B1 and thus also over-convert CHOLECALCIFEROL into the active form…and thus have low levels. Again, it is a non-health issue…other than, the misunderstanding amongst medical practioners in telling patients to take it based on the wrong lab…because as an endocrine hormone Vitamin D is a steriod and an immune suppressant…not so good for those with bacterial infections (very good for those with autoimmune however).

          Hence, people should always ask for (or demand) the 1,25 D test along with the standard 25,D test that they run…to ensure an actual def before ever taking, imho. Those with the genetic make up, or with bacterial infections, will have low 25,D (what they test) and normal to high 1,25 D (what they don’t test).

          Also, for those with the Vit D Reversal issue…taking D can also make them feel increasingly unwell. I know I get increasingly tired and ill feeling on it.

          Sun is always your best option, the body will never over-make the active form.

        • david,

          I will advise you this, its ok to learn but its really not ok to make conclusions based on forums, other peoples opinions and half knowledge. So for you to try to understand how rt3 and t3 function and hence conclude something beneficial for yourself is futile mission, and not needed to do so.

          1. There is maybe no other way but taking thyroid hormon supplements, to many people, and myself included this helped fix my gut!it helped tremendously for my metabolism to start using food i eat properly, to some patients even taking thyroid replacement wont help…this means either they have not found their root cause or they have many other problems….there will always be exceptions to any rule.
          So your task is to determine your tsh, ft3, ft4 lvls and antibodies. If your tsh shows clearly you are underactive, plus your ultrasound….then you cant go aroundnthis naturaly becasue the problem did not start just 1 year ago, it may be on for years….remember first time you started beeing cold in not normal situations ……like in the summer or somethingmlike this, how long ago was that?
          2. Regarding vitamin D…the one obtained from the sun is water soluble, its much better form becasue it performs many other activities……i cant elaborate on it now, its really irrelevant since so many of the unknowns is there regardingnthis vitamin, but it has very protective role, against cancer, it lifts your mood, energy lvls, and helps immunensystem A LOT!! Supplement is not ideal, but is ok…if there is no other option….i restored my vit d3 lvl by 25% only in 4 weeks of tanning during the summer time…..so during 15 mins in the sun between 12_2 pm you can get total dose for a day in amounts to 20 000 i.j
          3. To help naturally your thyroid you must kick out gluten, corn! Eat 30% of carb,protein and fats……and start eating real food…….then supplementing iron is ok, with vitamin c, b complex…….you should test ferritin lvl that for you as a man mus tbe around 90 if its 50 or lower you are mulnourished…….in that sense….and it has no relation to ferum blood lvls…ferritin is beeing depleated to keep blood lvls unchanged until one day…..that body is preventing to come by slwoing down metabolism

          So your task is to wake up metabolism, and how you do it:-) there is lot more to learn …. if necessary takingnthyroid hormon therapy to restore optimal lvls of ormons in blood means tsh to be from 0.6 to1.5 this sort of lvls and other hormons in the interval!!……and so you have enough to do only there and leave theories of rt3 to some that wants to work on that……..thinkingnhow you will solve this puzzle over night is not realistic especially trying to figure out something not so relevant as rt3. Every body produces this!!!be it healthy or a sick..its just one little thing in the process and you dont understand so many of them so why to other about rt3

          Best of luck……

    • Hi David,

      I am sorry that you are experiencing this. It sounds like you have done your reading and tried everything mentioned.

      Two myths abound on the internet regarding thyroid. One is that iodine helps the thyroid. Iodine can only help when one’s thyroid is truly def of iodine (most peoples thyroids have stored a lifetime supply by the time they reached adulthood if they ate a typical or even better than typical western diet). True iodine def is rare…it would be evidenced by very high TSH, very low T4…and is only one of the possible reasons for those labs.

      In truth, the thyroid “digests” iodine…renders it bio-available. Iodine is then attached to a thyroid molecule (T4 = 1 thyroid and 4 iodine). The two compounds that deal with iodine in the thyroid are Thyroid Peroxidase (TPO) which is the enzyme that converts iodine into something we can use, and Thyroglobulin (TG) which binds it on the thyroid molecule. BOTH TPO and TG are the primary subjects of attack in thyroid autoimmune conditions which comprise the bulk majority of thyroid patients. Thus, taking iodine increases the tow subjects of immune attack.

      I strongly reccomend that people have iodine tests PRIOR to ever taking iodine to prove def status. The risk is setting off an immune attack and possible thyroid crisis.

      Regarding cortisol and thyroid. While the hypothalamus regulate both…and does so by instructing the pituitary to signal both…the signals are two completely different compounds. Furthermore, the hypothalamus reads two completely different things in determining what is needed. There is no other biological connection to the two. In other words, cortisol is not needed for thyroid production or use…and thyroid is not needed for cortisol production and use. It is an utter myth started and perpetuted on the internet. Sorry that there is not better information out there.

      Hair lose can be related to numerous hormonal and nutrional deficiencies. Estrogen is the usual cause in women…I am unsure what it is in men. My best reccomend is to get a good multi-mineral and have a hormonal base test. Hope that helps, sorry I don’t have more on that.

      RT3 will be high if you starve yourself or have an underlying illness. FT3 will also be low in underlying illness…but can have other causes. Did you suspect an underlying illness??? If so, then correcting that should correct the thyroid levels (if they are off).

      One thought I had…the usual symptom of adrenal issues is if you cannot go without eating for long. For example, super grumpy or irritable if you don’t snack.

      It can be hard to track down just what is going on with the body. Throughout the day our hormone levels fluctuate. Standard ranges only mean that this is where they usually are for most people who have gone through that lab…but do not necessarily reflect what is normal for individual people. In my years of researching this kind of stuff, I have come to the conclusion that the hormonal labs (where there is not gland failure…ie cancer/tumor/atrophy/inflammation/cysts/etc) that odd levels are merely the body adjusting normally adjusting itself to whatever else is going on within us. For example, being sick with the flu, the body will create excess RT3..which slows us down so that we will rest and give our immune system a chance to heal itself…and this is what it should do. When the flu is gone, the RT3 naturally goes back to normal levels.

      The problem is, by middle age…even the best diets are misguided (we tend to negate trends and fads 10 years after they start)…and def. We inject disease into people who then breathe it out infecting people with man-made germs that the body has no resources for. We have pollution we cannot avoid. In response, our bodies begin breaking down…we have illnesses that the medical system is clueless how to respond to (because they only know how to match symptoms to meds)…and we end up with odd labs that no one knows how to interpret.. Many will tell you how to…but as you found out through your own trial and error, they don’t really know either.

      I am sorry that things are not more advanced…or that doctors don’t often use what they learned in med school about how our bodies actually work. I too wish I had better answers. I wish you the best, I hope something I shared helps.

    • PS: I spent 1,5 years on antibiotics…however, my digestion problems started before taking them. Most food I eat comes out clearly recognizable in the way corn does for most people.

      That said, I have been hearing of a lot of people who are having the same issue and who haven’t had antibiotics.

      Probiotics are the usual reccomend. They haven’t helped me.

      Digestive enzymes are the second reccomend. They have only minimally helped me…and then, not really.

      Fecal implant is the next thing they try. I have not tried this.

      That said, I saw an odd video a while back where they put a camera in someone’s stomach when they ate ramen noodles and claim that even 36 hours later they are not broken down. They claim it is a preservative. Leads me to wonder is this preservative, or something like it, isn’t being put on a lot of the food out there.

      In the mystery, and for what its worth, I digest processed food better than whole. Mangos, apples, orange juice, greens, grains, come outvirtually untouched.

      Again, I wish I had more for you…sorry. I can only add to the wondering.

      Best of luck.

      • Hi Faith,

        Thank you for your response. I read your previous post on vitamin D and it’s interesting how active vitamin D can compete with T3 in the body. I’ve been consuming vitamin D that’s in hair supplement I take, which is about 670 iu per day. Maybe prolonged consumption of vitamin D has led to cause thyroid problems. I am going to see what other alternative I have for the hair supplement I am taking currently.

        I completely agree with your statements about diet in general. I’ve never had issues in early 20’s, so I kept eating anything I want, including a lot of meat, no veggies, a lot of grains, and fried foods. Now that I am in mid 20’s, my body has been damaged quite a bit from bad diet habits I had in the past. This is very stressful and I hope somebody would have told me in advance.

        I am going to get some blood test to see what is really wrong with my body. The test will include TSH, free T3, free T4, rT3, cortisol/adrenal levels, free testosterone, DHT, ferratin, and vitamin D 1,25 levels. I’ve been throwing shots in the dark for a while, hoping that random supplements I take would miraculously fix my issue. I am sick of getting bad results and additional shocks I am causing by throwing random treatments. I will report back when I have results from the lab. Thanks everybody.

        • Yes perfect plan!

          And defo kick out gluten and corn, try just for 3_4 weeks, if you sense any improvement , continue, since this is natural help to your thyroid…and dont kick it before y have a plan how to substitute….dont substitute with rice:-) ….in huge amounts or potatoes:-) ……try looking for some LCHFbreads that you will bake instead and increase coocked vegetables and butter, olive oil and other fats, coconut oil is praised by benefits…..dont be afraid to eat fats:-)

      • Beeing 1.5 years on antibiotics is more then enough to ruin someones gut for a lifetime, restoring goof bacteria is hard task, because taking probiotics is like a massage, if you have back problems massage will only fix you short term, to make pain easier, but the underlying problem is les diversity…

        We all have 3_4 kg of gut bacteria!this is 10x more genes, and that gut bacteria is like our second brain, those creatures make you like some food more then the other, this is a problem of chicken and egg, if you will eat sugars you end up with such bacteria, but once you loose some of the species becasue of taking antibiotics for such a long time….its veery hard …to get it back, and this is only now beeing studied

        Maybe going to some ecological farms with domestick animals could help restore some of the bacteria…..like workingnon a farm, earing fermented food, sauerkraut every day….this is what i would start

        And taking system enzimes, betaine hcl’pepsine, and such stuff i agree is just mild short term help…nothingn serious

        And digestion of this kind, when you miss gut bacteria defo cant be solved by thyroid hormon replacement of any kind

  88. I have had ‘CFS’ for 14 years. and then recently found out I had low T3 free and subesequently low oestrogen and progesterone. I have been treated with thyroxin tablets and have been using oestrogen and prog creams to try and get my levels back to normal I am a lot more capable physically than I have been for years , though still get tired easily/ feel hungover/ headaches. I am an aussi living in Denmark with a lack of resources here, as the health system is VERY against CFS and small minded when it comes to looking outside the box. I am being treated by a doc here, but would be grateful for new contacts. Does anyone have any contacts in DK that could help me?

  89. I had undiagnosed hyperthyroidism for 3 1/2 years after an abscessed tonsil. Ramping up, my T3 was in the low range and T4 with high high normal.tsh was normal. Things were still not right with the low normal t3. I was saying things wrong without knowing it. And there were others symptoms-like tingling toes/legs. I suggested to the Dr cytomel. It made my heart race for about two hours. The doctor suggested time released compound t3 with my t4. I was much better. While on t3, I would have reactions-boils-from dental injections for example. I started taking my morning thyroid pill with purified Or distilled water. Wait one hour. And them eat an have coffee. Wait to take medication/vitamins for four hours. I am not taking T3 now and my t4 was reduced from 125 to 112. My new doctor is upset because my TSH is below normal. I told him if I took100 that my t3 would be out of range low. I feel great on 112 but tend to get pretty cold at 70°. I feel that if I took 5 µg T3 per day with my T4 that I would be so feel so good. Undiagnosed hypo was so bad for three years that I lost weight. I had arthritis in my fingers. I had bumps on my knuckles. I had Neck pain constantly. I was highly allergic to MSG. I had swelling from head to toe-eyes, face, chest cavity, ankles…. 112 pounds. I felt like I was 90 years old. I couldn’t walk to the corner of the sidewalk. I went hyper from taking prednisone prescribe for tennis elbow. The prednisone evidently Addressed an adrenal problem. When I went hyper. every ache and pain and all swelling went away. I remember telling my brother that I felt like superwoman. I could roll around in the bed again just stretching. Could Walk or run around the block again. It take from the experience that the aging could age more gracefully if on adequate levels of thyroid replacement. And those who are thyroid deficient could have a better quality of life if on adequate levels as well. This means having better than the minimum t3level. This means having t3, 1/4-1/2 within range. So, if the normal range is 1-32, wellness is a minimum of 8-16. Once on replacement, I believe the tsh means nothing unless it is too high. Tsh tells the thyroid gland to make t4/t/3. If taking thyroid replacement pills, the pill is in charge. I will find another dr if mine doesn’t understand. I have already been to an endocrinologist locally and to one at Vanderbilt. Some people just need to take the pill right-nothing for 1hour, no chlorine, bromide, fluoride, coffee or tea. If that doesn’t work…..add t3?

    • Hi Becky,

      I agree, many people could enjoy a better quality of life if they had thyroid levels that were right for them.

      I think that is the biggest challenge, is to get to the point where we can realize that our numbers may be different than the norm and yet still right for us.

    • Becky,
      You mentioned Vanderbilt, so do you recommend whomever you saw there? I am looking for the right doc in or around Nashville. My free T3 is low even when I take meds.

      My close friend is pushing for me to get an endocrinologist. I’ve always seen integrative or holistic physicians.

      I was on Armour several years; found it to be stressing my body. A new doctor put me on Levothyroxine this summer; I got terrible insomnia; toyed with dosing; no change. I left that doctor for another doc’s Nurse Practitioner; she saw my free T3 was still too low. That was the first I’d known about what the free T3 number was supposed to do.

      Am supposed to see her for a follow-up to last week’s bloodwork and she will probably recommend something T3 besides Armour. I can’t keep going to her because their clinic switches to direct-pay soon.

      I’ve been off all meds a couple weeks, am having bad fatigue.

      • hello there, its not about what you were on but what doses….armour is unbalanced treatment it contains too much t3

        have you ever tried anything along physiological lvls like taking 100t4+ 6 t3?

        becasue if you take too much t4 your body will automaticaly fight against it making lower t3 if you then add too much t3 to that combination (like in armour)…you will overstress body…it cant get rid of so many redundant hormons….

        taking too many make you feel fatigued as taking too little, but many times people take too many meds, what i have seen so far

  90. My fluid retention improved markedly with bentonite clay. I use bentonite clay externally to detox. I smear it on my body, covering at least half my body, wait an hour while making sure it does not dry out, then go shower to remove it. It made me lose most of the fluid that my body retains, going back from size L pants to size M.

    I have euthyroid sick syndrome, normal blood values and symptoms very much resembling hypothyroidism. I was very ill and not able to take care of myself anymore at the age of 22, suffering extreme fatigue, very much muscoskeletal pain, feeling very cold all day, and a lot more symptoms.

    I have been taking dessicated thyroid for over the last 15 years, following the work of John lowe, which did improve my situation, but over the last 10 years, ive slowly become more sick again, leaving me to need more and more dessicated thyroid.

    At my worst period (age 29), I had built up to 60 pills of Thyro-Gold a day, without any signs or overstimulation (hyperthyroidism) (the equivalent of 120 armour thyroid pills). I still had symtoms of hypothyroidism, but less than before.
    This is an extremly high dose, and I cannot recommend it to anyone at all (this dose would kill a normal person) , but at the time I was very very ill, once again no longer able to take care of myself at all even inside the home (though still better than before I started the thyroid pills), the mainstream doctors said “your blood is good so we cant do anything, you just have to live with it” so I was very very desperate.
    When at some point my brother stumbled upon new research I started taking iron, something I had not done for long, because I get a lot of bowel problems from it, and I started needing less and less thyroid pills. Currently I need only 1-3 Thyro- Gold pills a day, as long as I keep taking iron, I still suffer from a lot of hypothroid symptoms, but at least I can take care of myself inside the home, (I am still homebound).

    This webpage seems to describe what I have, I have a lot of problems with inflammation (candida, leaky gut, sinus problems) however I am not sure how to treat these more permanenly. I drink a lot of Pau D’arco tea, which improved the candida, I get medicines for candida and parasites from my holistic doctor, but nothing seems to aleviate these problems for longer than just a short time. I also take probiotics for my bowel, unfortunately they are too expensive to take a higher dose. Each time one infection is treated, another will show up, my immune system does not seem to work very well. My holistic doctor does not know how to help me either, he does his best but none of the doctors seems to know how to really fix these problems, neither the thyroid problems, nor the repeat infections. This page may hold part of the answer.
    I would very much like to try a diet to reduce inflammation, since that is something I never tried, but there are very little food producs I can eat, my digestion is very bad, I take digestive pills for this, but even on those the only food I can eat without getting ill after each meal is quinoa and raw or cooked vegetables, and once in a while some salt-less meat, but I can only eat it separately, in combination with the quinoa its too much.

    I will print out these pages and take them to my holistic doctor,but if anyone has any additional advice on what I can do to combat any of these problems (or a part of the problems) advice is very, very welcome.

    I would also like to come in contact with anyone who has similar problems, especially if they also are very ill.

    • Lila,

      My heart just goes out to you and I am so sorry that you are sick and struggling. I too have been sick and struggling for years, and like you trying to find answers. Yes, it is very discouraging how little doctors know…but many of their hearts are in the right place.

      The poor immune system and chronic infections sounds similar to late stage Lyme disease. If you have the availablity of getting tests, you may want to run an CD57; C3a; and C4a. Quest does these…one of your docs may use Quest. Lyme tends to turn down the CD57. C4a tends to be high in Lyme (C3a in Lupus). I would run these before the cash-pay Lyme test…the standard Lyme screen only has a 35% chance of picking it up (so has far too many false negatives esp in late stages), the test you want is the Igenex one. It is $260 upfront, if you have non-aid health insurance they will reimburse you…so this is why I suggest running the other screening tests first to see if it is called for. For what it is worth, the symptoms of candida and Lyme are nearly identical.

      As well, autoimmune stuff will give you low grade fevers. Have you had your ANA or FANA yet?? If not, you might want to see if that may be behind it.

      All that said, the greatest help I got was from doing the 23andMe.com genetic test…but not in the way most people have. It is $99, but so well worth it. After the test you run it thru Genetic Genie (free) and get a basic report on genes you have that may be messed up. From there the general thing people do is take whatever they would make after the defects…however, that made me really much worse…so, I made a list of all the things the report said would be affected to see what, if anything, was truly affected…and asked my doctor to test them. Turns out I was not making a few things well…none of which are what current belief covered. For example, I don’t make the amino acid Taurine very well…and the supplementing of that has helped tremendously…went from using a walker and needing a wheelchair to being able to walk without a cane.

      Like you, I also have digestion issues…in that most food I eat comes out untouched (like corn does for many people). And I have increasingly been hearing about a number of other people who are having a similar issue…also not really being helped by digestive enzymes or probiotics.

      One the meat issue, you might consider grass-fed organic beef or I have found great success with lamb. That said, meat is said to cause inflammation.

      Juicing might help…there are two schools of thought, one is juicer for no-fiber/just nutrients…the other is belnder for all the fiber…both have healing properties so it is just a matter of person experience or preference.

      Dr. Joel Furman has a PBS special on the other day about an end to dieting and he mentions why the diets out there (ie Paleo) are harmful…he suggests similar to what you are eating…you might find it interesting. He goes heavy on the cruciferous veggies that are not so good for people with thyroid issues…and I don’t do well on greens…but other than that, he seems good.

      Have you had a RT3 test??? If not, you may want to…when one is sick, their body often turns T4 into RT3 rather than T3. Too much (over the range) RT3 can make you feel poorly and hypo.

      I know many practioners and people like dessicated thyroid…however, it is not preferrable to people who may have immune issues with their thyroid…as it is just more of the things the immune system is attacking. Don’t know if you know about a newer thyroid hormone called Tirosint, it is T4 without any fillers…and is by far the only one I have taken that didn’t make me feel yuk after. That said, I am on T3 only…and long for the day when my body can handle T4 again.

      Hope something I said helps, again I am so sorry that you are going through all this…hang in there. The more you keep searching…you will, here and there, start piecing it together. <3

      • I read a post recently where someone (and I can’t remember who they were but they did a lot of researching of pub.med type articles) tried to find out the studies that supported or even suggested the idea that taking biological forms of thyroid hormone stimulated antibody formation which went on the attack the thyroid gland. They said they only found 1 study, done in the 80’s which actually showed taking NDT, WTE or whatever one calls it actually lowered anti-TPO levels.

        Despite this, I’m sticking to the synthetics as I feel OK but if I ever did switch, it would be to the New Zealand bovine origin stuff. Even though I live in NZ, I think I’d have to get it from the USA. Annoying. As Faith has pointed out, the idea of taking the Armour pig stuff is pretty revolting due to the dreadful overcrowded pestilent conditions in which these poor animals are reared.

      • Faith-

        Thanks for the great post. I have a few questions. I’ve done 23andme as well. It’s interesting. I had an OAT test done and I think, if I’ve read it correctly, I have a break in the Krebs cycle @ tartaric acid. (Doing this from memory here.) I did some reading and began taking taurine, seem to tolerate 1500mg daily the best. It has been a huge aid for me. But, I curious what on your 23andme pointed you in this direction. Can you share?

        Also, if one is taking t3 only should a blood test show normal numbers for this or will it always be elevated? I’ve had a couple blood tests one taken when I didn’t take my dose in the AM that was 5.5 I think and one when I did take my med and it was 7.9! From what you’ve shared, it seems my liver isn’t getting rid of it or it’s too much. I’m slowly weaning off. I can’t say I’ve ever felt great on t3. Or any thyroid for that matter. I always thought I wasn’t taking enough. Now, I realize with a conversion issue, it may be something else entirely.

        I found this to be a great explanation of conversion. It’s a complicated function in our body. Maybe this will help others to understand what’s going on…..


        Thanks again, Diane

        • Hi Diane,

          You ask some really good questions.

          After the 23andMe, and the reports, my doctor kept trying all the usual supps that the “experts” say you should take only they made me worse. After about 8 of these tries, I made a list from the reports of all the things it said would be affected. Simple logic suggests that if someone had a double defect in the MTHFR that they would either be dead by middle age –or- some other gene/enzyme adds a methyl group to folate that they just simply don’t know about yet. Anyways, from that list I had my doctor test the things it said were affected to see what, if anything, were indeed affected.

          It was these tests (UAA, OAT, Pharmasan’s Neuotransmitter test, and a few other assorted individual tests) that we found that I was high in Cystine and low in Taurine and Glutathione…the two things you would make after Cystine. Also high in Dopamine, high in Norepinephrine, and low in Epinephrine (aka adrenaline). Both of these are at the end of the Methyl Cycle…and neither are covered by the “experts.” We also found a corresponding imbalance of high Glutamate and low GABA which make each other.

          Although I have been able to identify the exact enzymes I have issues with, there are no known treatments (yet)…and I have come to the conclusion that while it is really great to find the exact pathway that things are breaking down…that maybe all we are doing is watching the disease process up close. In other words, we are just seeing the process by which the body is down-regulating itself. Indeed, many of the other disease groups are finding particular patterns common among them. Rather than assuming the defects cause the disease…my view is that the disease is causing the defects…and that tending the particular defs is just mitigating the symptoms (sort of like pain meds helps one to deal, but doesn’t cure the cause of the pain).

          Regarding the blood T3 tests and taking T3…yes, labs would likely be wonky. Mine tend to be, esp my TSH which goes all over the place from way too low to way high. Although, I suspect a hypothalamic/pituitary issue

          What I know about the liver is this: When we eat, the liver takes about 4 hours to process the food we ate. During that time, it is not processing our hormones or not processing them well. This is why they say that sleep is restorative…it is not the sleep, but rather that we are not-eating so that the liver can finally balance our hormones. From what I know about Phil (from Fat Sick & Nearly Dead) and the juice fasting and the way his body just restored itself…I surmised that it was the extended fasting that allowed his liver to heal his body…and that the juicing simply let him extend the fast longer than one could if they were just taking water. Since people tend to eat multiple times throughout the day…the liver would be challenged to process the excess thyroid.

          This could be good or bad depending on what one’s particular body was doing with it. Excess thyroid can cause bone loss (which maybe should be checked regularly if one is on extended T3 treatment)…or the minimal excess could keep one from going low. A doc from the Mayo tried to explain that taking T3 would cause spikes and drops (too high/too low) throughout the day…in which case that small excess is probably great. I side on the checking each year or every 6 months. As well, I have become familiar with how too much feels to me (which is similar to how too little feels with a slight variation) so I can keep my doses in check.

          With all things there is a risk…and that includes T3 treatment. We each have to weigh them for ourselves. I know no way to have a consistent level throughout the day. I take it 10-12x a day. It is just one of the downsides of pills. I also tend to feel like our bodies compensate for that. I take an rx that is GABA (Baclofen) and it is pretty clear that my body knows when to expect it. I’d like to think it does the same with the thyroid.

          That is a good description…thanks for linking it. One thing that no one has explained, and you may also experience with the genetic work…is that it can seem like the body sometimes only can use what is freshly available (as like with B12) and that the storage amounts (ie B12) the body doesn’t seem to access as well. I find this with thyroid, at least for myself, as my dose and need keeps increasing over the years.

          There are issues with the description you linked…(referring to the D2 section) TSH is not regulated by T3 levels, it is regulated by the hypothalamus (which may be regulated by T3 levels). Also, if the pituitary was so easily thrown off, everyone’s bodies would be doomed. While it is true that doctors should not dose based on TSH…but this is not why. As well, it is making an odd chicken and egg argument…saying that being overweight/etc causes down regulation when indeed wonky hormones cause overweight/etc. Too little thyroid causes depression…not the other way around (unless depression is from other cause), antidepressants suppress thyroid (what makes thyroid-caused depression worse). TSH is not linked to conversion of T4 into T3…TSH instructs the thyroid to produce T4 and then carries the T4 into the bloodstream. Most of the rest seems ok. It is difficult to get exact information when studies or papers make wrong assumptions (ie Vit D studies using the wrong Vit D tests).

          It is a lot like the genetic stuff, causes the condition or is a result of the condition…all they can say for sure is that: low T3 occurs concurrent with this condition, not which caused which.

          Anyways, hope this helps.

          • i want to add something
            to thyroid hormons functioning

            you said it : TSH instructs the thyroid to produce T4 and then carries the T4 into the bloodstream.

            this is becasue it goes like this TSH rises when there is fall in total T4….and low ft4….so TSH is more regulated by t4 lvls…..this is why when you go t3 only some patients experience rise in TSH if they are not on supressive doses but small one…becasue body needs t4 wich is storage of energy not t3

            t3 in normal thyroid patients with no other illneses should be used in physiological amounts, i think these are up to 12 mcg ….

            its no wonder to me that someone on t3 only cant feel well enough, becasue one has to have ft4 to ft3 between 3-4 ratio……and normal blood levels, and even then if there are malnutrition evidences in the body, like low ferritin, low b12, low d3…..person can not feel energetic, becasue its not the thyroid hormons only that determines our stamina , but the overal composition of the body so to say!
            its a complex issue, and it takes time to heal and mineral vitamin defficiencies to fill up!!
            this takes complete chnage to dieting, becasue its many times bad diet that led to thyroid problems…….
            one should eat liver 1x weekly minimum! who eats it?

            these are things i have learnt from my own body

            i take 6 mcg of t3 plus 100 t4……..this gives my blood results balanced……

            i really dont think for majority of patients its wise to override those blood tests becasue thats moving away from logic, and there must be a good reason why to do that….many of patients just try to heal everything with thyroid hormons in 1 day!

            • Hi Ivy,

              You are doing well at putting everything together. Just a few pieces to add.

              The pituitary (TSH) is not regulated by T4 or T3…instead it is the Hypothalamus that is: the hypothalamus then uses Thyrotropin-Releasing Hormone (TRH) to tell the pituitary to release TSH, which then tells the thyroid.

              T4 is not-needed by the body. T4 is the storage form of T3…and its only use is that it lasts longer in our system than T3. T4 must be converted into T3 in order to be used by the body.

              Many people have low-grade undiagnosed health issues and often the only abnormal lab they have is their thyroid labs leading many to believe (falsely) that their issue is the thyroid…and even though it can look that way, their thyroid is functioning perfectly fine…only it is functioning in response to some other underlying health issue. In many of these cases, attempts to correct the thyroid often prove futile.

              The most telling sign of this is normal TSH, normal T4, low T3.

              Many people will mistake those labs to mean that they have a conversion issue.

              I have seen no evidence that iron has anything to do with thyroid function. Iron is, however, caused to become abnormal in underlying illness. Because underlying illness is the cause of both factors…many assume incorrectly that they can fix each other.

              In many people who benefit from B12 have normal levels of B12…there is no medical explanation for this (yet). I suspect that this has something to do with the body having a breakdown in its ability to use what it has. I believe that this is similar to what some might call thyroid resistance (that is not otherwise explained by excess RT3, Vit D, or genetic receptor defects)…in other words, someone has normal T3 but is still genuinely hypothyroid…failure to be able to use what one has. I do not (yet) know the exact pathway by which that happens.

              Vitamin D is something the body makes…and has no bearing on one’s nutritional status. That said, it is poorly understood even in the medical community that should know better leading to gross misunderstanding in the public. The test that they run for Vit D status is called 25,D this is the storage form of Vit D comparable to T4. The 25,D test tests for D3 and D2 and adds them together. D3 is called Cholecalciferol (everyone can check their Vit D3 bottle)…D2 is called Ergocalciferol). BOTH of these are storage forms and must go through 2 conversions in order for the body to use it.

              1) Cholecalciferol (Vit D3) is converted in our bloodstream into Calcidiol; then

              2) Calcidiol finds its way to our kidneys where we convert it into Calcitriol…the ONLY usable form of Vitamin D

              The test for Calcitriol is the 1,25 D test.

              Here is where the confusion comes in (besides that people do not have the correct information to begin with)…people who have a certain genetic code (many have this) and/or have a bacterial infection…will over-make the enzyme called CYP27B1 which converts the D3 you take (or make from cholesterol in the fat under your skin in the sun) into the active Vit D Calcitriol…so as to over-convert it.

              Those who over-convert Vit D will ALWAYS look low on the Vit D test. This is why the 1,25 D test is required in order to assess one’s true levels of Vit D. In the cases of those with bacterial infections, because Vit D is an endocrine steroid and immune suppressant, it is imperative that they assess their 1,25 D before ever considering taking a Vit D supplement.

              Also, I take T3 only and do just fine on it. I have been on T3 for over a year and see no ill effects from not having T4. For my own self, my personal experience negates the old thinking that thought T4 was needed for anything…but that is just my view.

              Hope this helps. 🙂

              • hello Faith, oh i replied to some of the things in the reply below….but let me add few more….i think that are crucial from my experience

                1. low grade inflamation can be casued by thyroid not working properly!
                this is what i noticed when i reduced my hormon levels….so i was on 150 mcg t4 this brought me hyper…even all above 75 mcg i had hyper symptoms, but my TSH was stable below 1 on 150 mcg dose…when i reduced it to 100 t4 + 3mcg t3….so this is quite some reduction….i experienced low grade inflamation back! starting from my thyroid that was struggling to make up for the hormons i need…my lymph nodules appeared! and i had them constantly enlarged before i ever took thyroid hormon therapy! had them for years
                so saying which is first…i would say this: thyroid hormon therapy that is not balanced will always have as a result low grade inflamation
                there is logic behind it too, the body is not clearing from the system all it should in time, is constantly under low stress!

                2. i want to say i dont agree that body needs only t3. there is a reason why there is mechanims t4 then t3…and i dont know exactly what that reason is except that some tissues in body want to have their own pace of t3 , and some tissues need the constant t3 thats been secreted on a daily basis by our thyroid!! so no conversion at all!!
                so the logic is: if your thyroid is broken you should only replace those amounts issued by thyroid and not more!
                this is my experience….why?
                becasue if you will add lets say 20 mcg of t3 the body will instantly reduce your ft4! and this happens SOOO many times, i have seen it..its normal way body responds to too many t3 even if you take no t4 with it!

                this is how body protects from too much ft3…..there are exceptions to the rule,

                what has happened to me when i was taking 25 mcg of t3…this was clasic hyper, my hungar grow to the extremes, i was getting huge sugar blood spikes, and then panick attacks triggered by sudden drop in sugar lvls……i got dhiarrea!

                so my understanding is…that t3 is not helping at all digestion its the t4!….also t3 messes around with some neurotransmitersin brain!! so one gets exchnages from euphoria!..then disspair

                but for majority of people i think its very good to keep their body as they were, and not depleating from t4…becasue some of them will notice after 80 days they can not go without t4…..for whatever reason there may be…..

                also i think body is able to adjust to whatever you give to it! i could have gone t4 only on 150 mcg t4 for who knows how long…..and suffer not even knowing there could be better until i would probably get some sort of dementia or whatever…..after 10 years or 15…..

              • oh i am firm believer that thyroid problem is mostly result of bad diets for years! and in critical period of life from 14-22 years old! many people have no idea what good diet is, becaue its extinct from our habits!
                so low iron is going hand in hand with low metabolism caused by low thyroid!
                i evidence this..and also evidence how hard it is to replenish the lost balance! becasue it only says this, my kitchen brough me there…..digestion!! not working well in so many thyroid patients why?…digestion is the root cause of all……and its all like one vicious circle, my ferritin and iron lvls improved after i started taking thyroid hormon replacement it goes slow! but my ferritin went from 6 to 34! this is huge improvement and most of that came from chnagning diet ….starting to eat bit better but that was not enough: lean meat is not enough!……then taking thyroid therapy improved my digestion a lot! ….then i hope now when i finally got good thyroid therapy …it will imrpve even more becasue i notice my appetite is going back to where it was longlong time ago when i was healthy person …….thyroid causes bad protein digestion….and its all so interconnected…..this is how low iron comes in place too!! what happens is this
                1st you become low in iron, minerals vitamins..
                2nd your thyroid starts falling apart in lets say 2-3 years time…
                3rd you go hyper first then hypo when things gone so that you can see it on the ultrasound

              • oh on t3 only there is a guy paul robinson who wrote a book, he is on t3 only for 17 years, so there are people who can do it…..i only firmly believe they are exceptions to the rule

                i know my personal experience , 25 mcg of t3 was like living hell to me 🙂 and it was not easy to spot on it showed only after 8 days 🙂 like problem it was together with 100t4, but i was on 150 t4 before….
                also when you dont take t3 you fall instantly….not taking t4 is no big deal…i love that cushion it provides, also there is no reason for me to go t3 only….i know you have lyme and this is something not connected to thyroid…..but i dont think t4 and t3 are so easily interchnagable..becasue i have seen how too much t3 makes me another person, this is like face lifting! yes you can do it…but is this ok?

              • oh thanks for vitamin d explanation this is one of the most valuable info i took from reading you here…there are other stuff too 🙂 i read many researches on vit D and its all still fresh, but i think i remember its all so not well researched yet….i must check my 1.25 form….becasue my 25 form shows i am little under..and when i supplemented i got moles sensitivity! it was just not coincidence i repeated the experiment in short period of time and it got even sooner and it was so that my mole would hurt!….so i stopped supplementing
                the thing is…vitamin d is connected to thyroid regulation in a way i dont understand ….but i read study on it too…..it was noticed that TSH varies according to seasonal effect, and my idea was it has to do with the sun and maybe citamin d lvls…but forgot must repeat the readings 🙂

                also vitamin d is not converted only in kidneys but in liver too 🙂 ..i think i read that too….

                and one veeery interesting thing i found…there are rats that naturaly have no vitamin d since they live under ground called naked mole rats…they have 0 vitamin D and no cancer, and live very long!! this is why tehy did so much research on role of vitamin d on cancer…and trying to connect d3 status …..but apparently the best vitamin d one can get is from the sun 🙂 and one more info i remember 10-20000 i.j. one can get per day from sun!! 🙂 so its huge!! :)…also the VDR vitamin d receptors are all over the body….and some say good vitamin d lvls are needed for the good energy lvls, this is why its so often mentioned together with thyroid, as well as iron…becasue thyroid affects metabolism…hence the connection….also iron is needed ingerdient for oxidative metabolism….absorbed in tiny space in duodenum! and if one has bad digestion no way he/she can replenish iron,

                also vitamin d is just like thyroid essential for functioning of everything in the body, i think this is not just pure coincidence those 2 receptors are in all cells and they have similar form of working from prohormon to active hormon 🙂

              • Faith,
                Can you tell me where you live? I want to go on T3 only, but my 2 doctors won’t agree to it. I take 125 mcg. of levothyroxine daily and 5 mcg. of T3 (liothyronine) daily, and I want to try higher levels of T3 (30-50 mcg. daily), WITHOUT levothyroxine. Thanks!

        • Hi Diane,

          You ask some really good questions.

          After the 23andMe, and the reports, my doctor kept trying all the usual supps that the “experts” say you should take only they made me worse. After about 8 of these tries, I made a list from the reports of all the things it said would be affected. Simple logic suggests that if someone had a double defect in the MTHFR that they would either be dead by middle age –or- some other gene/enzyme adds a methyl group to folate that they just simply don’t know about yet. Anyways, from that list I had my doctor test the things it said were affected to see what, if anything, were indeed affected.

          It was these tests (UAA, OAT, Pharmasan’s Neuotransmitter test, and a few other assorted individual tests) that we found that I was high in Cystine and low in Taurine and Glutathione…the two things you would make after Cystine. Also high in Dopamine, high in Norepinephrine, and low in Epinephrine (aka adrenaline). Both of these are at the end of the Methyl Cycle…and neither are covered by the “experts.” We also found a corresponding imbalance of high Glutamate and low GABA which make each other.

          Although I have been able to identify the exact enzymes I have issues with, there are no known treatments (yet)…and I have come to the conclusion that while it is really great to find the exact pathway that things are breaking down…that maybe all we are doing is watching the disease process up close. In other words, we are just seeing the process by which the body is down-regulating itself. Indeed, many of the other disease groups are finding particular patterns common among them. Rather than assuming the defects cause the disease…my view is that the disease is causing the defects…and that tending the particular defs is just mitigating the symptoms (sort of like pain meds helps one to deal, but doesn’t cure the cause of the pain).

          Regarding the blood T3 tests and taking T3…yes, labs would likely be wonky. Mine tend to be, esp my TSH which goes all over the place from way too low to way high. Although, I suspect a hypothalamic/pituitary issue

          What I know about the liver is this: When we eat, the liver takes about 4 hours to process the food we ate. During that time, it is not processing our hormones or not processing them well. This is why they say that sleep is restorative…it is not the sleep, but rather that we are not-eating so that the liver can finally balance our hormones. From what I know about Phil (from Fat Sick & Nearly Dead) and the juice fasting and the way his body just restored itself…I surmised that it was the extended fasting that allowed his liver to heal his body…and that the juicing simply let him extend the fast longer than one could if they were just taking water. Since people tend to eat multiple times throughout the day…the liver would be challenged to process the excess thyroid.

          This could be good or bad depending on what one’s particular body was doing with it. Excess thyroid can cause bone loss (which maybe should be checked regularly if one is on extended T3 treatment)…or the minimal excess could keep one from going low. A doc from the Mayo tried to explain that taking T3 would cause spikes and drops (too high/too low) throughout the day…in which case that small excess is probably great. I side on the checking each year or every 6 months. As well, I have become familiar with how too much feels to me (which is similar to how too little feels with a slight variation) so I can keep my doses in check.

          With all things there is a risk…and that includes T3 treatment. We each have to weigh them for ourselves. I know no way to have a consistent level throughout the day. I take it 10-12x a day. It is just one of the downsides of pills. I also tend to feel like our bodies compensate for that. I take an rx that is GABA (Baclofen) and it is pretty clear that my body knows when to expect it. I’d like to think it does the same with the thyroid.

          That is a good description…thanks for linking it. One thing that no one has explained, and you may also experience with the genetic work…is that it can seem like the body sometimes only can use what is freshly available (as like with B12) and that the storage amounts (ie B12) the body doesn’t seem to access as well. I find this with thyroid, at least for myself, as my dose and need keeps increasing over the years.

          There are issues with the description you linked…(referring to the D2 section) TSH is not regulated by T3 levels, it is regulated by the hypothalamus (which may be regulated by T3 levels). Also, if the pituitary was so easily thrown off, everyone’s bodies would be doomed. While it is true that doctors should not dose based on TSH…but this is not why. As well, it is making an odd chicken and egg argument…saying that being overweight/etc causes down regulation when indeed wonky hormones cause overweight/etc. Too little thyroid causes depression…not the other way around (unless depression is from other cause), antidepressants suppress thyroid (what makes thyroid-caused depression worse). TSH is not linked to conversion of T4 into T3…TSH instructs the thyroid to produce T4 and then carries the T4 into the bloodstream. Most of the rest seems ok. It is difficult to get exact information when studies or papers make wrong assumptions (ie Vit D studies using the wrong Vit D tests).

          It is a lot like the genetic stuff, causes the condition or is a result of the condition…all they can say for sure is that: low T3 occurs concurrent with this condition, not which caused which.

          Anyways, hope this helps. 🙂

          • Hi Faith –

            Thank you for your in-depth comment. I’ve been off line and will be again as I am doing some travel but wanted you to know I read and appreciated your input.

            Recently, I’d tried to up my cytomel and I could tell my body definitely didn’t like it due to symptoms. After reading your explanation and a few other things, I decided to go off t3 and see what happens.

            It’s so weird. Other than when I get too much in my body, I can’t tell any difference taking it or not taking it. I was taking it four times a day at a total of 37.5 mcg. At one time I was at 50mcg but a naturpath told me to lower it and I was feeling awful so listened.

            Anyhow, I believe inflammation is the culprit for me now. I’ve endured a ton of severe stress for the past twenty years. Much has been alleviated, at least for now. I’m finding tart cherry juice is being very helpful along with a lot of magnesium and P5P. That’s all I’m taking now but may need to add a tad of B12 in some form. I’m cmpd hetero and my B12 was lower than I’d like on my last test.

            I plan to do a good amount of testing in about a month to see what has happened in my body since changing everything. My energy is decent! My pain is much lessened! Now I’m hoping some of this weight will come off.

            Thanks again for all your helpful input.

            Take care,


    • hello,

      so this is what i can confirm low inflamation comes from broken thyroid, i got the symptoms back when i reduced my therapy and my TSH went from 1 to 2.22 in 30 days….

      at the same time my old synus problems came back and signs of low inflamation that show up as enlarged lymph nodes…on my neck under armpits…and strange abdominal pain, like my all body went inflamed!

      so to sort these problems i am sure, becasue i sorted those one has to have TSH back to 1.5 or lower…(for normal patients who have this hipotalamus pituitary axis working)….or sort the thyroid hormon lvls ratio in the blood first, then those symptoms will go back

      from what i have concluded here, i used to have bad digestion before too, it sorted out big time when i started taking hormonal therapy! and from what i have seen people with really bad digestion who dont metabolize food at all_ like faith says food comes out untouched….this is special case and maybe those patients not doing well on t4 for the digestion reasons….dont know just did notice link between very bad digestion and thyroid problems even with taking hormons…

      also meet does not cause inflamation! its a myth…i can confrim that when i started eating more meet and fat my overall body inflamation DECREASED……

      from every signle person you can learn maximum 90% 10% of what each one of us say is probably VERY WRONG

      • Hi Ivy,

        I think it differs between people. I also think it can be hard to tell information apart some just compare red meat to fish…as opposed to meat verses vegetable. So careful sifting through the information out there is necessary.

        All vegetable diets lower inflammation suggesting that meat/starch diets increase it or keep it there. For what it is worth, I eat meat and I have inflammation…I also eat a lot of fruit. I know that if I have dairy products, I am in significantly more pain for 48 hours.

        That said, Chris here wrote an article about it with some interesting information: http://chriskresser.com/does-red-meat-cause-inflammation

        • hello Faith,

          oh the article is goo as all Chris articles are good becasue he makes fool portray of pro and con, from all angles

          but this is the issue: thyroid patients need to get enough protein in the body! and this can only be done via eating meat!
          now where is the problem?
          the problem is we eat the same kind of meat all the time!
          read the article about liver from Chris too 🙂 our ancestors used to eat a lot more variety! and throw lean meat to the dogs, and eat only organ meat, like liver kidneys..skin….this is why dr ray peat suggests eating gelatine! casue you have better balance of different amino acids in those other parts!
          we twisted eating habbits and this is why the incidence of thyroid problem is rising on top of twisted living lyfstyle…

          this is what i know for myself! my thyroid got broken when i was not giving enough good nutrients to my body over long period of time!….and there is no way one can feel super energetic before fixing the whole package …slowly over time,it can take 2-5 years beeing on balanced thyroid hormons eting good food to fix energy issues! if nothing else broken….

          and many patients who are on t3 only just never hit good therapy they went like 100+25 or more and then concluded oh t4 not working so kick it out..and if t3 only is the remedy for its very short half life they should have felt great then immediately and this should have lasted…its know that one can feel good on t3 only for a limited amount of time up to 15 weeks

          and yes i would agree there are differences between people…some like more veggies , some more diary some more fish…its becasue of different environmnets we all live

        • you know for many things one needs just good logic, you can never go wrong if you eat ALL moderately!…and listen to what your body says this is the ultimate! eating is something that should be instinctive….
          i started feeling so much better when i kicked out white bread and started making a bread that is based on flax seeds with 6 eggs and cottage cheese, and added more protiens, and vegetables into my diet….the inflamation went down

          now the thing is they do hybrid seeds! you never know what they will invent that may become new source of inflamation in the body like that ATI protein in wheat! that is the real huge inflamatory molecule! and not gluten…its the most recent study you can look it up on sciencedirect or other page!

          thats why i am not really interested in kicking out any food group…one can spend a lifetime learning but i must eat as of today :)….and taking good protein is simply essential for anyone who has broken thyroid!

          • oh one more thing, you said you dont digest fat well?
            do you know the reason for that?

            usually people who are diabetic dont digest fat…..

            i noticed i love fats now more then sugars…and read that fat craving is symptomatic of hypo patients

            • Hi Ivy,

              I am not sure what this post is linked to or who you are addressing it to…so I might be off by chiming in if it wasn’t directed at me (my apologies).

              I have not found the cause of my digestion issues (yet). However, I have since encounted 10 people who also are no longer digesting many foods. One woman who is dying even after having had the fecal transplant.

              Fat digestion is done by an enzyme the pancreas makes.

              That said, I recently happened across a video of a pill camera in the stomach of someone who ate Ramen Noodles…not only did it say that after 36 hours (I am sort of suspect of that) the noodles still were not broken down. The interesting part was that they were connecting this to the preservative being used on the noodles. This led me to suspect (and I actually highly suspect it) that something being put on our food (maybe even just to clean it) is causing it not to be digested.

              It is very disconerting to me to hear so many people relating the same story regarding not-digesting. Recently saw a GI doctor who said straight off that they can’t do anything about the digestion. At this point I only minimally process bread (although I feel super yuk eating), necterines (that are no longer good/in season), and meats minimally (although don’t want to be eating. Romaine lettuce and pinapples are suppose to have natural digestive enzymes in them…and yet both come out untouched.

              Anyways…hope it answered your question.

              • hello Faith,

                oh i have come very quickly ahead of many things i did not know before.

                1st right move was finding good combination that put my ft4 to ft3 ratio in balance.

                I must disagree when you say many people have lowt3 syndrome.
                We have to dofferentiate 2 things: a ) do they take t4 or any other therapy b) is that low t3 , normal t4 and normal TSH what was found before they ever took any thyroid h.therapy

                this is crucial! becasue i dont agree many people have low t3 syndrome!
                most people have just thyroid issue. and they rarely end up online, and then there is this first problem, i had too

                where low t3 suddenly appears becasue of unbalanced thyroid hormon therapy i.e. going above physiological doses with t4 medication! my ft3 dropped immedately as i hit 100 mcg t4!! this is not a coincidence! since then it never recovered….

                so it can be just like i explained that body fights agains excess of t4 hormones…by reducing ft3 , producing more of rt3….to keep body from going too much hyper! and in that situation i was having symptoms of hyper: sweating, headaches….and symtoms of hypo :brain fogg,fatugue, sleeping problems

                these are 2 very improtant thigns to differentiate, so adding small amount of t3 to therapy can easily correct the low t3….when i added only 3 mcg to my t4 my ftr jumped from 3 to 4! it was 4.4 before i ever started medicating

                so telling that body doesnt need t4 and needs only t3 i would not agree, becasue WE DONT know….noone understands that issue so well to claim this….its like every cell in our body has its own logic, and having t4 is needed so many of those different parts can regulate t3 conversion as they like, also look how every cell in the body has 2 receptors:thyroid h and vitamin d hormons! and both of the 2 have the prohormon version and hormon version!

                there is too much unknown there so that anyone can claim we dont need t4 , ofcourse we do, becasue t3 sets the same pace for all cells in the body and maybe this is not how its supposed to be?

                yes i know hypotalamus is the master mind and pituitary is sort of manager, if hypotalamus is CEO :)…..i know this, i just saw that my TSH goes up when my total t4 went lower! body is trying hard to secure enough of t4…that is called energy storage prohormon..because t3 must kept constant….should not vary too much becasue of sensitive heart muscles..

                but then when you look thyroid, it secrets those 4-6 mcg of t3….all the other conversion goes in tissues…so what normal thyroid only patients should do is replicate what thyroid is secreting and not the total body production of t3 that is around 30 mcg t3 that i heard? but not sure of that info…never checked…if thats at all available or known fact?

                this is my understanding based on my hypothyroid experience! and i have been seriously hypo for over a decade before i realized i have broken thyroid….number one casue i think is malnutriton!
                digestion issues are very much connected to thyroid problems….since you said you can not take t4……i must tell you my digestion improved remarkably when i started taking t4 only!! in low doses…..it was very significant chnage…however low t3 makes personnot digest proetins well…..so only until i made good balance i digest proteins well now as well! and dont need betaine hcl supplements

  91. Thanks for explanation of all the T3s, except I mostly get low T3, not really low any of the others (total or free, etc).
    I did a corticostim test in which they inject you with cortisol and put you in an extremely stressful situation to see if your body can respond to the stress, and I responded above and beyond by making lots and lots of cortisone. So that means no pituitary problem.
    My endo is great and I have medicaid, so I can get more tests, but maybe, as you point out, there really is nothing they can do anyway, so they don’t bother.

  92. So, I’m wondering, is low body temperature an indication of low t3 or not? (IE the whole Broda Barnes scenario.) Since low t3 is not from an ill thyroid but a lack of conversion, will low body temperature have any bearing on if a person should seek treatment or not? In other words, will having low t3 cause low body temps?

    • Hi Diane,

      You ask is low body temps an indication of low T3 as in a causal effect, and no I do not believe that it is…however, the two things often happen together, although (I believe) are happening independently.

      To explain. When the body is sick, for whatever reason, the main hub, the hypothalamus (which controls both of these things), will change our body’s set points.

      Systemic low grade inflammation will cause the hypothalamus to set the body’s temp point lower…in the same way a bacterial infection or virus will cause it to set the body’s temp point higher (fever).

      The underlying condition causing the low grade inflammation (just being sick) will cause the hypothalamus (independently, through use of different chemicals) change the body’s set point for T3 lower. It is not that the body is not converting it well…just that the body is not wanting more, per the hypothalamus’s instruction.

      Both of these processes often occure together, although are happening seperately…and both are normal and natural and not in need of treatment (other than to treat the cause of the illness and underlying inflammation) as they will correct themselves on their own when the condition precident is removed.

      Hope that helps clarify.

      • Yes, very helpful Faith. And, interesting.
        I do have inflammation. My ferritin has been moderately elevated for at least a year. (250ish). It has been coming down (177 last check) as has a mildly elevated ALT. (mid 50’s and now normal at 22 last check.) But with what you’ve stated above, I wonder if Cynomel is the culprit, at least in part. I was quite ill Jan of 2013, I think it was EBV as I have high counts for an infection from sometime in the recent past. Huge fatigue and from blood work thought it was my thyroid, started Cynomel. I think I’ve started a vicious cycle here. I’m wondering if there is way to support the hypothalamus? Now I’m wondering about bone loss and my weight gain. UGH. I may need to wean off Cynomel.
        Question is, how does one ever determine the cause of inflammation? It could be just about anything.
        My ANA is normal. No Hashi’s.

        • Hi Diane,

          Interesting re the high iron. In my own labs they commented (my iron is normal) that it could be elevated due to anemia of chronic illness. Apparently, illness raises iron levels.

          It is often difficult to isolate what is causing what as it is usually due to complex interations. Oftentimes, the only or first odd labs we get are thyroid labs…so it makes sense to start treating it…when sometimes it is not the thyroid but something else.

          I’d still reccommend the book…and a look at your diet precceding each change on the off chance foods are triggering the flip flop.

          Hang in there, keep searching and you will eventually find your answers.

        • i dont believe there is something called hashi! its broken thyroid only…..nothing more, and you can get antibodies only when its in early stages, if you are in late stage of destruction there is no way antibodies will show up when all is destroyed allready….

          so what happens you take hormons but thyroid got broken becasue of somethign else!! and you built up vitamin mineral defficiencies over the years, you can mask a lot of it with hormones….but long term the overdose of hormons will start giving you new issues

          high ALT can be from too high t3!! yes my logic is staying close to physiological lvs in hormones is best approach..unless like Faith ….you have some special case…issue…which you may have but

          high doses of t3 and those are all above 5 mcg…….can be culprit…

          the same as taking 200mcg t4 its 2 x the physiological dose, taking 12 t3 is 2 x more…….it will mess with your t4 lvls…..t4 is good for something…..etc….unless you have some really good reason not to have it

          • since i wrote this i was reading some papers and now not sure anymore what physiological doses are….they may range from 4-10 mcg?

            so i would say taking more then 10 mcg of t3 is going way above physiological lvls

            would be nice that they finally say what are the physiological doses exactly of t3 is it 4-6 mcg or it is 6-10 mcg? anyone knows?

      • this is very nice explanation…..

        but in my case my low ft3 came becasue i was thrown out of balance by taking too much t4 meds! i was on 150 mcg t4…my symptoms would not go away on t4 only what i should have been given is tiny amount of t3 when t4 started not to work properly…and my tsh was around 1.4 this was achieved even on 75 mcg doses…..

        so above 100 mcg t4 there was very significant drop in my ft3

        this is caused by hyperconversion of excesses of t4 into rt3! this is what i learnt and fits in with my lab data…..its so clear that 100 mcg t4 was probelm for me and those days i remember i got all of the symptoms like sweating, hair loss, and feeling hyper!! but eventually my body accomodated to it!!

        amazing thing!

        so low ft3 number in people who take hormons can be produced only by excess of t4….in my graph this is so vividly shown

  93. About 10 years ago I started have issues with weight gain and feeling cold all the time. The cold is getting worse over time, the weight gain at this point seems to have leveled off at about 20 pound gain. Everyone I know has been bugging me constantly telling me I have a thyroid problem for many years. My TSH always is normal. I finally got some tests abroad (where I could afford them) and my T3 consisting turns out low are just at the low end of normal. I bought some cynomel on the internet and tried taking a tiny amount, but didn’t like the effects and quit. Still I am desperate to get warm. I tried the cynomel again this summer. I took approx .5 mcg two days in a row. The first day I felt warm. The second day I woke up at night with a terrible ringing in my ears, drenched in sweat, feeling just awful. At a certain point it felt like I was no longer inside the right half of my body (I kept touching it to make sure I could feel it to make sure I wasn’t have a stroke). I vowed I’d never touch cynomel again. Interestingly, over the next month or so I was generally warm, and sometimes hot. People thought I was having hot flashes. I also lost 10 pounds without trying to in any way, (this after 10 years of unsucessfully trying to lose weight). During this time of weight loss and heat, I had an appt with an endo doctor (I finally got on medicaid and could afford it). I really liked the doctor and mentioned that I felt like my thyroid had bounced back up (a similar thing had happened 4 years prior and I never understood why- this time I thought maybe it was the effect of the meds). He did many thousands of dollars of bloodwork which all turned out not just normal, but at the high end of normal. This did not surprise me given how I was feeling. Since then, in the past month or 2, I have gotten cold and started gaining the weight back. A more recent blood test still shows normal thyroid function. No one has tested my T3 since April because doctors consider it not important. Even when I ask for it and it is prescribed, the lab results give total T3 rather than T3. I asked the endo if it is the same thing and he said no. Since T3 doesn’t matter and all my other numbers are fine, I am considered fine. Yet I cannot go indoors in summer and cannot work because of the cold. Whatever was going on earlier in the summer, I want it back desperately. The doc said it could not have been the meds. I am negative for Hashimoto. What boosts my thyroid function and how do I get it to go back up again so I can feel well? I am desperate, so I am now putting a cynomel in my mouth every day and letting just a tiny bit dissolve. I have no adverse effects that I notice from this, but also am still cold. Why did it seemingly have a month-long effect before? Or what was it instead that boosted my thryoid function?

    • Hi Mare,

      I am so sorry that you are going through all this. Although I don’t have an answer as to what is causing this, I can shed some light that may help you further your search.

      Even though many people connect being cold and thyroid, it is in fact the hypothalamus that sets the body’s temp point. Even when we are sick, like with the flu, it is the hypothalamus that increases the body’s temp (fever) in order that e can make more white blood cells to fight it. I do know that inflammation will cause the hypothalamus to set the body’s core temp lower than normal. You did not mention if you have taken your temp when feeling cold all the time…if it is lower than normal, it is likely inflammation. The labs for that are C-Reactive Protien (CRP) and the SED Rate.

      Systemic inflammation, even low grade, ironically can happen from too much T3. Although, usually it is that whatever underlying issue that is causing the inflammation will also cause the body to, naturally, lower T3 levels. This looks like, in labs, as normal TSH, normal T4 and either low normal or low T3. This will likely not be helped by supplementing because the body (the hypothalamus) has set the body’s level of T3 lower so the body will work to sustain that low level.

      That said, taking T3, even when the body doesn’t want it…will become a problem if the liver is not clearing it like it should. Too high T3 can feel similar to too low and can even cause paradoxial weight gain…and, it can also cause bone loss.

      Although it sounds to me like the beginings of a possible autoimmune condition (non-thyroid) wherein the bad periods cause inflammation and thus low body temps as well as the flip hot times…before covering that, my suggestion would be to consider any differences in your diet the week or two before either of the shifts on the off chance that food may be the precurser to the issue.

      The main test for autoimmune is the ANA or FANA.

      There is a good book on both how to identify and also how to help yourself if autoimmune may be the underlying issue. And again, I don’t mean that it is anything outright…but more subtle and just in the begining stages causing just low grade systemic inflammation. The book is Why Do I Still Have Thyroid Symptoms When My Lab Results Are Normal? by a Dr. K. He discuses how to identify which side of your immune system it may be as well as the foods that may be behind it.

      Sorry I don’t have the answer, but hope any of this may help…I sure hope you find your answer.


      • Thanks, I will look into the tests you mentioned. My body temperature is generally around 97.6, but it varies. I’m cold all the time, whether my body temp is low or not. Recently the tests that I had that turned out off were low MCHC, low MPV, low eosinophils, low basophils, high immature grans, high lymph absolute, high mono absolute, high immature grans abs. Since I had just finished a low-grade corticosteriod treatment for back pain, I assumed that is what affected those test results.
        Also, I am confused as to what the difference is between T3,, total T3, Free T3, and uptake of T3. It is my T3, and occasionally my total T3 that are low, not the others.

        • Hi Mare,

          To help clear up the confusion re T3/TT3/FT3…in general, we make T4 (1 thyroid 4 iodine) the storage form of thyroid hormone…and we convert T4 into T3 (1 thyroid 3 iodine) which is what fits into the receptors cleaving the 3 iodine in the process. In order to preserve both T4 and T3 longer, they temporarily bind to carrier proteins…while bound to these proteins they are not-usable. TT4 and TT3 refers to a count of all bound and unbound T4 and T3. FT4 and FT3 refers to only a count of unbound and ready to use T4 and T3. However, I have yet to hear of anyone with an issue of too little or too much protein binding or protein binding being an issue. That said, to further compound the T3 issue, there is also RT3 or Reverse T3, which we normally make some of and is not-usable. When they do a TT3, they are also counting RT3. There is no test that just counts bound and unbound T3 without the RT3…so this is why doctors and patients prefer the FT3 test.

          The important thing to know is that just because someone may be low on FT3, they may have plenty protein bound T3 that the body can readily unbind and use at a moments notice…and thus the test can and often does give a very false impression of a person’s T3 level. In my opinion, it is best to draw a baseline of TT3, FT3, and RT3 in order to see what your particular body is doing. High RT3 will throw off TT3…but if RT3 is within normal range, then TT3 is a better way to see what your levels are. Although, you have low TT3 with normal T4 and TSH shows a true conversion issue…the question is why…as in, are you truly failing to convert or is your body converting less on purpose? One of the most common reasons that a body re-sets our set point is because we have some underlying illness going on…and in these cases, it is not a thyroid issue (as it will correct itself), but a side effect of being sick. And, in actuality, it is the hypothalamus that sets that base point.

          Running cold is a sign of hypothalamus involvement…whether from low grade systemic inflammation or other illness process. Like Chris suggests in this article (that we are posting under) the body just sort of does this when we are sick…and when the illness resolves, the weird settings clear up on their own.

          There is no known way to support the hypothalamus…however, all the standard advice on lowering body inflammation could help. Doctor’s do not treat hypothalamic issues…nor do they often test for it…I personally believe that they have no clue how to deal with it. No one on the internet (providers included, author of this article included) seem to break it down like this despite having learned this in medical school. If you want to pursue it, a cursory look at the Wiki’s on both the hypothalamus and pituitary will yield the relevant hormones that could be tested. I am told it is a stimulation test that only endocrine doctors can run…and that they don’t like running them.

          Hope that helps. 🙂

  94. Mark-

    Yes, snpedia, and also reading research studies like you mention above. There are several other snps that have been studied but the two I mentioned above seem to be the most important ones, so far. ( I tend to second guess myself, afraid I’m not determining the correct reading. Sometimes the ‘orientation’ of the snps are flipped and though I think I know how to read them I still wonder if I’m reading them correctly at times. )

    Thanks for the great tip on how to try and take the t3. That would make a lot of sense. I’m now wondering if the t3 has added to my inflammation? Also, I think I upped it too much, too quickly and I didn’t give my body time to adjust.
    = feeling crappy.

    Glad you figured out your snps!

    • I compiled an analysis of all five SNPs with supporting research documentation: https://app.box.com/s/vb2ck4vvfe13hoaer0wo

      Maybe you can glean some helpful info from it. So from your research, SNPs rs2235544 and rs11206244 are the most significant then? If so, then I can surmise the argument is that I sway more toward being a hyper-converter of T4 to T3.

      • Great research everyone and thanks for sharing.

        I don’t have much to add, other than to say feeling poorly on T3 is usally a sign you have too much…and that it can, eeriely, feel similar to having too little.

        As to what the genes mean, I would think that this is just a map of how your body converts…that said, if you were a super converter, you would have chronic low T4 because it is over converting it…similar to the Vitamin D Reversal Pattern where a person has chronically low storage D (25,D) and normal to high active D (1,25 D). The other signs of over-conversion would be low TSH.

        I think the pertinent point that is being missed is why some peoples body’s “set point” for T3 need is lower than the standard. The main reason there seems to be for this is some other underlying illness and that for all practical reasons the body (despite the low T3) is acting normally and doesn’t need to be messed with. Also demonstrated by when messed with (adding t4 or t3) it does worse. Sometimes, the body knows better than us. *shrugs*

        • I have to totally agree with you Faith. We often try and fix a ‘broken’ system in the body by taking and doing all manner of things. I’ve found supplements push the body chemistry, not always in the best direction. The human body is wonderfully created to fight for health, homeostasis. And, unless there is a disease process going on that it cannot overcome, often time is the best nutrient.

      • Mark- Thanks for the great document. I’m still checking and reading as time permits. I did read on a few studies the two snps I mentioned are the main ones. Although, I suppose another researcher could have a differing opinion. Thanks again for putting this all together. I downloaded it and will spend some more time researching it all. Also, I noticed the last article on thyroid and depression. I’ve definitely had that, especially when the winter days are so short. I’ve read more thyroid med is needed in the winter months and personally, I’d say I think this is true.

  95. Thanks for the post above, Faith. I’d been feeling tired and recently upped my t3 from 37.5mcg/day to 50mcg/day. Now, I’m feeling even worse. Maybe I need to take it the other direction. I would love to not take any thyroid.

    Chris, my question to you concerns the deiodinase enzyme snps. I am homozygous for rs2235544 A/A and rs11206244 T/T. From the bit of reading I’ve done, these are two of the main snps associated with fT4/fT3 conversion. In the past when tested I’m always on the low end of normal for fT3. Mid level for fT4. Does this necessarily mean that I am not able to convert well due to these polymorphisms? Looking back, I’ve dealt with ‘thyroid type’ symptoms since my mid-20’s. Early 60’s now.

    Although, from your article, I’m wondering if my problem might be more related to inflammation. Elevated ferritin with normal iron levels and elevated HSCRP. Sed rate normal. I have high markers for EBV virus, past infection. Might this be the culprit for my inflammation?

    Thanks, Diane

    • Hi Diane,
      I’m also low or low normal on fT3 while mid-range for fT4. I tried taking a very low dose of T3 and felt much worse.
      In my case, I *think* the reason that I’m not converting T4 to T3 is that I have ferroportin-loss-of-function disease, the second most common type of genetic hemochromatosis (aka iron overload disorder.) Ferroportin LOF is characterized by high ferritin and low or normal transferrin saturation, with different tissue types getting overloaded than with regular HFE hemachromatosis. There’s a good summary on iron overload disorders from the NEJM posted here: http://www.trinity.edu/rblyston/documents/JAMPjanReading/Fleming2012.pdf
      Fleming RE, Ponka P. Iron overload in human disease. N Engl J Med. 2012 Jan 26;366(4):348-59.
      Inflammation does put up both CRP and ferritin – but if your ferritin is a lot higher than can be explained by your CRP, as you can see by the flow chart in the NEJM article, you might want to ask your doctor about ruling out ferroportin LOF disease. (The one upside of ferroportin disease is that it is treatable with bleeding to get rid of the extra iron, although people with ferroportin LOF often end up having to be bled less often so they don’t get anemic. Still, with patience and perseverance, we get “de-iron’ed” in the end!)
      Ferroportin disease isn’t that common, but it’s often missed because the transferrin saturation doesn’t go up until the ferritin is very, very high.
      Just in case this could be a helpful clue for you –

      • Gillian,
        Thank you for the response and input. Appreciate it. I have looked over my snps for possible HH but haven’t found that I have any snps, even heterozygous.
        I did find it good that my most recent blood work showed my ferritin levels lowering from mid 250’s to 177. But, even better my ALT enzyme had been in mid to upper 50’s for a year or more. This time, very normal at 22! So, I’m heading in the right direction. With normal iron TIBC, UBIC and % sat, I do think it’s inflammation that’s been causing the elevated numbers.
        Great that you were able to find out what was occurring with you. And, especially that it’s fixable!
        Thanks again….Diane

    • Diane – Wanted to commend you for making this discovery of your +/+ SNPs. I am glad I just happened to read this post in my inbox. I also use 23andMe raw data quite frequently. How did you pinpoint these specific deiodinase SNPs? Was it from somewhere you read or did you run search on SNPedia? In my case, I was mistaken all along, thinking (assuming) I had a conversion block when in fact I do not (I am -/-); in other words, I am a hyper-converter, therefore, the NDT and T3 I’ve been taking along may have been making me worse! This is further supported by the fact that the one time I trialed T4 only for a month, I converted just fine, my T4 dropped as did my rT3 which is what’s supposed to happen, and my TSH was <1.0 for the first time ever, and my FT3:RT3 ratio was 67, but I didn't stick with it because everything in the alternative community that I followed told me T4 is "evil" and I need to run back to T3! I would think T3 would be the remedy for you since you're an under-converter [yes, you have a problem converting based on the research – see risk allele "A"" http://www.snpedia.com/index.php/Rs2235544%5D

      Strange why you felt worse. But maybe not, as speaking of inflammation, I was told by a well-respected doc some time back that T3 up-regulates immunity and can cause inflammation, especially if it is taken on an empty stomach (and 80% of our immune system is in our gut). His advice: take T3 with food since 95% of it is absorbed regardless. Perhaps that will help.

      • hello there,

        what is your ft4 to ft3 ratio in a blood?

        i think one can only look at that ratio before taking meds and target that sort of lvl later! my ratio was 3.4 before meds, when i started taking t4 it went to 4 and dropped below 4 and i was feeling great!…my doc nevertheless chased TSH and after 100mcg t4 i ended up dissbalanced! my ft4 to ft3 ratio in blood jumped to 5.5!! which is soo much worse then should be my TSH was regulated well dropped below 1

        that beeing said i think best is to keep it above 1 slightly 1.4 maybe….below 1 is maybe overdose…..

        so after taking 150mcg t 4 for a year and having low ft3 becasue of dissbalance i chnaged to 100+3 mcg and my brain fog lifted but after 3 weeks i felt hypo symptoms back and my TSH jumped from 1 to 2.22 in 30 days…
        i am trying 100+6 now, but from this lower dose 100+3 i got my lymph nodules inflamed….i hope this did not come from 3 mcgt 3 but becasue of TSH that moved to 2.22
        and y ft4 to ft3 ratio dropped to 4.5 which is good….and i aim for it to drop below 4! since my natural ratio was 3.4

  96. it is 13th day i am on combination therapy! taking 100mcg t4 +25mcg t3, i made a switch in 1 day from 150mcg t4, now not too sure if thats the perfect way to do it, but have learnt various things in the process….

    finally think i know where panick attacks come from, from drop in t3 lvls…body keeps t3 very stable….and on 11th day i took only 19mcg t3+ 75mcg t4 in the morning and was feeling sick all day long….

    i looked up my old lab test 2007-2009. and it shows how my ferritin was 6 and minimum was 30 🙂 so seeing ferritin in 2014 at 34 is not that bad thing ? :)…i was blaming it on low ferritin, that probably has something to do with conversion process from ft4 to ft3 since it stood better then when i was very low in ferritin…..but not so much worse as it got when i was on 150mcg t4

    but adding t3 in my body i realized that hormone plays important role for heart!, for mood and energy and brain fog…feeling tired has the most to do with heart not beeing at its best…..this is my feeling…..i.e. with low ft3 …and even the slightest chnage in ft3 hormone is able to trigger panick attack, that is designed instead of electro shock for heart….so hypo people use a lot their adrenals…instead of ft3!

    i also noticed when TSH drops , also does theconversion of t4 to t3 and that total body production of both hormons stands at around 100 mcg t4+ 30mcg t3…..which is 3.33 ratio…and before i was medicating hypothiroid my ratio stood at 3.41 i dont think this is coincidence only

    and when i reached 100mcg t4 intake in my boody(at 150 t4 tablets, since i absorbed probably 70% of it taking it immediately before clacium breakfast 🙂 my TSH remained supressed below or at 1…and ft3 fell to low border of the range…….
    and i feel so sad now….casue not sure if this combination therapy will work for me, its creating me wolf hunger and if i dont eat exactly 5-6 hours after breakfast i get shaky and dizzy and like i will die out of hunger and that creats perfect situation for a panick attack …..but in general my mood was better, i was euphoric how energetic i was, but the last 2 days when i had panick attack due to messing around the dose….i got dissheartened…and today feelign tired all day long…really tired….my adrenals probably exhausted…..
    and why i messed around the therapy becasue i was afraid its too much too soon, and my heart is under too much effort since i had sensations around chest area and i started reading…..

    do you think i will be fine? and it was not that big deal to switch from 150t4 to 100+25 combo?…..

    one day i did sport and i noticed that exhausted me ..but i was energetic and could do it much easier then before, just that hungar is annoying…i dont eat overall much more..probably about the same?……but today i feel depressed…cause tired and its 13th day…2 days ago i messed the dose so this took me out of balance…today was managable but i am afraid now..and not relaxed..and thinking…and just so so tired…:(

    thank you!!! for lsitening and maybe some word of encouragment :))

    • Hi Ivy,

      Well I applaud you for trying things and keeping careful track of how you feel.

      The feeling shakey when you don’t eat IS adrenals…that is the one sure sign. Unlike everyone else, I feel better when I don’t eat.

      Too much T3 will make your heart beat funny…which could easily set off a panic attack. If I remember, you did not do well on T3??? If not, then you do not want to take a big dose all at once…it doesn’t act like T4…and the fact that you get the heart issue and panic suggests that your body is not clearing away the excess T3 that well. For what it is worth, I only take T3…but I have to take it 10-12 times a day. My body clears it really well.

      Both too much and too little T3 feels pretty much the same…tired, yuk feeling. The difference between the two, I have found, is too little makes you sad…and too much gives you the weird heart racing thing.

      Take heart, everyone is different in their need for thyroid hormone…and what works for one does not work for another. Keep trying things, eventually you will find what works best for you.

      Hang in there. 🙂

      • hello Faith, i am back with new info 🙂

        i read dr Blanchard book, this has been somehting like an eye opener for me….

        you know i have 16 data points from 16 measurments of my hormons through 3 years time….and i noticed my TSH moves up in the summer, i found explanation for this in the book…sor tof and i added my own explanation to it, it must be connected to vitamin D! …i remember all cells in the body have receptors for 2 things, vitamin D and thyroid!! this is not just coincidence

        and research showed much higher TSH seasonal variations in subclinical then euthyroid patients so i assume it can go as high as 1….

        so i set new target for myself i will target my winter TSH 1,4 so that summer goes to 2.4 like it did last summer

        i was on t4 only for 3 years but slightly increased to 150, where i spent 1 year this supressed my TSH to below 1, and symptom of low energy stay there

        so this is my big conclusion now: overdosing masks the underlying problem each of us have…i know malnutrition is great trigger to develop thyroid probelmS! and my ferritin beeing low i can not feel more energetic on the borderline ferritin 🙂 so no matter how much hormons i throw in it wont do me good, and i was clearly overdosed on 150 t4! and then

        i took 100 t4 +25 t3!! oh boy this was one of the worst nightmares so far in my life!!!! i was having starvation hungar! that threw me into panick attacks! i was fighting for my life, eating like crazy!! and euphoria and disspair were swaping through the day my BP went to 140 over 80 and heart rate 74 always and 80 sometimes…..and my usual HR is 63!….and bloos pressur enever higher then 125…..

        then i dropped to 100+3 mcg t3 only it felt great , soo good for 3 weeks then i started noticing huge dropp in t4….i did not notice before …t4 is slow worker…so i upped to 135 10 days during my PMS ….now 100 for 2 days…i plan to keep that dr Blanchard approach cause i was amazed how many things he explained well in the book, and

        the most improtant take is t3 in very small doses lifted my brain fog!! and improved my mood!! i still have eneryg problems, am only like 35 days into it…..so too early to tell, and not perfect yet….becasue i think my thyroid supressed for some time now…and must start working again…..

        so i was getting old symptoms back , i hate it 🙂 like lyphatic nodules becoming bigger, and synus sensitivity…but on the other hand PMS was nonexistant almost!! and no headaches and finally not feeling so crazy hungry! omg what a rollecoaster t3 is, 25 mcg t3 affected even my short term memory!! can you believe it?

  97. Hi Everyone,

    All the comments are running together in my mind (sorry about that), so I am just going to make a more blanket response here (hope you don’t mind).

    Yes, it can be very difficult to get doctors to see the logic in things, I think we are all in the same situation with that.

    I think it is great that we are all reading and trying things, even if we later find out those things don’t work. I try to post what I learn about things because so many of those things are costly and a lot of people do not have the money to waste on what doesn’t work.

    I don’t know what to say about the iron issue…I am very chronically hypo, but my all my various iron levels are fine. The B12 issue, I believe, is a whole different story that I don’t believe anyon has gotten to the point of even formulating the question of why is it that people who are struggling with their health do soooo much better on B12? For me it seems like a breakdown in my ability to use my stores of it…since my levels are also fine.

    The research is hopelessly behind, in my opinion…because all the B12 work is on the autoimmune and digestive issues of not having enough “intrinsic factor” to process it from food…but I test fine on those tests too. When I take B12, I am fine for about 4 hours and then I need more. Why is this? I have no idea. It also helps my kids and my mom. Nothing I have seen in all the cycles (like the methyl cycle) points to the process by which we process and use B12 so I have no idea.

    I agree, I think we all know what will work for us…I honor that part of people that knows this stuff.

    Regarding Vit D…sunlight is my best choice. Back before I researched it, I got Borage Oil (from a plant) and Flax Seed Oil…I think for Vit D, deffinitely for the essential fats. There is a really great video on YouTube about mixing Falx Seed Oil, Flax Seeds, and Cottage Cheese…the Budwig Protocal. This mixture renders the fat water soluable. I was intrigued by this because I don’t digest fats well. The Cottage Cheese they mention is really very sour…if you like sour, go for it. I ended up having to use regular Cottage Cheese, because the other was just too sour for me. With the regular Cottage Cheese, it could be a replacement for cream cheese on a bagel or something. In the end, I just cannot do dairy products so I had to stop.

    This is a great group of people. 🙂

  98. was searching through the web yesterday, and reading researches on the ferritin , b12 and folate and iron metabolism…..

    there is one hormone that is called hepcidin, it is in the liver, and it regulates complete metabolism of the iron, i noticed many hypo people have problem with low iron and/or b12! and this puzzles me why this is not addressed together? (some studies on mices showed that combined therapy of iron +t4 gave better results then taking just on or the other on treating iron lvls)

    It seems that body doesnt want to absorb iron from the food if there is low grade chronic inflamation going on…and that kind of inflamation can be caused by exercising…..and i remember i was always active even though my body was depleted with everything (so body with hypo people can register walking as exercising too if its more then it can do??)….

    iron is directly correlated to oxidative metabolism, which is again affected by hypothrioid condition….so probably body concludes there is no reason to uptake more iron if the oxidative metabolism will just make the body weaker….becasue not sufficient hormones to keep it going??

    this is just my theory…but bottom line is…..when one finds hypo problem should check ferritin level and prescribe both things together, if ferritin is not improving this means thyroid hormones are not balanced enough??

    this was my case at least, my ferritin could never improve….

    so curious to see if on better therapy after 1-2 years my iron gets fixed …….my serum b12 is good, did not measure folate (since i think there may be false rsults).
    Also not enough copper, zink can influence iron absorption..but i watch my diet for the last 6 years….was bombing myself with iron rich food :)…eat bluebrrries every single day now 🙂 meat etc…so it my feleing the body doesnt want to absorb more! :), i tried with more stomach acid too, but to na avail……iron is absorbed in duodenum 1-2mg per day only and that same amount is wasted every day too

    if anyone has any other clue….t3 may be the missing link, becasue i was on t4 therapy only…so my ferriting tells my thyroid therapy maybe not ok my latest feritin lab was 30( 30-300 is lab range 🙂 maximum i saw is 34 in me

  99. Dear Gilian thank you so much for your effort, appreciate it.this is great community here very informative, but
    I dont believe in h.pylory…its something so prevalent in the population, but low ferritin and hypo go so well together, my serum b12 is high, so if it was for pylory i would be low in b12 too, i think it has something to do with metabolism, and they did not investigate it yet, they dont know what function ferritin has, thats what i read today……

    Helicobacter, i read may even have some postive effect in our bodies! It so ething co pletely new, i put it into same category as gut bacteria, something thats not been researched at all, and not used in healing at all, h.p. can cause problems in some people i know thta, i have read many things, and no way i would be taking 2 antibiotics and proton pump inhibnitor that makes me sick person,to get h.p. next time i go for a coffee:-)

    I do take a lot of calcium, eat lots of milk products, but dont drink coffee , tea:-) …and was supplementing iron for years..but was never on proper thyroid medication, i did notice that my ferritin dropps immediately if i dont supplement for 1.5 months….and it is connected to low ft3 lvls and hair losss……so i was thinking there is something to it……am very curious if on this new balanced therapy that includes100t4+ 25 t3 i will maybe move that ferritin for the first time in 15 years up:-) ….then i will know its closely connected to thyroid…..

    But i am so so surprised that they did not establish explanation between low ferritin, low b12 and hypothiroidism…..

    Yes i just learnt today how those trace elements must all be inbalance i never supplemented anything beside iron, so this may well created some imbalances but i doubt it can be so that i prevented me from creating more ferritin…..

    Have no idea, but i never had any stomach problems in my life……i did develop hypochloridia …which i did not know, but every summer i would be feeling like vommiting for a month……even on t4 only it improved! Now 5 days taking combined and i think t3 is of great help there…and i will turn that metabolism higher……..

    Yes like faith said..maybe its in my genese something that prevents me from creating more ferritin..but i dont know what could help there….i did notice i have higher bilirubin in my blood , but slightly, they told me i have gilbert syndrome, so i become a bit yellowish if i fast…nothingnserious about it 5 of people have it…but this is some liver, blood, metabolism connection, i feel is not investigated at all??

    So little of really good infor tion found…did you ever find the research on t4 to t3 ratio? Some topics are deliberately avoided i think, and its only about money, its also not in docs interwt to fix us with one tablet so we wont be cpming for more checkups!!! My doc was so trying hard to put me off from combined therapy and i insisted on pure logic:-) …….just freakin amazing, i wish i could take him to court…..but in my country how could i explain that i was misstreated when not even in the USA you can prove misstreatment with t4 only

  100. Oops, forgot to mention that besides reducing iron absorption, H. pylori infection of the stomach can also reduce absorption of B12 and some other vitamins –

    Minerva Gastroenterol Dietol. 2011 Dec;57(4):369-77.
    Nutritional aspects of Helicobacter pylori infection.
    Vitale G1, Barbaro F, Ianiro G, Cesario V, Gasbarrini G, Franceschi F, Gasbarrini A.
    1Internal Medicine Department, Catholic University of the Sacred Heart, Gemelli Hospital, Rome, Italy. [email protected]
    H. pylori is a gram-negative pathogen, etiologically associated with atrophic and non-atrophic gastritis, peptic ulcer, primary gastric B-cell lymphoma and gastric carcinoma. Several observations demonstrated a correlation between H. pylori and malabsorption of essential nutrients; epidemiological studies have shown an association between H. pylori infection and iron deficiency anemia, while the absorption of some vitamins such as vitamin B12, vitamin A, vitamin C, folic acid and Vitamin E may be affected by the infection. The main mechanism related to malabsorption of this components is the modified intragastric pH (hypo – achlorhydria) due to H. pylori infection. Moreover H. pylori is also able to determine a modification of gastrointestinal hormones by reducing plasma levels of ghrelin and increasing those of leptin and gastrin, thus affecting appetite and promoting the occurrence of dyspeptic symptoms. On the other hand, H. pylori eradication has been shown to improve serum level of iron and vitamin B12, has some effects on Vitamin A and Vitamin E absorption and has a late effects on ghrelin levels. As a consequence of those effects, H. pylori is also associated with childhood malnutrition in developing countries either for the occurrence of malabsorption or for an increased susceptibility to enteric infections caused by hypochlorhydria.

  101. and one question for you faith pls

    regarding glutathoine……since i started having grey hair in my 30s , rather earely i read this may be a sign of some problem with that glutathoine….

    what do you supplement for that problem?…..
    is l glutamine doing anything helpful to it?

    and what do you think of ashwaganda, i am confused since i have hashi and some say its great thing and on one powder i bought it says WARNING its not for hypothiorid people…..

    thank you very much! i love reading from you

    • Milk thistle has glutathoine in it, I think it may be why it’s a great liver herb. I take it in an extract as I think the powders/pill/tablets arent as effective.
      Ashwaganda stimulates the adrenals. If you’re wired and tired already this will make you worse. You have to get rid of the stress, emotional but also BODY stress—inflammation, illnesses etc and then heal the adrenals.

      • hello Helene,

        thank you very much!!

        BUT i dont know why then they mention this ashwaganda everywhere around hashimoto issues..i bought it :(( so another money spent for no reason uff….

        i am starting to believe its the liver that needs some support not just the gut, everyone is so much obsessing with gut, becasue it looks like a black box….and i remember when i did not know anything , and read no books intuitively i thought i may have some liver problem, becasue i had chronic synus problems, and i heard from one holistic doc who is very very good, he is fixing knees, that synus problems point to liver problem…and i was taking some herbs in form of tablets for synus, when i read up active ingredients of those pills, they were all good for the liver!! and these pills helped me significantly for my synus problems (this was no 1 pills in germany for synus problems, Synupret forte)

        • DrBerg.com is an ND who explains alot of this kind of talk. He’s where I learned about ashwangda. He tried to dispel alot of the common misconceptions adn confusions about health out there. LOTS of free info on his site. He’s in Virginia in the USA.

      • amazing before i read anything i was thinking to take that thing for my liver that milk thistle, then someone told me i dont need it :)…..i think we all know intuitively what we may need!……i connected my liver to my synus problems, and basically i think liver is really essential and so far noone put that much importance to it, all are just focusing on gut, and gut permeability which i think is stretched idea…i dont believe this is source of autoimune disease…..but rather consequence, that by beeing ill you become more sensitive to certain foods……ofcourse eating healthy is crucial, just me going gluten free , did nothing for better conversion from t4 to t3 🙂 it may even made it worse :)….becasue i was eating more protein, fats…….i do follow the same diet now and is nice! but only becasue i fixed my hormonal therapy am taking close to that ideal ratio of 3.5 🙂 taking 100mcg t4+ 25 mcg t3

    • Hi Ivy,

      Gray hair, esp early, is generally a sign of copper def.

      Regarding glutathione…and L-Glutamine…


      Glutamine makes Glutamate…which turns activity on. Eventually, Glutamate makes GABA, which turns activity off. I make way too much Glutamate (why my tissues tighten up) and not enough GABA. How it works is this:

      A.1. Glutamate + the enzyme L-Glutamic Acid Decarboxylase = GABA

      B.1.a. GABA + the enzyme 4-AminoButyrate Transaminase (along with active B6) = Succinate Semialdehyde
      B.1.b. Succinate Semialdehyde + the enzyme Succinate Semialdehyde Dehydrogenase (via the Citric Acid Cycle) = the enzyme Glutamate Synthase
      B.1.c. Glutamate Synthase then makes Glutamate

      And the cycle continues ad infinitum.


      On the other hand, how we make Glutathione is this:

      In short, Cysteine (which is what they would give you to help you make Glutathione, only mine is already high) makes Taurine and Glutathione (both low in me). How it does so is this:

      1. Cysteine (mine is high) + Glutamate (mine is also high) via the enzyme y-GlutamlCysteine Synthetase = y-GlutamlCysteine
      2. y-GlutamlCysteine + the enzyme Glutathion Synetase = Glutathione

      As I mentioned, they give you Cysteine to help make Glutathione…and due to my issues, this is where I have to accept that there are so many more processes involved than even the experts understand…Cysteine would make me sick, as would more Glutamate…my body is clearly trying very hard to make Glutathione. This is why it appears blind to just tell people to take something for something when they don’t understand the process involved.


      Since Cysteine (mine high) also makes Taurine (mine low)… I clearly have a breakdown in those enzymes. Whether that is genetic (if so, they don’t know which genes (yet)), or some other reason…like my body slowly breaking itself down due to my being sick, it is hard to say. It is equally hard to say whether taking Taurine (and/or Glutathione if we could) would solve my health issues, or merely cover a deeper process going on.

      I am a firm believer in finding out the actual process things work by, and not just taking what someone who made a website or wrote a book said, because when you can understand the process…things just become visible that were not before…and the path to our health, if it exists, also becomes visable…like, for me, taking taurine. Nowhere in my defects (so very little is known about them anyways) would it suggest that I would not make taurine or glutathione…and yet, labs show that I am not…for me, I put my trust more in the labs that trending notions. That is not to say I didn’t try, I did…just that it wasn’t it.

      Hope that helps. 🙂

      • oh thank you very much!!! ,

        i did notice recently i can not stop eating dark chocolate i know it is rich in copper…..

        i have good vitamin b12 in my blood, and yet i am not sure if that is good or not, maybe its only in the blood….and not beeing used properly, so me supplementing b12 i did not feel anything, usually when something is really defficiant helpful i notice it for the 1st tablet…….

        i can totaly understand how these docs make wrong conclusions…..it doesnt surprise me at all….

        in a way if you ask me i think they know too little!! and this surprises me so so soooo much, that i can not understand where they spend years and years of learning, some things were obvious to me in few months after started reading……i am especially pissed at study who made t4 beeing recommended as 1st therapy

        thank you very much for this explanation of the process, which is part of methylation process…i never took time to investigate it….just went on to try everything other people recommend 🙂 so i bought myself that powder lol, and i was resisting a long time to it…and then i do sports so it may help me some, but since i was on t4 my muscles did grow somewhat…so am not that very sick person…..but still i know now its all about chemistry and that metabolic process that is in the core of life………

        thank you very much dear Faith!

      • The thing is paying for these labs is cost-prohibitive. You don’t want to know the convoluted way I went to prove my T3 was horribly low. My doctor was then basically forced to give me the cytomel, which the ins had to pay for due to the lab documentation. She would have never tested for it though–just the T4.
        Labs would be nice. Most ppl just have to research, guess and try. The selenium actually seems to be helping me. But I’ll just have to see.

        • hello Helene, tell me about it 🙂

          i came with 2 charts to my doc, which i am paying extra, so private insurance(although i have right to national insurance), to ask to give me combined therapy t4+t3, i just followed the logic, before i started medication with t4 only i was having 3.5 ratio of ft4 to ft3 in my blood, 3 years after that ratio jumped to 6, becaue my ft3 went lower then it was without medications…….in a way i lost faith in those docs, i think they are severely undereducated, and just lack too much logic.

          it is beyond me that recommended therapy for hypo people is t4 only! and they dont check ft3 at all

      • oh it just dawned on me….i was supplementing iron for years without any pause, so this may lead to my copper defficiency? i know i am eating cashew for years, and i eat all bag in 2 days….recently noticed i love dark chocolate……

        i could never get such an advice from doctor, and why i can not build up my ferritin no clue to that, and many hypo people suffer with either low ferritin or low b12…but nowhere did i find my case persistent low ferritin despite iron supplements…..maybe i was missing copper in the equasion….and docs told me just about vitamin c , b complex to take with iron

        copper, iron , zink they all have some part in glutathione production, and i read today what you all probably know that taurine is put into energy drinks!…that taurine has many beneficial effects! i think i notice it in that supplement i take there is 200mg of it in it gives energy!

        • Hi Ivy,

          H. pylori infection of the stomach can cause low iron (which will result in ferritin being low when there isn’t any inflammation) even though someone is taking iron (see a couple of links and article abstracts on H pylori vs. iron deficiency at the end.)

          Iron absorption will also be reduced when iron-containing foods (or supplements) are taken with things like calcium, zinc, magnesium, copper, tea, coffee, etc. (There’s a nice discussion at http://www.parentingscience.com/iron-absorption.html that might be helpful.)

          Taking too much zinc can also cause copper deficiency, as noted in this handout from the UK http://www.patient.co.uk/doctor/zinc-deficiency-excess-and-supplementation . It works the other way, too – e.g., from http://web.mit.edu/athletics/sportsmedicine/wcrminerals.html : “High intakes of calcium, iron and copper may also limit zinc absorption.”

          And here are the H. pylori vs. iron deficiency article abstracts, in case they are helpful –

          Helicobacter. 2013 Jun;18(3):222-8. Epub 2013 Jan 15.
          The effect of Helicobacter pylori infection on iron stores and iron deficiency in urban Alaska Native adults.
          Miernyk K1, Bruden D, Zanis C, McMahon B, Sacco F, Hennessy T, Parkinson A, Bruce M.
          BACKGROUND: Helicobacter pylori (H. pylori) infection has been correlated with low serum ferritin and iron deficiency. As a secondary analysis of a study of H. pylori reinfection, we investigated the association of H. pylori infection and the effect of its eradication on serum ferritin and iron deficiency.
          METHODS: Alaska Native adults undergoing esophagogastroduodenoscopy had sera collected and a (13) C urea breath test (UBT) was performed. Those H. pylori positive were treated with an antibiotic regimen; those who tested negative 2 months after treatment were evaluated at 4, 6, 12, and 24 months by UBT and serum ferritin with an immunoradiometric assay. We excluded persons from further analysis if they were prescribed iron by their provider.
          RESULTS: We measured serum ferritin for 241 persons; 121/241 were H. pylori positive. The geometric mean ferritin (GMF) for persons with and without H. pylori infection was 37 μg/L and 50 μg/L, respectively (p = .04). At enrollment, 19/121 H. pylori-positive persons had iron deficiency compared with 8/120 H. pylori negative (p = .02). Among 66 persons tested at 24 months, the GMF was higher at 24 months (49.6 μg/L) versus enrollment (36.5 μg/L; p = .02). Six of 11 persons with iron deficiency at enrollment no longer had iron deficiency and had a higher GMF (p = .02) 24 months after treatment.
          CONCLUSIONS: H. pylori infection was correlated with lower serum ferritin and iron deficiency. After H. pylori eradication, serum ferritin increased and approximately half of persons resolved their iron deficiency. Testing for H. pylori infection and subsequent treatment of those positive could be considered in persons with unexplained iron deficiency.

          Scand J Gastroenterol. 2010 Jun;45(6):665-76.
          Iron deficiency anemia in Helicobacter pylori infection: meta-analysis of randomized controlled trials.
          Yuan W1, Li Yumin, Yang Kehu, Ma Bin, Guan Quanlin, Wang D, Yang L.
          BACKGROUND: Helicobacter pylori (H. pylori) infection and iron deficiency anemia are prevalent in disadvantaged populations worldwide. The benefit of H. pylori eradiation for iron deficiency anemia has been extensively studied, but data are still equivocal.
          METHODS: A search in The Cochrane Library, PUBMED, EMBASE, EBM Review databases, Science Citation Index Expanded, and CMB (Chinese Biomedical Literature Database) was performed. Randomized controlled trials (RCTs) comparing anti-H. pylori plus oral iron to oral iron alone for the iron deficiency patients in whom H. pylori was positive were selected for meta-analysis. Reviev Manager 5.0 software was used for the performance of meta-analysis.
          RESULTS: Sixteen randomized controlled trials totaling 956 patients were included. The meta-analysis showed that the difference from baseline to endpoint of hemoglobin (Hb), serum iron (SI), and serum ferritin (SF) was statistically significantly different between anti-H. pylori treatment plus oral iron and oral iron alone (SMD, Hb 1.48; 95% CI, 0.96, 2.00; p < 0.00001; SI 1.15; 95% CI, 0.87, 1.43; p < 0.00001; SF 1.84; 95% CI, 1.20, 2.48; p < 0.00001, respectively).
          CONCLUSIONS: Our study suggests that treatment of H. pylori infection could be effective in improving anemia and iron statue in IDA patients infected by H. pylori, particularly in patients with moderate or severe anemia.

  102. Just chiming in with my experience. Tried cytomel for 6 mos. Did NOTHING. Tried it again 6 mos later. This time tried for a year. Did NOTHING. Used 10 mcg. Tried using 15mcg but got palpitations. At the end was down to 5mcg a day as my numbers were “normal”. Well honey, they ain’t In Range for MY BODY. Then I had my levels tested again about 6 mos later when all T3 out of my system…my RT3 is 21 and my T3 is 2.2? Isn’t that a horrible ratio?
    Would love to try the Wilson’s protocol but have no money to pay for it.
    Am trying all sorts of diet modification for about 6 mos now but nothing works. Havent lost a pound in almost 3 mos now.

    • Hi Hélène,

      Thanks for sharing your experience. You sound like you have been doing some research. My two bits is this, and I am sorry if it comes off poorly, but the ratio notion is purely made up. However, I don’t want to just say that without telling you why.

      As someone who has an RT3 issue, and by that I mean that whenever I am on T4 (I don’t have a thyroid), my RT3 levels skyrocket. I have never been on T4 longer than 6 months, however, my RT3 levels have been upwards of 180 points over range. At about 100 points over range I start collapsing, I assume from being so hypo. So my doctors have me on T3 only. In trying to solve my own issue, I have learned a few things along the way…namely, the way the thyroid system works…and, in doing that, also inadvertantly learned what stuff out there is bs and why.

      For starters, the body normally makes RT3…and it is normal to have some. There is no ideal ratio…nor any way to change it as the body makes it according to its needs. For example, if you are exposed to a cold or flu…or if you didn’t eat breakfast before labs, your RT3 levels will be higher (normal, but still a higher normal). Throughout the day your RT3 levels fluctuate.

      The role of RT3 is to regulate metabolism…and, in general, to slow it…whereas T3 speeds it…so they work together.

      The ratio notion hinges (incorrectly) on a false assumption that adrenals and thyroid are connected, when, in fact, they are not…or rather, they are not in the way that they porport. The thyroid system is seperate from the adrenal system…other than from their comand centers, the hypothalamus and pituitary that commands them both. However, they are commanded 100% by completely different chemicals that the body makes. IF, for some reason, a person had issues with both (and this is where I am disappointed with practioners who do the ratio bs), then you have an issue with your pituitary or hypothalamus…and, if they went to medical school, they should know this. If you follow the Wiki’s from the hypothalamus down to pituitary, to thyroid and/or adrenals…you will see that they are seperate independent systems. I am sorry that they lied to you.

      Also, RT3 is made 100% in the liver. Nowhere on their sites do they mention this or even seem to know this…other than maybe they have read me in the last 5 years trying to correct them.

      The ONLY time anyone needs to worry about RT3 is if their level is over the range and they have persistent hypo sysmptoms despite normal T3 & T4 levels.

      T3 is not a feel good medicine…nor will it help anyone lose weight (unless they are truly low due to non conversion)…and it has the side effect of making one’s bones demineralize. The ONLY reason one should consider trying it (besides an RT3 issue), is if they have nornmal T4 and low T3. That said, if their T3 stays low…then it is NOT due to not converting enough and likely due (as the liver is sweeping it on the instruction of the hypothalamus which sets the levels) to being sick or not eating enough…in which case, the only course is to fix the sickness and/or eat more.

      That is my two cents…I am sorry that you are having issues, and sorry that it still frustrates me that the misinformation on the web is keeping nice people chasing their tails. The surest cure for the misinformation is to figure out how the system works from start to finish.

      Hope that helps, and I sure hope you find some answers.

      • Yeah, I went to college for nursing and then again for massage therapy so I have had a lot of physiology, myology and even nutrition as I’m headed for my bach in nutrition and culinary arts. Plus the decades of self study I’ve undertaken becuz I’m really into nutrition and cooking, let alone alternative healthcare.
        I’ve never heard the notion the RT3/T3 ratio is not important or just made up. Of course, it fluctuates but I’ve really just paying attention to it as I’m investigating ANY avenue to see what’s up with my body (and it’s not just up becuz I’m almost 50, I’ve been sick since I was at least 25, probably longer—I’ve had PCOS at least that long).
        I have come to believe that the adrenals and thyroid are co-dependent, if only in the fact the thyroid isn’t usually even the problem. It’s the adrenals underlying that; affecting the thyroid due to the adrenal dysfunction. HOWEVER the adrenals are often underlain by the GUT and its dysfunctioning. This is where I am focusing now. T3 is made in the gut also. 20% of it–a significant amount!
        Feedback loops all affect each other too. The body all runs as a whole. Once one thing is off, a lot more goes with it. In massage we learned (and phyisologists hate this & argue it) that fascia out of shape in one part of the body can affect somewhere totally different…cause pain and dysfunction. This is so true in many aspects of the body.
        I have definite hypo symptoms with “in range” T4 and low T3 (once it was 42 and 100 was the lowest normal range number!) I eat plenty lol I am dealing with chronic inflammation of several decades in duration.
        Thanx for your reply. I shall keep on keeping on in my quest for resolution!

        • Hi Hélène,

          Like you, I too am ever interested in nutrition and how the body works…and more so due to also being sick. For me, only 6 years, however, it has been a disabling 6 years and I very much want my life back. Being sick, I have come to find many others who are also sick with things that the medical profession do not seem to know what to do about. And, also probably like you, believe that diet and nutrition can play a big part in how we feel…as well as recovery.

          I have come to believe that MANY people have issues with either their hypothalamus or pituitary that are undiagnosed, and thus subsequently untreated…this is the only biological explaination for issues with both. Other than, a slow shut down of both (as well as other biological functions) due to underlying illness. If you study the biochemical compounds that the hypothalamus and pituitary respond to, then you will see that they are independent of each other in regards to all the different glands they control.

          I am a firm believer in going back and figuring out how all the various things actually work…because often, then, the cure or fix becomes readily visable…but that is just me.

          One thing I did, which started an amazing trail of discovery, is genetic testing. You may have heard a bit in your research about MTHFR et al. It goes into the genes that code the making of enzymes, which then control how we make and unmake nutrients and chemicals out body needs. I found this very interesting as we only need to eat a small fraction of what we need to make…and, I wasn’t getting well with nutrition (currently, most foods I eat come out untouched). So it goes into heady things like the methyl cycle and all the other various cycles.

          The premise is that you take what you would make after a defect. So, for instance, if you had a defect in the MTHFR gene with codes the enzyme with the same acronym…which adds a methyl group onto folate, you would simply take methyl-folate. However, umpteen of these supplements my doctor gave me made me much worse…so, I looked further…and this is where I began having my own ah ha.

          What I did was to take my genetic reports and list all the things it said were afftected and have my doctor test those things to see what, if anything, was actually being affected. My premise, IF a person has a double defect in MTHFR…then either they would be dead by middle age…OR…something else (that they don’t know about yet) is adding a methyl group onto folate.

          This panel, which was rather simple, lead to more answers than I have ever found in 5 years of being sick. I found out that I was not making taurine (the supplement of which brought back my strength and saved me from needing a wheelchair), nor do I make glutathione well…yet have high amounts of cycteine (which makes those two things)…and why my liver was getting so sick from the antibiotics they had me on…the removal of which has led to my increasing health.

          I also found out that I was not making adrenaline or GABA. No cure or fix (yet) for the adrenaline issue, but the rx Baclofen has gone a long way in relieving the stiffness that had my body curled up.

          Many people who are sick are very smart people…only some of those people have the money to buy all the supplements that so-called “experts” say we should take…and then only to find that they didn’t really work…or worse, made them worse. What I learned by my study of the methyl cycle et al, is that even what we believe to be healthy food (ie greens), can make certain people very very sick (ie those with MTHFR defects)…as can supplements. The genetic testing is one way to personalize supplementation. But again, how the experts do it…and the logic I applied to it still has a gap between. That said, I am many many times better than before discovering all that. My belief, we are all just trying to find answers…I try to share what I have found esp as far as what I have found different from others.

          The RT3 thing…just goes down to understanding how it works. As I say, I have a huge issue with RT3…I take T3 only (as I have no thyroid), and look forward to the day when my health is under control enough that I can go back to T4. I ache for those who are sick and struggling, and hurt for the practioners (well meaning as they are) who read the internet and what people want and just give it to them sans their medical knowledge…like those who give T3 to every tired person or to help people lose weight…or just give Armor and/or iodine to those with thyroid autoimmune…they do it with stunning fregency, because someone who wanted to make a name for themselves on the internet said it was good on a website…and they want to sell what people want to buy so they throw their own knowledge to the side…as these things do in fact make people very sick. The RT3 ration thing was made up by a person who is not a doctor, or even a nurse…and yet are practicing medicine in a yahoo email group..to the point of telling a person on T3 to ignore her heart palps, she had a heart attack following their advice and nearly died. Hence why I always advocate to educate yourself on how the actual system works step by step (medical books, not the internet) and apply heavy doses of logic and reason.

          I have no issues saying something different than what the crowd is saying…been that way my whole life…and found that there is about a five year turn around time until what I am saying becomes common knowledge. Those thyroid sites are NOW, five years later, finally starting to connect liver and T4 to T3 conversion. I cant control the world, nor do I care to, but I can share what I have learned…and that I do. Whatever helps, I am glad…however much you disbelieve, that is fine…if you keep searching you will eventually come to what I have found.

          Best wishes on your journey back to health. 🙂

          • hello Faith,

            ever since i heard about methylation, i thought its the bottom line of how one should feel in his life, energetic or low energy, it makes sense, but they say 50% of total population has some deffect on those genes…..and the environment triggers genes to switch on and off, i am firm believer of that one too……the lifestyle can determine if someone will become seriously ill person, and one that functions “normally”—

            i was diagnosed hashi 3 years ago, when i was put on t4 only i immediately started feeling better, i felt my thermostat finally works, i was no longer feeling cold!, still i was not tolerating summer heats so effectively as i thought i will…..
            my lab tests showed both my hormones ft4 and ft3 went higher and this correlated with my feel good….then my doc started increasing t4, and i did not know why becasue at a time i had “nough” of benefits on that dose i was taking….when we went to 100 mcg i satrted having same old issues, hair fall, feeling tired, and having hot flashes….so nothing was working ……but i could not go back becasue on lower doses i would be tired the same as i was before…….my lab test showed my ft3 decresed on that does below normal range!

            now 3 years later i did a chart of my hormones, and saw that my ft4/ft3 ratio was 3.5 before i started taking t4 hormon!…….this funnily enough corresponds to good combined therapy ratio of t4/t3……….after taking 100mcg that ratio jumped to 5.5…..my doc responded to that giving me even more t4…..i did not read anything at a time….i ended up at 6! so my ft4 was 6 times more present in my blood then ft3! obvious sign of not converting well…..

            now many hypothiroid patients have low ferritin …this is protein in the liver and it was low when i started medicating when t4 did work for me…..but what i noticed adding too much of t4 indeed stopped conversion of t4 to t3 with me! it must therefore be that excesses of t4 is blocking proper conversion..becasue this happened 1 year after taking t4…then the body stabilized somewhat again, and then….i chnaged my diet to more fats/protein, to stabilise my sugar….and either coincidence or not…my t3 showed up again the lowest ever, below the range….

            now i started taking combined therapy 100mcg of t4 +25 mcg of t3…..and i feel huge improvement! i am not there 100%

            i do think that t4 monotherapy is just not good for seriously hypothirodi people, like i was! and that right therapy must keep ft4/ft3 ratio around 3.5!…..and i dont get it why it all got so complicated in the process???

            and why do you think reverse t3 is not of any value?

            when i started supplemeting betaine hcl + pepsine witch is said to improve methylation in the liver and kidneys only….my brain fog lifted!! it was AHA moment for me…..i di dnot feel like that since my teenage….but after 5 weeks that magic stopped working!!…..

            after all my experience i started to believe that something like reverse T3 exists…..becasue i did notice how doses above 75mcg of t4 did start to make me worse, my hair started falling out….

            and yes look for signs about bad methylation, but 50% of people would develop some metabolic issue…and i guess genes are not perfect with anyone…and still they dont develope thyroid disease, …its part of living we can not be perfect, but i think we CAN find a way to treat it to feel better, and i think combined therapy t4 and t3 must be standard for hypothiroid treatment! and not just t4!
            t4 helped me only not to feel cold, and nothing else so much!…..

            my anti stress supplement has taurine too, and when i drink it i feel better, my mom too! so i think not only you but many people would benefit from taurine!…….

            can you pls tell me what suppelemts are the most safe in your oppinion? are larger doses of b complex safe to take?
            i am as well very wary of what to supplement, i treid d3 becasue i am slightly below low range, and after 2 weeks of taking 3000 i.j. i developed mole sensitivity!! my moles started like bruning…inflamed…..then i thought to myself omg is this a connection between sun , vitamin d and melanoma?
            i stopped supplementing……

            i spent huge amounts of money on supplements none ever worked, recently i am trying to buy only products contaning b complex and a little bit of this and that….becasue i notice they help me..magnesium was very beneficial! was huge discovery for me

            and i think beeing hypothiroid for 15 years must casue mineral vitamin deficiency in the body

            and the gut bacteria….i think they also influence a lot what minerals and vitamins we will be deficient in…..its 80% of our immune system this is real hard core biochemistry whats going on there…..its researched on mices…..if you share diabetes 2 gut flora with new mice it will develope the same disease!!

            looking forward to your answer on reverse t3…thank you

            • If you think you may have MTHR, etc. take the methylated folate and B12. I do and i eat TONS of greens and sufficient animal products also. I take the methylfolate as its inexpensive on vitacost.com. The methylB12 I need to order still. Im already taking 20mg zinc, 200mg selenium and some iron (till my ferritin steadys out).
              But then again I take kelp for trace minerals and the iodine so you mite not agree with that.

              • You should test your selenium first, symptoms of too much are the same as too little.

                For years they thought that was my issue, but supping keep making me sick…come to find out, years later, mine is at the top of range.

            • Hi Ivy,

              To clear up any misunderstanding, I think RT3 is of great value…what I view as useless is the “ratio” idea that someone (not a doctor) dreamed up.

              They removed my thyroid because it was large and had multiple nodules, they did not test me for thyroid autoimmune beforehand. I was put in T4, like everyone else is, and became worse and worse. By this time I had read a little, enough to ask for RT3 testing…mine was over 100 points over range and I was collapsing. My doctor at the time increased my T4 dose even though my TSH, FT4, and FT3 were fine…I got much worse, new doctor revealed my RT3 was now over 180 points over the range…she put me on T3 only, which I do well on.

              Like you, when I heard about the methylation stuff I was excited…thought it could explain and fix everything…until all those suggestions, from my beloved doctor, also made me much worse. It was then that I asked my doctor to run labs on all the things my reports said should be affected…again, my logic was that if someone, for instance, had a double defect in MTHFR…then they would either be dead by middle age…or…some other gene/enzyme adds a methyl group onto folate. Lo and behold, my labs revealed nothing any of the experts ever go on about…my taurine was very low, and I wasn’t making adrenaline. Both of these are in the methyl cycle…but are not associated (by the experts) with my particular defects. I have concluded that there is more that they don’t know on the subject than what they do know…and even though I think, if they applied more logic to it that it could help more people…they are not going down that path (yet).

              Because everything they keep dreaming up to give me keeps making me worse, I have (personally) come to the conclusion that NO supplements are inherently safe…and, for myself, now…after years of trial and error…I take only those things I test low in. For me, that is taurine and the rx baclofen which is GABA that actually crosses the bbb. These two things have helped me the most. All my tissues were tightened up, my body was curling in on itself…the baclofen helped 95% with that. Before the taurine I was growing weaker and weaker, I was very close to needing a wheelchair and I did use a walker…after taurine I grew stronger and stronger.

              I would no longer recommend people listen blindly to the hypothesis of taking whatever comes after a defect (ie methylfolate for a MTHFR defect)…instead, I strongly encourage people to do the lab work and see what, if anything, is truly affected.

              That said, take what works…with the open mind of if it ever doesn’t work stop for a while.

              The heat sensitivity is common in autoimmune.

              The true test for Vitamin D is the 1,25 D…not the 25,D that they run…that is only a precursor, many who are sick (like you with the autoimmune) will test low on the 25,D…but will probably test fine or high on the 1,25 D…the only usable D. I think of the 25,D like T4 and the 1,25 D like T3.

              Hope that helps. 🙂

              • hello Faith,

                thank you for your explanation here, i think we agree on every point, yes i first came here and read some of your discussion with one person and also started to think d3 is like t4 🙂 and people recommend taking that d3 like its a candy :)….

                i was trying to follow the advice tested only 25 one and tried supplementing, after 10 days or so i noticed all moles on my body are hypersensitive, not all at the same time but sporadically! i tested it 2 times, so i gave my d3 to my mom, she has osteoporosis so it may help to her……, as she was taking some prescribed by a doctor(yes i agree medicine knows far less then what they dont know so i dont trust ANYONE 100% anymore…..just see more value in talking to patients like myself, then docs 🙂
                yes ideally i would go on and test myslef, the problem is there are no such tests here in my country, and i dont know what tests would be best for me…..

                i noticed taking that formula with taurine def helps ! and my mother confirmed it too, she asked me what pill was it 🙂
                i was supplementing with b complex all in several times higher doses then recommended, i did notice some energy lift….but nothing longer term significant for me, i.e. i dont see difference if i dont take it, and i take it before sleep because it calms me down 🙂

                selenium i tried! 2 days 200mcg and i felt awful, just not for me, i felt exactly like i did not take my thyroid hormones for that day…so it makes me feel worse, so that i dont want to try it again

                so 2 most recommended things vitamin d3 and selenium not working for me…..

                i think many hypothiroid patients have low ferritin, and i have it for years. i.e. i first noticed it when i think my thyroid problems started…and i think this would be crucial to understand the link between ferritin and hypohiroid and liver

                i totaly agree with you that people missuse rT3…and luckily i did not fall into the trap, i did notice in my body that when you take more t4 then your liver can convert to t3 it starts producing rT3…..and that it can make you feel worse….and before i start taking any medicine my ft4 to ft3 ratio was 3.5…..i read some studies who confirm this ratio found in normal people, thats what make me think this should be targte when medicating! i was taking t4 only for 3 years and this ratio gone slowly to 6! body was trying to bring it down but slowly it just shot up to 6 …and this was correlating with my sense of energy…..
                so i would recommend taking combined therapy in ratio 3.5 or lower to target that 3.5 ratio in the blood, i am no doctor, but this is what i concluded based on my own experience…..

                on supplementing i was never firm believer on it, but once i tried betaine hcl + pepsine, this was such a difference that i started thinking these supplements can make a difference 🙂 now i think 1st is good thyroid therapy…and supplements only where it makes a difference, and this is what i learnt after i bought too many of them :))
                i bought l glutamine, and just read yesterday this does not helps glutathione :)…some say it does some say it does not 🙂

                thank you very much for your answer!!! its really helpful

                • One thing with the D3…I usually would not take the selenium even but eat, say, Brazil nuts daily instead. However a endo who has Hashi says she doesn’t think it works for Hashi ppl–its didnt for her; needs the supplement. So I’m doing that supplement but may switch to Brazil nuts in a few months.
                  With the D3, I would take fermented cod liver oil ONLY. It has Vit A in it also, along with of course, ur O-3s and O-6s. It’s a food more than anything. I don’t work for nor have any affiliation with Green Pastures, but that is the only brand I would take. I don’t take any D3 currently as I just cannot afford theirs. The others are a waste of money IMO.
                  How much longer I take the folate IDK either. I see no difference and am just finishing my supply at this point in case it needs awhile to kick in lol.

      • oh i would comment on this—–i absolutely disagree that taking t3 is not remedy for people, and only t4 is….

        i think since too little is known the logic principle would be most prudent to follow, and that is taking t4+t3 in a ratio found in the blood of normal people which is 3.5 ……..and thats the safest way to go….

        i know how taking t4 only can make people feel, in the end….having low energy…and disstorting the normal 3.5 ratio……so you end up at 6 or so which is huge difference…the excesses of t4 can make people sick, stop the metabolism……as well, like any supplement you take in a excess is producing the same result as wehn there is too little of it!!
        this is all ABOUT BALANCE! fine tuning, for too little knowledge medicine has its no wonder …..

        but how on earth anyone came to idea that only t4 is remedy and not t3 as well …is beyond me! and beyond any logic!

  103. I am 56 …. I was diagnosised with hatichmono disease at 21 years of age. At 17 years of age I was diagnosised with elevated white blood cells … but no known caused.

    At 19 I had a baby; had an emerengcy C-section due to placenta priva (sp??) then at 21 and 2 weeks I had my 2nd child C-sections .. no complications.

    Soon after the birth of my 2nd child I dropped her twice during a mid night feeding as I fell fast asleep – passed out type. My husband prodded me to see a dr. I was then diagnosised with hatichmono disease.

    I had issues with the para thyroid also; and it was impartive to reduce the goiter size. I had nucular treatment.

    I was then put on Synthroid; I swear I was exhausted … from kids or illness for 5 years! Finally it seemed I had balance.

    Until I was 17 I was full of energy … I never walked … I ran everywhere. I was very athletic and I was busy.

    Then I got married had children and became the laziest person you ever met. I had many traditional side affects, but not really weight gain. After one year I lost all my baby weight for both pregnancies. I could never decided if being lazey became such a habit that when I felt better I still did not have the same gumption.

    Some place around 5 to 7 years I recovered. I felt good again.

    Symptoms … I was cold, dry hair, skin and I cried. I have always been known as a crier even as a child. But I really cried over everything.

    Once I was stablized (5-7 years) I really felt well. During the next years I worked out at the gym regularly … 10 years ago I ran a marathon. Then I stopped all my work outs. I didn’t think I wanted to … I told myself I should go to the gym … I just quit. And then I started to gain weight. Menapause? No exercise? LOTS of stress at work!!

    Now at 56 I have my yearly blood test, and my TSH is a whopping 42.48!!!!! norm – .4-4.2 (I believe or close) so you see how out of wack TSH was. Then T4 normal, T3 -3.5 … so my doctor put me on Cytomel along with my synthroid.

    I feel so much better. But why did this happen? I want to learn and understand what happened to me that TSH went crazy or that T4 stopped converting to T3? Why???

    Any help out there is appreciated.


    • Hi Jackie,

      Sorry that you have experienced so many ups and downs. For me, the crying is a sure sign of too-low thyroid…as the symptoms of too much and too little, beyond that, are identical (for me), including weight gain. With Hashi’s you likely go hyper- and hypo-…so it will be helpful to you to discern the differences with how you feel with each.

      The TSH is the pituitary’s request for more thyroid hormone…when it is high like that, it really wants more. The question is, why? Esp if your hormone levels were fine.

      That you feel better on T3 is a big tell about what might be going on, and why you might have had the high TSH. Until recently, the medical world (and much of the thyroid world) believed that TSH only responded to T4, but this is not so…and it responds to T3 just as well. I don’t know how much you know, so forgive me if I explain things you already understand.

      T4 is the storage form and is not usable…T3 is what we convert T4 to and the only one we can use. There are reasons that the body will convert less T3…one is some underlying illness, another is starvation…and the body will generally down-regulate (make less T3) whenever the body is compromised. One thing to check, if this is the issue, is what is known as Reverse T3 or RT3. If this is high, and by that I mean over the range, then RT3 will dock in the thyroid receptors preventing usable T3 from getting in…one reason for being hypo when blood tests are normal.

      Another thing that competes with the thyroid receptors is Vitamin D. If you take Vitamin D, you may experience hypo symptoms even though your thyroid hormones are normal. Many people (falsely) believe that they are low Vit D because doctors test the wrong thing (25,D), they should be testing the 1,25 D.

      I hope that gives you a place to start, please keep asking. 🙂

  104. Hello,
    I’m currently on Levothyroxin 50 mcg, 1 tablet morning and
    Armour thyroid 30 MG, 1 tablet morning and still having trouble with my T3’s being too low. In the past we have increase the armor and decreased levothyroxin but than I go hyper. I did have stressed induced cardiomyopathy last june leaving me with heart failure, which i’ve recover from. At that time I was hyper. I just keep swinging back and forth and am currently at a low. My doctor doesn’t want to increase me anymore so I’l stuck here. interesting point you made, I have a high CPR level and been there for many years. Don’t know what the cause of it is.

    • Hi Mary,

      I am sorry that you are experiencing so many health issues. You sound, to me, like you have thyroid autoimmune issues which, unfortunately, I don’t know all that much about. However, there is a really great book on the subject that you might find interesting.

      Why Do I Still Have Thyroid Symptoms? by Dr. Datis Kharrazian

      I am admittedly clueless why that particular combination…other than maybe to suppress your thyroid from producing. That said, IF you have thyroid autoimmune, the Armour would make it worse because it contains the things your immune system would be attacking, which may account for why you get hyper when you increase it.

      CRP is C-Reactive Protein…it is elevated when you have inflammation…which would also be consistent with autoimmune issues.

      At some point they estimated that 80% of thyroid patients are thyroid autoimmune…so if you haven’t been officially diagnosed with it, you may want to get a consult. The two main things that the immune system attacks are TPO or Thyroid Peroxidase…which is the enzyme that “digests” iodine and renders it bioavailable. The other is TG or Thyroglobulin which is a protein that binds the now bioavailable iodine on the back of a thyroid hormone. Both of these are present in desiccated thyroid products. If you have thyroid autoimmune you will want to avoid natural or desiccated thyroid and iodine as they both will stimulate attacks.

      Normal TSH, normal T4, and low T3 is usually a sign of an underlying issue. To be clear, barring actual liver failure or disease, this pattern is a result of the body determining to have less T3. The main reason it does this is because one is ill…and this includes low-grade, chronic illnesses that may even be so low-grade that the person doesn’t even realize they are sick. As Chris states in the article, this fixes itself when the illness is cleared up…and is also the main reason doctors don’t worry about it or treat it.

      That said, you may consider stopping the Armour (increasing the Levothyroxin) and possibly adding Cytomel which is T3…and see if that doesn’t improve things. That said, if you still have a thyroid, I personally would be concerned taking thyroid hormone…but again, I don’t know much about the treatment of autoimmune thyroid or whatever point or purpose they have for doing so…other than to maybe shut down the thyroid and thus overcome the immune attacks. I don’t know why more doctors and practitioners don’t realize, or warn you, against Armour/desiccated thyroid…but suspect that many follow the desires of patients to the peril of their health (sell em what they want). No one with autoimmune thyroid issues should ever have desiccated thyroid ever. Yes, yes, some will claim they feel better on it…but I deeply suspect that this is because it contains other things they need. Anyways, that is my two cents…hope it helps.

  105. so one has to find what chronic deasease one has to maybe help convert t4 to t3, and i know only of hashimoto that i have…..i may have other issues, my only worry is my memory loss, and brain fogs and beeing tired all the time will make me dementious when i am 60…..which is too early, i would like to be old and have good brain….so this is what i am trying to fix, what must one do and eat to be heatly old person…have seen demetia and its disgusting, and more and more people have it, and nowdays people do not live longer then they used to live in 19th or 18th century! its a lie….the graveyard is full of 90 year olds from 19th century in my country…..
    have a feeling these all autoimune diseases are coming from bad quality of food….and maybe too much stress?…like living a life of a perfectionist…..i think this all si so unnatural…could it be the main cause just the stress?
    i still think its the food too, beeing off the gluten took away so many problems i had and total level of inflamation decreased becasue i no longer have such PMS , its reduced 80% the only thing that is not good around pms now is headache which i think is related to progesteron, but doing exercises on those day help treat it without taking tablets….its just not convinient while working…..so must wait for the end of working time to get exercise so i dont end up with strong headache like migrene…so this is new stuff, so i connect it with aging, but am sure there are things one could do to solve those issues, i just wish i know which one are those?

    it seems like thyroid issues are actually many many various issues and its like fixing a car, each car is different, but the problem to me is, that dont even recognize parts of that engine and what they do individually….let alone how to fix it

    • Yes, I agree, more people are sick now than they used to be. It is hard to know the exact reason why, and I tend to think it is everything mixed together.

      Although more people now have issues with gluten, in times of old when people ground their bread from whole wheatberries (more gluten), there was not this issue.

      One thing you did not mention is vaccines. Vaccines are comprised of partial viruses and bacteria…meaning incomplete, just a part of. Not only that, but they bypass the immune trigger system by being injected. They have found that many of these partial viruses and bacteria live on in the gut…and may, I think, contribute to food sensitivities.

      They also cause problems in other ways by injecting the body with mercury and aluminum in ways that the body is less able to get rid of them (the body is more able if they come through the gut).

      This is one thing that is new…and seems to correlate with the increased amounts of sick people.

      The other thing you did not mention, is that certain things can change our DNA…turning things on or off…and then, this DNA gets handed down. In my own situation, my parents were pretty well…I am sick in middle age…all four of my kids are sick, two since babies, one at 10, the other since teens…all with the same symtoms.

      Unfortunately, and I say this with all due compassion to the medical community, the medical industry is forced to operate about 20 years behind the knowledge that is out there. Also, depending on the doctor, people are likely misdiagnosed for a long time before they are properly diagnosed and treated…

      Or, as is more often the case, many are just sick for years before any doctor figures it out. I think many thyroid patients fall into that catagory…they are sick with something else and the only abnormal lab they have so far is too low T3…so they research thyroid to a great degree, when it probably wasn’t the thyroid at all…and only the normal body response to being sick.

      Also to blame is the really weird (makes no sense) way doctors test things. For example, in a standard check up, doctors test liver death numbers…not liver function numbers (so they could actually help someone before they got sick). Or, they only test T4…or only test TSH…and not the actual T3. If they could just design tests to screen for things that might actually lead to results that would help them help their patients before people get so sick.

      Anyways, just wanted to add those things. And yes, the idea is that when the illness is fixed, the thyroid will correct itself.


  106. I am 21 years old and almost 5 years ago, I was diagnosed with Graves’ disease. I underwent the radioactive iodine treatment and had my thyroid ablated. I was put on the generic levothyroxine, got bloodwork done every few months but my levels and dosage were always changing. I changed doctors, she recommended I go on Sythroid. So I switched, continued getting bloodwork and for a while everything seemed okay but recently it’s been changing again like it had before. Within the almost 5 years, I had an appendectomy and also had a cyst on an ovary removed. I eat very healthily, work out and get plenty of rest. I continue to have problems with exhaustion, weight, hair loss, mood, the whole nine yards of everything. For the most part I am diligent about taking my medicine but sometimes things happen and I’ll forget for a few days and that seems to always throw me off to extremes. My primary dr has done multiple general blood tests and everything she says is perfect. Is there anything I can bring up to my doctors that could help? Or is there an alternative process to take my synthroid that would help me forget less or just another medicine in general? Thanks

    • Don’t know if this will help with remembering to take your synthroid but I read a link somewhere that said taking it in the evening can be pharmakinetically beneficial. So I switched to taking mine in the evening as waking up to take it on an empty stomach when camping in the winter in a tent is very unpleasant, trying to track down the tablets as there’s no pocket in the tent, tracking down the water bottle in the crowded little tent or realising I haven’t set it up the night before etc. etc.

      Also I was having to wake up half an hour before I was served breakfast in bed, so this was disrupting my sleep at home. Now I get the extra half hour…nice.

    • Hi Crysta,

      Sorry about your Graves Disease and other issues. A few things come to mind that may help you.

      One is that when I was on T4 (synthroid or generic), I took it at night right before going to sleep. Not only did that help me remember it, like Honora mentioned, I felt yukky after taking it and so taking it at night helped.

      You don’t need to worry too much about forgetting once or twice because T4 stays in your system 6 weeks or longer. T4 is the storage form of thyroid hormone and your body need to convert it into T3 to be used.

      As to your numbers going up and down…well part of that is that your needs fluctuate…and there is nothing you can do about that.

      The other thing that may be affecting you, and I know it affected me a lot when I was on T4, is that certain foods interfer with thyroid. Your snythroid should even say in the insert to avoid soy and walnuts. Soy is in pretty much everything from all the breads on the market (except Ezekele’s 7 Sprouted Grain), fruit flavored tea, gum, and chocolate, and pretty much everything processed…it is very difficult to avoid.

      In addition to that, veggies in the broccoli family including kale and cabbage also affect it. Many people argue the point, but I noticed a huge difference in when I had them and when I didn’t…very hypo when I had them as though I hadn’t taken the thyroid at all.

      You can do a search on “goitergens” and find a number of lists. This may help you a lot.

      The only other medicine is T3, doctors don’t like to give it…it only stays in your system a couple of days so forgetting it can have huge consequences…and you have to take it multiple times a day. I take mine 10x a day.

      Hope that helps.

    • Buy a one week pill dose pack at any drug store or dollar store. Put out one week’s worth of medication in the individual compartments. Put the dose pack on your nightstand along with a glass of water. First thing in the morning, take it and make sure you wait at least half an hour before eating or drinking anything other than clear liquids. If you forget, you’ll see the tablet in the day’s compartment, in which case, you take it immediately unless it’s almost time for the next day’s dose. You’ll know if you forgot your daily dose and how many you are forgetting to take.

  107. I am on Thyroid from a compounding pharmacy. I take 2.5mg daily. My blood work came back with a very high T4 and very low T3. I am concerned and cannot find a physician who can explain this. I’m wondering if I should stop taking this.


    • Hi Audrey,

      Most doctors cannot explain this as it is (still) outside their current “standard of practice.” The current industry “standard” says that for low TSH (the pituitary’s request) or for low T4 (the storage hormone) to supplement thyroid hormone.

      As far as understanding how all this works together, to understand what your numbers mean, you need to understand how the body operates. If the body has a need for additional thyroid hormone, the hypothalamus (a gland within our heads) will signal its desire for more… to which the pituitary (another small gland connected to the hypothalamus) will release additional TSH to tell the thyroid to make and release more T4. The body (primarily the liver) then converts the T4 into usable T3. The main question is, why are you not converting enough T4 into T3?

      There are a few reasons this could be. One is that you don’t, in fact, need more. Some bodies operate just fine on less…and just because the industry has a standard “norm,” your personal norm could be less. A huge tell in if you need more is if your TSH is over the range…if not, you probably don’t need any more.

      Another reason can be that you are not making enough of the enzymes to convert T4 into T3. I do not know of any test for this and doubt that one exists. There are also no known treatments to help with this that I know about…and since most people who advice on the thyroid fail to understand that most conversion takes place in the liver, they don’t even seem to include advice in supporting one’s liver.

      However, the main reason that people have normal to high T4 and low T3 is some underlying illness. When the body is sick it naturally down-regulates itself…and although doctors know all about it happening in hospital settings, they do not treat it because it naturally resolves itself when one is well. The challenge comes in when one has a chronic illness. The author of this article is only asking the question of whether or not it should be treated (it is currently not-treated).

      One thing you may wish to have tested is RT3. When the body has too much T4 it will often convert it into unusable RT3 or Reverse T3. Again, this is a self regulating matter and the body does this normally. It will do it when you are sick and if you exercise too much or fail to eat enough nutrition. Again, it will correct the matter on its own when the condition causing it to do so is resolved…again, the problem comes in when it is something that is not going to resolve, like chronic illness.

      In general, you seem like a candidate for T3 only treatment…however, this again is outside the “standard of care” for the industry and finding a doctor who will rx it for you can prove quite a challenge.

      In my opinion, you do not need to worry about the high T4 as it is just a storage form and not usable in itself…however, I would not take any extra T4 if it was me. It also kind of highlights that your liver is not doing its job sweeping the excess hormone from your blood stream…this could be because your liver is being taxed in other ways, like you may be one of those people who eat little bits throughout the day or eats before bed…the liver also has to deal with what we eat and thus has to suspend hormone balancing in order to do so. Just a thought.

      Hope that helps explain it some. Best of luck.

  108. I have low FT3 (2.20), low FT4 (.66), and low TSH (.343). I have been on Armour Thyroid 90 mg. Seems if I increase it, I get shaky. My adrenal gland is in the Maladapted Phase II. My cortisol is above range in the mornings and in the low range after the late afternoon. My ND has increased my iodine dosage to 57 mg. to try to help my thyroid (with Tri-Quench). However, I am afraid of such a high dosage. I do have Lyme Disease. Does anyone know if high dosages of iodine help or are safe?

    • Hi Mary,

      The low T4 and T3 is disconcerting, however, the low TSH is more telling. Your TSH (pituitary’s request for thyroid hormone) is low…suggesting that, for whatever reason, your body does NOT want any more thyroid hormone. The question is why?

      One thought, is that the normal ranges that they give may not be your normal. Maybe your body operates just fine on less thyroid??? That is one possibility.

      You did not mention if you still have a thyroid or not. Iodine is only useful if you have a thyroid…and then only useful if you are not making enough thyroid due to no other reason than lack of iodine.

      Many practioners do not understand iodine and thyroid…in industrialized countries lack of iodine is extremely rare and then only if you live on a farm and drink well water def in iodine and eat only the food from the farm (no meats) that is watered with iodine def water. The thyroid sucks up all the iodine you eat…and “digests” it for lack of a better term the enzyme Thyroid Peroxidase or TPO is what turns the iodine you take or eat into something you can use. Th ethyroid then stores it. The iodine your body uses, the ONLY iodine your body uses, is what comes off the thyroid hormone.

      To better understand that, T4 = 1 thyroid hormone and 4 bioavailable iodine molecules. The liver then liberates 1 bioavailable iodine to make T3, which = 1 thyroid hormone and 3 bioavailable iodine…which are then liberated when the thyroid molecule docks in the thyroid receptor.

      There is (or there should be) a huge caution in giving people iodine. Most thyroid patients (like 80%) have thyroid autoimmune issues. Iodine causes the thyroid to make TPO which is the main target of attack in thyroid autoimmune…hence why they test TPO Ab. The other target of attack is Thyroglobulin, or TG…this is the protein that bind iodine onto the back of a thyroid molecule…hence the TG Ab tests. Taking iodine massively stimulates the production or TPO and TG thus causing an immune attack. You did not mention if your practioner tested your TPO Ab and TG Ab prior to giving you iodine, but he or she should have…and if not, you should request this as this could be causing your problem as your body may be turning down production in an effort to slow the attack.

      Also, there is a huge misunderstanding re adrenals and thyroid connection…the only place that they are connected are the hypothalamus and pituitary who instructs both of them. The thyroid hormones and adrenal hormones do not talk to one another nor stimulate one another. My suspicion is that many thyroid patients in fact have hypothalamus/pituitary issues and not true thyroid issues…and your labs sound a lot like that because otherwise why would your TSH be low?

      The hypothalamus is what determines what your hormone levels should be…and for the thyroid it issues Thyrtropin Releasing Hormone or TRH which signals the pituitary to release Thyroid Stimulating Hormone or TSH…which then the thyroid responds to by creating and releasing T4.

      In the same way, the hypothalamus determines the amount of adrenal hormones you should have and issues Corticotropin Releasing Hormone or CRH which signals the pituitary to release Andrenocorticotropic Hormone or ACTH which then causes the adrenal gland to release Corticosteroids…one of which is Cortisol.

      The testing they do to determine if you have a pituitary/hypothalamus issue are stimulation tests and they are done by endocrinologists.

      On the subject of thyroid autoimmune, Dessicated Thyroid like Armour, also contains the things that the immune system attacks.

      Autoimmune thyroid attack can leave you going up and down hypo-hyper and make you feel very sick.

      You did not mention hypothyroid symptoms…if none, your body may just need lower levels. Having Lyme, it is very difficult to discern the differnce between Lyme symptoms and hypo symptoms as they can be the same. As can hyper symptoms be the same as hypo…and can have paradoxial weight gain rather than the usual loss.

      You also did not mention having your RT3 levels checked, you may want to do that. When the body is sick, it will often convert T4 into RT3 rather than T3 and may account for your low T3 levels.

      Another thought, you may be making enough T4 and just simply converting it fast…low T4 by itself is not an issue as you have some. T4 is not usable, it is just the storage stuff waiting to be converted to be able to use…the low T3 is the main issue…and again, bearing in mind that your body does not seem to want any more (low TSH).

      Lastly, if you still have a thyroid and are taking thyroid…your thyroid will naturally make less.

      My advice would be to check your RT3 and then maybe consier taking very small doses of T3. If your T3 improves, and you don’t feel shakey, then conversion is the issue. The only way to bypass RT3 conversion is to take T3 only.

      I suspect your RT3 will be high due to having Lyme. The body naturally does this when one is sick and it will generally stop doing it when you get well. The problem comes in when one is chronically ill.

      Best of luck.

  109. Hi i want to warn anyone reading these comments not to follow them as a truth, because some of the ideas here may be missleading, i totaly dont agree that hypothiroid condition is a way of body downregulating itself, and the whole article gave no answers just raised question and pointing negatively, there is no solution just negative energy around many of these comments, i really empathyze with lyme desease patients, because what faith wrote looks like horrible condition, but also i was finding solution to my hashimoto and was almost sure i need to take t3, to my therapy, on t4 only for 3 years, i sturggled , went through bad stuff and am finally stable at 150 mcg, dont know if too high or not, but seems like stable now, after 3 years, but my t3 constantly low, lower then when i started therapy 3 years ago, and steadily fluctuating in tight range from very low to low
    There is no logic that the immune system would attack itself to downregulate! When we have heard that there is assumption gluten sensitivity causes autoimune response, my experience is all related to malnutrition, i was anorexic for 4 years from 16 to 20s and getting slow out of it, this combined with some methylation genes is i suspect the reason, why? 12% of population has bad methylation genes, under lot of stress this can weaken imune systme, you get some bacteria , or gut problems autoimune develops…..

    This is my theory , this is what i went through in my life, am 37 now, i dont believe that taking shower caused this or me going to the swimming pool for years, i know exactly when it all started, with malnutrition, i was starving myself out i think not many people would live through that…..

    So saying that adding thyroid hormons is bad is nonsense, how the hell would body heal from vicious cycle, i added up betaine and it helps my methylation and i hope this will help make t3 if not i think taking some t3 to my t4 will help, also my iron issue goes on since that time of my early 20s……and adding iron to bad absorption is usless, but saying it is harmful, this is just negative energy and making no solution, saying that everything that people add to feel better will not be good is just spreading negativity that is not based on any fundamental data, and projecting only from ones own experience, while my experience is genes + malnutrition for years, and system could not be rebooted once it could not absorb food properly, i suffered dhiaria until 3 years ago every month

    • Hi Ivy,

      I am sorry that you are experiencing thyroid (and/or other health) issues, however, am glad that you are trying to find your own answers.

      You mention not understanding the ways in which the body down regulates itself…and I will try to explain. However, please understand that everyone’s case is different…and each case of hypothyroidism likely has its own causes.

      That said, what is being referred to in the article, and what I was referring to is normal TSH, normal T4, low T3 with no other explainable cause. This means that the hypothalamus/pituitary is NOT asking for more…and that the body is viewing this state as normal.

      There are two primary reasons for low T3 when everything else is normal. One, the body is not converting enough T4 to T3 because the liver due to some dysfunction (or because one is consuming too many supressants like kale, broccoli, walnuts, soy, etc) and is failing to do so; or two, the body is not converting enough T4 to T3 because the body does not want more T3.

      It has long been recognized and known in the medical industry that when one is critally sick, in the hospital, that the body will over-make RT3 and have low T3. However, because this clears up on its own, when the patient is no longer sick, they dont treat it. This is why the medical industry ignores RT3 and low T3. However, the issue comes in when one is chronically sick…and so therefore chronically has low levels of T3…and whether or not to treat it.

      Thyroid autoimmune and the immune system in general are seperate issues. No one knows why the immune system attacks healthy or needed tissue in people…only that it does. The gluten hypothis is one of many.

      I too have a MTHFR defect, as well as many others in the methylation cycle…it is not just one gene that goes bad and throws a whole body off. Futhermore, if someone had a double defect in the MTHFR gene…either they would never be able to add a methyl group onto folate (and thus would be dead long before middle age) or some other gene is doing it that they just don’t know about yet.

      I went a step further…I took my reports and had my doctor test all the things that the reports asserted were affected…to see what, if anything, actually was affected…and I came to find out that things people who are into that stuff never connect to it were affected…like, I don’t make taurine very well…which is no where on their methyl cycle charts. And, there is not just the methyl cycle…but a number of other cycles. So your simple answer of just don’t eat gluten and take methylated folate fall short for many who are struggling to find answers…and, if it helps you – great. The methylated folate made me super sick…despite my defect. Taurine, on the other hand, helps a great deal.

      I am all for people finding their answers…as I am all for people learning (precisely) how the body does stuff…and, I am a big geek for that.

      So, to be clear…the immune system does not down-regulate, the body does…and it decides in ways no one seems to understand (yet). But if normal TSH, normal T4, and low T3…the body is NOT asking for more…and presumably wants it that way. The fatigue from it could be caused by things other than low T3.

      Hope that helps clarify. 🙂

      • hello Faith,
        oh yes now i get it much better now, so i went through my records, and made a chart of my free t4 and freet3 hormons and it shows that i felt the worst when that ratio was 5.5 and the best when it was below 4,my doc never took time to get that relationship, so now i am searching the help for myself, and in my country i dont have any expert to ask,
        i did not notice adding methyfolate helping me as well that much consistently, adding high doses of b complex was actually making me very tired,now i am taking some anti stress formula wich has that tyrosine, and b complex and for some reason i feel better, i just dont take them day by day, and i started agressively on helping my gut with probiotics, i know intestine is the key to immune system , so i read one great book, says that 2kg of body weight goes to those intestine bacteria, and experiments on mices shwo that if you inplant a sick mouse intestine flora who has diabetes 2 or is obese into steryl mouse, he will develop the same disease …..now the question is how to grow those good bacteria, what food to eat, they say that we should eat 30g of fiber per day to grow good bacteria in the colon, then there are 3 major types of bacteria, they learnt this in 2011, 60% of living bacteria still not known, but experiments show direct connection between type of bacteria in intestine to some diseases or obesity….which is so interesting to me, and so i am taking biotin, and b complex, betaine hcl pepsin, which did wonders for me, i started feeling like a human beign after so long long long time, i still have issues i want to solve, and they show clearly up in my blood tests, t4/t3 ratio should be around3.5% and its 4 for me, and it increased with the increase of levytiroxyn, i am on high dose now 150mcg….and TSH has dropped to below 1, but my sense of feeling better correlates exactly with that ratio t4/t3 and not so to tsh lvl….and my doctor did not see that….so now i am going with my chart to him and will ask the answer…….
        i would like to make my t3 higher since it was higher before taking t4 therapy! ……
        also have a feeling that blood sugar lvl has some to do with it, so i found one good article from dr ray pete, also reading his articles confuse me so much, one article he said one shoudl avoid fish oil , and all other PUFAs…etc so now i dont know who to believe,but this one on thyropid seems good to me
        am taking coconut oil, this is very good for thyroid….and
        my last solution is trying to take t3 supplement, and i am alsmost sure my progesteron is on the lower side….also my constant anemia…..have no idea what to do with it, maybe part of perniciosa aneamia, but my blood b12 is high….and i dont see chnage while taking high bcomplex with b12 vitamin..so i guess anemia is part of the whole package….

        and yes on gluten, i have tried making my sourdough bread, must say i fel good on it, ate just one loaf so far, i liked it so much, scientists from germany found out that it may not be gluten who is making sensitivity to people but ATI protein, newly added to enhance properties to fight against some insects! its a protein that flares up immune reactions, and autoimune responses!……so thats why i did not notice that eating pasta is so bad to me like eating bread….in pasta its preatty much safe….etc etc…

        i am a bit dissapointed that there is so little studies done on combined t3/t4 therapy, and so little knowledge about t4 to t3 conversion, and so little knowledge about it all, becasue seems like every other woman has some sort of thyroid issue, not that they have heath issues as of yet, but that it impacts the quality of life(beeing tired etc) and that modern medicine can not even offer 3-4 good theories to why is that…..

        huh, ill keep reading although i feel like my head will explode…

        • Hi Ivy,

          Knowing what your own ideal numbers are is a great way to help yourself, kudos. 🙂 Also, I am soooo glad you are finally starting to find things that help.

          Interesting about the gut flora…I read an article that suggested obesity was caused by too much flora breaking down too much food.

          It can be hard to know what to trust as every week someone seems to come up with a new theory on how the body works.

          Increasing the T3, I also feel, is important. Your T3 should be in the normal range.

          However, I am not sure about the ratio idea…and here’s why. T4 is just the non-useable storage form and so even low amounts are fine, whereas T3 is the active form and is what the body uses…if that makes sense. If your body is not converting T4 properly into T3, then the excess T4 will cause your TSH to go down…and, subsequently, for your doctors to want to give you less.

          You might want to try taking a small amount of T3. It is called “Cytomel.” This will bypass conversion and raise your T3 levels.

          Doctors do not, generally, prescribe T3 because it is outside the “Standard of Care” which limits what they can do. The “Standard of Care” for thyroid issues…which assumes that everything else is fine and only the thyroid is failing…was written by the makers of Synthroid, the leading brand of T4. The thyroid “Standard of Care” states to dose based entirely on TSH (again, assuming that only the thyroid is failing)) and to only prescribe T4 because then the body can decide when to convert and how much to convert. It actually makes sense and is good advice if only the thyroid is failing…but that is only about 5% of thyroid cases. Doctors can lose their license if they go outside the “Standard of Care” so most are unwilling to do so. However, there are some who will.

          If, for whatever reason, taking T3 does not raise your T3 levels…then you might start looking at why your body wants its levels low. One main reason is some underlying illness…which may be so minor that you do not even notice it. If the body wants your T3 levels low, then your liver will filter out all the excess you are taking and get rid of it. The same holds true in opposite, if taking too much T3 and the liver is not filtering out the excess…then issues with the liver. Since you say you haven’t felt well, my guess at the low T3 is due to underlying illness.

          When the body has too much T4 (which you may because the TSH is going down), the body will convert it into what is known as “Reverse T3” or “RT3” which is non-usable. This is normal. However, too much RT3 (over the range), will cause it to compete with T3 in the thyroid receptors…making you feel hypo even when you have enough T3.

          Regarding vitamin B12…the true tests that you want for it (because the blood test is not all that accurate) are: Homocysteine, and Methylmalonic Acid. Methylmalonic Acid will become high if too little B12 and low if too much. It is what is used to process B12. Regardless of your B12 status, many people feel much better on Adeno-B12 or Hydroxy-B12. No one seems to really know why, but many people who are sick seem to be less able to use stored B12…and so take often through the day. My doctor says not to get the regular B12 they sell because (she says) it is mixed with cyanide…I personally disagree and think she doesn’t understand the compounds, but I haven’t looked it up so am just passing along what she said since I cannot say for sure.

          Oh thanks so much for reminding me about the ATI/Gluten thing…I had long since forgotten that and have been trying to get away from breads, only, like you, noticed that some wheat products do not bother me and others, like bread, do. Now my own situation (regarding bread) makes so much more sense. Thanks. 🙂

          Anemia is common in those sick…and made more common because paradoxically iron can look normal in the sick when a person is still anemic. It is called, “Anemia of Chronic Illness.” That is just the little bit I know about it, otherwise know not much else.

          Three tests that helped me the most were the Organic Acid Test (OAT); the Urine Amino Acid test (UAA); and a neurotransmitter test (this one from Pharmasan Labs). These showed, more conclusively, what I was and wasn’t making.

          Hope that helps. 🙂

  110. Hi Ashevegas Gal,

    Posts like yours do help…many are searching. It also helps for those of us who have been around awhile to learn what others are doing.

    You mentioned Medulla??? and adrenaline…are you saying that there is a product with adrenaline in it??? I ask because I don’t make adrenaline well and no one seems to know anything that can be done to help.

    • Hi Faith, I think she’s referring to whole adrenal glandular supplements as opposed to just adrenal cortex? Ie. if you have adrenal fatigue with low cortisol and or aldosterone, you likely have an excess of adrenaline which will just wear your adrenal glands further by making you exert yourself and not sense how tired your adrenals are… People who are supplementing with adrenal gland avoid whole adrenal gland and stick to adrenal cortex, to avoid the adrenaline that whole gland would contain. Have you tried taking adrenal glandulars? I have low cortisol and find whole gland overstimulating and it does feel like an adrenaline surge followed by a crash… I use Nutrimeds adrenal cortex which would be similar to the Thorne product Ashevegas Gal mentioned…. I hope that helps, Is that what you were asking?

      I’m not sure if you’re still posting feedback but I would love your thoughts on my labs, I have Lyme and hypothyroid, but I’m not sure about T3 conversion, I’m quite sure my thyroid condition exists long before the Lyme… My labs showed slightly higher than normal TSH and low normal T4 with mid low normal Free T3. I’ve had symptoms since I was a kid but much worse over the past few years which could definitely be attributed to Lyme and major adrenal fatigue. I feel better in NDT and have been playing with the dose, but I’m not sure if I need extra T3, if so I’m thinking not very much, that is based entirely on intuition but I would like to look into it more. I appreciate your comment on too much NDT causing weight gain, I do not know that and I think I pushed my dose too high. Because I have Lyme it’s a bit hard to measure by symptoms with fatigue and temperature fluctuations being part of the treatment experience… 🙂

      • Hi Megan,

        Re your labs…high TSH is the pituitary asking for more thyroid hormone, which is followed up by your low T4…which is classic hypothyroidism.

        I am glad you like NDT, but should that ever change you might appreciate a product called Tirosint, it is a T4 with no fillers. I had trouble with NDT, likely due to the fillers and autoimmune conditions.

        Low T3 syndrome is the body’s normal response to being sick. It looks like normal TSH, normal T4, and low T3. It also returns to normal whenever we get over being sick…so many are unsure whether to treat it or not. That is what I had.

        Having Lyme can make it very difficult to tell what you are feeling and why. In addition to low T3, I made a lot of RT3 from my T4 treatment. So when I was treating my Lyme (and have continued), I take only Cytomel (T3 only) treatment now…by passing the RT3 conversion.

        Selenium made me very sick, and I came to find out that not only do we need extremely little of it, but that symptoms of too much are the same as too little.

        Not sure what the conversation was anymore, but my cortisol levels are fine, as are all my other hormones…I just do not make enough adrenaline (and any stress makes me very ill). My doctors were more thinking on the lines of the genetic issues causing that. I am always curious of ways to possibly fix that with an adrenaline supplement. As far as I recall, adrenaline is not part of the cortisol process…but instead descends from dopamine and norepinephrine (which I have too much of).

        Anyways, hope that helps.

        By the by, after treating the Lyme for a year and a half with antibiotics, have come to learn it was likely never Lyme at all, but instead a muscle weakening autoimmune.

        Hang in there.

  111. I’m just really hoping this helps someone bc it could have saved me years if I’d read something like this before:

    I was diagnosed with subclinical hypothyroidism but let me tell you, it felt anything but subclinical. I felt like a mental zombie. I went from being high energy, with loads of vitality, to being exhausted all the time. If I got up and kept moving then I could get through the day but if I worked (hospital, 12hr shifts) 3 days in a row then I’d sleep or lay in bed for two days after before wanting to do anything. Poor sleep (waking at 3-4:30) and always constipated. they diagnosed me with Irritable Bowel but the stuff they gave me never worked really or had terrible side effects. The worst thing was my mind. I simply could’t retain any information, could’t remember details or people with specificity, couldn’t come up with anything interesting to say – ever. I did a saliva cortisol test to see how my adrenals were functioning over the course of the day and I was a little low in the AM, little high in the PM. TSH was 5.5 (little high), T3 & T4 were a little low & the Dr started me on NDT, Nature Throid (getting up to 32.5 mg) until my levels showed more in range but even then, I felt only marginally better. It was terrible. At this point I’d had colonoscopies etc. I still had some trouble eliminating. The gastro Dr said I must not be drinking enough water, but I really was. It was so frustrating.

    A year later, still tired, more comprehensive bloodworm showed iron and D3 were really low, TSH 2.5, T3 and T4 okay according to labs but T3 on the low side of ok. I took things into my own hands, got some advice outside the normal physician realm. Here’s what I’m on now – and all my symptoms are pretty much gone, even my constipation.

    AM: Armour thyroid 15mg with 12.5mg of Cynomel (T3 that comes in 25mg tablets, I just break it in half)

    DAY: Thorne adrenal cortex (no medulla, so no adrenaline, and it’s raw), I take these copiously throughout the day depending on my patient load etc – probably use at least 4-6 a day most days. I still forget to take these on my day off which isn’t good on my adrenals.
    and D3 varying dosages

    PM: Floradix liquid herbal iron (dose varies depending on my cycle), and MK7 (vitamin K for absorption of the iron)

    I can think! I have energy! I poop! I sleep through the night, mostly!! Good luck to those of you who suffered as I did.

    One last thing, to those of you who are being told you’re depressed, that it’s not a metabolic problem – if you feel like the depression came as a result of your fatigue and is a result of that frustration then trust yourself! I can’t tell you how many times people told me I was just depressed. Made me crazy. Keep at it! Trust yourself! You’ll get there!

  112. I’m 55 years old, female, diagnosed with Hashimoto’s thyroiditis in early 40’s. I was once active, working 12-14 hour shifts as an RN, then doing more physical labor when I wasn’t “working” and on my feet all day. I was also misdiagnosed with lupus at one point and eventually diagnosed with fibromyalgia. I have had several injections with corticosteroids in my spine over the past few years. I fell into an opportunity to try human Growth Hormone (hGH) in the form of injectable Somatropin. I knew that I was “guinea-pigging” myself in my desperate attempt to feel better, basing most of my symptoms at that time on fibromyalgia. I was reading a lot about hGH being produced during the sleep cycle and that people with FM didn’t fall into that phase of sleep at night. So, I decided to try hGH on my own. First it needs to be known that this is definitely growth hormone, from a reputable pharmacological source. Now, a question for Chris: I recently had my thyroid blood work done and for the first time I had a low T3 with T4 and TSH on the low end of normals. My T3 was 49 with a normal range of 100-200. I’ve never felt as rotten as I have over the past few weeks. No energy, muscle pain, thinking is foggy (at best). I was put on a Prednisone burst (today is day 3) and my Levothyroxine was increased from 75 mcg – 100 mcg (day 8). Is it possible that my use of hGH has caused the current problems with my thyroid? It’s been 1 1/2 years that I’ve taken it with dosing anywhere from 0.5mg to 1.2mg sometimes daily (Monday through Friday) with weekends off. Sometimes every other day dosing (M, W and F) with weekends off.
    Initially I had GREAT results with the hGH. High energy, great mood, increased stamina, ability to sleep at night, decreased depression, muscle mass like I’ve never experienced in my entire life.
    I always knew that I might be causing long-term damage or even the possibility of cancer or early death by taking the hGH but I was of the mind that I’d rather have 5 good years and die younger than to have 20 miserable years of intolerable pain and fatigue. But it’s now been about a year and a half since I started the hGH in varying doses (directed by myself!) – my physician is aware that I’m taking the hGH and has tested my IGF to be sure that I’m getting “the real thing” – which I am.
    I will be getting a full workup of my blood hormones in a few weeks, to include adrenal functioning. I’m wondering if it’s time to give up on the hGH by slowly decreasing it prior to eliminating it? I know my source won’t be around forever and at some point in the not-so-distant future I’ll be forced to quit taking it.
    Comments from anyone? Chris?

    • Hi Peggy Pearl, love the name by the way.

      Some comments…long ago I was dx’d with fibro (it was my first dx), thankfully, by a fibro specialist. He explained, in great detail, that (and fibro community please don’t hate me for being the messenger) fibro is actually a symptom (pain) of some other underlying condition…and, again thankfully, he encouraged me to keep looking for what could be causing it. To this day I am deeply greatful for his sage advice. I share with you so that you too will (hopefully) keep looking…because the answer is there.

      Regarding the low thyroid…that is very normal when one is suffering any illness. You may consider having your RT3 levels checked. The thyroid (primarily) makes T4, a storage form of the thyroid hormone…and the body (primarily the liver) converts it into T3, the active form of the thyroid hormone. However, it also converts some into RT3, permanently not-usable. Only the RT3 also docks in the thyroid receptors and blocks the T3 from getting in. In cases of underlying illness…the body often over-makes RT3 (above range)…and that can be a problem.

      Regarding Lupus…even if they changed the dx…you may want to run two additional labs, the C3a and the C4a…these are specific aspects of your immune system and will let you know (since dx’s are often subjective anyway) whether or not you have Lupus of something else that can mimic it sans the organ injury. I mention because you sound like you are getting worse?? C3a will be higher in Lupus…and C4a in the mimic…the reason for differentiating them, is that the treatments are opposite each other…and either harming the other.

      I know that many with fibro just want to feel better…often regardless of the costs, and I totally get it (am in same boat). But as someone who recently experienced the costs of horrible disfiguring and utterly embarassing dystonia (unwanted movements)…let me be the voice of some costs are not worth it. Sometimes it really is robbing Peter to pay Paul and you lose in the end.

      While the cost may be prohibitive, my best pain relief comes from theraputic massages.

      I also had VERY good luck with genetic testing (23andMe.com) along with a panel of labs to see what, if anything, was affected by the defects. Generally, the theory is to take whatever you would make after a defect…however, that only made me very sick…hence why the panel. The general panel was a UAA (urine amino acid), an OAT (organic acid test), and a neurotransmitter test by Pharmasan Labs.

      What I found out was that I was not-making Taurine, and I was making too much Glutamate and not enough GABA…which likely caused the muscle knotting (and the fibro dx). Before the Taurine, I was needing a wheelchair and used a walker…after the Taurine it has been a steady (slow, but steady) improvement to where a year later I no longer need the cane. I also take an rx called Baclofen which is GABA with a little molecule added to confuse the neurons into accepting it (supplement GABA does not cross the blood brain barrier)…which stops the tightening and allows be to not be so curled up. I still need to stretch daily and work to regain what was lost.

      Hope any of that helps.

    • Growth hormone can affect the function of most other important hormones. It tends to boost thyroid hormones, androgens (and I think estrogen), but lowers cortisol or increases the need for it. I believe it is supposed to increase conversion of T4 to T3. When I started GH (for GH deficiency) my doctor said I may have to reduce my thyroid meds by as much as 30-50 %. So far I’ve had to reduce the dose by about 1/6.

      However, most of the other hormones GH affects also affect other hormones. If for you it happens to boost estrogen and lower cortisol more than it increases the T4 -> T3 conversion, that might explain the results you’re getting. You might need hydrocortisone, for example.

      How much of GH are you taking (or were, if you’ve since discontinued it)?

  113. My free T 3 was extreamly low, I was tired all the time, very moody, joint pain, dry skin, weight gain, and cold all the time. The doctor put me on cytomel 12 mg within the week I felt better, more awake, didn’t need my 32 oz of coke a day. Really everything got markedly better. Then after 5 months some of the symptoms returned. Took blood work again and my T 3 is good but my T 4 is below low. I am now starting on a T 4 medicine along with continuing my cytomel. Hope it puts thing to how they were for those great 5 months.

    • Hi Judy,

      I am sorry that you are experiencing all this.

      I would be very curious what your TSH numbers are.

      It sounds to me like you have a classic case of down-regulating. Wherein the body down-regulates itself due to some underlying issue.

      One of the first steps it takes is that the hypothalamus determines that it wants a lower level of T3…so the body (primarily the liver) converts less T4 into T3. If that doesn’t work, then the liver will begin over-converting T4 into what is known as RT3 (unusable hormone). RT3 will fill the thyroid receptors and prevent active T3 from getting in.

      Since you probably still have a thyroid, the last ditch effort your body will take to keep your thyroid level where your hypothalamus wants it (in your case lower than normal) is for your thyroid to not-make T4…which sounds like where you are at.

      Why the body down-regulates itself is not well understood…but it generally does so when you are ill. This is true of when we have the flu for a few days…and it is true when we begin developing a chronic illness. Often the first thing noticed is fatigue…and doctors most often check the thyroid when patients complain of fatigue…and due to the down-regulation going on, often rx thyroid hormone…as if that will help you stop being sick. It may improve the numbers, but it doesn’t change the status of possible illness developing inside one.

      While I certainly think you should try the T4…I would caution you to do so with eyes wide open. IF your hypothalamus has down-regulated you (which is what it sounds like), your body will continue to make every effort to keep your levels low. This means that even with the T4, you will eventually need more and more…until such a point where your thyroid stops producing any. At that point, your thyroid will begin to atrophy…and at some point will no longer be able to produce thyroid hormones anymore, and leave you permently dependent on taking either synthetic or animal hormone.

      I share that with you because…as most thyroid patients eventually find out, that man has not successfully reproduced nature at least as far as thyroid hormones go…and many (too many imho) thyroid patients (who are dependent on hormone replacement) experience ongoing issues. So just a word of caution.

      Also, a suggestion that you may want to consider checking into whether you could be developing some underlying issue that is causing the downregulation. I hesitate to suggest that because it seems that doctors these days are more keen on late stages of anything and are generally not at all adept on catching things in the very beginning.

      Hope that helps.

  114. I’ve been following this thread. I have been experimenting with ways to limit or stabilize my dependence on T3 and T4 supplementation for several years. The most effective thing I’ve found so far is to follow the diet recommended at the end of the following article:

    The author’s rationale in choosing these recommendations are explained in excessive detail in his book (free download) and all his blog and newsletter posts. I was able to completely flip my progesterone vs. estrogen ration within 5 days of starting on the diet he proposes.

    I’m still experimenting with all the ratios, but it’s been more dramatic than any creams, pills, herbs or other diets I have attempted. . . particularly the parts about going starch-free, choosing types of sugar, and limiting unsaturated fats. Those concepts were all shocking to me, but I had immediate relief when I tried them.

  115. Hi Mimi,

    You are correct in assertaining that no one knows what to do about normal TSH and normal T4 with low T3.

    Normal TSH (the pituitary’s request for hormone) suggests that the body does NOT want any more thyroid hormone. Normal T4 suggests that there is adequate amount of the storage form of thyroid hormone for the body to convert what it needs when it needs it.

    Low T3 (in the face of normal TSH & T4) is almost always a sign that you have some kind of illness going on in your body, possibly low-grade. In other words, for reasons no one knows or understands, the body has down-regulated itself…and one of the ways it does so is by making less T3. My own personal theory is that it does this to make you tired so you will rest in order for your body to divert its energies to healing you. But yes…no one knows why it does this. And, in addition, no one (in the medical field) cares because when you treat/heal/correct the underlying condition…the body will start converting more T3 all on its own.

    Now, no one likes that…particularly the chronically ill…because that means being tired for years…so we want to push nature, to take control of things that are likely out of our control no matter what we do.

    So…in this situation (normal TSH, normal T4, low T3), you have 2 choices: to supplement T3 or to not supplement T3. Most drs will NOT supplement as this is not an approved standard of care (yet), and they risk their license to do so. Realize, your TSH is the pituitary saying that your body absolutely does NOT want any more thyroid hormone. Also, few want to do the work to investigate what could be wrong with their health causing the down-regulation.

    There are a number of inherent issues and dangers with supplementing T3. But, first of all, it is important to understand how the body works. The liver, not only (primarily) converts T4 into T3…but, when it is working correctly, sweeps our blood of excess hormone and removes it. Therefore, if your body set its levels of T3 low…it will 1) not convert more than that set point; and 2) will sweep any excess over that amount out. Meaning, even if you take some T3…the liver will remove it.

    Now, a great many people’s livers are not working correctly…allowing them to have an excess of T3 (hyper-thyroid)…which is a deadly condition (another reason drs do not like to supp T3). Not only can it kill you, but too much T3 leads to a demineralizing of your bones (osteoporosis).

    What I have found, from experience (I do not have a thyroid and am on T3 only), is that the symptoms of too much T3 and the symptoms of too little T3 are identical…and, unbeknownst to most people, too much T3 causes weight gain as well…most believe it causes weight loss. It causes heart palps, which in some can lead to heart attacks.

    There are numerous other dangers…but the point being is yes you are right, NO ONE knows…the medical community doesn’t know…and worse, what things we have we can do are imperfect and, at best, dangerous. So all you have is a choice, to supp T3 or not to.

    Lastly, realize that the lab normals are arbitrary. They are for reference only. At best, man can only guess about nature. Your body (nature) knows best what it needs. It can be difficult to trust one’s body.

    Best of luck to you.

  116. I read all discussions. They all led nowhere. No one seems to have any idea what to do about low t3 levels in light of normal t4 and TSH. it was not helpful.

  117. Hello,

    I was on 240mcg of Armour for several years and labs were is ok range but still presented with hypo symptoms. Started T3 Therapy mid December and worked up to 90 mg. Stayed on this for over a month before dropping down to 75. Tried 60 at night in the split dose for a few days but felt less well. Plan is to continue on 75 bid until I get hyper symptoms. Have not had labs since I started this . At the onset my RT3 was 21 and FT3 was 2.3

    My question is this. The last week-10 days I have noticed that I have much less strength in my arms. I play tennis and have been doing yard work – moving the trampoline, etc and I feel like I have about half the strength that I used to. Not working out per se during this time, but active.

    Could the T3 therapy be causing this?


    • Hi Pam,

      That is hard to say…as many things can cause weakness. The weakness is something that you should keep your dr informed of.

      That said, if your body (and particularly) your liver is working correctly, then you should never have symptoms of too much. The liver’s job is to sweep the blood of excess hormones…and it does so rather quickly.

      What I can tell you from experience that the symptoms of too much T3 and too little T3 are virtually identical…and that it is possible to paradoxially gain weight on too much T3. Although that is not much help.

      Sorry I cannot be of more help.

    • Great links, thanks 🙂

      The one problem with the Vitamin D studies…and this is nearly universal…and renders them false on their face is this. The Vitamin D that they test is 25,D…and this tests yoru levels of D2 and D3 and adds them together. D2 is Ergocalciferol; and D3 is Cholecalciferol

      However, 25,D (Ergocalciferol and Cholecalciferol combined) are the STORAGE FORM of Vitamin D…which is comparable to testing only T4. The salient fact missed (by doctors and researchers, not to mention savy internet readers alike)…is that they MUST BE CONVERTED in order to be used. Since no savy internet reader would ever advocate for testing T4 only and dosing based on that…they should be applying the same logic to the Vitamin D issue.

      It takes two whole steps for Cholecalciferol (D3) to become active/usable. First the body converts Cholecalciferol (D3) into Calcidiol…then, Calcidiol finds its way to the kidneys where it is converted into the ONLY USABLE form of Vitamin D, Calcitriol.

      the 1,25 D test tests for Calcitriol…the ONLY USABLE FORM of Vitamin D.

      I know, I know…many well loved doctors mistakenly call D3 “active”…but they are wrong. Both D2 (plant source) and D3 (animal source) are not-active. The mistake comes in because an old study found that we absorbed D3 slightly better than D2…but not enough so that Vegetarians need to concern themselves about it…and taking D2 is just as fine.

      While I personally cannot believe, or rather am deeply disappointed in, all the doctors who make this rather huge mistake…I do realize that it will take them about 5 years to catch up, but that one day they will…I would like tothink that the savy internet readers will get there quicker than the medical world.

      However, because of this egregious mistake…ALL STUDIES who only test 25,D are false on their face.

      As I said previous, those with a certain genetic mutation (that would never cause anyone a problem and, because no one tests it would never be the wiser), make too much of the enzyme CYP27B1 which converts D2/D3 (not active 25,D) into Calcitriol (active 1,25 D)…so that they will ALWAYS, ALWAYS, ALWAYS look low on the 25,D test…but will, in fact, be IDEAL in the 1,25 D test.

      As well, those with bacterial infections…even the low grade ones…will also over-make the enzyme CYP27B1 and over convert 25,D (not-active) into 1,25 D (active). Because Vitamin D is an endocrine hormone…and a steroid (aka immune suppressant)…this is a very critical issue…and the effect of the erronous testing, and erronous results, results in people with low grade bacterial infetions being told to take Vitamin D…which supresses their immune system and makes them worse because it allows the bacteria to florish.

      All I can say is shame on doctors who should know better. They either should know (because they studied this), or reasonably should have known…which puts this subject and treatment in the legal catagory of negligence.

      So please try not to be misled by studies that use this erronous information.

      In the case of autoimmune (which you would only know with an ANA/FANA test AND the specific antibody tests)…then, immune supressants work wonders. Vitamin D is a steroid in the same way prednisone is. But for those with a bacterial infection…this is the worst thing possible. The only way to test for and know if a true def exists is with the 1,25 D test that doctors hate to give. Why? I have no clue…but then much of what they do makes no logical sense.

      Hope that helps (maybe not you, but the other readers). 🙂

        • Hi Mary,

          I thought that is what I said(??)…yes, the belief is a bacterial infection that can become autoimmune. However, I do not know anyone who is treating their Lyme with immune supressants.

          That said, very little is known or understood about Lyme at this time (although many act like they know)…I believe that we are still in our infancy of understanding it.

          Lyme is believed to be a bacterial infection…and, about a third of late stage (disseminated) patients seem to have significant improvement from antibiotics. The other two thirds, however, do not seem to improve much from antibiotics and generally grow worse (overall) on them calling into question whether it truly a bacteria?

          The other question regarding those who get worse on antibiotics is, has it become autoimmune? Again, no one (unless things have changed recently) in the Lyme community would reccomend immune supressants autoimmune or not.

          That said, some have greatly improved on anti-protozoa meds…begging the question.

          As well, many who have late stage Lyme are positive for viral activity…likewise, begging the question.

          What I do know, is after a year and a half on antibiotics, that no one knows (yet) any agent that kills it 100% effectively…and then there are the 77 studies that those who argue for the long term antibiotics hold up showing that even after years of antibiotic treatment they still pull out live Lyme spirocetes. For me, this just begs the question…maybe it is not a bacteria, but some other (viral, protazoa, parasite, etc) critter in need of a different anti-…but that is just me.

          I do believe that within the next 10 years (and certainly by the 20 year mark) they will discover what kills Lyme…and by the what kills it (ie anti-protazoa) we will better know what it is.

          I also believe, that those who are better on antibiotics should be given them for as long as they are needed…and I am deeply grateful that some are helped. For the sake of the rest, who do not do well on them…my hope is that people keep looking.


      • Here’s our lab’s explanation:
        This is not a valid measure of Vitamin D Stores.

        It is the active metabolite of Vitamin D, which may be elevated in patients with granulomatous disease and hypercalcaemia. Apart from the rare indication in patients with hypercalcaemia of unknown cause and a suppressed parathyroid hormone there is little or no clinical reason to request this test.

        For further information contact a Chemical Pathologist or Endocrinologist

        I guess it’s the same scenario for T3 then. It doesn’t measure stores of thyroid hormone (T4), just the active hormone and yet is thought by many doctors to be a worthwhile test for management of patients with known thyroid disease. Go figure…

        • Hi Honora,

          That would almost be funny if it wasn’t so sad.

          For everyone else that hasn’t caught the issue yet: 25,D (the combined cholecalciferol (D3) & ergocalciferol (D2), collectively known as calciferol), which is just a metabolite or precurser (pre-vitamin they call it) of usable Vitamin D, but is NOT the usable Vitamin D (yet). Cholecalciferol (the D3 you take) is converted in the blood stream to create Calcidiol (likewise a precurser, or pre-vitamin to active Vitamin D). Calcidiol is then converted, in our kidneys, into Calcitriol…the one and only truly active and usable Vitamin D. This is tested with the 1,25 D test.

          In two situations, bacteral infection and certain genetic defects (that you would not notice), the body makes too much CYP27B1 (also called 25-Hydroxyvitamin D3 1-alpha-hydroxylase) which is the enzyme that converts D3 (unusable) into usable Calcitriol…resulting in an always low 25,D test…and a high or normal 1,25 D test. However, by whatever stupidity, the medical world only ever tests 25,D….which results in a lot of people thinking they have low Vitamin D, when in fact, they may not. In order to properly know, one must test both 25,D AND 1,25 D.

  118. Treating thyroid without T4 is tough, without a doctor is tough. When I first started on t4 levoxyl, months later I noticed that my T4 was on the high end and my T3 was at the low end of the reference range. My toes were still purple and I was still not saying things right sometimes. I talk to the doctor about it and asked him about Cytomel. I could not tolerate Cytomel because it was not time released. It would make my heart race for a couple of hours and that’s all I got out of it. I try splitting the pills and it really wasn’t working. Went back to armor split the pills because I was getting tired by 2 o’clock in the afternoon and it didn’t work either. Then back to Levoxyl and time released compounded T3. It worked. I was at a ratio of 2 to 1. When I stopped drinking tap water -purified instead. My T4 levels jumped up and my Dr reduced t4. I stopped taking T3. . I am not good On T4 112 µg alone. Recently I found out that my vitamin D was below normal. I have been taking vitamin D for about three days and I do not feel cold at 63 degrees…outside temp. I read an article that suggested that people who have autoimmune thyroid disorders should be taking vitamin D supplements even if within reference rage. I am taking 2000 IU’s (1000 twice per day) at this point even though the doctor suggested 1000. My skin has been dry (not from vitamin d) and I have noticed fishscale type appearance to my skin. Not terrible, but it looks crinkled. I have actually had dry skin like this for more than a few years. The article also suggested that vitamin D supplementation can help to convert T4 to T3 more efficiently. High hopes! At this point I am able to wear a short sleeve shirt and shorts when it’s 63° outside and I am comfortable. Last week I felt cold when it was 70° in the middle the day in the sun. I was biking for 25 miles and it took 2-3 days for my t3 to catch back up. Slept a lot. Will be interesting to know if intense excerises will be better without the t3.

    • Hi Becky,

      Thanks for sharing your experience and I sure hope it works out for you.

      Had some thoughts to share.

      One is, you may want to consider trying a T4 called “Tirosint”…it is T4 with no fillers and may clear up some of your issues. It is a name brand so your doctor will need to make an argument for it to your insurance.

      You are not converting a whole lot of T3…and, although many people try a gamut of supplements, the most common cause for not converting much T3 is some form of illness going on. As Chris writes in this article, the low T3 conversion will clear up when the illness does and so may not need to be treated. As someone without a thyroid, and who makes high amounts of RT3 (over 180 points above range) and collapses when on T4, is chronically ill, and who takes T3 only…my view is that it is unrealistic to ask someone to remain hopelessly tired and hypo for years just because they have a chronic illness.

      The problem of hyper symptoms upon taking T3 are not uncommon…but do also point to a possible liver problem. In a properly working body, the liver would flush any excess T3 out of your system within a minute or two of it appearing in your blood stream…and then, of course, you would grow increasingly hypo as your body uses the T3. There really is NO great work-around to this issue…T3 needs to be taken throughout the day to keep levels up. I have no experience with the timed release so I cannot speak to that…I take mine 10-12x a day and it works well that way.

      The issue of Vitamin D is a deep and confusing one. First off, Vit D is not a vitamin at all, but rather an endocrine hormone…a lot like thyroid hormone. When they test your Vit D levels, what they are testing is 25,D…this is a STORAGE FORM of Vit D…and is the exact same as testing T4 only. The active form of Vit D is the 1,25 D (same as T3)…and they hate testing this in the same way they hate testing RT3. However, I strongly advise getting BOTH tested (25,D + 1,25 D) before supplementing. I also am deeply concerned that anyone is recommending to just take Vit D anyways because it is a fat soluable supplement and excess is not flushed away, but can build to toxic levels. The reason for the dual testing is this…people with certain genetic mutations (that you would normally never be aware of) AND those with bacterial infections will make too much of an enzyme called CYP27B1…this is the enzyme that converts 25,D into 1,25 D. What this means is that these people will over-convert 25,D into 1,25 D (like those who over-convert T4 into T3). Now, most who do this will have chronically low 25,D (the one they test) and perfectly ideal 1,25 D (the one they do not test). However, if you are sick and doing this…you will over-make or over-convert 25,D into 1,25 D and have too high 1,25 D (the one they don’t test).

      While this is not a huge problem for those who are autoimmune…because Vit D the endo hormone is a steroid and immune suppressant…it IS a huge problem for those with bacterial infections because excess Vit D will suppress their immune system’s ability to fight the infection.

      They call the issue of low 25,D (the one they test) and high 1,25 D (the one they don’t test), the “Vitamin D Reversal Pattern”…of which I also have. For me, who like you was also tested and found very low, tried taking Vitamin D…feeling great at first and then very tired and sick, only to feel better again when I stopped taking it.

      I advocate for the dual testing because I was so shocked when I learned about it…and especially because no one who is in the know now on thyroid issues would only ever test T4 and dose based on that, that I find it sad that doctors are still only testing 25,D and dosing based on that alone. I know that they will catch up eventually…they just haven’t yet.

      I am not saying don’t supplement…only adding so if you end up not feeling good supplementing, that there may be a reason for that.

      Lastly, the liver (primarily) converts thyroid hormone. I don’t have any suggestions for what you can do to help or support your liver. And just adding again, that low T3 when T4 is fine or high, is generally a sign that you are sick with something…and is likely to remain like that until you fix the something else.

      Best of luck.

      • Sick with something…? I have osteopenia. Triglycerides are pretty Low-50, and DHL is high end of range. Liver function results are normal.
        How is your tsh level? Mine was below normal as it has been since taking thyroid replacement. My new dr. Is intense about it and wants to reduce my t4. My t3 is 83 with the range of 78-181 so if the dr reduces me to 100 mcg makes sense I will be t3 deficient the next time I’m tested. Other dr didn’t care about tsh. I tried tirosint and previous dr tried to make a case for it but ins wouldn’t cover it-$85/mo. Some Walgreen’s make compounded time released t3, (doesn’t have to be refrigerated)but it has been hard working with dr’s to get to that point as of yet. $35/mo….

        Anyway, I did well on t4 and compounded t3. Went to jamaica, frig broke and my t3 ruined so I went days without, felt fine until t3 dwindled and here I am trying to working it out again after 7 years of doing well.

        Let me know if you can come up with any underlying disease based on this:
        The thyroid problem was triggered by a sore throat in 2002 that got worse over 2-weeks, amoxicillin, then cortisol, then z-pack made my tonsil swell tremendously. Ent gave me augmenton and it resolved. For the next 3.5 years my dr did not catch that I was hypo even though I visited frequently with many problems, developed tennis elbow in 2006 and was prescribed 3-4 weeks of pred and went hyper-(developed bump on neck-nodule and made appt) doc didn’t catch it and put me on t4. After ramping up from 25mcg to 100 I couldn’t tolerate t4-had hyper symptom again. Of course the first time I went hyper I didn’t know that It was thyroid storm-just knew if I didn’t lay down and stay still I would probably die. I was not on t4 yet due to testing. (Uptake tech asked me why I was there, told him hypo and he told me I should get another blood test- but didn’t tell me I was producing a lot of t4 on the uptake). Asked doc at that point If he thought I could be hyper instead of hypo. He said there is no way and did nothing else but hand me my first samples. So, I was in myxedema crisis, and came out of it in not such a graceful way. If diagnosed before the pred, I would have been admitted to the hospital.i was 112 lbs and had water retention. I even tried to tell the dr when I went in for tennis elbow that things were not right an he basically ignored me. So, I read about treatment for myx. Cortisol, high levels of thyroid and antibiotics. I got pred, went hyper and requested a round of augumenton after discussing all this with the doc at the time. While taking aug, I could feel a sensation across the top of my head like something was clearing out-only went on for a couple of days.

        • Hi Becky,

          Hard to say what the underlying illness is to be exact…however, as we share a number of similarities, I will say that there are a great many thing going wrong with people these days that haven’t made it into “standards of care” (yet) so doctors don’t know about them. Sort of like workers who are like, “if it doesn’t come up on the computer, then they don’t know what to do.” You probably experience this as well, if you don’t fit perfectly in a dx box…then they have no clue. It is a challenge to be patient with the drs. The current “standard of care” for thyroid that they must follow is to dose based on TSH…it is a challenge to find a dr that will operate outside of that. Unfortunately, this assumes that 1) the pituitary/hypothalamus is working correctly; and 2) that the only thing wrong is the thyroid. Never, ever have I seen a dr or internet thyroid group talk about the liver’s involvement in hyper-thyroid since hyper is ultimately a failure of the liver to remove the excess hormone. Many people pay for cash-only drs. For those of us who have to depend on insurance covered drs, my suggestion is trying an “integrative” dr…they try to get to the bottom of things, treat the whole system, and can use supplements as well as rx’s…and are far more likely to use T3 and dose based on how you feel.

          When on T3 only, my TSH is all over the place…less than 0.1, less than 0.1, 9, 14, less than 0.1, 17 (normal being 0.5-5.0). all in a span of 6 months on the exact same dose.

          The lower bone density sounds very much like hyperthyroid (and too much T3)…am guessing you have had your alkaline phosphatase levels checked. Mine are also high…only my dr thinks is gall bladder related which can also cause that.

          The liver tests they run are actually liver death/damage numbers and not for function (yes, stupid, I know). Unfortunately, I don’t know what the function tests are…but do know, in the basic panel low BUN and Creatinine together = liver; high Alkaline Phosphatase = liver (also bone demineralization); and higher than normal ALT = liver. Mine are all wonky…but only slightly so. Your cholesterol numbers are great…which the liver makes…it would suggest that it is healthy.

          No one seems to know by what process (exactly) the body down-regulates during illness. They see the after-effects (low T3 et al), but they don’t know how or why. I imagine that something is instructing the liver to make less T3 (or, to remove more T3). Not knowing what it is…no one knows what to do about it. Many say to take supplements of the things you need to convert…but, poor conversion is rarely due to def. Also, many things one is told to take (selenium, Vit D3, etc) has the exact same symptoms for too much as for too little…esp selenium. My recommend is always test to ensure def before taking…esp as now that I have learned about the genetic stuff, supping things can really make a person sick.

          Like you, I have chronic tennis elbows…started from muscle knotting in my forearms. I get cortisone shots, this helps with knotting all over my body. My dr gave me Cortef based on my improvement from the cortisone shots. I still take a partial pill once or twice a month to keep the knotting down. Eventually, my body became very tight and physical therapists had to stretch me out. My doctor gave me Baclofen which is GABA with a little molecule added to confuse the neurons into accepting it. Later on, a different dr I see who does the genetic stuff, ran a neurotransmitter test from Phramasan…this showed that indeed I was making too much glutamate (turns muscle/tissue on) and not enough GABA (which turns them off). I tried all the various GABA supplements, but they did not help…the baclofen works great and is cheap as far as prescriptions go (I think 11$ a month). So, just a thought on a direction you might pursue.

          On the same line, my cortisol is fine…but by the same neurotransmitter test, I am not making adrenaline well. Everyone seems to know what to do for low cortisol…but no one knows anything about what to do re low adrenaline.

          You mention needing to lay down or die…omgosh, I feel like that so often also…however, until you mentioned it, I had not thought of that as thyroid related. To me it feels like my body doesn’t make the chemicals it needs to support life…and if I do too much it is like instant forced need to sleep to restore.

          Like you, I also have water retention.

          The sore throat suggests to me two possibilities…it is common to both autoimmune and infection. As well, many in the autoimmune community believe that the autoimmune condition is caused by an underlying infection of some nature. That you improve with antibiotics suggests some kind of low grade infection going on.

          I would be very curious your temp. If it is lower than normal, this would suggest Lyme.

          However, that said, my first thought on low grade infection is to wonder if you have recently had any vaccines? They don’t tell you this, but they can cause a permanent state of low-grade infection in adults. The MMR vaccine used to be attributed to chronic fatigue syndrome…is a virus, but operates in the same way, a permanent low grade viral infection. The other thing it suggests is Lyme disease. Unfortunately, the screening test for Lyme only has a 35% chance of picking it up. The gold standard test for Lyme is the Igenex test…they don’t take insurance so it is $260 upfront and then insurance reimburses. Your dr would have to get the kit, draw the blood, and then you send it in. Lyme is very insidious…and can mimic so many things. For me, the main symptom was that for years I never got sick and my temp was a degree cold. There seem to be 3 kinds of people with Lyme…1 who gets better on antibiotics (and benefit from long term antibiotics); 1 who goes up and down on antibiotics; and 1 (like me) who get worse on antibiotics. Lyme can turn into autoimmune. The one benefit to a Lyme dx, is that you have a running chance of knocking out the underlying infection of autoimmune…imho…with the antibiotics.

          Augmentin is not usually used to treat Lyme…but that you improve strongly suggests bacteria of some nature.

          If you haven’t yet…you may ask them to run these tests:
          ANA/FANA (for autoimmune)
          RA Factor (also for autoimmune)
          C-reactive Protein (for inflammation)
          SED Rate (for inflammation)
          CD57 (immune response, low if Lyme)
          C4a & C3a (immune differential between Lyme & Lupus)
          CBC w/ Differential (will tell you which white blood cells are most active)
          Blood Smear panel…not sure what it is called exactly, but will tell you viral or infection

          You also might get a test of the usual suspects like EBV.

          The two immune tests specific for Lyme are covered by insurance (although you may need an order for an outside lab, like Quest), and if suggestive of Lyme then would warrant the Igenex test…if not, then you can save the money re skipping the Igenex.

          Beyond that…re hypo/hyper thyroid, which you seem to be swinging…the liver should sweep the excess within minutes of it being there…meaning, no one should ever be in a state of hyper for long. I know mine used to…not so much now. No one knows the process by which it does this…or, how to help it do this…drs don’t even look there, people on the internet (smart as they are), took years to realize that the liver was eve