Reverse T3 Treatment Guide + How to “Flush” it out of Your Body & Start Feeling Better

Reverse T3 could be the missing link to figuring out why you're still have hypothyroid symptoms on thyroid medications. 

Or why you feel terrible with "normal" lab tests...​

The crazy part is that most Doctors don't even order Reverse T3 and even if they do most don't know what to do with it. 

And high levels of Reverse T3 could be acting to slow down your metabolism, reduce thyroid function at the cellular level and result in full blown symptoms of hypothyroidism.

​That's why it's so important for you to understand the basics of Reverse T3 and thyroid function so you can be informed when you see your Doctor. 

And don't worry:

I am going to make this easy on you by giving you all of the information you need to know about Reverse T3 including: ​

  • How to tell if you have too much Reverse T3 in your body
  • What blood tests you need to have your Doctor order and how to calculate your Free T3:Reverse T3 ratio
  • What causes high levels of Reverse T3
  • How to "flush" out high levels of reverse T3 and how I treat patients with Thyroid resistance and high levels of Reverse T3 in my office


What is Reverse T3 Anyway? 

Are you new to this whole thyroid thing?

No worries, I'm going to make this easy on you.

There's a lot of information out there (much of it conflicting), and it's easy to get lost in the sea.

What it boils down to is this:

Reverse T3 is a hormone metabolite​ that is created from the T4 thyroid hormone. And it looks something like this: 

Thyroid hormone metabolism

​Your body basically has the option of converting T4 into the ACTIVE thyroid hormone T3 or the INACTIVE thyroid metabolite Reverse T3. 

​Much like the image above, it's sort of like a fork in the road. Your body is constantly deciding which direction it is going, left or right. 

If most of the T4 in your body goes down the the ACTIVE T3 pathway, then your tissues get the thyroid hormone they need and everything is good.

If too much goes down the INACTIVE Reverse T3 pathway, then the active thyroid hormone is BLOCKED and you may become symptomatic. 

Sounds pretty simple right? 

T3 hormone = Good

Reverse T3 metabolite (in high amounts) = Bad

​Now that we know what we want the body to do, let's focus on doing the things that help your body convert T4 into the active T3 hormone and NOT the inactive Reverse T3 metabolite. 

​Why does your Body even have Reverse T3? 

That's a great question and answering it will help you understand why sometimes the body will create too much of it in certain medical conditions. 

Reverse T3 is meant to be there acting as a "Brake" on your metabolism during times of EXTREME stress.

Let's look at chronic illness as an example:

When your body is recovering from an illness (like pneumonia or a blood stream infection) does it make sense for your body to increase the metabolism and provide energy to your muscles? 

Of course not! ​It makes more sense to conserve your energy and metabolism by SLOWING down energy production and providing energy to vital organs. 

Unfortunately this condition used to be seen only in patients who were hospitalized, but has become more and more common in patients with multiple chronic medical conditions OUTSIDE of the hospital. 

And it may surprise you that this condition actually has a name and is WELL documented in the scientific literature.

It's called euthyroid sick syndrome.

Euthyroid sick syndrome definition

Patients that are under extreme stress develop this condition which results in LOW Free T3 levels, HIGH Reverse T3 levels and NORMAL T4 and TSH levels

Hmm... Does this sound like your lab results???

​You see: 

Despite the fact that EVERY Doctor knows about euthyroid sick syndrome, they suddenly forgot about ​it once they leave the hospital. 

Thyroid diet 4 week plan side bar

Which is unfortunate when you have studies like this one, showing that calorie restricted diets lower free T3 levels and INCREASE Reverse T3 levels and cause changes in thyroid function that "resemble sick euthyroid syndrome". 

And, don't worry, I'm going to go over all of the conditions that may be causing this syndrome with HIGH levels of reverse T3 in your body in the coming sections...​

​Are you Pooling Reverse T3 in your body?

​Now that you know you want Reverse T3 levels to basically be as LOW as possible in your body the next thing we need to know is what CAUSES the high levels to begin with. 

​Before we jump into the causes it's important to know the symptoms to look out for. 

As you might suspect as Reverse T3 levels increase your metabolism will go down and this will result in some serious consequences to your body. 

​Patients with high levels of Reverse T3 tend to have one or more of the following symptoms:

  • Lower than normal metabolism
  • Constant weight gain without changing eating habits
  • Crushing fatigue
  • Symptoms of hypothyroidism
  • Chronic pain
  • Depression, anxiety and/or bipolar disorder

​These are the most common symptoms, but realize that each person presents with different symptoms. 

For instance, I've had people with high levels of reverse T3 present with the complete inability to lose weight and with SEVERE depression.

If you have one or more of the following symptoms it's going to be VERY important for you to get your Reverse T3 levels checked and follow the treatment instructions below...

But first:​

What causes elevated Reverse T3 levels, and what should you look out for? 

​In my experience these are the most common reasons that people have high levels of Reverse T3:

6 Conditions that cause high reverse T3
  • Calorie restricted dieting - Especially HCG diets or VLCD (very low calorie diets). These diets have been shown to reduce metabolism, increase reverse T3 and make permanent weight loss almost IMPOSSIBLE. 
  • Chronic illness and infections - This includes viral infections like infectious mononucleosis, bacterial overgrowth syndromes like SIBO and even chronic illness like: cancer, cardiac/heart disease, arthritis, diabetes and even obesity itself. 
  • Chronic Inflammation - ANY cause of inflammation can result in decreased T4 to T3 conversion and higher levels of Reverse T3. Inflammatory states include: any untreated autoimmune disease, leptin resistance, insulin resistance, intestinal dysbiosis, cancer, etc. 
  • Chronic untreated Gut infections/Imbalances - Up to 20% of T4 is converted to T3 in the gut, which means if you have gut issues you are missing out on up to 1/5th of your conversion power! Gut imbalances include: SIBO, dysbiosis, reflux/GERD, yeast overgrowth, history of chronic antibiotic use and inflammatory bowel disease
  • Emotional and physiological stressors - This includes social issues like: death of a loved one, family problems, divorce, etc. And it also includes trauma: psychological (PTSD) and physical (motor vehicle accidents, TBI or otherwise). Read more here
  • Certain Medications - The most common medications causing elevated Reverse T3 include: Blood pressure medications, diabetic medications, anti-seizure medications, narcotics and anti depressants. Take for instance beta blockers, these are used to treat symptoms of HYPERTHYROIDISM and is a common blood pressure medication! 
Inflammation and T4 to T3 conversion

​I know, I know... 

I said I wasn't going to get technical and I did anyway.

I apologize but it's important to know why MANY people are suffering from this issue. Chances are VERY high that you fit into one or MORE of the categories above and it's highly unlikely that anyone has ever looked at your Reverse T3 level.

Because most Doctors don't order Reverse T3 levels it means that if you do get your Doctor to order it, they probably won't know how to interpret it. 

That means it's up to you...​

Everything you need to know about Testing for Reverse T3

Luckily it's pretty straight forward to test for Reverse T3 levels.

There is a serum marker for Reverse T3 that most standard lab companies can run. ​

​The tricky part can be understanding your results. 

​Before we talk about ranges you need to understand how these lab tests all fit together with one another:

One of the main reasons Doctors fail to recognize this condition is because they look for thyroid studies in the "normal range". 

If you haven't already please read this post which will show you why that's a recipe for disaster and how easy it is for your thyroid issue to be missed using this mindset. 

​To start you will want to get a full thyroid lab panel which includes: TSH, Free T3, Free T4, Reverse T3, TSH and antibody levels

Euthyroid sick syndrome lab values

As you can see from the image above you can have high levels of Reverse T3 and MOST of your lab tests will likely NOT be out of the "normal" range but that doesn't mean that your thyroid is working properly. 

In fact it means just the opposite: your thyroid is NOT working.

​One of the most obvious changes to notice is the Reverse T3 levels and the Free T3 levels. 

You can see that as Reverse T3 levels rise, free T3 levels will fall.

These two lab tests are by far the MOST important tests to get.

Not only that but you want to check your Ratio or Reverse T3 to Free T3 to get an idea of what is happening to your tissues.

In an optimal world you want your Free T3 levels to be as high as possible (generally upper 1/2 to 1/3 of the "normal" reference range) and you want your Reverse T3 levels to be as low as possible. 

For reverse T3 I use > 15 as my cutoff for abnormal.

But remember that it's possible to have a "normal" Free T3 and VERY abnormal "reverse T3" which is why the ratio is so important.

To get your Free T3: Reverse T3 ratio simply divide the numbers.

Your ratio should be > 0.20

​Any ratio < 0.20 indicates TOO much reverse T3 to Free T3 and means that you need to flush out the reverse T3 in your body. 

How to "Flush" Reverse T3 out of your body

You need to realize that treating your Reverse T3 problem is only effective if you treat the UNDERLYING cause

​If your high levels of reverse T3 is secondary to insulin resistance and diabetes and you don't change your diet, then even with treatment your high levels will come right back. 

​For this reason it's VERY important to find the underlying cause before you initiate treatment - because part of your treatment needs to be at that issue. 

Having said that, there are definite ways to lower Reverse T3 levels quite quickly...

​I've split treatment into 3 main categories: 

1. Thyroid Medications to Flush out Reverse T3

​The fastest and easiest way to get rid of excess Reverse T3 is with bioidentical hormone formulations that contain pure T3. 

This would include medications like liothyronine, cytomel or sustained release T3 from compounding pharmacies.

​The reason this approach works so well is because by giving the body T3 hormone, it doesn't have the substrate to produce Reverse T3. 

Naturally what will happen with T3 supplementation is that your T4 levels will decrease, your Free T3 levels will increase and your TSH level will drop.

When on this therapy ​it's important to monitor Reverse T3 levels closely, usually once every month or two. 

Typically within 2 months (and assuming your dose of T3 is high enough) your reverse T3 should be < 10.

In terms of dosing on the T3 medication, it is common for me to start patients out on 10mcg per day and increase the dose by 10mcg every 10-14 days while monitoring pulse rate and symptoms. ​

As I mentioned above, this is by FAR the fastest way to reduce Reverse T3 levels - but it's important to still seek out and eliminate the CAUSE of your high reverse T3 levels otherwise they will just come back. ​

If you are a sensitive patient that titration rate may be too rapid for you in which case you may want to start somewhere between 2-5 mcg every 10-14 days.

"Sensitive patients" are patients that react to supplements and medications at low doses.

​NDT & Reverse T3 Levels

​Can NDT be used to help flush out reverse T3 levels in the body? 

It certainly can help but there are a few things to realize when trying to flush out reverse T3 levels while using NDT:

  • Each grain of NDT has about 38mcg of T4 and 9 mcg of T3 - that means that NDT is still mostly consists of T4
  • In order to flush out the reverse T3 you must lower the substrate of T4 which generally means lowering your total dose of T4, in most cases that means dropping your total dose of NDT
  • NDT dosing is static meaning you can't individually alter the concentration of T4 and T3 unless you add medication to the NDT

​With these considerations it's usually best to decrease your total dose of NDT and add T3 in addition to the NDT to help reduce levels. 

For most patients dropping NDT down to 1-1.5 grains is usually required to get the most benefit.

​Remember this:

Simply manipulating the reverse T3 number by changing medications does NOT treat the cause of the elevated reverse T3 to begin with and if you don't treat the underlying cause your levels will increase once you go back to full dose NDT.

2. Supplements to BOOST T4 to T3 conversion

In addition to medications every thyroid patient needs to be on some supplementation.

The reason is simple:

Being hypothyroid sets the body up for certain nutrient deficiencies and since most people are under-treated, most people also have these deficiencies.

Low thyroid = low stomach acid = decreased absorption of nutrients and puts you at increased risk for developing GI imbalances which further impairs absorption. 

​You can check out this post here for more info about which supplements you should consider using and how to check to see what your body needs. 

When it comes to thyroid conversion we only want to focus on a few certain nutrients:

The two primary supplements that you should focus on are Zinc and Selenium. Both of these supplements have been scientifically shown to INCREASE T4 to T3 conversion, thereby DECREASING reverse T3 levels.

thyroid metabolism reset poster for side bar

We aren't as concerned about supplements to promote thyroid production because that isn't the problem with conversion issues (it may be for some but not for the majority). 

If your Doctor isn't willing to change your medication you can check out this post for more info on how to naturally increase your Free T3 levels. ​

3. Reversing Hormones that promote T4 to Reverse T3 Conversion

​As you are probably aware your hormones all work in tandem with one another. 

This means that as one system slows down it may drag down other systems or cause an increase in other hormones to make up for the deficit.

This holds true with thyroid hormone and leptin/insulin levels.

The link between these three hormones is clear:

This is VERY important because hypothyroidism leads to a state where developing both insulin and leptin resistance becomes much easier. 

Why do we care?

Because insulin and leptin resistance cause inflammatory states which contribute to T4 to reverse T3 conversion.

Not only do they cause high reverse T3 levels but they also make weight gain impossible.

Is this sounding familiar now?

Patients with high reverse T3 levels almost always have high fasting insulin and high fasting leptin levels.

In fact I have never seen a patient with a reverse T3 > 25 with a normal insulin/leptin level.

Leptin resistance labs
Fasting insulin and hypothyroidism

​You can see examples from my patients above showing abnormal reverse T3 levels, high fasting leptin and high fasting insulin levels. 

​These values may fall within the "normal" range but they are far from normal and will lead to symptoms of hypothyroidism, weight gain and weight loss resistance. 

​Another big reason I want to talk about these hormone imbalances is because Doctors don't frequently run tests on either of these hormone imbalances. 

Providers will check a Hgb A1c but rarely do they order fasting insulin and fasting leptin levels.

This means that if you have known high levels of reverse T3 (by the way they don't always order this test either), it's probably going to be up to you to request these specific hormones.

​Treating a reversing both insulin and leptin resistance is VERY important for not only lowering reverse T3 but maintaining low levels of reverse T3 over time. 

To learn more about how I address these hormone imbalances (including treatment options) please see the following case studies below:

​These case studies provide a step-by-step walk through of how to approach leptin and insulin resistance including medications, hormones and supplements designed to help both conditions. 

​If you know you have insulin resistance then you can consider using these supplements to help lower your levels: 

  • Berberine: Helps reduce cholesterol, improve fasting glucose and may help with weight loss.
  • Alpha Lipoic acid: Helps sensitize the body to insulin and may help to reduce nerve damage in certain patients
  • Chromium: Helps improve insulin sensitivity to cells and may help reduce cardiovascular disease in certain patients. 

​If you prefer the natural approach to treating leptin levels you can find more info here on how to target supplements towards OTHER imbalances for the most benefit

Most leptin supplements don't work unless they are used correctly.

​4. Addressing Inflammatory Levels and "Cooling Off" Your Body

I usually don't like talking about "inflammation" because it's such a nebulous concept. 

Everyone knows inflammation is bad for the body, but very few people understand how it makes things worse and more importantly how to treat it if present.

Part of the reason for this is because the markers we use for inflammation are non specific.

That means most of the time we know inflammation is present, we just don't necessarily know where it is coming from.

Sure, in the presence of other abnormalities we might be able to take a guess, but we will rarely ever know with 100% certainty.

 ​But how does inflammation relate to thyroid function and reverse T3 levels? 

Thyroid conversion with leptin resistance

It turns out that inflammation directly promotes the production of Reverse T3 from the substrate T4 resulting in high levels of Reverse T3 over time. 

So if you have high reverse T3 levels you need to be actively searching for sources of inflammation and treating the cause directly. 


How do you test for inflammation? Check the following blood tests...

  • CRP: You want this to be as low as possible but definitely < 1.0 for optimal thyroid function
  • ESR: Another non specific marker of inflammation, for optimal thyroid function this should be < 10
  • Ferritin: Both a marker for iron stores and an acute phase reactant this marker can be used in certain instances to help isolate non specific inflammation in the body

​These are non specific serum markers and may indicate that inflammation is present somewhere in the body. 

If you know that you have both high levels of inflammation AND high levels of reverse T3 then you can safely assume that the inflammation is likely worsening your thyroid function.

The next step is to find where it's coming from.

In hypothyroid patients it's usually in these three places:

  • Hormone imbalances (especially insulin and leptin resistance): Please refer to the section above to understand how to both diagnose and treat these conditions. 
  • Undiagnosed gut imbalances like SIBO and SIFO: Both of these gut issues promote inflammation in the GI tract and lead to increased intestinal permeability. You can find more about both here
  • Undiagnosed food sensitivities: These sensitivities promote inflammation and further food sensitivities unless treated. 

​Bottom line?

If you have both high reverse T3 and elevated serum markers for inflammation you should be looking at the 3 main causes above and treating those if applicable.

If you don't know where the inflammation is coming from you can still do some good by taking supplements designed to help reduce inflammatory levels and promote the "clean up" of breakdown products in the liver: ​

This approach isn't ideal but it's better than simply ignoring inflammation to begin with. 

Remember to work with your Doctor if you suspect you have an inflammatory process contributing to your high reverse T3 levels. ​

​5. Lifestyle changes to Balance Hormones and Promote Thyroid Function

​Never underestimate the power of these 4 major areas when it comes to your health:

  • Getting 7-8 hours of quality sleep per night
  • Reducing and managing your stress
  • Daily low intensity exercise and episodes of high intensity exercise 1-3x per week
  • And a balanced diet full of real, whole foods

​If you don't practice these 4 basic things it doesn't matter what you do - you WON'T get better. 

​These are particularly important for those with high Reverse T3 levels. 

Remember that your body is a NETWORK of systems and hormones that all interact with one another. 

When one system isn't working properly, it will bring other systems down as well.

​Often times boosting thyroid function with steps 1 and 2 above while improving these 4 areas is enough to bring balance back to other hormone systems. 

That means you may find your menstrual cycle become more regular (as estrogen and progesterone balance), your belly fat to shrink (as cortisol level regulate) and your lean muscle mass increase (while testosterone levels out and insulin levels drop).  ​

Final Thoughts

​High levels of Reverse T3 can be a very serious issue for many thyroid patients and may help explain why you've been consistently symptomatic and resistant to weight loss despite taking thyroid medication. 

In order to diagnose high levels of Reverse T3 and thyroid resistance you need to order BOTH serum levels of Reverse T3 and Free T3.

Measure your ratio of these hormones (as this is the most sensitive marker for tissue levels of thyroid hormone). If your Free T3/Reverse T3 ratio is < 0.2 you have TOO much Reverse T3 in your body.

The best treatment for reducing these levels is by taking pure T3 thyroid medication, taking supplements to increase T4 to T3 conversion and by making the appropriate lifestyle changes to balance other hormones in your body.

Doing these things will finally help your body get back into balance and get RID of your hypothyroid symptoms. ​

Now it's your turn:

​Do you have too much Reverse T3 in your body? 

Have you tried pure T3 medications like Liothyronine or Cytomel?

Did they work for you?

Leave your comments below!​

Dr. Westin Childs

I'm Dr. Childs and I write these posts. I'm a physician that specializes helping patients lose weight, have more energy and FEEL better. My practice focuses on hormone imbalances, thyroid issues and weight loss resistance. My goal is to provide the BEST information out there on the internet that is both actionable and trustworthy. Get my free ebook: Hashimoto's Diet Guide here. You can also find more about my personal journey back to health here.

Click Here to Leave a Comment Below 221 comments
Patty - April 30, 2016


I have no thyroid but have Hashimoto’s Hypothyroid. Recent blood tests were TSH=.08 , T4=7.61 and t3=4.9….no reverse T3 run. Have to wait til July when I see new endocrinologist. These numbers seem good to me. Thoughts?

    Dr. Westin Childs - April 30, 2016

    Hey Patty,

    People get too obsessed with lab numbers when trying to treat the thyroid, they are not 100% accurate and therefore only represent a small part of a larger picture. I don’t recommend basing treatment off of lab tests alone.

      Madison - December 21, 2016

      Hi there, awesome article. I have high reverse t3 and boarder line low thyroid levels and I have never been on any thyroid medication so I’m just wondering if when you say “clearing out reverse t3” you mean it as it can be a temporary treatment that you use to clear the build up and then stop and have your thyroid revert back to normal and healthy.. Or would you have to be on it permanently?

        Dr. Westin Childs - December 21, 2016

        Hey Madison,

        I’m glad you liked the article. Obviously each patient is different, but some patients can flush out the system and have a return to normal (assuming they also treat the cause of the high reverse T3 in the process), while others may need therapy long term – it just depends.

          Madison - January 14, 2017

          Awesome thanks so much for getting back to me you are awesome! What if people have low/normal T4 as well as low/normal T3 and high/normal Reverse T3… In this situation is it usually better to use the NDT + T3 option so you are still getting the T4?

          I have sent and email through your site I really hope it gets to you 🙂

Patty - April 30, 2016

Please let me know previous thoughts on the email.

Laura - April 30, 2016

Dr. Child’s,

Thank you for these very informative articles. I’ve been on the Hashimoto’s ride for quite and have done a TON of research trying to help myself get better. I have also seen MANY doctors who have been useless in helping me. In Georgia Naturopathic type doctors are hard to come by. I have cleared high Reverse T3 levels several times during the course of my illness. I have addressed adrenal health and iron levels. Even still Reverse T3 always returns when I go back to adding NDT.

My questions to you are:
In your opinion can one simply stay on T3 only for life or is T4 medically necessary to the body. I’ve read conflicting opinions on this.

Secondly, could Reverse T3 levels rise due to taking too much T3 along with the NDT?

Thank you…

    Dr. Westin Childs - April 30, 2016

    Hey Laura,

    Most people do fine on T3 only medications. If you are a post thyroidectomy patient I would proceed cautiously, but in my experience they are still able to function quite well with T3 formulations only. I say proceed cautiously because theoretically some individuals may have a hard time transporting T3 into the brain.

    You also have to consider that you are more than just your labs. Your reverse T3 levels will elevate as a natural safety mechanism if your free T3 levels get too high. If you are not symptomatic, then don’t worry about your reverse t3 levels.

    And yes, I’ve seen reverse T3 levels rise as free T3 levels rise for the reason I stated above.

Ana - May 1, 2016

I am reading your very interesting information and seek to find some answers. I do know that my hashimoto antibodies rose after prolonged period of high stress. I did take 10mg of cytomel and within a month gained 25lbs on top of the 20lbs I previously gained within a year. Does this explain further any direction of uncovering the Sx and cause? Please advise.

    Dr. Westin Childs - May 1, 2016

    Hey Ana,

    Unfortunately that isn’t a lot of information to go on. Weight gain around the time of taking cytomel doesn’t necessarily mean that it was due to this medication (though it is possible). It’s also possible that you would have gained 40 pounds instead of 20 because you were on the cytomel. You need someone to dig into the problem and figure it out.

debbie - May 2, 2016

Hi there,
I have about 10-15 extra pounds of body fat around my mid section and my BMI is off. I eat really well, exercise and otherwise do everything ‘right’. I had my thyroid removed 15 years ago and ever since I crossed over to menopause (I’m 56) I have not been able to get back to ‘normal’. It’s not far off – I just know I could be feeling better. I SO appreciate this article as I never knew what reverse T3 was and no one (of many docs)bothers to check it. Are there natural forms of Zinc and Selenium – or supplements the only way to go? In appreciation.

    Dr. Westin Childs - May 3, 2016

    Hey Debbie,

    Yes, you can get zinc and selenium from natural sources – but I almost always have my patients add these supplements even if they try to consume enough via food sources. I just feel that the results are better that way.

      Gail - May 21, 2016

      What amounts of selenium and zinc would you recommend for an 11 yr old and do you want patients to take selenium along with Vit E? Thank you.

Leah - May 3, 2016

I love reading stuff about this. I’ve been dealing with my thyroid issues for 5 years and I’m only 22. They haven’t been able to level my thyroid my t4 levels are high my t3 is fine, but I still have all the symptoms. What should I ask my doctor next time I see him? I want to get to the bottom of this but evrytime I read about something and bring it to my doctor he tests me for it and I end up being normal. Just want to know the right words or terminology to ask him.

    Dr. Westin Childs - May 3, 2016

    Hey Leah,

    You will never get help the way you are going about it. If your doctor isn’t ordering the right tests it’s because they don’t understand how to interpret them. So, even if you get them to order the tests – they won’t know what to do with the results, which means you won’t get the right treatment anyway. You will need to find a new doctor to help.

maria - May 4, 2016

i taking armour and t3 25 mg in the afternoon
seems to be helping with anxiety

2 endo have told me to stop – it could ruin my heart and cause bone loss

any thoughts

    Dr. Westin Childs - May 4, 2016

    Hey Maria,

    It can definitely cause those issues if the dose is too high, the trick is getting on a dose that works well for the patient but doesn’t cause those side effects.

Cathy - May 16, 2016

What dosages of selenium and zinc do you recommend?

Lori - May 20, 2016

Hi Dr. Childs,
I’ve been hypo for about 17 years. Sometimes I test positive for Hashis and sometimes not. I take10 mcgs of Liothyronine three times a day (total 30 mcgs per day). I read in someone else’s post that this dose can cause heart and bone issues. Can you elaborate? Also, how would I know if this is happening? I do have occasional palpitations and would have more if I didn’t take Magnesium every night.

I cannot take any brand of T4, including Synthyroid, Levoxyl, Tyrosint, Armour, Naturethyroid and Westhyroid. When I do, even at very low doses, I experience widespread debilitating muscle pain. I have re-tried taking T4 more times than I can count and always have the same result. Not a single Dr. I’ve talked to has ever heard of this side effect or can explain it. Have you ever heard of this reaction? Seems strange given that I seem to need it. My T4 is always low, and Drs. always want me to take it.

    Dr. Westin Childs - May 20, 2016

    Hey Lori,

    It’s not about the dose so much as it is about your body and how you tolerate the dose. I’ve had people on much higher doses that do great, and people on much lower doses that are symptomatic. If 30mcgs is elevating your resting pulse > 90 and you are having palpitations then it may be too high a dose for your body. And it’s easy to follow bone density with dexa scans, so it would be worth looking into that as well.

Pam - May 20, 2016

Can you just add Cytomel T3 to Naturthyroid 1.5grams to clear out Rev T3?
Or do you take T3 by itself?
How much T3 do you add?

    Dr. Westin Childs - May 20, 2016

    Hey Pam,

    Usually you need to remove the NDT as well, but it just depends. Dose depends on the person, there isn’t a specific dose to start with. I usually gauge the dose of T3 based on the reverse T3 levels. But remember to search out the cause of high reverse T3 to begin with, otherwise it will come back again.

Danielle - May 20, 2016

So much conflicting information out there.

I recently found my adrenals are mostly low. I feel better in higher doses of ndt, but end up with symptoms of hypo and hyper at same time. Prednisone was prescribed, and it’s horrible too.

Can these issues of muscle pain, cramps, low temps, sleepless nights, swelling, be caused by reverse t3 levels being off?

cyndi - May 20, 2016

My problem with the Liothyronine or Cytomel they are made with a wheat-gluten filler. I am wheat-gluten sensitive, therefor I cannot take either of these medicines. What else can be recommended.

Jude - May 20, 2016

I had a partial thyroidectomy for a goiter in 1982 and put on synthyroid. My doctor six months ago added 10 mg of generic cytomel, I am on 112. Of synthyroid. Is this a effective combo? Thanks

Pamela - May 20, 2016

Hi.. I was on Synthroid only for last 10 yrs. felt horrible gained weight constantly cold all the time. Took my records went to see a new dr. Last reverse T3 was almost 30. Dr put me on T3 only. I’ve never felt better. Been on it now for 5 weeks. Best decision I made. I was diagnosed with Intracellular Hypothyrodism Diease.

    Dr. Westin Childs - May 20, 2016

    Hey Pamela,

    I’m glad you found a doctor willing to work with you! It’s unusual for doctors to prescribe T3 only medication nowadays even though your experience reflects what most of my patients feel as well.

Sheri - May 21, 2016

Hi! Thank you for all the information. I wish other doctors were better educated on thyroid issues. You mentioned that taking T3 will make TSH go down, but what if I have a lower TSH and high Reverse T3? Do I want TSH to go down any further? I suffer from hyper & hypo symptoms. My lab values are as follows: TSH .49 (.3-5.0), T3 Reverse 21 (8-25), FT3 3.3 (2.2-3.9), T4 1.6 (.6-1.6), TPO antibodies 28 (0-8.9). I clearly have something going on, but doctors just say I’m fine because TSH is great. I’m currently on the hunt for a new doctor. 🙂

    Dr. Westin Childs - May 21, 2016

    Hey Sheri,

    You are welcome!

    I was just stating it as a fact, not that it necessarily matters. Suppressed TSH levels are fine provided you don’t exceed the limit of what the body requires. If you exceed that limit then it can cause damage, but that’s why I recommend following resting pulse + basal body temp while on T3.

    And yes, you definitely have a problem with T4 to T3 conversion with a reverse T3 that high. I would also suspect a severely reduced metabolism.

      Sheri - May 22, 2016

      Thank you for your response! It sounds like the next step would be finding a local functional medicine practitioner who can help me search for my root cause as to why I’m not properly converting T4 to T3. What exactly do you mean by a”severely reduced metabolism?” My BMI is in the low/normal range, however my energy levels are much lower than they should be. Thanks again!

Kathi - May 21, 2016

Hi – just got back labs – let me say, I WAS on 300mcg Synthroid, and 7.5 mcg Cytomel. I didn’t feel like they were doing anything for me, still had issues with weight, and fatigue. We started all over again. No thyroid meds for a while, got labs done…
TSH 18.5, T4 Free – 0.2, T3 Free – 0.8, T4 Free (direct dialysis) – <0.2, then T4 Total – <0.8, no reverse T3 done. Put me on 175mcg Synthroid and no Cytomel this time. I'm still exhausted, and weight keeps coming on. My naps are HEAVY. But in my thyroid's defense, I only get around 5 hours of sleep a night until Friday night. Then I catch up on my sleep. I'm swollen and constipated too, and all the rest of the horrid s/s of hypothyroid disorders. I'm going to add zinc to the supplements I'm already taking. Good article.

    Dr. Westin Childs - May 21, 2016

    Hey Kathi,

    I wouldn’t put much weight on your lab tests at this point, it’s clear that you need more T3. Your sleep needs to be addressed ASAP as well.

Karen Walker - May 30, 2016

I have the symptoms of hypothyroid with normal levels but a low free t3/Rt3 ratio. I do have lyme disease but I was extremely well for 10 yrs after the tick bite, only becoming unwell 5yrs ago during a period of prolonged overwhelming stress. I have eliminated all the stress now and as most of my symptoms can be explained by hypothyroidism is it worth me trying T3 for a period of time to see if i can clear the RT3 and get my body back to managing the lyme as it was for all those years. Thank you.

    Dr. Westin Childs - May 30, 2016

    Hey Karen,

    It’s worth a shot, I’ve done it successfully with other lyme patients. Just make sure to use higher doses of T3, preferably sustained release.

    Alice - July 12, 2016

    I was wondering if you have tried getting treatment for your Lyme by repeated, mostly whole-body, hyperthermia ( H20 temp 109 degrees,to raise body temp to at least 105 degrees, sustained for 20-60 min) treatments? Repeated treatments are needed to repeatedly catch the spirochete out of its cyst form it was explained on one site.

      Josie - November 12, 2016

      Hi Alice,
      Would love to know more about the whole body hyperthermia treatment for Lyme. Where do you get it? Thanks

Ruth - June 17, 2016

Hi! First, thank you for all the great info you are putting on this website! So helpful and informative! I’ve been misdiagnosed for years and I have some of the lab tests to prove it. But I’ve now been on a combination T4/T3 50/12.5 for 9 months. Had to insist on my labs being re done because I went from feeling a little better to horrible once again. My FT3 (253pg/dl range 202-443) and my FT4 (1.5ng/dl range .7 -1.9) both stayed the same. The TSH dropped from 4.87 to .88. RT3 went from 20.8 to 27. Oh and my TPO increased to 387. TgAB went up to a 4. So obviously I’m not getting what I need into the cells and the autoimmune component is getting worse. Your article talks about T3 only, but I was wondering if I should be staying on the compounded T4/T3 and just add more T3 as a second med and increase as you have written about in the article? Side note, I’ve gone gluten free and reduced sugar so I’ve lost weight, but energy is non existent. 🙂

Jo - June 19, 2016

Hi Dr. Childs , would like to know what could cause high Rt3 when not on any thyroid medications ?

My son is 21 has type 1 diabetes (diagnosed at 10 ) , could that itself cause the high Rt3 it’s at top of range?

His FT3 is 3.1 (2-4.0 ) and Ft4 1.27

What can be done to make it lower without thyroid meds .

    Dr. Westin Childs - June 20, 2016

    Everyone with insulin resistance will have higher levels of reverse T3, the only way to reverse it is to reduce hgb A1c and insulin levels.

Jo - June 19, 2016

Als what do you think about LCHF way of eating ?

Kate Liker - June 20, 2016

Hi Dr Child’s!
Firstly thank you so much for your amazing blog!
I had a thyroidectomy almost five years ago. I’ve felt terrible ever since! After reading your blog, I searched for an integrated GP who ran the test for negative t3. My levels are 693! That same doctor unfortunately also prescribed 200mg a day of dedicated thyroid hormone and after 6 tablets I was in the ER needing medication to lower my heart rate, the doctors said I had thyroid poisoning.
Now my body is struggling to calm so my new GP is waiting a few weeks before we introduce t3, 10mg a day to lower my negative t3 (after reading this article), what happens if you can’t tolerate t3? Should we be lowering t4 so the my per day is the same?
I’ve had chronic iron problems for five years with my iron at 16, I’m booked to get an iron transfusion next week. Finally I have hope and I can’t thank you enough!!!

Sherrer - July 4, 2016

I really need some advice and help bc I am at my wit’s end with trying to my a solution to feeling normal again. 5 yrs ago when pregnant with my 2 child I happen to feel a lump in my neck. End up having a total thyroidectomy due to it being cancer. So I went from feeling totally normal never having any thyroid issues what so ever to Bam…Feeling like death ever since my surgery. Not one single Dr that I went to remotely prepare me for what life was going to be like post thyroid. They made it seem like you just have it remove and then take a pill everyday for the rest of your life and you will be fine. NO big deal….I went from being on 0 meds before my thyroid surgery to now I am on 5 different meds trying to get back to my old normal, Which none are working. I am constantly fatigue no matter how much sleep I get. Never want to do anything bc after I work and see about the house and kids I am totally worn out. I am very short fuse,irritable, and brain fog etc..These are just a few of my horrible symptoms my list goes on and on. I can’t even stand being around my own self. So I can only image what it is like for other people who have to be around me. My Endo Dr only believes in T4 and tells me as long as my TSH is were he wants it then that is all he cares about. He said my symptoms are related to post surgery and my season of life of having 2 small kids. I ask about adding a T3 along with my Synthroid and he said No bc that wouldn’t make any difference. After feeling very discouraged I was starting to just accept this was as good as it was going to get and this is now my new normal. I did do my own research and follow the Dennis Wilson Protocol bc once I started taking and recording my Temps they were always around 96 degrees. So I started on his T3 protocol and was able to capture my temp at 98 and maintain it but I still did not see any positive benefits from it. Actually they only thing that change was now I am constantly hot always sweeting and having real bad night sweets where my house stays on 64 and the rest of the family are complaining on how cold it always is in the house. Now I am very discourage bc I truly thought that the T3 was may answer. Here are my Labs that I got done on my own just to see If these symptoms were all in my head are was there truly something wrong with me and that I wasn’t crazy. TSH 0.009, total T4 10.7, total T3 118.3.
Free T4 1.83, Free T3 4.1 and Reverse T3 27. Can you please give me some advice from where to go from here. I am wondering if it might be Adrenal Fatigue. What test or medication would you recommend base on this brief hx. I would greatly appreciate any advice that you give that might help in any way….. Thanks in advance for your help!!!

tara - July 15, 2016

I am on 1/2 grain naturthroid my recent labs last month were tsh was 1.97 t4 1.19 t3 2.7pg/ml and i got my reverse t 3 tested for the first time and its 24.4 ng/dl. I have been severly fatigued and losing insane amounts of hair and anxiety.

    Dr. Westin Childs - July 15, 2016

    Hey Tara,

    Your reverse T3 is quite high, I would consider implementing some of the steps in the article to help lower it.

      Tara - July 16, 2016

      I am afraid of t3 causing more hair loss… I. Mean it’s not just a little hair loss. I have lost their half of my hair (no joke). I read online of some peoples hair loss getting worse by adding t3. I worked with a functional med dr 2 years ago. I am an extremely clean eater. No dairy, no gluten, hardly any soy or corn. Also stay away from foods I tested an IgG reaction to. I eat organic and plenty of veggies. I also only do filtered water not tap to not get added junk. I do liver supporting supplements and and adrenal support. I do t know other than possible heavy metals I have compound heterozygous mthfr or extreme stress or inflammation that’s causing this. Would I still add in some t3 and would I cut down my naturethroid?

        Dr. Westin Childs - July 16, 2016

        T3 can definitely accelerate hair loss, what I’ve found in some people is the hair cycle appears to just be more rapid in general. Meaning more hair is falling out, but more hair is also growing. Then there are some other people who actually do just lose hair on T3.

Jennifer - July 24, 2016

Hi, I just started armour thyroid 4 weeks ago for low free T3 levels (2.2) and lower than optimal T4 levels (0.9). My tsh was already .3. I started on 60mg and was fine for a week…then anxiety, racing thoughts and jitters came out of nowhere. I immediately went to 30mg and the symptoms disappeared within 24 hrs. I felt great at 30mg for 2 weeks, but then the achy joints came back so I decided to try 45mg. After two days of that dose the anxiety, along with depression and racing thoughts, came back with a vengance. Now I just decided to go completely off. I’m newly pregnant and I’m worried about the levels fluctuating so much. Does this sound like my reverse T3 skyrocketed with upping the dose, or does it sound like free T3 is pooling? How long would you expect it to take for the levels to drop and for the anxiety to go away? It only took 24 hrs last time but now it’s been 3 days. 🙁 Thanks so much!

    Dr. Westin Childs - July 25, 2016

    Hey Jennifer,

    Some patients don’t tolerate T3 or NDT. In these cases it doesn’t mean they don’t need thyroid hormone, but instead they need to try various types of medications to find out what works best for them.

      Jennifer - July 25, 2016

      Thanks. Do you have a list of functional medicine Drs that would be able to help me? I’m in the Twin Cities, MN. I’m having a hard time finding names. Thanks so much!

        Dr. Westin Childs - July 25, 2016

        Unfortunately I do not. Nowadays many people claim to practice functional medicine but really just practice conventional medicine with some supplements.

          Jennifer - July 26, 2016

          Dr. Westin, the symptoms of panic, racing heart, and inability to sleep for more than a few hours at a time are getting worse. I’m trying to make an appt to see someone that’s not my general MD (she just told me I turned hyperthyroid with the NDT and to wait 4 weeks to see her again) but most are booked out a bit. Do you have any insight in the meantime as to why symptoms are getting worse, not better, after removing the higher dose? The first time I removed the high dose 3 weeks ago the anxiety went away right away. Now I lower the dose to the pt of going off and symptoms aren’t going away. I am pregnant and I know cortisol and thyroid hormones change in pregnancy. The first time I lowered the dose I had just conceived. Now I’m 6 weeks pregnant. Could this have something to do with it not getting better as quickly?

          Dr. Westin Childs - July 26, 2016

          I would recommend you find someone local to see you and get checked out ASAP. While pregnant you don’t want to mess around with symptoms like these.

Kat - July 25, 2016

This article really opens my eyes, I have had Hashimoto going on 20 years, I have kept all my lab results since 2009. During that time period my RT3 has only been checked twice!!! Both times it’s been in the 9.5 range. My FT3 is way too low in the range (never going higher than 3) it’s only 13% of its range. and my FT4 is actually below range, last tested .76. Rule of thumb for me is for my FT4 to be about mid range and FT3 to be in the upper half to upper third of its range.
I find that I have insulin resistance, PCOS ( surgery induced menopause – complete hystertectomy with BSO), I have depressed progesterone. I know my hormones are all wacked. I gained 20 lbs in a year and holding steady at 179.

I am just started taking Selenium, but only 200mg so,I will up that. Berberine 3x 500mg ,Vitamin D, Biotin, Armour 90mg,Ashwaganda 800mg. Eating high protein, mid fat, low carb, 1600 calories a day, strength train full body 3x wk. not sure how that will all play out on my journey to healing or how long it will take. I get my probiotics in my Raw Meal protein shake, do you think that’s sufficient or should would Prescription-Assist be another needed layer? Can a person take too much probiotics?

No one is wanting to put the pieces together for a treatment plan.
I am hoping to find a functional dr to assist with my treatment, I plan on firing my Endo.

Thanks for the information.

    Dr. Westin Childs - July 25, 2016

    Hey Kat,

    No problem and good luck!

    In general it’s not necessarily about the amount of probiotics, but which probiotic your body needs. Most with hypothyroidism do better on soil based organisms.

Greer - August 7, 2016

I was diagnosed 10years ago with Hypothalamic Hypothyroidism (of unknown reason, all other Pituary levels were normal but my 24hr cortisol level was high normal) and I was started on synthroid and cytomel. I felt better with the hormones, I continue on them but feel that I may have induced the diagnosis due to the extreme stress in my life at the time. Do you think I will ever be able to stop the synthroid and cytomel.

    Dr. Westin Childs - August 7, 2016

    Hey Greer,

    Hard to say, some people are able to do it, others are not. Only time will tell.

    As an aside you should probably be checked for adrenal cushings with a dexamethasone suppression test. In some cases the cortisol can impact thyroid function and the tests appear relatively “normal”.

Isabel - August 8, 2016

Hello Dr.Westin,i really do need your help in reading my thyroid report.My doctor says i’m normal but i have all the symptoms of Thyroid disorder.Can you please give me your reading on my lab report.Thank-you.

Anti-thyroglobulin(Anti-TG)13 IU/ml
Anti-thyroid peroxidase(Anti-TPO) 6 IU/ml
Thyroid Stimulating Hormone 1.86 mIU/L
Free T3 4.0 pmol/L
Free T4 13.3 pmol/L
Reverse T3 406 (140-540)pmol/L

    Dr. Westin Childs - August 8, 2016

    Hey Isabel,

    I never recommend looking at thyroid lab tests in isolation, they aren’t normal by my standards but that doesn’t necessarily mean anything without the context of symptoms and other medical conditions.

Ana - August 10, 2016


Great article, very explanatory.

I would like to know your opinion regarding iodine supplements for thyroid problems, like iodoral.

I have been dealing with tingling and burning all over plus pain in upper back, arms and gluteus. After visiting a lot of different specialist, and without any clear diagnosis and help, I found a doctor who just ordered for me the complete thyroid panel that you describe plus several other hormonal tests.

In the mean time he wanted me to take iodoral every day, because he suspects problems with my thyroid.

I have my tests back, but won’t have the appointment until the 24th this month when my doctor will let me know his opinion regarding the results..

I took iodoral just for one day and I am still dealing with a weird sensation in my throat. As I have read is a side effect of iodoral.

I have researched about iodoral and lugo’s solution over internet, and there is so much controversy with iodine supplements. I am confuse wether to take it or not.

My T4 free is 1.18
TSH is 1.020
TPO is 8
T3 FREE is 2.9
T3 Reverse is 16.8


    Dr. Westin Childs - August 10, 2016

    Hey Ana,

    I don’t base my iodine recommendations off of thyroid lab tests alone. I would wait until you touch base with your physician and go with his recommendations.

amy - August 12, 2016

My son, age 13, was diagnosed with SIBO (Small Intestine Bacterial Overgrowth) and Fructose Malabsorption in the fall of 2014. He missed over half of the school year and slept 18-20 hours for several months. We now have the SIBO under control, but he still suffers from crushing fatigue, a very low body temperature (usually around 96-97 degrees), a weak voice, depression, constipation, weakness, and weight gain- just about everything that would point to hypothyroidism. (I am hypothyroid myself.)

We saw an endocrinologist at the hospital twice and she thought that his symptoms were not due to a hypothyroid. His GI doctor ran a reverse t3 test and it came back at 23. So far, we have just had him on thyroid supplements (that include zinc and selenium), which seemed to help him wake his body up a bit early on, but now over this summer he has been back to very low energy and the above symptoms.

Do you have any advice on what to do next or what to try? I am broken-hearted that my son is so lethargic and is not participating in life normally.
Thanks for your help!

    Dr. Westin Childs - August 12, 2016

    Hey Amy,

    I can’t give you any advice because he isn’t my patient but it sounds as if he might benefit from thyroid hormone with all of the symptoms you suggest he has.

Catherine - August 22, 2016

I’ve been to multiple pcp’s and endos and basically it of options with my insurance. They are all only concerned with TSH. Finally got one of the pcp’s to order reverseT3. He admitted he’d never heard of that. When the results came it was 60, which according to the lab was high. He hadn’t ordered freeT3 so not very helpful. I had already researched and concluded that I need T3, pretty much begged him to prescribe and he wouldn’t (because TSH was normal range). My main question to you is this, how can I get T3 without a prescription? Or is there some alternative supplement that would work? Any suggestions would be helpful. Changing doctors is not an option, been there done that.

    Dr. Westin Childs - August 22, 2016

    Hey Catherine,

    T3 is the active thyroid hormone and therefore the most potent of all thyroid medication which is why the only way you can get it is through a prescription. I don’t recommend attempting to self dose with T3 because it can very quickly lead to thyrotoxicosis if you aren’t experienced.

    I would also point out that T3 is likely only a small part of your problem here because low T3 and high reverse T3 potentiate multiple hormone imbalances in the body and fixing one generally doesn’t lead to significant improvement.

    At this point your best option is likely seeking further care outside of the insurance model.

Daniela - August 24, 2016

Hi am 42 year old female. I have been on ERFA f(125) or over two years and it hasn’t done much for me, other than I can get by with 7 hours sleep rather than 9. In fact when I started the ERFA I was not hypothyroid. My TSH level was something like 2.65. I had my T3 and T4 tested but can’t remember the levels, just that the doc was happy with the levels after the treatment.

Before taking ERFA I took a product called Thyroid Energy by NOW Foods and felt ok, just not good enough. I stopped that when I started the ERFA.

I became sick this May and had my thyroid tested then. The doctor said my T4 was dropping and put me on Thyroxine 30 mpg in the evenings which made me feel better initially and then much worse after a few weeks. I was tested again and told I was not responding to the Thyroxine. I had my Reverse T3 tested and was told that it was high, to stop the Thyroxine and to continue with the ERFA. I still feel awful.

I am off to see an endocrinologist on Friday, but I have seen an article saying I will need to come off the ERFA and take another medication for life. I am so scared about this! I just want to get off all meds. It’s costing me a fortune and not doing anything for me.

Has putting me on the ERFA when I didn’t really need this done this to me or would the reverse T3 problem have always been there?

Any advice much appreciated!

Oh and also I have a heterozygous MTHFR mutation and am taking 1000mcg of folate and 1000mcg of B12. I think this may be making the problem worse. My son has had the full gene testing and found other mutations that mean he cannot tolerate the methyl donors and I am concerned that I may also be carrying those mutations.

    Dr. Westin Childs - August 24, 2016

    Hey Daniela,

    It’s impossible to say unless you have reverse T3 checked before and after. Many thing scan cause an elevation in reverse T3 levels including T4 only medication but it’s certainly not limited to just that.

      Daniela - August 24, 2016

      Hi Dr Childs,

      Wow thanks for getting back to me so quickly!

      FYI doc stopped the Thyroxine when my T3 went to 3.5 pg/mL and Reverse T3 was at 30 ng/dL (T4 was 1.6 ng/dL and TSH was 0.01 uiU/mL). In May (before thyroxine) it was Free T3 1.0, Free T4 0.69 and TSH 1.04 (that’s when I had the M Pneumonia – I was told the changes in results from six months prior were a big deal but not linked to the infection – six months prior it was Free T3 2.9, Free T4 0.94 and TSH 0.06.

      Have you ever had patients come off the ERFA completely and be fine? I would like to stop it as the only difference has been 7 hours sleep vs 9 hours before and a slight change in energy. The ERFA costs a fortune here in Hong Kong and I really can’t afford it anymore!

      Thank you!

Ane - August 31, 2016

Hello. My Dr did order a rt3 and regular thyroid tests. The rt3 was very high. He wanted to put me on SNYTHROID. Reading about rt3 doctors seem like they don’t agree at all on this and seems I also have a heart issue. I declined the medicine as my Mother passed away having a massive heart attack was on Synthroid. So reading about the synthroid medicine and effects it can have on ones heart I felt I don’t want to touch that. So I have a few issues. I have hormones all over the board from female related surgery. Change of life from that. Weight gain and I suffer from tachycardia high blood pressure. I ask. What’s safe???? Can this ever get outbid my system? I did have a Dr say recent illness and stress can all raise this. Can it all of a sudden go away? The fatigue not as bad as it was but weight gain and not eating real different stinks. I don’t want to add problems to my problems. I don’t like to take medicines unless I have to. I am super sensitive to many. My Doctor knowing my situation knowing about my family’s heart iissues understood my decline for treatment with valid reasons. Left it up to me on research and what to do next. Reading all the controversy about rt3 is hard to choose the right thing to do. What would you suggest?

    Dr. Westin Childs - August 31, 2016

    Hey Ane,

    I feel that the use of T3 is quite safe if used correctly but that requires knowledge about how to use it and not everyone has that. I can’t provide specific medical advice to your situation so instead I would recommend you seek someone out who is knowledgable and who can help you further.

Jeff - September 23, 2016

Very informative article with great insight!

My Dr. says I am borderline for T3 meds and it is up to me.

I feel tired in the afternoon, have some anxiety, and have low body temperature at all times (96.6-97.4). I am currently taking .088 mcg of Synthroid.

Free T3: 2.6
Reverse T3: 14.5
T3/Reverse T3 ratio: .179
Free T4: 1.39
TSH: 3.05

Any thoughts on whether I should start T3? Thanks so much! Really appreciate all the articles and insight.

Anne - September 24, 2016

My 19 year old daughter has benefited significantly from Liothyronine. Her reverse T3 came out very high when she went in to be tested for fatigue, depression and extremely low bloodpressure 75/44 and positional hypotension which caused her to blackout even when sitting. The liothyronine 5mg twice a day has brought her temperature up to normal but she needed to take it with real licorice root extract (not DGL) (3x day at 400mg to bring up her blood pressure and reduce the blackouts. With both of these taken together, her low thyroid symptoms have resolved. What was the source of her reverse T3? Undiagnosed Celiacs. She is now on a gluten free, dairy free diet and will soon be starting the GAPS diet.

    Dr. Westin Childs - September 24, 2016

    Hey Anne,

    Great story and thanks for sharing! I would also point out that many patients nowadays have what’s known as non celiac gluten sensitivity which can also cause issues but antibody tests for celiacs disease may come up negative.

Elizabeth - September 27, 2016

Is it possible for your RT3 to be too low?

Rebecca - September 27, 2016

Hi, just thought I’d share my quick little story and ask for a bit of advice. I have been “moving through thick mud” for the last 6 months, finding it hard to move my legs, get out of bed, always feeling “like I’ve been hit by a mini moke” and still exercising like crazy, and eating like a sparrow because I was putting on weight…(10 kilo in 6 months!!) I went to my regular GP where he gave me a standard Thyroid test which all came back at normal levels, and he sent me on my way and told me to exercise MORE and cut down on carbs, after all Beck….your symptoms are telling you that you are 45 years old…. But I barely eat carbs!! I told him. “Come back in a month” he says “and I’ll weigh you again”. Buggar that! I thought….So I asked another GP from a different clinic what could be happening to me. She did a full blood test…requesting everything from Iron to folic acid. She found that my thyroid function test, like the other doctor, came back in normal ranges, however my serum Reverse T3 test came back at 628 pmol/L (normal range is (170-450). Now I know you said don’t get too hung up on numbers, but my second opinion did say that the result is very high…and has put me on a concoction of vitamins and iron tablets to see if my reverse T3 improves before putting me on anything else. She has put me on Vita D (results came back low), Folic Acid (as it also came back very low), Iron (normal range but a bit low), Selenium, and an Adrenal support. Is she treating me correctly for Reverse T3 issues or should I go and get a third opinion? I am running out of doctors in the area lol. I don’t want to appear like a hypochondriac but I want my old body back and I want to jump out of bed again without the stiffness and aches and pains, I also want my voice back!!! I sound like stevie nicks on a big night of smokes!!
Any advice would be greatly appreciated. By the way…I am in Australia, Melbourne.

    Dr. Westin Childs - April 14, 2017

    Hi Rebecca,

    Most patients with very high reverse T3 levels need more aggressive treatment with nutrients designed to improve conversion.

Karen - September 28, 2016

Great Article! I am a Graves patient treated with Radioactive Iodine 24 years ago. Have only recently found a doc that will treat me with NDT and look at other thyroid levels. I have been treated with Levothyroxine for all those years and just last month started on NDT. I had Rt3 at 20 before(on levo) and now it is at 24, with a ratio of 5.125 I am feeling awful. My doc wants to add Cytomel only. Don’t I need to decrease my dose of WP Thyroid when I add the Cytomel to get my levels to drop? Although he is willing, I don’t think he has the experience. Do you normally decrease the NDT when treating with Cytomel to lower Rt3? Not asking for medical advice just wondering what you usually do.

Thank you!!! Karen

Lisa Hicks - October 4, 2016

I have had Hasimotos for 9 years and have been treated successfully by an endocrinologist with T4 thyroxine treatment. Recently I moved and found a intergrative GP to help manage my thyroid condition. He did a reverse T3 test as he suspected my t4 dose was high and maybe not entirely effective, the result was the highest he has seen, 1000! He suggested t3 and t4 treatment. I am feeling nervous about changing my treatment when I have been feeling fine with no major symptoms. So I found a new endo and they said to not pay attention to this test and go back to t4 just slightly reduced as I was hyper-thyroid. I’m so confused with the differing opinions and don’t know what to do! I don’t want tondosregRd a test that was the out of range but I am feeling normal….your insights would be most appreciated.

andrea - October 10, 2016

I found this article while searching for Low RT3 numbers – just rec’d labs back and mine is 5.5 on a scale of 9-27.
My Free t3 was 2.6 on scale of 2.3-4.2
what does a low reverse t-3 mean? thanks!

Lisa - October 11, 2016

Hi Dr. Childs,
I want to express my gratitude for the impressive information you provide. It’s broken down into the basics for us “lay people” to really grasp. I didn’t think I could find a more knowledgeable thyroid specialist than my current doc, but am considering going to you on my next labs for a new perspective.
A couple others have also asked this question: My reverse T3 is less than <5. Is that good, or can reverse T3 ever be too low?
Thank you in advance.

    Dr. Westin Childs - April 14, 2017

    Hi Lisa,

    I don’t get worried when reverse T3 is low, though I don’t typically keep patients on regimens that maintain low reverse T3 levels long term.

michelle frankie - October 14, 2016

Im just understanding this finally…thankyou for such great explanation. So I just was diagnosed w Lymes and I did lab work and had low t3 and Im thinking thats do to Lymes. Im on antimicrobials killing off the bugs and feeling great but today i saw a thing Klinghart(kinda a lyme expert) said to do Wilson protocol with t3 . Just a little nervous as to what Im doing …I bought IAS t3 pro and have been taking 5mcg every hour going to try to get to 75mcg or 98.6 whatever feels best..What do you think?

Maureen - November 3, 2016

Thank you for the information. I exercise daily and I am VERY careful with my diet – no processed foods, no sugar, no alcohol, etc. About a year ago I gained 12 pounds. I have talked with several doctors to no avail and started research on my own.

T3 = 2.67
RT3 = 20.1
Thyroidglobulin antibody = 445
TPO = 319

I’m taking 125 mcg Levo and a few months ago my dr started me at 5mcg every other day of T3 (wondering if this is enough).

Based on my bloodwork, what suggestions would you offer? Would you consider the RT3 to high and T3 low? Should I be asking my dr. to take another look?

Appreciate your help!

    Dr. Westin Childs - November 3, 2016

    Hey Maureen,

    I can’t offer advice on your labs because I’m not your doctor but I would recommend you seek out someone who will actually look at them correctly.

Meng - November 9, 2016

Hi Dr. Childs,
Thank you for your article. I learned a lot of about RT3. The following are my test result from the past.

8-Jun-2007 24-Oct-2013
TSH 5.99 ulU/mL (0.40 – 4.70) 5.28 ulU/mL (0.40 – 4.70)
Free T4 15.6 pmol/L (9.0 – 25.0) 15.6 pmol/L (9.0 – 25.0)

4-Nov-2014 15-Jun-2015
TSH 5.22 mlU/L (0.270 – 4.200) 6.100 ulU/ml (0.270 – 4.200)
Free T4 14.4 pmol/L (12.0 – 22.0) 1.20 ng/dl (0.93 – 1.71)

In 2013/2014, I get tired very easily and have very little energy left to do work. Even though my TSH was high, my doctor said I am normal based on my Free T4. Only in Jun-2015, when my TSH was much elevated that my doctor decided to put me on Thyroxine (Euthyrox) initially for 50ug and 1 month later 75ug. And I didn’t feel tired or sleepy after that.

20-Jul-2015 12-Oct-2015
TSH 2.620 ulU/ml (0.270 – 4.200) 0.961 ulU/ml (0.270 – 4.200)
Free T4 1.42 ng/dl (0.93 – 1.71) 1.63 ng/dl (0.93 – 1.71)
Total T3 1.84 nmol/l (0.90 – 2.60)
TRGAb <10 U/ML (0.0 – 60.0)
TPOAb <10 U/ML (0.0 – 60.0)

19-Feb-2016 27-Jun-2016
TSH 2.770 ulU/ml (0.270 – 4.200) 4.280 ulU/ml (0.270 – 4.200)
Free T4 1.48 ng/dl (0.93 – 1.71) 1.28 ng/dl (0.93 – 1.71)

My TSH continue to drop and Free T4 increase. In May-2016, I decided to cut to Euthyrox 50ug.

Date: 1-Nov-2016
TSH 4.63 ulU/ml (0.270- 4.200)
Free T4 1.37 ng/dl (0.93 – 1.71)
Free T3 4.5 pmol/l (2.8 – 7.1)
Reverse T3 26 ng/dL (10 – 24)
TPOAb 29.3 U/ML (0.0 – 60.0)
Sex Hormone Binding Globulin 17 nmol/L (11 – 52)

I have been slowly gaining weight, despite my diet control & exercise. Almost everyday, I have moments of floating sensation and bouts of giddiness. I constantly have headache. My skin will itch every 4 days, and it will go off after taking Cetirizine HCl 10mg. So, on 1-Nov-16, I went for a full thyroid test above. The Reverse T3 is high. TPOAb has gone up.

Is my Reverse T3 and TPOAb a concern? Is my overall thyroid function a concern? Do I need to reduce the Reverse T3, and what's the best method given my situation.

Thank you.

    Dr. Westin Childs - November 9, 2016

    Hey Meng,

    You will have to take these questions to a physician, I can’t comment on your case because you aren’t my patient. The best thing you can do is find someone willing to help you further.

Josie - November 12, 2016

Hi Dr Childs,
Curious if you could speak to the difference of using Sustained Release verses Regular T3 medication for clearing out RT3? I’m assuming the daily dosage is the same. Do you have any preference and if so, can you explain why?

Dianna adams - November 19, 2016

It is making me gain weight.

Dianna adams - November 19, 2016

I take cytomel and t3 and I keep gaining weight even though I am trying to diet. I was fine before my tyroid problem I could eat and not gain any weight. Do you have any suggestions. Thanks

Marilyn - November 23, 2016

Hi Dr. Childs, I have been on NDT and Liothyronine for several years (Hypothyroid) and can’t seem to get a good balance. Eventually because my Free T4 levels are low, my doctor raises the NDT and I end up with too much RT3. One of my symptoms is a prickly kind of feeling in my arms. I haven’t found that symptom anywhere. Have you seen this before? I had the same thing happen when one doctor tried to switch me back to synthroid. It is frustrating because I already feel terrible and then I have to deal with this too. I do appreciate your article very much and hopefully I can show this to my new doctor. Thanks

Kat - November 26, 2016

So, I finally have an appt this week with a holistic functional MD, I finally have an opportunity for someone to listen and hopefully connect the dots. Dr. Child’s, I am nervous that I may talk to much but then worried that I may not tell her all my struggles, in your opinion what and how much should I reveal without sounding like a novel?
Also what would you say would be some of the most important questions for me to ask during this appointment- the first consulatation is an hour long. Any help would be appreciated, thanks in advance.

    Dr. Westin Childs - November 26, 2016

    Hey Kat,

    It’s more in the hands of your provider than it is yours. What I mean is that your provider should direct the questions so he/she can find out what is actually important. Unfortunately the skill level of holistic providers is all over the map, so they will either get it or not.

Brenda - November 28, 2016

Hi Dr. Childs,
Thank you so much for all the information. Great website. Thyroid test results: PA said the Reverse T3 is high and ratio of FT3 and Reverse T3 is off, but said nothing else. Results: Reverse T3=19, FT3=3.5
FT4=1.31, TSH=1.450, TPO=15 Is the Reverse T3 then collecting and not being used appropriately? Pre-diabetic.. A1C, 5.8… Have low body temperature and can’t lose weight. Also have had 2 ANA tests come back high. Any suggestions how to proceed to get the numbers in a better range?
Thank you so much!

Renee - November 29, 2016

Hello Dr. Childs,
My daughter was diagnosed almost 3 years ago at the age of 7 with Hypothyroid. Like most, she started on Synthroid, and has had good lab results since then. She is always complaining about being tired, having occasional headaches, and frequent mood swings. Recently I have been concerned about her weight gain. That’s when I started doing my own research and see that these can all be side effects from the Synthroid. Her last lab work results were all good in June ’16 – TSH=1.160 and T4 = 1.71. I just contacted her Pediatric Endocrinologist and asked if we could have T3 added to her lab work. She just dismissed it and said TSH and T4 are sufficient for her. I was taken aback by that… I thought she would be happy to add it to humor me. My daughter is due to go next week for lab work, for an appointment the first week in January. The Dr. just said she would like to see her sooner due to our concerns. I have brought up the fatigue for the last 3 years, and mentioned the weight gain at the last appointment, and she wasn’t concerned at all because her lab work was good. I don’t want to “waste” another appt with nothing to back up my suspicions. I am in the Tampa Bay area, where there aren’t a lot of other Pediatric Endocrinologists available. This Dr. was my 2nd opinion 4 years ago, for follow up on my daughters short stature. Do you have any suggestions? Should I maybe ask her primary Pediatrician if they will do the lab work? Do you think it’s necessary for a 9 (almost 10) year old? Thanks so much!

    Dr. Westin Childs - November 29, 2016

    Hey Renee,

    Most providers aren’t comfortable with the addition of T3 and most don’t understand the nuances to the advanced tests you are referring to. Your best bet is to find someone willing to work with you who understands these nuances.

Tina - November 30, 2016

Hey Dr. Childs,
I have been very passionate about functional medicine for the last 3 years and have altered my life to this lifestyle and never will change. However, despite eating gluten/dairy/soy/nightshade/egg free, taking targeted supplements, reading countless blogs and following medical functional docs (Hyman, Mercola, Axe, etc) seeing a “hormone specialist ND” , FDNs, DOs, etc, taking NDT, doing body weight training etc….I am only getting worse.
I recently was pushed too high on my Wp Thyroid with cytomel, and became hyperthyroid. Doc took me off and said my RT3 was too high and removed everything for 14 days to clear it out to start on a Wilsons type approach with ST3 medication. My temps are all over the place, sometimes 96.9, sometimes 99.0, etc. I haven’t been able to lose a SINGLE lb in 2 FULL years despite all my efforts. I have bad edema, acne, bloating, low progesterone etc. I have supplemented with progesterone bioidentically before and blew up in weight so immediately stopped. Everything has been all over the map and I just need help. I did a GI screen and showed no overgrowth as well as doing a lactose breath test and showed no SIBO. I also did a 4 point saliva cortisol and it showered normal/normal/moderately high/normal. So just a little elevation in the evening. I am so depressed on where I am at and don’t recognize myself in the mirror. I believe in eastern medicine and all of this lifestyle but it has yet to work at all for me.
I am hopeful that this T3 titration will work somewhat, however it’s day 3 and I just feel terrible and even more swollen/bloated and like I’m gaining more weight.
I am 145 at 5’4″ and just a swollen mess.
I have been told my testosterone isn’t high enough for PCOS , and I eat so clean that insulin doesn’t seem to be an issue (a1c was a 5.5). I just don’t know where to turn.
Iodine made me break out rapidly, progesterone made me gain so much weight, naturthroid and WP did nothing for the 2 years I was on NDT. I AM LOST and need help. Any advice for someone who has tried everything??

    Sharon Margiotta - April 6, 2017

    HI Tina… we must be twins. I am 53 years old, 5’4″, went from being 125 10 years ago to 143lbs and increasing. I work out doing interval weight training and cardio 3-5 week for an hour, eat clean, have seen holistic/alternative med docs for 15 years. My first one diagnosed me correctly with hypothyroid despite my conventional doc saying my symptoms were “normal” and as were my test results.

    I was on Armour Thyroid for past 8 years with improvement in fatique but not weight gain. Slowly added a few pounds per year. Past two years I gained 10-15 lbs without change in clean diet or exercise. I too need help and a functioning doc who specializes in thyroid. I heard Armour reformulated in 2009 and 2015. Curious if that has anything to do with my rapid increase in weight.

    After spending days reading and listening to every word in this blog, things are starting to come together.
    WIll do testing for Leptin Resistin, retest my thyroid T3 and T4 all levels as well as other areas suggested. Thinking at first glance, the more Armour thyroid my doc prescribes, the worse I get leading me to believe I am not converting to T3 but rather reverse T3.

    I too am lost and need help. Need to find a doc to help me.

Melanie - December 1, 2016

Wonderful article! Lots of good information! I found your article when trying to find out if turmeric can help lower rt3. I recently found I have excess rt3. I’ve been following the STTM (stop the thyroid madness) and it has been extremely helpful in my hypo journey. From the information in the books, on the site, and their groups, I requested to lower my NDT and add in T3 to help get my rt3 go down. My labs showed inflammation from my 4 iron labs. But I also suspect adrenals issues, also very common among us hypo patients. According to STTM, adrenal issues like low cortisol or mix of high and low cortisol can cause inflammation but also includes things like gut, autoimmune, hypothyroidism itself, heavy metal toxicity, lyme, just to name a few. Like you, they suggest using selenium (if labs show low), milk thistle but advise that milk thistle can lower iron in some, treating inflammation, and adding using T3. They also suggest treating adrenals and low iron issues. I wish more docs had your knowledge in treating hypothyroidism. But thankful for information in your article and from STTM sites, books, and FB groups.

Janelle - December 5, 2016

Thank you so much for taking the time to explain everything in so much detail! I’ve read through many of your articles, and am now at the edge of deciding whether I should take WP thyroid or just Liothyronine.
My TSH level has been on the higher side ranging from 3.5-4.3 on different days.
T4 Thyroxine is normal at around 7.9 ug/dl and Free Thyroxine at 1.2 ng/dl.
Free T3= 3 and Reverse T3= 16.7 so the ratio is 0.179 (less than your cut off at >2.0).
Since my T4 is normal, I’m wondering if taking NDT might contribute more to the problem to because my body may convert the extra T4 from NDT to reverse T3 instead of free T3.

Also, I remember you mentioned the SHBG level is an indicator of hypothyroidism at a cellular level. Is 61.0 nmlk/L normal.?

Lastly, is there any link between hypothyroidism and PCOS? Will thyroid medication affect testosterone/estrogen levels? Can NDT help lower testosterone? I’m looking for a good solution to hit 2 birds with one stone targeting hypothyroidism & PCOS high testosterone levels. Any good advice? You are the best! I wish every doctor was like you!

Cecilia Gollan - December 11, 2016

I have been on synthorid and cytomel for a while. In January of 2016 I started to gain weight and feel awful. I tried many different things increased cytomel, added supplements. In July, I stopped everything but synthroid. Then in September changed to natureroid. I have changed my diet and have had no success in how I feel and my symptoms are getting worse, especially with the weight gain. Any suggestions?

    Dr. Westin Childs - December 11, 2016

    Hey Cicilia,

    The best thing you can do is find someone willing to help you figure things out. I find that most patients who try to deal with their symptoms on their own end up frustrated and either over/under treated. These type of symptoms are quite common and fixing them usually isn’t too difficult if you understand what you are doing.

Linda Pontnack - December 11, 2016

Dear Dr. Childs
I am a 56 year old women. I have had hypothyroid about 7 years. I have been taking NP Thyroid 90 every morning. My TSH Sens is 0.02, my Free T4 is .69 and my Free T3 is 3.0. My leptin is 9. My thyroid Ab group is thyroperoxidase Ab, S- 1.4 and thyroglobulan antibody s – <1.8.I keep gaining weight and feel tired all the time. Any suggestions on what I should do? Thank you Linda

    Dr. Westin Childs - December 11, 2016

    Hey Linda,

    I would start with the suggestions in this article but realize they are only a starting point. Treating metabolic damage like you have is difficult and requires help from someone who understands what they are doing.

Rachel Van - December 18, 2016

Scratching my head over my higher reverse t3 numbers! My t3 is 2.2 pg/mL and my reverse t3 is 23 ng/dL. Well that puts my ratio at 9.6, ack! I also have awesome insulin and leptin levels, and follow the AIP diet. My fasting insulin was 1.7 and my leptin was 5.9. I started taking zinc and selenium and hoping that helps my body convert t4 to the right pathway! And will be pouring over your website to try and gain more understanding, thanks for all you do!

Bonnie - December 29, 2016

I am currently on 150mcg cytomel a day split into 3 doses around 5hrs apart. I have had no reliefe from my hypothyroid symptoms. Main thing is about 15-18lbs of water retention and weight gain,dry skin, acne and no libido ect. I am more temp tolerant, and my hair breaks less. That is it. I have been on this dose for about 1 week. I also want to know if you accept distance patients?

    Dr. Westin Childs - December 29, 2016

    Hey Bonnie,

    That’s a good dose of cytomel so I would be surprised if you didn’t have any improvement with it. Also, water retention could be from many causes including other hormone imbalances. And I’m not currently accepting patients right now.

Mark - December 29, 2016

Hi Dr. Westin Childs,

Where are you practicing right now?


Mike - January 1, 2017

I’ve been advised that a low T3:Reverse-T3 ratio contributes to coronary artery calcification, which I have been trying to control for the past five years. I’m advise to get T3 between 4-6 and T3:RT3 above 20. As briefly as possible, my T3 was in this range a few years ago before I learned its importance. I was taking 25 mg of iodine and my doctor thought that inadvisable, so I cut back and forgot about it. When I found out about the heart disease connection, I started trying to increase my now low T3 (2.4) by taking iodine. This time there was no improvement in about six months. So I found a doctor who would prescribe thyroid medication. I started with 15 mcg Liothyroinine and still saw no improvement. In fact my reverse T3 increased dramatically from 15.4 ng/dl to 26.4 ng/dL. My T3:RT3 went from 15 to 9. Three weeks ago the doctor increased my dosage to 25 mcg per day. I will re-test in a couple of weeks. My TSH has been between 5-7 with the iodine supplementation. Any thoughts about what is going on? Why did the iodine work so well two years ago but have no effect in the past six months? What might be causing the dramatic increase in reverse T3?

    Dr. Westin Childs - January 1, 2017

    Hey Mike,

    While yes that ratio does contribute to coronary artery disease and calcifications there are other conditions which seem to contribute more (such as insulin resistance and abnormal blood glucose homeostasis). I would also caution against focusing solely on lab values as a marker of success without changes in imaging (are the calcifications worsening?) or without changes in your clinical symptoms.

    Also, taking T3 thyroid hormone by itself should lead to a drop in T4 due to a lack of substrate, so if your reverse T3 levels are increasing then your T3 dose is not likely high enough to cause pituitary suppression which means your body is still producing T4. You can simply drop the T4 by increasing the dose of T3, but more important than that would be to focus on the cause of reverse T3 in the first place. You will want to look at inflammatory markers, insulin, leptin and other hormones to find out what is causing the high reverse T3 levels.

      Mike - January 1, 2017

      Thanks, Dr. Childs, and happy new year.
      As I mentioned, I’ve been working on the coronary calcium for five years. The past year I made some progress, an increase of only 26 points, against what had been yearly increase of 100 points or more. I think the major change was getting a root canal tooth removed after reading Dr. Thomas Levy on that issue. My most recent score was 695, still high risk.

      I do a lot of reading, and I’m taking a raft of supplements, including vitamins C, K2, E, D3, CoQ10, zinc, selenium, niacin to reduce Lp(a). You get the idea. My CRP has always been fine. PL-PLA2 sometimes a bit high.

      I have not tested for thyroid antibodies, but my wife and I eat low carb, non-gluten diet. I exercise vigorously and have no serious hypothyroid symptoms, only cold hands and low pulse rate, which could be because I’ve exercised strenuously for fifty years. I don’t have heart disease symptoms either, but I gather when the symptoms appear, things are well advanced.

      Mike - January 1, 2017

      One addendum: I have had one symptom of heart disease: atrial fibrillation, which was an issue before I started taking about a gram of magnesium per day.

Len - January 1, 2017

I was hoping maybe you could steer me in the right direction! I’m 32 and have been to multiple doctors (some Holistic) and no one has been able to help me! My guess is that I’m having both adrenal and thyroid issues. I have had most of these symptoms for over 5 years but I got a lot worse after I went through a very stressful event a few months ago (Didn’t sleep or eat much for over a mth)
Test results show:
No hashimotos
ANA direct = negative
Thyroid peroxidase TPO = 10 (0-34)
THyroglobulin antibody <1.0
Aldosterone 19.3 (0-30)
ACTH 49.6 (7.2-63)

TSH 2.60
T3 2.9 (2.3-4.2)
T4 1.0 (0.8-1.8)
Reverse T3 = 15
All lipids are within good range
Glucose serum 94 (65-99)
Sex Hormone Binding Glob is always high and has been for years 215 (24.6-122)
Free testosterone 0.5 0.0-4.2
Prolactin stays on the high side 23.4 4.8-23.3
Estradiol 193.39
Ferritin and iron is low
Iodine 40.9 (40-92)
Dhea has been low the past couple of years.
DHEA sulfate 47.4 (84.8-378)
Dehydoepiandrosterone = 475

Saliva test for adrenals shows normal levels throughout the day but high during the evening hours around 5 pm

Symptoms: Hair loss (has got a lot worse over the past few months), fatigue, Brain fog, Joint pain that comes and goes in hands, I wake up with a locked jaw that gets better as I wake up, Melasma over entire face, Gains wt easily but has kept my weight down due to diet and exercise. My body can’t handle any kind of stress or even excitement ( My body over reacts to everything that seems to get my adrenaline pumping and it takes a while for my body to calm down such as a rapid heart beat ). I have been dairy and gluten free for years. I try not to eat any soy and try to only eat sweets once or twice a week at the most.

I am extremely sensitive to most vitamins, caffeine, and all medications. I am also sensitive to chemicals (Clorox and other cleaning agents cause me to have headaches and I get very dizzy).

I currently take vitamin C, B complex, Vitamin D, and probiotics. I try to take magnesium but it tends to make me feel jittery. I drink 1/2 teaspoon of sea salt in water every morning for adrenal support.

I tried armour thyroid for only 3 days but it made me extremely fatigued to where I didn’t’ want to get out of bed . After trying armour my TSH shot up to 7 (was 2) but I can’t recall what my Reverse T3 was at the time. I am scared of trying any other thyroid meds due to that it took my body over a month to recover from the armour. My recent doctor prescribed me Slow release T3 compounded. Do you believe this would help or be a good idea to try? I also recently started taking kelp to increase my iodine levels. What are your thoughts on ways to increase iodine or if this sounds like a good idea considering my labs? Any help would be greatly appreciated! I’m scared to try any medications in fear of losing more hair (very thin now) and worsening my symptoms so I would love to hear what you think!

    Dr. Westin Childs - January 2, 2017

    Hey Len,

    Not everyone does well on NDT, and most people that transfer over do so at low dosages or never get to the therapeutic dosage range for their body. This leads to people wrongly believing they don’t do well on certain medications.

    You will need a full evaluation including other hormones to determine what your body would do best on. The best thing you can do is try to find someone local to help you out.

Karla - January 9, 2017

First, thank you for your website. It has been so valuable since having a total thyroidectomy in April. I have had trouble getting regulated on NDT. I have been systematically getting all the various labs done that you have recommended. I am addressing all of my “low” values (iron, ferritin, testosterone, adrenals), but my question revolves around Leptin. Within the last six weeks my FBS was flagged as high, as well as my A1C as compared to six weeks earlier. My fasting insulin has doubled and my Leptin is 30. I purchased a meter and having been checking myself several times a day. I feel like I need to address the leptin/insulin issue. What would you recommend, or how can I communicate this to my doctor. Though I follow a Paleo/AIP protocol and exercise with weight training 3x week, weight will not budge. I was also told in April that I have Hashimotos.

    Dr. Westin Childs - January 9, 2017

    Hey Karla,

    The sudden rise in your leptin/insulin is likely secondary to a reduction in your thyroid hormone post thyroidectomy. This happens to patients with just plain hypothyroidism but usually takes years to develop. The good news is that you know what is wrong, the difficult part will be obtaining treatment. General physicians aren’t taught to test or look for leptin resistance and there are few treatments available. On the other hand, general physicians don’t really know how to address fasting insulin levels that are elevated unless they are accompanied with an elevated Hgb A1c at which point they will recommend metformin or other diabetic medications. You are probably sitting in a position where you have high fasting insulin/leptin levels but relatively normaly hgb A1c levels which means most providers won’t be likely to treat you. The best thing you can do is find someone who evaluates hormones in a similar manner you see on this site.

Jessica - January 10, 2017

I am about three months postpartum and was being treated for subclinical hypothyroidism during pregnancy with T4 only medication. My levels were great…FT4 about mid-range and FT3 upper range during pregnancy. However, during the postpartum period, my numbers have gone crazy. My FT4 is slightly below mid-range, my FT3 is waaaay ABOVE range, and my RT3 is at 16. I have been told I could be pooling. But my numbers don’t fit any scenarios you discussed above. We ran my labs multiple times to rule out lab error. I decreased my T4 meds and rechecked after a month. My FT4 had dropped, probably too low, my FT3 was still high, and RT3 still at 16. Ferritin levels and iron levels were good. Vitamin D was at 60. My doctor has no clue what to do and wants me to find another doctor that can help me figure this out.

I was feeling perfectly good at first, but now I’m starting to have more hypo symptoms once again…mostly just foggy, depression, tiredness, and not losing weight. I do have a three month old baby that still wakes in the night. What do you think could be going on???

    Dr. Westin Childs - January 10, 2017

    Hey Jessica,

    Unfortunately, I can’t give you specific medical advice because you aren’t my patient but a couple things to consider:

    – Your lab tests don’t really matter if you are feeling well, meaning there is no need to change your dose based on your numbers below
    – If you dropped your dose then became symptomatic, then I think you have your answer
    – Postpartum hormones are always in flux, which is why I generally don’t recommend checking thyroid hormone (or other hormones) immediately after pregnancy

    Hopefully this helps give you some guidance.

Cathy Sandfort - January 10, 2017

Hey there 🙂 Found you by accident surfing on the web about reverse T3 etc. I have had Hashimotos since I was 23. I have always been on T4 meds like Levoxyl and Levothyroxine and did okay with them. I started on Armour and then Nature Thyroid because of my TSH level. Found out through a board on Facebook that I should be checking TSH, T3Free, Reverse T3, Free T4. Thankfully my doctor is amazing and willing to help and listen. At the moment I am on 2.25 grains of Nature Thyroid and I have NEVER FELT MORE HORRIBLE. The worst muscle aches and pains and weakness that I have ever had even being on the T4 meds only. I am so discouraged because there is so much info and so many opinions.
My T3 Free numbers were a 2.7pg/ml (Out of the range of 2.0 – 4.4 pg/mL)
TSH 1.850 uIU/ml (Out of the range of 0.450 – 4.500 uIU/mL)
REVERSE T3 was 23.1 ng/dL (Out of the range of 9.2 – 24.1 ng/dL)
T4 Free was 0.86 ng/dL (Out of a range of 0.82 – 1.77 ng/dL)
I have had gallbladder surgery last year and it seems like a reactivated Epstein Barr numbers in my blood work.
My doctor wants to put me on Cytomel? Will this help me? I am so scared to add or take away anything to my body since I have had so much the past two years. My doctor is so willing to help but don’t know how well versed she is in thyroid issues…..HELP!!!!

    Dr. Westin Childs - January 10, 2017

    Hey Cathy,

    I can’t provide personalized medical advice via this forum since you are not a patient of mine. Your situation is not as complex as you might think, but you do need someone who understands thyroid function to help you further.

Karen M Pesavento - January 24, 2017

Dear Dr. Childs,

I see that you do prescribe bio-identical hormones. Do you find that compounded bio-identical progesterone has an effect on compounded Tri-iodo-L-Thyronine. I know that progesterone supports the thyroid, so when supplementing both, have you found that one affects the other in any significant way.


    Dr. Westin Childs - January 24, 2017

    Hey Karen,

    I haven’t found progesterone to clinically impact thyroid levels, but I have found that thyroid hormone supplementation can impact progesterone/estrogen levels significantly.

Martha - January 25, 2017

Hi Doctor, Thank you very much for all the information you provide.

Do you know any fellow practitioner in Australia who follows a similar protocol as yours? My Free T3 is 2.7 (3.1 – 6.0) and Reverse T3 is 0.624 (1.200 – 2.200). I feel crushed. Also, I am Vitamin D and Iodine deficiency 🙁 …I am also a good doctor deficiency as well 🙁

    Dr. Westin Childs - January 25, 2017

    Hey Martha,

    Unfortunately I don’t know any other providers who practice like me, this is something that was self taught – so the only way that doctors may practice like this is if they spent the time researching on their own.

      Martha - January 25, 2017

      Thanks, Dr. Childs, for your reply.

      If there is any chance that you can treat me, despite of the (very) long distance, please I kindly ask you to let me know. I feel horrible and I think that what makes me feel worse is being unsupported by a good physician.
      Thank you very much

      Teri Burton - February 15, 2017

      Hi Dr. Childs,

      If you don’t know of any other providers who have a practice such as yours, and you are not accepting new patients, have you considered teaching and training seminars to educate doctors so we all may benefit from your knowledge? Thank you.

John - January 30, 2017


I can’t find the erase button on this board. Please erase my previous post.
My wife wants me to return to a previous doctor. And for legal reasons,
she wants this post removed.

thank you



IE : ” hi Doctor Childs,

This is all quite interesting. I say this after being treated on T3 – for 30 years —…………………. etc “”

John - January 31, 2017

Please remove.

chris - February 15, 2017

Hi Doc
I am a doctor myself and I must say your site is great. I have been having some symptoms my self for a few yrs. Persistently low DEHA-S levels, hair loss on my legs back pains etc..
Did my Thyroid panel: TSH 1.59mIU/l (normal for lab 0.4-4.5)
Free T4 1.0 ng/dl (Normal 0.8-1.8)
Free T3 2.2 ( low) (normal 2.3-4.2)
Reverse T3 22 ( normal 8-25)

Between 2011-2013 I was under tremendous stress with a legal issue, It took a toll on my system. I weigh 187 lbs age 48. Is a good idea to start on T3 alone..?? possibly cytomel/ liothyronine or 1 grain of westhroid ..

Regards Dr Uche

    Dr. Westin Childs - February 15, 2017

    Hey Chris,

    In this case it’s probably better for T3 only titration. I would also check both free and total testosterone and coritsol levels then treat both.

      Chris - February 15, 2017

      Hi there..
      Thanks for the quick response… When you say treat both I assume you mean Supplement the DHEA or do you mean the T levels if indeed they are abnormal.. Do you have a contact number ? or practice number..?

      chris - March 2, 2017

      Hi Dr Westin
      I weigh 190lbs.. I started off on lowering mt Reverse T3 ( level was 22) with Cytomel 10mcg.. It there an optimal dose..? IS it best to titrate up to 15mcg or titrate depending on symptoms..? and what a good duration.? 6wks or just depending on levels and symptoms..

        Dr. Westin Childs - March 2, 2017

        Hey Chris,

        There is no optimal dose based on weight/age/sex/etc. instead it’s based on a combination of other factors including lab tests, symptoms, body temp, resting heart rate, etc.

Irina - February 16, 2017

I love your website – tons of great info. Thank you for the education! I am a Chernobyl survivor battling Hashimoto for the past 30 years after partial thyroidectomy. I am on 112 mcg T4, and 7.5 mcg T3. My latest numbers are TSH 0.045, FT3 2.7, Ft4 1.1, rT3 15.6. Antibodies 37-42.
I calculated my T3/rT3=0.173
B12 573, Vit D 75, Zn 80, Se 145, CRP 0.31, low cortisol, low testosterone, low DHEA, Ferritin 20, HGB 13.9
I think my T3 should be increased, but my Doc is afraid due to low TSH. I am a classic hypo with low energy, weight gain despite clean diet, hair loss, brain fog, irritability, cold intolerance, constipation, low libido, and so on. I am a full time medical professional, wife and a mother. I am so exhausted of being exhausted. Any advise would be greatly appreciated!!!
Do you think its safe for me to be on T3 only?
What can I do to increase Ferritin?
Thank you for your expertise!

Shar - February 22, 2017

Hi. My mom is 6 months post thyroidectomy with 5% remaining thyroid. She is taking 75 mcg of Levothyroxine but still has depression, anxiety, severe leg cramps, hair loss, weight gain and started having epigastric pain that is the same kind of pain when she had a duodenal ulcer. Physcian ordered omeprazole. She was goiing to the gym 4-5 days/week but now does not have the energy.

I am an RN, nutritionist and currently in ND school. I ordered a lab panel and results are as follows: Electolytes normal – checked due to leg cramps. TSH=1.120, RT3=24.6 (9.2-24.1), FT3=2.8 (2.0-4.4), FT4=1.83 (.82-1.77), T4=11.5 (4.5-12). I am coming up with 0.11 ratio and think she would benefit from an RT3 flush with a bioidentical T3. Would this been reasonable to you? It is very difficult to find physicians that know the information that you are sharing. Her endocrinologist says she is “normal” because her TSH is normal and does not do any other testing. Her suffering is leading me to websites such as yours, trying to find an answer. Any information that you can provide is appreciated.

Charlene - February 27, 2017

Yes hi I have high rt3 at 134. My Dino test came back positive and an being treated with antibiotic. I am t3 meds 3mcg x2 daily repeating blood word in two weeks. Was put on tons of supplements, and on cortef. After being on cordef for two week was haveinv horrible side effects so had to stop. Also on ldn. Still not feeling well, it’s a day to day right now. Any recommendations? I suck at handling stress, am a recovering bulimia-purge.
Low vit b, was anemic, low mag, nutrient deficiencies. Currently gained 8 lbs, eating greens, and superfoods, implemented exercise three times per week. Been treeatdd by current doctor since Jan.

    Dr. Westin Childs - February 27, 2017

    Hey Charlene,

    Patients who have had bulemia and/or anorexia like behavior in their life tend to react much slower to medication changes and tend to take a lot longer to feel better.

Cheryl Myers - February 28, 2017

Roughly 5 years ago, (age 47) during an extremely stressful period of my life, I was prescribed levothyroxine for an elevated TSH of 4.7 (0.40-4). At the time, the only other level read was my FT4 = 1.22 (.80-1.8). I had felt many symptoms of hypothyroidism so was kind of excited for the treatment.

Two years later, with little change in my symptoms, and after my doctor quit his practice, I stopped taking the levothyroxine. The next year I found an endocrinologist who (for the next two years) ordered many tests and a whole lot of lab work, resulting in lots of head scratching and being told we will just monitor you for a while.

I am now 52, I still feel like crap and my weight of 185 at 5,8 makes me feel like a slug. Since stopping levothyroxine my FT4 levels have ranged between 2.98 – 4.48 (0.80 – 1.80) my FT3 readings have ranged between 9.2 down to my latest reading of 5.7 (2.30 – 4.20) and my DHEA, has ranged from 200 to 457 (15 – 170). No rT3 has EVER been ordered or suggested. I am currently in search of a new endocrinologist but was wondering if those numbers mean anything to you. So far none of my doctors can figure me out. Just looking for some direction.

    Dr. Westin Childs - February 28, 2017

    Hey Cheryl,

    Lab values by themselves mean very little if they aren’t paired with symptoms, body temp, resting heart rate, etc.

      Cheryl Myers - February 28, 2017

      Oh yes, I get that! It’s just that, even with my doctors having all that vital info before them, they still can’t make heads or tails of my numbers. They would explain “if this number were high while this number was low, then it could be this or that, but your numbers aren’t like that”. They literally have nothing to offer (besides, wait and see) to help me understand my combinations. So I was only wondering if you have run across numbers like mine or if am I just the ‘lucky one’.
      Thank you

Shar - March 2, 2017

Hello Dr. Childs. I posted on Feb 22nd. I realize you are bombarded with questions, but am I on the right “thinking” track in regards to needing a RT3 flush with bioidentical T3 for my mom? Thanks for letting me pick your brain. Shar

    Dr. Westin Childs - March 2, 2017

    Hey Shar, yes that would be a reasonable approach to start with.

      Shar - March 2, 2017

      Thank you so much!!!

        Dr. Westin Childs - March 2, 2017

        No problem 🙂

          TINA - March 2, 2017

          I know that you have mentioned before you no longer take patients and you don’t have recommendations on doctors in other areas, but like many, I am desperate. I have been to so many docs, gone completely broke, begged and pleaded and am suffering miserably. I live in Seattle. I need someone who can help. I have tried all kinds of natural thyroid meds, T3, Wilson’s protocol, diet changes, supplements and I have gotten worse. I need help. I truly can’t live like this anymore.
          If there is anything you can provide as far as recommendations I would be so incredibly grateful. Thank you!

          Dr. Westin Childs - March 2, 2017

          Hey Tina,

          I plan to email my mailing list when and if slots open up for new patients, but I don’t expect this to happen for a while (if it happens at all and I wouldn’t recommend you wait for that to happen if you are suffering). If possible you might be able to seek out someone local, but I don’t have any resources I can guide you towards.

          Shar - March 2, 2017

          Tina. I hope that I am not overstepping any bounds (including Dr. Childs :)) but I “hear” the desperation in your e-mail. My mom has expessed some of your same symptoms.

          I have been to many A4M conferences and those who go through their training/internship programs seem to look for root causes of imbalances and incorporate additional complimentary treatment protocols. Although I do not know any of these practitioners nor do I know Dr. Childs or his professional opinion, you can check out this website: http://www.a4m.com/directory.html#directory_search_form for those who are A4M boarded and practice in Seattle.

          Chris - March 2, 2017

          Hi Tina
          I feel your pain.. I am a physician and have Thyroid issues too.. what are your lab results.?? I may be able to give you some pointers

          TINA - March 4, 2017

          Wow. This was so kind. Thank you. I really appreciate the help. Means a lot

Gill - March 2, 2017

Hi – I just got back my lab results. I was on 3 grains of Armour Thyroid and my Dr said i should increase by half a grain, every time i went he asked me to increase, so i asked why he was doing this and he said he was just testing cos really i was normal. I told him i was not, it was 5 degrees outside and i was wearing a T shirt, i had serious heat intolerance and swelling, he then said, OMG since when, and i told him i had been saying this for the past 8 months, he then told me that if i had heat intolerance and swelling, then i had Thyrotoxicosis and that i should reduce the meds by half a grain. i didn’t do that, maybe i did wrong, but what i did was stop all my medication at once, i just continued to take my supplements. This was 2 months ago and now i’ve got my results as follows, l still have issues with weight, and fatigue and brain fog. I also have Hashimotos.

TSH 6.79 T4 Free – 6.5 T3 Free – 1.3 Reverse T3 <0,009
Thyroglobulin antibodies 103.00
Thyroperoxidase antibodies 345.5

I'm exhausted, and weight keeps coming on. My power naps are about 3 a day of minimum 30 minutes.

Catherine - March 6, 2017

Hi, I am awaiting results for reverse T3, I was amazed to see your point about beta blockers, I have been taking propranalol for years for essential tremor.
I have been to the Dr so many times about issues of sleep disturbance, fatigue in the daytime, joint pain and muscle weakness.
All I ever hear is it’s your age, I am 55 years, and had a full hysterectomy at 37 years of age. I just want to know if it’s a result of beta blockers or no HRT, or something else. How long would it take to determine the true cause of my issues, if they are related to reverse T3. If I stop the beta blockers I wont be able to do my job, If proven to be raised levels of Reverse T3 is there a medication I could take that wouldn’t contradict the propranalol.
Catherine Burton

Jessica - March 7, 2017

Hi Dr. Childs,

What a great article. I really appreciate your straight forward approach and easy to understand writing style. I believe I’ve been suffering from T4 to T3 conversion issues for some time. I’ve had hypothyroid-like symptoms for over 5 years, but my labs have always been in normal range. I’ve been to 5 different doctors both in the conventional world and the alternative world – none of them have been overly concerned about my thyroid. After reading your article I pulled out all my old labs and did the math – in 2014 my T4:T3 ratio was 0.11, in Dec 2016 it’s 0.13. My hair is falling out, my skin is so dry it hurts, my eyebrows are practically nonexistent… the list goes on. However, I am underweight, not over – for now.

I have a pretty good understanding of what my underlying factors are – chronic stress, EBV and definitely some gut issues. I am also homozygous MTHFR which as I understand it, makes detoxing more difficult. I’d like to bring this to the attention of my primary care doctor and work collaboratively with him to create a plan. He’s open minded and is usually interested in my input. However, I feel like we have yet to really get to the root of the problem. Any advice on how to have that conversation or suggested starting points for a treatment plan would be appreciated.

Thanks for all you do and for making information like this accessible and understandable for people like me! You’re really making a difference!


Denise - March 10, 2017

How would you treat a patient if their reverse t3 was exactly 15 and ratio above .20? Would you want this lower or is 15 the absolute cut-off?

    Dr. Westin Childs - March 10, 2017

    Hey Denise,

    Reverse T3 by itself is not very helpful, you need a more complete panel. Sometimes high reverse T3 is a normal compensatory reaction from high doses of T3.

Lise - March 13, 2017

I had to switch doctors. The new endocrinologist convinced me to switch to Levothyroxine from Armour Thryroid. I had been on Armour for 10 yrs. The doctor insisted it was a more stable medication, and that my blood tests were always fluctuating. It’s been a year on the Levothyroxine and I feel terrible. I have developed all kinds of muscle and tendon tenderness, tendonitis and muscle cramping. As well as weight gain. I am having a hard time convincing the Dr. to switch me back. Any thoughts on what I can say to convince them to switch me back?
It’s really terrible that as a patient I have to beg them to listen to me.

    Dr. Westin Childs - March 13, 2017

    Hey Lise,

    It’s generally not worth it to try and convince a doctor to treat you a certain way, your time is much better spent looking for someone who is more willing to listen to you.

Denise - March 13, 2017

Ahhh, gotcha and thank you Dr. Westin for the response. My ft3 was a tad above range, 4.4 with range limit of 4.2. Ft4 is still rather low at about 10% of range. I am on 150mg NP and 25 mcg cytomel. I am perplexed on which to cut, nurse practitioner said play around and find what makes me feel good. I feel if I cut 30mg of the NP, that should do the trick of getting that ft3 back down some.

Tracie - March 14, 2017

I have had low thyroid for over 20 yrs. I took T4 meds for over 20 yrs. No one cared about constipation, dry skin, memory problems, intolerant to cold, very low body temp, ect. Two years ago I tried T3 meds and loved it. About one year ago I thought I needed new hormones, (E2 and Test) pellets under the skin. By the last round in November, I couldn’t lose the weight that these things put on me, I started producing Tsh again. No one knows why. Is it important? Who Knows. The doctor suggested Nature Thyroid meds, so I tried it. I had allergic reactions 3x. So then I thought I needed an endocrine’s advice. This doctor told me taking T3 was cheating, like taking steroids. It would also hurt my heart. He put me on low dose of T4 med. Two days later, tummy aches, eyes puffy and swollen, ect. Finally, after one month I went back to T3 meds. Mood improved in less than 24hrs.

I also started producing thyroid antibodies that are going up, not sky rocketing, just climbing up. Yep, I’m taking my health back into my hands.

I work in laboratory medicine, and understand the numbers game. I just wish I didn’t have to play it. 🙁


Kristen - March 14, 2017

I found your article very helpful!! My doc tested tsh and t4 which came back normal. I asked her to check t3, which is on low end (2.4). She left it up to me if I want to proceed and treat, but didn’t say with what. After finding your website, I now know about rt3 and asked if she would check it, which she will. I plan to go in soon. She’s willing to check whatever I ask, which is great, I just wish conventional doctors were more in tune with this instead of the patient having to do so much research! So thank you for the very helpful info!
My d3 also tested low, (26.5) and my cholesterol high (ldl 129 hdl 147). In your experience, can either of these two be related to slow thyroid? I already was taking 2000 d3 (liquid form with k2) which I’m increasing to 10,000 then retest in 8 wks. I get confused what to focus on. If my rt3 comes back high, would you recommend treatment, or wait to see if increasing d3 helps my symptoms ( fatigue, stubborn weight, eczema, depression)? My doctor is willing to try what I suggest, depending on how I feel. Thanks in advance!

    Dr. Westin Childs - March 14, 2017

    Hey Kristen,

    As a rule of thumb if you have to ask for testing you will most likely never get the right kind of treatment necessary to feel better. Testing is only about 5% of the problem, the other 95% is dependent upon how and what you are treated with (including other hormone imbalances).

Kristen - March 14, 2017

Wow thanks for the speedy reply, I appreciate it! Yes, I feel I need to find a functional medicine doctor in my area to address my symptoms. I do believe in conventional doctors to a point, but I think they focus too much on prescriptions before exploring further. Thanks for what you do!

Alisha Khan - March 16, 2017

Dr Childs, I have managed most of my symptoms by switching from Levothyroxine to NathureThroid. I still have fatigue and brain fog…. but The one major issue I have is weight loss. No matter what diet I try, I cannot even lost 1 pound. Sometimes I even gain weight. Ive tried KEto, low cal, high cal. Paleo, you name it!

I could really use some guidance on that. PLEASE help!

Here are my labs:
Reverse T3: 17.4
T3 Total: 2.6
T4 Total: 7.9
T4 Free 1.29
TSH 1.55
Vitamin D 35 ng/ml
Ferritin 20 ng/ml
Average Glucose/ A1C 105 mg/dl 5.3%

isabel santiso - March 17, 2017

Hello Dr. Childs,

Love your website and the breakdown of information provided. I have had hypothyroidism for the past 15 years and was being treated with synthroid. Unfortunately, my symptoms have become much more severe over time and thanks to you website, i had my physician test my reverse T3 in addition to the others standard readings. My T3 just cam back today at a level of 30 with my TSH, T4 and T3 at normal levels. I was so relieved to now have the data to be able to better understand my thyroid condition and actually start taking an appropriate medication (doctor put me 5 mg of liothyronine) to help me during the next couple of months. In the meantime, since my symptoms and acid reflux has become so severe and debilitating over the past two months, I I am now committed to a total change in diet to help my body heal. I just downloaded your 4 week food plan and I noticed that in the list of basic guidelines, there is no mention of dairy products needing to be removed, however in reviewing all your recipes, I noticed that there are no dairy products. Should dairy products be avoided? Thank you for helping to educate and support those of us who have been living in a chronic state of illness not understanding why we just could not get better!

    Dr. Westin Childs - March 18, 2017

    Hey Isabel,

    Dairy is highly individualized, but the best way to approach it is to remove it for at least 4 weeks before a trial introduction back into your diet. If you find you can tolerate dairy products then using raw/organic/full fat dairy products may be fine for your body.

Gretchen - March 21, 2017

Hi Dr. Childs,
Thanks for another great article. I’ve printed several and put them in a binder I now call my ‘thyroid bible’ along with my labs, food and symptom journals and find the info very useful.

If I understand this article, if a person (me) has a conversion/reverse T3 issue and is given a higher dose of T4 (Synthroid), this could actually prevent balance of the thyroid hormones because being a poor converter, I now have more opportunity to create RT3, which might further block the absorption of liothyronine at the cellular level. If correct I get the sense my current provider is taking me down this path. A recent increase of T4 shows optimal TSH and T4, meanwhile doubling liothyonine saw no effect on consistently decreasing FT3 values. I was told that a sub-reference value (20ng/dl) was ok because things fluctuate. There has been no fluctuation in 7 months, only decreased values. Hoping this provider is willing to work within these constructs but if not I’ve scheduled with a local integrative/functional MD to pursue root cause and optimal treatment options.

Satu - March 22, 2017

Is it possible that Reverse T3 rises within quite a short time. I have adrenal fatigue, which was already getting better before we started treating my SIBO. I took first Biocidin for 3 weeks, but this got my SIBO so bad that I was spending most of my time in bed. So I went on Rifaximin for 4 weeks, which has helped and now I’m absorbing nutrients and things are better. But as a result I now get very tired in the evening as well whereas before I was kind of waking up towards the evening as you often do if you have a bit low cortisol. I have a functional doctor and a functional nutritional therapist helping me out. We checked my TSH, Free T4, Free T3, TPOAg and TyglAg and they had got better during the last 7 months. Yet, I got more thyroid symptoms like the tiredness in the evening. Cortisol is still the same a little bit below normal. So I’ve just taken a test for Reverse T3 and am hoping that this would be the answer to why I’m not getting better now. So I was wondering that as my symptoms got noticeably worse during the SIBO getting worse, I was wondering if the reverse T3 could have increased during a short time of feeling really bad.

El - March 25, 2017

Dr. Childs,

Thank you for this information – extremely helpful. Do you have any recommendations for colleagues in the NY/NJ area that understand thyroid issues particularly reverse T3? My T3 to RT3 ratio is low and I believe I may have subclinical hypothyroidism. I don’t want to go to someone that will misunderstand or put me on the wrong course of treatment.

Alternatively, would you be willing to consult with someone by phone or visiting from out of town even if they don’t live in your area?


Liz - March 27, 2017

Dr. Childs is the following possible? A person is taking both Synthroid and Cytomel or NDT. This would cause RT3 to be
elevated in order to prevent T4 from converting and increasing T3 too much with T3 meds on board?

Eljay - March 29, 2017

Hi Dr Childs,

Great reading! Several endocrinologists haven’t been able to offer any treatment protocol for exactly what you have described. I have normal T4 and TSH, low to normal T3, but highly elevated RT3 out of the reference range. Being out of options, I have obtained T3 myself and my only question top you is, what is the process following the recommended 2 months of T3 titration? I was under the impression you can’t abruptly stop taking T3 or is the dosage at the end of the 2 months not significant enough to damage/stop natural production if you suddenly stop taking it?

I will be getting bloods done at 4 and 8 weeks to monitor it.

Thanks in advance!

Jeanette - March 30, 2017

My Dr wants me to start cytomel and drop my synthroid way down. I am so nervous as I am a “sensitive” patient. What if I can’t tolerate this protocol? What should someone like myself do?

Appreciate any suggestions. Struggle with everything.

Thank you,

Jeanette - March 30, 2017

I had left another post but failed to mention that I also am dealing with adrenal exhaustion. I am so afraid to start this protocol as I already feel terrible.

Suggestions appreciated.


Shirley - March 30, 2017

I have the following blood tests as of 3/17/17:
Got my DHEAS & 4 times saliva test results back today. These were done by ZRT.
DHEAS (saliva) 8.8mgmL 2-23ng/mL (Age Dependent) in the picture this shows it as high
Cortisol 6:30 am 7.2 ng/mL Low 3.7-9.5 ng/mL (morning)
Cortisol 11:55 am 1.9 ng/mL Low 1.2-3.0 ng/mL (noon)
Cortisol 4:46 pm 1.8 ng/mL High 0.6-1.9 ng/mL (evening)
Cortisol 9:43 pm 0.5 ng/mL High? 0.4-1.0 ng/mL (night)
Iron total 85 45-160 mcg/dl
Iron binding capacity 299 250-450 mcg/dl
(calc) % Saturation 28 11-50 %
(Calc) & Ferritin 29 10-232 ng/ml
Vitamin B12 328 200-1100 pg/mL.
Magnesium, RBC 6.2 4.0-6.4 mg/dL.
TSH 1.03 .40-6.20
FT4 1.16 .54-1.24
FT3 2.7 2.5-4.4
RT3 24.8 9.0-27.0
TPA 1.5 <=9.00
AB <0.9 <=4.0
Selenium 197.1 60.0-230.0
Zinc 14.6 9.0-14.7
Iodine (urine) 57 34-523
I haven't slept in over 3 weeks for more than just an hour or 2 and then dose the rest of the night. Any suggestions?

Diane T - April 5, 2017

Hi Dr. Child’s,
9 weeks ago I switched from Armor to Synthroid and recently added cytomel.
After 2 weeks of 10 mcg of cytomel, my numbers are as follows:

I have Mitral Valve Prolapse and am VERY sensitive to all meds…haven been on a beta blocker for 30 years and I have started having a lot of palpitations and anxiety…any suggestions since my ratio is 16? Not fatigued at all, just more loose bowels than usual. Also working on getting magnesium levels up but very difficult!

Lydia - April 6, 2017

Dr. Child’s,
After reading many of your articles on Thyroid issues I noticed in one you had listed an Arizona address & contact info to see patients.
I moved from Queen Creek AZ to Washington state but had my former husband go to the address listed for you online. Long story short he was told you were no longer practicing there. I called the phone number listed and left several messages but didn’t receive any call backs. I’m fairly new to Hypothyroid as diagnosed just last Spring right after diagnosed with Fibroids and then undergoing Hysterectomy leaving healthy Ovaries. I was also diagnosed with OSTEOARTHRITIS just this past year by my Pain specialist. Its in my cervical’s and entire spine. Its just been one thing after another!
I’m having a horrible time finding a good doctor to help me. I dealt with terrible and long-term stress for many years which is I think reason for thyroid issues plus chronic pain after a freak accident slip & fall 1994 led to back & knee surgery. Due to over 1 year misdiagnosed issues damage to nerve root led to chronic pain in low back reason for pain meds & then accident car accident few years later 2005. Then another car accident just this Feb. 2017!!
I know this Email is quite long but please bear with me.
I decided to try & wean myself off one of my chronic pain medication since Feb of this year & it’s been horrible but I had actually thought I was going to make it after the worst part seemed to be behind me or so I thought was over..that is until this past week! My muscles & joints all over down to the soles of my feet are in excruciating pain! I just saw my new pain doc today & broke down. I explained I’d been trying to get my Endo to see me & get my last lab results from 2 months ago! I truly feel my levels have been off & may be contributing to severe pain.
She agreed & suggested I be checked every 6 weeks until feel better.
My usual weight of 115-120 has rocketed to 136 with majority of fat around my midsection. I look 6 months pregnant & feel so disgusting! I saw my GPA day b4 & she obtained my lab results of 2 months. She told me my Thyoid levels were pretty high. I explained I’d just been able to finally get an Appt with my Endo for next week. She said I’d need new labs taken.
My concern is when they finally called the girl on phone..some office person told me labs normal..when asked her about TSH..she paused & only said I’d need to cut back my thyroid meds’s & wait 6 months to be seen! I refused to wait that long & she clearly knew nothing about labs let alone what TSH even meant!
So Dr. Child’s I am pleading with you for your help.
I honestly feel the T3 and debilitating pain throughout my entire body for these last 2 weeks now truly has to do with the issues you wrote about..it’s as if they each are describing me and my body & symptoms!! I did see a Naturopath in Arizona last November after unable to see or reach you.
He prescribed changing from Armour to Naturethroid plus a number of supplements some of which I’d taken for years. He also put me back on a natural Progesterone cream & low dose Testosterone pill. I’ve been menopausal since 2009 (actually still had menses monthly but lab panel showed full menopausal with all symptoms) on bio-identical hormones right after being diagnosed. My new Gynecologist didn’t think it was necessary regardless of how bad I felt.
Naturopath also ordered battery of tests plus saliva and Adrenal Fatigue with numerous others. Yet..with being here & my continued issues especially zero sleep and weight gain plus fatigue I truly feel I NEED another doctor! He also feels it has to do with the fact that I’m exposed daily to Wi-Fi signals from computer system in house & told me to do away with & revert to dial up instead.
So, Dr. Childs are you available to see patients?
I am in a desperate need of a physician who actually knows and can treat this horrible illness! Helping people online is absolutely wonderful but also still
treating them personally and helping them to have a normal or semblance of normal life is a very generous gift!
One more thing…before my first freak accident in 1994 a slip & fall which led to both knee & back 1995 & 1996 surgery…I was extremely healthy and active & looked beautiful and had a great healthy body & never took any drugs or had any illnesses!
Just wanted to give u a bit of my former health HX.
I also slept like a baby & have eaten a very healthy diet with supplements & never a smoker & social drinker
OR was social drinker..mostly white wine..now..nothing! Now I am Always exhausted due to
Lack of sleep & no meds have helped. Sleep studies first Dx Sleep apnea after contracted a severe staph infection in both lungs while trip to Mexico 1999.
Almost died. Took docs almost year to correctly diagnose! So..you see this is yet another reason I am begging you for your help! I’m afraid I will end up in same situation again…please..can YOU help me?
I relocated to a small town..Kennewick WA. NOT MANY Thyroid docs especially of your caliber!!!
Dr. CHILD’S, I will anxiously await your reply…please know I wouldn’t be so desperate if I had either experienced any change in my Thyroid issues but everything is only getting worse!
THANK YOU Dr. Child’s for all the information in these 2 articles. In case I don’t hear from you I plan to print out this info & take to my Endo Appt next week to both reason & run the T3 tests needed.
I truly feel this may be the issue…
Again Thank you Dr. Child’s.

Sharon Margiotta - April 6, 2017

Curious… I have hypothyroidism but continue to gain weight despite healthy clean eating and interval training. Looking into Leptin Resistance. I check all the boxes.

My Reverse T3 to Free T3 ration is .3 It is not below the .2 you mentioned I will get more uptodate blood work per your suggested areas to test. But, is this an indication that my body is not converting T4 to T3 but rather to reverse T3?

My doctor’s answer to increased weight and hypothyroid symptoms is to add an afternoon dosage of armour. I am concerned about taking any T4/T3 if I am converting to Reverse T3. Counter productive.

How do we find a doctor in Cleveland area?

Olga - April 9, 2017

Dr Childs,
Thank you for your articles, they are a lot of help!
Let me ask you what shall i start with? T3 only or T3 plus Ndt?
I have low FT4 ….11.3 ( 10.3 – 24.5)
Low/mid FT3 …..4.27 ( 2.3 – 7.00 )
High TSH……8.28
High Reverse T3 …..27 ( Insulin 7,8, SIBO)
I take all the reccommended supplements for several months.
I’m going to start with T3 only but i have read that T4 levels will be lowered after introducing T3.
Should i add some T4 or it is not necessary?
Thank you

Gypsy Savage - April 11, 2017

Hi! I’m currently struggling with high RT3, but am also pregnant. I’m reading that I need to drop the NDT and Cytomel that I’m currently taking in order to flush the RT3 out, but I’m scared of doing this while pregnant. I’m reading conflicting information about the baby’s needs for thyroid hormones (most commonly said is baby takes T4 and converts it to T3, which makes me scared to take away the little T4 I currently have. There’s very little information about treating pooling while pregnant – can you point me to someone or a resource to guide me? Currently my functional doctor doesn’t recommend flushing the RT3 and says the elevated number is likely just bc of pregnancy. Obviously, my reproductive endocrinologist isn’t knowledgeable in this area. Any wisdom? Thank you!

Suzanna - April 17, 2017

Hi Dr. Childs, thank you so much for information very useful but hard to implement without a right doctor. How can I become your patient? Who do you recommend if I can’t see you? Please help, what you are explaining makes so much sence. I am looking forward to your response. Please help.

    Dr. Westin Childs - April 17, 2017

    Hi Suzanna,

    Unfortunately Dr. Childs is no longer accepting patients and we currently don’t have anyone to refer you to.

      Suzanna - April 18, 2017

      If I get the program and Dr.Childs recommends the medi1cation list, will he be prescribing them as well?

        Dr. Westin Childs - April 18, 2017

        Hi Suzanna,

        Dr. Childs only prescribes medications and hormones for his patients and he is currently not accepting patients. If you are referring to one of the other programs we offer, those do not include medications.

Stefanie Kerwin - April 18, 2017

Hi dr child’s!

What a great article thank you!

I asked my dr to check rt3 last year as weight loss was extremely difficult. Rt3 was 585!!!
I started t3 I’m on 15mcg daily. 6 months later my rt3 is 274.

I am diabetic on insulin. I eat under 30g carbs daily. My leptin levels last time I checked were very high (can’t remember exactly but very high!). I weight 80kg – 12kg over my happy weight. I’m down as type 1 dm but no antibodies. Metformin doesn’t work for me but I do think I have insulin resistance as my insulin requirements are increasing even on low carb diet.

I take 200mcg selenium & 60mg zinc citrate daily.

I was thinking I might need more iodine? Last iodine spot test was 80 & I take 5 drops 3 x weekly.

I have been recovering from very severe cfs following EBV. Before then I was very active & fit. I do think my thyroid is the main cause of my weight issues.

I’d love any input you may have I’m 100% compliant!

Many thanks
Stefi x

Perhaps I should be increasing the t3?

michele - April 18, 2017

Hi Dr. Childs in your post you wrote “For reverse T3 I use > 15 as my cutoff for abnormal”. Couldi you tell me please what is the considered unit of measure for reverse T3?

    Dr. Westin Childs - April 18, 2017


      michele - April 19, 2017

      Thanks Dr.Childs. I tried to calculate my ratio Ft3/Rt3 and I don’t realize your indication about.
      I have a good Ft3, upper 1/2 of the normal reference range (0,33 ng/dL), and I have also a good Rt3 by your indication (14 ng/dL). I expect to have a good ratio but if I calculate FT3/RT3: 0,33/14 = 0,023, that is very far from >0,20 you consider in your post. What’s happened?

        Dr. Westin Childs - April 19, 2017

        Hi Michele,

        The ratio is only important if you symptomatic. If you are just fine then don’t worry about the numbers.

          michele - April 19, 2017

          Dr. Childs I would talk with my doctor about your interesting post without any doubt. So, if you consider 15 ng/dL as the limit between normal and abnormal RT3, and 0.20 the limit between normal and abnormal ratio FT3/RT3, I realize that the limit between normal and abnormal FT3 is 3 ng/dL. This is impossible: the usual range for FT3 is 0,15-0,45 ng/dL. It could be that the limit ratio FT3/RT3 is 0,020 instead 0,20?

Marie - April 18, 2017

I’ve been treated for hypothyroidism for about 11 years now. It was only recently discovered in my labs that I have low progesterone, testosterone, and cortisone along with my thyroid issues. I have been on a very high dose of thyroid medications for a long time. 10 grains of NDT and 75mcg of Cytomel daily. My free T3 and T4 are above range. My other low hormones are now being treated with more bio identical medications. Yet I still have hypo symptoms. I am wondering if it is from pooling RT3. I will try to have the lab done for it soon. Maybe you can help me with one major question I have until then…I have seen where some information online suggests dropping NDT down to 1-1.5 grains a day to clear the RT3 out, other sites suggest dropping NDT by half the person’s total does to accomplish this. What I don’t understand is are you supposed to drop your medication levels suddenly or taper them down to get rid of the RT3? Like would I need to drop to 5grains or 1.5 if RT3 pooling is confirmed or taper down over a couple months?
Thanks, Marie

Anna Claire - April 20, 2017

Dr. Childs,
What if the patient has a free T3 of 4.9 and a Reverse T3 of 43… TSH is elevated at 5.8. Free T4 is 1.4. Antibodies are not elevated. Patient is symptomatic. Would you recommend starting lower with T3 supplementation for this patient? Patient also has symptoms of testosterone deficiency & adrenal fatigue… working on getting those labs.

Francesca Fender - April 20, 2017

Dr Childs
My Dr & I have found your videos & information very valuable. I am very sensitive to meds & a lot work paradoxyl on me.
I was on T4 88mcg for 4 years & felt great @115lbs. Then out of no where it was causing issues of fatigue, weight gain & etc. My levels on or off the T4 were much the same so I decided to stop it & felt much better. My Rt3 levels started to drop from 28. I am gluten, sugar & dairy free, I eat very little processed foods. My leptin was 17.7, RT3 serum 15.8 T3 Serum 2.54. T4 1.07,Uric acid 7.0, SHBG 50. So she put me on a compounded T3SR 2mcg. All as it has done is to make me exhausted & the pharmacist says I should get energy. So I started taking it before bed making sure I had not eaten for a few hours, then night sweats. I have not lost 1 ounce. When I was first put on T4 I lost 9lbs in the first 48 hours?
We are at a loss now. As she said if the T3 doesn’t work she doesn’t know what else to do? I have tried for a wile to get in with Andrea.


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