Causes, Symptoms, and Treatment of Low T4 (Natural + Conventional)

Have you been diagnosed with low T4 through lab testing?

Are you also experiencing symptoms such as fatigue, weight gain, depression or hair loss?

If so, then you may be suffering from low T4 or hypothyroidism. 

This post will teach you what you need to know about T4 testing including the symptoms associated with low T4, what causes this condition and how to treat it: 

More...

What Does your T4 Level Mean?

What does T4 actually measure in your body?

T4 is a blood test which gives you insight as to how well your thyroid is functioning.

In order to understand how this all works, you need to know some basic physiology.  

Under normal circumstances, your body should produce two very important thyroid hormones: Thyroxine and Triiodothyronine. 

T4, also known as Thyroxine, is the most abundant thyroid hormone that your thyroid gland produces.

T3, also known as triiodothyronine, is not produced in high quantities because it is the most biologically active and most potent thyroid hormone

Both of these hormones are produced in response to another hormone known as TSH or Thyroid Stimulating Hormone. 

In this way, your TSH helps directly influence how much T4 your thyroid gland is producing. 

The connection between TSH and your T4 gives valuable insight into how well your thyroid gland is functioning and these two hormones should ALWAYS be tested together (more on that below)

But understanding what T4 is doesn't necessarily give you information on why it is important. 

So what does T4 actually do in the body?

T4 as a thyroid hormone is not as biologically active as T3 (1), but it does play a very important role in regulating how much T3 your body is able to produce. 

And this is perhaps the most important function that T4 plays. 

It acts as a reservoir for T3 production that your body can draw upon as necessary. 

What this means is that low T4 will usually lead to low circulating levels of T3 or low levels of cellular T4 conversion which ultimately leads to the symptoms of hypothyroidism (which is probably the reason you are not feeling well). 

You can think of this analogy to help make sense of how this works:

Consider a dam and how it works. 

Water is backed up behind the dam and slowly let through over time, but there is always a large reserve of water behind the dam to draw upon if necessary. 

In this analogy the water behind the dam is T4, the dam itself is the conversion process of T4 to T3 and the water that comes through is the T3 itself. 

In the end, you HAVE to get the T3 and your body uses the dam (in this case specific enzymes) to take water behind the dam (T4) and let it pass through (as T3)

This mechanism is set in place to allow your body ultra fine titration of thyroid hormone as it sees fit. 

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Symptoms of Low T4

Low T4, while easily diagnosed with lab testing, is often associated with very specific symptoms. 

These symptoms tend to bring patients into their Doctor as they tend to feel very run down. 

The symptoms associated with Low T4 are quite expansive, but I've included a list below that you can draw from. 

Symptoms associated with Low T4: 

  • Hair loss or other changes to your hair texture/quality
  • Fatigue or feeling run down
  • Weight gain (usually mild)
  • Dry skin
  • Constipation
  • Depression or other changes to your mood
  • Changes to your menstrual cycle
  • Infertility

Why do patients with low T4 experience these symptoms?

It has to do with the analogy we discussed above!

T4 is required for the creation of T3. 

States which cause low T4 will almost always result in a condition known as hypothyroidism (a state associated with low thyroid hormone production). 

You'll probably notice that the symptoms listed above are all very closely aligned with hypothyroidism. 

What's interesting is that some patients may experience a low T4, but have a normal TSH. 

Hypothyroidism is predominately diagnosed via TSH testing (which isn't the best idea), so many physicians will consider your thyroid as "normal" even though you have low T4 and the symptoms associated with hypothyroidism. 

So how does this happen?

Well, consider that all medical conditions exist on a spectrum. 

Before your body develops overt hypothyroidism it will have to develop sub-clinical hypothyroidism and before that, it will develop low T4 and so on. 

In this way, low T4 can be an EARLY warning sign of hypothyroidism and may also be a warning of other conditions that may be reversible (2).

4 Causes of Low T4 

There are 2 main ways that your body can develop low T4. 

#1. Your thyroid gland simply can't produce thyroid hormone (T4 & T3) due to damage, removal of the gland or some other problem.

#2. Your thyroid gland is not getting signals from the brain to produce thyroid hormone even though it is technically capable of producing thyroid hormone. 

Almost all conditions that alter T4 can fit into one of these two conditions. 

#1. Hypothyroidism

Hypothyroidism is the name given to the condition which results in low thyroid hormone which can be caused by issues with your brain (not common) or with your thyroid gland itself (much more common). 

Obviously, hypothyroidism, because it is associated with LOW thyroid hormone, is one of the main conditions that cause low T4. 

Knowing you have hypothyroidism doesn't necessarily give you a lot of information, though, because it's more important to understand what is CAUSING it and then try to treat that problem. 

One of the most common causes of hypothyroidism is the autoimmune disease known as Hashimoto's thyroiditis (3) (discussed below). 

#2. Thyroiditis (Hashimoto's thyroiditis)

Hashimoto's thyroiditis is a condition which causes hypothyroidism but it is the result of direct damage to the thyroid gland itself. 

The production of antibodies by your immune system sit on and attack your thyroid gland which results in inflammation and the eventual destruction of your thyroid gland (4).

If your thyroid gland is destroyed then obviously it will not be able to produce thyroid hormone (T4 & T3) which will lead to low T4 over time. 

This condition is VERY common and is speculated to be the #1 most common cause of hypothyroidism in the United States

If you have hypothyroidism, and you don't know why then you should get your antibody levels checked to see if this is the cause in your body. 

Hashimoto's is also notorious for causing hypothyroid symptoms even though lab tests can remain somewhat "normal" for a long period of time. 

The damage to your thyroid gland is accomplished slowly over years and years. 

This slow, but eventual, destruction of the thyroid gland allows your body to try and "adapt" to these low thyroid levels which may explain why serum thyroid levels remain preserved for so long. 

Despite this, it's often recommended to treat patients who have low T4 but a normal TSH if they also have Hashimoto's. 

This approach results in an improvement in quality of life and a reduction in symptoms

There are also other causes of Thyroiditis which you can read about here, but they are not as common as Hashimoto's thyroiditis. 

#3. Nutrient Deficiencies

There are at least 13 different nutrients which are required in optimal amounts in order to produce thyroid hormone from your thyroid gland. 

Among the most important include Iodine, Tyrosine, Selenium, and Iron

A deficiency, even a minor one, may negatively impact your body's ability to produce thyroid hormone. 

You can think of these nutrients as the "building blocks" required to make thyroid hormone. 

If you run out of these building blocks then your body will be unable to create these hormones, even if your brain and TSH are telling it to make them. 

You can't squeeze water out of a rock no matter how hard you try!

Nutrient deficiencies tend to cause a similar effect in the body. 

What's interesting is that many people may be deficient in these nutrients without even realizing it. 

T3 conversion booster results

It's not uncommon for people to be iodine deficient due to soil depletion and due to the standard American diet (5).

Likewise, iron deficiency is fairly common among women due to menstrual issues and absorption issues in the GI tract. 

These nutrients can easily be replaced with other the counter supplements. 

Testing and treating iron deficiency is slightly more tricky, but you can read more about how to do that here

If you don't think your thyroid producing nutrients are up to snuff then you can use a supplement like this one which supplies your body with all of the necessary nutrients in optimal amounts

#4. T3 Supplementation (From Medication)

Another less common cause of low T4 has to do with the direct effects of using T3 containing thyroid medication. 

Medications such as Cytomel or Liothyronine, when taken for hypothyroidism, will cause a direct reduction in circulating T4 in the body. 

This occurs because of how T4 alters thyroid function in the body. 

Remember:

T4 acts as the reservoir for T4 to T3 conversion in the body under normal circumstances. 

By providing your body directly with T3 you are cutting T4 out of the loop and you no longer need to draw from the reservoir system

T3 supplementation will almost always cause a reduction in T4 (Low T4), an increase in Free and total T3, a drop in the TSH and a drop in Reverse T3. 

This thyroid lab testing pattern is common among people who use T3 medication and it can even occur (to a lesser degree) in those who use medications such as Armour thyroid or Nature-Throid

Options for Treating Low T4 (How to Raise it)

Fortunately, treating low T4 is actually quite easy. 

Your focus should always be on attempting to reverse whatever is causing low T4 in your body. 

This does require that you have a diagnosis in hand which will likely require a complete thyroid panel, but once you have this information you should be good to go. 

Your focus can either be on the thyroid gland itself (attempting to increase the amount of thyroid hormone you can produce naturally) or directly on providing your body with thyroid hormone itself through supplementation

  • Supplement directly with T4 thyroid hormone (thyroid medication) - The most common treatment for low T4 is the use of thyroid medication such as levothyroxine and Synthroid. These medications will provide your body directly with T4 and will act to normalize the deficit in your body. Supplementing with T4 is both an art and a science and you can read more about how to do it correctly here. Those who are not supplemented correctly will often still remain symptomatic. 
  • Supplement with thyroid hormone precursors (over the counter supplements) -  If your low T4 is the result of nutrient deficiencies then you can replace those nutrients. This approach will often result in an increase in thyroid hormone production from your gland. 
  • Reduce the autoimmune attack on your thyroid (if you have Hashimoto's) - If you know that you have Hashimoto's then you can also focus on therapies which normalize immune function and reduce the immune attack on your thyroid gland. You can learn more about these therapies here
  • Supplement with T3 thyroid hormone (thyroid medication) - In lieu, or in conjunction with, of using T4 thyroid medication you can also use T3 thyroid medication. T3 thyroid medication may cause low T4 but that isn't necessarily a bad thing if your body has enough circulating T3. This is an advanced concept but you can learn more here
  • Lifestyle interventions such as Diet, Exercise, and Stress Reduction (these should always be done!)

Final Thoughts

Low T4 is a condition commonly seen in hypothyroid patients and is becoming more and more common over time. 

This condition is associated with serious symptoms which may dramatically alter your quality of life. 

Treatment should focus on supplementation with medication or by providing your body directly with nutrients to optimize thyroid hormone production

Now I want to hear from you:

Are you suffering from low T4?

Is your TSH normal or high?

Do you have the symptoms of hypothyroidism?

How are you approaching treatment?

Leave your comments below! 

References (Click to Expand)

This post was most recently updated on August 23rd, 2019

Dr. Westin Childs

Dr. Westin Childs is a Doctor of Osteopathic Medicine. He provides well-researched actionable information about hormone-related disorders and formulates supplements to treat these disorders.He is trained in Internal Medicine, Functional Medicine, and Integrative Medicine. His focus is on managing thyroid disorders, weight loss resistance, and other sex hormone imbalances.You can read more about his own personal journey here.

81 thoughts on “Causes, Symptoms, and Treatment of Low T4 (Natural + Conventional)”

  1. How do I treat this? Do you offer Skype sessions? Need help and No Drs. in my area seems to understand all of this. Thank you.

  2. Hi Dr.Childs, I left a message on another blog. I have been diagnosed with vitamin d3 deficiency since September it was 44 iu was told is extremely low, the specialist put me on 1000 iu, I took it for 8 months, it only went to 55 iu the doctor put me on 2000 iu and want to check it again in 3 months again, he doesn’t know why my body is not absorbing vitamin d3, the normal is 75 iu. I checked my thyroid is normal, and it was in Greece too, slightly enlarged, was told I might have Hashimotos thyroiditis. I also have insulin resistance, and when I drank the drink, went 5 times higher, I also have low testosterone and high bioavailable testosterone and other hormone issues, and my body produces lots of hair.
    Doctor wants to check other vitamins in my body and recheck vitamin d3 after 3 months. He also thinks I might have celiac disease, but doesn’t think I should get tested, wants to see my blood work first. Let me know what you think, why my body is not absorbing vitamin d3.
    Any suggestions will be helpful. Thanks for your blogs, Voula!!!

    • Hi Voula,

      It sounds like assessing for conditions that might impede absorption would be a good idea given your history.

  3. I just received my labs back. My T3 Free was 4.32 & TSH was .010. I have been on 3 pills of Nutri-meds for a 1 1/2 now. The last 6 months I had been experiencing the tissue level hypo you posted. So I added 24 mcg of t3 to my regimen, also dropping my pill dosage down to 2 pills a day. I added this after I took my labs. The Dr said he didn’t want to do anything with my thyroid cause I seem to be fine. Right now we are working on my high estrone, testosterone, and progesterone. What are your thoughts?

  4. I had my thyroid gland removed in January due it being cancerous. I’ve been taking levothyroxine and it my dr wasn’t satisfied with my numbers and now I’m taking Synthroid. After three weeks of taking the Synthroid, I still feel sluggish and depressed and I do have those energy dropouts around 3 or 4 in the afternoon. When I sleep, I dream so much I don’t feel rested when I wake up. What are your suggestions for natural supplements or diet changes I should make?

  5. I have gone over a number of checklists that offer reasons as to why a person can have “normal” TSH levels and yet have (very) low T4. Blood tests recently showed both Free T4 and Free T3 near the bottom of the range. And of course, I have felt like “road kill”, with severe hypo symptoms for about the past 10 years. Always, past visits to doctors turned out useless, because my TSH was always “within normal range”.
    Is it possible for a person to have I diagnosed Hashimotos for so many years that the thyroid gland ends up so damaged that it can no longer make much T4? Autoimmune disorders are rampant on both sides of my family, which is why I think I have had undiagnosed Hashis for about 20+ years.

    • Hi Jeanne,

      You’ll find more info about how you can have a normal TSH with low T4/T3 levels here: https://www.restartmed.com/euthyroid-sick-syndrome/

      It most likely stems from a reduced production of TSH/TRH which keeps TSH low or “normal” while all circulating thyroid hormones remain low due to decreased stimulation of the gland itself.

      As you suggested, autoimmune disease may also be playing a role.

    • Hi Panchetta,

      That would usually indicate you are taking too much T4 thyroid hormone or you tested your blood after recently taking your thyroid medication.

  6. My problem is FT4 is high at 17 range (9-19).
    FT3 is low at 2.7. Range (3.1-6.2)
    Tsh 0.88.
    It seems I’m not converting T4 to T3. I asked the doctor for T3 which she has me taking only 5 mcg a day. I feel that is way too low but she said she is not going to increase as T3 is dangerous for the heart and bones.
    Any suggestions? Thank you

  7. Hi Dr. Childs,

    Thank you for another great article! Question: what do you do if you take NDT, your FT3 is optimal, TSH is suppressed (as is would be on NDT), RT3 is around 13, but your FT4 remains at the bottom of the range?

    Thanks! 🙂

    • Hi Claudia,

      I would say it probably depends on what symptoms (if any) you are experiencing. If you remain hypothyroid despite the numbers you listed that would be an indication for a medication adjustment, but if you are chasing the number despite feeling well, then I would probably not make any changes. Some people respond to NDT by dropping their T4, but it isn’t necessarily a problem unless it is also accompanied by symptoms.

      Hope this helps!

  8. Hi Dr. Childs,

    What about Graves Disease? Would your program help with hyperthyroidism?

    I’m on 5mg of Methimazole daily.

    Thank you,
    Maggie

    • Hi Maggie,

      All of the therapies in the program may help but because each person is different I can’t say for sure. I can say that many patients with Graves’ have used it successfully in the past.

  9. I am on nature thyroid and T3 and my T3 is in good range and my reverse T3 is good but my T4 is low which I read could happen with taking T3 but my TSH went from 2 to 6? What would cause this?

    • Hi Kari,

      If your TSH is going up despite taking medication then you are either not taking the right type/dose or you aren’t absorbing the medication.

  10. Hi Dr Childs,

    I have emailed before, I had a total thyroidectomy in 2011 due to cancer. My Dr came on board and agreed re T3 medication and I started on T3 Liothyronine late last year. I am currently on a 50mcg tablet (T3) a day. When I started on T3 I was having it by itself. However after my last blood test, I was put back on T4 as my T4 levels were low. The results of my last blood test are below:
    Free T4:2.0 pmol/L ( 7.0-16.0 ) L

    TSH:<0.01 mU/L ( 0.3-5.0 ) L

    FT3:6.5 pmol/L ( 3.6-6.5 )

    I am currently on a 50mcg tablet of T4 Levothyroxine.
    Would it be alright to ask my Dr to increase the T4 level.
    Initially after the thyroidectomy I was on much higher doses of T4 and lost a lot of weight. I have struggled with weight issues for many years and the initial huge weight loss was awesome. When the dosage was reduced, the weight came back on.
    Also, a year prior to having the thyroidectomy I had a total hysterectomy also due to a different cancer.
    I am noticing a great improvement being on both the T3 and the T4.
    I am feeling that an increase in my T4 medication up to 100mcg or even 120mcg would really help me, is this right?
    Thank-you for your articles and helpful advice.
    Regards,
    Barbara

    • Hi Barbara,

      I use many factors when determining dosing for patients so it’s really impossible for me to give any advice based on this type of information.

  11. I have hypothyroidism and I’m trying to focus on my thyroid gland and increase the amount of thyroid hormone I can produce naturally. But you didn’t give any insight on how this is done. If you have an article on that part I’d love to read it.
    Thank you,
    Michal

  12. Hi,Thank you for the important knowledge you provide! I would like to point out a typographical error in the text, just in case it doesn’t confuse anybody reading the post.

    “Remember:
    T4 acts as the reservoir for T4 to T4 conversion in the body under normal circumstances.”

  13. When first switching from levothyroxine to NDT if I do get a reaction to the T3 on a tiny dose should I reduce it even more or just persevere until I get used to it? Have read lots on switching but never found the answer to this.

    • Hi Helen,

      It really depends on the person. Some people can tolerate it when they stick with it and others will probably never tolerate it.

  14. Hi Dr. Childs,

    I had papillary thyroid cancer and my thyroid and 2 parathyroid glands were removed in 2014. Since that time I have been on .88 mcg of synthroid. I have asked for additional Cytomel or the equivalent but, was told, since I have CAD synthroid is the only thing I should take. I can’t seem to lose the 25 pounds I gained. Do you agree with my endocrinologist? Is there anything else you think would help me?

    Thank you,
    Vicki

    I

    • Hi Vicki,

      T3 can increase the demand on your heart so it’s reasonable to avoid it if your doctor believes you can’t handle it.

  15. Hello Dr. Childs:

    My thyroid gland was completely removed in 2015. I am taking levothyroxine 150 mg and struggling to lose 15 pounds that I gained. In addition to the levo, can I utilize other supplements and what would those be?. I am on high blood pressure medicine. I developed high blood pressure when I went into a thyroid crisis in 2015, thus the removal of the gland. It is now stabilize with meds. I went into a thyroid crisis a few months after donating stem cell transplant for my younger sister, I guess due to developing an autoimmune deficiency. I am a moderate exerciser, taking stairs and steps instead of elevators, and floor exercises. I do this 4x weekly.

    Kind Regards
    Di

  16. Dr. Childs,
    Have you ever seen T3 timed-release work great for someone at the start and then lose it’s magical effect? That was my problem. Also, a doc told me that timed-release T3 was dangerous to take so I quit it. Now I’m on NDT and not doing well. I really really want to see you! I live in AZ. Please please.

    • Hi Daryl,

      Yes, that does happen somewhat frequently and usually has to do with dosing. For this reason, I generally recommend that people start off low and titrate over several weeks to months.

  17. I have been on a roller coaster of trying to become well….I went through extreme weightloss that was unexplained…low b12 and pernicious anemia were noted. After 2 years of eating whatever and whenever I wanted I began to gain and gain (at my lowest 100 lbs now 170 lbs)and began to look into thyroid issues deeper (sister has hashimotos and mother hypothyroidism) I was “normal” but antibodies present. Still battling with weight, on cytomel and now have low t4 and higher antibodies…..not sure what to do at this point.

  18. Hi Dr Childs! I love your website! I took your information on thyroid testing and got my NP to run every test! Yay! But results are puzzling my NP and family doc. TSH . . . O.17
    Ft4 . . . . .87
    Ft3 . . . . . 4.5
    Rt3 . . . . . 12.6
    Antibody . . . Neg.
    My family doc is pretty smart but is confused. He’s sending me for some pituitary tests. BTW . . .I suffered a severe concussion several months ago and lots of things are whacky: BP is high then low;BP different in each arm; debilitating brain fog; very cold; bad brain fatigue. I would love to find info on your website it or you could point me to another source, my poor brain and I would be so grateful!!

  19. Hi Dr. Childs,
    I have 2 of your products, but due to life chaos, I haven’t started your program.

    I am a 65 yo retired woman, who has had hypothyroidism for at least 10 years. Since I am also a physician, I knew I had hypothyroidism years before it was finally diagnosed. I had a TSH of 6.0 which wasn’t considered low enough by the internist. An endocrinologist made the dx, but I never heard from him about Hashimoto’s antibodies—but have presumed that since it is the most common form, that that is what I have. My T4 and T3 are WNL, and my TSH is just slightly above 1. I take 62.5 ug of Synthroid and 25 ug of Cytomel. I have recently started supplementing w/ Zn, Mg, and selenium.

    I am slowly recovering from a severe, treatment resistant depression that left me nearly bed bound for 10 years—psychomotor retardation is hell.

    I initially gained 30 lbs. from the hypothyroidism. From a psychiatric medication, I gained 20 more. Nothing, and I do mean nothing, has helped w/ weight loss. The poundage has made me sleep apneic.

    As I said, I expect to start your program in the next few days. My question has to do w\ language: when you use the term “hypothyroidism” do you mean untreated or treated hypothyroidism? I am clinically euthyroid, but suspect that if I went off the meds, I would rapidly become hypothyroid again.

    It makes a difference w/ knowing how to interpret what you write.

    Thanks,
    Sheila Wall

    • Hi Dr. Wall,

      In terms of terms of language, when I use the term “hypothyroid” I am usually referring to the clinical state of the patient. But there are many patients who remain hypothyroid (in terms of symptoms and labs) despite being “treated”. So it has more to do with the clinical state rather than whether or not someone is on treatment. If you are on thyroid medication and clinically euthyroid then I would consider you to be adequately treated. But whether or not your thyroid can mount sufficient thyroid hormone production if you removed your thyroid medication likely depends on what caused your condition initially and if that is reversible or not.

      Also, there is some delay in terms of how quickly your HPT axis can rebound after stopping thyroid medication. So in almost every case, even in those who can regain 100% normal thyroid function after stopping medication, people will temporarily feel worse until that rebound occurs.

      Hope this helps!

  20. When taking T3, what low temp is used to increase dose?

    How high can dose go before it must be cut back?

    I take 12.5 mcg T3 bid. At first, my temp was at 96.5, in the morning.
    After 2 weeks, my temp is 99.3 in the morning. How high can I allow my temp to increase before I should cut back?

    Thank you.

    • Hi Regan,

      It’s often best to dose based on a combination of symptoms, lab tests and other variables such as body temperature. I wouldn’t focus on just one of those as it may lead to overdosing or other issues.

  21. Hi Dr. Childs,
    I’ve been reading about the Wilson T3 protocol and it sounds very interesting. Is that something you would support?
    Thank you,
    Daryl

  22. Hi Dr Childs,
    I have low T4 and I’m also taking T3. I’m taking testosterone, progesterone, and estradiol. I’ve gained 35 lbs and no matter what I do I cannot lose it. Can you give me some suggestions?
    Thank you!

    • Hi Heather,

      Your T4 will always drop if you are taking T3 (depending on the dose) so that’s not necessarily a bad thing by itself. To figure out what is going on with your weight, however, you will need to check more than just your thyroid. Tests such as leptin, insulin and a complete thyroid panel should help get you started on the right track.

  23. Hi Dr. Childs,
    If T3 is the active hormone, why don’t most doctors just treat with that rather than T4 alone or NDT? Is there some reason we need T4?
    Thank you,
    Susie

    • Hi Susie,

      They assume that the body will be able to adequately convert T4 into the active T3. The problem with this is that each person does this at a different rate (some more efficient than others).

  24. I pray someone has some advice to offer. My hypothyroidism has not been managed effectively in over 6 years. My labs are all over the place. I just had labs last week with my T4 free at 0.79, my T3 at 178 and my TSH at 0.019 after a month of being on 88 mcg of synthroid and a recent addition of 25 mg of cytomel. A month prior to that my T4 free was 0.92, T3 was 101 and my TSH was 0.620 with only synthroid. I feel so horrible all the time. Sluggish, weight gain, not sleeping, carpel tunnel which I’ve had before but had resolved with thyroid medication change but not this time. I have major muscle and joint pain and feel lousy every day. I’m 49 and my wonderful mother has been diagnosed with ovarian cancer and she needs me and I’m struggling. My mom has no one but me to help her navigate through her diagnosis and Iove her more than anything and want to be at my best to help her. Can anyone offer any help or advice to me? I would really be so grateful. I wish everyone well and good health to you and all your loved ones. Thank you for reading!!

    • Hi Amy,

      The single best thing that you can do is to search for a knowledgeable physician to help guide you. You most likely won’t be able to do this on your own or solely with advice from me/others because you may need prescriptions and other therapies. You can find more info on how to find a doctor here: https://www.restartmed.com/thyroid-doctor/

  25. This might not be the place to ask but I’ve been watching your YouTube channel for a while now and I have a couple questions. I was diagnosed last year with Hashis but instead of my gland atrophying, it grossly enlarged to wrap around my trachea causing problems swallowing and made me a level 4, difficult intubation. It went down to my jugular notch so it wasn’t technically substernal. Looking at the Cat scan or mri (whichever it was) it looked like a donut around my trach. I had a TT this past Oct. using the “awake intubation”. My labs for hypothyroidism for the last 10+ years have been all over the place. Since the TT my labs are much more stable. My TSH was accidentally suppressed to .008 with high T4 but I was symptom free. I’ve been cut back to 150mcg levothyroxine. I don’t feel as good but I don’t feel bad. Now my questions: Is it odd for hashis thyroid to enlarge vs atrophy? How long can you be suppressed before worrying about exophthalmic?
    Thank you for all of your videos!! They have been instrumental in understanding my health on many levels.

    • Hi Lorri,

      Hashimoto’s is an inflammatory condition which may cause enlargement initially followed by atrophy long term.

  26. Hello, just listened to your podcast about this topic.
    I was wondering what it may mean if Armour has lowered my T4? I have always had normal T4 (around 1.0-1.1) but I was put on Armour for a TSH of 2.9-3.3 range (and had a miscarriage-trying to get below 2.5 for pregnancy). After 6 weeks my T4 dropped to .84 and my TSH is still 2.8. Any ideas what may be happening?

    • Hi Rebekah,

      NDT contains T3 which can suppress the ability of your body to produce T4 on its own which can be reflected in serum tests.

  27. Hello, I have been taking Armour thyroid for about 7 weeks. I got my bloodwork done last week and my TSH dropped from 3.3 to 2.8 (which is good) but my T4 also dropped substantially from 1.3-.85. I find this concerning especially because I am wanting to get pregnant in the next couple of months. Should I be concerned about this? If so, what should I do about it? Should I switch medications? I really don’t want to go on T4 only medications as I have heard of so many bad side effects from them.

    • Hi Rebekah,

      You’ll need to check your free T3 as well next time to help give you a better picture of what is happening. It’s not uncommon for T4 to drop when using T3 containing medications like NDT or T3 and it’s not necessarily a problem.

      • Hi Dr. Child’s, thank you for your response! I did get my FT3 and it is up from 2.4 to 2.9. So it is increasing. So you think I should not be concerned and continue on armour? My doc says it’s a good dose and wants to keep me on it, but I am just concerned about the T4 for the baby if I do become pregnant. Thank you so so much. It’s hard to get any answers and I appreciate you actually responding to questions!!!

  28. Dr. Childs, I’ve seen a trend in the alternative world of docs walking away from patient care. It seems they are only interested in writing newsletters & books and selling supplements. It is nice to learn the information that is put out, but where does that leave us when doctors won’t see us? Is this because the heat from the conventional medicine world is too great, or is it the easier way to become wealthy? It is a great frustration for those of us looking for quality alternative medical care. I’m curious as to why you do not see patients. After putting the work & time into becoming a doctor, why don’t you do it? Thanks.

    • Hi Susie,

      I can’t speak for others but for me, I have more passion for working with a small group of patients and researching, experimenting and writing about it on my blog. I feel that I can make a larger impact this way by sharing what I’ve learned.

      I suspect that issues with insurance, tighter regulations and heat from the conventional medical world likely play a role as well.

  29. My doctor had me do the iodine radiation 1/25/18 and I recently stopped PTU prescription…feeling no changes of weight gain, fatigue and Graves Disease in left eye…when should I start Levothyrixine? Thank you

  30. Hi Dr. Childs,

    I’ve just switched dosage in my thyroid meds and I’m experiencing constipation.

    I increased my compounded thyroid meds from [76 T4 / 18 T3] to [66.5 T4 / 20.25 T3]. (So really I decreased my T4 and increased my T3)

    Why would I be having constipation issues? I’m noticing good things from the increase of the T3 like weight loss and more energy. Could the slight decrease in T4 have caused this?

    Here are my labs BEFORE I changed dosages while I was on the 76/18 combo:

    t4 free = 1.24
    tsh= .015
    Reverse t3= 15.9
    Free t3= 4.0
    Thryroglobulin antibody= <1.0
    TPO= 12

    • Hi Brittney,

      Constipation is a potential symptom of hypothyroidism so you may have accidentally reduced thyroid function with the switch. It could also be related to inactive fillers/dyes or completely unrelated to your medication switch!

  31. Hi Dr Childs,
    My doctor increased my T4 Levothyroxine dose back up to 100mcg and has kept my T3 Liothyronine dose at 50mcg.
    I find those doses good, I have energy, not lethargic, I walk an hour a day 5 days a week. the only issue is that I can’t lose weight. Since being on the T3, my weight hasn’t gone down. Should I ask my doctor to increase the T3 dose? Thanks for your help re this.

  32. Thank you for sharing your knowledge Dr. Childs. I was recently taking Nature-throid and felt hypo symptoms coming back. Previous to that I was taking T3 only and doing very well. When my T4 was low a new doctor put me back on NDT. I eventually convinced him to add T3 back to my regimen, but still do not feel as well as I did on T3 only. It seems obvious to me I have some kind of conversion issue, not to mention not making T4 hormone anyway. T4 only supplementation has never helped. In addition my hormone levels tend to run on the low side – testing post-menopausal when I was still menstruating. I am 49 and going through menopause, haven’t had a period in about a year. Cortisol also on the low side last time I tested. I am in between doctors and have an appointment scheduled for January (soonest available). I was not able to get Nature-throid script filled due to shortage so I was forced to go to someone local temporarily to get some thyroid hormone to get me through until January. I am now on 1 grain NP thyroid by Acella, plus only 10 mcg T3. Sorry for the long backstory, here’s my question: is it really a huge deal to have low t4 when your Free T3 is in the top of normal range? And, in your opinion, what is the best way to dose T3 only. Prior to all of this I was taking it 3x daily which was tricky and kind of a hassle. I was taking 75 mcg and it always seemed like a low dose, like I could feel better if I was taking more but I never was able to. Thanks for your time!

    • Hi Melissa,

      Not necessarily, it’s usually not an issue (for most people) to have low T4 on T3 medication but it can be bad if you severely suppress your TSH in the process.

  33. Last year my TSH was 3.7 and my free t4 was 0.7. This year my TSH was 3.5 and free T4 was 0.8. I have many symptoms but my doctor thinks nothing is wrong and won’t do a full thyroid panel. Should I get a second opinion?

  34. [email protected]

    My TSH and T4 are both low, but my T3 is within the normal range. What can I do to help this? Another factor is that I also have slightly elevated Thyroglobulin Antibodies. I take Nature Thyroid and follow a very healthy gluten free, healthy fats, organic produce, grass fed, free range meat sources. I just started a multi with zinc and selenium as well. I have been working since Sept to address SIBO and overall gut health. My issue is my IBS but constipation. From reading and listening to your podcasts I’m realizing that I should probably give up all dairy. From what I’ve shared am I missing something important? Is there anything else I could be doing?

    • Hi Melody,

      The long and short answer is that you probably are missing something, but you’d need a full set of labs and complete history to figure it out. It sounds like you are generally heading in the right direction, though.

  35. I have been taking 30mg of Armour for many years as well as Bio Identical Hormones(Bi-est). My new doctor did labs recently and wants to increase my T-4 level with NP Thyroid. I want to find a more natural approach. Would appreciate your suggestions.

  36. I have been symptomatic for years (dry skin, fatigue but sleep problems, hair loss, headaches, depression), but in the past year, I have been losing hair like crazy. I had extremely thick hair and a lot of it, so it is just now I am seeing thinning and scalp showing and I’m freaking out. My endocrinologist keeps saying my Tsh is good. Though my FreeT4 has ranged from .40-.61. My Tsh has gone from the 3.34 to the 1.31 in the past 3 years. Why is Tsh dropping? T3 is always normal range (3.2-4). Looking back at blood work, these were tested 5 times last year and twice already this year. I also have PCOS and possible rheumatoid arthritis that has just begun medication (swelling and stiff joints).

  37. Hi there Dr. Childs. Thank you so much for your articles! These are the last labs I had since December of ‘18. I started taking your T3 booster in January because of years of trouble losing weight. Do you think this is necessary to take at this point? Is there anything that you would recommend. I take 150 of Nature Thyroid and 50,000 units of Vitamin D per day.

    TSH- 0.01
    Free T4- 0.8
    Free T3- 3.1
    25-OH Vitamin D- 56

    • Hi Rachelle,

      I would base your decision to continue or not on how you are currently feeling. If you are feeling great with the supplement then I probably would not stop taking it because you may revert back. If it’s cost prohibitive then you can try to go off of it for a few weeks to see how you feel and then start up only if you continue to feel poorly. Labs can be deceiving, so I wouldn’t use them to determine whether you should continue the supplement or not, especially as your TSH is suppressed from your Naturethroid dose.

  38. Hi! Thanks so much for your article and youtube responses. I was diagnosed with Hashimotos 9 years ago. It has been an uphill battle ever since. I am always looking for ways to improve my health and minimize symptoms. I have changed my diet completely, eliminating gluten, most dairy, and sugar. I still struggle with exhaustion on a daily basis and never feel rested. I have recently changed doctors and have been lowering my t3 and Armour dosage since last October. One of my main concerns has been my heart rate, blood pressure, and weight gain. All of these symptoms have improved slightly over the past few months, so I feel that we are on the right track, but I am so tired all the time. I am also freezing cold and have Reynaud’s syndrome, which doesn’t help. I am an avid runner, cyclist, and personal trainer, so it is difficult to feel so exhausted and continue the sports I enjoy so much as well as work. My most recent blood work results are:
    Free t3: 3.67
    Free t4: .4
    Tsh: .012
    My t3 has come down from 5.67 and my t4

  39. Hi Dr. Childs,

    Do you have any experience with secondary hypothyriodism? I have been tested for pituitary tumors, adrenal issues, etc and everything comes back normal. However, my TSH is low at .01, T3 is normal, and my T4 is low at .4. I am currently on Naturethriod and have been taking a variety of different thyriod medications for the last 3 years.

    Thank you!

    • Hi Hayley,

      Yes, I am very familiar with both. But I have to say that most cases of supposed secondary hypothyroidism are simply misdiagnosed because many people have a combination of both primary and secondary hypothyroidism. The primary hypothyroidism is very well recognized by physicians but most physicians discount the negative effect that things like yo-yo dieting, stress, etc. have on pituitary function.

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