Why Low T3 causes Weight Gain + Symptoms & Treatment Guide

Why Low T3 causes Weight Gain + Symptoms & Treatment Guide

Checking your total T3 and free T3 may be the most important thyroid tests you can look at. 

Unfortunately, many physicians aren't even ordering these tests which may lead to a missed diagnosis of low T3 syndrome. 

Fortunately, there are several therapies that you can do to increase this important thyroid hormone and take steps to reduce your symptoms. 

If you are experiencing weight gain, chronic fatigue, chronic pain or a slow metabolism then increasing your T3 becomes even more important. 

Let's discuss how to increase these levels and how T3 impacts weight and weight loss...


Why T3 is the MOST Important Thyroid Hormone

T3 thyroid hormone is one of the most important thyroid hormones (we will go over the other arguably more important hormone below).

T3 is the active form of thyroid hormone in your body.

It can be measured by testing your total T3 in the serum and by assessing your free T3 levels.

The total amount of T3 in your body represents all of the T3 in your serum (blood), and the free T3 represents the amount of T3 available to be used and for binding.

You can think of total T3 as a reservoir for free T3, but both numbers are important. 

But why?

It turns out that all of the beneficial effects of thyroid hormone in your body comes from T3 (NOT T4 thyroid hormone).

T3 thyroid hormone acts directly on the nucleus of your cells via a nuclear receptor to literally turn on your genes (1) and alter genetic transcription.

This is very important because it can help you understand exactly how thyroid hormone works in the body.

The fact that thyroid hormone works on the nucleus of the cell helps to explain why it takes weeks for changes in thyroid hormone to take effect. 

Altering genetic transcription, altering enzyme production, and changing cellular transcription takes times. 

These changes in genetic transcription help increase energy, increase metabolism (2), stabilize hair growth (3), and do all of the functions associated with proper thyroid hormone function. 

  • Bottom line: T3 thyroid hormone does all of the good things that you want thyroid hormone to do. It is the most important thyroid hormone to monitor for this reason. 

Download my Free Resources:

Foods to Avoid if you have Thyroid Problems: 

I've found that these 10 foods cause the most problems for thyroid patients. Learn which foods you should absolutely be avoiding if you have thyroid disease of any type. 

The Complete List of Thyroid Lab Tests:

This list includes optimal ranges, normal ranges, and the complete list of tests you need to diagnose thyroid hypothyroidism correctly!

Download more free resources on this page

Understanding the Difference Between T4 & T3

The biggest issue with T3 is that most doctors, physicians, and endocrinologists don't actually test for it.

And that's why you need to understand the difference between T4 and T3. 

You're probably familiar with T4 whether you realize it or not:

Some physicians actually test for T4 (so you may actually have your free T4 levels to look at).

Even if your doctor doesn't test for T4 and instead uses the TSH only for monitoring your thyroid function, you are probably being treated with a T4 only thyroid medication like Levothyroxine, Synthroid or Levoxyl.

And that's the problem:

T4 is used in the body as a reservoir to be turned into T3 through a conversion process known as T4 to T3 conversion. 

So why is that a big deal?

Doctors make one big mistake when treating and supplementing hypothyroid patients with T4 only medications:

They assume that your body will take all of that T4 thyroid hormone and turn it straight into T3.

And, as you can probably guess, that doesn't always happen. 

Instead, your body is just as likely to turn it into the antithyroid metabolite reverse T3.

Reverse T3 directly competes for cellular binding with T3 and can actually cause hypothyroid symptoms.

So when testing for thyroid hormone and when evaluating if you are being managed correctly it's far more useful to know your T3 levels instead of your T4 levels. 

Make sense? 

Why Low T3 Leads to Weight Gain

One of the biggest issues that hypothyroid patients face is weight gain.

Part of this problem is mediated by the fact that many patients don't actually convert T4 to T3 efficiently, and the other part is the reliance upon TSH as a measure of proper thyroid hormone in the body.

The truth is that most patients don't actually convert thyroid hormone efficiently AND TSH is not the best marker for evaluating thyroid function in the body.

These problems, along with low T3 levels, help contribute to the weight gain and weight loss resistance that many hypothyroid patients face and struggle with. 

The reason T3 is so important for proper weight management is simple:

T3 is one of the most powerful, if not the most powerful, mediators of energy production from your mitochondria. 

natural thyroid supplements version 2

The energy production from your mitochondria serve 2 very important functions:

1. Help determine your basal metabolic rate. 

2. Help provide you with a subjective sense of "energy". 

That means that low levels of T3 will directly (or indirectly) result in a slower than normal metabolism (sound familiar?) and may result in the symptoms of fatigue and/or low energy levels. 

Obviously, both of these factors are very important for maintaining a normal and healthy weight, but they are most important for losing weight.

Your metabolism accounts for the majority of calories burned throughout the entire day, so a slow metabolism results in weight gain.

Meanwhile, low energy levels may prohibit you from being able to exercise making weight loss difficult.

So what is the solution?

How to Test your T3 Levels

For the reasons listed above (and many others we won't be discussing) testing for your T3 becomes a VERY important part of thyroid management.

I need to take a second and make a disclaimer here:

If you have to ask your Doctor for these tests there is a good chance they are NOT going to understand how to interpret them correctly. 

So don't assume that you will get proper treatment for your thyroid problems just by getting these tests done, the testing is really only the beginning.

What matters more than the actual tests is the treatment and management afterward.

So, while testing is important, don't make the mistake of assuming that your physician or provider will be willing to treat you appropriately once you have the results.

Ok, back to testing:

These are probably the most important thyroid tests to get if you want to understand how your thyroid is functioning in your body:

  • Total T3
  • Free T3
  • Reverse T3
  • Sex hormone binding globulin

You will probably notice that TSH and free T4 don't even make an appearance, and that is definitely intentional. 

TSH really only gives you an idea of pituitary levels of thyroid hormone and T4 is only somewhat helpful in evaluating thyroid conversion.

Instead, I want you to focus on getting the labs listed above and then interpreting the results based off of "optimal" levels and not "normal" levels.

When it comes to hormones there is a huge difference between being in the "normal" range and having adequate function and being optimal.

For instance:

As a 20 to 40-year-old woman, you don't want your free T3 levels to be in the range of an 80-year-old. 

Use the sample ranges below to determine if your levels are optimal or not. 

Optimal ranges for the following lab tests (assuming you aren't taking T3 containing thyroid hormone already): 

  • Total T3: Should be in the upper half of the reference range
  • Free T3: Should be in the upper half of the reference range
  • Reverse T3: Should be as low as possible, any number higher than 15 is a problem
  • Sex hormone binding globulin: In men, this should be 20-30 and in women, it should be 70-80 (this value isn't helpful if you are taking oral estrogen or birth control pills)

These values assume that you are NOT taking any thyroid medication (if you are, you can't use those ranges) and it assumes that you also are experiencing the symptoms of hypothyroidism

I want to take a second and point out the value of sex hormone binding globulin:

SHBG helps give you an idea of the tissue levels of thyroid hormone in your liver.

As an aside, you can think of TSH as a marker of tissue levels of thyroid hormone in your pituitary. 

The liver is a better marker of other tissues in your body because it contains both deiodinases.

The pituitary doesn't contain the deiodinase which transforms T4 into reverse T3, which means that ALL thyroid hormone hitting the pituitary will be able to convert just fine.

But that same thing may not be true in other tissues, and that's why SHBG is helpful.

Low T3 Syndrome + Euthyroid Sick Syndrome

Let's say that you have your tests in front of you and you have determined that you do indeed have low T3. 

It turns out that there is actually a name for your condition:

It's known as low T3 syndrome and/or euthyroid sick syndrome.

Almost every doctor is aware of this condition, but they've probably forgotten about it over time (or don't realize its importance outside of the hospital).

The reason is simple:

Low T3 is a compensatory response to harmful stimuli on the body.

We can sum it up like this:

Anything in your body that causes high levels of stress, high levels of inflammation, physical/emotional trauma or any other stressor on the body may result in this condition. 

Another surprising reason for low T3 is simply being overweight.

Patients who are obese have lower levels of free T3 (4) and higher levels of reverse T3.

Medications can also reduce the conversion of T4 to T3 including blood pressure medications, diabetic medications, pain blocking medications, antidepressants and nerve modulators (gabapentin & Lyrica, etc.). 

When you look at all of the potential causes of low T3 that exist, it's easy to see why this condition is becoming more and more common. 

Nowadays it's not uncommon for people to be overweight, stressed out and already taking multiple medications. 

I should also take a second to discuss that one of the most common causes of low T3 is calorie restriction and a history of yo-yo dieting (5).

If you've ever done these types of diets in the past there is a very good chance that you not only have damaged your metabolism but that you also have low levels of T3. 

If you fall into this category don't worry - we are going to talk about treatment below:

Symptoms of Low T3

But first, we need to talk about the symptoms of low T3.

If you recall I pointed out earlier that you need the combination of symptoms PLUS low lab values to diagnose low T3 syndrome.

Use this list of symptoms in conjunction with your lab tests to determine if you have low T3:

  • Cold body temperature & extremities (less than 98.0 degrees)
  • Low resting heart rate despite being overweight and non-conditioned (resting heart rate less than 50-60)
  • Weight gain and/or weight loss resistance
  • Decreased energy levels and inability to sustain activity levels for long periods of time (even low-intensity exercises like walking cause worsening fatigue)
  • Other hormonal problems including estrogen dominance, low progesterone levels, insulin resistance, and/or leptin resistance
  • Chronic pain and/or chronic muscle tension/cramps
  • Hair loss, hair breakage, dry skin and/or brittle/damaged nails

As you may have noticed this list mimics many of the symptoms with some exceptions...

Many of these symptoms result from a lower than normal metabolism and may directly or indirectly lead to weight gain and weight loss resistance.

In addition to these symptoms, you may experience any (or all) of the traditional symptoms of hypothyroidism

It's important to note that the symptoms of low T3 may vary from person to person, but the list above represents the most common symptoms that patients may experience.

Use the list above in combination with your lab tests to determine if you should move on to the next step...

Natural Treatment to Increase T3 Levels

I'm going to go over how to approach low T3 levels and what you can do about it. 

This is really important because, as I mentioned previously, most physicians don't pay much attention to T3 levels.

This means that they aren't likely to change your medication, increase your dose, or even mention these lab tests, to begin with.

It's therefore important that you are knowledgable and do whatever you can to increase your T3 naturally.

I will also go over how to increase your T3 the easy way (taking T3 medication) below.

#1. Boost Conversion of T4 to T3

One of the easiest ways to boost T4 to T3 conversion is by taking targeted supplements to help boost this natural conversion process. 

It turns out that there are several supplements that can help accomplish this goal:

  • Zinc: Zinc has been shown to increase T4 to T3 conversion, act as a powerful anti-inflammatory and reduce oxidative stress. Zinc is also a VERY common nutrient deficiency in the US. Standard zinc supplements also fall short because they don't contain zinc bound to picolinic acid or citrate (which is the most absorbable form of zinc (6)). Doses of 30-60mg per day can help boost thyroid conversion if taken with selenium. 
  • Selenium: Selenium can also improve T4 to T3 conversion, act as an anti-inflammatory and help balance the immune system. Selenium is also very helpful for patients with autoimmune thyroiditis or Hashimoto's thyroiditis. Taking 200-400mcg per day (when accompanied by zinc) can help boost thyroid function and conversion. 

#2. Reduce Reverse T3 Levels

Another indirect way of increasing the effectiveness of T3 levels in the body is by reducing your reverse T3 levels.

Recall that reverse T3 directly competes for cellular binding with T3 levels.

This means the higher the reverse T3 the more free T3 you need to counteract the reverse T3.

By decreasing reverse T3 levels you don't necessarily need to increase T3 levels because it will be easier for the T3 to do its job.

Make sense?

So how do we do it?

You have to tackle the main problems that might be causing high reverse T3 levels to begin with.

Use the list below and address any or all of the problems in your body to reduce your reverse T3 levels:

  • Lower inflammation: Inflammation from any cause will increase reverse T3 levels and result in decreased thyroid function. You can test for inflammation by checking ESR and CRP. If these are elevated then you should consider taking anti-inflammatory supplements like Turmeric, Krill oil with astaxanthin and quercetin + bromelain
  • Treat SIBO or other GI related problems: Treating your GI tract is very important for managing thyroid conversion because the gut is the place of at least 20% of the conversion process. This is further complicated by the fact that many conditions like SIBO, IBS, GERD, and SIFO reduce conversion by increasing inflammation and reducing the conversion efficiency in the gut. Approximately 50% of thyroid patients have concurrent SIBO/SIFO whether they realize it or not, you can learn more about treating and managing SIBO here
  • Lower insulin: High insulin levels (and also high blood sugar levels) inhibit the T4 to T3 conversion process and contribute to weight gain. If your fasting insulin is greater than 5.0 you should aggressively treat and manage your levels with supplements + dietary changes. If you have insulin resistance (or high blood sugar) consider using the following supplements: Alpha lipoic acid, Berberine, and chromium
  • Lower leptin levels: Leptin is another hormone that contributes aggressively to weight loss resistance and is missed by most physicians who either don't know how to treat it or don't understand its importance in managing thyroid levels and managing weight loss. I've written extensively about how to test for and manage leptin resistance and you can read more about that here
  • Stop dieting and consciously limiting your calories: If you are consuming less than 1,500 calories per day just to maintain your weight you are damaging your metabolism and contributing to low T3 syndrome. In order to heal your metabolism, it will be necessary to STOP consciously reducing your calories to halt and reverse this process. 

Reducing reverse T3 levels can be quite complex and may require some digging to get to the bottom of your specific problem. 

#3. Increase Thyroid Hormone Production

Another roundabout way to increase T3 levels indirectly is by increasing your total thyroid hormone production.

This doesn't always work by itself, but if used with techniques designed to both boost T4 to T3 conversion AND reduce reverse T3 levels it can be particularly effective.

It turns out that over 10 different supplements are required for proper thyroid hormone production.

If you are deficient in any of these nutrients then you may suffer from decreased thyroid hormone production over time leading to worsening symptoms of hypothyroidism. 

You can find the full list of supplements required in this post as well as how to test for and determine which supplements you may need to take.

T3 Thyroid Medication Therapy

Now let's talk about the easy way to increase T3 (well relatively easy way). 

Simply taking T3 can automatically provide a boost to your T3 levels and significantly (and usually quickly) reduce any symptoms you may be having from low T3.

We touched on medications previously, so it's worth discussing them a little bit more in detail. 

Part of the reason that so many patients feel terrible despite taking thyroid medication has to do with the conversion process of T4 to T3.

You already know that most physicians prescribe T4 only medications like Synthroid, levothyroxine, and Levoxyl.

What you may not realize is that these T4 only thyroid medications may be converted into reverse T3 instead of the T3 you want it to turn into.

So, in some cases, you might actually be making your symptoms worse by taking thyroid medication.

In some cases, you may be fueling the fire by providing your body with more substrate to produce reverse T3 with.

So how do you deal with this problem?

This problem can be dealt with by reducing (or eliminating) the amount of T4 hormone you are taking and instead providing your body with T3 only thyroid medication.

If you give your body direct T3 there isn't any substrate to produce reverse T3 from so these levels will automatically drop.

Getting your physician to prescribe T3 only medication can be difficult, however, so this may not work for everyone - but if possible it's certainly worth a try.

Better yet - the combination of all of the natural therapies listed above with T3 only thyroid medication is very effective.

NDT vs Liothyronine/Cytomel for Low T3

What about natural desiccated thyroid hormone, where does NDT fit into all of this?

As you may know, NDT is predominately a T4 thyroid medication, but it does contain some T3 in it as well.

The ratio is in favor of T4 about 3:1, however, which means that NDT can also contribute to reverse T3 production.

In some cases dropping the total dose of NDT may be required to flush out reverse T3.

In addition, some patients do quite well with the combination of NDT + T3 medication. 

Recap + Final Thoughts

Having low T3 is a serious problem that tends to be ignored or underappreciated by most physicians. 

Because T3 thyroid hormone is the active thyroid hormone in your body it is the most important thyroid hormone to evaluate. 

If you are experiencing any of the symptoms of low T3 syndrome or euthyroid sick syndrome make sure that you get the following lab tests: free T3, total T3, reverse T3 and sex hormone binding globulin

If you find that you have low T3 then a combination of natural treatments plus changing your thyroid medication may be in order. 

Remember that when it comes to improving your thyroid function it will likely require a combination of therapies to achieve the best results. 

Now it's your turn:

Do you have low T3?

What have you done to increase your T3 levels?

What has worked for you?

Leave your comment below and I will personally respond. 

References (Click to Expand)

the low t3 weight gain connection - this is why you you can't lose weight

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.

151 thoughts on “Why Low T3 causes Weight Gain + Symptoms & Treatment Guide”

  1. Hello! Awesome article! Thank you for providing this information in such a clear manner. I was diagnosed with Hashimoto’s after my first son was born 6years ago. I was placed on a T4 only medication which I have been taking since (hopefully this will change soon ;). I have recently started my Hashimoto’s educational/improvement journey. I asked my primary care doctor to order the lab tests mentioned in this article, along with some you have mentioned in other articles. He obliged and I am still waiting for the results. There are optimal ranges for lab tests mentioned, if you are not taking any thyroid medication. What are the optimal ranges for lab tests if you have been taking thyroid medication? Thank you!

    • Hey Ryan,

      I will have to create a different post entirely on that subject because it can be very confusing if not explained correctly. Right now I don’t have that information available on my site.

  2. Doctor,
    I have been on t4 since past 4 years but i did not loose any weight at all though i exercised 3-4 times a week, last year my i started t3 (100mcg) on my own after researching and it made me lose about 15 pounds in a span of 3 months with reglular weight training 6 days a week, now the problem is i am on t3 since past 8 months but i am again not losing any weight and i am weight training regularly, i also included clenbuterol for about 2 months ( 2 weeks on 2 weeks off ) but i am not at all losing weight and i am getting depressed because of this, should i start T4 or T3? What is the exact dosage i i start t3 again? Please help me doctor.


    • Hey Nim,

      There is no exact dose or “perfect” dose to be used as a standard. I use various doses for various patients based on a number of factors including history and lab tests.

  3. Hi Dr Childs,

    I love how you make these subjects so easy to understand especially the importance of reverse T3. Fingers crossed I’ll be starting T3 soon.

    However, I am wondering whether to reduce T4 slightly when introducing a low dose of T3 as I’ve heard some people do this or should I stick to the current T4 amount and just add a small amount of T3?

    Is RT3 the reason why some people do this?


    • Hi Aysha,

      Yes, sometimes it’s helpful and necessary to reduce the T4 dose with the introduction in T3. It really comes down to the person and their circumstances, etc.

  4. Thank you so very much for your advice and information. I’ve been stuck in ‘T4 dr. syndrome’ for over a decade and with your advice i am hoping to enlighten my present dr. regarding the need for t3. First, of course, there are the tests for such, which i will ask him to do. I cant thank you enough for your kindness, caring and incredible knowledge and insight. Ive been 70 lbs overweight all this time due to thyroid medications that are not helping me at all. Wish me luck.

    • Hey Brenda,

      As a general rule, if you have to ask for the right tests then your doctor probably isn’t going to be able to help you. Interpreting the test results and treating is 95% of the equation.

  5. Hi I have low t3 and im medicsted with levothyroxine. I take all the mentioned supplements but is there some product that can build up t3 alone? Thanks.

  6. Hi I was diagnosed with postpartum thyroiditis and now suffer with hypothyroidism I am on T 4 after reading up about it I tried T3 which I brought privately and felt loads better so I went to the doctor to ask if they can prescribe me T 3 and the doctor said point blank NO and that they are not allowed to prescribe it! Is that right surely if that’s what you need they should give it you. The doctor looked like she knew it was wrong she even said it could be to do with cost and advised me to buy it privately.

  7. Hi Dr.Childs,
    I’ve been hypothyroid for 13 years, was put on 175 mcg T4, it never helped in relieving my symptoms. After reading your blogs, last year I discussed the T3 issue with my doc and thankfully got referred to a very cooperative Endocrinologist who immediately put me on 50 mcg pure T3. But my brain was wired all the time on T3, I had spikes of energy in the morning followed by terrible mid day crashes, hair loss and insomnia and most importantly I wasn’t losing weight at all, instead I gained 30 lbs during transition period! My bloods on 50 mcg pure T3 was THS= 0.4 which is optimal & free T3= 7.7, which is above normal range so it doesn’t make sense why did I not feel better & why did I gain weight ?
    Had my endo appointment last month and he adviced me to try T4/T3 combo instead, so now I’m taking 40 mcg T3 & 50 mcg T4, feeling a lot better already on the combination but still not losing any weight, so my endocrinologist gave a go ahead for me to start an extreme calorie restricted diet (800 cals/day) but it’s medically supervised so I know I will lose weight safely but I’m worried about my metabolism! They did do a breathing test to check my metabolism before
    the diet & it turned out that my body is only burning 1350 calories/day which is not exciting at all but, Just wanted to ask you that as now I’m on more T3 will it damage my metabolism any further? Or if I’ go back on T3 only medication, the calorie restricted diet shouldn’t have any effect on the metabolism anyway or will it?

    • Hey Rubiya,

      Calorie restriction in any form will harm your metabolism if continued for longer than 14 days straight.

  8. What would cause high sex binding hormone? My T3 and T4 are low normal and my RT3 is 15. I have low normal Testosterone and normal estrogen levels. My sex binding hormone has been really high for years and the doctors act like it’s no big deal.

  9. I am on Nature Thyroid, an NDT, but I suspect that I have low T3, based on weight gain, fatigue, and very low resting heart rate. What levels should I be looking at in a thyroid panel, since I’m on NDT?

    • I Have noticed that upon testing T3 can be on the higher side when patients on taking NDT despite TSH still being in a healthy range. Have you noticed the same @westinchilds?

      • Hi Dr. Emily,

        Yes, part of it depends on when you decide to check their labs and how recent they took their medication. Some people also seem to just have higher T3 levels compared to others on NDT and I’m not really sure why. Could have something to do with thyroid conversion or genetics.

  10. Dear Dr. Childs,

    Thank you so much for all your advice and free-of-charge information. The more I learn about thyroid issues and hormone imbalances, the angrier I get at all the doctors who treated me falsely or not at all during my entire life. My parents took me to a medically supervised weight loss program for the first time when I was ten years old. The doctors put me on a high-carb diet with tightly restricted calories (though I was not extremely overweight at the time, just somewhat chubby). And they did all this without running even a single tiny test on my thyroid, insulin, other hormones or any physical reasons for weight gain whatsoever. I was ten years old, I was active, played outside a lot, and still no one cared to check if there might be something wrong with my hormones or metabolism. At age 22, I went to my GP and asked him to check my thyroid because I had all the symptoms (and I was about 190 lbs at the time). He ran the tests, then of course told me everything was normal… Today at age 27 I’m 270 lbs and I know for sure that I have Hashimoto’s, insulin resistance as well as leptin resistance (my serum leptin is 64). I also most likely have PCOS and have had it for a very long time (since before puberty). ALL OF THIS I found out by my own research, not one single doctor I consulted ran any blood test on me that I didn’t specifically ask for. But still, and this makes me furious: The whole world still thinks it’s okay to blame ME ALONE for being obese, that it’s okay to fat-shame me and discriminate me. After all this time, my hormonal disorders have become so complex and so severe that I have given up on trying to fix them. (I live in Germany, no Dr. Childs around here sadly.) If I’d been diagnosed and treated correctly when I was a child, I’m sure most of my current issues wouldn’t have developed at all. But still, no one blames the doctors who have failed to help. No one understands that I am not lying when I say I can’t lose weight. My own mother still believes that I’m lying to her face and it breaks my heart. I just wish the media would finally stop painting a false picture and instead make it clear that a whole lot of people have medical conditions which lead to obesity and that, to this day, the bigger part of our physicians are unable to effectively treat these conditions. You, Dr. Childs, are one of the very few, but most precious exceptions and that’s why I just want to say: Thank you.

    • Hi Marina,

      I know it can be frustrating to not be treated correctly but I would encourage you to try and focus on the positive things you have learned. I also agree with the notion that as a whole the medical community has really let down anyone with weight gain as they truthfully have no idea how to treat the condition. This leads to the cycle you have described such as blaming you for the weight gain, etc.

      Thanks for sharing your story.

  11. Hi, been hypothyroid & on 100mcg for 20+ years. Got prescribed t3 15 years ago,which I think helped,but British NHS cancelled these prescriptions. Have struggled on but seem to have hit a crisis, NHS increased my thyroxine dose then reduced it back again as I wasn’t feeling good.Another year on I feel terrible so got private blood panel,tsh 0.01 t4 total 16.0. Free t4 7.97. Free t3 2.02. I would appreciate your thoughts,due to see same endo in a few weeks who suggests pituitary issue? Thank you

    • Hey Barbara,

      Make sure you get a full thyroid lab panel, it’s difficult to manage patients without the full picture.

      • Hi,Dr Westin,appreciate your response.My blood panel on 9th Jan 17 reads:

        TSH 0.01
        T4 Total 16.0
        Free T4 7.97
        Free T3 2.02

        lab suggests I get my pituitary checked. I feel I’ve aged 10 yrs in the last month.Very concerned re cognitive decline over last few years,I’m 67 . Thanks again

  12. Great article! I am on NDT and T3, however still have symptoms of hypothyroidism. You provided lab values, however stated they are not to be used if already on T3. What labs should I go by to determine if I may need additional NDT or T3? Thank you!

    • Hey Gina,

      Currently I don’t have any posts going over that information because it’s more complicated than most people realize, and most lab values I provide are prior to taking thyroid medication (which is where most labs are actually helpful).

  13. Could Low T3 be what triggered my weight loss when I stopped taking my Levothyroxine? I was in school at the time and had no insurance, so I quit taking my Levothyroxine and lost over 60 lbs in about 8 months. Now I’m back on Levothyroxine, I’ve gained all the weight back, am struggling to lose weight, and have no energy.

      • Hello Dr. Child’s,
        Thank you SO much for all of this information!

        What protocol does one take once one finds out their T3 free levels are other thyroid levels are not where they need to be?
        My T3 Free 2.4.
        T4 Free 1.09
        TSH 1.750
        T3 reverse 21.3
        Vit. D 25
        Ferritin 5
        Lipid Chol. Panel 226
        LDL 127

        I’ve read that high Choleseterol is linked to thyroid issues.

        Am correct in saying I need to be treated for hypothyroid? My practitioner just put me on Thyrosol.

        What else should I do? My throat get hoarse and feels “tight” and uncomfortable for the past 2 years. Taking a Kelp supplement has helped a little but isn’t working like it used to.

        Thank you!


  14. I am on levothyroxine but still feel terrible. Constantly tired and no energy. My doctor tested all the labs you listed and said my t3 is good and my antibodies are high which means it’s an autoimmune disease. I have read there are many people that labs say they are good but still have symptoms of hypothyroid. Could this be possible that I’m having symptoms if the t3 is ok?

    • Hey Michelle,

      Yes, it could also be for a variety of other reasons as well. It’s best to be evaluated and treated by someone who is knowledgable in this area.

  15. Great explanation of a complicated issue! I desperately need a doctor that can help my 16 year old son with these issues. I went to your website and see that you are not taking new patients. Can you make any suggestions on where I might find a doctor who knows about/believes in this condition and is willing to treat it?

    • Hey Heather,

      Unfortunately I don’t know of any other doctors who practice like me (I’m sure they are out there, I just don’t know them). All of the information you see here is self taught, gained through experience and practice, etc. There is no training course for physicians to learn these techniques.

  16. I am a 69 year old male. 5’11” 290 lbs. They removed half of my thyroid 8 years ago. It was not cancerous but they did not like the way it looked. I have been on Levothyroxin since then because they do not want the other half to work. the levels that they check are always fine but I cannot lose weight no matter what I try.

  17. Hi,


    I know for a long period of time that I have Hashimoto-Hypothyroid however in my country doctors do not seem to know what to do apart from giving Levothyroxine for lifetime.

    Currently I am taking (Eltroxin – Levothyroxine) 200mcg daily. Just got my fresh tests done as follows. Reverse T3 testing facility is not available in my country:

    Anti-Thyroid Peroxidase….274 IU/mL…..(Ref Range given: less than 35 IU/ML)

    Serum Anti Thyroglobulin…<20 IU/ml…..(Ref Range given: Less than 40 IU/ML

    Serum Free FT3…2.80 pg/ml….(Ref Range given: 2.1–4.4)

    Serum TSH….0.950 ul/ml…(Ref Range given: 0.4–4.2)

    Serum FT4…..1.28 ng/dl…..(Ref Range given: 0.89–1.76)

    Serum Testosterone….522.2 ng/dl (Ref Range given: 249–836)

    Serum TIBC….379 ug/dl…..(Ref Range given: 250–400)

    Serum Ferririn…226 ng/ml….(Ref Range given: 28–365)

    With an abnormal Anti TPO and Free T3 on the lower side, do you think it would good idea to start Cytomel? My currently problem is: for long I am trying to loose FAT but not achieving.

  18. My 16 yo was prescribed T3 in August and saw weight loss and energy increase fairly quickly. She is still struggling significantly however. She is also celiacs.
    I can’t get any endocrinologists in Utah to look at her because her TSH and T4 are in normal range. Our primary doctor says she’s probably just over doing things. Should I get her to a gastroenterologist to work on her celiac symptoms, in case leaky gut is the problem? I hadn’t even thought of the correlation until I stumbled on this article.

    • Hey Wendee,

      Lots of factors may be at play, but addressing GI issues if present would be a good first step. I wouldn’t go to a gastroenterologist for help with increased intestinal permeability, however – as far as they are concerned she is considered cured as long as she is gluten free.

  19. Thank you. You are the first physician to take me seriously in six months. Three endocrinologists refused our doctor referrals, and the fourth said the thyroid problem is a “mothers fantasy she needs to get over.” This without ever seeing her. Now I just need to learn how to heal leaky gut!


    • Hi Wendee,

      Just thought I would comment to let you know I have seen considerable improvement in patients once “leaky gut” and/or “SIBO” has been addressed! I hope you have found the help you need for your daughter!

  20. Dr Childs,

    If you’re T3 and T4 are low, RT3 high, Insulin resistant and on Metformin can you take T3?
    And can high T3 lead to insulin resistance or make it worse?
    So do you have to check your levels every few weeks and when you hit optimal T3 and your RT3 lowers do you stop the T3? Or titrate down?
    If you eat right and exercise during this time then should the weight loss (assuming you lost weight) be stable? Or once you’re off T3 can everything can come back?

  21. Hi…
    I’m a 48 year old woman who has suspected low thyroid for some time now….I am experiencing hair loss, cold sensitivity, low basal body temperature, cracked heels, tiredness, and I have extreme difficulty losing weight but gain weight very easily. Last week, my doctor ran a thyroid panel and found my T4 to be normal, but T3 to be low. He prescribed 5 mcg of cytomel to start, with a follow up visit in a couple of months. Is there anything else you recommend that I do?
    Thank you,

    • Hi Kim,

      That’s a reasonable place to start. After you’ve been on the medication for a period of time you can then evaluate how you are feeling and go from there.

  22. What would you recommend for a child who has this issue with T3? Doctors are widely unwilling to prescribe anything but T4 for kids. It sounds like increases in T4 may only serve to drive up the need to make higher levels of T3 to combat RT3 production ? TIA

    • Hi Gail,

      Children are different than adults in that much of the thyroid abnormalities they deal with are related to stress.

  23. I request a RT3 test be done when I had all of my annual physical tests done and I was told No by the and we heatedly discussed to where she agreed. Also argued about ferritin test an she ended up agreeing to that although I was told I wasn’t eating properly if I had an iron issue

    I got the call that my test results are “normal” but oh by the way a entire large hospital in SE Michigan does not run RT3 tests as they do not see the need so it was not done. Although the tests were”normal” they were not optimal and I have been gaining more weight so I will start to adapt to some of the supplements recommended here — I have every single sypmtom on this list and my ends wants to remove my cytomel —

    Btw Ferritn was not normal and I need to supplement-

    Bottom line – education of yourself is your best defense. Doctors see you couple of times a year for minutes at a time and do not know more about your body than you do

  24. I fought for 23 years to be put on a T3 thyroid med. From day one of diagnosis of Hashimoto’s it was nothing but extremely painful long lasting muscle cramp and weight gain. I gained 65 pounds 2 weeks after diagnosis and stayed that weight for 11 year till breaking my leg from a muscle cramp that lasted 13 hours. I was a very very strong woman lifting 500 pounds with coworkers, after diagnosis I became crippled after any exercise or doing my very strenuous job. Fast forward to in 2012 I stopped breathing cause my T3 was too low! Because of my lifetime of Asthma I fought to start breathing by trying to use diaphramatic breathing exercises. And the worse part was that when we got to the ER there was no way to get any thyroid levels checked quickly. At the time I was on Tirosint 120mg I had been on every single synthetic on the market getting progressively worse. In 2013 as my endocrinologist was calling to give me current labs he finally took note that my T3 was very low. It took an argument to get me on Armour, I had cleaned my toaster over and 3 days later I was cramping from head to toe! As we are treating the T3 instead of the TSH I’m doing better, I’ve had set back from a job I had ….and taking longer to rebound, as I’m now type 2 diabetic, and have ankylosis spondylitis, as well as morphia scleroderma, and lichen sclerosus et atrophicus. I’m on 180mg of Armour now, slowly coming back, unemployed, I just don’t get why doctors don’t listen.

    • Hi Theresa,

      The environment is such that it’s potentially harmful if a doctor steps outside of the box and practices the way I am discussing here. They will always revert to the safer approach usually because of the risk of litigation.

  25. Dear Dr. Westin,

    reading your article, I can clearly see I am the case of low T3. My TSH and T4 was normal, but T3 below normal levels. I now take T4 + T3 and feel hudge improvement. My question is what does it mean when SHBG is too high? You mentioned it is very important but you did not explain what it means when it is not within the ranges. My Total T3 is 50% and FT3 80%.

    I would be very gratefull for your answer!

    • Hi Barbara,

      High SHBG indicates your thyroid dosing is too high, you have too much native estrogen, or you are supplementing with an oral contraceptive or oral estrogen derivative.

      • Thank you so much for your answer! I do not take any synthetic estrogen, only natural estrogen cream as my estrogen level is very low… I will decrease my T3 dose in that case. Especially that my TBG is too low, which as I have read also indicate too much thyroid hormones…

        One more thing I forgot to ask, what does it mean when RT3 is below normal levels? I could not find such information enywhere…

  26. Hi Dr. Childs,

    I live in Singapore where doctors are not allowed to prescribe T3. I have all of the symptoms of hypothyroidism (weight gain, high cholesterol, depression, poor circulation) with normal labs except for Free T3 that falls in the lower part of the normal range.

    Free T3: 4.2 pmol/L (Reference Range 3.5 – 6.5)
    Free T4: 1.1 ng/dl (Reference Range 0.71 – 1.85
    TSH 0.78 uIU/ml (Reference Range 0.55 – 4.78)

    Do you think I should pursue treatment outside the country?

    Thanks for your time and help.

  27. How do I find an actual doctor who looks at all these things and understands the actual optimal ranges and how it all works together? Anyone in Southern California you could refer me to?

    • Hi Kamela,

      You have to specifically seek them out as this information is not standard in their training.

  28. Hi Dr. Childs,
    Thank you so much for this article!!
    My TSH, T4, and Free T3 are all at the bottom end of normal range, but my Total T3 is low at 58. I have typical low t3 symptoms and hypothyroid symptoms. I saw an endocrinologist who told me that I am just fine and that there is nothing wrong with me or my thyroid.
    On one hand, sure, that’s great to hear, but on the other hand, then why is my Total T3 so low and why do I feel so bad? (and why do we run tests if we are just going to ignore abnormal results?)
    Should I not be concerned about the low total t3?
    Unfortunately, I don’t have many options. The endo won’t do anything, therefore the fam doc won’t do anything. I will try your suggestions in this article.
    Thank you so much.

  29. Dr Childs,

    I suffer from pituitary failure and therefore have TSH issues, which my endocrinologist prescribes 125mcgm Thyroxine. I have asked him about my T3 levels, but in Australia, Endocrinologists don’t want to know about T3, and believe that T4 is the only medication needed.

    I have recently completely come off 300mg SR Pristiq daily, and have reduced my Tramadol from 200mg SR x 2 daily to 50mg Sr once daily, and have started swimming about 2.5km’s per week.

    I suffered severe serotonin syndrome last year, hence the removal of the SSRI and Tramadol, but I still need to take Hydrocortisone 22mg daily (to stay alive).

    I dropped from 132 kgs to 102 kgs last year, but since dropping the pristiq, I have put on 13kgs and am very tired and suffer from severe back pain, which is what i was like before I started on Thyroxine.

    My previous T3 results have been up and down, and relate to my TSH levels, but it’s pointless trying to get a Dr in Australia to talk about T3, which i have only become aware of in the last week from someone with Thyroid issues who takes a lower dose of T4 and also takes T3, and says it works wonders for her (and it’s obvious that it does).

  30. Aloha Dr. Childs,
    I have syptoms of hypothyroidism for about 5 years. Conventional doctors just checked my T4 and told me I was within the normal range and didn’t treat me. I had hormonal issues and heartburn for about 6 months before I went to a naturopath. I went to a naturopath and she checked my T3 as well as my hormones. It was low, so is my body temperature, blood pressure and resting heart rate. I live a really healthy lifestyle but I am always extremely fatigued. She put me on a T3 therapy cycle for two months and I felt great. She had me stop and says I need another cycle in the future. It’s been two weeks, I am exhausted again. I can’t even make it through a day without napping and pushing myself. My body temp is low again. Do you believe cycles of T3 help or is it something one needs to do long term? I have heard T3 may not be good for your heart. Thanks!

    • Hi Ronit,

      The cycles that you are referring to can help some people, but I’m generally not a fan of that type of dosing.

  31. I had my thyroid removed 7 months ago. I have been on levothyroxine 125 mg which took a long time to work up to because I am “extreamly hiper sensitive to the thyroid hormone. It makes me extremely ill. I have been put on 12.5 mg now and still get ill from it. My doctor wants to leave me on the levothyroxine and add T3 to it. I ask if this was going to take away the horrible side effects that I get from levothyroxine. He did not answer that question. He gave a reason for it but did not address my question. I feel it’s time to change to a different med with T3 in it. Any input is appreciated.

    • Hi Debbie,

      You can consider switching to tirosint as it has less inactive ingredients than other formulations of thyroid hormone and tends to be better tolerated.

  32. Hello!

    Are heart palpitations part of the symptom list? I am in the very beginning stages of finding out what is wrong with me. Have over 17 symptoms of the list but of course all my blood work is “normal”. Heart palitations and feeling on edge most days is takkng my life quality. Cardiologist did a work up which was fine except ECG which was abnormal….but not to worry…..oh yes, my BMR is super slow.

    • Hi Barbara,

      Heart palpitations can be a symptom of thyroid disease but can also be a symptom of many other issues, it’s hard to say for sure without a full evaluation.

  33. Dr. Childs,

    I am female age 54 have not had a mense for 15mos.

    Re: Severe Hair Thining, Excessive Loss and very little new growth.
    5’5 175 lbs and cant loose weight. I’m not on a low cal diet. I consume 1500-2000 calories/day on average and eat a little of most things trying to limit too many sugars.

    I have been on Naturethyroid for a year. My NP runs very extensive tests and each time my T3 is low, she says it is not converting form the T4 yet, all my Bs, D3, selenium, and zinc etc are in a good range. I am supplementing with Thyroid Energy by NOW and feel improved physical and mental energy. My NP has also had me use Cytomel 5mcg. It really didn’t help much and I don’t want to take meds. rather I desire to get off of meds. all together.

    I can function pretty well on the Naturethyroid and compound cream 50mg Progesterone/Biest 1.25. Hair loss slows a little but same thinning and loss of very little new growth. Recently she increased the progesterone to 100mg and the excessive hairloss happened just after 1 week of use. (I count them, it’s over 400 and the new hairs that are shorter are falling out also). She says I don’t have high DHT. The dermotologist says I have male pattern baldness…How can I balance my hormones/thyroid and get my healthy hair back/ loose 30lbs?

  34. I have been diagnosed with Hashimotos in 2011. Tsh was 16. I was put on Levothyroxine and have adjusted up and down through the years as bloodwork varies. Currently I am taking 100 mcg. Bloodwork done 7/21/16 tsh was 1.35. I should state that I’ve never felt great ever since being diagnosed. But, the past month I’ve felt a lot worse. Lots of hypothyroid symptoms, plus it felt like a pill was stuck in my throat. I went for bloodwork tsh .24L (hyperthyroid!) and total t3 72dL (low- range 76-181 normal) t4 free 1.4dL (normal). Ultrasound performed, no nodules but wavy in appearance. Doc recommended lowering levothyroxine and seeing endocrinologist. I asked what do you do to treat low t3. She replied, “We wouldn’t do anything.” I would love your opinion!

  35. Hello,
    I am so glad that I found your website. I was wondering if you can help me out? I went to my doctor and got a lot of the blood testing you suggested.She is very open to what I have to say and easy to work with. I am having a hard time deciphering it all though. I want to go back to my doctor with a clear understanding of what I want to take for Thyroid meds and anything else.
    Here are my current results:

    Reverse T3 -17.9 Test results ranges are in parenthesis ( 9.2-24.1)
    Free T3- 2.7 (2.3-4.2)
    T4- 1.13 (.90-1.70)
    Testosterone Total 54 (2-45)
    Testosterone Free 5.5 (.1-6.4)
    TSH 2.2
    Fasting Insulin 9.1
    Fasting glucose 93
    A1C 5.2
    SHBG 43
    I am currently still waiting for my Leptin test results.

    So after all these tests and reading your blog I have started Berberine, ALA, Chromium, Vitamin B complex, Vitamin D and Magnesium.
    Am I right in thinking I should be on T3 only medication? I am currently on 32.5 mg of Naturethroid. Also I was going to ask my doctor about Metformin. Would you suggest these as well?
    I am currently about 40 pounds over weight. Tired all the time and CANNOT lose weight no matter what I do!
    Thanks for listening.

  36. I glad I found this page. I have symptoms of Hypo but most of testing always comes back ok. On the low side of the range, but according to the doctor ok. This last time they tested by FREE T3 and it came back as 1.8 which seems really low (range 2.2-4.0) but the doctor still said all is ok. FREE T4 is 6.2 (range 4.8-13.9 mcg/dl) and the PRHP-Thyperox is 20 (range 0-34). I’m not sure I had the last test before. They didn’t test by TSH like they usually do this time. I feel like I am going nuts. lol HELP

    • Hi Kim,

      The best thing you can do is find a new physician who is willing to work with you. It’s generally a waste of time to try and convince your Doctor to change how they practice and you will find the almost ALL Doctors will practice the same way. I would recommend you skip the process of switching through 4-5 doctors and just find someone who can help right away.

  37. I have been experiencing extreme exhaustion, muscle aches, flashing white dots, dizziness, dry skin, constipation etc so all pointed towards thyroid. Dr would only test TSH and this was within the normal (2.27). At 47 they said it was menopause, but have no hot flushes etc, in fact the opposite as always cold! Reluctant to go onto HRT, I paid for a thyroid blood test. Results show I am low end of normal for T3 (range from 3.10 – 6.8pmol/l and my reading was 3.2. T4 reading was 142.2 and range was from 59 – 154nmol/l. Because it is all within normal range doctor won’t do anything, however, my CRP is 5 (range 0-5) and ferritin 169 (range 13-150). Liver enzymes also showing high ATP. All of which does point to inflammation which makes sense for the T3, however, all of which is being ignored by GP and still wants me to go onto HRT. Any advice? I am concerned about inflammation but not sure where this is coming from. I also note I have taken Krill oil for 3 years and have a very clean diet, free from sugar and all refined carbs. I also take B complex, magnesium formula and an antioxidant formula, all from BIocare

  38. Hello Dr. Childs!
    Thank for this great information-it’s so clear and easy to read. Just to give you some brief history leading up to now. I am age 43 and the Reproductive Endocrinologist originally prescribed 25mcg of Levothyroxine in 2009 or 2010 when I was undergoing infertility diagnostics. My holistic MD did not agree but I eventually felt at [their mercy] because we wanted to get pregnant and thought that may contribute to helping. Pregnancy occurred without other fertility treatments for us. In any event I stayed on the medication. No specific doctor really followed the levels after that. I just rolled into the “hypothyroidism patient” category and my TSH levels tested here and there. My holistic doc ended her practice. Due to not feeling well with the Levothyroxine and also reading possible negative effects, I decided on my own to stop the medication..but my new PCP was aware as well. I stopped it in Oct 2016. The PCP ran labs which included T3..on her own…I did not ask. Besides the B12 being low 2016..the T3 was also low [2017]. She had me start B12 last year but nothing yet regarding T3. She does however want to retest it. After getting these results and having symptoms of low energy, moodiness/depressed feelings, weight gain, bloating with certain foods, I wanted to research more and found your articles. So..now I want to have her check the other lab tests you suggest. I am interested in getting Zinc and Selenium.
    Do you have any other suggestions for me? My other main question is how does one find a good doctor in relation to this type of issue?
    Thank you.

  39. So… I sit here with my lab results on my lap.
    Went to dermatologist for hair loss and hives. Did a full thyroid panel and many other labs. Please help me decide my next step for treatment before I lose all my hair, and my mind.
    TSH 1.53
    T4 free. .9
    T3 free 2.2
    T3 TOTAL 63
    T3 UPTAKE 35
    Im 45…I do feel as though it has been hard to lose weight even while exercising and weights. I’m tired in the afternoons and moody. HELP

  40. I feel like I’m dying. After 8 years of crying, fatigue, not even close to feeling myself, I went to a chiropractor who does functional medicine. He finally gave me an answer after 27 Drs. Hashimottos. I had my thyroid taken out in 2000. My tsh is 2.8. My freet3 is very low. I am on synthroid my free t4 is sky high. I need to find a functional medicine md that can write scripts. I live in Tallahassee, Florida. I don’t know what to do? Help!

  41. Dr Childs,

    I was recently diagnosed with a T3, Total 69 and a Free T3 2.4 – My T4 is fine at 8.5 and TSH is 2.5. My Integrative Medical Practitioner prescribed
    “Armour Thyroid”. You dont mention this in your article, is there a reason why?

    Thanks for making the article so easy to understand and digest.


  42. I was on Tirosint 75mcg for a good while and felt much better. My new insurance won’t cover that & they tried switching me back to Levothyroxin 75mcg. They are not the same. The Dr hasn’t ordered T3 tests they only test my TSH. I am currently on Unithroid 75mcg & feel better than I did with Levothyroxin but not as good as Tirosint. I have almost all the symptoms you described.

  43. Hi, I have been suffering from exhaustion, fatigue, muscle aches, dry skin, constipation, foggy headed etc for almost 2 years. Blood tests with doctor all came back normal (Would not do T3 or T4 or antibodies). She felt I was menopausal despite FSH being normal and wants to put me on HRT. Had bloods done privately and results are as follows:

    FREE THYROXINE 18.56 pmol/L 12.00 – 22.00
    TOTAL THYROXINE(T4) 142.2 nmol/L 59.00 – 154.00
    FREE T3 3.2 pmol/L 3.10 – 6.80
    THYROGLOBULIN ANTIBODY 19.98 ug/L 2.91 – 50.00
    Inflammation Marker
    CRP – HIGH SENSITIVITY 5 mg/l 0.00 – 5.00
    FERRITIN*157.6 ug/L 13.00 – 150.00

    Both my parents are on thyroxine.

    I have been taking B12 since the bloods. I am desperate to feel better but don’t want to take HRT if the cause is low T3, but doctor won’t even consider this. I asked why my CRP and Ferritin was high, would that indicate inflammation but she said it wasn’t high. Any advice?

  44. HI Westin – I was diagnosed with Hashimotos 6+ years ago. After I was diagnosed I started on Synthyroid but still experienced Hypo symptoms so my doctor added Cytomel. I have been able to maintain a weight range of 115-125 for the past 4-5 years, however this year I am tipping the scales at 138. I have maintained my healthy lifestyle and OCD calorie tracking, gluten and dairy free diet and work out activity. My synthroid is 112 mcg and I am on 15 mcg of Cytomel daily. I only take brand name and my TSH is around 0.08 (on the very low end) My personal trainer is dumbfounded as he sees how hard I am working. My resting heart rate is 50. I haven’t checked my basal metabolic temperature but I will do that tomorrow morning and report back. My doctor also tested my hormones like cortisol, etc. which were in the normal range.

    • Fasting Cortisol: 15.2
      T3, Free 2.3
      Thyroxine, free, direct: 0.9
      Thyroid peroxidase abs >900
      Thyroglobulin abs: >1000

  45. Getting ready for my doctors appointment tomorrow, hoping she will increase my Cytomel, I am on 5mcg and 112 of synthroid, gaining weight no matter what I do, I am going to start taking Zinc after reading everything also, do you think if she bumps me up quite a bit on Cytomel it will help me start dropping weight?

  46. Hi Dr.childs.I have been diagnosed with a low level of t3 -70 while tsh and t4 are normal.please advise me regarding the treatment or medication if any.I am a 25 year old female

  47. Hi,

    I have a low T3 it’s in the low 60’s and a low TSH .25. So my Dr. wants to cut back on my levothyroxin from 88 mcg to 75. I’m still concerned about low T3. I eat normal portions and gain weight frequently. Do I need a T3 med? What else can I do? Should I encourage more blood tests.

  48. Hi! I am so thankful I found your site! I’ve been on levo 50 mg for 2 yrs. I insisted on having my antibodies tested. My peroxidase is 138.6 and thyroglobulin is 292. My last TSH was 1.54, T3 Free 3.0 and T4 Free 1.16. That was in March of this year while on 50 mg levothyroxine. PCP said I have hashimotos and referred me to an endo. Worthless visit to him. He wouldn’t even discuss anything with me and said to keep taking my levo. I asked if you can have symptoms of hypo and hyper and was told no, although I have symptoms of both. I also asked to be put on T3 alone and was told I didn’t need it.

    I can’t possibly print off all of your information and quite frankly, I’m totally confused! Do you have a book I can buy with all of this information in it?

    I have a 6 mo. checkup with PCP in Sept. Should I request any particular blood tests? I need help!!

    Thanks in advance for any information.

  49. I’m Uk based 31 year old male

    Recently diagnosed by an endo as having metabolic syndrome, a moth like eaten thyroid and a fatty liver

    My mum and sister both have an underactive thyroid

    I’m at rock bottom to be honest

    Symptoms include

    Major fatigue and weakness

    Plaque psoriasis


    joint pain

    low libido

    weight gain around the abdomen

    Bloating after eating and IBS like symptoms

    brittle nails

    brain fog and short term memory loss

    Dr has said to lose weight and put me on cilotropam

    But Ive never been overweight in my life just developed this belly out of no where

    Despite thyroid being moth bitten like he says tsh 2.58 and t3 / t4 and antibodies are normal

    here are my T3 and T4 results from last year

    T4 16.4 (11-24pmol)

    T3 4.3 (3.90-6.80pmol)

    Another result I have just found for Vitamin B12


    Scale of 180 -2000

    Please can I get some advice on what to do next

  50. Hello Dr. Childs,
    Thank you so much for your helpful article. my T-3 Total is at 105. With the range being 76-181.
    My T-4 Total is at 7.1 with the range being 4.5-12.0
    I am taking naturethroid 65mg one and a half tablets.
    I used to be on cytomel and my Dr. switched me to Naturehtroid. Looking at my levels do you think that I am good and should just continue doing what I am doing? or should I ask him to put me on some of the cytomel along with my naturethroid? to raise my t-3. I don’t know if you can mix those two. I don’t feel that great overall but I also know it could be because of high cortisol or something else wrong with my adrenal glands. So I am not sure if I should try to get my thyroid levels higher or just keep up what I am doing. Thanks so much for taking the time to read this.

  51. I am a 72yr old woman with Hashimoto’s thyroiditis. I’m taking 75 MCG of Synthroid. I’m gaining weight, am very tired, have dry skin and seeing hair thinning, plus lower back pain. My test results say tsh .62 t4 7.2 and t3 77. Have a doctors appt in a few days but not overly confident in his knowledge on this as I was the one asking for further test with t4and t3 levels. Will increasing Synthroid dosage help?

  52. I’m a 17 year old female with low T3, as shown by my most recent blood test. I lost around 20 pounds when I was 13 years old, which I know is extremely young. After doing a dangerous amount of physical activity at the gym, I started noticing all the symptoms of hypothyroidism (dry, brittle, thinning hair was my biggest concern), but my blood tests never indicated that I had any problem with my thyroid. I had a hormone test done and all my hormones appear to be normal. However, last year, it showed that I was deficient in several vitamins and iron. I’ve been taking supplements for over a year now and all my levels are fine. The only thing that is coming up is low T3. I’ve been taking ONLY T3 now for around a month and nothing has improved. In fact, my hair loss might have gotten worse. My skin is still extremely dry and my body temperature is below average. Yesterday, I found out that I’m very intolerant to gluten. If I take out gluten from my diet, do you think my hair will get better? What do you suggest I do to fix my hair problems, along with the my other symptoms? I’m no longer deficient in anything, my hormones are fine, I’m at a healthy weight and have a healthy diet, and I’m taking T3, yet nothing is working.

  53. Hi Dr Childs, I had a thyroidectomy in November of 2016. I have been taking synthroid 125mcg and having a fair success rate until about a month ago. I have trouble converting to T3 and every time my Dr tries to add T3 (I’ve tried compounded natural thyroid as well as compounded T3 only) my hashimoto’s symptoms flare up terribly. He is an integrative Dr and has helped me since my hashi’s diagnosis in 2013 so much – until now 🙁 what if you can’t tolerate T3?

  54. Hello Dr. Childs. I found your article when the nurse called and said my T3 was low but TSH was normal. I questioned why my T3 was low but didn’t get much of a response and she said the doctor would want to wait six months and test again. Six months????? I have most of the symptoms you described for low T3. I’m going to try your suggestions for supplements and natural foods and also want to read your book on foods to eat. I also want to try talking to my doctor about further testing sooner than six months. Thank you for an informative article.

    • Hi Denise,

      Glad you found it helpful. You will find that most physicians tend to take a “wait and see” approach to thyroid management which is why I try to provide lots of other options and avenues that you can potentially take. Good luck and keep us updated!

  55. I took T4 for years, and told my doctors it was not working/balancing my system. I finally went to a naturopath and she tested all my ranges (which standard med. doctors would not do). She put me on T3 and I take lyothirinine (spelling looks wrong. Lol) That is T3. I was still sick…but TMI for this venue. My NP recommended an immune specialist/rheumatologist. Strangely, I needed a refill for my T3 while my NP was out of town and he would not fill it. He had already told me my thyroid was balanced beautifully weeks before, but said he “did not support taking both T3 and T4!”. I told him my body does not convert well, and he said then you should raise the T4 because it gets converted to T3. Ugh. Well, sorry Doc, but that was not working for me. I had no *diagnosed* immune issues though.

    Here is the thing, while a lot of what you say about thyroid is spot on from everything I have learned, the problem is that you have not learned everything about the people reading this or there health history. You have no other baselines and you have no other specifics. I have PCOS, which is basically from insulin resistance, even though they name it based on it resulting symptoms. and you are born with it. It is genetic and runs in my family. Secondly, thyroid is very important and definitely needs to be balanced by a professional. The endocrine system handles functions throughout the body and Messing with it can throw your whole system into turmoil if you are not knowledgeable. I would never recommend going at and buying thyroid meds and popping some random dosage. Go to a Naturopath…not standardized medicine doctors. Get a recommendation or ask for free consults to evaluate them. Do not pop thyroid meds without a knowledgeable professional evaluating all you health history.

    I have food sensitivities and was poisoning my system with God given food. Food that I ate everyday, and would not give me problems for days. My immune system may not have a diagnosed disease, but it was so sick. Yes, my thyroid was part of that, but only part. I got a blood test of a 150 items and found I was high to high-moderate sensitive to many things. It is more common then you might think people. I could not lose weight and my thyroid alone was not the cause. My body was sick and getting sicker because I had anti-bodies attacking literally everything I put in my body. A few of sensitivities I now know I was born with…strangely one was bovine proteins…including milk and cheese. I thought it was the lactose or the milk fat…and I thought I did not digest iron for the meat side of
    It as well.Wrong! I am also highly sensitive to chemicals…food coloring, nitrates/nitrites, and versions they spray on all lettuce, even organic, to make it stay fresh. I also have issues with ALL grains and oats. The grains and oats my body does not digest and my insulin resistance has something to do with it processing and storing residual sugar. Also; I used to think fat was making me fat, but not eating it was contributing to that. Honestly My elimination diet was ILLUMINATING. I could only eat a few things and walnuts was one of them. I ate more fat, but healthy, in that first 7 months including walnut oil than I think I ate my entire life. The weight melted off me, but not just because of the fat, but because I eliminated what I did not know was poisoning me. This is not a sales pitch. I take no other drugs anymore but my thyroid, a sarcode for my pineal/hypothalamus/pituitary gland, and an adrenal medicine I just started. The last two are only while I am trying to heal and work with a wellness doctor. I also take B12/B complex which many people are deficient in. Magnesium is another, and I take Magnesium lactate, which is not one avail. in stores. I also take D3, Zinc, Copper, Iron, and Iodine mineral supplements. I have gut issues and so I take liquid versions of all but my adrenal and thyroid meds. My gut does not absorb them, hence taking them for years and my body was still being deficient. I hold them in my mouth for 30 seconds to absorb them that way. All of these are necessary for thyroid and immune health, but that is not mentioned here. Deficiency in them can cause symptoms you think are thyroid related…and they get ignored.

    My point is…also get testing from naturopath for vitamin and mineral deficiancies. If you have rashes, allergies (environmental or food), have digestion issues of any kind…including heartburn or indigestion, hair loss (I did and mine filled in a lot after removing these foods), brain fog, bloating, constipation, diarrhea…just to name a few. I had multiple, but I am an much older young person. Lol.

    As amazing, detailed, and knowledgeable this and other websites can be about a topic, symptoms ALWAYS overlap, and no one magic answer usually fixes issues someone has lived with for over a decade or longer!! Take the time to find a doctor who will work with you, and is knowledgeable about balancing your entire system…preferably as natural as possible. The one thing I have learned from standardized medicine is that most prescription drugs made to fix major issues make you sicker, not everything works for everyone and can actually CAUSE/CREATE issues, and the medical community knows little in how the encodrine and immune system and the gut/ntestine work. They just found a whole new organ last year. Anyway…I am done now. Lol.

  56. Dr. Child’s I live in Michigan and I see Dr. Neuenschwander in Ann Arbor he knows of the t3 I’m on 50 mcg of t3 and it’s making my blood pressure high why is that? I need prob still higher doses because of my Basel body temp are still low average in mornings 97.6 and still not much of a metabolism? I have a lot more energy my reverse t3 is 0.5 my free t3 is now in range where it should be, but now I’m nonexistent of making any t4? What would you suggest? Thank you Debbie Braun

  57. Hi Dr Childs

    I have had hypothyroid symptoms almost my entire life – there has never been any medical intervention. I am 44 y/o female and symptoms are becoming worse. My most recent lab results are as follows (I am in Canada) :

    Thyroid Stimulating Hormone [TSH] : 1.96 (range 0.32-4.00 mIU/L)
    *my previous test 6 months ago, results were 2.56

    Thyroxine Free [Free T4] : 11 (reference range 9-19 pmoI/L)

    Triiodothyronine Free [Free T3] : 3.4 (reference range 3.1-6.2pmoI/L)

    Thyroperoxidase Antibody : <10 (reference range < 35)

    Of course, since these results all fall within the lab's "normal range", my doctor suggests that we will retest in a few months. Can you possibly provide a bit of insight? Since Free T3 & Free T4 are definitely on the low end of the range, should I possibly be doing something?

    Many thanks in advance

  58. Dear Dr Childs,
    I am without thyroid for 6 yrs, struggling with t4+t3 Meditation.I never feel really good for long time. Niw I got hyperdosed with 150 t4 and 5×5 t3, had intense blood pressure issues with my Labs in the top of the ref. Range. Now I have to dose down – how much t3 would you recommend with taking 125 t4 now? I habe 5×3=15 but feel dizzy all day and my heart rate sometimes 45… I dont know whether this is just effect of changing or generally too low. Thanks!!!

  59. Der Dr Childs,
    Another question. I had an iron Infusion, ferritine in the 20s for 3 yrs now. My Labs Werke in the very upper part oft the ref range. With the Infusion, I got severe hyperthyroid symptoms. Do you know ans reason why? Do I tolerante Mord t4 and t3 when iron deficient?

  60. I just wanted to say thank you for this article! 6 years ago I had a great endo who had me on T3 only, and I felt better than I had in the 5 years since I had been diagnosed. I got pregnant so went back to synthroid, and my dr retired. Started a new doctor and for the past 5 years now it has been a battle with her to even test my T3. At my last appointment to tell me that my memory of how I felt on T3 was wrong. I told her that’s not true and I had been fighting with her since to go back on just that (due to multiple pregnancies I didn’t push too hard until now since I’m done having kids) and she looked at her notes and said oh yeah- you are right. Time for a new doctor I think…. She also told me she did research and T3 only meds was not the proper course of treatment and my last doctor was wrong. Hmmm okay?? After begging her I did get her to add a little t3 daily starting last week. Anyway, thank you for reinforcing the fact that I am not crazy!

  61. I found your article to be very informative. I have TR 22 issue and my dr prescribed me compounded medicine from local pharmacy in 10 mg of T3 only. I’m worried about potential side effects like anxiety? Please advise.

  62. Dr. Childs, thank you so much for your information. I was diagnosed, by an endo, with Hashimotos 16 yrs ago…was stabilized (I suppose) on .88 mcg levoxyl for 10 years. After experiencing my childs cancer and eventual death, about a month later I went to my GP and my t3 was low at 73. She changed me to synthroid and inreased it to 100mcg. After 6 months, my tsh had climbed to 3.38 (past tsh always between .8 and 1.5)and t3 still low at 74. She tried me on cytomel 5mg once a day taken with synthroid dose….cytomel helped greatly with energy and focus, but caused nausea and afternoon crash. So I tried 2.5 a.m. and afternoon helping with crashing, but not nausea. Sent to another endo…told her my history. She increased my synthroid to 112mcg. I seem to get a little better energy, etc. This past 3.5 months I have suffered from severe fatigue 2 hours after I awake in the morning. Finding myself napping a lot, very cold, very dry skin on arms and legs, constipation, night sweats and small weight gain (without any increase in food intake). Went to GP for labs. My tsh is 1.8, but t3 is 64(low). The PA decreased my synthroid too 100 and put me on cytomel 2.5 (I have to split it) twice a day (and added Zofran for nausea if needed). I am already feeling better in my fatigue level, my constipation, and concentration. I can tell you that I am a person who knows my body andI KNEW THINGS WERE NOT RIGHT, EDPECIALLY WHEN THE FOG LIFTED AFTER STARTING CYTOMEL. I don’t know if this will be the right dose or not, but I know it is a trial and error situation. But I HAVE TO ALMOST TELL THE DOCTOR WHAT I WANT….WHY????? Why will they not listen….no one has time to listen anymore. Thank YOU for listening Dr. Childs!

  63. Hi, was diagnosed with Graves disease in 2011 and hyperthyroidism. After Meds failed and irradiated iodine course my thyroid was completely removed in 2013. Since then I’ve tried every maker, generic and brand named T4 Meds. At 400mcg I finally talked my doctor into giving T3 a shot. She agreed. There was a misunderstanding of how to take the Meds. I thought she wanted me to add T3 to my T4 which worked. Was the best I had felt in 6 years, but she says she wanted me to only tak the low dose of T3 by itself. When we tried that it didn’t work I put 20 pounds back on became very depressed and wanted to just give up. I have seen her again and agreed to try it her way with a small increase of T3 and zero T4 for two weeks and she agreed to look at it differently if there is not a marked improvement of my TSH levels which is all she looks at. Well, and my kidney function that is decreasing as I get sicker. My biggest question is… is it ok to be on T3 and T4 at the same time? As my Tsh gets higher 300+ and I gain weight of course depression takes control and I’m feeling hopeless in a system where I think doesn’t really care

  64. Hi! Please can you advise me… I have just had my blood results done and I am showing that my T4 is slightly above the normal range but my T3 is borderline on the low end). I have been hypo for 15 years but was told I am now hyper but I have all the symptoms of hypo not hyper. My dr. only tells me to lower my Levo T4 but this does not address the low T3 so I am going about supplementing T3 myself. Do I need to lower my Levo to do this? I am prescribed 100mcg currently.

  65. Hello Dr. Childs,
    As an adult, I have always had a low body temp, as low as 95 with the normal around 97. I also have low blood pressure, today 92/62. I have symptoms of hypothyroidism, weight gain, hair loss, fatigue, depression, but the blood test are always normal. Today I came across Wilsons Temperature Syndrome and wonder if that is my issue. The problem is that testing the blood will not prove the issue. Do you have any suggestions for figuring out if that is the problem or to treat the issue if that is the problem? thank you, Tara

  66. Hi Dr Childs, I am a 44 yr old mom of 3 that was dx’ed with hoshomitos 14 years ago and T1D 12 years ago. My body seems to have trouble converting t4 to t3 and even being on large amounts of t3 does not raise my t3 number. After reading your article I’m wondering if my blood sugar issues do to T1D could be playing a factor in my t3 levels raising? Any thoughts on the connection with the 2? I am planning to add zinc and seleium to my supplements, any other advice? Thank you!

  67. Hi Dr Childs, thank you for the great information. I want to take the natural route to curing the low T3 in my body. I have been taking Zinc & Selenium, also following your program which I purchased with intermittent fasting 3-4 days a week. I am wondering 2 things:
    1) How long should I keep up with the supplements?
    2) Generally I don’t eat 1500 cal, especially on fasting days, because I just cannot eat that much and I am not hungry, am I still damaging my metabolism this way?

  68. Hi,
    How can you naturally lower a high SHBG? Mine was 194, which was 4 months after stopping birth control pills (12 years of use). After 7 months of bcp, my SHBG was 187. My thyroid levels, rt3, etc, are all within range, but close to the limits of normal. I still haven’t started a period, either. DHEA 73, estrogen 42, progesterone 0.6, LH 27, FSH 11.1. salivary cortisol normal, but closer to the low limit. Is this high SHBG level the reason why I haven’t started to ovulate yet?

  69. Hi Dr. Childs,
    This is the best article I have come across. So easy to understand and you are so correct. My T3 has been low since 2016. It stays at 0.7 I just had it re-checked 2 weeks ago and it remains at that level. I do have an Endocrinologist but each follow up visit I tell him that I am fatigued, weight gain even with no appetite, hair loss, elevated Cholesterol and LDL, and a complete list of Hypothyroid symptoms. My symptoms of extreme fatigue and weight gain started in 2015. I asked my GYN at that time if he would do a Thyroid panel and also a hormonal panel. He just ordered a TSH which was in normal range but I had a very low level of Progesterone, Estrogen and Testosterone even though I was on HRT for 20 years. He stopped the HRT. I felt worse after that. I saw an Endocrinlogist as I have a Goiter via Thyroid Ultrasound. No biopsy has been done due to the stable size. I had a Lumbar Radiculopathy and Lumbar Spondylosis in 2015 and then due to nerve damage after surgery, had a TVH with Cystocele and Rectocele repair. Cystocele repair again 3 months after and then a Sub Total Colectomy in October of 2016. September of 2017, I had a Pain Pump insertion. I know a lot of this contributes to the fatigue, etc.

    I always remind my Endocrinologist of the low T3 and he is never concerned. His PA called last week about the lab results and since it is still at that low # and I am still very tired she started me on Cytomel at 5mgm 1/2 tablet Q.O.D. Just a few days since I have been taking that I am waking up early and actually able to function.

    My TSH was 3.35 on 03/21/16. your opinion I also have Sinus Bradycardia and now have a Pacemaker. Blood Pressure is very low, but Cardiologist does not seem concerned.

    Could you please give me some direction?

    Thank you,

    Mary Ann Maycen

  70. Thank you for helping explain this disease. I am 31 years on Levothyroxine .88 – have Raynauds Syndrome in my hands and feet since I was a child. I am constantly cold. I am not anemic. After reading your articles, I went to my doctor to ask for Thyroid tests last week – TSH was normal, T4 was normal – she only ran my T3 (which I had to beg for) and it was 51. Their range is 50-170 so she says I am “fine” and refused to order more T tests. Any thoughts about T3 being 51, or is that just one piece of the puzzle and I need the other tests? I am 54 years old and feel wired-tired and chilly most of the time.

  71. Hi Dr. Childs,

    I have a history of hypothyroidism and had been medicated with Levothyroxine for the past 11 years. However, in the past 6 months, I found that I was gaining weight (despite a very healthy diet and intense workout regime). I ended up going to a Dr. Doctor who made me check my T3 hormones and indeed they were low. He put me on a 4-month course of Tiratricol (I started 3 weeks ago), but I haven’t seen any results yet. I still maintain a very healthy diet and exercise but I haven’t managed to lose any weight and still feel very bloated.
    Thank you so much for your advice!

  72. I had a total thyroidectomy in March 2018. I am on 75mcg Synthroid. My TSH and FT4 are in optimal range but my Ft3 is .1 under the range and I’m having all the symptoms listed above. In order to get to the upper half of the range, I’m considering asking my Dr to let me add liothyronine. I’m afraid he will reduce my Synthroid to add the liothyronine and I’ll start having more symptoms. Any suggestions?

  73. Hi Dr. Childs:

    After years of being treated for hypothyroidism, I had a thyroid crisis in 2012 that resulted in Grave’s disease diagnosis concomitant with Hashimoto’s (positive Abs). Since then I have up/down and Dr switched me from synthroid/cytomel to Armour Thyroid. That helped for about one year but then led to more yoyoing as the batches were different for each script (every 90 days). My recent labs came back as: TSH 0.8 (i feel better when it is low); Free T4 is 0.74 ng/dl; Free T3 2.6 pg/ml. This doesn’t make sense. My Dr is switching me back to synthroid/cytomel and I have been on that for 4 weeks with no improvement in fatigue.
    Can you recommend some tests that would help with this diagnosis? I have more labs slated for early June.


  74. I have Hashimoto’s and have been on levothyroxine for 8 years. Finally found a good provider (NP) and because I was so cold all the time and still battled fatigue she checked my T3 which was low. She started me on T3 and I was looking forward to feeling better, but then I couldn’t sleep at night. So, I guess I go with the lesser of evils and remain cold and tired vs insomnia? I know I do feel better with a selenium supplement.

  75. In 04/2018, I completed an egg donation for my older sister. Prior to the cycle, they ran my TSH numbers to see where I was at and noted my level was high. Of course they only looked at the TSH and put my on synthroid and recommended I see my dr after the procedure to get a full work up.

    1st TSH (12/28/17) – 4.660

    2nd TSH (1/14/18) – 5.437 – started Synthroid 50mcg

    3rd TSH (2/17/18) – 3.62

    Now that the donation is over (retrieval was beginning of April) I went to see my primary care to request a full workup on my thyroid. I don’t think he ran the total tests (I asked for free and reverse). He told me to get a better idea of how my thyroid is working, to go completely off the synthroid and I have been off for a month (stopped in beginning of may) and just recently had the bloodwork back. TSH is lower (3.42) and no antibodies (negative readings) but wanted to get some insight/recommendations! I think my t3 is too low which is in line with my always being cold and mild fatigue.

    Tsh 3.42
    T3 .7
    T4 5.9
    Negative for two antibodies

    I’ve been keto since the end of February so no gluten or grains and am feeling Better but not as good as I know I can. I also supplement with zinc, lglutamine, b vitamins, 1-2 Brazil nuts about 3-4 times a week, collagen protein powder 3-4 times a week. I will certaintly try to up my zinc and take with Brazil nuts at the same time.
    Another thing was that my pcp did an ultrasound of the thyroid and determined a small nodule on the right side. He didn’t seem concerned and just said to get a rescan in 4 months.
    Thanks in advance!!

    • Hi Lindsey,

      It looks like your thyroid may not be performing optimally but that all depends on your symptoms and how you feel/look clinically.

  76. Hey Dr. Child’s
    I just had TSH, free thyroxine index, t3 uptake, and thyroxine t4. My TSH was 5.9, free thyroxine was 1.8, t3 uptake was 22 L, T4 was 8.1. Last year my TSH was 1.96. My doctor said she isn’t worried about my results she said it’s on the border line. Should I be worried? I have gained weight and I don’t eat alot. I’m very tired which is not normal for me. Im usually very active. I was told I have tachycardia and high blood pressure. Any advice will be appreciated.

    • Hi Tammy,

      It looks like your results are sub-optimal, but they should always be addressed in the setting of your clinical symptoms.

  77. Had a thyroidectomy 12 years ago. On t4 only for 10 1/2 of those years. The last year and a half 25mcg of t3 has been added. Felt better, lost 20 lbs in just a few months. Lbs I could never get rid of with t4 only. Over the last month, I have gained 5 back. I am going into premenopausal stage in my life. I was curious if being premenopausal causes fluctuating thyroid and if women tend to need adjustments in meds when you reach this stage? Thanks.

    • Hi Dorothy,

      Yes, it is my experience that other hormones are affected during the menopause transition including thyroid hormone.

  78. Hi, I was diagnosed with autoimmune thyroiditis back in December 2017. I’m now on levo, 50mcg/day, but the don’t feel well at all. My TPO is >1300, my symptoms are weight gain, aching joints, weak legs, very painful feet, not sleeping, sweating flushes occasionally. I am vegan, have been for years, now gluten free too, I walk 20 miles per week to/from work. I am 55 years old, female. I’ve had immense stress in my life for over 20 years, relationship problems, the tragic deaths of loved ones. My job is very stressful too. I feel a mess and want my life back. My joint pains are getting worse, my lower back is painful, I suffer from sciatic pain, my hands ache, mainly the left, elbow pain, but mostly my legs are weak and my feet feel as if they could collapse, to the point that I cannot run anymore.
    Any advice would be appreciated, I’m seeing my GP again on Monday to decide what happens next, thank you.

    • Hi Jackie,

      The best thing you can do is find a physician who understands hormone balance and thyroid management to work with you! It sounds like you may be on the right track, but in general, most PCP’s don’t know how to do this.

  79. I have been tested multiple times over the last 10 years for thyroid issues because I have all the symptoms but my labs have always come back in the normal ranges so no one wants to treat me. I recently had labs done showing:
    Free T3: 2.59 (1.94-5.1)
    Free T4: 0.73 (0.58-1.38)
    TSH: 0.819 (0.45-5.33)

    Based on your information I feel like starting me on something may help. Is Liothyronine the right medication for this? I have a provider that I feel like may be willing to help me if I was able to provide her with enough information supporting it. Thanks.

  80. Hi Dr. Childs.

    This is a great article. I am a 39 year old female. I have 98% of the symptoms you state for low t3. I just got labs back for free t3 and free t4.

    My Free t4 -.9
    Range 0.8-1.8 ng/dL

    My Free t3 – 2.4
    Range 2.3-4.2 pg/mL

    These are still in “normal” range it appears. Does it mean anything specific to have low levels of both free t3 and free t4?

  81. Hello Dr. Childs,
    I’m on a journey trying to address several issues, and just realizing they may be interrelated. I found your information and am trying to figure out if I’m on the right track. Your insight is appreciated.
    4 years ago, from a life insurance exam, I was found to have critically high liver counts.
    Sgot: 87
    Sgpt: 163
    Ggt: 180
    I was tested for everything. Fatty liver, hepatitis, blockages, cirrhosis….everything negative in the result.
    I’m 52 y.o. female.
    I went to a nutritionist took a regimen and while initially got my levels to
    Sgpt: 35 &
    Ggt: 45, they are now increased to
    Sgot: 36,
    Sgpt:39 &
    Ggt:50, despite me maintaining my regimen.

    Not sure why or how to control.

    New symptoms now include very heavy blood clots, for hours at a time. OB-gyn doc doesn’t want to do a hysterectomy bc of needing estrogen after as I’m not in menopause yet and my liver levels are elevated.
    Blood work indicated some thyroid issues….. but I’m not sure what it means
    Tsh: 1.74
    T4: 8.4
    T3 uptake: 22 (not sure if that’s the conversion you write about?)
    T7 (free t4): 1.8
    T3 free 2.9
    Sex hormone binding globulin: 145.6

    My question is …is my thyroid and other hormonal issues and liver related? Am I potentially having liver issues (undiagnosed as to cause) because of my thyroid and is that potentially affecting this cycle change?
    I’m now starting to take Douglas labs supplements with the selenium and zinc in it.
    Am I on the right track? Are there other insights you can offer?
    I’m on no thyroid or any other meds as this was found by my ob-gyn.
    I’m 52 y.o. 5 ft 3 inches and 138 lbs.
    It is difficult to lose weight and I have many hypothyroid symptoms.
    Ty for any help or info. It’s all new and overwhelming to me.

    • Hi Dominique,

      Your conditions are most likely related in some way, but you’ll need more advanced tests to figure it out. When you have a complicated history such as yourself, it’s often best to find a knowledgeable physician to help guide you and that’s probably the first place that I would recommend you start.

  82. I started on a T3 only treatment for low free T3(lowest of normal range). While I saw tremendous positive results, after 3 months I started having heart arrhythmia(PVC’s) and what seemed like fluid retention in abdomen, thighs, etc.

    I’m now 21 days off the compounded T3 and finally have no more pvc’s. Where can I go from here? My dose over 3 months only maxed out at 15mcg once per day. My lab showed a free T3 close to the upper end of normal. My Dr. was pleased with that but skeptical that that dose would cause arrhythmia.

    • Hi Kate,

      You may be able to tolerate the T3 if you increase your dose more slowly and then also take it in split doses throughout the day.

  83. I have been on thyroid medication for 40 yrs in past five the numbers keep changing going up and down. I was on 75mcg for many years and then dr. kept changing to 50mcg and up again to 75mcg when lab tests came back. I finally asked Dr. if T3 medication would help my symptoms of always cold and not being able to lose an ounce of weight I am an avid exerciser and keep gaining weight. My question will the adding of liothyronine 5mcg along with levothyroxine 50mcg help with the ups and downs of lab test and help to stabilize my weight gain. Also, I am 80 yrs old and I am concerned with side effects.

    • Hi FloDeMayo,

      The short answer is maybe, but it really depends on a lot of factors including your thyroid lab tests and other hormone levels in your body.

  84. Female, 40 years old and weigh 179. I’m on 90mg or Armour. TSH is 0.010 low, ft4 is 0.9 and ft3 is 2.1 low. I’ve been hypo for 5 years mostly under my PCP’s care then switched to a Functional Physician who can’t figure me out either. Meds have been increased and decreased and my ft3 remains either low or bottom of the reference range with a continuous low TSH. I keep hearing that my TSH is too suppressed and meds need to be lowered but I always feel so much worse whenever they do that. What do I do?

  85. I had a blood test evaluation by you, am now on T3 only 70mcg am, and 45mcg pm and am feeling amazingly better. What values should I be looking at if already on T3?

    I lost my doctor and am looking for a new doctor, thank you for the information that you provide, it is one of the reasons that I am well now, well, not completely well, I still have a ways to go considering all of the other hormones that need help.

    Thank you so much for your path in life!

  86. Hello,

    I have been struggling with persistent low t3 for the past 4 years following a 3-4 year period of restrictive eating. Despite backing off from running, eating more and following the AIP protocol/other ant-inflammatory lifestyle practices, I have not been able to reverse it and continue to gain weight. I’ve remained incredibly distressed over the weight gain aspect–about 40-50 lbs, but more rapidly in the last year than before–to the point where it is affecting day to day functioning.

    I’m a 30-year-old female, and my last 2 labs were as follows:

    October 2018

    TSH 1.92
    FT4 .94
    FT3 1.7
    Thyroperoxidase Ab 2.2
    Thyroglobulin <1.8

    Feb 2019

    TSH 2.56
    FT4 .73
    FT3 1.8
    RT3 7

    Throughout the last 4 years, the values have remained mostly consistent with the first set and changed this winter. I'm already supplementing with the mentioned nutrients.

    Do you think T3 only supplementation would benefit my situation?

  87. I began Synthroid a few months ago when my TSH showed that it was in the 4’s. It brought down my TSH into the 1’s, but my Free T3 was still undetectable low (below 2.3). 6 weeks ago, I was taken off Synthroid to see if I really do have hypothyroid and my TSH has consistently increased (now 2.98) and the Free T3 is still below 2.3. My Free T4 was 14 and now it is 13 (9-19 is the reference range). I am so confused about my extremely low T3 and always feel extremely tired, and like it is impossible to get up for work and function. I am unsure whether I should start back on the Synthroid, and don’t see an endocrinologist until November. Any thoughts?

  88. Hello, Dr. Child’s……… wonderful article. I have learned more here than I have from multiple physicians. I have been told that Total T3 is not important and on your website, I find that it is indeed very important. I have just one simple question. My Total T3 is 73, which I find is at the bottom of the scale. Free T3 is 2.3 and free T4 is 1.34. Could the total T3 be responsible for extreme muscle pain, weight gain, fatigue, etc? Thanks so much for your wisdom on this subject!

  89. I have had graves’ disease since 4/16. Total thyroidectomy 1/2019-I was having sever hyper symptoms -heart rate 130bpm with minimal exertion. Since surgery, I have gained 15-20# with no increase in food intake.( I have never been this heavy-#140. I have moderate fatique and take Lasix every 2-3 weeks and drop 5-8# overnight. Free t3 always low(last 1.5) (2.18-3.98). Free t4 usually normal(1.32)(0.76-1.46) and TSH usually low(o.105))(.358-3.740). Dr afraid to up Cytomel over 10mcg/day. My dose currently and Synthroid 88mcg/day. I would like to get my energy back and lose all this extra weight and feel like myself again(I also have emotional swings of which I had never been previously prone. I want my life back again, even though I know it will never be exactly the same closer to the old me would be appreciated!!

  90. This article was very eye opening. Over the last 5 years I have been experiencing unexplained weight gain (42 lbs total). Every time I lose a few pounds it is offset by an even larger weight increase. I exercise regularly and eat healthy. When I was younger I had issues with restricting my calorie intake to loose weight. I have worked with many doctors and suspected an issue with my thyroid (runs in my family) but none would run further tests as my tsh was normal. Last year I ran a thyroid panel on my own through LabCorp and it came back mostly normal except T3 uptake was low (21). Reading this my free T3 is in the lower range and my Reverse T3 is 23 (>15). I am seeing a new PCP soon. Do you recommend informing my new PCP on this? If so, how? I don’t want to sound crazy. I am just ready to figure out what is going on so I don’t keep gaining weight and get other health issues.

  91. Hello. I have had low thyroid symptoms my whole life, but only recently have my numbers been abnormal. My symptoms include fatigue, heavy periods, hair loss and brittleness, facial hair growth and the last three years weight gain after a cortisone shot for calcific tendonitis in my shoulder. My TSH has fluctuated the last three years, going from 1.3 to 3.7, then down again the 1.7, my free thyroxine hovers around 1.10, but my free t3 fell from 2.5 to 1.5. Also, my reverse t3 stays around 20. I fell 7 years ago and have a fair amount of inflammation in my back which has gotten somewhat better, but I believe has caused arthritis. Taking anti-inflammatories for it has caused microscopic colitis, so I can no longer take NSAIDs. I suspect I have an autoimmune problem, however all markers come back negative. Would t3 supplementation be advised? I can barely function from the fatigue.


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