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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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1,033 Comments

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  1. taking cortisol can crash your adrenals, you should be very cautious there. Low T3 is usually treated with Synthroid, Natural Thyroid Medicine, or Cytomel which is synthetic T3. Have you been on the Stop the thyroid Madness site? There are several yahoo groups you might find helpful, http://www.stopthethyroidmadness.com/talk-to-others/ , most people start with the natural thyroid group but you might find http://health.groups.yahoo.com/group/T3CM/ helpful given your stated issues. All the best, Beth

  2. One more thing, I started taking Potassium Iodine tablets as well. 65 mg a day I think they are. Forgot to mention that. I am basically flat on my back in bed all day with the energy of a dead halibut. Used to be a body builder, runner, blah blah blah…. Did it all and now I am exhausted 24 7 and have not been in a gym in 6 months. Just want to get my energy back so I can live life again. Any suggestions would be awesome!

    NP

    • I don’t have any idea what is ideal. I get the low dose of Iodoral (12.5mg) and take one of those a day. In some people’s view, that is too much. I’ve been doing it for 3 years and it agrees with me. I don’t have a thyroid. I do it because I think it’s good for breast health and it has solved some issues I was having previously.

      Good luck!

  3. Hello everyone. Long story but basically got bacterial poisoning from a bum root canal. Had 3 modern medicine tests of my blood to find out why my energy level just died slowly but surely and no one could tell me anything. Went to a holistic type doctor and did a dark field blood test and found the bactieria infection. Had the root canal removed and bone surgery to remove the dead bone from my jaw from all teh mess that was there and now I am left with a dead thyroid and adrenals. Went to idiot normal doctor who tested ONLY T4 and TSH. TSH was up around 8 and the T4 was 1.64 so basically perfect. Holistic told me to go back and get the whole pannel done and I did and my T3 was low 2’s so my T3 was shot, T4 normal so thyroid normal and my TSH gone cracked because of the lack of conversion between T4 and T3. Holistic told me to kick up my cortisol levels 3 times a day and take selenium as it helps T4 and T3 convert properly.

    I was not aware you can take T3 supplements directly but would love to learn more if anyone else has similar situations going on. Great forum by the way! With Low T3 can anyone point directly to supplements you need to be taking to test out what works?

    Thanks!

    NP

    • T4 of 1.64 is not perfect. and TSH at 8 is horribly high. With your T4 so high, I suspect your RT3 is very high. Your T3 is very low (assuming that is Free T3 and not Total T3 that is in the 2’s). Did you test for antibodies and Reverse T3? You’d need to test for that as well as iron (Serum, Ferratin and TIBC). Probably also be nice to know where your B12 and Folate stands as well as Magnesium, potassium and sodium.

      Lots of guys who body build and run end up with very high Reverse T3. When you do that much physical activity, the body goes into survival mode and starts converting a lot of T4 into RT3 instead of T3. Of course, the infected root canal could have caused those issues, too. The thyroid tollerates weight training ok, but not a lot of aerobic training. The adrenals tollerate some aerobic training, but not weight training. So, between the two, if you’re having troubles with both of them, you shouldn’t train. Walking, Yoga, meditation and that sort of activity is good. Just not the stuff that pushes your body.

      Are you taking selenium? Especially if you’re taking iodine, you should probably supplement selenium and consider supplementing zinc (in the evening as it sometimes will slightly lower cortisol). They are both supportive of good conversion of T4 to T3 as well as degradation of RT3. My understanding of iodine is that 65mg is a detoxifying amount and way more than the thyroid needs.

      It took me 2 years to figure out my adrenals/thyroid and get back to working out. I’m 57, so I don’t work out like I use to, but I hike several times a week, use my elliptical trainer on the other days and I do weights 3 days a week (lightly, not to body build). I’m back to normal now and feel better than I have for 20 years.

      Good luck to you!

      • WOW Karen, thanks for responding. I will have to look through my paperwork and see if I have all those numbers. I don’t think I do. I was told T4 of 1.64 was pretty good! Those numbers were taken in the first week of May but it was by a general doctor and not a specialist. My Holistic Doctor told me that just checking T4 and TSH was no good so I needed to go back in and get it done again and get the Reverse T3 and so on. Oddly enough I got these results back today. Since I had the root canal removed and Ozone therapy to sort out the bacterial infection of my blood my TSH has dropped down to 4.14 which is awesome. The rest of the results as of today are FT4 1.38 now, FT3 is 2.47 and my Reverse T3 is 34.0 Ng/DL. I went to my regular doctor to get a referral to an endocrinologist or however it is spelled and the earliest I can get in is the end of August! Absolute insanity! Let me see, what else of what you asked do I have…..Vit B12 is sent out and still waiting. I have not been in the gym in a year it seems as I just lost the energy to go in there. I am hoping now the bacterial problem is solved I can now focus on the Thyroid. i really have been in bed for a month unable to do anything. I am taking 400mcgs a day of Selenium. My holistic doctor is Alex Haskell. If you youtube him, he wrote two books on thyroid and one on Hashimoto’s. He knows his stuff for sure and suggested taking the Selenium and cortisol. I saw the note on zinc on this page and started taking it a few days ago. Haskell does not suggest taking a lot of iodide so I may lighten up on that. I was watching a few videos on line on iodide if you go here http://www.bbc5.tv/download and download the “Iodide, misunderstood nutrient”, it is long but it talks a lot on how it helps thyroid so based on that I thought I would test it out but it is not working. I am having to lie down in the middle of the day some times twice and rest as walking up the stairs knocks me out. How much zinc do you suggest. I guess my question is that I have been battered up with this pretty good over the last 6 months so how long does it take to reverse it all? I was told to take synthoid or whatever it is called but my doc said that if my T4 is normal than the Thyroid is normal and that it was my T4 to T3 that was out of whack causing my TSH to be so high. My cortisol levels were low so he put me on tabs of that and selenium, 400 mcg. I will add zinc as well but my question is, when should I start feeling a bit better! I keep wanting to be back to normal and when something does not work in a week I start getting antsy and want to test something else. Very frustrating this for sure. Logically if T4 is not being created to T3 and all that has to do with iodide then taking more of it should be a good thing no? Hard to know what to do. Doctors do not have a clue. My western medicine idiot just said your TSH is high so take synthoid. I told him I wanted armor and he asked why and I told him and he said well ok if you want, take that then. here I am telling him what I need to take. Just something wrong with the system. 2 months to see an expert, obviously folks out there are really suffering with this. I was raw vegan for most of my life so I had no cortisol so I guess that did not help. I am adding more meat to the diet now. Any other suggestions I would appreciate. This is a very helpful forum.

        Newfie

        • I see folks writing they are taking T3, what do they mean exactly? Is that something you can get over the counter or does it have to come from a doc?

          Newfie

          • It has to come from a doc…an rx…called Cytomel.

            It is not without issues…and NO ONE should ever take endo hormones over the counter. Unlike vitamins which one excretes if they take too much, the endocrine system and corresponding glands react to excess by simply making less…and you run the risk of atrophying the galnds and essentially killing them.

        • Be sure to get antibodies tested. You need the WHOLE picture and that’s an important part. The iodine helps with thyroid production. Taking more doesn’t help produce more. You just need the amount that you need. The amounts you’re taking are more like detoxification amounts (although most people who detox with iodine take 100mgs or more). Raw vegan is not good for your thyroid either. Many of the vegetables that you would have been eating raw (broccoli, kale, cabbage, etc.) are goitrogens and are bad for your thyroid. Cooking them makes them healthy for your thyroid. Same with Soy except that even cooked Soy is still a goitrogen. And, I’m sure you know, now, that your adrenals need healthy fats (animal fats, coconut…….saturated, NOT unsaturated).

          Karen

          • So much to know that no doctors will ever bother to tell you! Thanks! You have given me a lot to think about. How much potassium Iodide is ideal to take in your opinion for the mess I am in?

            Thanks!

          • Iodine is bad, very-very bad, for those with thyroid autoimmune conditions and should NEVER just be taken without testing to assure that it is safe…because the risk is thyroid crisis and possible death.

            How that works out is this…no iodine that you get from food or supplements can be used by the body UNTIL it is converted by an enzyme called THYROPEROXIDASE or TPO (which is made by the thyroid), into something that is bio-available. Next, the protein THYROGLOBULIN or TG (also made by the thyroid), binds the now bio-available iodine on the back of a thyroid hormone. T4 and T3 stands for 1 Thyroid Hormone and 4 or 3 Iodine (respectively).

            Thos with thyroid autoimmune (already dx’d) know well that TPO Ab and TG Ab are the two MAIN targets of thyroid autoimmune attack. Taking iodine stimulates production of TPO and TG to process it.

            This is just one more of the really bad advice (albiet good and logical sounding on the surface) you can find on the internet. Sorry.

        • Newfie,

          You need to figure out your RT3 ratio. If you also have low iron or low cortisol, then you most likely have a rt3 issue like Karen said. If you go to this site: http://www.stopthethyroidmadness.com/rt3-ratio/

          There is a calculator on the site. You want your ratio to be bgreater than 20 to NOT have a RT3 issue. You may want to look around the site and join the Facebook groups too. Very helpful. It sounds like you hae a cortisol issue, but you need to know exactly how low. Did you have a saliva test? This will tell you when during the day is your issues. Also, taking T3 should help the T3 and possibly the cortisol issues.

          • Thanks Saleen, problem is I guess i am getting my numbers down here in the US so it might be different than up there. My FT3 is 2.47 (range they say here is 2.50-3.90 and my Reverse T3 is 34.0 (Range is 13.5 – 34.2) It does not say what the T3 is measured in but the RT3 is measured in Ng/DL. That is not even one of the choices on the calculator so the measurement is no doubt off.

            I am going to go back and ask them to check my blood again so could everyone give me the total list of what they need to check me for?

            Obviously the TSH, T4, T3, reverse T3, is there a difference between T3 and FT3 and T4 and FT4? Karen said something about knowing the antibodies. I have no idea what they are or how to get them tested. If i went to the doc and said I need all this tested above and my “antibodies” is he going to ask “what antibodies?”. I need to give them the total list as they really are not smart enough to know all of this on their own. First time they only tested my T4 and TSH and said go home and go on synthoid.

            If someone could post the whole test list that would be awesome. I am really dead lately. Not sleeping, getting up lying on the floor all day long, just in a total mental haze. No energy, it really blows. I am still eating healthy, juicing every day, blending, getting tons of enzymes and so on but body it just shutting down.

            • TSH, FT3, FT4, RT3, TPO Antibodies, Thyroglobulin Antibodies (TgAb), you should also get Serum Iron, Ferratin, TBIC and Saturation (a calculated value).

              Your FT3 is horribly low and your RT3 is very high. If I get a chance, I’ll calculate the ratio for you later this evening, but it’s very, very low. That’s why you feel badly.

              • Thanks everyone! I noted the whole list. My regular doc does not know anything it seems and was ready to throw me on synthoid after looking at my T4 and TSH only. My holistic doctor said where my T3 is low I need to take cortisol and selenium and that is what I have been doing for the last month or so but it is not really helping. I have a bottle of armour thyroid here in hand but have not started taking it yet as I was told by my holistic doc the thyroid is fine if the T4 is fine. I was thinking of testing it out and trying to take it for a while. I have hit a wall and have absolutely no energy at all. It is absolutely insane. Not sleeping for a darn, dragging myself out of bed and going right to the big cushions on the floor. Been off work for a month as a result of it. Just can not get the energy to do anything. OK so assuming the T3 is shot, what is the plan of action to restore it? Is cortisol and selenium the answer? I will go back and see if i can talk them into getting all that checked out and I can post it in here.

                Thanks everyone! You are all very informed for sure!

                Newfie

              • Also if you have these problems, how often do you go get your blood tested? Also once you identify the culprit and you get on a plan to sort yourself out, is this something that just makes you feel better instantly or does it take a long time and if so how long? I have been on the cortisol and selenium for a month and I feel awful but I don’t want to go jumping around testing things out if a month is nothing and it takes 2-3 months of doing something before you notice a change if you know what I mean. I tell you this is the battle of my life. I have never felt so horrible before and I am a pretty flipping healthy dude.

                • Did you have your cortisol tested before your doctor put you on cortisol? I was on cortisol for about 6 months and it made me feel like crap! Never want to do that again. But, if you decide to get off of it, you know you need to wean off slowly, right? Don’t just stop taking it.

                  Karen

              • I was told by my natural doctor that I was low so I needed to start taking it. Cortisol I mean. I am scheduled to go to an endocrinologist but it is 2 months away. I have armour thyroid here and may start taking it to see what is what. I went to my regular doc today and he said expect 2 months before you notice any changes. Oh well. He said to wait another month before I get more blood work again to see where I am. Hopefully it slowly starts to turn around.

                I will post any progress for sure!

                Thanks everyone!

                • How did he determine you were low in Cortisol? Cortisol results are pretty immediate. It doesn’t take 2 months to tell if it’s helping or not. Did he do saliva testing on you (where you spit in a tube, 4 times a day)? How much are you taking per day?

                  Karen

    • First of all, so sorry that you ahve had to go through all this.

      It is very true that on-going bacterial infections DO affect hormones…however, how they do is still poorly understood in the word at large. That said, Chris in this article goes a long way to explain it. Basically, the body down-regulates itself…to make you lay on the couch so you can get well. In short term illnesses this is what we expect…in long term situations this really affects one’s life…so we naturally seek answers. Unfortunately, there are not many good (correct or right) answers…only hypothesis.

      Yes, your thyroid IS functioning because it is making T4 as it should. The pituitary (TSH) and/orhypothalamus may or may not be functioning (few doctors even think to look at the pituitary or hypothalamus as cause in the matter)…the current belief in the medical community is that TSH responds to T4…and not the low T3.

      Yes, it is true…the low T3 IS an issue…and YES, you can take just T3…however, this is outside the acceptable “standard of care” that doctors are forced to follow (so, IF you can find a dr that will give that to you, great…hang onto them)…it is unlikely that your current dr who only tests TSH and T4 will do that for you, but you can ask. The medical community has a lot of reservations about T3 only treatment (and yes, I am on T3 only and have been for a year or so…and 9 months before that)…and rightly so. T3 is short acting…so, if you get into an accident or are unconscious and the hospital does not-know that you are on T3 (and if you have no thyroid) then you will have absolutely no thyroid in yoru system in aprx 48 hours…and run the risk of coma and death. So that is just one issue with it.

      The other issue with it…is no one really knows what happens with it inside your body. You cannot store it like T4…and current hypothesis is two things. One, you spike too high and then sink too low after every single time you take it…and thus induce disease state. Or, two, that your liver works to clear it immeditaely after taking it so as to keep levels in range…which means most is wasted. And assuming that one’s liver is opperating correctly.

      One of the pains for those taking it is that one needs to take it multiple times a day (I take mine 10x a day). Some do not mind this, others would find it an unreasonable hassle…you will have to decide that for yourself.

      You may want to get an RT3 test run…the Total T3 includes RT3 and FT3 and Bound T3. Free T3 or FT3 is what you can use. RT3 is the other thing you convert T4 into…and it may be that you are making too much RT3 especially if you have some kind of chronic illness. If so…then this is normal…or rather, the body IS operating normally…even if it is a pain in the you know what. Chris, in this article, goes on to say that maybe it shouldn’t be treated. Bold question, admittedly. I have to treat because I have no thyroid.

      Also…unlike the misleading internet advice, most of your thyroid is converted in the liver…so you may want to make sure your liver is finctioning well. As an FYI, the liver tests that they run are for dying livers…not liver function (i know, I know, it makes no sense…but it is what they do anyways).

      Good luck.

      Oh, the name of the T3 only is Cytomel.

      • Faith, perhaps I can add a little to what you have said, since I do have a thyroid (and a goiter), so the L-T3 that I take, is as a supplement instead of a replacement. As such, I can take an extremely small dose. I have built up in recent weeks from 1/8 of the smallest tablet (5 mcg) of Liothyronine to 3/8 tablet daily. My doctor expects me to build up to a whole tablet eventually, but has told me that I may do it in the 1/8 tablet increments. I don’t feel any need to space these out through the day, and feel that it is closer to normal to have the amounts of the hormone in the blood fluctuate a little.

        I also think that many people are under-diagnosed and under-treated for low thyroid, and if the doses of L-T3 were made smaller by the drug companies, more doctors would be willing to prescribe some for those who may be borderline hypo. Once the thyroid is under control, it is much easier to see if there is another health problem that needs addressing.

        If being put on the couch by low T3 doesn’t help you heal in a short amount of time, I think it is time to get more T3 and up off the couch! No more suffering for decades while doctors shrug their shoulders and offer no help!

        • Hi Fern,

          While I agree with you regarding many who are under-diagnosed…however, I disagree with your blanket statement that all people who are low T3 need T3…or even that they would benefit by it…and invite you to consider some possibilities that you don’t appear, to me, to be considering at present.

          Also, you are making a basic assumption that is false…that is that if you take thyroid hormone supplement that your body’s thyroid levels will increase. While that makes sense on the surface, that is not necessarily true.

          First of all…there are at least two possible reasons why thyroid levels can be low. 1. That the hypothalamus has set the body’s thyroid level low (often because of chronic illness); or 2. that the thyroid is failing to make thyroid hormone (this would cause a T4 def and a rise in TSH).

          In case number 2, the failing thyroid (primary hypo-thyroidism), then supplementing WILL benefit the person and WILL cause a rise in thyroid hormone levels. EVERY DR OR PRACTIONER SHOULD ALWAYS LOOK FOR THIS SIGN, imho.

          However, in case number 1, IF the hypothalamus set the levels low…then no amount of thyroid hormone will help because not only is it is NOT a thyroid issue, the liver will flush the excess thyroid hormone from the bloodstream…as it should…as it does with excess of other hormones as well…and as it does with a lot of things. EVERY DR OR PRACTIONER SHOULD ALWAYS LOOK FOR THIS SIGN AS WELL, imho.

          Failing to tell these two conditions apart is the cause of endless harm to patients who have suffered for decades and spent further decades repairing the damage. So it goes both ways. And this is why you cannot make blanket statements about every case of low thyroid needing thyroid supplementing.

          Another issue with doing that, just simply supplementing, is that it completely ignores WHAT WENT WRONG. You hurt? Here’s a pain killer, so you are fine now. The author of the article (a doctor I believe) is asking a bold (and difficult, imho) question…should we maybe not-treat chronically ill patients with T3? (Those who have a thyroid). Frankly, I don’t know…but I am comfortable enough to entertain the question.

          Low T3 or High RT3 puts one on the couch…no, that doesn’t necessarily make you well…and everyone with the flu should down some T3 and get into work (not). In the end, the body has only so much energy…you cannot run a marathin AND heal from the flu…it just doesn’t work like that. The issue comes in, or at least how I see it the issue is, many of us with chronic illnesses are not going to heal…but the illness is going to progress until we die. And yes, in theory, it sounds like a great thing to take T3…IF…it was as simple as that. However, our systems are infinitely more complex than that…and the body has other ways to down-regulate you than just low T3 or RT3.

          So there is a need to seperate those with failing thyroids (what you are suggesting will work for)…and those who’s thyroid’s are low for other reasons. It has been estimated that only 5% of thyroid patients in the USA are true primary hypo-thyroidism…meaning that have truly failing thyroids…the rest of us are something else that don’t fit as easily into those boxes.

          And I will tell you what, I would LOVE if taking my T3 (I take 10mcg 10x a day) gave me energy, caused me to lose weight, or got me up off the couch…but as I say, it doesn’t work like that. And I think you’d agree that I am on a mighty high dose. So let’s let evidence prevail.

          If you disagree with honoring the body and not-giving sick people T3 (as the author suggests), then maybe take it up with him. I am not sure how I feel about it…he makes a compelling argument…then again, I am sick and take T3. Fwiw, most of my posts are to add information…often descenting information…not because that is necessarily how I feel…but because I think it is worthwhile that people should know as many sides as can be illuminated…so as to make a more truly informed choice about what they wish to do.

          Too much T3 can cause bone demineralization. It has also been linked to various female cancers as someone on the Mary Sholomon’s Yahoo Thyroid Group illuminated us all too. So there is a dark side to it. Also, if I were to get in a car accident and as my scar is not detectable…and because even if they saw it they’d assume I was on T4…I could die in a matter of days from lack of T3. So it runs a risk. Again, wish it were the cure-all to things…but that has not been my experience. I cannot tell you how many times I wish that things were that simple.

          IF the hypothalamus has set the thyroid level low (for whatever reason, but chronic illness seems to be a popular one)…then one of two things is going to happen when you give that person theyroid hormone. 1. The liver will flush it out in order to maintain the balance set by the hypothalamus (this is what will happen in a person with a healthy liver and not a true thyroid issue)

          • Faith,

            I didn’t say nor mean to imply that “all people who are low T3 need T3”. What I meant was that there are probably some other people like myself who suffer needlessly with low T3, having it withheld from them because the doctors are afraid that THE SMALLEST POSSIBLE DOSE WILL ADD UP IN THE BLOODSTREAM to make the patient hyper. Essentially, that was what I was told by the doctor. You call it a false assumption. If it is, it is not my own assumption but one from the doctor.

            I know that particularly with L-T3, doctors will often suspect addictions to occur. I was told that by 2 different doctors. I understand that doctors are, and should be, committed to “First do no harm,” but what I do NOT understand is why drug companies cannot be persuaded to make small enough doses that there will be VERY LITTLE chance of the L-T3 doing the HARM that no one wants. Personally, I want health, not harm. Doesn’t everyone?

            “… the liver will flush the excess thyroid hormone from the bloodstream….” That is a blanket statement that I have not seen verified in any official medical source.

            I don’t have a problem with (Dr.?) Chris Kresser asking the question about whether or not to treat low t3 syndrome with thyroid hormone, and it seemed like he wanted to hear from us about whether or not the L-T3 helped in our individual cases. I don’t know how much he is still interested in hearing. Care to comment, Chris?

            You said, ” I would LOVE if taking my T3 (I take 10mcg 10x a day) gave me energy, caused me to lose weight, or got me up off the couch…but as I say, it doesn’t work like that. And I think you’d agree that I am on a mighty high dose.” I DO agree it is mighty high. I’m NOT saying that high doses are better than NO doses, EXCEPT in cases like yours, where you have no thyroid. Even then, I wonder why you have to be on SUCH a high dose, (just curiosity, NO judgment intended.) I’m also curious if you have to take beta blockers also, or if it is the Lyme disease that makes it so you can absorb so little L-T3 from what you take, or what? You don’t really need to answer these questions if you don’t want to–like I say, I am just curious.

            Is there also a reason you can’t take L-T4?

            I also wish things were more simple. They’re not. Maybe what I really wish for is for the medical field to continue advancing in their understanding of what is going on and in their ability to help those of us who suffer for whatever reason it is. At least in the 5 years since I started going to endocrinologists, I have seen some important advancements made.

  4. I have being taken T3 for about 18 days. I am not sure if I have seen any results yet. I think I feel lighter and less swollen and maybe my tempreture has moved slightly up but I haven’t lost any weight which is the main reason to take T3 replacement ( I split 2 pills of 25 μg in 3 days). My FT3 is low but within the range ( about 2.8 pg/ml and 2.97 for THS). I have antibodies which means I have Hassimoto. Reading your article I have second thoughts. Should I continue?

    • Not sure where people get the idea that taking T3 will help lose weight…but the usual result is a paradoxial weight gain. I have yet to hear a report of ANYONE who lost weight taking thyroid. The hypothalamus regulates temps.

      I take double what you are taking…but I have NO thyroid.

      Here is the issue…IF you have a thyroid AND your thyroid is making hormone…taking hormone results in your thyroid making less…and it will make less and less the more and more you take, until you atrophy the gland (essenitally killing it) and forcing yourself to remain on thyroid hormone for life.

      You are unlikely to force a hyper-thyroid state (excess thyroid) IF your liver is functioning because it will sweep out the excess.

      I wish there was a better answer. High norepinephrine will cause weight retention as well low taurine.

      • Unexplained weight loss is a symptom of hyperthyroidism. My hyperthyroidism was discovered after I had finally lost about 12 lbs in 12 weeks on a new diet–it didn’t matter that I thought it was quite reasonable to lose a pound a week. I wasn’t treated right away, though, because my FT4 was barely above range even though my TSH was virtually zero.

        Unexplained weight gain is a symptom of hypothyroidism, too, but no one thinks they can’t explain that. It is simply chalked up to: “You must be eating more calories than you are burning.” True. Hypothyroidism causes low calorie burn, so it is very hard not to have everything you eat go into fat storage.

        Ironically, you can’t eat enough to avoid having your body think it is starving if you get too much T3, and when you are starving, your body creates more RT3 and puts you flat on the couch the same as with any non thyroid illness–in my opinion. That is why I say you have to eat nearly as much as you are burning to actually lose weight. Also, eat a balanced and nutritious diet.

  5. I’ve been taking T3 for about 2 years now. While I”m mostly satisfied with the treatment, I am still interested in the root cause and possibly switching to Natural Thyroid or getting off it completely. Before I was diagnosed, my labs show a TSH creeping up to about 5.74. Without knowing it, I had just about every symptom of hypothyroid. I suppose I should be grateful my general physician wrote me a letter telling me my “torpor” (his words not mine) were not explained by a defective thyroid. That opened my eyes and led me on a quest. My worse symptom which developed around this time was a very heavy period that lasted 4 months. Of course I had to have tests for uterine cancer, polyps and any other cause before an ablation was recommended. Before I underwent surgery I wanted to make sure that it wasn’t the cause of my thyroid. Progesterone wasn’t working either. I had tried Synthroid without much luck and Armour (although it was difficult to get at the time) with very little change in my symptoms. At this point I had my Free T3 and RT3 tested and the first was low the latter was high and I tried T3 only. During this time, I had been monitoring my temps which were consistently very low. The T3 did the trick and I avoided the knife and anesthesia. Thanks for article, its very helpful for those of us on a quest to get better with this elusive condition.

    • Correct me if I am wrong…but somehow I think T3 is related to female cancers. Someone in Mary Sholom’s Thyroid Yahoo group talked about it a lot, with lots of links…which I unfortunately never read.

      Armor and NaturalThyroid are not near as natural as we have been led to believe. Armor comes from Armor meats…best known for hotdogs. Feeder animals (and the aniumals these come from are the worst of teh worst feeder animals) are feed an overdose of endocrine hormones…so much so that they die of the overdose at age 1.5 years. Law says slaughter has to happen before 2 years…but animals are slaughter just before 1.5 years due to endocrine OD death. The pills are just dried out thyroid gland…so also have everything in it that cause thyroid autoimmune attacks.

      Granted, SOME people do great on them (and all the power to them), and maybe they need one of those something elses in them. But they are neither clean nor natural..and Armor is known for using fillers like soy that inhibit thyroid and are constantly changing their formula (which is hard on a number of patients).

      Another alternative is a relatively new T4 called Tirosint…it is T4 with no fillers. When I took it, it was the only time I felt fine after taking something (no reaction). However, I still made way too much RT3….so it is T3 only for me.

  6. Interesting article. I was diagnosed with hypothyroidism a number of years ago. I started on Synthroid then, and have had to increase dosage gradually over the years. I’m now up to 137 MCG’s daily.

    Because my numbers still wouldn’t quite right – my endocrinologist put me on T3 months ago. Not too long after that, I began noticing skipped heartbeats – sometimes irregularly irregular for a couple of hours – although I’m not entirely sure that the relationship was causal rather than only correlational. I stopped with the T3 and I went to a cardiologist who found hypertrophy (and put me on verapamil). It has been a couple of months, the irregular heartbeat episodes seem to be mostly gone (I still feel skipped heartbeats on occasion but they aren’t for extended periods of time (maybe just a couple of minutes long now).

    Anyway, I have an appointment with my endocrinologist tomorrow and was looking on line to find out some information prior to going in. My latest blood test showed TSH of 2.85, T4 free, 1.6, and T3 total, 52. So, my T3 remains low, although the TSH and T4 seem to be OK.

    I have never felt symptomatic with any of this, although my thyroid is somewhat enlarged (had a work up done a number of years ago that showed no cancer). No chronic problems that I have ever noticed. The one thing that I think may be a “symptom” is that I’m @15 lbs “overweight” (I’m 5’10” and about 195 lbs or so) and was not losing weight even though I exercised extensively (I have lowered my exercise amounts for now to see if maybe laying low and being on the verapamil might reverse the hypertrophy – which did not exist when I had an echo done some 5 years ago).

    So taking T3 seems to be ill-advised. I’m wondering if you might have any thoughts on how concerned I should be about the T3, and whether there is any other way that I might address that issue without taking a T3 replacement.

    • I forgot to mention – I’m 54 years old, so the difficulty of losing weight despite high levels of exercise may just simply be mostly a product of the aging process. I have worked on reducing my caloric consumption – particularly since I’ve reduced my exercise levels temporarily – and I’m hoping that I can get a result of some weight loss via that route long-term.

    • Joshua, what is your Free T3? FT4 seems slightly high. I’d guess that you have a lot of Reverse T3. Also, have you checked thyroid anti-bodies? Many times an enlarged thyroid can be a symptom of auto-immune disease (Hashimoto’s or Grave’s). I would also check your sex hormones.

      Have you tried taking selenium/zinc/iodine to help you convert your T4 better?

      Thyroid definitely affects the heart and some believe that chronic hypothyroidism can cause congestive heart failure. I would definitely see about figuring out your hypothyroid issues rather than using verapamil (which has horrible side affects).

      If you do have thyroid anti-bodies, many times just taking supplement natural desicated thyroid will solve the problem. It stops the thyroid from cannibalizing itself.

      Dr. Brownstein has several good books on iodine and thyroid. They’ve been very helpful to me.

      Good luck!

      Karen (just a patient, not an expert)

  7. This is very interesting topic. I have hypothyroidism and am not able to convert T4 to T3. I used to take T4 only and felt fatigue, a bit depression, foggy thinking , lack of interest , and messed up menstruation. My doctor just asked me to exercise. When the depression became severe, I started to take cytomel. It helps a lot. When my T3 goes up, I feel happier and smarter, not fatigue any more.
    I think professionals should pay more attention to low t3 syndrome, currently in Canada, if the specialist chose ft3, ft4 and tsh without specific request on the chart, the labs won’t do t3 t4 if TSH is normal This is so wrong!!

  8. I have panhypopituitarism due to complication from a brain meningioma. I also developed Hashimoto’s disease. I am under the care of an endocrinologist who regulates my hormones. I was treated with levothyroxine (thyroid medication) and hydrocortisone, but it was not enough. I still suffered from lethargy, weight gain, and constipation. He started me on liothyronine sodium (Cytomel) and this has made a world of difference in my energy level and mood. I feel that after seven years of recovery from a partial brain resection and radiation, I can finally leave an almost normal life.

  9. I am 30 yrs old doctor,with increasing symptoms of sleepiness lack of concentration lack of interest to the surrounding lethargy ,my circadian rhythm is upside down for long time just i can go to bed only in the early morning ,I have significant psychological stress ,anxiety and manic behaviors,accidentally i have been tested for thyroid function test which reveal LOW T3 despite normal range T4 and TSH. I HAVE MISSED BEATS IN ECG WITH SENSE OF IMPENDING DEATH WITH PALPITATION AT NIGHT. my physician commented it is normal TFT .but i think it is not .put me on anxiolytic and bisoprolol 5mg. and i am worried that i might be in need for further treatment.AM I RIGHT THAT I HAVE T3 SYNDROME ?????

    • The circadian Rhythm is a function of your hypothalamus…and I suspect that more patients have issues with their hypothalamus or pituitary (which controls the entire endo system) than with the individual glands…but it will probably be another decade or ten before the medical world catches up. The anxiety suugests adrenal involvement and/or neurotransmitters. Phamasan Labs offers an awesome neruotransmitter test you might look into. The heart palps is a strong suggestion of too much thyroid hormone T4 pooling…or not being cleared quickly enough. This actually suggests more of a picture of thyroid autoimmune if thyroid at all.

      Low T3 or Low Thyroid mostly leads to feeling tired and apathetic…sleeping all the time, weight gain, and increased pain for those who have chronic pain. The high anxiety stuff can be from toomuch thryoid.

      To test for thyroid autoimmune they generally test TPO Ab and TG Ab (there are a number of other thyroid anti-body tests…but you will likely run all over town to get them.

      Good luck.

    • bakri abuagla, you may have low T3 syndrome, but getting a doctor who would help you is very hard. Especially having palpitations, no one will want to prescribe L-T3 or even L-T4, since it is seen as more of a hyperthyroid thing. There are people on the support group at dailystrength.org that could possibly help with finding a new doctor who might be more helpful.

      Interestingly, when I took my first dose of 2.5 mcg L-T3, I immediately felt like all the stress of the past was lifted from my shoulders. I slept all night long and was more fully awake in the day. Each of us is different, though, and what I experienced might not be true of anyone else.

      I am now taking less than 2.5 mcg daily. 2.5 is half of the lowest-dose pill, and today I just started taking 3/8 of a tablet. Because of my experience being hyperthyroid, I know that a big worry about that is high blood pressure and especially high heart rate, so I test them every day to be sure I am not taking too much of the L-T3.

  10. Chris any thoughts on hypopituitarism? I am 43 yr/o, have celiac, hypogonadism (amenorrhea 2 years), all the symptoms of hypothroidism (weight gain, ataxia, orange skin, low body temp and heart rate, water retention, ascites, memory loss, fatigue, exercise exhaustion, heart murmer, etc).
    Low TSH and free T4 (just below normal range) and very low free T3.
    I did paleo low carb for 6 months and plummeted, realizing I run much better with carbs, and probably was eating too many eggs, cabbage, nightshades, and sw potatoes (all bad for thyroid function). I have a hard time digesting fats also.
    Still relatively paleo and then some (no dairy, no eggs, no grains- except rice in am only, no beand/legumes, no sugar, no fruit, no potatoes, no nuts, no seeds, no soy, no corn, no cruciferous) and absolutely no improvement (except with eliminating sugar, but my weight has never budged- I’m presently 15 lbs overweight. I have been gluten free for years and never really got 100% better.
    I also have fibrous dysplaysia, and wonder if this can all be related.
    I’m waiting for results of pituitary MRI to rule out an adenoma. In the mean time am about to start .44mg of synthroid and alesse birth control.
    Noone has spoken about being diagnosed with hypopituitarism, I’m wondering if anyone else has seen it and been treated like I am about to be, and had any success?
    I mentioned armor to my endo and he said when the pituitary is involved it is vital to have a consistent time released T4, and the armor, despite being T3 is unstable. He also mentioned that T3 is converted from T4 in the muscles and has nothing to do with pituitary or thyroid damage, so is not necessary to supplement with in my case (whatever that means, he blew the suggestion off and told me it was not safe).

    Any advice or sharing of similar experience would be appreciated.
    Chris if you have time, your thoughts on hypopituitarism would be greatly appreciated.

    • I, too, would love to hear your thoughts on treating hypopituitarism. I was diagnosed two years after the birth of my daughter in 1999. After going off bc, realized that I was not able to have another child without fertility treatment (had twins in 2006). Deficient/low in all pituitary hormones. Ruled out pituitary tumor with MRI and told “possible Sheehan Syndrome” . Have only been treated for thyroid (levothroid at adjusted doses over the years) but would like to explore options to safely treat other, pituitary related, hormone deficiencies. Any way to go about this gently/naturally? Supplements, dhea, pregnenolone, etc?
      Symptoms that I believe to be related include (sometimes extreme) fatigue, waking during the night, hypoglycemia, gluten and dairy intolerance, low blood pressure. Follow a paleo diet but do struggle with binges that tend to be high in sugar (might be too low carb?). I know that there’s alot going on…sex hormones, acth/cortisol, growth hormone.
      Again, would love to know your suggestions/thoughts. Thanks…

      • HI Jordan. I’m not a doc, but I’ve researched this a bit. You might try Chaste Tree Berry. It’s suppose to stimulate the pituitary. Also, look into chinese medicine. If you live in a big city, find a good Chinese medicine doctor.

        • Karen, thank you for the suggestion. I am trying to get a sufficient education before I decide how to go about treating my hormonal problems. The balance is so tricky…but I’ve become tired of living with all the symptoms.
          I will look into the Chaste Tree Berry. I’ve also been told to check into bovine, ginseng, liccorice… Want to explore more natural options before getting into possibly replacing several different hormones. Also finding that it’s not advisable to treat the thyroid without first stabilizing the adrenals (which I’ve/doctors have been doing for years).
          Chris, I know this is much less common and more complicated than treating thyroid problems alone. Do you have any experience with this in your practice or research?

  11. I was on Synthroid 137mcg. My endocrinologist lowered it to 127mcg. 6 weeks later she stated my T3 is low so she put me on cytomel 10mcg. I just went in after 8 weeks and she said my TSH and my T3 and T4 are low and she doesn’t know why. So she is increasing me back to 137mcg Synthroid and 20mcg Cytomel. I am healthy. About 20lbs overweight and frustrated. I work out every day and I want this to go away and be back to normal. What do I do?

  12. I changed doctors in January 2012 and had TONS of bloodwork done. My labs show T3 reverse, of 33 or a HIGH diagnosis. Doctor prescribed Liothyronine. Doc also says I am pre-diabetic. I’m 38 years old and have never been told this before. I feel a bit like this doc wants to push weight loss meds, shots, hormone replacements, etc. Yes, I am overweight. I don’t know what to do and am really stressing over my upcoming appointment. I have results of all my past bloodwork and am trying to make heads or tails of it myself. It’s so confusing.

    I did have a repeat of some bloodwork in Feb. On those tests it shows different results like TSH (0.69), T3 uptake (22), T4 total (8.4) and Free T4 (1.9). Those labs state these are all in normal ranges. Is this because of the Liothyronine?

    Can anyone interpret these results?

  13. I’ve had it with the medical arena. After using compounded T3 on and off for eleven years, I got “fired”by another ignoramus doctor and packed off to an endo. No thanks. They know less than I do.
    This doctor was a replacement for the one who had actually listened to me and believed me. I had gotten tired and drained of cash traveling three hours to a doc who did Wilson’s Temperature protocol. I gave my spiel to this family practioner and he agreed to give me the prescriptions-he didn’t want to see me more than once every two years, which was cool…nothing was wrong. I felt perfect. Then, he retired. Then new lady doc prescribed for a year and a half before deciding to deny me care, telling me that I was endangering my heart, putting myself into a hyper state. I pointed out my temp was 98.4, pulse 75, and blood pressure 120/80. I told her those vitals she just jotted down are not indicative of hyperthyroidism. She had no clue what she was talking about…as evidenced by her idea that I should just “deto from this meth-like drug and go cold-turkey.” I was on 60 mcgs/ 2x day. I told her T3 needed to be slowly weaned off and she told me that it was a sign of my denial of my addiction!! Ver tense conversation as I had her look at my many perfect tests. She said …”But your Free T3 is almost 10! That is dangerous. I had to let her know that that is expected when you are taking it about an hour before a blood draw. She didn’t understand why my tsh and t4 were suppressed either. She was invincibly ignorant.
    I decided to wean off and go it alne. So far I’ve gained ten pound, lost eyelashes and a lot of hair, got heart palpitations, bladder problems returned, low temp, no energy, dry itchy peeling skin, swollen legs and ankles, lung rales in the morning from fluid pooling…cholesterol is higher, fasting blood sugar is 112 (on t3 it was 92)….
    But hey! My Thyroid panel is “normal”…..I’m fine.

    • You can buy Cynomel in Mexico it comes in 25mcg tablets it’s T3 its about $12.00. I would recommend seeing a naturopathic doctor. Best wishes, Carrie

  14. This has puzzled the endocrinologist as he could not understand why I could have a low TSH and a low (or under range) T3 with a low T4. I suggested I might possibly have two conditions hypothyroidism and low T3 syndrome.

    I was first diagnosed with hypothyroidism with a TSH of 8 and put on thyroxine. I was fine on thyroxine alone for about 10 years. I then started to get all the thyroid symptoms but my TSH was within normal range on the thyroxine (1.6) and therefore it was not considered my symptoms were anything to do with thyroid.
    I was offered anti depressants which I refused. As my GP was not willing to investigate further I went and had a private blood test done.

    I was found to have pernicious anaemia, and although my TSH was within range, my T4 was quite low within the range but my T3 was well below range.

    I saw a private doctor who prescribed T3 along with the thyroxine and all the symptoms went, some quicker than others.

    I am well on a combination of T4 and T3 together with B12 injections. I was diagnosed with diabetes type 2 a few years before the original diagnosis of hypothyroidism. All three conditions are hereditary (diabetes 2 on my mothers side, thyroid on my fathers, and his mother died of PA) . My sisters have diabetes 2 and hypothyroidism although they are fine on thyroxine only.

  15. I am trying to get help. Like the above poster I had TSH in the mid range, FT4 barely in range, and ft3 at 1.3 (2.0-4.2). I am on military healthcare, Doc (GP) says there is nothing wrong. Brought up all manner of secondary hypo, pituitary problems yet I get Euthyroid Sick Syndrome noted in my medical record no treatment, no recommendation, no referral. I am very anxious about this condition. I have a low tolerance for stress lately. Really struggling physically although im mitigating this through CBT and psychiatry. I am awaiting more of the above labs but I have a feeling I am more of a burden on my health care system, constantly feel like I am begging for an investigative approach to my symptoms. My last request I asked for antibodies and prolactin and testosterone. Well I guess I will have to beg even more for testing as I was only put in for two out of the three I asked for. Atleast I got FT3 again, after all, my Doc said it was not an important metric. Thank you for your post.. And thanks Chris for the Article. Especially hit home the comments about leptin and an overabundance of food and the rats and stuff. Rang a bell although I can’t put that into words. Which is why im going to again try to get better through diet. Although my diet is probably better than the average person.

    So far out of all the symptoms ive had over the past 4 or 5 years or so my best results came from limiting all sugar and carbs to very minimal and eating an even mix of protein, fats, and carbs. Low glycemic carbs. Lots of resistance training and try to limit over exertion through Cardio. But I am in the Marines so it is kind of hard to get adequate rest, get the right diet, etc etc etc. Probably have to get out due to this condition, but I really don’t want to. Thanks again for your time.

    • Low T3 syndrome is primarily caused by stress and inflammation. I imagine it must be really hard to manage stress in your current job, but it’s crucial that you do as much as you can in that arena. You should also ask them to test your thyroid antibodies to determine if you have Hashimoto’s.

      • Thank you for the response sir.

        My most recent labs were TSH 1.6, free t4 .89, t3 3.3.. all fairly good ranges right?
        I got a thyroid antibody panel, no results are in yet. But something incredible happened to me today. A CBC came back with slightly High MCH, and MCV, and Eosinophils 9%. Googled it and went to the exchange and picked up B12. 30 Minutes after ingesting the b12 my palate stopped itching, the sore on my tongue went away and felt less swollen, i stopped having chest pains, stomach pains, muscle soreness. Brain fog lifted a lot, cognitive functioning and reasoning got fairly sharp again. Headache I had today went away. Generally the “flare ups” as I call them went into remission. I have cycles like this sometimes 3X a week, sometimes 1x 2 weeks.

        I highly suspect some food allergy going on. Thanks a lot Chris.

      • I have hashimoto’s, but it seems that the treatment is the same as hypothyroidism. antibodies decrease if TSH is at low level. how do you treat hashimoto’s?

        • This is definitely true, mine went from 34 and now that I have been on T3 only for 8 months they are at 8. I am trying to get them to zero.

    • The TSH is merely the pituitary’s request for thyroid hormone…and ideal is at the bottom of the range, meaning that you have enough and it is not asking for too much more. T4 is the storage form of the thyroid hormone and must be converted by (primarily) the liver to T3. FT3 is the only usable thyroid hormone…and the only number there you need to worry about. The low FT3 suggests that your body is in down-regulation for some reason…stress, diet, illness.

      The low tolerance to stress sounds more like adrenal issues. Cortisol deals with everyday stress, but adrenaline deals with over-stress. As for myself, I do not make enough adrenaline so I am somewhat familiar with the subject…but can tell you that it is a lot more complicated than just treating the adrenals…and no, they will not give one adrenline as an rx (I have tried…if you find a dr that will please let me know). So…to try to explain in a nutshell, we make enxymes that convert things into things. In this case…we make dopamine (not in the adrenals) that we then make into norepinephrine (not in the adrenals)…that we then convert into epinephrine (or adrenaline). However, lacking the enzyme(s) to do this will result in not enough adrenaline. How this comes off for me is that stress instantly makes me feel quite ill and I almost immediately need to sleep. Unlike a normal stress reaction. A neurotransmitter test will let you know if this is the case.

      If so there is a relatively cheep genetic test (23andMe,com) for $99 that you can then see if you have mutations in the genes that instruct the making of the enzymes. Sometimes diet can throw off the cycles (ie the methyl cycle) and cause subtle and not so subtle health issues that doctors find hard to treat.

      Anyways, best of luck.

  16. I have had hypothyroid symptoms since the birth of my first child 4 years ago. I experienced significant bleeding. We think the bleeding was more extensive than the medical professionals realized, although they were alarmed when morning came. An annoying beep kept us up all night, and we realized it was MY monitor in the morning). At this time my b.p. was somthing around 70/50. I also developed gluten intolerance and have anti-gliadin antibodies. My TSH is normal, low free T3, lower free T4, and low zinc. Zinc supplements seemed to help briefly, but maybe not. I do not seem to have symptoms of adrenal insufficiency, but I am beginning to suspect Sheehan’s disease. Is this something you have dealt with in your practice? Do you have advice for a paleo/primal girl looking for testing/diagnosis/treatment in NC? I am already grain, dairy, and legume-free. My symptoms are weight gain, constipation (extreme when dosed with gluten), dry hair and skin, hair loss, cold, possible fatigue although I am a bit too busy. Thank you for your help in navigating conventional medicine!

    • Well, just got back from the endocrinologist, and well, it didn’t go well. She felt my free T3 was only barely out of range, so no problem. My TSH and free T4 were in the normal range, so no problem. My symptoms are apparently not important to a diagnosis, so I was patted on the back and sent my merry way. I have now been on strict paleo + no eggs and no nightshades for a month, but have had zero weight/pudge loss. I do bodyweight OR 1.5 mile run 3 times a week, which I plan to increase in frequency. I am feeling very frustrated. Any thoughts? Thank you!

      • It is not much consulation…but it may not be your thyroid. Which is frustrating (believe me, I get it) when you are trying to find answers. Too much thyroid can also cause weight gain or weight that is difficult to lose (internet doesn’t tell you that though). As can too much norepinephrine…as can too low taurine (an amino acid we make). As can many other things. Current science is now linking too much good bacteria in the gut…breaking down too many nutrients thus causing the body to absorb too much.

        I doubt very much that paleo results in weight loss…most people who are overweight (and I look at overweight as being a symptom of an imbalance) have nutrient deficiencies…thus, further restricting the diet is of little use.

        I know that exercise causes a release of glucose…which in turn causes a release of insulin (which makes you fat).

        Most people who take thyroid for weight loss are sorely disaapointed with the paradoxial weight gain.

      • Most people I have heard comment on the FT3, say they feel best when it is in the upper third of the normal range, even if the TSH is very close to zero.

        I was being treated for Graves’ disease with the anti-thyroid drug Methimazole (MMI,) and my FT3 dropped off the bottom of the range. I was in utter misery and stopped the MMI immediately after the blood draw, with the belated approval of my Endo #2. Later, my labs showed little if any increase in FT3 while my FT4 stayed mid-range and my TSH slowly dropped until it was borderline hyperthyroid, as tested by Endo #3, and I started on the L-T3 therapy with my regular doctor a month or so later. After the first 2 months of that treatment, taking L-T3 as I thought I needed (haphazardly) my TSH had risen more into the normal range, while my FT 4 and T3 where close to where they were before, but I felt a whole lot better.

        I was always told “it’s not your thyroid” but no one could find evidence of anything else.

    • I had almost the same thing happen to me after the birth of my second child and I suffered for over 6 years with all of your same symptoms. I kept having my thyroid levels checked and they kept coming back in the “normal” range. Normal for who?? What was my “normal” before my babies were born, I kept asking myself. Finally, my thyroid antibodies were tested and I was diagnosed with Hashimotos. The problem with Hashimotos is that is can fluctuate your thyroid levels up and down from normal to low and to high for several years. I think that every time I had my test done I was in a “normal” range. Get your thyroid antibody test taken. The TSH, T3 and T4 test are worthless in the case of Hashimotos. Good luck.

      • Thank you NicevilleMom. I don’t appear to have overt autoimmune disease, as I don’t produce antibodies to thyroid, thyroid hormone or tissue transglutaminase. I do, however, produce antibodies to gliadin and have elevated IgA and CRP, and low-ish free T3. I guess the short story is, I have gluten intolerance and clinical signs of general inflammation and hypothyroid without sufficient labs to suggest any treatment. Am self-treating with paleo diet but not getting results. I wish it would just get better, but barring that, I wish I could find someone to prescribe a trial run with Armour to see if it alleviates my symptoms.

        • To “maddieaddie” re “I wish I could find someone to prescribe a trial run with Armour to see if it alleviates my symptoms.”
          If unable to get Armour, you could try the Dr John C. Lowe, LLC product (sadly Dr Lowe died last year but I his people are continuing to to carry on his legacy to help people) – he helped formulate a dessicated thyroid product called ‘Thyro-Gold’…
          The following is excerpted from http://www.thyroidscience.us/products/thyro.gold/intro.thyro.gold.htm
          “Thyro-Gold is a whole-food product. It contains the whole thyroid gland from New Zealand cows. The thyroid gland from the cows is freeze dried and desiccated so that it contains all the natural constituents of the gland. The thyroid tissue in Thyro-Gold comes from pasture-fed New Zealand cows. The cows are raised without the use of antibiotics and growth stimulants such as estrogenic compounds and genetically-modified somatotropin. We assure you that the thyroid tissue in Thyro-Gold will always come from cows raised in countries such as New Zealand and Argentina. Our reason for using tissue from New Zealand and Argentina is that these countries maintain the highest standards for the health of their beef.”
          Might be of help to you? Just a thought…
          Peace,
          Mare
          S. Ontario, Canada

        • Hi Maddieaddie,
          You can get a product that is basically the same as Armour thyroid called thyodine at the greenwillowtree.com. I have been taking Armour for years and used this product when they reformulated Armour and it was not available for months. The dosage is not regulated so could possible vary from tablet to tablet but you can get an idea taking a thyroid supplement would help you.
          http://www.greenwillowtree.com/-strse-Thyroid/Categories.bok

    • Maddieaddie,

      I hope you still read this board, as I realize I am late in responding to your entry! Yes, there is a condition known as Sheehan’s Syndrome. Women who bleed out excessively during childbirth can cause damage to their pituitary. While pregnant, your pituitary swells beyond it’s normal size and it engorged with blood, trying to produce the many hormones your body needs for a healthy pregnancy. A sudden loss of blood at birth can cause a post partum pituitary necrosis. Some women will lose their pituitary directed hormones (thyroid is one) immediately, others lose hormones (adrenal, sex hormones, growth hormone, etc) gradually over years in no particular order. One thing Sheehans women always say: they never felt well from the point of giving birth going forward, yet doctor’s will offer all kinds of excuses for this. You know your body, if you still feel unwell please check out the blog Hypogal.com. Good luck.

  17. Your site was linked to an article I was reading from Mark Sisson about hypothyroidism and I wanted to write you.

    I am male, 52, and working with a well-respected M.D. in Monterey that specializes in men’s issues. I have been on sustained-release T3 for over a year now @ between 50-60mcg/day.

    Past labs showed continued improvement in TSH/rT3 levels until my levels crashed on my latest labs (see below).

    I have elevated rT3/TSH, HS-CRP, fibrinogen, increased android and gynoid bodyfat and other signs of chronic subclinical inflammation [I have had a long-standing chronic intestinal candidiasis infection and/or dysbiosis for 30 years, however, it is difficult to determine whether that is still “running in the background” causing upregulated overactive immunity or if it’s something else].

    I have been on the VLC Paleo diet for about the last year to help reset leptin and lose bodyfat. My fasting insulin is <2.0, leptin @ 4.0, but adiponectin is @ 4.0. I resistance train 4x's/week and am unable lose bodyfat and build lean mass. If I lose weight, I lose both mass and fat proportionately.

    I showed TgAb @ 21.5 which is within normal range (<40), but it is still a presence. I had <10.0 TPO (<35), but the symptoms I experience are classic hashi's symptoms [tightness/thickening feeling around throat, lowering of voice as described here: http://www.stopthethyroidmadness.com/hashimotos%5D.
    I also showed some benign thyroid nodules that came up in a scan.

    The rest of my thyroid labs as of 10-11:
    TT4: 6.5 (down from 7.1 in June, 2011)
    rT3: 262 (up from 176 in June, 2011)
    TSH: 4.406 (up from 1.96 in June, 2011)
    FT3: 2.9 (down from 3.4 in June, 2011)

    Also, my LDL went up to 144 from 92, but TGL dropped 147 to 113, HDL up to 47 from 42. HS-CRP @2.40.
    The only thing I changed is I went lower carb but read that in some LC can suppress T3 and raise rT3. I still eat some carbs, but very little. I am not on a keto diet.

    Doc wants a serum ferritin level of 150 for thyroid function and is focusing on the inflammatory signaling.

    I am interested in your further perspectives on treatment with respect to inflammation, hypothyroidism, etc. and whether you are open to work with a patient's physician.

  18. I had low thyroid symptoms for yrs. Synthroid & related synthetic brands were prescribed which didn’t help much at the low recommended dosages. The drs. refused to give higher doses which I was told might be harmful to heart function, so eventually I stopped taking thyroid meds 10 yrs. ago and just put up with the symptoms. In 2010 I tried taking a bovine based thyroid supplement recommended by a nutrition educated chiropractor. No noticable improvement. However at his suggestion, I did a saliva test which indicated I am glucose intolerant. After some time doing without wheat and similar grains, I began to feel better, more pep and energy. After awhile though my heart was racing a lot, going from the usual 60-70 bpm to 90 – 110 bpm. So I stopped taking the thyroid meds and my heart has gone back to normal.
    Now that the underlying problems caused by the wheat intolerance have been addressed, my body is healing and able to utilize the thyroid my body produces.

  19. Hey Chris,

    I noticed low body temperatures about a year ago (I was 24 at the time), so I got my thyroid levels checked. I had low T3, everything else was in normal range. I also noticed that my total/hdl cholesterol ratio was 5:1, whereas in the past it had been about 3:1 (in the ideal range). I’ve been eating paleo for about 2 years and was on the low-carb end of things. My theory is that I was seeing high cortisol levels from exercise, low-carb, and a chronic injury. My doctor had no idea about any of this, but was happy to give me some T3 to supplement with. I did my own research and learned that T3 can regulate reuptake of LDL cholesterol, so I tried the supplement.

    I supplemented T3 (25mcg/day cytomel) for about 6 months and started eating more carbs. I had my bloodwork redone about 1 month ago and my T3 had gone past the normal range and my t4 and TSH looked to have gone down a bit to counteract this. My cholesterol was back in the 3:1 ratio range though. I’ve since stopped taking the cytomel and feel ok.

    I would say that the T3 did offer a bit of an uptick in energy which was welcome. My temperature was still low throughout the period that I was supplementing (around 97.2-98.0 typically — so not super low).

    All in all, I think it was a good experiment to take the T3 supplement, I’ll try without for a while and see what my bloodwork looks like in another 6 months.

  20. Have you read any of Jack Kruse? He uses T3 measurement to diagnose Leptin resistance. It would seem that from his research that much of the symptomotology of Thyroid issues is actually a metabolic disturbance from Leptin resistance. His stuff is really interesting, just thought I would throw it out there.

    • Yes, I’m familiar with Jack’s work but I wouldn’t agree that all thyroid issues are related to leptin resistance. I have many patients that don’t fit that profile.