How to Increase Free T3 Levels Naturally: 8 Step Guide + Trips & Tricks

How to Increase Free T3 Levels Naturally: 8 Step Guide + Tips & Tricks

Free T3 levels are THE most important measure of thyroid function.


Because T3 is the active thyroid hormone in your body, it does all of the heavy lifting when it comes to thyroid function. 

Everyone wants to have "normal" free T3 levels because that's how you optimize thyroid function and feel better. 

But the big question is:

How do you do it?

And that's the frustrating part...

There's an easy way to increase free T3 levels and there's a not so easy way. 

The easy way to increase free T3 is by simply taking T3 thyroid medication like Liothyronine or Cytomel

This strategy works well if you have a Doctor willing to work with you and change up your medications. 

But what if you don't?

If you don't then you'll have to be smart about how you approach thyroid function. 

And that's why I'm going to talk about the "not so easy way" today:

Taking the natural approach and doing everything in your own power to increase your free T3. 

Let's jump in: 


Is it Possible to Increase Free T3 Levels Naturally?

The answer is yes. 

There are actually many different factors that are within your control and each of these factors may be acting like a "brake" on your thyroid function right now. 

The goal with treatment is to "release" the brake and allow your body to function to whatever capacity it is capable of. 

To get to this point you need to understand the most common problems that may be slowing down your thyroid function and acting like a brake on the system.

To make this simple, you can use this image to help guide you: 

Factors that affect thyroid function

This image outlines the steps that thyroid hormone must go through before it is activated and able to function in your body. 

Each step in the image is a potential place that can "slow down" thyroid function and lead to downstream problems in thyroid hormone metabolism. 

In order for thyroid hormone to function properly in your body it must:

From the image, you'll notice that there are several key vitamins and nutrients involved in each step. 

You'll also notice that several environmental factors can also influence these steps. 

Our goal will be to focus on these steps to naturally enhance thyroid function. 

With this in mind, we can now discuss the 8 main steps that you can take to improve your free T3: 

1. Optimize Key Nutrients

There are many nutrients that are required to create thyroid hormone in the body, in addition, several are involved in the conversion of T4 to T3. 

You can imagine a scenario in which a minor deficiency in any of these nutrients may cause big problems for your thyroid. 

In a world where the soil is depleted of nutrients (3) and where we often eat unhealthy and processed foods (4), it's easy to see how we can be deficient in some of these major players. 

And that's exactly why you want to ensure that you have enough of these nutrients in your body. 

Even though there are at least 15 major nutrients involved in regulating thyroid function at all three levels, you don't need to necessarily worry about every single one

Some nutrients tend to become deficient more readily compared to others. 

For hypothyroid patients, nutrient deficiencies in Zinc, Selenium and Vitamin B6 tend to be more common than deficiencies in fat-soluble vitamins (5) such as Vitamin A, D, and E. 

Yes, vitamin C and Vitamin A are important - but for the most part, people aren't commonly deficient in these (though you still may want to ensure that you are not before you skip supplementing with them completely). 

So, how can you replete these nutrients if you suspect (or know) that you are deficient?

You can supplement with these vitamins in 2 major ways:

The first is through your diet and the second is through over the counter supplements. 

Consuming vitamins through your diet is the ideal approach but it can be difficult. 

natural thyroid supplements version 2

If you are already eating a healthy diet, and you still suspect you are deficient, then supplementing may be your next best step. 

But not all supplements are created equal. 

Some, low quality and cheap vitamins, contain the wrong formulation of vitamins or contain fillers and dyes which may make absorption difficult. 

You can bypass these problems by only purchasing supplements from reputable places (avoid using grocery store brands and Amazon brands). 

When you find a reputable brand, look for the following nutrients (and formulations):

I recommend using a combination supplement with contains both Zinc and Selenium such as this one

These aren't the only nutrients involved in regulating your thyroid, so be sure you also evaluate for other deficiencies as well. 

Most people, based on my experience, tend to notice some improvement when replacing basic nutrient deficiencies. 

The benefit that you may obtain likely depends on the degree of deficiency (if present) in your body. 

2. Improve Gut Health

Your gastrointestinal tract does much more for your body than just absorbing nutrients and food. 

It's best to think of your gut as an organ system which contains its own hormones, neurotransmitters and is an active participant in your overall health. 

As it relates to your thyroid, your gut may help your body "activate" up to 20% of thyroid hormone (8). 

It turns out that the composition of the bacteria in your gut matter a lot when it comes to optimizing your T3 levels. 

And here's the deal:

It's very possible that you may have some gut related issue because of the way that thyroid hormone influences the GI tract. 

It's a bi-directional relationship. 

Thyroid hormone helps your stomach produce stomach acid (9) and it also helps your intestinal tract move forward at a normal pace (10). 

When thyroid hormone is low your intestines move slower (predisposing you to constipation) and making you more likely to develop conditions like SIBO (small intestinal bacterial overgrowth), Yeast overgrowth and Acid Reflux.

Gut issues can also further worsen nutrient deficiencies as stomach acid falls (11) due to malabsorption. 

All of these conditions predispose you to develop a condition known as increased intestinal permeability (12)(also known as Leaky Gut). 

When your intestinal barrier becomes less effective (AKA you develop Leaky Gut) an endotoxin known as LPS can get through into your blood stream.

LPS directly lowers T3 levels in the blood (12).

Now that you understand how important your gut is for your thyroid the next big question is what can you do about it? 

Treating Gut Imbalances

The first step is a diagnosis. 

In many cases, a thorough history of your intestinal function, including your symptoms, is enough to help direct treatment and diagnose gut related issues. 

For instance:

Are you experiencing bloating, gas or abdominal pain 30-60 minutes after a meal? You may be suffering from a combination of SIBO +/- Yeast overgrowth.

Do you get a metallic taste in your mouth when you lay down at night or do you get a burning in your chest after eating certain foods? You may be suffering from acid reflux or GERD.

Do you suffer from chronic constipation, pain with bowel movements or alternating diarrhea and constipation? You may be suffering from intestinal dysbiosis or irritable bowel syndrome (13). 

Are you experiencing depression, acne, seasonal allergies, asthma, autoimmune disease or any of the above symptoms? You may be suffering from increased intestinal permeability or leaky gut. 

By evaluating your symptoms and history you can usually get yourself started in the right direction. 

Addressing these gut related issues may help to improve the intestinal concentration of bacteria in your gut and may, therefore, help improve your thyroid. 

Treating each of these can be very tricky and may take anywhere from 3-6 months (or longer!) depending on the severity.

But, having said that, I do have some recommendations to get you started right away:

  • Consider using a digestive Enzyme - Digestive enzymes help your body break down food and help absorb nutrients. They can also help to break down immune complexes in the blood to help treat autoimmunity. 
  • Consider using an Ultra potency, multi-strain probiotic - High potency, multi-strain/species probiotics can dramatically reduce local inflammation in the gut and even reduce systemic inflammation. Patients with hypothyroidism/Hashimoto's should ALWAYS use a high-quality probiotic for 2-3 months and then switch to a daily probiotic for maintenance. 
  • Use Essential Oils to kill off bacteria and yeast - Essential oils have been shown to be as effective as antibiotics in treating SIBO (14). I recommend using a combination of Oregano oil, Thyme, and Berberine.

Use these to help get you started, but realize you may need further testing to completely fix your gut.

3. Reduce Reverse T3

In case you aren't familiar with Reverse T3, I will fill you in. 

You can think of Reverse T3 as an anti-thyroid metabolite that your body creates under certain conditions. 

It acts by directly inhibiting or blocking the actions of free T3 (15). 

This is not a good thing! (You do not want this to happen in your body). 

Reverse T3 is the product of evolution and its function is to act as a natural "brake" on your metabolism in cases of emergency. 

For instance:

If you are critically ill or sick from some life-threatening infection, you want your body to focus on killing the infection and not on growing your hair follicles. 

Your body directs energy into certain tissues by manipulating reverse T3 levels. 

Unfortunately, it can very easily get out of balance due to a number of conditions including Insulin resistance, Leptin resistance, inflammatory states and the use of certain drugs (anti-depressants, beta blockers, mood stabilizers and pain medication)

When this happens reverse T3 levels rise and they directly BLOCK your free thyroid hormone. 

Because of that, you want this guy as low as possible.

You can easily evaluate your reverse T3 level with a simple blood test known as reverse, Triiodothyronine. 

By checking your reverse T3 you will be able to determine if this is a problem for you or not.

Because of the importance of reverse T3 on thyroid function, it's always a good idea to order reverse T3 when you check for other thyroid markers such as TSH, free T3, and free T4.  

You'll want your reverse T3 to be as low as possible and definitely less than 15.0 ng/dL. 

You can lower high levels of reverse T3 with these strategies: 

  • Get on T3 only medication (Like liothyronine or Cytomel) - Using T3 only thyroid medication will directly increase your free T3 and overpower existing reverse T3 competition. It also acts to help reduce Free T4 levels in high enough doses. 
  • High-intensity interval training - Adding HIIT will help your body create a demand for thyroid hormone and help "push" T4 down the T3 path and not the reverse T3 pathway. 
  • Stop restricting your calories - Calorie restricted diets create a "starvation state" which your body responds to by increasing reverse T3 conversion (16). This will ultimately make weight loss more difficult. 
  • Reverse Leptin and Insulin Resistance - High levels of Leptin and Insulin tell your body to create MORE reverse T3. Read this guide on how to reverse Leptin Resistance here and how to reverse Insulin Resistance here

4. Optimize Iron & Ferritin

Adequate iron levels are required for optimal thyroid function.

Studies have shown that the level of iron correlates with TSH activity and cellular thyroid function (16). 

This means that if you have low iron then your thyroid function may be impaired and contributing to your current set of symptoms. 

One easy way to assess for iron in your body is with the use of ferritin. 

Ferritin can be easily ordered through routine lab work and can give you an idea of the status of iron in your body. 

Low ferritin may indicate that you have low iron stores while high iron may indicate that you have high iron stores. 

When it comes to iron you want to try and get just enough. 

That's why I refer to Iron as a "Goldilocks" kind of nutrient. 

Too much may cause iron overload and lead to inflammation (17) while too few may lead to impaired thyroid metabolism. 

I've written about how important iron is to thyroid function here, but I will point out some of the most important parts in this article:

  • Low Iron makes Thyroid medication less effective - Iron is required for proper T4 to T3 conversion. Low iron = low conversion. 
  • Iron is required for adrenal function - When your adrenals aren't working they put increased strain on the thyroid and lead to adrenal fatigue and adrenal burn out. 
  • Hypothyroidism leads to Iron deficiency - Thyroid hormone is required for Iron absorption. When thyroid levels are low it leads to iron deficiency which in turns worsens thyroid function in a vicious cycle. 
  • Hypothyroid patients tend to do well on Liquid Iron (instead of Iron tablets) - Remember when I said that Hypothyroid patients tend to get constipation? Well, iron tablets can actually make constipation worse. For that reason, it may be preferable to use liquid iron to reduce gastrointestinal upset. 

When you are evaluating your serum ferritin you'll want to look for levels in the 40-60 ng/mL range. 

Values less than 40 ng/mL may be contributing to hypothyroid symptoms (18) and thyroid dysfunction. 

You can treat low ferritin with the use of over the counter iron supplements such as liquid iron or iron tablets/capsules. 

5. Check Liver Function

Remember when I told you that 20% of your thyroid is activated and converted in the gut?

Well, a large majority of what's left is converted in the liver. 

Some estimates put it as high as 60% (18).

Which makes your liver one of the most important organs for ensuring that your thyroid hormone is metabolized correctly. 

Dysfunction in your liver, including inflammation of the liver from diseases such as NASH or NAFLD may contribute to decreased thyroid metabolism. 

You can evaluate liver function with standard "liver function tests". 

Liver function tests

Liver function tests are an easy and quick way to assess liver function. 

Liver damage is becoming more and more common due to our diet and its impact on insulin resistance and blood sugar levels. 

To ensure that your liver is properly metabolizing thyroid hormone you will want your liver function tests to fall within the following ranges: 

  • AST: < 20 
  • ALT: < 20 

If you find that your LFT's are even slightly elevated then you will want to look at your blood sugar and insulin levels as well. 

Other conditions can cause liver issues, but by far insulin resistance is the most common (19).

Optimizing your liver function may result in the highest increase in T3 levels of any other therapy.

6. Optimize Adrenal Function & Manage Stress

Constant stress causes adrenal fatigue

Another important way to increase your free T3 is by focusing on your adrenals. 

Your adrenals sit on top of your kidneys and they produce important hormones such as cortisol and adrenaline. 

These hormones are released during times of stress, so the more stress you are under the more hormones your body will produce. 

This is a good thing, up to a certain point. 

But if this system is overstimulated then it can start to drag down other hormone systems such as your thyroid. 

It has been shown that as cortisol increases (20) your TSH may increase as well (thus, potentially making thyroid function worse).

This scenario may lead to characteristic symptoms including: 

  • Debilitating fatigue even after a good night sleep
  • "Wired but tired" sensation
  • Sugar and salt cravings
  • Increased energy at night and no energy in the morning
  • Constant weight gain

The good news is that you can take certain steps to help fix these symptoms and improve your adrenal function: 

  • Consider taking an Adrenal Supplement - Adrenal supplements contain important ingredients such as adrenal adaptogens and/or adrenal glandulars. These are vitamins that may help your body tolerate stress and reduce the impact that further stress has on your hormones. These vitamins have been studied and shown to impact cortisol as well (21). 
  • Cut out Caffeine - The use of caffeine may act as a stimulant and put increased strain on your adrenals. If you find that you are reliant upon caffeine for "energy" then that may be a sign you need to cut back. 
  • Consume extra salt - Salt helps to nourish the adrenals and is required for the creation of certain adrenal hormones (22). 
  • Calm down with Yoga or Meditation - These stress relieving activities may help lower cortisol and cut down on the demand from your adrenals. 
  • Replace other nutrient deficiencies - Other nutrient deficiencies can potentially make adrenal-related symptoms worse. You can find a list of supplements to help support your adrenals here.

7. Ensure Adequate Iodine Concentration & Saturation

Iodine is another important nutrient involved in the creation of thyroid hormone. 

Iodine deficiency may result in decreased substrate and may, therefore, lead to reduced thyroid hormone production. 

Iodine deficiency is more common than previously thought because the primary source of iodine in humans is from our diet. 

Soil depletion of nutrients, an avoidance of sea-vegetables, and a preference for using non-iodized salt have led to reduced ingestion of iodine

These factors may contribute to iodine deficiency and may potentially lead to reduced T3 levels. 

Despite this, iodine supplementation is not as straightforward as you might think. 

Some studies have shown that the consumption of iodine, without other nutrients such as Selenium, may lead to an increased risk of developing Hashimoto's thyroiditis (23). 

With this in mind, and before you begin supplementing with iodine, consider these recommendations: 

  • If you are going to trial iodine it's best to start low and increase your dose slowly - Your body needs around 150-170mcg of iodine per day and you may not want to use doses higher than this initially. 
  • If you have Hashimoto's and you want to trial iodine make sure you take Selenium with it - Supplementation with iodine, in cases of concurrent selenium deficiency, may trigger inflammation and thyrocyte damage.

If you've tried other supplements and have symptoms of iodine deficiency (like fibrocystic breast disease) then it may be a good idea to consider iodine supplementation. 

8. Diet & Exercise

I can't overstate the importance of lifestyle changes when it comes to improving thyroid function and T3. 

I use lifestyle changes as a broad term to include the food that you eat, how often you move or exercise, the amount of sleep you get and how stressful your life is.

In my opinion, these 4 lifestyle factors create the foundation upon which everything else is built. 

These factors help influence inflammation in your body, help regulate neurotransmitters and help ensure the production and function of other hormones. 

By combining these changes with supplements, medications, and the other therapies listed in this post, you will set yourself up for the best results possible. 

Failure to set this foundation will severely limit your results! And in this case, may result in decreased free T3 levels and increased reverse T3 levels. 

Because of how important these factors are I've already created a guide meant to walk you through the basics: 

You can find it here

What about T3 Medication?

What if you've tried these therapies before and they haven't worked?

What are you supposed to do then?

If you've exhausted this list of natural therapies then it may be time to consider using T3 thyroid medication. 

T3 thyroid medication is the quickest way to increase your free T3 because, by using it, you are providing your body with the very hormone you may be deficient in. 

Your thyroid gland naturally produces T3 thyroid hormone (about 20%), but the addition of T3 medication can also be very helpful. 

This is especially true for individuals who have undergone thyroidectomy or radioactive iodine ablation.

You can also obtain T3 thyroid hormone in combination medications such as Natural Desiccated Thyroid (NDT)

Some physicians don't believe that using T3 thyroid hormone is necessary so you may need to seek out a second opinion if your Doctor is unwilling to prescribe this medication. 

Newer studies show that the combination of T4 with T3 thyroid hormone helps reduce the symptoms of hypothyroidism and improve quality of life (24). 


It is possible to take action and to naturally improve your free T3. 

The best way to accomplish this goal is to focus on the variables which may negatively impact thyroid function in your body. 

By focusing on factors such as reverse T3, inflammation, nutrient deficiencies, adrenal function, iron status and your lifestyle, you may be able to positively impact your T3 levels. 

If you find that you are unable to obtain symptomatic improvement, despite utilizing the tips here, you may need to consider altering your thyroid medication and adding T3 thyroid medication to your regimen. 

Lastly, don't forget to look at other thyroid lab tests which can give you valuable information about your thyroid gland and its function. 

Now it's your turn:

What have you done to increase your T3 levels naturally?

What has worked? What hasn't?

Have you been able to find out why your T3 levels may be low?

Leave your comment or questions below! 

increase free t3 naturally

Dr. Westin Childs

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 45,000+ people have used them over the last 4.5 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

183 thoughts on “How to Increase Free T3 Levels Naturally: 8 Step Guide + Tips & Tricks”

  1. Thank so much for sharing this information. I read an article you wrote last week on iodine and selenium supplementation. I am iodine deficient but when I supplemented, within a few days was then taking too much and my thyroid was inflamed. The two together work marvelously. My daughter checks the dose daily through kinesiology and it is making a big difference. Thank you so much!

    • Hey Jenny,

      You are very welcome! I’m glad it worked out for you! Supplementing with iodine can be tricky, and I like to do it – it just needs to be done cautiously. And it sounds like you are in good hands 🙂

      Let me know if you have any other questions.

  2. Hi ~ I was diagnosed with under active thyroid in 2013 and put on levothyroxine. In the last 18month my symptoms have become significantly worse. I have chronic groin/pelvic pain which has changed me from an extremely fit active slim 53 year old to an overweight inactive jobless 56year old. I paid for a thyroid scan last week (due to regular choking episodes) and it was confirmed that I had hashimotos (I was told by the radiologist that my thyroid was shrivelled ~ and had I heard of Graves or hashimotos ) my most recent bloods came back saying I was now suffering from hyperthyroidism and it was recommended that I reduce my levothyroxine to 100 from 125 (I haven’t done this yet as I think I am on the hashimotos roller coaster of hypo/ hyper) I have asked to see a endocrinologist and will take all that I have read from your Facebook page and hope he will listen. I was diagnosed with osteitis publis after an MRI scan but I now think the chronic pain which stops me from even walking very far (hence the job loss) could actually be due to Hashimotos. My main request will be for desiccated thyroid to be added to my regime. Thank you for all the information you have provided. You have been a life line and I intended to knock down as many doors as possible in the hope that our great NHS will listen and react accordingly. I will keep you posted re my journey.

    • Hey Lynne,

      I would definitely dig a little deeper into the “hyperthyroid” component. With a shriveled up thyroid from years of damage due to autoimmunity, it’s unlikely that you are suddenly producing large amounts of T3 hormone causing hyperthyroidism. It’s far more likely that your TSH is suppressed from the T4 dosing, but that doesn’t necessarily mean you are “hyperthyroid”.

      NDT may improve your symptoms, but you would also benefit from extensive blood testing and repletion of any and all nutritional deficiencies.

      Good luck and keep me posted!

    • Hi,

      I also was diagnosed with hypothyroidism in 2013 and since then was increased on levotheroxine from .25mg to .125 mg. No success. Then I heard about LDN!!! Low Dose Nalterxone, it is not priscribed by any doctor, but digged dip and found one who did. Got my medication on June 15, 2017, I feel improvement.
      Here is the website with more info:

      If you wish to join the group, email me and I will provide you with the group info.


  3. Great information and diagrams. Very grateful for this. I’m a bit puzzled though when the text above refers to “Get on T3 only medication (Like liothyronine or NDT)”. My understanding is that NDT contains T4, T3, T2, T1 and calcitonin. Correct me if I’m wrong.


    • Hey Honora,

      You are correct, the sentence should say “Get on medication containing T3”. Liothyronine is a T3 only medication, whereas NDT contains all of the other components you mentioned including T4 AND T3. Thanks for bringing it to my attention!

      • Is it correct that NDT, like Armour, while it contains T3, it may not be enough and it would still be beneficial to supplement with Cytomel? Do you have any thoughts on ordering Liothyronine online if doctor won’t prescribe?

        • Hey Terri,

          Yes many of my patients are on a combination of T3 + NDT or T3 alone. I don’t recommend using liothyronine without the assistance of a Doctor, you don’t know what you are getting and too much T3 can be dangerous.

          • Other than having T3 levels checked, how else do you know if you are having too much? I have low T3 2.3 (2.4-4.3 range) and a long history of hashimotos. I am doing every diet and exercise change to improve my health and my doc won’t increase my T3 even though its below normal. Is there really danger in increasing it? I am a healthy 44 year old, on 1.25 grains of NDT and just 5mcg of T3. Shouldn’t I increase my dose until my T3 comes up? Thank you!

      • Hi Dr Child,

        You are my teacher! Thank you very much for this site and information,it is very usefull.

        You are a very professional and the BEST thyroid doctor!!

        I live in UK ( originally from Hungary) but without your knowledge I didn`t find the right doctor in UK how have correctly treat me, because I need the power and knowledge about the RT£ issue and hashimoto.

        Thank you again,
        Krisztina Aranyi

  4. Hi Dr Childs, what I’ve read from your sight and blogs makes alot of sense! My Dr is brilliant and we have been working together for at least 3 years trying to tweek my thyroid & Hashimotos. She has me on20mcg T3 and 70mg of thyroid extract which has put my TSH, T3 & T4 in the normal range. However every now and then my thyroid goes out of Whack and it’s back to playing with dosages to get it right.

    I am a coeliac and have 2 of the C strain MTFHR Gene, with high estrogen levels so I take a progesterone troche (had a hystorectomy @ 34 due to a begnin tumor. I am seeing a naturopath and she had me do a hair strand test that shows what triggers inflamation for me and she has been helping me with adrenal fatigue and liver tone.

    She has recomended going Paleo but I struggle with red meat, I’m ok with small amounts of chicken and fish even though my blood type is o positive. I eat alot of salads and vegies, little fruit. My Dr says my diet is brilliant but I can’t seem to shift weight! I only need to lose 6-10kg and occasionally when the plumbing is working well I shift 2kgs and then it suprisingly comes back! Grr!

    I kind of feel like I’ve hit a wall as I’m doing what’s recommended and I seem to progress and then it all goes pear shape and I can’t work out why? Any other suggestions?

    Keep up the good work in helping people understand what’s happening to them and why. 🙂

  5. The first time I was diagnosed with hypothyroidism was 27 years ago. After being placed on medication for a short period of time, it supposedly resolved. In 2013, I was again diagnosed with hypothyroidism. It took until mid 2015 to get my level within a “normal” range. Only a tsh level was ever drawn throughout the year. In January, my level was abnormal again, tsh only. Since I started receiving your insightful information, I decided to give it to my PA at my endocrinologist. I’m hoping she will work with me. I am diagnosed celiac disease, so I eat a healthy diet, no dairy products, and already take the supplements you recommend. What complicates my situation is that I am in chronic pain everyday. These are other conditions not being adequately managed due to severe allergies to the medications normally given. Due to this, they tell me to “deal with it”. Unfortunately, when you’re dealing with several conditions, it becomes debilitating. I’ve gained 60 pounds in two years, gone from being very active nd healthy to barely able to do anything, decreased appetite. To complicate matters, none of my doctor’s understand celiac disease, including my primary doctor. Do you have any suggestions?

    • Hey Kimberly,

      I don’t recommend trying to get treatment in the insurance model, 99.9% of the time you will just be ignored – even if you give them information. Endo’s and most doctors aren’t interested in being educated by patients. The other big issue is that even if you ask for the right tests, they won’t know how to interpret them or treat you based on the results. I would recommend looking for a functional medicine doctor near you.

      In regards to your other issues you can take a look at these articles, and they may very well be related to your thyroid:

  6. Thank you for this information! I’m so glad to see a Dr who is truly into helping people be their best.
    I have had labs run for most of the things you stated but as you have also stated I received the results in “your labs were normal” form without any levels showing. Very frustrating!!

    I would love to get on top of my Hashimoto’s and feel better again. My brain wants to go go go and my body says no no no. I do know I am insulin resistance and have adrenal fatigue on top of Hashi’s. Could I just start taking selinium and iron without a test? Or is that dangerous?

    I am currently taking 48.75 mg of NatureThroid. I have been taking that dose for 2 weeks now and my throat seems to feel tight. Could be allergies as those are bad right now too. 3 years ago I was on 80mcg of Synthroid and 10mcg of Cytomel which the Synthroid made me feel horrible.
    I’m really not sure where to go from here except that I want to feel better!!! I am so tired of being so extremely tired!!

    Thanks so much! I would drive the miles just for you to be my Dr!! LOL! Do you have any good recommendations for the Ft Worth TX area?

    Marci Pruitt.

    • Hey Marci,

      You are welcome! You can try selenium, but I wouldn’t recommend taking iron without lab testing as too much can be toxic to the body. The combination of cytomel + synthroid can work for some people, but the T3 dose needs to be high enough.

      Unfortunately I don’t know any doctors in the ft worth area – I am sorry!

  7. I had a thyroidectomy last week. I’m talking calcium carbonate now but still the tingling in my hands doesn’t go away. I also take vit D3.
    I have no energy and my stomach is very upset so I can’t eat. At this moment, I regret the surgery (I had Graves).
    Would it be beneficial for me to take selenium, perhaps magnesium to help with the muscle weakness and fatigue? Thanks.

    • Hey Kim,

      They probably won’t hurt but I don’t think they will help either. You need to fix your calcium levels first and manage your thyroid medication – both are more likely causing your symptoms.

  8. I tried Cytomel with low amounts of Naturethroid and I had too much heart palpatiation. So my doc keeps on increasing natuthroid.
    I am now taking 1 97.5 in morning, and 1 97.5 in late afternoon. I take selenium, zinc, Vit D, raw adrenal from standard process, magnesium at night. My Reverse T3 is 11.9, Free T3 is 2.8. My Free T4 is .91. I know my Free T3 should be around 3.8 and Free T4 shoudl be 1.3.. seems that even though they keep slowly increasing my meds nothing really works. I am really afraid to try cytomel again and I had full panic attacks.. Its been a rollercoaster since 2011 diagnosis of Hashimotos. Large nodule on thyroid, however, it is benign. Thyroid is shrivled as well. gluten free, dairy free, grain free most of the time until I just want to have corn taco ! LOL. any ideas ??

  9. I recently read this article and purchased several of the recommended supplements. I am trying to Kickstart my thyroid naturally before trying the medication route. I am been suffering with constant fatigue, foggy memory and trouble losing weight. I am a 37 year old female and my labs show:
    TSH = 2.3
    FREE T3 = 2.8
    FREE T4 = 1.12
    My question is when should I take the supplments and should I follow the dose recommend on the bottle. I purchased:
    DSF Formula – Nutri-West
    Gastrointestinal Support
    Zinc 30
    Super Enzymes
    All products were linked in the article above. Thank you for your help!

    • Hey Robin,

      It really depends on your symptoms and other lab tests (not just your thyroid), it really requires a comprehensive look at everything.

        • Hey Robin!

          I know your comment is over a year old, but I thought I’d just ask, how are you doing? How is your thyroid, energy levels, ability to lose weight, brain fog? I was struck by your comment because our situations are very similar. I am almost 36 years old. Same symptoms as you. I just had Thyroid blood work done. My Free T3 is 2.9, my Free T4 is 1.1, so very similar to yours. Though my TSH came back as 1.1. My Total T3 is 93. From the research I’ve done, it seems my T4 – T3 is not converting well, which led me to this article . Super helpful info!!!! I have my list of supplements I’ll be starting. Anyway, just thought I’d reach out. I hope you are healing and thriving!


          • Hi Jenny, I know it’s been a year since you posted your comment, but I was wondering how you were doing and if you could tell me what hormone medications you are taking, and what supplements you are using as well, and how they worked for you. I am hypo. and have been taking just 25mcg. of Synthroid for about 4 months (it took me several months to work up to that amount). Everything was going fine and then I began having heart flutters and ringing in my ears. My doctor suggested increasing my dosage, but that only made me anxious and jittery and did nothing for my palpitations or the ringing in my ears. I started supplementing with Selenium a few days ago and am waiting to see if this helps. I’m curious what you’re taking and how it’s working for you.
            Hope all is well.

            Thank you so much,


          • Hi Lashell

            I had the same symptoms as you, ringing in ears and heart flutters, I was diagnosed with very low iron. Hope this helps.

  10. Hi there doc. I am in NZ and understanding of thyroid issues here seems to be fairly stone-age (at least among conventional medicine, funny that) compared to alt medicine. I am currently treating leaky gut (only been 1 week so far). I had suspected hypothyroid and convinced my doc to give me tests. Symptoms are fairly mild but classic (however with a strong asthmatic reaction) – this is a chronic condition triggered whenever I live somewhere with chlorinated water).

    TSH levels are 3.23mU/L, FT4 is 206 ng/dL (16.3 pmol/L) and FT3 is 64 ng/dL (4.9 pmol/L – I hope I got the US conversions right!). For me the high TSH means my body is asking for more energy; there is a lot of T4 however my thyroid is struggling to convert this to usable T3 for energy.

    My Ferritin level is 135 ng/ml (normal) and my cholesterol isn’t great (I am quite skinny): total 149 ng/dl; HDL 36 ng/dl; HDL ratio 121 ng/dl; Random triglycerides 45 ng/dl and LDL 93 ng/dl. For me these readings are indicative of underactive thyroid. Also, CRP is at “less than 3” on a scale 0-5.

    Anyway I am taking 1 x Piping rock Ultra Thyroid complex per day. Can I increase to 2 x per day? I see this contains desiccated thyroid and I think I could do with trying to boost T3 levels if possible?

    Many thanks!

  11. Hi Dr. Childs!
    I wanted to say how much I appreciate your online articles on thyroid health. I am a thyroid cancer survivor, so I have to monitor my T4, free T3 levels often. My free T3 is typically low, and so I am taking NDT. However, I continue to have fatigue and weight gain.

    I know that iron is very important for the T4 to T3 conversion, I wanted to ask you about a recent iron panel I had done (see below). From what I read, Ferritin is needed to transport T3 into the cell, and it looks as though my level is low-normal. I have read that the optimal Ferritin level for a female on thyroid hormone is 80-90, while mine is at 19. This tells me my iron stores are not too strong. Do you have some thoughts on this lab? I’d like to increase my Ferritin to an optimal level while not pushing the other measures over the range.

    Iron 137 ug/dL (50 – 170 ug/dL)
    Iron Binding Capacity 313 mg/dL (265 – 497 mg/dL)
    % Saturation 44 % (15 – 50 %)
    Ferritin 19 ng/mL (7 – 270 ng/mL)


  12. Dr Westin,
    Just want to say this is one of the most impressive and thorough articles that I have ever read on how to increase T4 to T3 naturally.
    Thank you so much!

  13. Best info I have read yet. I pray I can get a dr who will prescribe T3
    I am so frustrated I started zinc. Selenium
    Just ordered oil of orgegano
    So it’s a start
    Now I need T 3. Thinking about ordering online

    • Hey Sharon,

      I’m glad you enjoyed it. I would caution against ordering medications online, however – you never know the quality of the medication and dosing T3 can be difficult and dangerous (which is why many providers are scared to use it).

  14. Thank you great articles. I was diagnosed with 4th stage liver disease in 2004 but functioning well now. I because of it had anemia and hypothyroidism. I was put on liquid iron and levothyroxine. Since I have gained 50 lbs. I have a very active exercise plan everyday, and eat at home right. Moderation on everything. I have tried everything to lose this weight in my stomach area. Never had it my whole life I was average. Also I find somedays it is hard to swallow. My dr. Is great but says my levels ar great were at 9.5 now <1. What should I try do you think the ntd. Or add in. T3 only med. thanks Christine g of austin mn

    • Hey Christine,

      I’m sorry but I really don’t understand your question. There are multiple thyroid lab tests so you will have to elaborate on which test you are referring to for me to be able to help you further.

      • Hi Dr, sorry my tsh level is all my Dr says I need and it’s great. But like I said I never had weight gain until I started the levothyroxine. Same thing happened to my father and my sister. Fortunately my Dr is a great guy and is willing to work with me as he knows I am proactive on my health so if I were to ask him I’m sure he would help me. But I want to have as much info as I can because he is such a busy guy. So my question is in order to figure out if this is my thyroid meds should I try the naturethroid or have him add on a t3 med to my levothyroxine. Or go straight to the t3 alone. Or have him order tests first? Thank you so much Christine g

        • I understand, but unfortunately there is no easy way to answer that question. There is no easy way to predict the type or dose of thyroid medication that any given patient will need for optimal results. Lab results can be used as a guide, but they don’t always tell the complete story – that’s why it can be difficult (or impossible) for a patient to treat/dose themselves.

          A good place to start is with a complete thyroid panel + fasting insulin + fasting leptin + estrogen/progesterone + Testosterone. This will give you a starting point to base other decisions off of, but again this is just the start.

          • Dear Dr, thanks I talked with my Dr, and sure I can try this nt, so he sent me a prescription which I had to,pay for as insurance doesn’t pay for. Anyway, I was switched from 100 mcg to 97.5 mcg naturethroid. And I feel fine all day until after dinner I feel like my head is pounding and a little off not quite dizzy but off. I also feel cold in the evening. Should I have did a 50/50 dose for awhile? In other words 50/ levo and 50% nt? And gradually ween myself off of levo? My dr says we will do bloodwork in a month. I’m not sure he works with nt a lot so any help you can give is great. Thanks Christine g

  15. Hi. I was diagnosed 5 years ago with under active thyroid. I was very slim and active and never needed to diet. Now 5years later I am 5 stone heavier even though my THS levels have been normal for 3 years or so my weight continues to rise and still very tired. Been to an endo and was told by one endo then the weight gain and fatigue is ME (how) and the other endo told me that my fatigue is to do with my weight as I am now 103kg and 5ft 4in and very over weight. None of the endos agreed with me that I need to change my meds to T3 only. I was told that I should have gastric surgery as my weight gain and fatigue still continues even though I eat very well and and am very active and I have tried orlistat, nothing is working for me. I just don’t know what to do anymore.

    • Hey Kerry,

      The best thing you can do is find someone who specializes in what I do and have them evaluate your lab work and provide treatment recommendations. Most PCP’s and endocrinologists have a very cursory understanding of what it takes to lose weight so they are not the best place to look for answers.

  16. Hi Doc,
    I am writing from Bulgaria to thank you for the very useful information on your blog. I have had Hashimoto for almost 20 years and have been struggling with waight, brain fog, fatigue and so on. As I was always very busy I did not pay much attention and just took my meds (88 mg Euthirox). Over the last few years however I had a thrombus, my prothrombin time was off, my triglicerides were high and I have a fibrocystic breast disease.So I started paying attention and reading. My FT3 is low, FT4 – high, so obviously I am not converting. I am currently on AIP trying to fix my gut and have been gluten free for almost an year. I excercise, walk and do yoga. FT3 meds are not sold in Bulgaria and, even if I bought them from abroad, I doubt that I will find a doctor who can work with me and fix an appropriate dose. So is there anything more that I can do to help conversion?

    • Hey Elena,

      The easiest recommendations are listed in this post, further recommendations would require help and specific advice regarding your situation from a knowledgable physician or provider. This post is meant to be a starting guide.

    • Hi Elena! It’s 4 years later, and I’m wondering… How are you doing? Lynne Farrow wrote a great book called “The Iodine Crisis.” In it she talks a lot about low iodine being at the root of Fibrocystic Breast Disease (FBD.) And of course your thyroid needs iodine too.

  17. Hi there!!
    I don’t have hashimotos but when I did a blood test a year ago my fT3 was 2.9 and now it’s 2.8. All of my other numbers looked fine. They were in the normal range. It’s just my fT3 that is off. That and my vitamin D was low. But those were the only two things. Would you recommend the same treatment for just fT3? She wanted to put me on nature thyroid but I have some reservations about it if it’s only my fT3 that is a little low. Wouldn’t that affect my other levels? I know I’m late to the post but hopefully you’ll have some insight for me. Thank you!!!

    • Hey Kathy,

      The best thing you can do is search for someone to help guide you, it can be impossible to figure much of this out on your own.

  18. Hi Doctor Childs,
    I have had a crazy year with health problems. I had a surgery which led to a C. diff infection, which led to Reactive Arthritis. I seem to have overcome those issues now, and I have been trying to heal my leaky gut, eating mostly Paleo, and my doc has me on a small amount of T3 and LDN. I quit taking the T3 because sometimes it made me sweat, but mostly because it gave me diarrhea. Do you have any recommendations so that I don’t get diarrhea when taking the T3? I quit taking it, and can’t seem to lose weight, despite eating a really strict Paleo diet. Also, can taking T3 cause your body to produce less of it’s own?

    Heather K.

    • Hey Heather,

      Most hypothyroid patients will not lose weight by changing their diet alone, they will need to test for and balance other hormones that the thyroid influences.

  19. Hi, I have hypothyroidism since several years, and take levothyroxine (T4) and liothyronin (T3) . We have the same problems here in Sweden with low knowledge among physicians, but mine prescribed T3 :))) I found your site since I still have remaining issues. But I acutually do not want to ask about them, but give a tip about something that helped me tremendously. I had a lot of issues with twitching and stiffness and pain in muscles, joints and tendons, among them plantar fascitis (I do think it is connected to hypo, I have heard the same problems frpm other hypopatients) . I started taking MSM, and now I only have pain and stiffness when I get tired r stressed, not a constant pain. Also I take fluid magnesium before bed. Now I know that I should look into zinc as well, maybe that is will help. I am on anti-depressants, is there any study on that they inhibit conversion of T4 in body? I eat glutenfree and milk free, and mostly raw food, (maybe raw should be on your diet list? ) Thank you for your informative site and all the good work.

  20. Hi Dr. Child’s,

    After 10 years of using birth control pills I finally quit and my body has been out of whack ever since. My most debilitating symptom is air hunger and chest tightness which I’ve read can be a progesterone deficiency or hypothyroidism. My latest thyroid test result shows
    TSH 1.2 (.4-4.5) range
    FT4 1 (.8-1.8) range
    FT3 2.9 (2.3-4.2) range
    RT3 15 (8-25) range

    Do you believe I could benefit from an increase in FT3? I have other symptoms as well but my naturopathic doctor noted my thyroid looked great. What are your thoughts on the levels? Thanks!

  21. I’m curious why when my Naure Thyroid was increased 1/4 grain (from 1 1/4 grain to 1.5 grains) my Free T3 and Free T4 plummeted as did my iron levels despite my taking an iron supplement during this same six week time period. My total iron is 58 and the iron saturation is 27%. My ND does not feel the ferritin is a good marker for me since it seems to fluctuate with my level of inflammation and the ALT, and AST. Needless to say I feel extremely fatigued and my mood is not great. Now she has decreased me to the lower dose (1 1/4 grain a day). She can not offer an explanation as to why my iron dropped so much even with the additional supplementation. I might add that since Oct. I have been eating clean, having done a liver cleanse, and now a candida cleanse. I exercise regularly. So I’d be very interested in your suggestions as to how to proceed.

  22. Hi Dr. Childs – Thank you for this article. Still making my way through it and I’ll be discussing with my doctor.

    Is it possible to have low T4 or RT3 and not really have symptoms? I learned I had low T4 over 20 years ago from routine blood work, but I didn’t have symptoms (that I’m aware of). At the time, testing for RT3 wasn’t done. I just had my RT3 tested and it is low (203), but again, I don’t feel that I’m having symptoms… or maybe I just don’t know what if feels like to be fully functioning! Do you have any thoughts on that?

    Note: Please check the first diagram, Factors that Affect Thyroid Function. Seems the top and bottom columns may not be on the correct sides, and the lower left column should read, “Factors that decrease (not increase) Conversion of T4 to RT3.”


    • Hey Joanne,

      It’s important to follow the patient and just not the labs. Whatever is “normal” for you may not be the standard “normal” for everyone else.

      Also, the diagram is accurate. Stress, trauma, etc. increase conversion to T4 to reverse T3 which necessarily reduces T3.

  23. Dear Dr. Childs,

    What a great website, I am so glad I found it! I wish there were doctors like you in Europe…but they seem few and far between.

    I have been on natural desiccated thyroid for the past five years. I started on Armour, then switched to Erfa which, unfortunately, also seems problematic and does not seem to work like it used to. So I decided to order NDT from Thailand, at a fraction of the cost of prescription NDT where I live.

    Regardless of brand, I seem to require a lot of NDT for complete symptom relief (I am currently taking 7 grains which means 266 mcg of T4 and 63 mcg of T3 daily). Yet, I have no hyper symptoms, and both my free Ts are in range (FT4 at the very bottom of range, FT3 midrange 24 h after latest dose). TSH completely suppressed, but I understand that is normal when taking T3. Also, I understand I can expect my FT3 levels to be about 20% higher on the previous day, as I only take NDT once a day (in the morning). My FT3 levels were 2.9 (ref 1.7-3.7) 24 h after taking NDT, so about 3.4 the previous day…?

    My question is: could I be suffering from rT3 dominance? Many claim you need less T4 when taking both T3 and T4, but I seem to need even more T4 now compared to when I was on levothyroxine only; back then, I took 200 mcg daily…which kept my FT4 levels at the upper normal limit, but my FT3 levels were never more than midrange.

    I have considered switching to another brand of NDT; I am currently on Thyroid-S which contains a lot of fillers, including cellulose, which could possibly decrease absorption of thyroid hormones.

    In your experience, is it unusual to need as much NDT as I seem to do? If my FT4 levels are low (0.9, ref 0.8-1.5), does that point to a potential rT3 problem? If so, I will ask for that test to be included next time I go to the lab.

    Thanks a lot in advance,

    • Hey Catarina,

      I’ve found most people feel like they need 3+ grains of NDT likely have contributing issues, are getting too much T4, or have other hormone imbalances contributing to their symptoms.

  24. Hi Dr Childs,

    Hoping you could comment on what you think would be the cause of reduction in FT4/FT3 levels?

    TSH = 12
    FT4 = .73
    FT3 = 3.8
    R3 = 13
    TPO in range

    I changed my diet recently to reduce inflammation, low carb/low sugar (was also gluten, dairy, soy -free for 2 yrs) within 3 weeks of new diet and new sleep schedule (actually getting sleep!) I felt better but my levels changed to:

    TSH = 6.6
    FT4 = .62
    FT3 = 2.9
    TPO 34 (out of range by 6 pts)

    Just wondering why I would feel better, cut TSH almost in half, but have lower levels of FT4/3 and increase TPO? Any ideas on why this would happen?

    THANKS! Leeanne :))

    • Hi Leeanne

      Were the blood tests taken at the same time and both after you had withheld your morning dose?

      To illustrate this, I experimented with having a blood sample taken at half past eight and then again in the same day at 1pm recently. I think I took my morning dose after the first blood test (brain fog!!)

      my first results were:
      TSH 0.44 (0.40-4.00)
      FT4 9.45 pmol/L (10-24)
      FT3 4.3 (2.5-6.0)

      The second results were:
      TSH 0.32 (this triggered the lab to measure FT4 and FT3!)
      FT4 10.00
      FT3 6.5 which is out of range suggesting either T3 ingestion (yes), or T3 toxicosis.

      Low carb/low calorie diets can trigger increased conversion of T4 to RT3 instead of T3 and aren’t a good idea for us folks with hypothyroidism.

      For my part I am now alternating WTE with Thyrovanz and will see if the FT3 levels drop. I feel the same as I ever did (asymptomatic). I think if the FT3 is too high, it demineralises the bones which I don’t want.

      • Honora,

        Thanks for reply. I’m not taking any thyroid meds. Trying to treat naturally and get thyroid working again on its own. I was happy to see TSH drop — so right direction there but wasn’t happy about FT3/4 dropping also.

  25. Hi, thanks for this, it’s very thorough. Do you have any thoughts on how helpful Tyrosine is / would be in this situation? It certainly makes me feel better but I’ve seen mixed opinions on it. I currently take Gaia Herbs Thyroid Support which has a couple different adaptogens including schisandra and ashwaganda plus 50 mcg iodine and 100 mcg tyrosine per capsule. I’d be curious to know if you have written anything on tyrosine. I would search the blog but can’t find a search bar… Thanks for your response!

  26. Hi.
    Thank you for your post. I hope you can help me.
    I am overwhelmed with current health issues and all the information I’ve received.
    I was diagnosed with Hashimotos in 2012. I am certain that my adrenals are strained, and have Leaky Gut issues as well(I am also deficient in iron, iodine, D-3, anemic. per tests) But the doctors I have seen will not consider the cause and/or treatment to address the autoimmune nature of Hashimotos. They only want to put me on meds.
    I KNOW I have to treat/fix the cause first – not just a bandaid fix!
    I have eliminated all wheat and gluten from my diet. Dairy and eggs on occasion. I’ve been adding necessary supplements. This has made wonderful changes to how I feel. but its not enough.
    The dietary changes are the most confusing. What is good for the adrenals and Leaky Gut, is not good for Hashimotos. (cruciferous vegetables, tomatoes and red peppers in particular)
    I know that I don’t eat enough. I have no appetite and have to make myself eat and/or what I eat bothers me and I am severely constipated. I’m taking supplements, started probiotics, fiber, teas, etc. I can’t “move” And I continue to slowly gain weight. Bloated belly is the norm now and It is utterly frustrating and discouraging. This is most of my stress…a vicious circle.
    I do NOT want to go on medication! That is my absolute last resort.
    I want to fix the cause of the autoimmune condition! And I cannot find a doctor who will work with me. I have numerous books – guide books, recipe books,etc. Can I fix all three issues at the same time? Which of my problems do I work on first? When is the best time to take supplements?
    Can you help me?
    Thank you,

  27. Hi Dr. Childs,

    Thank you so much for posting this information! I was hoping maybe you could help me understand a little further on a couple things.

    Last year, I went about 4 months without any periods which really worried me (I am 24 years old). In November I scheduled an appointment with my obgyn and after some tests she found that I had (subclinical) hypothyroid which was causing me to not ovulate or something. TSH was 11.2, T3 FREE 3.3, T4 FREE 1.05. So she prescribed me levothyroxine 50mcg. I got my period within a week after starting levo. At this point in time, I was 141 pounds. For the first couple months, I wasn’t taking it correctly though, so my body wan’t absorbing it all (didn’t wait long enough to eat after I took it).

    Starting Jan/Feb I made sure to start taking it correctly. About a week ago, I weighed myself and have gained 13 pounds in less than 3 months even though I watch everything I eat!!! I am now 154 pounds and feel like I have a pregnant woman’s stomach, it sticks out like crazy! I seriously went into a panic! I am getting married this year and I can not even fit in my wedding dress now! Then this past month, I again did not get my period. I scheduled another appointment with my obgyn and told her about the weight gain and my period not coming she said that from my last set of tests my results were TSH 1.08, FREE T4 1.31, FREE T3 3.0 and that since I was just “subclinical” I could just stop taking levothyroxine and the weight would come back to normal and my periods should resume if this is cause of it (no, I am not pregnant). Is she right about this?? I asked her if she can give me some T3 and she said no and that we need to wait for a couple months to see what happens to my Thyroid levels after I stop taking levothyroxine first. She said that maybe she can refer me to an endocrinologist later if my levels go off track again. I am terrified of this taking so long. I feel awful about this.

    Also, I have ADHD and take AdderallXR. Would T3 have any possible bad combination with my adderall medication?

    Thank you for your time,

  28. I have a desiccated dietary supplement I was able to buy online made by Nutri-Meds, do you recommend any easy to purchase supplements for the Thyroid as I now live in Spain and it would help me tremendously!
    Thank you so much for a really informative website, will defiantly read more!
    Appreciate you!

  29. Will Welbutrin affect Reverse T3. I have been following a great food and exercise program fir 10+ years. I am now working on Wheat free, Dairy Free, grain free and soy free diet along with homemade sauerkraut and water Kefir.

  30. Hi Dr.Childs!

    I’m 17 years old and suffer from hashimotos. I’ve avoided taking any pharmaceuticals for two years other than LDN(3 months) without any improvements in my stagnant weight, hair strength, extream fatigue,etc. I take over 15 supplemts each morning for the past year in hopes of finding a natural solution using your tips. Do you suggest I start a T3 hormone supplementation or are side effects harmful?
    Thank you so much!

    • Hi Natalie,

      The addition of thyroid hormone in the setting of Hashimoto’s should be assessed on a case by case basis – the same is true of T3. I don’t have enough information to say one way or the other.

  31. Hi, I had a subtotal thyroidectomy in 1995 due to graves disease. my thyroid didin’t recover and I am on 250 micrograms of thyroxine daily. Am I able to naturally increase my T3 levels with a functioning thyroid gland?

    • Hi Annie,

      Yes, the T4 you are taking orally must be converted in the body to T3 before it is activated.

  32. Hello,
    I have been on levothyroxine my entire life as I was diagnosed with hypothyroidism when I was born. Until a year ago I never suffered from acne and now have a lot of acne only on my chin. Reading online I have read that it is due to hormonal imbalance. That is leading me to think that it has to do with my thyroid. I talked to my endocrinologist and dermatologist who ensured me it has nothing to do with my thyroid. What can I do to make them understand or take a closer look that my thyroid can be a problem. In your blog you mention checking your levels but do doctors supply you with your own lab test when checking your thyroid levels? Any recommendations on how to proceed? Thank hou

  33. I do not have a thyroid .15 months ago I have it surgically removed due to Papillary Cancer.I have been extremely tired and have gained a lot of weight since then..All my blood test are normal but I continue to tell my Dr my symptoms and want her to treat me with T3 medication but she will not do it..I saw another Dr for a second opinion and she would not treat me for T3 will your recommendations be what I need to try and see if I do get better?..i ask because I do not have a thyroud..I take 150 mcg of Levothyroxine once daily.thank you

    • Hi Donna,

      These recommendations should help to improve your thyroid function. How much it will help is up in the air and largely depends on you and various other factors.

  34. This year will be 20 years I have had hyperthyroidism. My T3 has always been low but last year my T4 was high. I could tell something was off. Tired more than normal, no energy… this year I had my blood work done and my tsh went from .51 to 2.62. my question is what causes one to be high and the other low? I am using oils and a higher fat diet trying to help my gut funtion and get my thyroid working better. Eating cleaner for many reasons but mainly this. I would love to get off the T4 meds really both altogether but definitely back to taking one a day rather then 2. Any help or guidance would be appreciated.
    Thanks so much

  35. Hi Dr Childs, Im on the 22nd wk of my pregnancy now and I have had 3 tests so far for TSH, FT3 and FT4 with the ff results:

    Result#1 Dr’ Advise – take 25mg tablet of PTU-Propyltiouracil everyday for 3 weeks then test again
    TSH < 0.05 uIU/ML
    FT3 5.31 pmol/L
    FT4 22.06 pmol/L

    Result#2 Dr' Advise – take 25mg tablet of PTU-Propyltiouracil every other day for 4 weeks then test again
    TSH < 0.05
    FT3 4.31
    FT4 14.41

    Result #3 Dr' Advise – no medicine but will take the test after 3 weeks
    TSH < 0.05
    FT3 3.64
    FT4 8.11

    Normal Value based on hospital's form:
    TSH 0.25 – 5
    FT3 4-8.3
    FT4 10.6-19.4

    On Result#2, I thought the levels are already okay since the figures are within the normal value but the doctor told me that its not applicable to pregnant.
    On Result#3, she told me to stop the medicine and have the test after 3 weeks because I need to be within the normal range (as indicated above).

    Her advices are not consistent and it worries me a lot for my baby. We are planning to consult with another doctor.

    But for now, could you please advise and help me identify the normal value for pregnant like me.

    Thank you very much in advance.


  36. I am suffering from a myxedema state of being. I am a 48yr old female with Hashimoto, Lupus, hypothyroid, insulin dumps, pericardial effusion, murmur, stroke, MI, hypoglycemia,myxedema
    sores .I eat and slip into a deep sleep for hours. I used to hear during state. Now I don’t. Loss of balance, severe confusion, inability to speak at times. I am dying. I know this. Can’t afford an Endocrinologist. I wish I could get well for my kids. I am all they have. No other fam. I hope my med history will help someone someday. I think a lot about walking off into the woods. For them, I don’t

    • Scottie, I’m so sorry to hear this. 🙁 I know it’s almost 4 years later. How are you doing? Your symptoms could be related to Lyme Disease. You need an LLMD (Lyme Literate Medical Doctor) for proper diagnosis and treatment. Register for free on and do a provider search in your area.

  37. Hello Dr. Childs,

    I was diagnosed with hypothyriodism in 2012 after having a blood panel ordered when I switched jobs and received health care. At this time I didnt feel I had hypothyroid symptoms, however the doctor suggested I take 125mcg of Levothyroxine. At the time of my diagnosis I was 5’3″ and 125 lbs. Since taking the medication I began feeling much worse and at my lowest point in March of this year, weighted 175 lbs. ALL OF MY MANY DOCTORS have told me to stay on the meds and that my levels are fine and correct. My endocrinologist has now put me on Phentermine to lose weight. I have been taking it for 6 months and have only lost about 15 lbs. I have asked about adding a T3 med and have been denied. I recently paid over $600 out of pocket for a full metabolic blood panel only to once again hear that all my levels are normal and I should continue taking both levothyroxine and Phentermine. Phentermine is expensive and I dont want to take it. I want to stop taking the Levo, but am told that it would be dangerous.
    for your reference, my blood work as of 3/12/17 says my T4 is 1.5, my TSH is 0.704, my glucose serum is 98, AST is 16, ALT is 14, free testosterone serum is 36, T3 free serum is 3.1 and TPO is >600.
    Can you PLEASE help me interpret this?? I guess my main question is: would I benefit from T3 medication despite labs saying that my free T3 is in normal range?

    Thank you so much for your time.

  38. Hello Dr Childs,

    I am the mother of a son of 21, autism, fairly normal functioning but a lot of issues since childhood : socially withdrawn/shy, GI issues,funny way of running, no interest in sport, nailbiting, concentration problems in school, problems with language development, problems with temperature regulation, acne, minor cognitive issues, reduced energy levels, hard time to become awake in the morning. I am living in Belgium and doctors are not really helpfull in that regard over here, they either deny that these syptoms are related to his autism and state that is just the mental way he is, I just have to accept it and go on with my and his life. He is doing a vacation job in Brussels and altough he sleeps more or less 8 hours during the night, he has great difficulty to keep his eyes open on the train, in the morning. That is something that seems abnormal to me, regarding his age and the fact he has no social life outside the house. He eats glutenfree as much as possible, lots of fruit but less vegetables. He did take a lot of supplements (natural) in the past but none of them gave a breakthrough. After I read this article, I am thinking about a thyroid problem. Could I have a point there and should I consider doing a blood panel abroad ? Or perhaps give a small amount iodine and tyrosine to see if I get an improvement ?

    Thank you very much for any reply !


  39. Hello Dr Childs,
    Please advise…6 months ago my blood work looked like this – TSH 0.83, Free T4 1.4, Free T3 2.8. Since that time I have been on 100mcg of levoxyl and 3mcg of time released compounded T3. Last week my blood work looked like this – TSH 0.28, Free T4 1.4, Free T3 2.2 LOW TSH combined with LOW T3??? I have not had any relief from symptoms of fatigue, brittle nails/hairs and extreme difficulty in losing/maintaining weight (I am 48 year old female, weigh 134, work out 4-5 days/week, a year ago I weighed 126 – I know that isn’t a significant gain to some, but it seems impossible to not continue to gain). What are your thoughts? Thanks!

    • Hi Sarah,

      It’s very possible to have both a low TSH and low T3 levels if the majority of your medication consists of T4. This is one of the many reasons why the TSH isn’t the best measure of thyroid function in the body. In regards to weight loss you can find more in these sources:

      Weight loss guide:
      30 day reset guide:

      Alternatively you can also find further information on various blog posts.

  40. I was diagnosed with hypothyroidism about 5 years ago but it was only on the cusp of having hypothyroidism and I was only on a very low dose of euthyrox so I was terrible at taking it.

    I’m kicking myself now. I now have hypothyroidism and hashimotos. I am 32, 168cm and 75kg and I am struggling to lose any weight. I know that shouldn’t be my main goal, but I have read countless blogs and websites and I know I am doing everything else right: diet, exercise, supplements. The only other thing that I’m not sure about is including T3 medication. However I live in Singapore and doctors don’t prescribe T3 medication. My most recent levels were: Free T4 18.20, Free T3 3.68 and TSH 0.03.

    I am currently taking:
    2x B12 spray daily
    2x Vitamin D oil drops daily
    1x 7-Keto DHEA daily
    1x folic acid tablet daily
    75mg thyroxine
    1x omega 3 fish oil capsule
    1x brazil nut daily (selenium)

    Is there anything that I’m missing? I know stress is not helping me as I’m stressing about not losing weight so it’s a bit of a vicious cycle for me at the moment.

    I weight train twice a week and HIIT twice a week. I need to reintroduce yoga to help manage my stress.

    Any advice would be greatly appreciated.

  41. So thankful to have found someone who provides tons of information.
    Had TT due to 7 nodules and 2 showing significant enlargement within a year of watching them. Had 3 biopsies but was encouraged to have TT. Removed Dec 2015. Feel like I’m on a roller-coaster ride. Have palpitations. Had cardiac workup. Nothing significant.
    Had GI workup. Normal.
    Latest Labs:
    TSH. 4.78
    Free T3 2.80
    Free T4 1.94
    Cortisol 14.70.
    Selenium 135
    Vitamin D. 56
    I was on Levothyroxine 175. Decreased to 150 in July. Now on 137.5.
    Have only palpitation feeling rarely now. Doesn’t last long. So much better than it was since lowering Levo. Still have to take zantac 150 on occ. Feel so tired a lot of the time esp afternoons. Get massages to help with stress which helps. Trying to watch diet. Going to even more so after reading your articles.
    Any ideas or advice would be greatly appreciated. I asked my Endo about taking Cytomel. She didn’t think it was good idea since Ibe had palpitation feelings. Thought I was having heart attack more than once or twice but is better.
    Thank you for your help. Wish you were in my town or nearby I would be coming to see you ASAP. My endo won’t order Rev t3. Says it doesn’t matter since I had TT.

    • Hi Paula,

      Really the best and only thing you can do is focus on what is in your control: stress, supplements, lifestyle changes, diet, exercise, etc. You won’t be able to convince your doctor to change your medication or force them to order tests or learn how to properly manage your medication. If you’ve tried all of the options listed above or you’re feeling stuck then your next best move is to find a new physician who specializes in the sort of treatment discussed here.

      You can find information on how to help in each area in various places on my blog including which supplements to take and what foods to eat, etc.

  42. Hi Dr. Childs,

    My 24 year old daughter has undergone total thyroidectomy more than a year ago. At present she has been taking levothyroxine and calcium with vitamin D3. She has gained a lot of weight after her operation which is causing her a lot of worries.

    What can you advise to help her lose weight? Are there any supplements needed?

    Any assistance will be greatly appreciated. Thank you verh much.

    • Hi Johnny,

      Yes, this is important if you are taking T4 only thyroid hormone medication such as Levothyroxine, Synthroid or Tirosint.

  43. I was diagnosed with hypothyroidism in 2008, and so have been on thyroid medication since then. All of my life I had never really had a problem with weight or other health issues for that matter. Since my diagnosis, weight gain has been a constant issue and now other health issues as well. What really doesn’t help at all is when you have a doctor who, instead of helping to find a cause, only makes it out to be your fault that you can’t lose weight. My eating habits, like most people as they age, has not increased, but decreased. I have also cut out a lot of things as well…things that are considered “unhealthy”, simply because they just no longer appeal to me. The bottom line here is that regardless how much I change my diet, exercise or whatever..
    IT IS NOT WORKING, but to have some arrogant Jeri doctor tell me that my weight gain is due to “excessive calories” goes beyond the pale. Then you say most “conventional” doctors are not willing to prescribe what will help. If you can’t find a doctor who is willing to help you rather than judge you, what the heck do you do?

    • Hi Jason,

      All references to the claims in the article are provided as hyperlinks in the article. Some points may be repeated from other articles on my site in which case I may not have included the link to provide evidence for claims that I’ve already outlined (but you should be able to find those in other articles as well).

  44. I am a 20 year thyroid cancer survivor and taking unithroif to replace the entire thyroid removed because of cancer and holding my own; however, the unithroid doesn’t make t3. Are food sources the best wat to increase t3 levels? I fall, like clock work, asleep at 230 pm.
    I got rid of a stressful job and am getting back on a realistic routine as I look for new employment. Thank you.

    • Hi Sarah,

      There are no foods that would act to increase T3 levels. Instead you would want to focus on food choices that would indirectly reduce barriers that prevent T4 to T3 conversion, but these would be different in each person.

  45. So it’s possible to elevate just t3 and free t3 without medication? All other thryoid tests are in the functionally optimal range just free t3 is super low 2.2 so I feel every symptom on hypo. No anytibodies. But yes, I have low sex hormones, amenorrhea, and adrenal fatigue. All tested. So over time if I do these steps and eat well, I can elevate t3 without medication?

  46. Thanks for a very informative article!

    I have fairly low free T3:
    TSH: 1.70
    T3: 2.4 (2.3-4.2). It has always been at or below the lower reference value, once as low as 1.2.
    T4: 1.4 (0.8 – 1.8)

    Given the importance of proper thyroid function, I would like to increase my free T3 levels (preferably naturally, but using drug if required).

    I believe increasing free T3 would lower my fairly high cholesterol some (TC 260) and allow me to do ketogenic diets without my TC soaring to ~400. A ketogenic diet would help lower my blood sugar (I am pre-diabetic, fasting BG ~102, A1C 5.6). I am skinny (BMI 20.5), just not producing quite enough insulin.

    My diet is pretty healthy (no gluten, processed food, vegetable oils, etc.), lots of vegetables every day with some poultry or fish.

    Do you have recommendations / pointers for improving my free T3?


  47. I was just recently diagnosed with hypothyroidism last week. My TSH is 9.54. My doctor agreed to let me try a natural approach for 8 weeks before retesting. I had been told L-tyrosine would be beneficial and have been taking it for a few days but further research makes me concerned about side effects. Should I discontinue its use? I am also slightly anemic (taking iron ). Other supplements added to my routine are ashwaghanda, B-complex, 2 Brazil nuts for Selenium, D3, a good probiotic. Considering adding zinc as well.

  48. Hello, does this still apply if I had graves for years and then RAI sent me into Hypo. Docs keep thinking I am over medicated because of my TSH, but I still feel sick and better on a higher dose of medication. I am at my wits end with this. I went from 180 mg to 75 and my TSH hasn’t changed much at all. I have done everything from cutting all grains, dairy and sugar from my diet, I exercise everyday and still can’t get the weight off. I am now pre-diabetic (diabetes doesn’t run in my family) and they don’t understand that I wouldn’t be if I could lose this weight I wouldn’t have this issue. I am struggling really hard just to maintain where I am currently without gaining weight. I weigh more now then I did 9 mon. pregnant and with nothing to show for it. Please help!

  49. Good Morning,

    I have been on WP Thyroid for about 2 years. My numbers “look normal” according to my doctor, but I don’t feel good whatsoever (or like my old self). Still debilitating tiredness, irritability, athletic stamina very much decreased, feel out of it, etc. I just had another blood test that said my B6 levels were elevated, my free T4 was low, TSH was normal, and free T3 was “normal” (not in the upper 1/3 though). I also have extremely elevated Epstein Barr levels right now even though I had mono several years ago. Any thoughts? I have taken all of the supplements in the books and seen several holistic doctors/DO’s. Would adding Cytomel to my WP Thyroid potentially help? I have adjusted my WP Thyroid to a higher dosage with no help whatsoever. I have also tried to eat gluten free, no sugar, etc.

    Thank you!

  50. Hi,

    I was diagnosed with Hashimoto’s late last year. I am apparently sub-clinical, not requiring medication even though my symptoms are out of control. Although I convinced my doctor to put me on something to help with the Symptoms. He put me on Eutroxsig 50mcg on Mondays, Wednesdays and Fridays.
    This helps a little.
    I sleep 9hrs most nights and I need at least a 3-5hr nap during the day just to function. I have put on 20kgs of weight in the last 2-3 months without changing diet and mostly on my abdomen. Extreme sensitivity to the cold, mental fogginess and poor memory being just some of the symptoms.

    My doctor wants to take me off the Eutroxsig since my numbers are “normal”. but everytime he takes me off them my symptoms get worse and I end up begging to put on them again.

    I have gone gluten, dairy and soy free because I have heard that this helps. But have yet to see an improvement. I am on an Iodine solution to help with my moderate Iodine deficiency and am now considered not to have a deficiency. This had in no way improved my condition.
    Both of my FT3 and FT4 are in the bottom range of normal. convincing my doctor to do a reverse T3 test is impossible. He says that it is not needed and keeps saying that my TSH is with in normal range so I don’t need medication and everything is fine.

    Should I find a new GP that knows more about Thyroid conditions? should I request to see an Endocrinologist?
    I’m at a lost as to what to do.
    Please HELP!!

  51. Brought my 20 year old son to a new doctor. He thinks all labs are ok aside from elevated RT3 but I don’t think that’s true.
    TSH .87 (.4-4.5)
    Free T3 3.0 (3.0-4.7) Should be 4.275?
    Free T4 1.5 (.8-1.4)
    RT3 18 (8-25)
    Seems to me he is having a conversion problem, can you confirm this thought)?

  52. Hi,
    I am already taking zinc supplements. But there are so many forms of zinc like gluconate it is confusing which one to take. Which form of zinc do you recommend and what is the dosage?

  53. Hi,
    You say that optimal ranges listed don’t apply if on medication.
    How can I interpret my labs while on medication?
    TSH, T4 & T3 are all low, T3 almost never changes (2.4) even if the others do.

    • Hi Margie,

      Yes, that is correct – once you introduce thyroid medication into your blood stream you are manipulating serum thyroid hormone levels which makes them more difficult to interpret. I have not discussed the interpretation of thyroid lab tests while taking thyroid medication on my blog yet but it’s on the list for future posts.

  54. I was taking Eutirox (levothyroxin) of 75mcgfor long time and I was doing perfect. 4 months ago I started taking generic levothyroxin and also started working as a teacher. It has been the most stressful 4 months of my entire life (I’m 31) I got my labs done and it shows I have low t3 levels, I have gained like 10 lbs in 4 months and while being on a Ketogenic diet I have not lost any weight, just gained. I have acne in my jawline and headaches everyday. My family dr put me in Armour 30mg a week ago. Should I request more lab tests to se other hormone levels, my dr said my cortisol is normal. Please if you can guide me in what to do. Thank you

  55. I was born with no thyroid gland at all and I haven’t taken my levothroxin in months. I grew up on Armour since they found out at 3 months old that I didn’t have a thyroid. I don’t like the levothroxin and can’t afford the Armour. I want to treat my hypothyroidism all naturally. I was currently on 300mcg. Please help me accomplish this goal. Sincerely, Jean Stroman

    • Hi Jean,

      It’s not a good idea to stop taking your thyroid medication if you do not have a thyroid gland as it may lead to very severe consequences. You can use therapies to boost thyroid function naturally, but if you don’t have a thyroid gland you need to get your thyroid hormone from some source and thyroid hormone is required for life. Lack of thyroid hormone period may lead to coma and death.

  56. Dr. Childs very helpful article. In 2015 I switched to a strict ketogenic lifestyle and although I love this way of eating, in the past year my body has put on weight (despite consistent eating habits and exercise). I suspected a thyroid relation and the first sign was low T3. Then I noticed a gradual shift in tsh from a baseline of 0.55 to 0.86 and a few months past at 1.47. The weight gain is the biggest indicator because I’ve never had my weightloss efforts go unnoticed and no matter what I’ve tried, no avail. I am taking your recommendation and seeing a new doctor to test for rt3. It’s worth looking into. If an elevated rt3 is the issue, would a diet change correct it (considering it was a diet that brought me here)? Thank you Dr. Childs.

    • Hi Marine,

      It’s possible to improve thyroid function through dietary changes alone provided the reason for thyroid dysfunction was secondary to diet to begin with. Many times, however, thyroid dysfunction results in other issues that may not be reversed with diet alone – so it just depends on the situation!

  57. Are you familiar with Wilson’s Temperature Syndrome?
    He talks about T3, and has tons of resources for physicians and patients. Wilson’s Syndrome is people who have symptoms of thyroid issues yet normal thyroid blood tests; and the main symptom is low body temperature consistently (around 97.8 or lower).

  58. Hey doc!

    Thank you for sharing all this information, hormones are so delicate and few doctors know how to look at the big picture and interpret it correctly.
    I had a baby 2.4 years ago, got an IUD, took it out after 9 months because it was horrible and then started having all kinds of hormone issues. I’m 40 years old. I’m seeing a naturopathic doc who helped me get estrogen and progesterone back on track, adrenals are being supplemented with organs and adaptogens, which has given me enough energy and mental clarity to go about life feeling alive. She also put me on Naturethroid, started at 0.5 grain and bumped it up to 1grain 3 months ago. A month ago my TSH was down to 0.82 and free T3 is at 4.3. But I still can’t lose the last 2kgs of baby fat. I checked my labs again yesterday and my reverse T3 is at 13, which might explain my inability to lose weight despite exercising (cardio 45-60min 4times per week+yoga+Pilates and some strength training) and eating right (organic, slow carbs, lots of veggies, no processed stuff). Would you recommend switching to a T3 only medication? Or lowering my NDT dose? Should I supplement with zinc and selenium anyway? How can I get my naturopath to help me better?
    Thank you again!

  59. Hi Dr. Childs,

    I had a thyroidectomy in 2007, followed by RAI. I had only taken levothyroxine-T4 until recently. Around 4 years ago, I started a new job and over a years time gained 15+ pounds. I’m not obese or even considered overweight. more in the category of…a few extra pounds, but still healthy. I regularly work out and ate healthy, for the past 3 years with no results in weight loss. After finding your website and realizing that it could be inefficient conversion to T3 and that switching to cytomel could help, I recently switched endocrinologists. Before switching endocrine doctor I was taking 175mcg levothyroxine(5 days per week) and 150mcg(2 days per week). I am now taking 150mcg(5 days per week) and 175 mcg(2 days per week) along with 5mcg Cytomel (2 x per day once in morning, once in afternoon). I have only been on this combination of medicines for the past week, so I haven’t really seen any results thus far. I am hoping that the addition of cytomel will help increase my energy and help with weight loss. I plan to continue with my exercise and healthy eating. I’m just worried that the doseage of cytomel is too low to have the positive effects. What are your thoughts? Also, Today I read about a supplement called Nano Glutathione. Have you heard of this supplement and do you think it could help? Thank you, Alison

  60. Dr Childs:
    I am hypothyroid, I have anemia, constipation, high rt3, low body temperature, I am obese, I am short of breath. I feel tired, weak. I sleep from 9pm to 2am or 2.30 am. I get up, I take a chamomile tea, listen to the BBC radio in UK for an hour or less. Go back to bed and fall asleep until 6 am or 6.30 am. I practice mindful meditation. It helps. I do not have palpitations or things like that. I take zinc, and selenium and gentle iron supplement, vit B complex, Liposomal Vit C. I have been taking NDT since April 2015. Up to 3 grains in 2016, but I was not feeling well. So I took less and less and more, and less trying to feel better. I am taking HC 18 mg/day and weaning of. But I had to increase last week. I got a bad cold and my Endocrinologist (I cannot trust) advised me to increase HC to 18 mg/day. I was feeling so sick the last few months, that I did not know what to do. My Endocrinologists does not want to check my FT3, least of all my rt3. I paid on line for a rt3 test and is on the border with ‘high’. I live in Australia. I felt so sick, I stopped my NDT altogether as I did not know what to do. My endocrinologist wanted me to take T4 only. I DID!. After 4 days, I stopped it. I was scared the symptoms were killing me. I feel better since I increased HC a little and stopped medication for the thyroid. But I know I need t3 which I bought in US and is coming next week. I am an elderly person and I know I have to take very little Cytomel to start with.
    I can buy blood tests on line. My endocrinologist is only interested in my TSH which is very low. Last month, another endocrinologist tested me for Ft3 and I was a bit over the range.Can you tell me what you think I should do? I’d appreciate it very much.

    • Hi Kim,

      No, after your thyroid is removed you are reliant upon T4 medication which your body must still convert to T3. The same therapies and principles apply but in a slightly different way.

  61. I’m on Levothyroxine and want to take something to boost my T3.
    My hair has been shedding for over two years.
    My doctor doesn’t want to put mine on T3.
    What can I take to boost my T3?
    I’ve read all about thyroid it points to me needing T3 added to T4’ any suggestions?

    • Hi Ann,

      Yes, potentially, because conversion is still relevant if you take T4 medication orally (as opposed to producing the T4 naturally from the thyroid gland).

  62. Just wanted to say THANKS for all your articles. They are well written and easy (relatively for the complexity ) to follow and highly informative. They have been super helpful to gain understanding. Thankyou!
    Regards Martin

  63. Hi Dr Child’s, I’ve been thinking about your article and believe I have a conversion problem. I am on both NDT and T4 medication and have noticed that whenever I get my T4 up (to the upper third of the reference range) that my symptoms get worse. I have done RT3 tests and my T3/RT3 ratio seems to sit around 15 (stubbornly). I suspect that I am converting to RT3 too much or not producing enough T3. I have tried T3 only and don’t seem to handle that well.
    My only abnormal blood tests are my liver function (ast and Alt fluctuate between 50 and 70) (upper end of their range is 45) and this may be because u have been taking anti inflammatories (naproxen) for the last two years.
    Given that you have mentioned that the liver can account for up to 60% of the conversion could my liver function be the cause of the problem?
    Is the likely cause of the high liver function the naproxen or is there something else (thyroid related) ?
    Do the same factors that impact T3 conversion also impact RT3 production?
    I have a cancer related question but will put it in another post

    Thankyou very much

  64. Hi Dr Child’s,

    I have Hashimotos and I think perhaps conversion issues as a result of elevated liver function. Given that as you mentioned 60% of T4/T3 happens in the liver I have the following question.

    My father in law has been diagnosed with chirosis of the liver which has led to agressive cancer. He has gone downhill very quickly (weeks). Is it common for chirosis /cancer of the liver to create conversion issues in patients? (And if so is it worthwhile getting him tested for it)?


  65. My aunt who is an expat and works in Europe was diagnosed with hypothyroidism. She had great success using Bio-Selenium+Zinc. In the past year, I started gaining weight, feeling tired and cold all the time and my hair started thinning. As I couldn’t get the product here, I ordered Solaray’s 50mg Zinc and Pharma Nord’s SelenoPrecise. I have been taking those faithfully for the past 6 months and it has really helped. Now that I am looking closely at your conversion factors, it is obvious that before I was not converting enough T4 to T3.

  66. Hi,
    I have both Graves Disease and Pernicious Anaemia. I no longer have any thyroid function due to radioactive iodine therapy four years ago.
    Since my treatment, my lab results (TSH and T4 only) showed that I was borderline hyperthyroid – yet all physical symptoms were hypothyroid (gained 15kg, always exhausted, gravelly voice, foggy brain, half eyebrows, depression). After researching, I requested T3 & rT3 labs with the following results
    T4 – 17.8 (pmol/L)
    T3 – 3.9 (pmol/L)
    TSH – 0.13 (mIU/L)
    rT3 – 511 (pmol/L)

    I switched from straight T4 (100mcg) to desiccated pig thyroid. It has been six weeks and I have had labs done again. My results are as follows:
    T4 – 11.7 (pmol/L)
    T3 – 4.3 (pmol/L)
    TSH – 0.07 (mIU/L)
    rT3 – 302 (pmol/L)

    For a brief window before switching to the pig thyroid, I was on straight T3 and felt fantastic. Now that I am on the desiccated supplement that includes T4, I feel almost as bad as when I was on the straight synthetic T4.

    Long winded message (apologies) but I’m wondering whether I can take just the T3 and never bother with the T4 (and the T1 & T2 that is also in the desiccated supplement)? I also noticed that my TSH is ‘off the rails’ low, and am wondering what is also going on there, please? My endocrinologist doesn’t believe in the whole rT3 thing, and my GP is happy to order the tests for me but acknowledges he has no idea what to do with the results.
    I’m in Australia and can’t seem to find a specialist who is open-minded about such things, so would really appreciate any advice you can give me.
    Kindest regards,

  67. I had a total thyroidectomy 12/22/2010 (which also damaged parathyroids) and was stablilized for 6 years on a dosage of 138mg of Synthroid(generic levothyroxine caused issues). Although my TSH was consistently in the 0.18 range, I was very physically active, felt great, weight was almost exactly where I wanted it, etc. Last November(after the end of fall softball season), I took it easy with very little physical activity at all…by 12/10, I began experiencing arrhythmia/tachycardia, which evolved into A-Fib on 12/30/17. My synthroid dosage was reduced to 125 then to 112 in January, finally resulting in stabilization (i.e. elimination of A-Fib symptoms) by mid March.
    My question is whether you are aware of any studies or opinions on the relationship between higher dosages of thyroid hormone/corresponding low TSH and exercise/physical activity specifically in women? I am convinced that that is the case and why I experienced no negative symptons even with TSH around 0.18 for years. This spring I have gradually increased my physical activity again, while remaining on the 112 dosage and my TSH went from 0.21 in April, 0.57 in May and now 0.43 in June – no change in dosage.
    Practically speaking, I experience most symptoms of low thyroid (fatigue, hair loss, weight gain, some muscle weakness(although I also struggle with hypocalcemia due to parathyroid damage))
    Thank you for any wisdom or suggestions!

    • Hi Susan,

      I’m a bit confused by your question. The only relationship between TSH and exercise capacity would be as TSH increases it would be less likely that the patient would be able to exercise due to fatigue from hypothyroidism. As far as I know, there is not a relationship between low TSH and exercise capacity, though you might feel more energy with a lower TSH which may account for increased energy/exercise on a personal level.

  68. I currently live in Australia. I had thyroid surgery in my teens carried out by a local surgeon (unfortunately was not referred to specialist). Very poor follow up meant I was seriously ill with hypothyroidism for 4 years – until I researched and diagnosed. Surgery was 45 years ago and I have never been able to find a doctor that knows enough. In the UK for a couple of years I had a wonderful osteopath/naturopath. Suffered unnecessarily from fibromyalgia for a couple of decades, until I discovered Dr John Lowe. In researching my current test results, I discovered your website – the information you provide is invaluable. I have an explanation for my high T4 and only mid range T3 – ie, not converting properly. All doctors want to do is cut down T4 medication (unfortunately none treat with T3 as well.) I no longer follow bad advice. I am now going to focus on improving T4 to T3 conversion. Thank you so much for making this information available.

  69. Hi Doc!

    Loved your article and the way you practice. You probably could have helped me and I wish I found you sooner. As it was I had to figure out my problems on my own as the doctors were clueless. Long story short, I had a chronic fatigue situation, I do have hoshimotos too, (Epstein Barr IgG antibodies were over 750 at the time this all started). No help from the doctors…. I figured out on my own about nutritional deficiencies, needing to eliminate dairy, gluten, etc. Added dark leafy green juicing… slowly added some high quality organ supplements including thyroid, slowly started on some kelp only after months of using whole food supplements such as selenium, zinc, vit b, vit c (from acerola cherry), etc. Slowly got well, over MONTHS. I went from not being able to walk around the block or work to walking up hills around the house, now back to work part time and generally felling better than I have in years. I did finally find a decent naturopath who confirmed I was on the right track. She told me to keep an eye on my body temperature, to get it up to 98.6 as a sign my thyroid is functioning well. I also read that the pulse is a good thing to check for thyroid function as well – your thoughts on that?

    Thank you!


    • Hi Suzie,

      Body temperature can be used as a proxy for metabolism and it was used before we had more advanced thyroid lab tests. The problem with using body temp is that you often end up on a higher than necessary thyroid dose which results in symptoms and may damage your metabolism in the long run.

  70. Hey, I loved this article! I am a T1,on an insulin pump, I exercise (Burn Bootcamp) 6 days a week and I eat health and Whole30(ish). For 6 weeks I was in a challenge at bootcamp and I dropped 5 of those last 10lbs to be at 137.8lbs and dropped body fat to the lowest its been at 23.7% When that challenge ended…..2 days later I fell running and broke my collarbone and now have a metal plate….but it doesn’t stop there. The bone pulled away from the plate in the 1st week or recovery and I had revision surgery 11 days later. I’m healing slowly but no pain. All that to say, I am back at bootcamp as of mid April, weighing 138.2lbs, heavily modifying then and have increased what I can do now. But……I have gained those 5 lbs back, plus 5 more since April 11 and now I’m at 145 lbs. My BF% went up as well by about 7%. I am burning the same amount of calories as before so now I’m wondering if my Hashimoto’s is trying to take charge? I’m not ok with that. Did my back to back surgeries screw my body up? What gives? Should I go to my endo and get bloodwork done? I’m realy frustrated to no end because I workout HARD everyday and I had my weight and nutrition all under control and was making those gains and reaching my goals and then it stopped, without warning within 2 weeks of returning to bootcamp. As far as location on the’s my lower belly (baby belly), boobs and thighs…..but mostly belly. HELP guide me in the right direction, please.

  71. Hey there, thanks so much for this article. It was great information and I am excited to be able to use it for my clients and to have a resource I can refer them to. You’re incredible.

    Ashlee cNC

  72. Thank you for this detailed, easy-to-understand guide: it was exactly the information I needed and will help me tremendously in my efforts to support my husband’s healing from damage done by military vaccinations that destroyed Orexin neurons and caused a cascade of lifetime complications, beginning with Narcolepsy at the age of 18. Now in his fifties, after having been misdiagnosed multiple times with a myriad of conditions (including Multiple System Atrophy), we’re finally understanding the root cause of his illness and making progress in reversing the damage.

  73. Thank you for the compiled educational articles on your website. So appreciated.

    Iused to take i-throid iodine daily but am not sure if it contributed to heart palpitations. I take selenium daily, zinc several times a week, and the iodine maybe once a week. You gave suggested does of iodine as “150-170mcg of iodine per day”. i-throid contains potassium iodine 7.5 mg, free iodine USP 5 mg, and Potassium iodine USP 2.5 mg. How does this dosing compare with your recommendation? I don’t know mcg from mg. Is the i-throid higher than what you recommend? Do you have another brand that your patients work with? Thank you.

    • Hi Robin,

      I almost exclusively use my own supplements on my patients but that’s primarily because I know they work and I’ve tested them on thousands of people. I’m sure there are other supplements out there that can also work, I’m just not familiar with them.

  74. This was a great article. I am on np thyroid, 210mg, daily. This was just increased from armour 180. I had radioactive iodine in 1995. I’m 44. My weight has been 121 for two decades. Over the last 3 years my weight has increased steadily. I am at 130. I teach fitness and eat well. I can’t lose a pound! I have extra fat around my middle/thighs. My doc did see that I have a huge gap between progesterone (.04) and estrogen and put me on progesterone 100mg.
    My reverse t3 is high. According to your article, how do I know if I’m restricting too much and that is why I’m gaining.
    I also take iodoral and no selenium. Should I add that?

  75. Hi Doctor ,my question is I was diagnosed Graves’ disease 2008 my blood test results was :TSH 0.01 freet3: 19.39pmol/L (3.6-6.5)freet4: 30.9 (9-19.1) my freet3 and freet4 levels was up and down but my antthyroid medication dose exactly same almost 8-9 years why ? ignorant endocrinologist or what ? I checked my blood test results since 2008 March 2009 my TSH was 1.5(0.35-4.94) but dose exactly same why ? Thanks doctor

  76. Thank you for the quality information you share.

    I wonder if you have written about how to make a choice between:
    Surgery to remove part of all of the thyroid, vs Radioactive Iodine to stop a suddenly over producing nodule (biopsied and not cancerous).

    There is so much conflicting advise one way or the other.
    I hope you will consider making a blog or video to help someone with a newly hyperactive thyroid nodule to make the best choice.

    In the meantime, I’ve just started a low dose of Methimazole following the herbal Thyroid Calming tincture from Herb Pharm. It’s a very serious decision to get surgery or RAI, and I would really appreciate how you would suggest making a choice.

    Thank you!

    • Hi Elizabeth,

      Sure, as a quick overview…

      If you have the option to keep some of your thyroid gland versus taking out all of it or destroying all of it with RAI then it’s probably best to keep whatever amount of thyroid gland you can. The thyroid gland can hypertrophy to make up for lost gland but if you remove all of it then you will be 100% reliant upon thyroid medication for life.

      • Can Graves’ disease lower dopamine levels sir ? My symptoms was low mood ,anxiety and low libido thanks doctor ….

  77. Please advise me :diagnosed Graves’ disease 2008 my TPO was 269u/mL my first symptoms was right hand shake my first blood test results was TSH 0.01 freet3 19.39pmol/L (3.6-6.5)
    Freet4 was :30.9pmol/L (9-19.1) and next blood test results TSH 0.01 freet3:10.67freet4:22.7(9-19.1) 6 October 2008 :TSH was0.01 (0.35-4.94) freet4 was 25.0pmol/L (9-19.1) freet3: 9.95pmol/L (3.6-6.5)30 mg carbimazole a day 6 November 2008 :TSH 0.01 (0.35-4.94)freet3:6.23(3.6-6.5)freet4: 14.1(9-19.1)9 December 2008!:tsh0.01 freet3: 5.77(3.6-6.5)freet4: 11.6(9-19) 3 March 2009 blood test results:TSH was :1.5(0.35-4.94)freet4: 12.2(9-19.1)my CK was 3944u/L (0.200) doctor said muscle problem or too much PTU (propthyuracil) 17 March 2009 blood test results:TSH was 0.04 (0.35-4.94)freet4:14.3freet3:6.45(3.6-6.5)28 April 2009 : CK :268 TSH 0.06 freet3: 5.35 freet4:11.6(9-19) 27 July 2009 blood test results TSH 0.01 freet3: 8.09(3.6-6.5)freet4: 17.3(9-19.1) 6 November 2009:freet3:9.04pmol/L freet4: 20.2pmol/L (9-19.1) TSH was 0.01 (0.35-4.94) 19 April 2010 blood test results was:TSH 0.01 freet4:21.3freet3: 9.19pmol/L (3.6-6.5) nhs uk 22 February 2011 :TSH 0.01 freet4: 11.8 (9-19.1)freet3: 7.52 (3.6-6.5) same dose 300 mg PTU I refused the RAI treatment 2011 ( I don’t know why ? I was scared) doctor said you think about it RAI or surgery (maybe I made big mistake refused rai ) 23 January 2013 :TSH :0.01 freet4: 16.0(9-19.1)freet3 7.89 pmol/L(3.6-6.5) 6 May 2014 blood test results was:TSH 0.01 freet3: 5.04 (3.6-6.5)freet4: 11.3(9-19.1) i didn’t know any this blood test results!! I thought I will be ok with antithyroid medication 9 October 2014 my TSH was normal 1.3 mU/L (0.35-4.94) still same dose PTU 300’mg a day 30’june 2015 my thyroid levels start going up again didn’t feel very well symptoms was anxiety ,low mood TSH 0.01.freet3 was 7.66pmol/L freet4 was 14.4 1 st September 2015 blood test results was TSH 0.01 freet3 was 8.63 pmol/L freet4 was 16.2(12-22.0) after this test I was ill I went to emergency to hospital my hands was shaking doctor said anxiety go home nothing serious he said 13 January 2016 I had another blood test my thyroid levels was going up again freet3 was 9.30 pmol/L freet4 was 14.2(12-22.0) and February I had mini stroke (TIA) doctor said coincidence no connection with high thyroid levels but I think it was because next blood test results my thyroid still was going up freet3: 11.86 pmol/L freet4 was 19.3 (12-22) 15 March 2016 ……poorly treated almost 9 years

  78. My symptoms was since diagnosed Graves’ disease : sweating ,low libido ,easily bored ,easily get stress and angry and low mood my question is can Graves’ disease lower Neurotransmitters? Biologically lower dopamine levels? Thanks …

  79. Hello Dr Childs,

    Thank you for a very informative page!

    I have a question that I haven’t found an answer to yet.

    What specific tissues in the body require the 20% of direct t3 that is produced in a healthy thyroid?

    If I have not misunderstood it seems that at least some part of the heart tissue requires direct t3 whilst other parts require t3 through conversion.

    Now I wonder if there are more tissues in the body that are specifically in need of the direct t3 that is produced in a normal thyroid gland? Do you have any knowledge about this and perhaps links to relevant articles?

    Best Regards


    – 10 years on mono-medication after full thyroidectomy due to Graves. Nowadays with arrhythmia and slower heart rate.

    • Hi Carolina,

      I’m not quite sure I understand the question. All tissues require T3 (with the exception of maybe the brain) and it doesn’t matter if those tissues get the T3 via conversion or through direct production.

  80. This is the most comprehensive article on T3 conversion. I have Hashimoto’s for the last 17 years, my thyroxine dose is 125mcg now. I have been to all the endocrinologists in the city ( Dubai) but they have the same basic knowledge which is very frustrating. My last week’s reading is low TSH, normal (mid-range) FT4 and FT3 slightly lower than lower normal range. The dr, as expected, asked to cut down on dosage and bring it down to 100mcg. This is my plan, I will take 100mcg for 5 days and 150mcg 2 days. My real focus will be to take the above steps to increase the conversion to T4 to T3 and repeat the results after 4 weeks to see if there is any difference at all. BTW I am a doctor myself and have good baseline knowledge. Thanks, Dr. Westin for your efforts, it’s a true community help.

  81. I am so incredibly thankful to have found this article! I have Graves Disease and had my thyroid removed 5 years ago. Whilst I live a busy life, I have been finding myself feeling increasingly exhausted and have put on 20 kilo’s… not happy. I take 125mg Thyroxine a day, my last blood count read T4 20, TSH 0.35. I am also at the very lowest end for my iron levels and sometimes under.

    It appears I am taking enough Thyroxine, but not sure that my body is processing it correctly. I get a sore bloated stomach after each meal, and am either constipated or more recently have been experiencing a lot of gas and diarrhea. I am going to now get my FT3 and thyroid autoantibodies checked. I am going to take your advise and start taking zinc, selenium, vit B6, a liquid iron supplement and a probiotic.

    Thank you for this advice, I feel very hopeful.

  82. I’m taking levothyroxine 88 mcg and gaining weight. I do take blood thinners, water pills, hight blood pressure medicine and cancer medication chemo. I have not loss weight with the medicine.

  83. I just had a major blood workup. My surprise wasn’t that my thyroid was an issue. I’ve suspected that it wasn’t really normal for a long time, even though results are in normal range, as I’ve struggled to lose weight. Recently, I did lose doing KETO and am now in a normal weight range. I just calculated my thyroid tests and none appear to be in optimal range and I had the antibodies test done which showed Thyroglobulin antibodies of 12. My thyroid peroxidase antibodies were in the normal range but at the top with a value of 8. In addition, my sex hormone binding globulin was high at 123. I tested low for iodine at 51. My iron and ferritin levels were in normal range ferritin being 78. My selenium was in the normal range at 162 but could be higher with no problem and probably should be. My zinc was mid-range at 11.49. I’m thinking based on what I have read at your site, I should supplement with zinc, selenium and iodine. In addition, begin taking a digestive enzyme with each meal and do probiotic right before bed. Then, get retested and see if it makes any difference in what I am doing.

  84. My doctor says my thyroid is at the upper end of normal, and I should be zipping around (definitely not!). Body temperature averages around 35.5 during the week, with Wilson Temperature Syndrome being the cause – thyroid with low temperature when results are normal. Also a reading for a fatty liver. UK only prescribes Levothyroxine with a reluctance to issue T3 as a remedy. Been overdosed on Thyroxine, which gave me an irregular heartbeat. Would like to know what natural supplements I should be taking to function better and get more energy.

  85. Hello Dr,
    My wife received her order yesterday of the T3 Conversion Booster. Her rt3 test value was 27.6 and her dr started her on 5mcg of liothyronine. The dr wanted to start slowly though the website said 25 mcg was a good starting point. Is it safe to take the Rx and the Booster both together? Please advise

    • Hi Arthur,

      Yes, perfectly safe to use T3 conversion booster with all T3 medications including liothyronine/Cytomel.

  86. Hi Dr Childs,
    I have a few questions about conversion that I would be grateful if you could answer:
    1) can being underweight cause conversion issues?
    2) I have read that if t3 levels are too low conversion will drop further due to the body focusing on reverse t3 – is this true and therefore does getting t3 past a certain point aid conversion of further t3?
    3) And the one I am most curious about – if one is already taking t3 is it possible to improve conversion whilst taking it and therefore raise t3 levels without having to take more liothyronine even on a bigger amount of t3 say 12.5mcg?
    Many thanks!

  87. Hi

    I have a question, I’m pretty sure I have hashimotos although I haven’t been diagnosed yet except with having lifelong hypothyroidism and Thyroid antibodies of over 2000 , I’m 20 so it does seem like a end of the world thing. So far I’ve been refraining from free sugars completely and eating more fruit and veg. My GP is being really stubborn so far but I’m sticking with her until I get my thyroid scanned.
    So I had access to my results a few days ago and I realised I had a high Bilrubin level (higher than normal around 3.0). Is there anything I could to to remedy that? My GP didn’t mention it at all.
    Thank you for giving me hope.

  88. Dear Dr. Westin Childs

    I am a 56 year old women. I have been taking Eltroxin for several years and this was prescribed to me based on a high TSH level. I then went to an Endocrinologist who said I may have Hoshimoto, Eltroxin is what I was given. I just now had a blood test and there are my values>

    TSH 3.89 uIU/mL on the high side
    T3 2.63 PMOL/L too low
    T4 13.29 PMOL/L normal?
    Ferritin 41.89 NG /ML too low

    the reverse T3 etc was not tested
    The reason I asked for tests is because I started the Keto Diet a good month ago together with intermittent fasting. I exercise, I feel ok, but I am unable to lose any weight. Energy wize I feel good on this diet, I also sleep well etc. But I am unable to lose weight. I went on the diet because I started gaining weight, although I did not eat more than usual.
    I love to exercise, I do not eat processed or junk food ever.
    Its all very strange.

    Should I request further testing?
    Which Vitamins should I supplement and what amounts per Vitamin if speaking of
    Vitamin B6
    How do I add Iodine at a sensible level?

    Thank you for any help you can offer!

  89. Thank you for all of this great information. What do you suggest to help the liver function better? Also, I am taking a break from my T3 meds since they were making me so anxious and jittery. I have become gluten free and take extremely good vitamin and mineral supplements and am wondering if that is why my T3 meds were doing that to me, since maybe my T4 is converting to T3 on it’s own now. I have also added a blood sugar supplement as well as gut supplements and aloe. I still have problems with acid at night when sleeping, coming up my throat and making me cough. I am not sure what more I can do for that, since I have had a history of acid reflux with my thyroid problems (20 years) I am planning to do a liver cleanse in January to see if that will help. Thank you!

  90. Read the entire article! Lots of information to take in. You have eerily described my health problems though out my life. In high school many moons ago a doctor I went to gave me thyroid medication after blood tests and said even though they were normal I needed meds. Lost weight no anxiety no nervousness actually felt “normal” . After he passed couldn’t get another doctor to believe me. Showed the records and still no. Most of the women in my family take thyroid medication and some male cousins have actually had it removed. All are on levothyroxin only . I take Fluxotene 30 mg and still have restless leg and 90% of listed symptoms of hypothyroidism. I’m so tired.


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