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


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

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.

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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.

Articles in this series:

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  1. Wow that’s really awesome. Datis seems like a very technical and detail oriented guy. Btw, I’m an affiliate for your product. I really like what you’re doing!

    • I agree…and am likewise so glad to hear that you have gone beyond his work. Thank you for all you are doing.

  2. I have never used any thyroid medication but I know a lot of people who have. I’m wondering if you’ve looked into the work of Datis Kharrazian? It’s really quite fascinating and I’m sure you’d love it.

    Thanks for posting Chris!

  3. do you know if a severe magnesium deficiency .5 (1.5-2.2 range) would cause a poor ft3/rt3 ratio? my tsh and ft4 are normal.

    i’ve been supplementing for 4 months now, hoping my ratio improves

    • Not sure that a magnesium def alone would cause it…but many underlying illnesses can cause both a magnesium def and too high RT3, as well as too little nutrition. Magnesium needs to be taken with other nutrients like calcium as they bind together and by taking one will deplete the other…just an FYI. High RT3 is the body’s way of dealing with illness or nutrient def…it is the body’s effort to slow your metabolism down to deal with either less nutrients or to help your immune system. Low vitamin D, and low iron as well as magnesium are common to many illnesses…I do not believe that the def causes the illnesses but rather is secondary and my best guess to why that is, is that the body likely needs more of those to deal with the illnesses.

    • Conventional medicine authorities have decided the Wilsons protocol is quackery. Conventional practitioners do not have an alternative diagnosis that I am aware of.

      My doctor likes to stare at me whist implying I am mentally… not right. Because my TSH is lovely and I cannot be having these symptoms. I can’t tell you how many doctors I’ve had that react in the exact same manner.

      The proof is in the pudding though… my TSH _is_ lovely. However, my very high cholesterol has never resolved. They can’t explain that. x

    • After lengthy research (medical as opposed to internet theories), there is no connection between adrenals and thyroid hormone conversion. The main culprit in thyroid conversion from T4 into T3 takes place in the liver. This is why the medical community refuses to recognize it. Wilson himself does not recognize that the ONLY connection between the adrenals and thyroid is in the pituitary and hypothalmus…and yet offers people NOTHING to support or test those. Hence, why he is deemed a quack…and why his protocol will ultimately not-help people. If there is something wrong with either the pituitary or the hypothalmus it is likely to affect both the adrenals and the thyroid…and only supporting the adrenals and thyroid will allow the condition to continue…sort of like constantly filling a leaky tire rather than fixing the leak. Worse, by needlessly taking any endocrine hormones, you cause the respective endocrine gland to slow down production or even stop making them altogether…in other words, you inadvertantly cause/contribute to gladular failure by needlessly taking endocrine hormones.

  4. Hi
    I’ve been on T3 treatment for about 5 weeks now because my tests showed i’ve got normal TSH and T4 but very low T3.
    I also have problems with my adrenals,probably because i’ve gone untreated with this for a long time.
    Therefor i am also on adrenal support.
    The first three weeks i didn’t feel any improvement,i rather felt a bit worse,but that was mostly due to my adrenals having a hard time coping.
    After about three weeks i suddenly felt alot better,it was a huge difference in my brain,my constant brainfog just disappeared and it felt like i could think and use my brain again.Hard to explain,but i think anyone who’s had brainfog problems knows what i’m talking about.
    I’m still very tired, but i think in my case alot of my symptoms i have now are related to my adrenal fatigue.
    I apologize for my bad english,it is not my first language since i’m swedish but i hope you understand what i’m trying to say anyway .

  5. Excellent article Chris.

    Do you know of any data showing how common Wilson’s Syndrome may be? I’ve had a lot of experience with friends and clients who have good thyroid levels, but who suffer from low body temp until they clean up their diet and lifestyle. Do you know of any other factors which cause low body temp, besides lack of movement and not eating enough?



    • Web you say the levels are normal, do you mean optimal? Many people have normal levels and are hypo

    • There’s no research on incidence of Wilson’s that I’m aware of, because from the perspective of conventional medicine it doesn’t exist.

  6. Chris,

    Quick question, what is the ideal TSH range for adults. I was pretty sure that in one of the articles you we’re saying that it was 0.8-1.8, but when i was looking over the acticle again it said 1.8-3.0. Did you change it recently? The reason im asking is my TSH is 2.46, which is normal by medical standards, but im experiencing all the classic hypo symptoms. My endocrinologist bluntly denied any corelation with hypo and offered bunch of drugs: htz for swelling, trazodone for sleep, and birth control pills to regulate my hormones. I politely declined her offer and recomended to keep up on the research.
    So im very curies if you did change the range or im i making this up ? thanks buch, appreciate everything you do.

    • Hi,

      I had a similar problem: being ALMOST out of range and feeling terrible. The thing to keep in mind about ranges is that they are determined by drawing on a random sample of people. so what if that sample was sick? Then the range is based on sick people…its better to go by your own symptons than anything else. I felt so out of it for a long time – all the classic symptons of hypo but every time I was tested, it came back “normal”. After about a year of this, I asked to see the results myself. Because I had previously had graves disease in my early 20s, I had YEARS of tests to compare it to. The years i felt great, my TSH was less than 1 or about 1. However, over the last couple of years, my TSH shot up to 2.8 or so. In fact the more symptoms i had and the worst I felt, I could track to the uptick in my TSH. I had to BEG to be tested for hashi’s. My endo finally gave in, and I tested positive BUT because i wasnt higher then 4 or 5 (they were using old range standards) they refused to treat me for my hashis. I was told it would take me 1-2 more years to get out of range so they medicate. At this point I was almost to the point of going on sick leave so waiting that long wasn’t an option – I have bills to pay….I found an integrated health doc who finally took care of me.

      Sorry for the long winded response, but what I’m trying to say, is dont worry too much about the ranges, go by symptoms and what is normal for YOU.

      • Hi Meg,
        You wrote that you’d “…found an integrated health doc who finally took care of me.”
        Please explain what is meant by this type of doc and exactly WHAT did he/she DO that took care of you? And please don’t hesitate to be long-winded either – other folks’ lives are literally at stake here! I am SO utterly sick and tired of ‘looking’ okay which others’ see as being okay while inside feeling rotten the majority of the time so, I WANT to hear it, and am sure others do as well, ALL that you have to say about this so please, I beg you, DO elaborate for the potential benefit of us all?
        I’m not saying that what’s worked for one may work for all as we are all individuals, but, the more we can learn from others’ experiences, the better I say.
        Gratefully yours,

        • Hi!

          I found an MD who was an integrative health doc. He actually specializes in allergies so you may be better off with an allergist as opposed to an endo. Before that, I was going to one of the best hospitals in the coutnry and the endos did not know what to do with anyone who displayed hypo symptons but were “technically in range” of normal TSH (and by the way, there were using an outdated range at that.) They never ran tests to check on T4, T3, Revers T3 antibodies etc. I had to BEG them to run the test for hashis and when it came back positive they basically said “yeah, so what?” I basically educated myself on the right labs to run and the best way to read them.

          If you read Dr. K’s book on thryoid and google “stop the thyroid madness” you’ll find a ton of helpful info! Esp in regards to helping you find a doc that knows how to think outside of the box.

          My current doc ran all of the above tests and even told me to avoid gluten bc that kind of stress has a tendancy to cause hashis and other autoimmune disease. This is easy for me as I’m gluten intolerant so I never cheat in that regard, I am now also eating paleo/primal. Basically I was impressed with the fact that this doc didnt want to just pump me full of drugs, he was interested in gut health, what I was eating, etc in addition to treating my symptons. However, as much as I am pleased to be feeling better, I am still not 100% in other areas – I don’t think he is up to speed on adrenals or other hormones so am now trying to find another doctor who is (perhaps in conjunction with this doc).

          One tip I was told to help find a doc like this – go to your pharmacy and ask the pharmacist the names of Drs who prescribe armour. Typically if they are ok using that they have a different approach to medicine. If they understand the need for T3 sometimes, then they are probably on the right track in terms of not just going by TSH.

          I think hospitals etc just like to run labs and look at the numbers and then dont actually analyze the numbers. They have a hard time treating the cause instead of just the stymptons and thats a prob, esp since a lot of “treatments” just end up causing more probs/symptons which then just means more meds etc. Its a horrible cycle.

          My current doc spends about an hour wiht me for each visit – not just 5 minutes. Thats huge. I dont think the current medical system is set up to handle this type of one-on-one care but its NECESSARY for optimal health.

          Funnily enough, I live in a big city and could not find docs like these in the city – I have to take a half day from work to drive out ot a burb about 45 minutes away in order to seek treatment. Crazy.

          I hope that helps!

          • I should also add that I made a huge lifestyle adjustment. Sleep is a huge priorty, I take supplements such as D3 and Iron (test showed I was very low at both,but curiously my Hospital doc never commented on it – I stumbled on it when I got my labs!) Omega 3s, tumeric/cinnamon (helps with inflammation and controlling blood sugar). Holy basil (adrenal help), Super Enzymes and Probiotics for digestion. However, I would find a doc you trust first before embarking on supplements. You don’t want to just take things willy-nilly.

            I also do yoga and walks as opposed to high intesnity stuff, eat really clean: grassfed beef, lots of fats(coconut oil. avacados) low carb, no grains legumes or dairy (welldairy occasionally – I’m lactose intolerant so avoid it as a rule and occasionally have tortilla chips when I have mexican). You really have to ensure you are eating high quality foods. Its HUGE.

            For the most part I avoid things that supposed flare up autoimmune probs: like eggs and nightshades

  7. What’s the cause of low basal body temperature and normal thyroid tests? Is it anything to be worried about?

  8. Am now a 57 yr old married female with FMS/CFS, hair loss, dry skin, constipation, osteopenia, leaky gut, sleep problems, zero sex drive, next to no resistance to colds/flus since having a complete hysterectomy with double oppherectomy in 1999. Docs kept telling me symptoms were all in my head
    and was just ‘unnaturally mourning the death of my mother in ’96’ and would be prefectly fine if I would just take antidepressants & antianxiolytics (even when I presented with a transient goiter but thryroid blood tests at the time still showed normal). Dx in March 2010 by endo with Hashimoto’s. Told endo right from the start that I felt worse after my GP put me on T4 (Synthroid) only but endo insisted I had to take it regardless although he did agree to add in T3 (Cytomel) afterwhich I felt an immediate improvement with sleep and lost 10 lbs without trying albeit this effect was only temporary. Weaned myself off Synthroid completely and felt the best I had in years but endo flipped out when he learned of it and threatened to not treat me if I didn’t go back on Synthroid which I reluctantly did and immediately felt worse again so have stopped it yet again and at present am on Cytomel only. I do feel a lot better, more energy, etc but it’s clear it’s not enough as still very susceptible to colds/flus at any exposure to other people which is just about every week when I go get my groceries. Endo won’t even talk about natural thyroid and have had adrenals checked but he says they’re fine so I don’t know what else is going on. He refuses to look at any other glands such as hypothalmus, etc so I don’t know what to do next as there’s really no one else to go to here as I can’t afford a naturopath. Am sick and tired of being sick and tired:-(

  9. Well, this is interesting…. I have recently been wondering if I should even be taking thyroid hormone. My blood tests indicate that my thyroid is working correctly, but that my T4’s are not converting to T3’s. I also have extreme mercury toxicity (can this cause the problem?). I am currently undergoing chelating therapy for about 8 months now. Things seem to be progressing nicely.
    Now, originally what brought me to my naturopath’s door was the fact that I had unexpectedly, with no apparent reason, gained 20 pounds. My basal temp is VERY low, but other than that not many symptoms of hypothyroidism (except hair loss which could also be from mercury toxicity). In fact, I have a ton of energy.
    My new family MD says that maybe I shouldn’t even be taking thyroid hormone.
    And, after just reading some books about Primal/Paleo lifestyle and am thinking that maybe there is such a thing as “functional hypothyroidism”. Lower thyroid and slower metabolisms have been linked to longevity.
    So, my thinking currently is whether I even need this thyroid hormone.

    • I am 65 years old, and I have had the symptoms of hypothyroidism for most of my life, but not being diagnosed because my TSH was never high enough for that. So, for the last little while I have said, “Enough is enough already.” I had enough of doctors hemming and hawing around and never knowing what was wrong with me. The only thing they (especially the endocrinologists) could say with certainty was: “It is not the thyroid,” and making excuses for why they couldn’t dose according to my low free T3.

      All I wanted was for my free T’s to be in the upper third of the normal range. I was told the FT3 test is a poor assay, and I understand why it is regarded that way since the normal range is very small and measured in picograms. 1000 picograms = 1 nanogram and 1000 nanogrames equal a microgram, etc. Still, if it can’t be measured accurately, then I wanted the opportunity to measure its effect on me by taking the very small dose and measuring my blood pressure and heart rate to keep them in the normal ranges.

      I wanted to be normal thyroid before I fuss with checking out innumerable other possible causes of my symptoms. The thyroid is, at least, real, not some made up diagnosis such as CFS, IBS, etc. Even depression is not diagnosed from a blood test.

  10. Hi Chris, thanks for the article. My naturopath doc put me on a low dose of T3, and I felt terrible. I had insomnia (which I never have), occasional discomfort in my chest, and just a general feeling of discomfort. This was taking only 5 ug in the morning, which my doctor said I should not even feel at all.

    • Vanessa, extra T3 for those who don’t need it, will most certainly create side effects similar to the one’s you experienced, I hope your naturopath informed you about the possibility. In my experience, all the other variations of thyroid medication failed to work on me with any long-term success, but once I tried “compounded”(timed release) T3 my condition improved dramatically. It certainly is not for everyone and many traditional medicine doctors will shy away its use.(fear of cardiac involvement). have a history of heart palps and an arrhythmia, I needed to be at my very worst in order to take the “risk” to try T3. It actually resolved my cardiac symptoms and I never had an adverse reaction unless you count being a bit warm a few nights on the highest doses I tried. Good luck with your search for a treatment…I’ve learned that you must just keep trying and keep careful logs of how you react to each medication/supplement.

      • I agree 100% with this. My doctors were similarly out of tune. They are so used to miraculous results as a result of armour thyroid and/or cyto that when you have a negative symptom they dont quite know what to make of it. I do so much better since I am on the right dosage but also had swelling/edema that was quite uncomfortable. Instead of thinking that perhaps i had gone up too fast in dosage they instead figured i must know be allergic to pork (amour is pig thryoid)…well, no, I wasn’t (!). Luckily, I figured out for myself that I was on too much medication. Not sure if you have tried this, but I find it helpful to spilt up my dosage. I take half when I wake up and the other half of my dose after lunch.

        They also weren’t up on adrenal issues so am still trying to figure that piece out. after i kept crashing after exercising, I called and asked if I was not supposed to be working out and they said it shouldnt matter. still trying to find that perfect doc!

        I guess my worry noow from reading these articles and from the book “Why do i still have thyroid symptons”, is that maybe i shouldnt be on medication at all?

        • Meg

          We seem to have quite a bit in common…regarding lifestyle, exercise (even the running and boxing!!). I would love to see if you are open to corresponding outside this space…to share notes and support. I am totally frustrated with my Doc, meds, fatigue, weight and thist! Thanks in advance. [email protected]

      • Hi Mattios, I can relate very much to your post. I too have low T3 and was an avid surfer before having CF among a list of other diagnosis’s for the last 3+ years. I’m curious about the compounded T3 and the manufacturer. I’ve started liothyronine at 5 mcg/ day, but still feel like I’m in a coma, Armour made my hypo symptoms worse. I’m looking for any help I can get to steer me in the right path. I have a 3 year old and would really love to surf more often. Thanks

    • The problem with natrapaths doing this is that they are entering carelessly into a dangerous game with patients. To best understand the complexity of the issue, you need to know that because we make hormones they cannot be patented so pharma and the FDA care very little about regulating them and they often end up on store shelves along with other vitamins and supplements. And, because the supplement sellers want to make as much profit as they can, they do not tell you about the limited conditions and situation in which it would be helpful…indeed, they make their money on people buying stuff that ultimately is of no use to them. Now, the second part of that is the public’s misperception that endo hormones are like vitamins and are safe to take (which they are not). Because here is what happens…the endo system is highly sensitive and extremely self regulating…it decides the levels of hormones it wants and it keeps them there. So, if you take thyroid hormone, your thyroid will make less (unless there is something wrong)…and because you are making less, drs and natrapaths give you more…and in turn the gland makes even less…untill eventually it stops making any and atrophies…at which point you will be forever dependent on taking that hormone for the rest of your life. All of which is completely unneccesary and entirely avoidable. This is one area that freelance practioners really get a big, “shame on you,” in my view…they should know better. And it breaks my heart that faced with people having issues on it that they do not even know enough to tell the patient to stop, double shame on them. 🙁

      • Wow! Faith, I think the same can be said of mainstream doctors. IF a persons body is not producing the hormones they need there is a reason for it and, in my experience, integrative and functional practitioners do labs, read labs and listen to their patients symptoms then try to get to the root cause of the problem. Sometimes that involves prescribing hormones or mineralcorticoids that the body does not produce enough of or does not produce at all. I have found the opposite with doctors, they write scripts and keep big pharma in business whilst our population gets sicker and sicker! Just take a look around.

  11. I was diagnosed with non-hashimoto’s hypothyroidism in January of this year and put on Armour. I had high-end-of-normal FT4 levels, moderately elevated TSH, low FT3 levels and undetectable antibodies. This sounds to me like low-T3 syndrome but my doc had never heard of it. Fortunately he was forward thinking enough to realise that putting me on thyroxine when clearly my issue was T4 – T3 conversion was pointless. I have experienced many improvements this year but whether that’s related to my Armour I don’t know. The last time I saw my doc he raised my dose to 3 grains daily (1.5 BD) but I started having hyper symptoms and reduced my dose to 1.5 in the AM and .75 in the PM. I’m now trying to wean myself off the Armour altogether. As of today I have reduced my AM dose to .75 also. I also recently started taking Iodoral and this seems to have done more for my symptoms than the Armour did. My temp has consistantly been 36.6-37C since starting Iodine supplementation when I was hard pushed to get it above 36.5 on Armour alone.

  12. I have been on t3 only since the spring. I also went on hydrocortisone at the same time to support my adrenals. I also have chronic Lyme disease. It took a long time to feel better on this proticol but I have read that is normal. I started t3 only because of a reverse t3 ratio problem. I was taking 125 mg of cytomel a day for a while and now am on 75. I was on 35 mg of hydrocortisone a day and now am on 15. Until a month ago I was feeling very good but then I went on vacation for 2 weeks and haven’t been able to get back to where I was before vacation. I really don’t know if this is a Lyme thing, a T3 thing or what. I can tell that my adrenals are much improved over the past 6 months. I’m also following the GAPS diet for the past 2 years. I’m not sure if this helps any or not. After all it is all anecdotal but I don’t feel any worse on this than I felt on naturethroid and in fact feel a bit better. I have been on thyroid medication for many years.
    My daughter is on naturethroid as well. She started when she was 5 and is now 7. We tested her because of my thyroid issues and also because I had read that often AD/HD symptoms are undiagnosed hypothyroidism. In her test results only her ft3 was out of range low. FT4 and TSH were in range but her Dr put her on meds because of the low T3. We started her on adrenal support (isocort) in the spring after testing and she was doing so well that we tried to wean her off of her thyroid meds thinking it might be a adrenal issue and not a thyroid issue. Her anxiety went through the roof when we reduced her from 1 grain to 1/2 grain. Thankfully putting her back up to 1 grain fixed that. She also is now weaning off of her adrenal meds and doing quite well. We are about to run tests to see where her thyroid is now. She also has chronic Lyme disease fwiw.

    • You and I are in similar boats, I also have Lyme…late stage. The RT3, I believe is an effort of the body to slow us down in order to more effectively launch an immune response…in other words, secondary to the Lyme. I too was given hydrocortisone, although do not take it daily…only when my muscles tighten up. The issue with hydrocortisone is that it also lowers the immune response which is needed in fighting Lyme. Sorry to hear that you and your daughter have Lyme, I also believe that my children have it as they all show similar weird symptoms as mine (we are waiting on tests). Lyme is a horrible infection…and I wish the world knew that a negative on a standard Lyme screen is valueless…in other words, it does not mean you don’t have Lyme…in fact it doesn’t mean anything at all. I think late stage Lyme is a very possible cause behind anyone with RT3 issues. The best screening test I know of is a cash pay test by Igenex.

    • I am have Chronic Lyme and also taking LDN as I have heard wonders of it helping Lyme and Thyroid. I am taking Armour, but feel awful. Did you feel awful when starting? I have GI issues and low energy. My body temp went up a degree which is great. I am not sure if it is related to the LDN and my immune system working or the thyroid meds. Not sure if with LYME we should be on thyroid meds. Gained a lot of weight with Lyme and just trying to figure this out. Taking LDN without thyroid made me feel well. Confused.

  13. I’m currently taking 100mcg T3 (Cynomel) and have been since mid-June of 2011. I’ve had adrenal issues along with it and had trouble getting those supported. My starting average daily temps were 96.8 (I didn’t transpose that). They are now 98.6 and I’m feeling very well. I still have some symptoms that haven’t subsided, but I’m on my way to much better healthy. My pulse is up to 65-72 from around 55. My blood pressure is up to 115/65 from 90/55. I’ve taken off 10 pounds without trying (I’m not fat, but could loose another 8 pounds or so). I’m not on adrenal support, so I do have to be careful not to overdo too much. I have stopped weight training, but still do aerobics daily (it’s winter now, so I’m not hiking, but normally I would hike for aerobic work).

    I have no thyroid and before starting this therapy my FT3 was 2.4 (bottom of the range) and my RT3 was 460 (top of range being 350). I haven’t tested RT3 because there is no need at this point, but my Ft3 is 4.4 now (slightly above range). FT4 is .2 (way below range) and TSH is .01 (very suppressed).

    • Do you only take T3? I don’t have a thyroid gland either. Every time I even try small amounts of T3 I get hyper like symptoms even though my labs are are very low. I take Armour but still can’t get my T3 and T4 in the normal range. I am also following Dr. Wilson’s Adrenal Fatigue protocol. Any advice?

      • I was back then only taking T3. I have since moved back to a combination of T4/T3. If you don’t have iron serum over 100, you may have these sort of reactions to T3. But, also, some people just don’t do well on only T3. I think T3 only is very hard on the adrenals and liver. I’m still working out a combination that will work for me. It’s slow going and I’m due to test in another 2 weeks. Last time I tested, my FT3 was a bit high and my FT4 was low. I’ve lowered T3 and raised T4. I wouldn’t normally go by test results, but I have been feeling hypo and I think the test results at least help me determine if I’m converting and also letting me know why not (ie., taking too much thyroid hormone would cause me to convert to too much RT3).


      • I do not have a thyroid and I only take T3. Because I had so many complications processing thyroid hormone replacements (including Tirosint which is a T4 with no fillers), I did some indepth research and found that the adrenals are NOT linked to thyroid conversion…and the online thyroid community as well as Dr. Wilson (if he suggests that they are) are wrong. The liver is the main culprit in thyroid hormone conversion and it has NOTHING whatsoever to do with cortisol or adrenaline. However, that said, MANY people who think they do, do not have actual thyroid or adrenal issues, but a pituitary (or hypothalmus) issue…either of which can affect both the thyroid and adrenals. In that case, treating both the thyroid and adrenals while helping how you feel does NOTHING to help the real issue which is either the pituitary or hypothalmus. Furthermore, dosing adrenals and thyroid when one has healthy organs will cause those organs to slow down or even stop production as the body is esquisitely self-regulating. The guy writing this article has a point. With no thyroid, I do not convert enough T3 and if on a T4 of any kind (including Nature Thyroid) make way too much RT3 and become very symptomatic. One of the main causes of too much RT3 is that you have some other chronic illness…correct that illness and your RT3 levels will improve. Too much RT3, unless you are anorexic or not eating enough, should always (imho) signal one to look for some underlying illness. Can you live on just T3 alone? Yes, I do. Can I tell a difference when I take T4? Yes, my hair and nails grow faster. So the T4 must be doing or adding something. Beyond that, I don’t care to get into theory debates with medical professionals who don’t have any real life experience with it. One of the issues doctors have been raising is that if you take T3 (I take twelve 5 mg pills a day) that your blood levels rise and fall multiple times a day…this is 100% untrue. I have had blood draws after 24 hours of not taking it as well as within a few hours of taking it and my blood levels tend to stay relatively the same. Furthermore, regardless of blood levels…cells are not going to accept any more T3 into themselves than they are prepared to accept. For the people who think they can “force” metabolism with thyroid, esp T3, this is untrue…except maybe in some people who are prone to high or fast metabolisms in the first place. There are NO tests for our cell’s usage of thyroid hormone…only for how much hormone is available. Unneeded hormone is quickly bound up on protiens (total T3 verses free T3) in order to preserve it longer…which it does. The danger in taking T3 only is that you HAVE to remember it daily…if you get in a car accident or something and are unconscious and they do not know you do not have a thyroid you could be SOL after 24 hours…but that said, there is a safe 24 hour period…unlike what some doctors think. Also, as to excess hormone in your blood…well, guess what…your liver flushes that out as it is in charge of keeping hormones in balance in your blood stream. Back to the article’s point…the body does seem to down-regulate itself when facing illness…and it can be a quiet, low-grade, illness that you are unaware of having…such as some cancers or odd things like a developing auto-immune condition or something like Lyme which can suppress your immune system. All of this will be a load on your body’s immune system…and no matter how quiet or weak our body’s ability to respond…just like when we are sick with a flu, the body wants you to lay down and let it get to work…and does so by altering your metabolism…esp by creating increasing levels of RT3. The problem is, we want so much to “feel” better or “feel” good…that we seek ways to over-ride the body’s own regulation telling us what it needs. Lastly, if your T4 is not in range then you are not taking enough hormone…and/or are not absorbing it into your blood stream. Your particular situation sounds like you have another underlying illness whether dx’d yet or not…and that your body is very much not-wanting more thyroid. What do your TSH levels look like? TSH is the body’s request for more hormone…which in your case might be a better indicator of your need. If the TSH is wonky, you may want to look into your pituitary gland and your hypothalmus. But you will not force your thyroid issues by forcing adrenals…they just are not related that way. Also, Armor is notoriously bad for a number of reasons…the least of which is that it does not have consistent levels of thyroid in it…and they change the fillers constantly, often using fillers that actually prevent absorption. But, perhaps the largest issue with Armor and Nature Thyroids and the like, is that they come from commercial cows and (worse) pigs. Commercial animals must be slaughtered before age two in order to prevent mad cow disease…but, are fed so many endocrine hormones (to grow them bigger faster cheaper), as well as GMO corns, that the endocrine hormones kill them before age two…so they are routinely slaughtered at 1.5 years of age to prevent endo-death. What you are getting is dehydrated thyroid that is saturated with enough endocrine hormones to kill the animal…and on no level can I imagine that that is good for us. Also, pig and cow thyroid are perhaps good for pigs and cows, we are neither a pig or a cow. Imho, I do not believe that Armor or Nature Thyroid are near as “natural” as people think they are. They also do not contain enough T3 to get your levels normal, nor do they contain T2 or T1 as some internet sites suggest. Also…while the thyroid produces hormones…it releases them into the blood…they don’t store them…dehydrating a thyroid is a slice of the manufacturing plant and not the product, or very little of the product…only what happens to be in the manufaturing plant at the time of death…which could, due to the animal’s stress, be arguably very little.

        • Just curious Faith. Do you take your T3 all in the morning at once or dose it throughout the day according to a schedule? Also do you notice any absorption based differences taking with or without food?

          • Hi David, I take my T3 throughout the day…10 mg 8xday to be exact. I do not generally take with food, but have not noticed a difference…what I have noticed, however, is some days I need more and other days I need less. I also have Lyme Disease, so not sure if inflammation or immune changes have anything to do with these fluctuations…but on days I need less I can tell because I get heart palps and feel sleepy soon after taking it. On days I need more I tend to be weepy…take a dose and no longer weepy…strangest thing. My pills are in 5mg size so on days I need less I will just take 1 pill instead of two. This would probably make most doctors cringe, but I feel pretty stable on the T3 only.

            • Thanks Faith.

              I have an autoimmune disease that I am finally having some success in treating (knock on wood). But over the years my rev T3 went to earth shattering numbers which makes sense in hindsight. I still do much better on T3 only which of course means I have not won the war with my autoimmune disease. That being said I take 75 mcg of Cytomel a day but I do it all in the morning (one dose right when I wake up no food) and the other with food 1-1..5 hours later. I do this split since I am slowly trying to migrate to a no food only situation as I have noticed some difference with absorption / effect. In the past I had problems with moving a 2nd dose too late in the day but I am rethinking now what my dosing schedule should be. The irony is my morning fasting T3 levels are not very good (free and total) but during the day there is a distinct clinical effect of the Cytomel. So I suspect I am riding a bit of a wave even though the biological effects of a T3 dose have longer term effects. The other option is the deiodinase III enzyme is still in overdrive and as opposed to converting T4 to rev T3 is now converting T3 to T2 to quickly. But your information is useful since maybe I would be better off spreading things out. Thanks.

              • Hi David,

                You know, I have heard a lot of hypothosis’s regarding T2…but nothing that pans out (however, on a similar subject, I was just reading some fascinating studies on the Vit D Receptor which is another endocrine hormone that can cause the tyroid receptors to shut down creating thyroid resistance). The thyroid receptors take T3. T3 is hard to manage, which I suspect is why many drs will not rx it. The sad part to this puzzle is that doctors really just do not have many answers on this. There is a slow release T3, but I have never tried it. That said, I generally do not take my T3 for 12-24 hrs before blood tests and my levels are good…so, despite medical hypothesis’s, it clearly hangs out for a while. You might be having thyroid receptor resistance…as well, some ther underlying chronic illness will really mess things up. While no dr has ever mentioned this that I know…I believe that the liver will sweep the blood of excess T3 soon after you absorb it so that levels will never be too high, but then as you use the T3 through the day, levels would sink. It is hard to say.

                • Thanks Faith that is first I heard about the vitamin D receptor and thyroid resistance. Still regardless of thyroid resistance the only way for both the free AND total T3 too be lower than expected on a strong dose of Cytomel is if it is getting broken down. Maybe you are right and there are other reduction pathways in the liver (though I have not seen anything about them) but deiodinase III still seems like it has to be part of the problem. Then again maybe I just need to split my dosing better. Thanks for the ideas.

                • Faith,

                  There is a good reason for T3 “hanging ou”t in the body 24 hours after you take it. It has a half life of 24 hours. That means, for every dose you take, 24 hours later, 1/2 of it is still in your system. It takes 8 half lives to completely clear one dose of any medication. So, with T3, if you take 25mcg, 24 hours later there are still 12.5 mcg in the system (just from THAT one dose), 12 hours after that, 6.25mcg still left, 6 hours after that, 3.125mcg still left, etc. Add on top of that the multiple doses and that leaves quite a bit left on the next morning after you’ve abstained for 12-24 hours.

                • Hi David,

                  One thing that makes understanding what is happening inside our bodies a difficult affair is because people tend to override science with logic…and as long as something sounds reasonable, then assume it must be true. To determine the exact reason why you have low T3 when taking T3 is to follow the pathway…you take the med, it goes into your intestines and then has to be absorbed…so one possibility is that you are just not absorbing very much. While I do not know the specifics, it is possible that thyroid needs to be carried into the system on a protien or other such thing (many things we absorb this is the case)…you may not have enough of that carrier, so that is another possibility. Still another possibility is that you are just not taking enough…but I am assuming here that you have tried increasing your dose (if you haven’t, you may want to give that a try). I had been on what me and my dr thought was a high dose, but having been bedridden for 6 months in massive amounts of pain that I assumed were due to Lyme…someone suggested upping my dose until (my symptom) of too much (heart palps)…I ended up doubling my dose and wah-lah, pain back to bearable levels and I was no longer sleeping 22 hours a day. So it is hard to say about dosage. Still, another possibility is that your body has set your levels at a low level (this does not necessarily mean you would feel good at those levels, just that this is what your body has set). Then consider what happens once it hits your blood stream…say your single dose is too high (not for the day, but for that first hour)…you liver is then going to quickly sweep out the excess in an attempt to keep your levels where the body wants them…so you have the right levels of thyroid. Only then what happens is that throughout the day you use the T3 and the levels become lower because your are not replenishing them. And, having been to a number of drs including the Mayo Clinic, I have yet to find anywhere that tests T2 or T1 and am no longer all that convinced that they have anything to do with anything. T3 is the active hormone that docks in the receptors. Additional areas of possible contributors to the issue is that various foods interfer with thyroid function…and I know that many will say that if you don’t have a thyroid they are ok to eat…but this has not proven to be the case with me and any soy or the other foods will decrease my ability to make use of the thyroid hormone. One other possible issue, and again I am not going to have very good details, is genetic mutations…while unrelated, things like the MTHFR gene interupts one’s ability to process folate. I have heard of other genes that do not allow one to get rid of toxins very well and instead to recirulate them. It is also possible, although again I have not found any place that has testing available to them…but one can make an antibody to the T3 and essentially attack it as a foreign invader. There were a couple of good (what look like) thesis papers on the internet concering liver and thyroid conversion. In one, they mention for example estrogen…when a certain enzyme is present in the GI tract, we will re-process excreted estrogen back into the system…is possible the enzymes in the gut play a role in whether we absorb what we are taking…but, I’d start with absorption.

                • @Faith, @Karen:

                  I am sure absorption is a factor but I have been taking more and more of my dose on an empty stomach one hour before food. The rest of the 75 mcg dose I take with food (40/35 split). Unlike T4 or armour or other thyroid meds, Cytomel is ONLY absorbed in the stomach. I have also been careful to not take near any calcium or iron though in fact the Pfizer white papers on Cytomel clearly state that does not matter for T3. I do feel better now that I am adjusting more of my dose to first thing in the morning with no food. So there is indeed something going on with absorption.

                  As far as T2 and T1 goes. I am not suggesting that they are beneficial. I am simply saying they are the metabolites of T3. If I am taking a large enough dose that I should have total T3 and free T3 numbers the next morning are reasonable but I am NOT then yes either (a) I am not absorbing it, (b) I am not taking enough, or (c) it is breaking down.

                  It is my understanding that the chief mechanism for metabolism in the periphery is in fact deiodinase III. Deiodianase I may be involved in the liver, but deiodinase III is the primary mechanism for breaking down T3. Just like it is the primary mechanism for making reverse T3 from T4. While I can’t dispute the possibility of thyroid resistance, it does not explain low total and free T3 are low (i.e. I am taking 75 mcg a day but have 10% percentile total T3 and free T3 is 2.5 – 2.7). On the other hand when I adjust more T3 to be taken without food, I do feel better. So I am not so resistant that I don’t receive benefit.

                  Like Karen said it was my understanding that the biological half-life is quite long. Actually 2.5 days according to the Pfizer white paper I mentioned. 95% of the T3 is absorbed in 4 hours (pretty sure they mean absorbed into the cells to be honest).

                  Right now I am trying to figure out the best balance point for me. In my case a nasty autoimmune disease basically shut down my adrenals and sent my rev T3 to unbearable numbers. T4 and armour therapies only made things worse. I have been on T3 only now for about eighteen months and certainly benefited. But after one doctor suggested altering how much I take with food, things have improved in terms of how I feel … yet my fasting morning labs have not improved very much for T3. There is enough significant room for improvement on the labs that I am eager to figure out the balance since it may help me feel even better.

                  It is possible the supra-physiological doses of glucocorticoids I take are exacerbating the deiodinase III activity just like cortisol release does under stress. But then again it may just come down to amounts and spreading out the doses. The only problem is when working with thyroid meds any changes have to generally be done slowly, right?

                  Thank you both for the stimulating discussion. It has been thought provoking 🙂

                  Btw Faith do you have any links that discuss the vitamin D receptor connection you mentioned in a prior post?

                • Hi David,

                  Again, people come up with a lot of logical sounding ideas about what is going on inside the body, but as good as they sound they are rarely backed up with science. (ie…Lyme is hard to kill and needs long term abx because abx do not get into the deep tissues where Lyme goes. Sounds reasonable enough…until you take something like Cipro or Clindamyacin that is famous for getting into tissues, tendons, and even bones). So again, T3 by itself may have a half life…the liver will still sweep the excess out because the body doesn’t like too high amounts. Your issue is likely due to you taking it all in the morning. Unless you are taking the slow release. You take, the body absorbs, the liver clears excess…then you use it all day long…now you dont have enough. There is not really anything else I can say to that…I take mine 8x a day and doing great. I can feel when I need more/less…and if I have inadvertantly forgotten I can feel it…and this could only be because it gets low throughout the day. That said, I don’t know anyone except you who takes their T3 all in the morning. I take 80 mg/mcg(?)…and some days I take 100. The Vit D Recetor study (posted with the caveat that I do NOT agree with the treatments or protocols that have been come up with to address this as they make people very sick) is here: http://autoimmunityresearch.org/preprints/WaterhouseAnnals2009Preprint.pdf

                • Fair enough. I don’t dispute that T3 has a half-life. And you may be right that there is another mechanism besides deiodinase metabolism to explain its breakdown. I guess all I am saying is that thyroid resistance or even the Marshall protocol (which I also don’t think is a good idea) based on VDR dysfunction, would explain comparitvely LOW values of free T3 for a significant dose. So I have to think more about it being excreted, not absorbed or broken down. I think you may be onto something with the multi-dosing and I will bring that up with my doctors. I know both of them want me to try multi-dosing but in the past it caused sleep problems. Maybe I will be more tolerant now or I can simply lower the total dose if I split it up. I still think there is some connection to why my reverse T3 values were so absolutely absurd on Armour. Oh well.

                  P.S. Thanks for the paper. I scanned it quickly and will read more later. Frankly the Marshall protocol scares the *bleep* out of me. I do have some issues maintaining a proper vitamin D balance between the active and inactive forms but that could also be due to my high intake of magnesium (the mechanism to activate vitamin D). But again the Marshall theory would predict blockage at the nuclear hormone receptor sites by vitamin D metabolites and thus result in higher T3 / T4 levels. In my case I have almost no T4 being made and TSH is really low. So the T3 numbers tell me pretty much what is happening other than of course how I feel. Hence the conundrum and I think the Marshall theory is in direct contradiction with this.

                • Hi David,

                  Then you and I are in agreement about Marshall…no I don’t recommend him at all. He, however, did not do the study…Waterhouse did. That said, I like the science…not necessarily other people’s conclusions about the science. The probably cause to my not converting enough T3 and too high RT3 is that I have a chronic illness…the current thought is that it is Lyme Disease. My interest in the science is that Lyme is now being linked to an autoimmune, hence why treatment often makes people very worse. I also have low D…and taking it makes me worse. When I happened across the study, a dr very much like Chris here, was retracting his reccomend that Lyme patients take D…it had my attention. The reverse D issue (low 25-D and high 1,25-D) had my attention…it struck me how just like the tendency for thyroid drs to only test T4 (comparable to 25-D)…one could be low T4 and still high T3. Also, the fact that D is a endo hormone and a steroid and as such an immune supressor. It seems like almost everyone with Lyme chugs vit D…and it has me wondering whether by taking D they are causing/contributing to Lyme being chronic. Unlike Marshall, I don’t care to fix the D issue because it seemed obvious enough to me that when you correct the bacterial infection you will stop making the chemical that causes you to over convert it and the issue will resolve on its own. In any event, it would seem…if one had the reverse D issue…that taking D would shut down T3 receptors and cause resistance…that said, it wouldn’t (I don’t believe) make your blood levels low. I don’t know what to say about the sleep issue…I used to take my T4 at night because I’d feel terrible after taking it. Wish I had a better answer for you.

                • My neuroendocrinologist explained it to me as follows with the 1,25 calcitriol and 25 OH ratio imbalance: basically chronic inflammation causes the body’s macrophages to go into attack mode. The inactive form of vitamin D acts as a regulatory suppressor(?) of macrophages while the 1,25 form is essential to activating the macrophages. So if the innate immune system wants to pick a fight it will want more 1,25 and less 25 OH, hence the imbalance.

                  In an analogy, cortisol suppresses the immune system. If someone has a chronic infection or an autoimmune disease the immune system wants to be able to do its “job” full steam ahead. Hence the immune system actually can command override the adrenal output of cortisol in a chronic condition, and this is why it is not uncommon for people suffering from such conditions to have low output of adrenal hormones (not just cortisol as the whole adrenal gets down regulated). The immune system is not “intelligent” enough to know that the condition is chronic and that it needs to stand down to let the patient have a chance to get help (exogenous) to fight the original problem.

                  In my case I have a rather nasty autoimmune disease that can only be controlled with exogenous hormonal support. Even then … well you get the idea. However, it was because of this particular autoimmune disease that my RT3 was almost 500 points above the top of the normal range when I was on Armour or other T4 medications. My doctor said the only other person they say with a higher value was someone who was riddled with severe Lyme’s and multiple co-infections with serious neurological damage.

              • Hi David,

                You have to go over the study, they explain in great detail the role of D…and in some autoimmunes it is very helpful. Had to chuckle at what your dr said, sounds like he/she could have been describing me…late stage neuro-Lyme and very sick with it. Sadly, there really is no good treatment for Lyme…antibiotics and immune stimulators…but that tends to make the majority of us worse. They are now linking Lyme to autoimmune…but at the same time, immune supressors make people with Lyme worse…so people with late stage or diseminated Lyme are sort of just left to suffer while politics play out. How I got to the D study was a Lyme dr…a blogger, LymeMD…found his blog looking for something else, and saw he retracted his recommend that people with Lyme take D…he cited the D Reversal Patttern which had my attention since I am low 25-D yet feel worse when I take D. Anyways, again, I am opposed to Marshall’s conclusions and ideas…I think the sum total of the gem of knowledge from the studies is the science itself. Interestingly, in Lyme Disease, I am coming to find that a number of things one is low in probably is that way on purpose and probably shouldn’t be supplemented (like magnesium as part of biofilms, and iron and B12), although no good studies on those yet. It would seem, very much like Chris’s article here…the body makes some changes in response to illness and it would appear that it does so to save us…and, I have come to believe that he had a point in maybe we should leave well enough alone. Unfortunately, I don’t have many answers…just more questions. Anyways, here is another study…by the MS community…apparently the Vit D Recetor is the thyroid receptor…which had me a bit gob stopped and wondering, are we making selves hypo thyroid by taking D while sick with bacterial infections??? As I say, just more questions. http://www.mendeley.com/catalog/vitamin-d-neuro-immunomodulator-implications-neurodegenerative-autoimmune-diseases/#

                • Thank you for the paper. I see a connection there already with the as anti glutamic acid decarboxylase antibodies are associated with diabetes mellitus type 1. My rare autoimmune disease is the progression of those antibodies in the periphery to crossing the BBB and attacking GAD antibodies in the brain, primarily in the basal ganglia, mid / internal cerebellum and brain stem (joy!).

                  I concur that the body goes into an aberrant pattern to try to fight something or survive. And the real enemy is the prime cause. Some times the condition is not treatable and the best one can do is placate or ameliorate side effects. But I would contend that even when the primary problem is neutralized or improved, the body can still stay stuck in aberrant patterns until something is done to “shock” it or coax back on the wrong path. I have some success at managing my autoimmune disease through many sacrifices and high prices paid by certain medications. My personal focus is now to repair enough of the collateral damage that I can live in some sort of balance (as tenuous as that may be).

                  I think for me the positive signs are that whereas in the past things like T3, calcium, B-vitamins, D-ribose, etc. did little for me suddenly in the last few months they are doing much more, i.e. there has been an equilbrium shift that has been wonderful (first time in 12 years. So now I am trying to balance and fine tune things as much as possible to keep recovery going. For me now is the time to strike 🙂

        • Faith said: “Can I tell a difference when I take T4? Yes, my hair and nails grow faster. So the T4 must be doing or adding something.”

          I’m just now in the process of trying to figure out my issues with rT3. I’ve been hypo for years and my TSH was a bit high so a little higher dose of T4 was added. Just got my test results back with elevated rT3, (first time it’s ever been tested) but I just commented to my husband last night that the T4 must be doing ‘something’ because my hair and nails are growing! Your experience is helpful for helping me figure out which way I should go with this, thanks.

          • Conversion to RT3 can have many reasons…but one of the main reasons is a chronic underlying illness…which can make sense in the scheme of trying to answer why one’s thyroid went bad in the first place. During illness, the body likely uses the thyroid to down you on the couch so it can divert energy to heal…normally, we don’t think anything of this…until one has some low grade chronic issue making them tired and sluggy. At which point maybe the only numbers that seem off are the thyroid being somewhat low. Unfortunately, drs do not try to get to the bottom of why that is or treat the root cause…instead they just treat the numbers, and low means giving hormone. But here is the problem with that, and the dangerous game we unwittingly get into with our drs, is that IF we are ill…and IF our endo system has decided it wants those numbers low…taking excess hormone causes the gland to make less…and we go back to the dr, our numbers are still low so they give us more…and so on until the gland stops producing and atrophies and we are on hormone for life. (Integrative doctors do try to get to the bottom of things). That said, and esp for women, it can be a long hard journey to try to find out what’s wrong (if some low grade chronic illness)…but, on the good note, treating the illness often resolves the thyroid issues. For me it happened to be Lyme Disease…3+ years of progressively worsening symptoms before a diagnosis and I am coming to find that the common thread beneath many of the chronic conditions people have these days are either bacterial, viral, fungal, parasite, or toxins that we have developed antibodies against…most of which have created conditions for people that are told that there are no cures…only symptom management…it is very sad. But my first marker was the RT3…then low grade inflammation…and that was all my dr and I had to go on. All I can say, is keep searching what could be behind it because it is a symptom of something.

            • I have hashimotos..take synthroid 88 and cymtomel 5mcg..two years ago dropped 20 pounds without trying..lots of muscle. Other symptoms are sensitivity to white light, a motion sickness feeling, sensitivity to noise at times..low t3 and anemia are constant. Many times pressure behind eyes. Mris..cat scans normal. Low t3 and anemia are only tests that are off. Any suggestions..never know how I will feel day to day. Very frustrating. 52 year old female.

        • while most of what you say makes sense, and works for you, you are incorrect about how they make Armour and other NDT’s. the whole gland (several/hundreds of them) are prepared and combined. then once properly dessicated, the powder is tested to ensure quality/power.
          the manufacturer then uses either more or less filler to make each pill the correct dose. it has nothing to do whatsover with the actual animal it came from. It’s made in a batch, and if the batch is not up to standard they can add, substract, or dispose and start over.
          It’s all quality controlled, and as it is an actual drug with a DIN number, has to have the potency it specifies, and I know it does because I’ve been taking Erfa NDT and never a problem. and I am super sensitive I would know if it wasn’t consistent. That being said, people absorb at different rates, what works for me (taking twice a day AFTER breakfast and after dinner) may not work for another. (I find taking it after meals offers steady levels. if i take it an hour before breakfast I will have a bad afternoon…)
          dont bash NDT for those of us who suffered needlessly (myself for 3 years) with adrenal issues and hypo symptoms all caused by low thyroid. I was written off by several endos and GPs as “chronic fatigue” and menopause complaints and was on disability and almost lost my job. Finally got a Naturopath to listen and put me on Erfa. 2 months later I was back at work feeling well and never looked back. Why suffer and have zero quality of life, take the meds required to feel good and have a real life!

  14. Chris, very good article. I have a question though. In this study you referenced “The effect of T3 and reverse T3 administration on muscle protein catabolism during fasting as measured by 3-methylhistidine excretion” they say that the dose of T3 was ” pathophysiologic”. I infer this means they were aiming for hyperthyroidism. Given that, do you still think your conclusions are as valid? I wonder what would have happened with a physiologic dose.

    • There are other studies that used physiologic doses and either found no effect or a worsening of symptoms. But, the research overall in this area is sparse.

      • Chris, I’ve heard bodybuilders often use T3 to get ripped. It apparently increases their use of fat but keeps the muscle. It’s mostly anecdotic, but it would suggest thyroid has a net beneficial or neutral effect on muscle. I would love to see those studies (the ones with a physiologic dose), since I know things tend to be much more complicated.

      • Hi. I just found this blog and was diagnosed with “low thyroid”…whatever this means. I started on 30 armour thyroid 10 days ago. I have put on 4 pounds and don’t understand this. My thyroid was at the low end of spectrum a year ago and now my total t3 is 71 but my free t3 is 2.14. My total t4 is 4.9 and free t4 .9. My tsh is 2.43. I don’t understand any of this. I am 53 and work out an extreme amount. I found recently that I can’t keep up the intense workouts. I also sometimes get so weak I have to lie down. Can anyone help? Chris I would love a recommendation near me. I am currently seeing an Osteopath for this but maybe I need an endocrinologist? I also have an M-Spike in my serum protein electrophoresis but no cancer. My numbers have been steady for 3 years – an anomaly. Do you know anybody near Locust Valley, which is Nassau County, Long Island, New York? email [email protected]. Cell 516-455-8187.

        • Hi Eloise,

          It is difficult to say on your numbers since you did not give the lab normals. However, Your TSH (the pituitary’s request for thyroid hormone) does not seem all that high…or even high at all. This means that your body is not asking for any more thyroid hormone. It may also be that your personal numbers run low. I know other thyroid patients who feel best when their numbers are in the lower end of the range. Some doctors/practioners still operate under a false belief that T3 numbers should be in the upper third of the range, but everyone is unique and it should really go by how you feel

          That said, if you are now taking hormone and gaining weight…you should know that a paradoxial side effect of being hyper (having too much hormone) is weight gain (even though they usually talk about weight loss).

          As well, some practioners believe (however strangely) that NatureThyroid or Armor are in some way “natural” or “good for you”…not that they do not help some…but they come from feeder pigs (Armour Meat/Armour Hot Dogs)…not exactly things we generally consider good for us. As well, feeder animals are fed fatal overdoses of endocrine hormones to the point of needing to be slaughtered early…again, not necessarily a “good thing”. Those who are helped by it, I suspect, need something else that is in the dried gland…but that is just my speculation.

          In addition, ANYONE with thyroid autoimmune (meaning one’s own immune system is attacking their thyroid) should not take the dried gland because it also contains the very things the immune system attacks…thus, rendering one all the more hypo (too little thyroid).

          The trick is this…you can try taking some hormone and IF you feel better, great. If your number stay low then it is likely your body wants your numbers low. If your numbers improve then it is because you are failing to make enough.

          Two other things to consider…reverse T3 or RT3…and Vitamin D. When we take or make T4 (storage thyroid hormone) we must then convert it into T3 to use it. Sometimes we make some RT3 which is not-usable. It is normal to make some…but it is not good to make too much (over the range). The RT3 fills the receptors and will prevent T3 from getting in causing hypo-(too little) thyroid hormone even though blood levels are normal.

          Vitamin D is not a true vitamin, but an endocrine hormone like thyroid hormone. The test that they run tests only the storage form of Vitamin D (the unusable form)…sort of like T4. People who have certain genetics or who have low grade bacterial infections will over-convert Vitamin D and thus ALWAYS look low on the standard Vitamin D tests. Therefore, it is improtant to get BOTH Vitamin D tests…the 25,D (that they always test) AND the 1,25 D (that they never want to test). The 1,25 D is the ACTIVE form (like T3). Now, IF you are low in the 1,25 D then by all means take it. However, IF you are an over-converter and your 1,25 D is normal…or high (it is likely to be high when you take D)…then you should know that too much 1,25 D competes (and wins) with T3 in the thyroid receptors and can make you hypo-(too little)-thyroid even tough blood tests show normal.

          Lastly, man has yet to reproduce nature…and pig thyroid is a poor substitute for what we make naturally. Taking pig or reproduced hormone, while it helps, has its share of problems. Every now and then I hear tale of someone who is on thyroid and doing well (Jillian Michaels/Nicole Curtis(?))…but mostly I only hear of difficulties (sadly). Nor is it a perfect science yet. Why I love Chris Kresser’s article is because he is on the cutting edge pushing the medical community forward.

          Hope that helps. Sorry you are having a rough time of it.


          • Faith, I learned a lot about vitamin D from your post. Thank you! Is there a good article (link?) that explains Vitamin D, its different forms, and the tests?

  15. wow, your article could not be more relative to my current situation. I’ll try and keep short: I’ve been suffering from an undiagnosed chronic illness for nearly 4 years now and previously was a vibrant early thirties male, avid surfer, yogi, Qi gong practicing, whole foods eating, entrepreneur, very productive individual. Over the course of 4 years, I became: Osteopenic(several passive fractures), extreme fatigue, brain fogged, hypogonadal symptoms, joint/bone pain, muscle weakness, non-restorative sleep/insomnia, nocturia, chronic infections, bradycardic, Hypothyroid symptoms, bowel variability, lost 18lbs of muscle, on, and on… I nearly had heart surgery(to possibly fix electricity of heart or pace me), but turned it down in my constant search to find the “source” of what was causing my entire sympathetic/parasympathetic systems to go haywire. I’ve been given the diagnoses of: Adrenal fatigue, CFS(Mayo clinic), hypothalamus pituitary axis dysfunction, Osteopenia, Hypoparathyroidism, hypothyroidism, possible celiac, possible Hemochromatosis(I’m heterozygous, but last iron saturation was 93%, been to 8 docs and still no official hemochromatosis, but ready to start blood draws with red cross). Over the course of 3+ years almost nothing I’ve tried has provided any relief, until I was put on thyroid meds about 1.5 years ago. I had a “honeymoon” period on my first trial with low dosage of levoxly .then it kinda wore off, then switched to armour…similar experience, then put on naturthroid +tirosint, had some positive effects and took my pain levels down and gave me more energy, but still wasn’t even close to old me(maybe 25%). Over this period my Osteopenia got worse(repeated DEXA) and fractured my 5th metacarpal and now pisiform in wrist(both stress). btw, during the last year I have been on a serious green smoothie regimen and have been dosing on Vitamin D(pure) 10,000 iu and essentially getting as much Sun as a person can get(was basically living a lifestyle that my bones should have been super strong even before i got ill, just upped my usual regimen). I also eat close to a Paleo diet with the gReen smoothie added in as my post breakfast pre dinner meal. So, there is a ton more, but let’s get to the T3 portion… I recently went on a compounded T3 regimen(wilson’s protocol) given to me by my Naturopath and I have not felt this good in 4 years, still not back to my old self, but as close as I’ve been. I did 3 cycles, starting at 7.5 2 times a day and ramping up to 37.5 and then back down, then a day or two off, then 7.5-30ug and back down, then a few days of, then 7.5-22.5 and back down(monitoring basal temps the whole time, 4 x a day). I never felt awful on the regimen, but did get warm overnight a few times, but no heart issues or other side effects. I was also on a compounded DHEA cream of 100mg during this protocol(but I was on this previous to starting T3). Overall, my pains were nearly gone, I began putting on muscle, I had energy to exercise and was not washed out after, my brain turned back on(amazing!), and I smiled a whole lot more:) 🙂 My naturopath and I decided to take me off the protocol to see how I do(maybe thyroid has recovered along with adrenals, etc…)…well, I’m about a week into being off and I’m starting to feel the “sick” me coming back…so, for myself, T3 has been the best and perhaps only palliative treatment I’ve found for my “illness”. I still don’t think we have found the source of my problems, but if T3 gives me my brain and energy back, i will then be able to continue my pursuit to find the answer. I am actually planning to visit your practice in the coming months, but want to prepare a thorough “digital” file that is concise and will allow you to look at my case and hopefully help. I have really enjoyed your podcast and have forwarded your articles along to my “healing” community. My ultimate goal is to take what I’ve learned while getting my “doctorate” in chronic undiagnosed illness(from the standpoint of 30 something surfer dude that was incredibly fit, and vibrant before all of this) and pass along to others the many different modalities/treatments which I have used to recover(from green smoothies-rebounding-qi gong-T3 etc..). Thanks for the service you provide, believe me, I’ve been to so many doctors and your insight combined with your ethos, are very rare commodities in the healthcare world. Keep it Chris! Sorry for the long winded comment, but hard to keep it short and sweet. If you have any questions or want to contact me feel free. I actually just called my naturopath to inform him that I think I need to go back on T3, so perhaps I can update you on results. one ? do you think I could be exacerbating my bone loss through thyroid treatment? Top Endo at OHSU, said he thinks that is an issue, but I was never on any thyroid meds when I got my first DEXA saying Osteopenia…so I respectfully disagreed/fired him;) thanks again!

    • Matthaios (and Chris)
      Your description sounds really similar to my experience with chronic illness over the past few years. I too was an athlete (ultimate, cycling, etc). I got sick after my daughter was born and have never been right since.(fatigue, weakness, joint pain, dizziness…) I have low TSH and low T3, and a variety of absorption issues with nutrients. I have been doing a vegetable cleanse and then paleo, but if you have any more information about groups or your routines for getting well (exercise, what is in your ‘green’ smoothie, etc) I would really appreciate it.

      Can my body ‘reset’ itself if I am religious about my routine? (like Mr. Juice Fast in the movie Fat, Sick, and Nearly Dead?)

      • Hi Danielle. It’s common for thyroid issues to occur after giving birth. Mine occurred the spring after having my son. They took my thyroid out. I’m pretty sure I could have gotten well without them removing it.

        Fasting, of any kind is hard on your thyroid and adrenals. You really should get some comprehensive testing to find out exactly what’s wrong. Have you had antibodies tested to see if you have Hashimotos or Graves? They are both auto immune and would go hand in hand with having issues absorbing nutrients or having other auto immune issues (insulin resistance, Celiac, etc.).

        Thyroid doesn’t respond well to aerobic exercise and adrenals don’t like weight training. So, before you start an exercise routine, make sure you know the health of both of them. Walking is good.

        There are some good thyroid groups on Facebook: Stop the thyroid maddness is a good one and has several offshoot groups that deal with T3 only protocol and Hashimotos disease. Sometimes, I feel, they can be a bit radical. But, there is some good education there. Just remember everything in moderation and don’t change too much at one time so that you can figure out what is helping or hurting.

        • To answer your question about Lyme and treating thyroid, my thoughts and concerns are this…the body is esquisitely self-regulating so whenever people take any endocrine hormones…the associated gland will produce less accordingly. While man tries his best to reproduce nature, he never quite gets it right…and cow and pig thyroids are not human thyroid no matter how much people might try to sell us on them. So, essentially what people are doing is removing nature and adding something artificial and not quite right.

          That said, it would depend on you and your symptoms and how well you are able to manage the symptoms…the choice to supplement thyroid or any endocrine hormone is a deeply personal one. I believe it is a lot like the author suggests, that the body down-regulates in chronic illness via the thyroid…and that as long as you have a thyroid it will do that even if you are taking a supplement. As someone without a thyroid, I can say that I have had endless problems taking thyroid hormone due to Lyme Disease…can can verify that much of what non-drs put out in the internet about thyroid conversion is (especially in their wanting to tie it in with adrenals) is false. My and my dr’s hope is that by treating the Lyme my thyroid issues should resolve.

      • Hi Matthaios and Danielle…
        I have optimal (from what I understand) TSH and free T4, but low T3. I also tested anemic, very low in ferritin and Vitamin D. Through my own research and supplementing I also discovered I was very low in stomach acid (and supplementing for months was not helping) and low in zinc (again supplementing not helping).

        My dr had me try supplementing with iron and also Lugol’s iodine. He also suggested a full GI panel, which I put off for awhile because of cost. I could not tolerate the Lugols (only 2 drops), but it seemed to exacerbate hypothyroid symptoms… cold hands and feet and anxiety in waves.

        Since, my energy has since gotten worse, as has mood, muscle mass and ability to exercise. 6 months ago I did everything…. yoga, spinning, cross fit.

        So I decided to go ahead with the full GI panel, which was a great thing. Besides very low SIgA…Found out I have two parasites and an overgrowth of three different kinds of pathogenic bacteria. I just completed two weeks on Alinia….. and will be doing another round in 4 weeks time. Hoping that will wipe the slate clean.

        Working to rebuilt my immune system and increase SIgA with collostrum and mushroom supplement for Beta Glucan.

        Also doing some testing on mineral ratios, heavy metals and full adrenal panel.

        I am not sure if living with parasites (maybe for years and years) caused food sensitivities…. I did the ALCAT years ago and the list was long. But I am sure I have many issues reacting to foods. Dont’ have obvious reaction which makes it hard, but do have elevated blood pressure and wheezing in the lungs that comes and goes. I think I also need to examine this further…. I cut gluten years ago, no processed sugars, dairy and limit eggs to every few days…. still eat some grains. This is overwhelming to me because I think I have too many sensitivities to keep track of…. my goal is to rotate foods and try not to eat the same things all the time, hoping to heal the gut.

        SO…………. long story short………… I am so glad I found this article. I was thinking of discussing hormone replacement to see if it helped with my energy. Now I am not sure if I should or not? I’m hoping I am on the right path and that as my body heals it will regain balance. Just hoping I don’t have to feel awful for too long.

        Hope this helps others… testing for parasites and bacteria may be something to checkout.

        • May I ask how you discover SIgA and parasites? I swear I have it but stool tests come up negative! Would gladly appreciate any advice! Thanks!

          • My dr. uses a lab called Diagnos-Tech. The test I did was saliva AND stool over several days. Its called the Expanded GI-Panel or test GI-02. Gives you lots of information on bacteria, parasites, SIgA, even some food sensitivities. Cost $600 but its very extensive and will give you alot of info.

    • Matthaios,

      Do you live in the Portland area? If so, what naturopath do you go to?
      Thank you greatly!


    • I can relate 100% to what you are going through Matt. Please update us, how are you doing today? Better? Anything good to report? Did you ever have trouble taking T3 medication? I have had trouble with it. Thanks.

    • Matt – how are you doing now? I am curious – have you ever had problems taking T3 in the past? I had some issues with it – still not sure why.

    • Hi Chris,
      I read your post from a while ago about your illness and saw that you were studying medicine. Would it be okay to call you or email you. I had graves disease and had RAI six years ago. I have never felt like my old self since. I have been on every thyroid med around and every dosage….to no avail. Anyway, here is my email and phone number.
      [email protected]

    • Hi, Matthaios.
      I am extremely interested how you have been doing now and what happened with the T3 protocol. Are you still on it?
      I am experiencing something similar to what you describe above. So any insight to what is going on after a few years is very welcome.

      Thanks in Advance.

  16. The only symptoms I had was pain, in my hip/groin and shoulders back of neck and to a lesser extent in my whole body. My GP gave me a series of blood tests and the only one of any note was a low thyroid level. About a year and a half ago I started on 50 micrograms of Eltroxin ( Levothyroxine sodium) and gradually the pain eased and has gone completely now.

    • For what it’s worth, low thyroid only very rarely causes pain…and generally in the form of muscles tightening up. Your symptoms sound very much like Lyme disease…which will cause you to make more RT3 and if untreated long enough will also result in low T3 levels. Lyme tends to suppress your immune system….and is known for attacking joints, particularly the larger joints. Unfortunately, the standard screening tests are all but useless for late stages of Lyme due to it supressing the immune system (the tests test for immune response to Lyme) and a negative value is valueless which comes from the creators of the test and not internet opinion…unfortunately, we (and I suspect doctors) see a negative value and think it means we don’t have it. The test one needs for later stages is unfortunately a cash pay test (there are some organizations that can help with that) run by a private company names Igenex…it is a much more sensitive test and will show if you have any antibodies to Lyme (if you haven’t had a vaccine you shouldn’t have any…and even if you have had a vaccine, the Igenex test tests for the other strains as well). Because of Lyme’s ability to significantly lower the body’s immune system the test makers and doctors recognize this and diagnosis is based on clinical symptoms rather than on the test alone. There are many things I did not know about Lyme that I wished I had…like most never see the tick (baby ticks are as small as a tiny grain of sand), most never have a rash, most never have a fever or flu-like symptoms…later stages of Lyme has symptoms that are similar to Lupus and MS as well as causing many heart condtions. Anyone with unexplained pain, especially in the larger joints, should consider Lyme.

      • I have low T3 and am trying to find out what to do about it. I read about inflammation and the gut etc. Then I read what Faith says about Lyme. I have had Lyme twice, 13 years apart. The second time I had lots of stomach and gut problems as well as the joints, brain fog, fatigue, sudden fevers and all the rest of it. I am sure the thyroid problems started when I was pregnant 36 years ago and became worse after the first Lyme infection possibly worse still after the second. I am sensitive to wheat, eggs and cows milk. I was blood tested in Europe for food sensitivity. It all adds up and points to inflammation in the guts. If I am right I think large amounts of antibiotics (pneumonia before I was pregnant and lack of knowledge in those days about what antibiotics do to the guts and using probiotics after to help put things right) did not help. The Lyme really hit my immune system and I got sick with every bug that was going (more antibiotics) until I found out I had Lyme. I looked at my treatment options and I did not like them, there had to be another way other than months and possibly years of antibiotics. Being European I knew that Lyme has been treated for many many years over there before anyone knew it existed here and I found the answer. If you are interested look up Regumed Bicom 2000. I had to travel 1250 km once a week for 6 weeks, Lyme gone. If only the T3 thing was so easy but I will keep working on that. Put the guts right and see if I can talk my Dr. into giving me LDN. I have been on natural dessicated porcine thyroid which has helped a lot but I don’t know how long it will continue to do so.

        • First of all, I am so glad to hear about your quick recovery from Lyme! I agree that there is no great treatment options for Lyme. Some use the Stephen Buhner herbs…he gives dosages etc online, however his book gives detail about why he choose those herbs, where else in the world they are used, what they are used for, and their success rates. The powdered herbs irritate my gut though. One thing I learned about Lyme is that it may still live in you quietly. I don’t read the groups any longer however, in hearing a number of stories of Lyme it became clear to me a pattern…or rather set of patterns…that seems similar to the MS patterns (relapsing remitting, relapsing remitting progressive, and progressive)…just what I noticed. Also, common to Lyme, and the only place I have heard it talked about is in Lyme communities, is a odd adjustment of the immune system where people with Lyme don’t get any colds ever (granted you seemed the opposite), but I mention because it might appear like wellness (not that you are not, just adding some tidbits to the puzzle). So if that were the case, it is possible that the body would continue to keep the T3 level set lower…or at least not an unreasonable question. What I have learned about the thyroid is that if you supplement T3 and your levels stay low, then this is a potential sign that your thyroid system is working fine, but that the hypothalamus/pituitary have simply set the levels lower…for whatever reason (although low-grade Lyme could be a reason). If, on the other hand, you takes some T3 and your levels improve and you feel better…then that may be a sign that you are not converting well…which is a sign of liver or diodonating enzyme issue which could be a genetic issue. Here is the bummer about Lyme (not that there are not many bummers about it), but one of my doctors suggests that it is the Lyme that throws the genetic stuff out of whack. Like for me, I stopped making taurine very well…where before being sick I was fine…and, of course the every present question is, if it is a genetic thing why wasn’t it a problem before this? So some food for thought. I got my genetic test through 23andMe…there i rumor going round that they may be forced to quit selling the test, but as of last night the site still has it for sale. From there, and because the internet hypotheses and experts made me worse, I had my doctor test all the things the report said were affected…that is where I found some answers at long last. I also discovered that I have multiple defects in my thyroid receptor which could explain some of my issues. I offer that as T3 issues are generally beyond the grasp of most doctors you may encounter…and it was the quickest most effective method I have found thus far to get to some answers. Best of luck, and thank you so much for sharing your recovery (twice)…gives me goosebumps and hope for my own recovery. 🙂 I’ll look it up. 🙂

      • I have low T3 and I believe I have Lyme Disease. I have taken Armour Thyroid and I feel worse since. I am more tired than I ever was and more depressed. My Armour Thyroid was increased three times. I’m at 120 mg right now. I don’t want to just keep increasing. My doctor’s theory is that she needs to get me healthy first before treating me for the Lyme.

      • Terry Wahl’s is doing research and has good info on the Lyme Disease connection symptom overlap – you should check it out. The Wahl’s Foundation.

  17. First time to comment but would love some input as I am currently taking T3 for Wilson’s Syndrome. I have been dosing up and up and have been experiencing water retention but the Doctor does not think it is related to the T3. Have never had this water retention issue before and am still trying to get the dose right on the T3. Have not noticed that I am feeling better with it so far but I am hopeful. Would love to hear from others of their experiences.

    • Hi Valerie, I too have experienced chronic fluid retention for years and have also been taking thyroid meds for as long. Doctors always told me it was coincidental and could not be related but since stumbling across other suffers it appears I’m not alone with this plight!! Have you received any guidance as to how we can remedy this issue? I live in Australia and still search to this day for some answers 🙁

      • I also suffer from chronic fluid retention. I never know what my body will be like from one day to the next. This is my last symptom that needs addressing and I have researched endlessly. I believe that it is called myxedema and it is common with hypothyroidism.

        I hope that once I am through with clearing the RT3 that is clogging the receptors in my cells (this apparently takes about 12 weeks) and then the T3 starts doing it job that the fluid will disappear as quickly as it appeared 18 months ago.

        • Soraya,
          If by fluid retention, you mean puffing of your lower legs, there are two types: pitting and non-pitting edema. With pitting edema, when you push on the puffy area with your finger, then take the finger away, a dint (or “pit”) is left behind. With non-pitting edema, pushing on the puffy area doesn’t cause a dint to form.
          Low thyroid causes myxedema, which is one cause of non-pitting edema.
          Pitting edema, however, is caused by fluid retention. Fluid retention can result from high glycemic index diets (because insulin causes salt retention), high salt low potassium diets, sleep apnea, and – at least in some people – being low in progesterone, taking non-steroidal anti-inflammatory medication, and many other causes.
          Here’s a short list of causes of edema from the Mayo Clinic – http://www.mayoclinic.com/health/edema/DS01035/DSECTION=causes and a somewhat longer list from Medical News Today – http://www.medicalnewstoday.com/articles/159111.php .
          Hope some of this information might be helpful to you in your search –

          • Of all drs I’ve seen only one (my daughter’s pediatrician) showed me how non-pitting edema IS pitting edema. You (or someone) have to grab your ankle and press for one minute. He did and my so called non pitting edema became pitting edema. I went home and my ankle still had the pit made by dr’s hand. He said “you are right, you have water retention”. Everybody else thought i was fat, but I always knew since you feel very tired and have shortness of breath. It was caused by my thyroid med Armour being too high.

          • Horse chestnut can be very helpful for such edema. I swelled up like a balloon from hypothyroidism and not all of it came away even with T3 (I think the valves in my bveins or the veins themselves were damaged from the longstanding edema), but horse chestnut has helped a lot. It’s not a diuretic but strengthens the veins.

        • Hello Soraya how do you clear the T3? Should I continue the T4 also. I have fluid on one of my feet and recently found out that I had arthritis and the doctor said it was fluid caused by underactive Thyroid.

          • Hi Diane, Its RT3 that needs clearing and I used T3 (Cynomel or Cytomel) to do that. Yes in order to clear high RT3 lab ranges you need to discontinue T4 because when T4 doesn’t convert to T3 in your body it becomes RT3.

            I highly recommend you look at joining the RT3-T3 yahoo group! The mods there can help guide you better than I can. They are mote knowledgable than most docs…in my opinion.

            Good Luck!

            • I’d use caution about taking any advice from the RT3/T3 yahoogroup. They’ve made many people more sick using their protocols. They do NOT understand many things about the body.

              You have RT3 because your body is sick. Taking T3 may help you short term, but your body has other ways to down regulate other than just RT3. So many people who get on T3 only feel better for a short period, but then the body starts binding the thyroid receptors via other means. If you notice, many on the RT3 site, after months on T3 only, have very high levels of FT3, but still feel bad. The monitors tell them their T3 is pooling because of low iron and a million other things. The fact is, the body is down regulating again, via Vit D (or who knows what else that we just haven’t discovered yet), so the T3 is just floating around in the body not being used. Does no good for the levels to be high. It needs to be getting into the cells where it can be used.

              Finding, and hopefully solving, the source of the inflammation is the best way to rid one’s self of high RT3, IMO.

              • Karen my Endo closely monitors my thyroid labs and T3 dosing. RT3 group helped me start T3 when I didn’t have a clue. Just yesterday my endo confirmed my labs were in range on my present dose. I have Hashimotos disease and will be on thyroid supp for the remainder of my life.

              • Karen, your reply is insightful. However, no one can seem to find the cause of my inflammation. T3 medication helps me to feel better, but I don’t want to take it if it will harm me in the long run. Is there no solution?

                • Hi Mike. I believe the solution is to find out why your body isn’t giving you enough thyroid hormone.
                  I just don’t believe there is a simple answer. I came to these boards because I felt badly. I’ve since gotten straightened out enough that I feel well now. So, I don’t frequent this place anymore. My gut was sick. I also had high EBV antibodies likely causing some inflammation. For me, getting my diet under control helped both issues. I don’t have a thyroid and I feel good on a grain of NDT supplemented with more synthetic T4. I convert pretty well, so I’m basically just trying to provide my body with a dose that is similar to what it might make. I’m almost 60 and I have all the energy I need to work a full week and play hard on the weekends riding endurance on my horses. But, I do realize that most here have much worse issues than I even started with.

              • Hi Karen, I was reading the post here and when I read your posts…. ” I’m almost 60 and I have all the energy I need to work a full week and play hard on the weekends riding endurance on my horses. But, I do realize that most here have much worse issues than I even started with.” I erupted into a balling fest I haven’t done in some time. I have Hashimoto’s and I was only 32 when diagnosed but despite having read non stop on yahoo and doctor info, had the gut, lyme, and made many changes on T4 to T3 to T4/T3….but still NO relief. I have ALWAYS been horse crazy and spent all of my time on them (except when I HAD to go to work to keep them fed….LOL) However, I became bed ridden and near coma 4 yrs ago, was then diagnosed with Hashimoto’s and then started the research, had half of my thyroid removed due to nodules, 2 years of a doc who is willing to try new things/meds/tests….I cut out ALL possible allergens in my home/cosmetics/soaps etc.., I did the AI diet for 18 months, NO chance for gluten hiding in or cross contamination of food. I did test for very low cortisol so doc put me on 400mg of Spironolactone but it hardly put a dent in the inflammation and did nothing for my non stop fight or flight response “jumpiness”. I was able to stop gaining weight of 180 armour, but still have ALL the hypo syptoms from before EXCEPT, less constipation, less dry hair, somewhat less headaches and body pain (but minimal decrease to say the least)….Anyway, I am beginning to think since I have done everything that is suggested on ALL other places/sites/books/research, maybe I am missing something somewhere?? But of course with all of the inflammation I have, my brain is UNABLE to draw conclusion or compile my research…but the WORST of all, since being diagnosed 4 yrs ago, I have NOT been able to get my health to the point that I can ride my horses at all !!!! I still have them, at the utter frustration of my selfish hubby, as he has become their caretaker….I need to be able to have some quality of life or I need to die and get this hell over with….I am so frustrated with the lack of compassion from the medical field, who gladly use the DUE NO HARM commitment to excuse the fact that they DO NOT LEARN after the 60 year old medical journals that have NO help for Hashi/Graves……The special few will try anything you ask of them in order to try to help us, but they are quick to admit that this disease is NOT PROFITABLE enough to have anyone (big pharmaceuticals) willing to invest money into research for us…..In a nut shell, some of us are beyond help, but it is no life at all, I just spend my days wishing this slow and horrible death would just hurry up already……I feel like I will never be happy again, and while I can sometimes see my horses, I can’t stand there looking for long, because my feet and legs swell to unbelievable pain….I cant walk out to pet them because I am so easily winded to the point of passing out, my leg muscles and joints are almost uselessly weak…I have a high heart rate but less thyroid made me TOTALLY HYPO????? I just don’t know what else to do…I feel so alone when I read about others with a much lesser degree of Hashimotos issues, or who were able to get it under control through Armour and diet……I used to be so optimistic that I could get this under control if I work hard and dedicate myself to learning from others in my shoes……I guess now I realize that there are many varying levels and symptoms of this making it manageable for some but impossible for others……..I have not been happy since the last time I was on my horse….I truly do not want to live if this is the best it will ever get…..headaches several times per week, TMJ PAIN, unable to think much less learn (doc put me on Ritalin but it barely helps focus, not memory/vocabulary selection at all), sever back pain between shoulders and in lower back, always dehydrated no matter how much H2O, dry mouth, dry eyes, runny nose, white goo in eyes, light headed when standing, Spirono causes chronic UTI’s (despite what docs say it is the Spironolactone), I still get the swollen lymph nodes in my neck/chin, carpel tunnel, arthritis, sore feet (Plantar fasciitis, I had lost the additional Hypo weight after a year on Armour, I had gained 50 total, the first 30 were in 7 weeks, then I was diagnosed and treated and it slowed but still gained the additional 20 over 8 months until I was put on Armour….I used to ALWAYS feel cold, my body temp was always between 95.7 and 96.3….but now, in the last month I have been CONSTANTLY HOT, sweating, it feels like a 24 hr hot flash (which is something else I had since being diagnosed, but 24/7 hot “flash” is unbearable…my heart rate is high on any amount of Armour, SUPER low on even high/low amounts of Synthroid….$00 mg of Spironolactone for almost a year is frightening, and I want to stop it but doc says I need it for inflammation/low cortisol….but I have not seen any change in these things, it only helps the Hashi related acne…….I think I am ready to give up…I know my doc is ready to give up on me too…..There are NO other docs here who ARE WILLING to run unconventional lab tests much less prescribe Armour ( I never improved in 8 mos of Synthroid doses)……I am torn between wanting to be happy for you, or be jealous that you can still function!!! I am sorry, I know I should not feel that way, I just never knew it was possible to DIE at 32 but be kept on life support (Armour) by docs to drag out my miserably slow death, while trying to keep a marriage and a roof over my head…( As ALMOST ALL Hashimoto’s patience know, it is not a VISIBLE disability, so everyone says “oh your not that sick, you look fine to me”, or “just get up and go do something, you’ll feel better”. or “you just need to get outside, get some sun and you’ll be fine”…UGH!! …I just don’t know how much more I can take…..

                • I should also note the Gut/candida/Lyme test all came back negative….and at 5’4 118 lbs, the ritalin would have been great back when I couldn’t lose the sudden weight no matter how hard I tried….until Armour and a year passed….but now that I was put on Ritalin, I feel like it is ramping up my heart rate, causing me weight loss, and headaches, but doing little for the “inflammation causing memory problems”…but doc is sick of my never ending calls stating, “this isn’t helping at all”……I can’t work OBVIOUSLY, and my hubby pays $1400 a month in child support + $400(of course MUCH MORE $$$ when near a birthday/Christmas for 3 kids a month to travel the kids back and fourth to/from their moms house, keeping them food at our home and clothes/toys/electronic study type stuff at our home +$300 a month for the kids health insurance…so I get no help from him…although he did point out that my horses costs “HIM” $120 a month to maintain so selling them ($600 each) would be $1200 I could use to “cure” myself!!! (he’s an idiot, yes)..But of course the truck is always breaking down so I know the selling of my horses would result in fixing the truck he doesn’t take care of………So when others say I need a doc who doesn’t accept insurance, I just kind wanna scratch their eyes out!!!…….I ALSO get all of those RARE issues, I have been suffering for over a year with Vulvodynia and can’t get surgery because it is too far, too expensive, and MY problem…..Why not divorce???With what money? Where would I live? How would I eat? Who would pay the medical insurance and the costs per month for my meds? How would I get to doctor appts? Who would keep me in a home and utilities?? All in all, I know my selfish husband can and WILL leave at some point….then what?? Took doctors too long to find the problems so I don’t “qualify” for disability, only SSDI….NOTHING…….

                • Wow so sorry for you. Sounds like you need a good doctor who really cares to listen. So maybe some good endocrinologist in your area could switch your med. I too was on synthroid for years then slowly going down hill mentally decided to switch to armour thyroid which helped a little. But then I thought I wasn’t getting enough of t4 in my dosage I just decided in January to go back on synthroid and add cytomel to the mix. Revelation!!! It worked my mental outlook improved and I was happy again. No depression and I could function. Edema went down along with feeling like I could function normal again. May I suggest you find a new Dr and do some more testing and insisting that they try new meds that work for you. I truly believe that the armour caused me to have that white goo in my eyes and strong heart pounding. Now I’m back on the t4-t3 mix my cholesterol is down my heart rhythm is normal and I can wake up in the morning and enjoy what the day brings. Good luck to you and I wish you too can make some change to be able to enjoy your horses again.

      • 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.

    • Valerie,

      I have read in “The Complete Idiot’s Guide to Thyroid Disease” (written by a well known doctor in Scottsdale, AZ) that one of Wilson’s own patients died of heart failure after taking large amounts of thyroid hormones. In 1992, the Florida Board of Medicine suspended his license to practice. Be careful.

  18. I should add that my doc put me on cytomel after running tests and noting that i did not appear to be converting T4 to T3 and had a high Reverse T3 level as a result

    • anyone know why the Reverse T3 would be low. when I wen t on 5mcg of T3 it came up a little and we upped the T3 to 7.5mcg and it is now going the other way.

  19. I take Armour (T4/T3) and a small dose (5mcg) Cytomel a day. I have hashi’s so not sure it it applies? I started out with a normal TSH that gradually and then drastically started to increase before being medicated. The hypo symptoms were horrible and did not start to subside until the T3 was added. I had edema, swelling, weight gain, foggyness, fatigue, cold sensations, dry skin, constipation etc and almost all are better. I eat paleo and have since identified a gluten intolerance and lactose intolerance so addressing those has been very beneficial. I still suffer from fatigue that can be extreme from time to time (most noticeable after working out too many days in a row).

    I read your articles with great interest esp since you mentioned the various things that can contribute to hypo. I’m not sure that my doc is up to date on all of this and have wondered if i should not be on medication at this point. He did tell me to avoid gluten where i ended up being celiac or not (I found out i was so no brainer). What tests should i ask for to determine if this is the correct treatment. I can say that I do not exp any weird symptons while on medication. For a while while they were adjusting doses I had bad side affects – extreme thirst and urination which told me it was messing with blood sugar – tightness behind my eyes…but now its all calmed down and my heart rate is great so i’ve not been too concerned.

    I’ve worried about adrenal/cortisol issues as well. I used to bike over 20 miles a day, run on the weekends, do cross-fit and suffered extreme burnout – 3 days spent in bed with horrible fatigue and weakness. This was while I was being treated for hashis. Now, I’ve scaled back to just doing yoga and walking (past 6 months). I feel better since switching it up, but would like to feel healthy enough to do a boxing class once a week and want to proceed cautiously. Should I look for a particular doc to run hormone/cortisol/thyroid tests? i live in the Chicago area if you know of any!

    • I have hashimoto I take 125mcg t4 and 60mcg t3 I feel great the addition of t3 has changed my life not only did I loose weight was 105kg now 78kg I am so full of energy I cycle everywhere. Also my asthma, rhinitis, and sinuses and allergies have all disappeared. I. Had this condition for 46 years until a dietitian realised it was the thyroid that happened 2 years ago. Now I have a life full or energy.

      • I too have Hashimoto’s (after having Grave’s, which I treated with chinese herbs for years, so I still have a thyroid). I’ve been wondering about the importance of ratios in t4/t3 dosage vs actual amounts used.

        I read an article from Germany that said 5:1 made a lot of people feel good. I know Thyroid-S (like old Armour, made from pig glands) is 4.22:1. But I have been wondering if anyone’s studied or tried 3:1 or 2:1 ratios.

        I saw you’re doing 125mcg/60mcg, about 2:1.

        I wonder if you would mind telling what particular products you are taking (are they synthetic, compounded, natural, time/sustained-released?) and how you are taking them?

        I’m allergic to synthetic T4. Even natural T4 gives me slight headaches. My dr had me on 50mcg t4 and 10 mcg t3. After I told her I was having a reaction to the T4 (Levoxyl) the same as I had on Tiroisint, she said “Oh, just stop taking the T4. And take only the 10 mc of T3 and call me in 5 months.”

        So I bought myself Thyroid-S. I found I feel better with some T4, despite mild headaches. Like you, I found a lot of my allergies, sinus, etc cleared up. The Thyroid-S has a 4.22:1 ratio, with 1 grain = 38.5 mcg T4 & 9 mcg T3. However, thanks to my endo, I do have Cytomel T3 (not time released) that I could add to lower the ratio.

        Thanks for sharing!

        • They are synthetic here in Gibraltar it is not possible to Get natural NTD. The synthetic ones that I do take are made by Goldshield they are not timed release. The t4 I take late in the evening together with selenuim. T3′ 20mcg I take at 7am and again at midday and then at 4pm.

          At the moment no symptoms and full of energy, I do a lot of cycling especially on the weekends were I do very long stretches of cycling.

        • Hi,
          Long story. I was on low dose Synthroid till i gained 100 lbs. I was struggling. At the lowest.point i stumbled over a.naturopath doctor. My temperature every day was hovering between 95.6 and 96.3,
          My cortisol fall to 0.3.
          After all the testing, he put me on 2 grain Armour, and T3 but not cytomel, it has terrible highs and lows plus other side effects. It is Triiodorthon. Also he put me on a very strong natural mix of adrenalin suport, and when i felt better a little two month later, i went on two round of HCG diet and walking every day. It took a year to take off 115 lbs. Since than, i am ok. After loosing my doctor unfortunatly i fall in the hands of an endo specialist for s year. Oh gosh, again, temp dropped no ebergy, fog, hairloss, dry skin just because he does not believe in T3. Well. Finallyi am in the right place again, back on T3, getting warm and out of the fog.
          Thanks for reading.

      • Hello Derek I have just started cynomel T3 and take four slit quarters of a 25mcgs tablet and I have continued with the T4. Some people advise just to take the T3. It’s just that you said how much full of energy you felt. Did you feel bad on T4 alone? I have taken this for 18 years and still have weight problems. Would be grateful for any feedback.


    • I do my own labs that I order online with econolabs (the cheapest) and then take the order to labcorp who complete the labs and they are sent back to econolabs and on to me via email. For cortisol, you can join canaryclub.org and order a 4 panel cortisol saliva panel at a discounted rate of $109 that is sent thru ZRT labs.

      Just be sure that you follow all the instructions, or better yet, go to ZRT Labs site and watch the video for saliva collection before you start collecting.

      • My previous post was intended for Meg and her Nov 22, 2012 posting. Meg mentioned getting labs done at the end of her post.

        Re T3; I also have Hashis and started taking T3 5 weeks ago. I am following the Wilsons Temp Syndrome protocol using a slow release compounded T3. Problem with the slow release T3 is that it is only half as strong as Cytomel/Cynomel so you are left taking higher doses twice daily at 12 hour intervals. I have been told that doing this is not necessarily healthy for your adrenals.

        Since I have high RT3 levels I intend to switch over to daily multi dosing as soon as the Cynomel I ordered arrives. Yahoo group RT3-T3 has been a wonderful resource and I can highly recommend joining the group if you have questions you need answered regarding T3. The moderators of this group are kind, helpful and very knowledgable on this subject.

    • Chris is right: one must be really careful about adding T3. I have low T3 but tested normal on THS and T4. I did really well for 4-5 months on 1/2 grain of Naturthyroid (t3/t4 combo), but when the doctor added more T3 (Cytomel), I felt horrible in two days and quickly became severely hyperthyroid. I lost 30 pounds (I was already a size 6 at 5’10!), my heart enlarged and I had tachycardia with a pulse of over 120. I could barely walk and had to go to the ER. So CAUTION! Start with very low doses and keep track of your symptoms.

      • oh gosh pysiological dose of t3 secreted by thyroid is only 6 mg….anything else should be taken with caution…..i was on 25 mg for 14 days it was TOTAL disaster, i had all they symptoms of hyper!