Thyroid hormone resistance gets a lot of attention from thyroid patients for one very important reason:
Because it has the potential to explain why so many thyroid patients continue to feel poorly despite taking thyroid medication and despite having thyroid lab tests in the normal range.
While this is true, the assertion that thyroid hormone resistance exists gets a lot of pushback from the conventional medical community.
The reason for this has to do with the fact that most doctors are only familiar with one type of thyroid resistance that is very rare:
The genetic type.
If you are only looking at the genetic version of thyroid resistance then, sure, it’s easy to make the case that it’s not very common and those people stating they have it, are most likely incorrect.
But if we use a broader definition or even the most correct definition, then those patients who believe they have it suddenly start to make a lot more sense.
Let’s jump in:
Is Thyroid Hormone Resistance Real?
Let’s start with the basics:
Is thyroid hormone resistance real?
Absolutely.
There are plenty of studies that show this to the be case (1).
If you look at the evolution of thyroid hormone resistance, you will see something interesting.
In the past, thyroid hormone resistance was felt to be quite common and was said to be present in patients who had a decreased metabolism despite taking thyroid medication.
Back in the old days, thyroid patients were treated based on their metabolism and not on blood tests (this was prior to the widespread availability of TSH testing).
Back then, doctors would provide various doses to thyroid patients in an effort to increase their metabolism and they were said to be “treated” when their metabolisms were normalized (2).
As a practicing doctor, you could look at people and determine who would have thyroid resistance based on how much thyroid hormone they needed.
If one person needed 2 grains of NDT to normalize their metabolism and another needed 4 grains of NDT to normalize their metabolism, then you could make the assumption that the person needing a higher dose may be more resistant to thyroid hormone.
This isn’t a perfect way to assess thyroid function or thyroid resistance, by any means, but there’s still value in looking back at how things used to be.
You can compare that philosophy with how doctors think about thyroid resistance today:
And right now it’s considered a very rare condition with around 1,000 cases reported in total, most of which, are genetic in origin.
Is it really the case that thyroid resistance syndromes dropped off the face of the earth or is this a case of changing definitions?
Probably a little bit of both.
It seems like the pendulum swung from an overdiagnosing of thyroid resistance (due to the inability to accurately test for it) to an underdiagnosing (due to an overly restrictive definition).
We can probably safely assume that we are now in a period of underdiagnosing for a couple of reasons:
#1. In virtually all other hormone systems in the body, acquired hormone resistance syndromes are far more common than genetic hormone resistance.
Current experts would have you believe that this is the exact opposite of what happens for thyroid resistance (I will explain this in more detail later).
And #2. The current plight of thyroid patients suggests that something is wrong with the diagnosis and management of hypothyroidism.
You wouldn’t expect hundreds of thousands (maybe millions) of thyroid patients to be unhappy (3) if you have your treatment “figured” out.
Between these two points alone, I think we have a good argument for thyroid resistance but we don’t have to stop there.
We can just take a look at the standard definition used in medicine to diagnose hypothyroidism…
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The Difference Between Hypothyroidism and Thyroid Hormone Resistance Syndromes
We know that thyroid hormone resistance exists, but how does it compare to hypothyroidism?
In a sense, they are actually very similar.
To better understand what I mean, let’s look at exactly how the body regulates your thyroid.
This part can get a little confusing but hang in there as it’s very important to understand:
Here’s how it works:
- It all starts in your brain with your hypothalamus where thyroid hormone in the bloodstream is first sensed. Depending on the amount of hormone in your blood, your hypothalamus then sends a signal to your pituitary gland in the form of TRH (a hormone).
- The pituitary gland senses the amount of TRH and releases TSH in response.
- TSH then travels through your blood to your thyroid gland (located in your neck) and responds to this stimulus by producing T4 and T3 thyroid hormones.
- T4 and T3 thyroid hormones then travel throughout your body to target cells. They could be transported from your neck all the way to your toe or to your brain or to your gut.
- Thyroid hormones must then gather around their target cells, be transported across the cell membrane, and touch specific thyroid hormone receptors.
- After doing its job in your cells, thyroid hormone then travels back to your brain via the bloodstream where it is sensed by the hypothalamus and the process continues over and over.
If you’re a little bit confused after reading this, don’t worry.
It’s not necessary for you to have this completely memorized, but to just have a basic understanding of how it works.
What you need to know is that if any of these steps are not working properly, then the end result will be a reduction in thyroid function and the symptoms of hypothyroidism.
This could happen in your brain, it could happen in your thyroid gland, or it could happen in your cells.
When it happens in your brain, we call it central hypothyroidism (4).
When it happens in your thyroid gland, we call it primary hypothyroidism (5).
When it happens in your cells, we call it thyroid resistance or tissue-level hypothyroidism (6).
While every single case results in decreased thyroid function and, technically, hypothyroidism, each problem manifests a little bit differently and will impact your lab tests in a slightly different way.
You may have had a thyroid condition for many years and have never been made aware of these distinctions, and that’s actually not that uncommon.
The reason for this is that the most common causes of hypothyroidism result from problems with the thyroid gland directly.
The most common of these is Hashimoto’s thyroiditis which results in the destruction of the thyroid gland.
For this reason, most doctors don’t spend a lot of time testing for problems in your pituitary gland, your hypothalamus, or your cells to see if the problem is there instead.
They just tend to automatically assume if you have hypothyroidism that you must have a problem with your thyroid gland.
And this probably explains why most doctors aren’t familiar with thyroid resistance as a cause of hypothyroidism and why if you mention this condition, they will most likely give you a strange look.
But that doesn’t make it any less real or any less of a problem.
For all intents and purposes, you can think of thyroid hormone resistance as a type of hypothyroidism because it results in decreased thyroid function at the cellular level.
This means it’s just as important of a cause as something like Hashimoto’s, even though it’s different in terms of what causes it and how it manifests.
The Two Most Common Types of Thyroid Hormone Resistance:
Now that we know that thyroid hormone resistance is real and how to define it, let’s look at the two causes.
As I mentioned above, the cause that doctors think about when they think of thyroid resistance is the genetic version but I think that the acquired version is much more important and relevant for the average thyroid patient.
I think you will understand why as we go through these causes.
#1. Genetic Thyroid Hormone Resistance
Genetic thyroid hormone resistance syndromes are very rare.
This subgroup of thyroid resistance is not as interesting as the acquired version (which we will soon talk about below) simply because it’s so uncommon.
The exact prevalence is not really known probably because there are several different genetic variants of the disease and each presents in a different way.
The most common figure I’ve seen reported is that genetic thyroid resistance syndromes may be seen in as high as 1 in 40,000 live births (7).
All of these conditions have one thing in common:
Genetic mutations result in varying degrees of cellular resistance to thyroid hormone.
In many cases, this results in very high levels of free thyroid hormones that the body produces to try and push through some thyroid function.
You would expect the presence of high levels of free T4 and free T3, but what’s unexpected is that these levels are often accompanied by normal or high TSH levels (8).
These patients also tend to be very unresponsive to normal doses of thyroid hormone (not very surprising if you understand thyroid function).
There’s probably a fair amount of these patients who run through life without having any issues and their problems are only known if their thyroid function is accidentally tested for some reason.
In those people who have true genetic thyroid resistance, the effects are hard to miss if thyroid problems arise.
These patients may need doses of T4 as high as 500mcg to 1,000mcg per day (9)!
For reference, most hypothyroid patients do well on doses of levothyroxine and Synthroid in the range of 50 to 150 mcg per day.
This means genetic thyroid resistance creates an environment in which you need doses of about 5-10x that of normal to obtain normal thyroid function.
But I would say that this type of thyroid resistance is an anomaly and most of you reading this are more likely to have what I refer to as acquired thyroid resistance.
#2. Acquired Thyroid Hormone Resistance
Understanding that genetic thyroid resistance exists is important because it can help us better understand acquired thyroid resistance which is probably far more common than most people think.
I say that because, in general, acquired hormone resistance syndromes are always more common than their genetic counterparts.
Take for instance insulin resistance.
Acquired insulin resistance is incredibly common and is seen in some form or fashion in up to 40% of the population in the United States.
Acquired insulin resistance stems from the overconsumption of carbohydrates and sugars.
Genetic insulin resistance syndromes, by comparison, are far less common.
The same logic applies to other hormone resistance syndromes such as progesterone resistance from estrogen dominance disorders (10), leptin resistance from weight gain (11) and repeat dieting, and cortisol resistance from chronic stress (12).
Physiologically speaking, doctors accept that the acquired versions of hormone-resistance syndromes are always more common than the genetic versions except in the case of the thyroid.
My personal opinion is that this probably has more to do with our lack of understanding of thyroid resistance than the reality that it doesn’t exist or that it’s rare.
I say that because there’s a lot of real-world evidence to suggest that many thyroid patients are suffering from what looks like acquired thyroid resistance (13).
This is reflected in how thyroid patients perceive their thyroid treatment which is not very well.
Whenever thyroid patients are polled, they continually express concern about thyroid management, lingering symptoms despite having normal thyroid lab tests, and so on.
In other words, it doesn’t look like we have the whole thyroid dilemma solved simply by looking at the current state of thyroid patients.
If acquired thyroid resistance exists, and I believe that it does, then how would it manifest?
It would be very similar to genetic thyroid resistance but would vary in intensity and severity.
In other words, we would see thyroid patients walking around with the following attributes:
- Some thyroid patients would do well on thyroid medications like levothyroxine and Synthroid but we would not expect standard doses to work for everyone. Some thyroid patients would need very high doses of these medications, probably in the range of 150 to 300mcg (less than genetic thyroid resistance but higher than normal).
- Some thyroid patients would require higher doses of T3-containing medications such as natural desiccated thyroid or compounded thyroid medication.
- Even more extreme, some thyroid patients would require T3-only thyroid medications like Cytomel and liothyronine. And they may even require higher doses than what would be considered “normal” physiologic doses.
- Some thyroid patients would have thyroid lab tests that look normal but still remain symptomatic because even though there is a sufficient amount of thyroid hormone in circulation, the cells are not responsive to it. This would create a scenario in which labs look normal but thyroid patients would still feel hypothyroid.
- We would expect lifestyle changes to improve thyroid hormone function which would then reduce the need for thyroid medication. For example, if you lost weight, reduced stress, replaced nutrient deficiencies, and cleaned up your diet, then your need for thyroid hormone might fall.
Does this sound like the current situation that thyroid patients find themselves in? I think it does.
And it’s not that farfetched of an idea to think that the majority of the problems thyroid patients currently face might be caused by acquired thyroid resistance syndromes.
Obviously, we need a lot more research and testing to determine if that’s the case, but discussing it like this is a good start.
How to Tell If You Have Thyroid Resistance
What should you do if you believe you have thyroid resistance? Are there any tests that you can use to help you determine if that’s the case?
Sort of, but not exactly.
Right now we don’t have any solid tools that can be used to diagnose thyroid resistance but there are some things you can test for to make an educated guess if it’s present.
One of those tools is the assessment of your basal metabolic rate or metabolism.
The idea behind assessing your metabolism is simple:
If you can compare your basal metabolic rate to someone that is the same age as you but with normal thyroid function, then you should get a fairly good idea of where you would need to be if your thyroid was normal.
Imagine you are a 45-year-old woman taking levothyroxine who burns 1,600 calories per day.
If you knew that women your age without thyroid problems burn 1,900 calories per day then you could take thyroid hormone until you approached that number.
This method would be used in place of using thyroid lab tests to determine when you are “normal”.
The degree of thyroid hormone resistance would be made manifest depending on how much thyroid hormone you needed to get there.
I just used a 45-year-old woman as an example here but you could replace gender and age with whatever suits your personal situation.
This theory originates on the basis that thyroid hormone is the primary regulator of your metabolism (14).
While this is true, it’s not the only regulator of your metabolism which leaves some room for errors when using this method.
I happen to think this is a great option, though, if you have a way to measure your metabolism easily.
Another option would be to look at your thyroid lab tests in conjunction with your thyroid symptoms.
The standard approach to thyroid management places the primary emphasis on your lab tests, specifically your TSH.
If your TSH is normal, then you are considered to be normal, regardless of how you feel.
An opposite approach would be to focus solely on your symptoms and neglect your thyroid lab tests.
In other words, you would take thyroid medication until you felt normal.
Neither option is ideal as they both are on the extreme.
A better approach is to use a combination of both your thyroid symptoms and your thyroid lab tests.
Ordering tests like your free t3, free t4, and reverse T3 will allow you to better understand how well your body is converting thyroid hormone, how much T3 is available for your cells to use, and whether or not your body is using that T3.
Using the combination method of lab tests and symptoms allows you to feel better while avoiding the need to suppress your TSH to produce supraphysiologic thyroid levels.
These are the levels you want to avoid because they do come with some minor risks.
Practically speaking, this may mean thyroid medication pushes your TSH to be flagged as low but not as suppressed (there is a big difference between these two states and what it means for your body!).
Again, much like the metabolism testing method, this isn’t perfect, but it can definitely work.
Your goal should be to find a balance between how you are feeling (complete symptomatic control) and the risks that getting there may impose on your overall health.
You may be willing to accept a small risk of bone loss from lowering your TSH, for instance, if it means you have the energy you need to live your life, obtain a more normal weight, and regrow your hair.
I’m not here to make that decision for you, just to help better understand how you should think about the situation.
Final Thoughts
We are learning more and more about thyroid hormone resistance syndromes every year.
My suspicion is that as research continues, we will find out that acquired thyroid hormone resistance is much more common than doctors originally believed!
I think that eventually it will be recognized as perhaps one of the major reasons that thyroid patients have been struggling for the last several decades and may explain the unresponsiveness of some patients to medications like levothyroxine and Synthroid.
Right now we don’t have any solid ways for testing for thyroid resistance, but there are a handful of methods that can work.
If you don’t feel like waiting for the research to catch up, then you can try testing your metabolism or treatment based on thyroid medication that takes into account both your thyroid symptoms and thyroid lab tests like free t3, free t4, and reverse T3.
Now I want to hear from you:
Were you aware of thyroid resistance as a condition? Is this the first time you’ve heard of it?
Do you believe that you currently have thyroid resistance? If so, what makes you think so?
Do you have other hormone resistance syndromes like leptin resistance, insulin resistance, or cortisol resistance?
Are you planning on making any changes to your thyroid medication to try and compensate for these issues?
Keep the conversation going by leaving your questions or comments below!
Scientific References
#1. pubmed.ncbi.nlm.nih.gov/18940949/
#2. ncbi.nlm.nih.gov/pmc/articles/PMC4980994/
#3. ncbi.nlm.nih.gov/pmc/articles/PMC6916129/
#4. ncbi.nlm.nih.gov/pmc/articles/PMC3169862/
#5. ncbi.nlm.nih.gov/pmc/articles/PMC3931439/
#6. ncbi.nlm.nih.gov/pmc/articles/PMC3169863/
#7. ncbi.nlm.nih.gov/pmc/articles/PMC4790576/
#8. ncbi.nlm.nih.gov/pmc/articles/PMC2928892/
#9. ncbi.nlm.nih.gov/pmc/articles/PMC2928892/
#10. pubmed.ncbi.nlm.nih.gov/28423456/
#11. ncbi.nlm.nih.gov/pmc/articles/PMC6354688/
#12. ncbi.nlm.nih.gov/pmc/articles/PMC3341031/
#13. pubmed.ncbi.nlm.nih.gov/17383828/
#14. ncbi.nlm.nih.gov/pmc/articles/PMC4044302/
Just read your article about Thyroid resistance. Very interesting. I have thought for a long time that my body didn’t utilize thyroid effectively. I get muscle cramps while exercising. Like my muscles use up all of their energy and can’t replenish fast enough. About 20 years ago I had a primary care doctor who reluctantly prescribed T3 along with T4 and I felt much more “normal “ . The endocrinologist 8 years ago decided that that was a bad idea and took me off the T3. Sometime after that I started to have these muscle issues and gained 60 pounds. I’ve been reading through all of your articles on Hirshimotos and have been fascinated with your thoughts on treatment. I stopped eating gluten and started taking your supplements which has helped but I’m still looking for better treatments. Thanks so much for your articles, they have been so informative and encouraging.
Hi Susan,
Glad you found them helpful! In regard to your current situation, I would strongly recommend reading this article which better explains the connection between muscle issues and pain and thyroid function: https://www.restartmed.com/hypothyroidism-chronic-pain/
I have issues with THRB2, now known as TRB2. Also TPO genetic faults which have led to diagnoses of lupus etc. Plus others. Taking 165 mcg of t3 and I’m okay. Ive taken up to 200 mcg of t3 mono and it’s been fine. I don’t know how much higher I could go in dosing. My Endos are horrified. I’m homozygous for AMPD1, muscles ache a lot.
I think that thyroid resistance is common.
Hi Susan, I have been desperate to find the cause of odd muscle fatigue and what feels like lactic acid buildup when doing things like walking upstairs and even standing up and progressive exercise intolerance. My inclination is some sort of mitochondria dysfunction or thyroid resistance related to inflammation. I found out I have a MTHFR mutation and elevated homocysteine so have been addressing that with various supplements, (was at 18 in April, now at 14- should be around 7). I recently discovered that “impaired sensitivity to thyroid hormone is associated with elevated levels of homocysteine in the euthyroid population” (the title of the journal article I read). I still am struggling with the muscle fatigue. I am active and have always been active, but despite no change in diet and trying hard to maintain the same activity level, I have gained 10 pounds in the last year. I still insist on taking the stairs though! 😀 I had also found out in April that I had low ferritin (10 in April, 20 in July) …By the way, thank you Dr. Childs for your info which led me to ask for this. I was advised by my physician to correct with iron, which I did, however it didn’t change the exercise/ activity intolerance. My doctor, per my request after reading a different article on inflammation and thyroid resistance, prescribed liothyronine as that was what the authors suggested as a more effective treatment. I was on it for 3 weeks and felt better, still didn’t restore exercise tolerance, but I discontinued due to the hair loss I was experiencing. I did a DUTCH test in July and found I am on low end for estrogen (was taking DIM unwittingly thinking I had estrogen dominance prior to this so have since discontinued). I also found I have low cortisol. Managing stress, sleep and inflammation and supporting detox for the liver seem to be main themes in all of my digging and connecting dots. Anyway, maybe this will spur you on to some questions and answers. Best wishes to you on your health journey.
Hi Elsa,
Glad you found the information helpful! And, just an FYI, the hair loss associated with liothyronine/Cytomel use is usually temporary: https://www.restartmed.com/cytomel-related-hair-loss/
On health forums I was quite surprised to find that most patients battle it out with their Drs over a low or suppressed TSH on Levothyroxine. Not once have I ever had a TSH that was below 1.5 to 2.5 on Levo despite having FT4 levels top of range, many times over range. Even my FT3 was 3.8 yet I always had a higher TSH and hypo symptoms, which left me with a lack of energy and poor appetite. I always thought it was odd that my TSH was not even low despite such high FT4 and FT3 levels. A “full replacement” dose of Levo does not restore my metabolism. I’ve never been a pound overweight in my life, always active in my 20s, no other medical problems so it’s a wonder to me why I developed thyroid issues and continue to struggle with getting enough active hormone.
After realizing I’ve had an undiagnosed thyroid issue for most of my life, I am just beginning with journey with an osteopath/naturopath who put me on NDT and Adrenal Cortex a couple months ago.
It’s been rough.
After having intense headaches, high BP, high heart rate and intense hot flashes, she has continued to lower my dose.
Right now I’m on 90mg of NDT and, while the headaches have alieved and high heart rate lowered easily, I’m still navigating elevated BP and intense hot flashes in the night. It’s definitely not fun.
She advised I don’t have a conversion issue and that this may take time for my cells to open up to receive the T3 that is available. So it’s looking like I might have cellular resistance (tissue-level resistance).
She is going to have me take another round of tests, including my antibody levels to determine any auto-immune possibilities.
My question is around whether or not this is something that can heal over time with commitment?
And are my intense hot flashes a result of free T3 floating around my system unable to complete their mission?
Thank you
~Jess
Hi Jess,
It depends on the situation but hot flashes can be there result of excess T3 or hyperthyroidism. They can also be related to other hormone conditions such as low estrogen or menopause. Lab tests and a thorough history are usually enough to figure out what is causing them.
Dr. Westin Childs,
I have been a “hypthyroid” patient for more than 32 years and THIS is the first I am hearing/reading anything about “thyroid hormone resistance.” I am one of those patients who does “complain” or try to communicate to my provider that I’m just ‘not feeling well – fatigued, exhausted, and frustrated due to continual weight gain after being very very careful with my diet and exercising regularly.” I’ve mentioned not understanding why “western medicine” treats symptoms instead of issues. My doctor printed an article on “Weight loss” by Mayo Clinic staff. The article suggests diet, exercise and when that alone doesn’t work maybe surgery and diet pills. I find this alarming and was offended by the suggestion to continue with “bandaids” instead of addressing the real underlying problems/issues.
My previous doctor had diagnosed with with “Hashimotos Disease – confirmed”….but my current doctor seems a little hesitant to embrace that diagnosis.
Most recently I’ve had an unusual uptick in my blood pressure. I don’t understand this and the whole reality of just not feeling 100% for awhile already; and now the BP issue has me wondering what else might be going on with me. My lab tests seem to come back ‘normal’ for TSH, Free T4 and T3 Total. Current medications are levothyroxine 112mcg 3x a week, 168mcg 4x a week, 5mcg cytomel (liothyronine) 2x a day…doctor has also suggested taking Selenium, D3, and B12 in the morning with thyroid medications.
While my lab tests show ‘normal’ my overall ‘feeling’ is still sluggish, fatigued, and frustrated with continual weight gain after super health y diet and regular exercising.
Ideas?
Thanks.
Hi Colleen,
Unfortunately, your situation is quite common among thyroid patients and the very reason my website and information exist. I would recommend reading these articles for more information to get started as they will explain your situation in more detail:
https://www.restartmed.com/normal-thyroid-levels/
https://www.restartmed.com/reasons-hypothyroid-symptoms/
I will be forever grateful that I found this article. I was not able to properly articulate to my doctors what I believe is happening to me. I am consistently met with retorts ,looks of pity, indifference and accusations of self destruction. You have given me Hope and I cannot thank you enough.
Hi Karen,
Glad you found the article helpful!
I have had a complete thyroidectomy yrs ago and my TSH is up and down never stable. I have not felt like myself for a long time. Due to cancer of the thyroid they try to keep my level at !ower end of normal. Why can’t it be stabilized?
Hi Kay,
It can be, you’re just probably seeing the wrong type of doctor: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/
Hello Doctor.
Could you please do an article about people who cannot tolerate T3 and feel better with T4 alone?
Thank you very much.
Hi Lucas,
Sure, I will add it to the list of future articles.
I’m just starting this journey as until 4 months ago I had no idea that, although my thyroid has been medicated for the past 25 years, it is likely the reason I’ve had such a low quality of life for HALF OF MY LIFE NOW. I was dx shortly before I turned 20 and have been on varying low doses of T4 the whole time. I’ve gained and lost 60-80 pounds several times over the years now, with the losses coming only at very dedicated, very low calorie ways of living. The regain has always come at nearly zero effort (). I recently found a naturopath who only uses NDT and I felt somewhat better for a few weeks, but we’re still figuring out my dose. I went full carnivore 6 months ago to try and correct some of the hormonal problems I have, and ended up gaining 40 pounds. I’m at the lowest point of my life. Out of curiosity, when are you eligible to practice again? Do you have a list of docs who share your treatment philosophy? The doc I’m seeing now is overseas and it’s a bit of a trick to get her prescriptions filled. I’d like to see someone stateside eventually.
Hi Bethany,
I believe the date is 2022 or 2023 but I have no plans on getting licensed again, at least not for now. In regards to other doctors, you can use this resource to help you find someone: https://www.restartmed.com/how-to-find-a-doctor-to-treat-your-thyroid/
Would both a high T4 and a high TSH be indicative of thyroid resistance?
Hi Sue,
Possibly, but you’d need more information/tests to confirm.
Diagnosed with chronic Migraine 2003
Got diagnosed with hypothyroidism 2013 at age 40.
Diagnosed with reverse T3 a few months after hypo diagnosis by an allergist who looked at my labs and has reverse T3.
After 4 years switched dr (not good) switched to an Endo didn’t believe in Reverse T3 decreased Cytomel to 10mcg 1x day increased Synthroid to 75mcg.
Total hysterectomy in March 2021
Estrogen patch March 2021
Nutritionist in April began pea protein shakes and tons of supplements by Natures Sunshine.
No change to Thyroid meds after hysterectomy
started taking your supplements (thyroid & weight loss management) in July 22
made appointment to see original allergist
Sept 22 saw him started tirosint 100 decreased synthroid 25mcg
Started to lose weight in Sept.
My mom semi- suddenly passed away Oct. my body reacted crazy, rashes, not sleeping, weight gain etc..
Just went off Synthroid March 8, 2023
I can’t lose weight no matter what I do. My body is holding on to everything. No sugar, no carbs, orange theory 3x a week since April 22. Drink 60-70 oz a day. Take all of your supplements plus ones from nutritionist plus Selenium and Zinc.
March 1, 2023 blood test (before going off Synthroid)
TSH <.01
Free T4 1.39
TPO <0.3
Thyroglobulin Ab<1.0
T3 Total 0.9
Any suggestions you have would be most helpful.
Julie
Hello,
I have Always felt, for the last 50+ years that My body was resistant to thyroid hormone T3 as it has always been energy low, tired All the time, all the symptoms of hypothyroidism. Finally I was put on NDT a year ago thought it would fix the problems, had great hopes, but as tired as ever. Really frustrating I feel my dose is not high enough but to get the doctors to increase my dose is an absolute battle that I keep losing. But I really feel that the resistance fits my symptoms.
I’m gonna try to figure where my metabolism is in relation to “normal average” for my age etc.
Thank you for the help in trying to figure this out.
I was dx for leaky gut years ago by a chiropractor, and have all sorts of digestive issues. Does this direct me to look for resistance???
Gratefully,
Patricia
Hi Patricia,
I wouldn’t say the fact that you have digestive issues is highly indicative of having thyroid hormone resistance but it’s still worth evaluating as I believe it’s far more common than most people realize.
Thank you for your response!!
I have a weird question…. My daughter (45) has been dx with Hashimoto disease, dx within last 6-8 years. She has very low RBC
And Dr.s want to give her iron infusion. Which I understand is very hard on one’s organs.
Can hashimoto have any connection to low RBC, low volume and small size?
Thank you for your knowledge…..
Patricia Kavanaugh
Hi Patricia,
Yes, please see this article: https://www.restartmed.com/anemia-and-hashimotos/
Dear Doctor Childs,
I’m on T3 -T4 hormones,
25 mcg T3 Liothyronin, and 125 mcg T4 Thyroxin each day.
Is it possible to take more T3, about 50 mcg per day and take the same T4?
Or reduce T4 to a minimum dose and take more than 50 mcg T3?
My doctor doesn’t have any idea if Thyroid Resistance is exists..
But I do feel worse…
This little dose of T3 did help a little, but I surely need more!
Thanks, Eszter
Hi Esther,
Yes, some people require higher doses of T3 and T3 can be taken at the same time as T4 in many cases (but not all).
Hello Dr. Childs,
I think that you are a brilliant man who actually cares about patients. Thank you for your insights and website. What would you do if you had a patient who had acquired tissue resistance (leptin, insulin, diet, sex hormones optimal) and could only lose the 10-12 pounds of water weight associated with hypothyroidism at 125 mcg of T3, BUT, had a heart rate that is too high at that dose? The patient usually had a reverse T3 of 11-15 before medication and a large thyroid nodule (23 mm). Thank you.
Sincerely,
Andrea
I definitely have heard of thyroid hormone resistance and have been trying to find a doctor who could understand that my mid-range Ft4 and barely above mid-range Ft3 and my 0.04 TSH were not necessarily telling them that I am hyperthyroid and instead might be saying my cells were not getting the hormone into them and my extremely low TSH might be saying there could be a pituitary problem. I have all the symptoms of hypothyroidism and am told there is some other reason for all of those symptoms because my blood tests say I am hyperthyroid. But, they can’t tell me what those reasons are. Today it happened again. Giving up seems like the only option at this point. Reading your thoughts makes me feel less crazy, but also makes me sad you are not still practicing. I do appreciate you trying to get info out, though.
Hi Dr. Childs,
Your entire email on thyr hormone resistance has been my opinion as to why I am suffering for almost 4 years with NO T4/T3 since 2019. It has totally taken my life from me. I am debilitated. Inexcusable……
Endo’s are clueless to this…..no excuse. They are so behind on thyroid it’s unconcionable. None of them think beyond there nose. If I as a patient can figure this out…..what does that say for them? Easier and faster money sticking w diabetes. They just don’t give a drek. Being a detective
Is too much work and they would have to actually think.
Thyroid resistance is so late being brought to the attn. of so many women who continue to suffer. And at that there is no resolve.
I don’t take thyr meds anymore as they have never provided a positive effect no matter what type, dosage or brand. I’ve always known and felt it is not reaching my cellular levels. But who was I going to talk to about this and get help??
In the interim I am taking a powdered drink to help rebalance my hypothalamus as I believe is key and the reason why my H is not communicating w my P. All those interior hormones are deficient as I have the side effects.
I did the Basel test at home, but again thou it shows there’s a problem, now what? Therefore as you stated one can try to over compensate with they’re t4/t3. Which I recently decided to do (T3) since my gut is out of whack so I’m getting half the dosage. (Back in Feb. 50 mg SR T3 only compounded twice a day. Did nothing after awhile so I stopped.) s Because I follow your emails, I recently started 100 mg twice a day for the heck of it to see it makes a diff. I don’t see how it will to as there is obviously a block somewhere. But I’m always willing to try and I never give up.
I have been healthy all my life, no priors, producing my own hormones for 66 years. I will say not one doctor has ever tested iodine which happens
to be the very reason I lost my t4/t3. I’m the only one who had it tested.
Therefore being under-treated for so long the impact on my system is HUGE.
Interesting your comment with carbs and sugar causing the resistance. Since everyone over indulges in both, why effect mostly women?
Thank you for listening and your continued informative emails.
Thou I’ve been studying the Endocrine system since day one, you are truly my bible.
Best,
Cindy
Just read thyroid resistance article.
I have hashimoto diagnosed in 2005. TPO>1000. Now 40! I was on np thyroid 90 mg in am and 60 mg pm. TSH 0.3 free t4 0.8, FT3 3.8
Reverse t3 10. Started feeling hyper and had leg swelling… want to switch to Tirosint and cytomel but cytomel gives me insomnia.
What dose is comparable to np thyroid 150mg total?
Hi Dawn,
You can learn more about converting between thyroid medications here: https://www.restartmed.com/thyroid-medication-dosage-chart/
I think low pulse rate may be another clue to thyroid hormone resistance. It is an objective measurement that I would expect to respond to increased thyroid hormone. If it doesn’t, then there is resistance.
Other acquired hormone resistance have causes. What do you suppose is causing the resistance? Knowing this would empower people to do something to make themself less resistant and fix what caused the resistance. Just as taking more insulin might help insulin resistance in the short term, doesn’t it also make a person, even more insulin resistant over time? Would this also happen, with thyroid medicine?
Hi Teri,
Low pulse rate could certainly be considered but I would personally still favor metabolism as there are many additional factors that influence pulse including your fitness level.
I think a better comparison between hormone resistance syndromes would be to compare thyroid resistance to leptin resistance as opposed to insulin resistance. The approach to treating thyroid resistance is similar to that of leptin resistance.
Hello
I’m so confused. My TSH is high but the rest is normal. I feel fine no symptoms. Should I be on meds?
Hi Carmel,
I would recommend reading this article for more information on that topic: https://www.restartmed.com/subclinical-hypothyroidism/
I wish I had found this article 10 years ago! I’ve been on thyroid meds since 1997, starting out with levothyroxine and working my way up the dosage ladder till I hit 225mcg daily with still abnormal labs and symptoms. When I mentioned to my primary that I take a pretty large dose she replied that I wasn’t absorbing the med. EXACTLY!!!!! I asked to go on NDT but was dismissed but did get a referral to an endocrinologist. She was hesitant but did put me on it. I’ve been on NP thyroid 90 mg 5 days a week and 45 mg twice a week for 4 years now. Gee, you think the patient was right? Labs and symptoms are better and more stable than they’ve been in a long time
Found out older sister has Graves and older brother has been hypothyroid for years. Grandfather had a goiter so I guess it runs in the family
Is it possible to build up a resistance to the thyroid supplements? I noticed improvement just a week after starting the Adrenal Reset, Glandular Plus, and T3 Booster and within a few weeks I felt better than I have in 10 years with more energy, little appetite and dropped 15 lbs without trying. THEN at about 6 weeks, it was the light switch flipped off. I stopped feeling good and stopped losing weight. I continued taking the supplements in hopes of the benefits returning at some point, but it’s been 8 months now with no return of the benefits.
Hi Amanda,
That’s not something that I’ve seen and I’m not sure it’s even possible. Thyroid support supplements are made up of vitamins, minerals, and botanicals, and, to my knowledge, it’s not possible to be resistant to these ingredients. Thyroid support supplements are helpful insofar as they impact thyroid function, so if you remain symptomatic despite taking them, that would indicate there’s a problem with thyroid function and not the ingredients in the supplements. It may be that you are using the wrong supplements for your body (i.e. if you found different supplements you would get a better result) or that you are focusing on your thyroid when there is another cause of your symptoms. It’s hard to know for sure but that’s how I would think about the issue.
I have the problem that my symptoms disappear 2 weeks after a dosage changement then come back after 4 weeks. Doesnt matter if T4 or NDT or if ft3 is high in range or slight over. For sadness and suicidal toughts i took antidepressant what works. For sleeping problems sleeping acid but it is only a symptom reduction. My knees and elbows pain comes and goes.
But for lack of motivation, lack of drive, lack of interest, energy to want an to do something (apathy) sitting the whole day on sofa nothing helps! Also not over 10 other medications i tried. Prednisolon, Pramipexole Wellbutrin named only a few. My heart rate is everyday up to 120!
Doesn’t it look like thyroid resistance?