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.
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.
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:
- Low T3 Syndrome I: It’s Not About The Thyroid!
- Low T3 Syndrome II: Myths and Misconceptions
- Low T3 syndrome III: Inflammation Strikes Again
- Low T3 Syndrome IV: An Autoimmune Disease You’ve Never Heard Of?
- Low T3 syndrome V: Should It Be Treated With Thyroid Hormone?
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Hi – I am the classic case of having undiagnosed celiac most of my life leading to thyroid problems after my pregnancies. My kids were dx with celiac and then I was around the same time I was hypothyroid. I was treated with synthroid and although my levels were “normal” I still felt tired, on edge, cold and down. I went to a functional medicine doc and he looked at a more complete thryoid blood panel and discovered my free T3 was very low. He started me on cytomel around the same time I started the paleo diet. I ended up with SIBO and bad IBS and went low carb on the low FODMAP diet. I think I finally have that under control so have been following the PHD carb levels for a few months. I went back to this doc and after adding 10 mcg of cytomel, my TSH went down but there was only a small bump in the free T3, so he went down on my synthroid and added another 5 mcg of cytomel in the afternoons. I recently had levels drawn and my TSH is now .09, free T4 is .97 and my freeT3 is 2. I was on a strict autoimmune diet for almost a year, started taking selenium, supplement with fish oil. Not sure what else to do. I practice mindfulness meditation, yoga, exercise. So – am wondering if I do have some kind of autoimmune pituitary thing happening. I am sure I will be seeing an endocrinologist in the future.
Hi Ann. You should get tested for Hashi’s and Graves. Typically people with one autoimmune disease develop others. The way I understand autoimmune thyroid diseases, you want to completely suppress the thyroid, so you take a full replacement with your FT4 and FT3 being so low, you’re definitely not getting enough thyroid hormone. Dr. Brownstein has some good advice on treating autoimmune thyroid disease. You might get his books and study. He uses iodine and selenium. Especially with autoimmune, you can’t take iodine unless you also take selenium.
Hey Kayla. Did you have your thyroid antibodies tested? Is your liver ok? Have you ever tried supplementing with iodine, selenium, zinc to see if you could get your thyroid to produce and convert better?
Karen
Karen:
Liver is good, have not tested antibodies but thanks for the suggestion.
Have tried supplementing zinc up to 150mg/day and selenium 400 mcg/day with no help. Have not tried iodine as I understand overload/toxicity can have similar symptoms to deficiency and that concerns me, but I plan to try to assess iodine status at next appointment.
I developed some sort of problem after massive weight loss of 200 lbs. This all makes a lot of sense, but I still have no idea what to do about it. I developed what is currently being diagnosed as “hypothalamic amenorrhea”
I have low FSH, LH, and as a result — low estrogen, progesterone and free testosterone levels. Around the same time I developed highish TSH (in the 5-6 range), low Free T3 and usually pretty normal levels of FT4.
I am 26, it has been 5 yrs since the massive weight loss, and I have not menstruated normally in 4 yrs. Even with bioidentical hormone replacements, I do not menstruate. I have found I need massive amounts of hormones to normalize circulating estradiol (like 4x the normal amount). I use transdermal preparations/delivery systems (currently using FemRing + 2 pumps per day of .06% estrogel).
At the beginning of this illness – 4 yrs ago, I felt awful. Barely able to walk up stairs, hot flashes, severe weakness, night sweats.
I currently take Armour thyroid – again, pretty high dose (2 grains or 120mg/day), estrogel 2 pumps/day, femring, transdermal testosterone, and prometrium.
Combo of these meds does keep me stable. I have monitored intracellular micronutrient levels (selenium, copper, zinc, magnesium) and serum vitamins (D, E, A, K) and find nothing blatantly out of order. I also have leukopenia/low WBC which I would probably bet is related somehow. I have monitored inflammation with serum CRP levels but never get an abnormal result. I do not have any other inflammatory or autoimmune diseases.
I no longer have night sweats or severe lethargy, so I plan to stay on the meds, though I do feel they only treat the symptoms and not the underlying cause. No masses have been discovered on my pituitary, hypothalamus, or thyroid. At this point, I feel my disorder is on the outside edge of current medical treatment and I feel “fine” but wish my body would work normally because the prescriptions are expensive.
So, stable but not ideal situation. I worry about my bone density since I don’t menstruate and have difficulties normalizing estradiol levels. I have below average bone density for my age, and take a ton of vitamin D, calcium, and vitamin K to support my bones. I continue to monitor over the last 3 yrs and hope to see an improvement, but not holding my breath. At this point I would like to just stop the bone loss.
During my last pg I was experiencing extreme fatigue much more than normal pg tiredness. My mw did some bloodwork and all was normal except for low free t3 levels. Two days after starting cytomel I felt like a new person. I hadn’t even realized how depressed I had been until it lifted and I had energy for my life! It was amazing. I stopped the cytomel a few months after the birth of my daughter and all was well until recently ( she just turned three). I am again experiencing extreme fatigue ( not pg) and mild depression. In addition, my temp is real low. Normally I run low, like in the 98.0 range but lately it’s been in the 97.2 range. My mw doesn’t want to treat this outside of pg but she also says ‘good luck finding a dr who will script cytomel’. I came here hoping to find some guidance. I feel so crappy and really need some help!
Please ask your MW to order some more tests to find the root cause of your problem. If not the MW, find a dr, nurse practitioner, or go to a lab on your own.
Because your are 3 years down the road, and were fine for those 3 years, just taking T3 might not be the answer. To find out, you need to have more tests.
Retake the thyroid panel and ask for TSH, T4, T3, RT3, TPO, TGB antibodies tests.
You need to know if your making enough T4 AND if it’s converting too much of it ReverseT3 instead of T3.
I find Free T4/T3 tests are useless. Use Total T4/T3
If you are making enough T4 and it’s not converting to T3, you need to find out why.
TPO/TGB antibodies help you find out if your thyroid is having an autoimmune attack.
If that’s not the case, you might need an ultra sound of the thyroid.
At the same time . . . you want to do a complete hormone panel including
pregnenlone, DHEA-s, progesterone, testosterone, and estradoil (I think that’s how it’s spelled).
If the hormones are not optimal, it can affect your thyroid’s ability to function — and your body temp. I know of what I speak. At one time I was taking 80mcg of T3 and I was still at an average body temp of 97.5, for months. It was not until I started HRT that the temp rebounded to normal (within a few days), my thyroid function went back to normal, and I reduced my T3 to nothing.
At the same time as you do they thyroid and hormone tests, do a 24-hour cortisol test. You need to do all these tests on the same panel otherwise the results won’t tell you what you need to know. DHEA & cortisol need to be in ratio with each other, so you need to do both at the same time. Dhea & cortisol oppose each other. Too much stress, can cause the DHEA to crash, then cortisol is unopposed.
Once you have all this information, you’ll have a better picture of what’s wrong and hopefully understand what you need to do to feel better. Hopefullly too, armed with information, you’ll be better able to get what you need from a doctor, — even T3 if you’ve taken T4 or NDT before and have a history of adverse reactions. Some people can not convert T4 to T3 properly, so it’s not an option. Most people are fine with T4 + T3 (or NDT). If your thyroid really has a problem, a dr will be willing to help you.
There are websites that will sell you T3 without an Rx. If you live near the border you can simply go to a Mexican pharmacy and ask for Cynomel (same thing, spanish name). But I urge you not to self-medicate — especially if you really don’t know what’s wrong with you.
If after the tests are run and the answer is all you need is T3 but no doctor will help you, buy a copy of Paul Robinson’s book “Recovering with T3”. It’s the best advice out there. But I urge you to try and find a doctor or a nurse practitioner that will work with you because, at this point, you really do not know what’s causing your various issues.
You do not want to end up in a situation where taking T3 might only make things worse or mask a condition that is even more serious, like thyroid cancer or an internal infection that requires antibiotics.
I don’t follow this site, so I won’t know if you write back. Sorry. I hope you make a speedy recovery!
but can you eliminate a high rt# with naturethroid? or only cytomel?
I don’t think anyone knows the answer to that. I think it’s a crap shoot and you have to figure out what formula works for you.
Karen
They didn’t run TIBC and serum Iron just ferritin.
I am supplementing daily with Orthomolecular Vitamin K2 with D3, Orthomolecular Reacted Iron 29mg, Cytozyme AD for suspected Adrenal problems (I have not done the spit test), Digestive Enzymes, probiotics, and a multivitamin.
Hopefully this next round of tests will help me dial in the dosage. My doctor did mentioned that if my RT3 has gone down and my T4 is still low that she might add a small dose of T4.
Thanks again.
My Dr added some T4 back and even though it was a small dose once a day, it had major ramifications. You’ll know if it’s raising your RT3, just be aware. I had almost forgotten the nasty symptoms I had to deal with before and once I realized and stopped, things got back to normal.
I had just the opposite affect, Beth. I was only only T3 for about 16 months and never felt well despite my blood tests looking ever so much better. As soon as I added some NDT, I felt normal again. We’re all different. That’s why I mentioned to her that if she doesn’t feel good (don’t go by blood tests, go by symptoms), you might add in some T4. Many of us don’t feel good on only T3., Many of us ONLY feel good on T3. Everyone is different.
Also, RT3 is normal. The body converts well over half of naturally produced T4 into RT3. It’s nothing to fear until it becomes too high. It’s tough to get it all balanced. And, I’m not sure that even when you do, that it will remain static. I fear it’s a dynamic thing that fluctuates with activity, stress, age, hormones, etc.
The one thing I do know for sure is that taking TOO MUCH of any thyroid hormone will cause you to convert any T4 into RT3. So, be careful not to overdose whatever hormone you’re taking (if you’ve still got T4 of any kind in your system).
Karen
Karen
I totally agree, how you feel is most important! I had planned on weaning myself off Cytomel when I started taking t Naturethroid…oh well 😉 My major symptom (besides feeling tired, cold and all the rest) are terrible awful periods that won’t stop. I had one that lasted 4 and a half months! When that started back up, I knew I had to readjust.
Hi Chris, I wondered if you might give an opinion on diet and exercise for a newly diagnosed hypothyroid patient?
My labs are FT3 2.0, TSH 2.15, T4 1.0, RT3 30. Also low ferritin and vitamin D. Currently on 20mcg of cytomel.
My doctor thinks that my low calorie diet and exercise program combined with life stress could be the root of my illness.
My question is… What type of exercise and diet is best in my situation?
Thanks!
What are the ranges for your lab results? Also, did you do antibody tests/ You’ll need those as well as FT4 to make a full assessment. Did they test your TBIC and serum iron? Just ferratin doesn’t tell you much.
If you have high RT3, it could be because of your exercise and diet. Your body converts T4 to more to RT3 than T3 when the body is under stress (either emotional, illness or intense exercise related). Especially aerobic and anaerobic exercise. Weight training is hard on your adrenals.
I wouldn’t think that your exercise is causing your low FT3. but it could cause your high RT3 (don’t know that it’s high cause you didn’t include ranges).
Your thyroid also likes carbohydrates. So, if you’re starving your body of carbs, yes, it could also cause high RT3. Your adrenals like fats. So, if you’re starving your body of good fats, you could also be over stressing your adrenals. They want fats, cholesterol, salt and lots of Vit C.
A balanced diet with good fats and healthy carbs (veggies and fruits) are good for any body.
Does your diet/exercise routine also affect your menstrual cycle?
How long have you been on the cytomel? Were you on it when you had your last test run?
Hi Karen,
Thanks for your response. The lab ranges are listed below.
FT3: 2.0 (range 2.3 – 4.2 pg/mL)
FT4: 1.0 (range .8 – 1.8 ng/dL)
Total T3:116 (range 76 – 181 ng/dL)
Reverse T3: 30 (range 11-32 ng/dL)
Thyroglobulin Antibodies: <20 (range <20 IU/mL)
Thyroid Peroxidase Antibodies: <10 (range <35 IU/mL)
TSH: 2.10 mIU/L (range 0.40 – 4.50)
Ferritin: 24 (range 10-154 ng/mL)
Vitamin D 47 (30-100)
I began a intense diet and exercise regime approximately 3 years ago and did bootcamp style workouts about 6 days a week. I was on average burning about 2000-2500 calories a week working out and eating a low calorie (1500 cal / day) diet that entire time. It took 2 years to loose 18 lbs. In March 2012 after a period of intense stress I started gaining weight gradually even though I was doing all the above. Eventually I sought out a doctor who would run the full thyroid panel and got the results above in September. I started taking the cytomel mid october. I am up to 20mcg split between two doses daily. I am getting a follow up blood test run this week. My doctor says that I will likely be on a higher dose of the T3 because I am only in my 30s.
I have read so many conflicting reports about how to exercise and what to eat if you're hypothyroid, that I'm totally baffled. I want to loose the 5 lbs that I gained back since March but I just don't know what to do. Some say low carb is bad for Low T3.
Thanks again for the information. Any advice is appreciated!
Did you Dr tell you to increase your D and Iron supplementation? While the ranges aren’t too bad they are nowhere near the middle. Also you should have your B12 tested and make sure its in, at least, midrange. I also take Cytomel but in retrospect, I wish I worked harder at getting these three levels up before taking it. You may want to try splitting your doses into 3 or 4. Intense exercise can be brutal on your adrenals, have you had your cortisol tested? IF you are talking about cutting out unneccesary grains and potatoes, carbohydrates from veggies and fruits should be ample and good for your overall well-being including your thyroid, especially if you have Hashimotos although your test results seem inconclusive.
Yeah, I did a similar thing to you when I was in my 30’s. Stopped having periods because I was working out so hard and eating nothing. I did loose a TON of weight (got down to 98lbs). But, it wasn’t healthy and I’ve battled high RT3 ever since.
If I were you, I’d consider taking extra iodine AND selenium (don’t take one without the other), Vit E, extra C, magnesium and Vit D3. You have antibodies. I can’t diagnose you, but you shouldn’t have ANY antibodies. Being on the T3 is probably good for you. But, some people don’t feel good on only T3. Play it by ear and be willing to take natural dessicated thyroid if you need it. Maybe even just a 1/4 grain and then the rest in T3.
Taking the T3 will bind up some of your testosterone. And, while you’re female, you still need testosterone to burn carbs and build muscle, etc. So, just have your doc keep a watch on your FREE testosterone levels. I have to supplement testosterone even just on NDT.
What is your iron and TBIC level? You can’t tell if you need to supplement iron with only a ferratin level. You need all of the tests to determine if you need to supplement. But, if you’re low, you could have trouble utilizing the T3.
Sounds like you have a good doc. Mainly just eat a balanced diet. You need the fats, carbs and proteins, in balanced amounts to be healthy. Carbs feed your thyroid, fats feed your adrenals. Don’t skip meals and chill on the heavy workouts till you get healthy again. Walking/hiking/biking is very good for you. Just not the extreme aerobics and weight training. You’ll loose more weight by getting healthy and eating a balanced diet with moderate exercise than you would with your rigorous workout and starving yourself. The body shuts down your metabolism when you starve yourself (as you found out) by raising Reverse T3.
Karen
Karen
Thanks for the advice!
When my tsh level was elevated at 6.3 my doctor and I decided to try 50mcg synthroid. On the day my prescription was filled we drew my blood and my tsh had actually gone down to 2.3. I decided to take the medication anyway and I’m glad that i did. Within days my digestion became normal again after about a year of leaky gut symptoms. I have no hashi antibodies. Testosterone is at a healthy level. No HIV or other diseases. Only my T3 is at the bottom of the normal range. I am young. 24. Emotional stress precipitated my digestive problems. I didn’t have the stomach for food but i forced it down. Soon everything started to give me gas and later I started having allergic reactions to foods. I noticed that my legs were always, always sore. Things got worse for a while. Then i picked up some books on digestive health, connected a few dots and started killing some nasty bacteria. I caution anyone undergoing a candida/parasite cleanse to please take it easy. I went way too hard with it and roughed myself up. I wouldn’t doubt that a too aggressive cleanse could aggravate a pre-existing autoimmune disorder or worse, instigate an entirely new disorder. So please remember to support your immune system first and foremost!
I mentioned earlier that my TSH levels had actually fluctuated a bit dramatically while i was unmedicated. I think inflammation and stress from the die-off, fasting, high supplemental iodine and a serious love of saurkraut and raw cruciferous vegetables were to blame. After stopping all this my TSH came down to a normal level. but like i said the T4 has had a very positive effect on me. And my T3 is low. So I think i might make a good case study here. I plan to stay on synthroid for a few more months while supporting my thyroid, liver, and digestion and then coming off the medication. Tentatively speaking, I think I may have caught this thing early enough. Please, look out for anyone who says they are having digestive problems and inform them of the dangers. Get them educated and on a cave man diet pronto!
Thomas, I just read your comment of about a year ago. Would you please let us know how you have progressed since then? I hope things have went well for you.
My thyroid was removed for being enlarged and having nodules, so I must take thyroid hormone replacement. However, I have been and remained classically Low T3 Syndrome. On the best T4 only (Tirosint…T4 w/o any fillers) my TSH is at the low end of normal, my FT4 is at the high end of normal or even high, my FT3 is low, and my RT3 is extremely high (over 150 points above normal). I have tried the standard Synthroid (T4), Synthroid (T4) with some Cytomel (T3); Cytomel (T3) only; Nature Thyroid; and Tirosint (T4)…and am now back on Cytomel (T3) only. That said, I also follow many of the other patterns you describe…I have a positive ANA, positive RA Factor, high C-Reactive Protein; hig SED Rate…and I also have late stage Neurological Lyme as well as gut/digestion issues. I get what you are saying about the body making RT3 in an effort to help itself heal…which is all fine and good in theory…but low thyroid function over the course of many years is also not very good for one’s health and well being. As a result of low thyroid function, my muscles tighten up and knot on use…which makes walking and just daily functioning a significant challenge. I also understand that there are few, if any, doctors out there comfortable with a T3 only approach…however, as a patient who was told that if this situation cannot be corrected that I face becoming sicker and eventually dying, I do hope you will hurry at coming up with a workable solution. Lastly, my two cents on the T3 only issue…regardless of all the controversy, RT3 does dock in the thyroid receptors and does take a while to clear…then it just makes sense from a safety standpoint (in case I should go into a thyroid-coma) to not-have my system mucked up with all that RT3…just saying. Anyways, thank you for your article and all you are doing.
For what it’s worth, and it’s only my own opinion: It seems like chronic, untreated or under-treated hypothyroidism of any kind, including Low T3 Syndrome can cause a rise in RT3 and cause a vicious cycle to occur with the body, and doctors alike, treating it as a non-thyroidal illness that should continue to be allowed to suppress the thyroid, and so on. Also involved, imo, is the weight gain – dieting – more weight gain – cycle. I did read somewhere that extreme dieting can cause a rise in RT3.
I knew better than to diet while pregnant but I thought I was eating healthfully by avoiding foods with certain additives, while not realizing I should have replaced those foods with better choices. Then I became too tired to get off the couch and go into the kitchen to fix anything to eat. Finally, I just craved egg nog and guzzled it constantly until my baby was born January 8th.
If my thyroid problems didn’t begin then, it was much earlier, possibly even before my own birth.
Hi all –
The background: I have hashimoto’s (high antibodies) but so far my TSH has been fine since I was diagnosed in 2005 (highest it has been is 2.5). But, I still have been feeling terrible, and recently I was diagnosed with low T3 by my doctor. So, I was put on 5mg Cytomel twice a day which I’ve been doing for about 3 months.
The question: Is it possible that cytomel would make you gain weight/slow your heart down? Ever since I went on it, I have gained about a pound per week despite not having changed anything in my diet. I’m not overweight but if this doesn’t stop, I’m going to be. Heh. I also am incredibly thirsty all the time. I can’t get my heart rate up above 135 at ALL (I can’t run because of hip surgery, but even walking really fast at an incline, I can’t get it up high. This shouldn’t be a problem since I’m not exactly a world class athlete). From everything I’ve read, this is the opposite of what SHOULD be happening with the T3. So what’s going on? It hasn’t been very long so maybe it’s just coincidence, but still…
I am just concerned that I’m having a backwards effect and that this could mean something Bad. My doctor didn’t seem to think that this was caused by the T3, but I don’t know what else it could be. Anyone have any ideas or can point me towards a resource? I haven’t had much luck googling this one. Thanks!
Julie: there’s NO need EVER to raise your heart rate higher than that if you are exercising, unless you are an elite athlete. methinks your adrenals are depleted from either over exercise and you need to add SALT to your diet.
I believe your thyroid needs to be at optimum levels, probably in the upper third of the normal range to feel good and avoid uncontrolled weight gain. You also need to eat nearly as much calories as you are burning, with a good variety and balance of good foods. Restrictive Dieting will backfire. Having a heart rate above 100 is far too high. I try to keep my resting heart rate under 80 bpm even while taking the smallest possible crumb of Cytomel every other day.
Julie, since it has been a long time since your original comment, would you care to share what has happened to you since then? I hope you are feeling better and getting your issues resolved. 🙂
Hi There~
I have some T3 questions as well. I am a 29 year old female, not overweight, and relatively healthy. I’ve been eating Paleo for several months now and have taken out gluten and most refined sugars and dairy. Trying to stick with meats, veggies, fruits, healthy fats, and some starchy carbs. I have a 20 month old daughter who I had low progesterone with and was on Prometrium through the first tri. I got pregnant again a few months ago and then miscarried at about 6 weeks. I also had low progesterone then.
I had blood work done about 2 weeks ago and got my results back. Low in:
-Vit D 24 L
-Iodine 49 L
-T3, TOTAL 56 L
-DHEA 39 L
My TSH is 1.07, and my T4 is 7.2. The doctor has put me on 5mcg of Cytomel a day plus 2 drops of 5% iodine a day, 5000 iu of vit. D, and 10 mg of DHEA per day.
I have not felt that my hormone levels are right as my cycles are a bit irregular. I also have suffered from fibrocystic breast pain. As I said, not overweight…I’m 120 lbs at 5’7 1/2 and have been close to this weight my entire life. I exercise…yoga, walking, weights. I have insomnia from time to time, where it feels like my body won’t shut down and usually around ovulation or my period. I have suffered with some depression in the past but it was most severe a long time ago. I’ve also been under a lot of stress post-miscarriage but am doing a little better now and trying to focus on diet and less stress.
We would like to get pregnant again soon-ish. I’m concerned with taking this T3 and DHEA. Would I do better to try the Vit D and Iodine, and possibly the DHEA and see if that bumps my T3 level up on its own? I admit, I don’t know a lot about the thyroid levels and meds. I don’t want to cause further harm here but want my body to be healthy for the next baby.
Any help would be greatly appreciated!
I don’t think 5 mcg of Cytomel is going to do much of anything. You should join one of the Thyroid Patient Advocate groups to learn more about subclinical Thyroid and get input there. http://health.groups.yahoo.com/group/RT3_T3/ focuses on T3 only. There is a good primer on the topic at http://www.thyroid-rt3.com/
Your sex hormones and thyroid are all related so adjusting your vitamin levels and thyroid could normalize progesterone, estrogen and testosterone.
Best of Luck
Please be very cautious about the advice given on the RT3 groups. In my opinion, they do not understand the RT3 issues well and will have you royally upset the balance of hormones in your body. I followed that groups advice for several years and just made a mess out of my body and know many others who have done the same.
It’s difficult to find good advice and help, this some of the internet groups are way too aggressive!
I second that re the RT3 Yahoo Group…I watched as they told a woman not only to ignore her heart palps but keep increasing her T3 and she had a heart attack. I have RT3 issues and found their advice to not have had anything to do with my issue. As well, people’s RT3 is high for a reason…and if one just treats the RT3 and never looks into the underlying condition they are doing each other a disservice, imho.
You probably need to get more testing to figure out exactly what the issue is. It’s be good to have FT4, FT3, TPO and TGIab as well.
The vitamins can’t hurt. Selenium is very beneficial to both hormone metabolism and thyroid metabolism. And, along with Selenium, you’d want to supplement Vit E.
While taking large doses of Vit D, you should also supplement Vit A and K. I like the Carlson products. My suggestion would be their ACES product and their Vit K product.
Supplements *can* be helpful…but for those with genetic issues (and many more have them than realize), supplements can do more harm than good. Just wanted to thow that out there into the mix.
Kati, I see your original post was over a year ago… How are you doing now? I notice that Chris rarely responds to what is said here, and when he does, he makes it clear he can’t diagnose online. I would simply suggest that if you are not getting the help you need from your current doctor that you might want to go elsewhere for a second opinion.
I really would like to hear back about what has happened in the meantime. I hope things are better, but even if they are not, it would be good to hear from you.
Does taking T3 involve a medication name or brand name? Where do you buy it? I see a medication called levothyroxine that might be available without prescription on the internet overseas. No doctors willing to prescribe anything for only low T3. (prescription = just gain more weight and suffer). I have low T3 (but normal in all other number, TSH, T4 and free T3 and T4) and am FREEZING cold all the time. I can’t work because I can’t tolerate the extreme cold in the workplace. My unemployment insurance is running out. HELP!
There are Doctors who will prescribe it, keep trying. Alternatively there are sites that sell Mexican Cytomel but its a drug you have to be very careful of as it can stress your adrenals and make your condition worse. Your T4 is probably not converting to T3 which is what your body needs. Several things are thought to cause this, low ferritin, iron, B-12 and D. So you need to get tested for these and treat. If you do decide to treat yourself get the book Recovering with T3 by Paul Robinson.
Marie, how are you doing now? I hope you have been given some help. I have been posting some answers to others with similar questions… If you are subscribed to this entry, perhaps you have gotten an email about what I have said. Alternatively, you can do control F to find the occurrences of “Fern”…
Gut-Thyroid connection?
I know you are very buisy but perhaps you could offer you perspective. I have had low thyroid symptoms for 3 years now and recently started losing my hair. I was tested as having a TSH of 4.9, 5.3, and 4.7 within one month with a TPO antbody of 5 on the last test. My doctor says my free T4 is normal (14,2 pmol/L) they did not test free T-3.
The doctor says my labs are normal and will not treat but I still have typical symptoms of hypothyroidism. I have eliminated gluten and processed foods.
What is interesting is that about the time when my thyroid symptoms started I became very severly ill with some stomach bug after eating at a fast food resatraunt. I was fine in the morning, and by evening I was vomiting and having diarrhea continously for six hours until I was vomiting blood.
I Went to the hospital who did nothing more than give me morphine and take an abdominal MRI. said they didnt know what was wrong and let me go. I could barley keep anything down for several weeks and lost 20 pounds (and i only weighed 130 to begin with) worst pain i have ever suffered.
I have suffered continual flair ups with vomiting and diarrhea for no apperant reason then got diagnosed IBS which the doctor said was “emotional”.
My mother got the same bug I did, but her doctor gave her Rifaximin, and her digestive issues resolved.
Im not normally pro-antibiotic, but could a persistent bacterial infection in my gut be causing my other symptoms? could an antibiotic help such a condition?
Don’t go back to any Dr that won’t test your Free T3, it is the most important test for thyroid! Your TSH alone indicates you are hypothyroid! Your gut problems are interesting. I think I started feeling hypothyroid after a particularly bad intestinal bout. It *seemed* to resolve itself and I never gave any thought to the interemittant bouts of intestinal trouble I’ve had till I has a parasite test and it came back as blastocystis. It does seem that Rifaximin is the best treatment for it but it’s horribly expensive in the States even with insurance ($1200 in my case). I’ve ordered some from Mexico and hope it resolves everything but know that I may still have to deal with the hypothyroid. Best of luck!
Thank you Beth.
Unfortunatly I’m stuck with this stupid government doctor for the time being (I live in Sweden)
I would like to go to a private doctor but am currently unemployed and dont have the money.
I’m thankful for the care I have gotten here so far, because in the states I would have not have been able to afford even this, though poor care and apathy towards thyroid patients seems to be epidemic all over the world.
I have tried looking for Rifaximin in online pharmacies but most of the one I have found have bad reviews and I am a bit leery ordering anything from them as many peddle counterfit drugs.
I did find a place in the states with good reviews that I will order dessicated thyroid from though, because I’m tired of feeling crappy all the time and I’m really tired of knowing more about my condition than doctors and having to be at the mercy of their ignorance.
You’ll probably never see this, but Yersinia enterocolitica is a food-borne pathogen that causes e.g. bloody diarrhea. It has been connected to autoimmune thyroid disease, though the connection has also been disputed. However, even if this was the cause, that does not mean that antibiotics would necessarily help, as infections may trigger an autoimmune disease even if the actual infection is cured.
I have had neuropathy and fatigue for 6 years now. I can’t walk around the block with out electrical shocks in my legs. I trip and fall all the time. Had a high TSH to start with, with normal free T4 and T3. Now my TSH is under 1.0 and my T3 is low, and I have thyroid antibodies. I can’t remember the rest of the numbers. I had an MRI with contrast showing moderate demylenating disease that is not active. I’m on LDN 4.5 mg per night, and have been on it for a couple years. My new Dr has started me on Cytomel, I’m up to 36.5mcg per day in three divided doses. No signs of hyperthyroid symptoms. I can walk normal again, I can almost run, no tripping, great balance. I’m also on Adrenal support, DHEA, Pregnenolone, and some testosterone cream. All my hormone levels were low, except estrogen and progesterone, which is odd cause I’m 49 YO. From what you have mentioned in your articles makes me think my hypothalamus and pituitary are not working as they should. I’m very cold most of the time, I’m still cold on the T3. I read that low levels of T3 cause demylenation and raising up the T3 can cause remylenation. I feel so much better. Do you think this treatment with T3 could be harmful? Thanks for your articles, and any information you can provide.
I am new to all this. Just started nature throid and adrenal support via l tyrosine and small amount of raw adrenal. My concern is, doesn’t raw adrenal basically take over for and shut down the adrenals?
The T3 won’t fully work until you optimize your iron, ferritin, B12 and D. You also need to have your sex hormones tested. Are you breaking your doses up into 3 o 4 daily? Make sure you don’t have any food with iron when you take your medicine, that includes cereal (typically fortified with iron). Or don’t have any food at all with the doses. The T3 binds with iron. Also you need to slowly increase the dosage until you feel better. This can be a two year or longer process and you don’t want to make any great changes in T3 dosing as it can compromise your adrenals. The infections your son is having don’t sound like thyroid exclusively, perhaps he has a few things going on. Have you all tried cutting out gluten? Those are symptoms of celiac, as is your aching and is a genetic disorder. Many have both Hashimotos and Celiac which are both autoimmune diseases. Best of luck
I am 50 years mm with two children aged 29 and 15 years. I am currently (5 years now) on T3 following very low t3 results. I cannot say it is working for me since other symptoms of weight gain, fluid retention (all over the body including lungs) and lumps under the skin have not gone. Plus many other ailments that are not menopause related. My health has not improved and sometimes I can hardly walk without having my body ache all over like one with pneumonia. My eldest son seems to have the same problem with low energy and weight located in his waist. The 15 year old is now out of school due to ill health. His tests show slightly lower t3 and he is suffering attack after attack of infections, has lost weight, falls asleep in class. Some doctors think he is having problems in school but is high fever, diarrhea, headaches, swollen tonsils, ear infections that last weeks psychological? Does Somebody have answers for my family?
First, before assuming you need medications, I would check your diet and environment. Your house (radon, mold?), water, who knows? Are you eating healthy foods or the SAD (standard American diet) with lots of empty calories? Are there a lot of people in your area who have the same issues?
Hi Deborah (you posted July 18/12 @ 5:41 pm) – you wrote that you were given “additional T3 capsules”. Do you mean you were taking T4 but then your doc added in T3? I can only speak from my own experiences, we are each individuals and so can respond differently than someone else to the same things, but, the reason I ask is because in my own case, when I was given T4, I felt much worse, similar to what you described as happening to you. This was because ‘my’ body didn’t actually need T4, it needed T3 as I too have a dysfunctional conversion of T4 to the active form, T3. So I am wondering if you might not need T4 at all but might rather benefit more from T3 without T4 as I did? (per the work of Dr John C. Lowe @ http://www.drlowe.com). Also, if your adrenals aren’t also receiving supplemental support as well, I personally think it’s doubtful you’ll feel much better overall (just my opinion:-). I had taken tons of supplements and changed lifestyle and spent thousands of dollars over the last 13 years cleaning up my diet, practising stress reduction, etc etc, all the things experts tell you to do but I only really began noticeable (and lasting!) improvements when a) I was put on Cytomel (T3) alone, b) more improvements when I completely stopped drinking/cooking with fluoridated water last Nov 2011 (reflected in vastly improved thyroid test results in Dec 2011 because fluoride is a known thyroid suppressant, hence it’s prior use in Graves Disease) and c) even more benefits in every aspect of my life (sleeping better, improved energy, better digestion, etc etc) when I was finally put on an adrenal support supplement (‘Adrenplus-300’ by Douglas Labs – contains various adrenal-enhancing vit/minerals but also actual adrenal and spleen concentrate) 2 months ago. Just some thoughts and am sending healing thoughts and best wishes for finding the solution for ‘your’ body:-)
Peace, Mare
I have had problems with my thyroid in the last four years; my T4 is not converting to T3 and I was given additional T3 capsules. I about lost my mind; extreme depression and laid our on the couch most the time. I kept consuting my medical person and she said just hang in and you will adjust . I did not and finally quit it before I contemplated suicide. Having knowledge of mental illness I knew it was the medication and not me so finally had sense to quit and my depression went away. I am still tired and my TSH went from 1.14 to 2.25 and the internet said that was normal. Well, it is not normal for me as I feel very, very tired and felt better at 1.14. He admitted he knew nothing about hormones – did he really to to medical school? – so I am wondering is it anemia or what.
It is very true that low thyroid causes depression…and the sad fact is that anti-depressants further supress the thyroid (hence making the depression worse)…however, because the two bodies of medicine never seem to talk with each other we end up with all those law suits regarding anti-depressents as opposed to drs just waking up and realizing it is probably a thyroid issue. Sorry that you went through that.
Deborah, how are things going now? I see it has been over a year since you posted this.
I was going to suggest getting a second opinion from another doctor, but a lot could have changed in this time. I hope you have been getting better. 🙂
what a ‘nightmare’ this thyroid thing has become. in 07, i was having really bad hot flashes at night, thanks menopause and that was my only symptom so went to see my dr. and was told that is was hypothyroid but that was based ONLY on tsh, no other tests were done and i was put on 50 synthroid which i took with seemingly, no problem until about 2 yrs. ago when i started feeling sick after taking it, i got sudden, severe skin wrinkling, muscle loss in arms especailly and most of my eyebrows are gone, hair changes, A MESS and so i went to endo. he only based on tsh so i fired him and then, this dr. and that dr. and finally, my g.p. who is very willing and we are trying to figure this out together as he at least admits that ‘they don’t know’ exactly how to treat or what dose is right and of what medication. he sent me for tests and they are:
tsh: 2.379 0.358 to 3.74
free t4 0.85 0.76 to 1.46
free t3 183 210 to 440 (LOW)
total t4 10.3 4.2 to 13.3
total t3 0.87 0.7 to 1.9
he/we decided to try armour, i had bad reaction, heart palpitations and other things so, since i’d taken synthroid before, he started me on 25 synrhroid and 5 cytomel but i had strange reactions to cytomel too so then, just the other day i saw him and he said ‘try cytomel only’, i did and felt awful physically and emotionally so, now, i am trying 1/2 dose of armour, 15 a.m and 15 afternoon, i’ve never felt worse and like i’m not myself and no clue, what to do. why is my free t3 so low and what to do about it. i also have psoriasis since i was 5 and back then, we thought it was just a skin disease, didn’t know it was an immune disorder, i just wish someone could really figure this out.
Given that you have psoriasis, is a good indication that you may have allergies. Have you tried eliminating dairy and wheat? They are most common but also soy, corn and eggs.
You don’t say how long you have waited between these changes. It is my understanding that these medications do not show an effect for weeks, not hours or days. If I am misinformed, someone please let me know. It just seems if you are not waiting long enough between changes, you can’t be sure which medication or dose you are reacting to.
Laura,
You mentioned you thought that thyroid medication needed weeks to show affects…The affects of T3 can be felt rather quickly and am told that it only stays in the system a few short days. The so-called “nature” or deccicated pig thyroids contain small amounts of T3 in addition to T4. Hope that helps.
Levo-thyroxine, or L-T4 takes weeks to show an effect in your system because they have to convert to free T3 first, but L-T3 takes effect right away.
I know that the 5 mcg cytomel is the smallest size they make, and it is way too much for me, even though I need it desperately, so I cut the pill in quarters, to make a “fat quarter” which I then slice in half the other way to make a “thin quarter” (0.625 mcg) which I have just started taking every other day. Time will tell, but in the meantime, I believe it is valuable to have a day of rest between taking it.
L-T3 has a half-life of about 24 hours, if I understand correctly, and the high point for its effect is between 3-4 hours after taking it. It is because it is both fast acting and fast leaving your system that I have wanted to take it. I have both anti-thyroid and thyroid stimulating autoimmune antibodies going on, and I want to regulate myself according to what I may need at any one time.
Ah…the best resource that I have found regarding thyroid autoimmune (and autoimmune in general) is Dr. Datis K.’s book, Why Do I Still Have Thyroid Symptoms When My Lab Results Are Normal. He gives a very compelling hypothesis on how to overcome autoimmune…which I think might be stretched to cover other autoimmune issues as well.
Thank you, Faith, for responding to what I posted. I will look into the book if I can find it at the library, however, I am doing well on the dose I am taking now, namely, 1.25 mcg daily.
Conventional MDs have told me there is no cure or treatment for the autoimmune problem.
Mary Shoman recommends that book, I know, and her articles at About.com have been of some help to me, but I also know that some things she says is at odds with the traditional medical community. Even regular doctors are sometimes labelled quacks for diverting too much from the current decrees of the powers that be.
My ideas are also unconventional to some degree, depending on my personal experience with the disease, but if we all have differing opinions, not based on actual evidence anyway, why not go with the one that works for you?
My doctor sees the need for me to be treated with Liothyronine and is doing it–being more definite about how I should dose myself now. In a couple of weeks I will have new labs and the results, and I will go from there. Until then, I check my blood pressure and heart rate, since I know that a rise in those numbers could cause alarm bells to go off in those who are afraid of having a person overdose on thyroid hormones.
I generally try to look into the actual clinical trials that have been done to avoid being mislead by the various ideas that are on the internet, however.
And, Faith, would you mind explaining what your credentials are in regard to the thyroid?