This is a video/podcast of my interview with Paul Robinson. Paul is the author of 3 thyroid related books and is a thyroid patient advocate.
He personally has suffered from Hashimoto’s thyroiditis but through the use of T3 thyroid medication has been able to completely recover his health.
In this interview we discuss more about T3 thyroid medication, what type of people should consider using T3 thyroid medication, how to use it, what type of dose you’ll likely need to feel better, why it’s superior to other forms of thyroid medication for most thyroid patients, the dangers (or not) of TSH suppression and what happens to your lab tests when you take T3 medication.
See the entire video below as well as the transcript:
Show notes & links from the video:
I had a great chat with Paul and would highly recommend that you check out his website/books if you are someone interested in learning more about T3 thyroid medication.
- Paul’s Website – Learn more information about Paul and his experience.
- Recovering with T3 Book
- Thyroid Patient’s Manual
- CT3M Handbook
- Losing weight with Cytomel – Cytomel is the name brand of T3 thyroid medication and is mentioned in this video.
- How to use liothyronine – Liothyronine is the generic T3 only thyroid medication available in the US and mentioned in this video.
- Sustained release T3 – SR T3 is a sustained release version of T3 which can be used for those who are sensitive to immediate release T3.
- Problems with Natural Desiccated Thyroid – NDT contains some T3 in it but may not be preferred for a number of reasons.
- List of thyroid medication by names – Helpful so you know what type of thyroid medication you are taking.
Dr. Westin Childs: Hey guys, Dr. Childs here. Today, we’re doing something a little bit different. I have with me, Paul Robinson. So Paul Robinson is a British author and he’s a thyroid patient advocate. He has personally suffered from hypothyroidism and was able to recover with the use of T3 thyroid medication, which we’re going to be talking about in detail today. Paul has authored three books, including Recovering with T3, the Ct3M Handbook, and The Thyroid Patient Manual. So Paul, welcome to the show.
Paul Robinson: Thank you very much for talking to me. It’s great.
Dr. Westin Childs: Absolutely. I’m really excited to have you here. I think we’re going to talk about some good stuff here as we were just mentioning before. So what I want to do, Paul, is could you just give us a little bit of information on your own personal thyroid journey? Your story, how you got diagnosed, that sort of thing. I want people to sort of have a background of you.
Paul Robinson: Okay. Well, I mean, I’m 63 this year. So this is a long, long time ago, in a galaxy far away, okay? A long time ago. So I was probably about 28 when I first started to have any issues. And I didn’t know I had issues, because thyroid disease, as you very well know, Dr. Childs, is very insidious. It kind of creeps up on someone with symptoms that are kind of so generally that you don’t even realize they’re going on. So for two or three years, I got more fatigued. I put weight on. I started to have difficulty remembering things and things like that. And then it got to a point where one day I just took my heart rate randomly for some reason, and it was 42. And my heart rate is normally low 80s, high 70s, so I thought, “My God, I’ve got a heart problem. I’m going to die.”
So I took myself off to my doctor straight away. It was a heart issue. I mean, everything else I didn’t even realize was a thyroid issue. No clue what the thyroid was at that point. I have a clue now, but then I didn’t have any clue. So I took myself off the doctor and 30 years ago, medicine seemed to be kind of a bit more flexible. And my family doctor, she tested a whole bunch of things. I don’t know everything she tested. She will have tested iron, B12, and stuff like that. But believe me, she tested TSH, FT4, FT3, TPO, and, Tg-anti antibodies, right? Can you believe it? These days you have to plead to get those tested.
Dr. Westin Childs: That’s abnormal for sure.
Paul Robinson: That’s abnormal. But that’s a long time ago and see, medicine’s got more money-driven and things are tighter and there’s more processes in place that stop doctors doing the right thing, in my view. Anyway. So she tested all that, and the next thing I knew is I had a… Because, she signed me off from work. I couldn’t work. Signed me off from work and she said, “I’m going to come around and see you.” So this is a house visit. So I’m off work.
And by the way, I absolutely loved my job at that point. I was the first guy in the R&D lab every day, for 5:00 AM, 6:00 AM, turning the lights on. I absolutely loved my job, so having this going on, I mean, signed off, well, it was a really huge deal for me. I hated it. So she turned up and she said, “You’ve got a thyroid problem. You have Hashimoto’s Thyroiditis. Your TSH is about 70. It should be three or four. Your FT3 and FT4 are barely registering. They’re really low. And your antibodies, 300.” TPO was 300 or something. “So you’ve basically got Hashimoto’s Thyroiditis,” And she tried to explain to me briefly what a thyroid was, what it did, and what it meant to me. And then she uttered the immortal lines, “However, I’ve got this little bottle of thyroxine, T4. You just take one of these every day and you’ll be fine.”
Dr. Westin Childs: Solved. Problem solved.
Paul Robinson: Yeah.
Dr. Westin Childs: Yeah. That sounds about right. So let’s start there then, because I know that if anybody who knows you, they know that that’s clearly not the end of your story, right, because levothyroxine, I think it’s Euthyrox is the common version in the UK, right? Is that what it’s called, Euthyrox?
Paul Robinson: I’m not sure now, to be honest. I don’t know what it was called back then, to be honest.
Dr. Westin Childs: Yeah. I don’t either, to be honest. But I do know that obviously from your story levothyroxine or Euthyrox or T4-only thyroid medication, that didn’t really help you much. So what I want to know is how you got from being incapacitated to the point where you weren’t able to work, where your doctor was writing you off that you were able to stay home, to where you’re at now, where I would consider you… And I want to hear it from your own mouth, hear what you think about this, but you’re very functional, probably up to 100% of what you would consider to be normal, at least what I’m seeing here. So how’d you go from there to here?
Paul Robinson: Well, that took me 10 years.
Dr. Westin Childs: Yeah, that’s a story. I know.
Paul Robinson: I went through multiple family doctors. I went through endocrinologists, several endocrinologists, and private ones, which I paid good money to. And every time I visited one, I was kind of getting optimistic that this is the one that will fix it. And about three years in, four years on, I went to a big Oxford bookstore called Blackwell’s and I bought about seven or eight endocrinology books, because I was so fed up with this by then. I didn’t believe anything I was being told. I knew it was a thyroid problem. I knew the medication wasn’t working, so something’s wrong. So there’s something in the research somewhere that is explaining this. So I got the books. I spent a couple of years reading them and it was pretty obvious, straight away, that my theory was that I didn’t have the same level of T3 after being on thyroxine that I had before.
And that’s likely to be the issue, because T3 is the active hormone. It’s the only one that binds the receptors in the cell nucleus. The rest of it doesn’t do that. T4 doesn’t, rT3 doesn’t, nothing binds, so it’s just T3. So I went to all these endos and said, “Look, I think I’ve got less T3 now than before, so can you give me some? And they said, “No, it’s not that. Your FT3 is in the range.” Yeah, it was low in the range, but it was in the range. And so eventually, I basically did my research, I made my mind up what I needed, and I tried to find someone who would prescribe it, and eventually, I did. I put myself on it. But by that stage, my health was completely wrecked. I had got low cortisol as well, super low cortisol.
Dr. Westin Childs: Yeah. I think we will talk about cortisol as well. But I do want to focus on just the T3 for a second here, because obviously you have a book, Recovering with T3, and a lot of thyroid patients who might be listening to this may be a little confused on that. So you did kind of briefly mention the distinction between and T4 and T3, and I just want to reiterate that, and I want you to talk a little bit more about T3 in a second here. But as Paul was saying, T3 is far more biologically active than T4 is.
And the studies that I’ve looked at, put that somewhere between 200 to 300 times more biologically active than T4. And then also, its influence on the TSH level itself is significantly more compared to T4 as well. So when you take even small amounts of T3, you’ll see a wider impact on TSH compared to T4. But most people, they don’t even know what T3 is, right? Most thyroid patients, I would say. But T3, you can give it, just like you can T4, any prescription medication. So Paul, could you talk a little bit about T3 prescription medication, perhaps such as the names that it might be known as, and then we’ll talk a little bit more about that and how you kind of can use it and your experience using it.
Paul Robinson: Yeah. Let’s do the bit of the context like you talked about as well. I mean, most thyroid patients take T4, and T4 is fine in a lot of cases, because it converts pretty well to T3. And the thyroid patients taking T4 get enough T3, in many cases, that they don’t even know anything about T3. They’re happy with the T4. It works. But the T4 itself is relatively inert. It doesn’t actually connect to the receptors inside the cell where the cell nucleus is, where all the work happens in every single cell in the body. It’s only the T3 that does that. So if the people taking T4 get enough T3, great. They’re in good shape. But if they don’t, then they’re in big trouble because they need extra T3. T3 is the active hormone.
And basically, T3 comes in all kinds of forms. You can get it within natural desiccated thyroid, because that has T4 and T3 in it. You get it in brands like Cytomel. You get it in generic brands, liothyronine. It can be taken on its own. It can be taken with T4 medications. I have a combination for those people that can’t quite manage without a little bit of extra T3. And T4/T3 combinations allow people to adjust the balance, so they can get their T3 levels up a little bit higher. So there are all sorts of possibilities there. But T4 is great. It’s great for a lot of people. But for some people, it just fails utterly to do the job, because it doesn’t generate the level of T3 that’s required. And there are lots of reasons for that.
Dr. Westin Childs: Yeah. No, absolutely. And I want to kind of goad onto that point. So a lot of people perhaps watching this, they probably fall into that category where T3 would be beneficial, because as Paul was mentioning, a lot of the people who take T4 medication who are able to convert that T4 into T3, they’re going to be probably fine right? They’re going to be feeling okay. They’re not going to have reason to be searching out information, watching videos, reading blog posts, reading books like Paul’s written, stuff like that, because they feel okay. But there is a huge number of people who do not. And so what I want to ask you, Paul, is if you’re a thyroid patient listening to this, how do you know if you’re somebody who could benefit potentially from the use of T3 medication?
Paul Robinson: Well, it’s two ways. I think the most important thing that people find is that they’ve probably been on T4 medication for a year, two years, maybe longer. I mean, it took me seven years, right, I’ve gone through this, and hopefully, people don’t have to do that as long as these days. But they’ll end up having the T4 medication cycled up in terms of dosing, they’ll then have it lowered. The doctors will be tweaking it around, looking at what changes in the labs. If they’re lucky, they’ll have FT3 tested as well. Quite often FT3 doesn’t change a lot or if it does go up, the reverse T3 level will go up with it, which is a really big issue because a lot of the T3 doesn’t get used, it gets blocked. So they’ll end up basically not feeling a huge amount of improvement regardless of what T4 dose they’re on.
That’s one big indicator. The second clue there is if someone’s got thyroid tissue that’s been destroyed, either through thyroidectomy or through Hashimoto’s, that’s gone on a long time, then they’ll have lost thyroid tissue. And if you’ve lost thyroid tissue, you’re in big problems because the thyroid contributes more T3 from conversion than any other organ, more than the liver, more than the kidneys, more than the gut, anything else. And if you’ve lost a lot of thyroid tissue, you’ve lost conversion. So that’s T3 you can’t get from T4 anymore. So, that might well mean that you would benefit. And some people lose 25%, even 40% of their conversion capability by losing the thyroid gland. If you’ve got gene defects as well, there are gene defects that impair the conversion ability from T4 to T3. So those things can be discovered and they’ll be big clues as to whether someone needs some T3. But mostly, you’ll go through this exercise of trying different T4 doses and basically, you’re left symptomatic.
Dr. Westin Childs: So you’ve got this group of people who are trying the traditional method, let’s just say the T4 method combined with testing the TSH, right? That’s what most endocrinologists and most family practice doctors are doing. You’ve been doing this for some period of time. How long do you think that would be? Six to twelve months before you say, “You know what? This isn’t working for me.” Would you say two years? How long would you give that time frame?
Paul Robinson: I wouldn’t leave it two years. Life’s too short.
Dr. Westin Childs: Oh, I agree completely. Yeah. I mean, when I was looking at this study, it was talking about the average length of time that thyroid patients have symptoms before they try to seek other help, and it’s on the order of 10 years, 5 to 10 years.
Paul Robinson: I haven’t published this yet, but I’ve got a blog post lined up exactly on this topic. I’m really passionate about this whole idea of you cannot let this go on, because there is such a lot of collateral damage to a person’s life, to their jobs, their careers, their relationships, everything. Hypothyroidism causes cardiovascular disease. It causes osteoporosis. It’s linked to cancer. You cannot let it go on. It has to get treated fast. That’s the best way to deal with it.
Dr. Westin Childs: I 100% agree with that, and I see patients, they’ll leave comments, I’m sure you get this all the time. They’ll send me emails. They’ll say, “I’m working with my doctor, they’re just not listening to me. They’re not ordering the tests.” I’m like, “Oh,” and they’ll say, “This has been going on for, whatever, 18 months.” And I’m like, “The doctor is not living in your shoes. The doctor doesn’t know what it’s like to live day-to-day like you are living. And every day that you do that, every month that you do that, heaven forbid, every year you do that, you’re missing out on a big chunk of your life, even a percentage of it.”
Paul Robinson: I’ve spoken to people that have had it for 40 or 50 years before they get on T3 and feel better.
Dr. Westin Childs: Absolutely, which is just bonkers. But this is that. So if there’s one thing you take away, hopefully, you take away a lot more than this, but do do something right away. If that means finding a new doctor, whatever it is, we’ll talk about that in a minute here. But I want to kind of stay on the topic of T3 for a second here. So Paul, let’s talk about a little bit of the safety of T3, because if a thyroid patient comes into their doctor and they say, “I’m not feeling good on levothyroxine. My T3 is low. My TSH is normal, but my T3 is still low. I think I need more T3.” Kind of like how you were saying, and your doctor, their objection is going to be something like, “No, it’s going to be harmful. We can’t do it. It’s not right. It’s not going to be as regulated as T4.” So let’s talk about the safety of T3. So give me your thoughts on that.
Paul Robinson: My thoughts on that. There’s a heck of a lot. A heck of a lot of dogmatic teaching in universities to doctors and endocrinologists that’s just finding its way out into medical practice and it mostly is complete rubbish. Absolute rubbish. The things that are linked to osteoporosis are, well, two things. Hypothyroidism, for one thing, and then proper hyperthyroidism, particularly when someone’s not on thyroid medication and they do have genuine hypothyroidism, like Grave’s disease. Yeah, sure. They’ve got self-generated FT3 levels that are too high and that can cause osteoporosis, but the biggest cause is hypothyroidism and low estrogen, to be honest, but hypothyroidism.
Heart disease, biggest issue, cardiovascular issues, are hypothyroidism again. Not T3. I mean, I’m sick. I’m sick. I’m really have heard this so many times from patients that their doctors tell them, “Oh, we can’t give you T3, you’re going to have a heart attack. We can’t give you T3, it’s going to cause osteoporosis.” And the research does not support that. It just simply doesn’t support it. T3, be it in combination with T4 or be it on its own, if it’s correctly dosed for the person and their clinical presentation improves, they have no heart rate issues, no EKG issues, no BP issues, no any issues at all, it’s the most natural thing in the world. T3 is what works inside the cells. It’s not a problem.
Dr. Westin Childs: Yeah. That always cracks me up, right?
Paul Robinson: It’s BS, basically. It’s BS. And actually, I think it’s because the doctors and the endocrinologists are just being taught that it’s just too easy for them to say it.
Dr. Westin Childs: Yeah. And so let me just sort of kind of come back to what Paul is saying here. So you’re talking basically about the two major things that an endocrinologist will say. They’ll say it’s going to cause atrial fibrillation, which is a heart-related problem, and they’ll say it will cause osteoporosis. But as Paul was saying, which I think is really important, so I want to kind of reiterate it, he’s basically saying if you dose it correctly, the risks with these two conditions are probably non-existent and if anything, probably protective against other related issues. And so that’s kind of been my sense. It’s funny, as I hear you talk, it’s like talking to myself. Maybe an older version of myself. So no, I 100% agree with that. And so I wanted to clarify that for anybody listening, because they are going to get that objection, right? It’ll be the atrial fibrillation and/or the osteoporosis, but that doesn’t have to be an issue. So what I want to do… Oh yeah, go ahead, Paul.
Paul Robinson: I’m going to say, I know people have built bone with T3, on T3-only, on high doses of T3, in fact. I know people have basically resolved their heart issues on T3. I’m sick and tired of hearing these doctors say that. It’s really not right.
Dr. Westin Childs: I agree with that. And what I’ve seen, anyways, and you mentioned this previously with the low estrogen, is when women start to develop osteoporosis and heart disease occurs around the age of menopause. It’s actually five to ten years after that. And it’s more related, in my opinion, I think to the decline in estrogen than it is to the thyroid function itself. Now what people will say though, what doctors will say is that they’re really afraid of the drop in the TSH. So I kind of mentioned this previously, and I think you did as well, is that when you take T3, I know you’re laughing. We’ll talk about that. But when you take T3, it is the case that T3 will cause the TSH to drop more than T4 will, right? I think we probably both agree with that.
And so I think what ends up happening is we have a lot of people who use T3, who end up with a TSH that’s probably on the lower end. So let’s talk a little bit about that. Are you concerned if somebody is taking T3… Actually, I want two questions here because I hear this a lot. So number one, I get the idea or I’ve got the impression from thyroid patients who believe that no matter what dose of T3 you’re taking, it will always cause TSH suppression or a low TSH. And number two, what do you think about the TSH and what role does that play in relation to the dose of T3 medication that you might be taking? So we’re kind of getting a little bit of the weeds here, but I think it’s important for anyone who’s considering using T3.
Paul Robinson: Low TSH, firstly, is not a risk. It does not matter at all. It has no impact on heart disease, osteoporosis, anything. I really couldn’t care less about TSH most of the time. The only caveat to that would be if someone is on T4 medication as well as T3, then actually TSH is involved in the regulation of conversion rate of T4 to T3. So as TSH comes down, that T4 that they’re taking will tend to go to more reverse T3 and less to FT3, in which case all you need to do is lower the T4 dose, possibly increase the T3 dose. TSH, I couldn’t care less about, frankly. And the problem we’ve got is, and I think, again, it’s a matter of money, TSH is often the only thing that doctors are testing. And it’s not relevant.
It really isn’t relevant most of the time. It’s relevant if someone’s not on thyroid meds, if they’re not a thyroid patient, because that means, yeah, if the TSH is super low, that could mean that they’ve got Grave’s, or they’ve got hypothyroidism. But once on thyroid medication, there’s absolutely clear research on this. There are several papers on this. Once on thyroid medication, TSH doesn’t matter anymore. It’s quite safe for it to be low. It’s not relevant. What is important is FT3 and the clinical presentation of the patient. Are they actually hyperthyroid? And in most cases, these people are not. And yet, and often, often, because their TSH is low, their doctor is dropping their thyroid meds and making them sicker again.
Dr. Westin Childs: Yeah, absolutely. So yeah, basically, I totally agree with that and I see this all the time. We’ll see patients who, let’s say they’re on 100 micrograms of T4, their TSH goes down to, I don’t know, 0.05, right? It’s just maybe slightly low, but not really low, and their doctor says, “You’re going hyperthyroid.” And I want to kind of come back to that point for a second, because essentially what you’ve said here is that the TSH by itself is not necessarily a proven marker of the state of hyperthyroidism, right? What Paul mentioned before is that you must have the combination of your symptoms along with the TSH level in order to ascertain what is actually happening with your thyroid status. And so with that idea, I kind of want to shift into thyroid lab testing.
We kind of mentioned this a little bit previously, but I think it’s really important to talk about. And I know something that I kind of gathered from what Paul had said previously, which I think will be a good talking point here, and that has to do with optimal thyroid lab ranges. So when we look at the, let’s call it the less conventional thyroid community, including people like me, we’ll advocate for a different set of ranges within the thyroid lab test. So we’ll say, “Okay, let’s get the TSH.” But instead of looking at the standard range of, let’s say 0.5 to 4.5, your TSH should be a 1. And then let’s look at Free T3. And in the case of Free T3, the range is, I don’t know, let’s say 2.5 to 4.5. You want to be in the top 25% of that range. So, Paul, what are your thoughts on these optimal ranges versus the normal ranges, and how does this play a role in using T3 and your experience and all of that?
Paul Robinson: Wow. Okay. Good question. Let me start with two pieces of research, and it’s in The Thyroid Patient’s Manual book, and I’m not going to be able to remember the authors and the titles just like that, but there are two pieces of research. One, it’s by a guy called Stig Larsson. I remember his name. One piece of research that’s being done that shows that you’ve got a lab range, FT3 or FT4 lab range, it’s yea big, it’s based on a population of people that they assess, right? His research shows when studying individuals, a large number of individuals, and working out what dose they need to be on and what their FT3 or FT4 level needs to be, he’s found out that, basically, most people need to be in a space within that lab range which is less than half as wide as the population range.
And that’s the only place they can be in, if they’re going to be healthy. So 38% was the figure, if I remember it, typically. And so just being in the range, somewhere in the range, doesn’t mean you’re healthy. So my analogy to that is always it’s a baseball and a barn door. You’ve got a huge barn door and you’ve got a baseball. Most doctors are really happy if that ball’s thrown and it hits the barn door. It’s in the range.
Dr. Westin Childs:Anywhere, yeah.
Paul Robinson: Anywhere in the range. Except really, the reality is there’s actually a smaller circle and chalk on that barn door, and that ball has to hit the circle. If it’s not in the circle, the patient won’t be well. So their FT3 and FT4 for them, as an individual, has to be in the right space. So having a population range is fine, but you can’t just look at the results and say, “Oh, it’s within the range, it’s okay.” But how many times do we hear that that’s what patients have been told?
Dr. Westin Childs:Yeah. Normal, right?
Paul Robinson: Countless. Yeah. Standard. So, that’s one thing. And the second thing, another piece of research, is that FT3, the FT3 lab test is the only lab test that can be done that actually tracks symptoms. It goes up as symptoms improve. It goes down as symptoms worsen. The others don’t. FT4 doesn’t. TSH doesn’t. Just FT3. And yeah, FT3 is often the test that’s not done.
Dr. Westin Childs: Right. If you’re lucky, you’ll get a free T4, TSH to free T4. And so I think that’s really important. What do you think about the role of reverse T3 in relation to free T3? Are you an advocate for getting reverse T3 testing? Do you think it plays a role to help somebody clinically determine their dose? What are your thoughts on reverse T3?
Paul Robinson: Okay. My thoughts on that T3 are really based, again, on the research and I go at everything from the science, right? That’s the way I approach it. Reverse T3 itself does very little. It’s just what T4 is converted to, to clear excess T4. Basically, the enzyme that converts T4 to reverse T3 is called D3 deiodinase. D3 deiodinase does have a very sinister effect in the cell though. In the cell, if D3 is there, the T3 hormone can’t get to the cell nucleus. It actually blocks it. So rather than reverse T3 being a blocker, it’s the D3 enzyme that’s converting T4 to reverse T3 that blocks it. So if your reverse T3 is high, it doesn’t matter what your FT3 level is. You are not going to get all of that FT3 usable.
It’s going to get blocked. So if someone’s not responding to a T4/T3 combination, it is useful to see reverse T3. Because if reverse T3 is high, then chances are that FT3 level they’ve got is not actually effective. It’s actually low, effectively lower than that. So it’s useful, but I don’t believe any FT3 to rT3 ratio or fixed numbers. I think you just have to look at the way the patients responded to T4/T3, and then check the things and see if rT3 is high, well maybe I need to reduce the T4, increase the T3, just use a bit of common sense, because I don’t think you can just look at numbers and use specific ratios with things like FT3 and rT3.
Dr. Westin Childs: Yeah. And I think that people have a tendency to focus on numbers. I noticed that when I was working in the hospital. There was an obsession with numbers and to the exclusion of how the patient is actually looking. So you have this obsession with numbers and you’re ignoring clinically what is actually happening. And clinically just means how you’re presenting, what you’re feeling. So if the person has, I don’t know, let’s say a TSH of 0.01, and a free T3 of 3.5, but they’re feeling 100%, well then that’s good for this patient. It’s like, “Okay, great. You’re doing well.”
And conversely, you could have somebody who has similar lab results, but not feel well. And so I see this tendency among thyroid patients to be like, “What did you do? Where are your labs so that I can match them.” And I haven’t seen that to be very effective. Would you say, or would you agree that thyroid lab tests, the ranges that work for people, need to be individualized at that level? Or would you say there’s some way that we can look at a range and say, “For most patients, they feel better like this, so stay away from this, or X, Y, and Z.” What do you think about that general statement?
Paul Robinson: Yeah, it’s a good question. I’ve got a tendency to think we should have different lab ranges for different types of medication.
Dr. Westin Childs:Oh, okay. I like that.
Paul Robinson: So T4 treatment maybe it should have a type of lab rage for FT4 and FT3. A T4/T3 treatment maybe should have a different lab range. And a T3-only, God, that needs a different lab range, really different lab range, which allows a much higher top level of FT3 than it is.
Dr. Westin Childs: Yeah. I have this example of my wife who takes T3-only. I think we mentioned that previously. And her free T3, when I check it sometimes, is nine or ten. And the reference range is three or four, the top end. And so I don’t get concerned at all. I check her heart rate and her heart rate’s fine. She has no hyperthyroid symptoms. I don’t get concerned about that, and I know other people do. So let’s do this though, Paul, I want to ask one more question. Let’s imagine that somebody less than new to this, they’re not doing well on levothyroxine, because that’s what they’re taking, or maybe even something like T3, a low dose. Do you have an idea of what type of range that you’ve seen in patients in terms of how much T3 they actually need?
Because I’ll see people that will get on T3. They’ll be on five micrograms. They’ll be taking 75 mics of levothyroxine and five mics of Cytomel, let’s say. And they’re like, “T3 didn’t work for me.” And whenever I hear that, I’m like, “Oh no, it’s really looking at it the wrong way.” And I know it’s hard to give dose ranges, but if somebody is listening to this, they’re may be falling in that category, what have you seen, either personally or with other people that you’ve helped, I know you’ve done some coaching or some stuff like that, what kind of range of T3 do you see most people fall into? Just a broad range here.
Paul Robinson: Well, firstly, I started working with people about 15 years ago, well before I wrote the first book, because I needed to make sure the book was not just about my protocols for me. I needed to generalize it. So I’ve worked with probably well over 1,000 people on T3 for that time. A lot-
Dr. Westin Childs:That’s a good experience, by the way, for anyone listening.
Paul Robinson:Yeah, a lot.
Dr. Westin Childs:More than your endocrinologist, by the way. A lot more.
Paul Robinson: So I’ve worked with a lot of people, and I would say it depends on what they’re doing. If they respond reasonably well to T4 and only need a little bit of adjustment, then that’s a different dose range. So in that case say, say they’re almost right with a hundred micrograms of T4. Maybe they need to come down to 80 and add 5 or 10 micrograms of T3. And then you just add it very slowly and look at the clinical presentation, maybe look at the labs a bit, but look at how the person responds. And that could be fine for them. But as you find the people that have got more serious conversion problems, they can cope with far less T4.
So they’re going to need more T3, and they could need 20, 30, 40, whatever. I don’t know. Let’s go straight to the T3 people, all right? So imagine the people that have got virtually no thyroid function, it shut down, they’ve either had a thyroidectomy or they’ve had Hashimoto’s for a long time. That’s me, by the way. And most of them fall into a category, if they really need a full replacement dose of T3 to support them, somewhere between 40 and 80 micrograms of T3. That’s a lot of T3, and most endocrinologists would freak out at that.
Dr. Westin Childs:Yeah. That’s 10 times what they’d recommend at five mics.
Paul Robinson: I take 60 micrograms of T3. I’m at 60 micrograms and I’ve been on it for 15 years. I’ve been on T3-only for 25 years now. I’m completely normal.
Dr. Westin Childs:He’s totally fine. Yeah.
Paul Robinson: I’m completely fine. I’m not a single bit hyper. My temperature’s normal. Heart rate’s normal. Everything’s completely typical, and yet I haven’t got a single molecule of FT4 in my system.
Dr. Westin Childs: Yeah. It’s just non-existent there on your lab testing. And my wife, just for reference, is on 50 mics of T3, so right around that range. And I would say most people, probably somewhere between, I think you said 40 to 80, I see probably 50 to 75, if that’s T3-only, and I’ve even seen higher. So I mean, it can kind of go over the place. But it’s important, because if you have been placed on 5 micrograms, and we’re talking 50 micrograms of maybe the low end, this is 10 times the difference between these two ranges. So if your doctor throws you on… Yeah, go ahead, Paul.
Paul Robinson: And there’s a really big problem with that as well, Dr. Childs, and that’s if they’d been put on five micrograms, and you’ve said it yourself earlier today, that five micrograms of T3 tends to suppress TSH a little bit more than T4, the TSH is basically involved in the regulation of the deiodinase enzymes that convert T4 to T3. So taking T3 is liable to make that conversion rate of T4 worse. So chances are, they could even be worse on five micrograms of T3 with the levo. The endos should be looking at, “Okay, well, we’re going to need to drop that levo and we’re going to need to really get that T3 up.” And it might only mean getting up to 10 or 20 micrograms, but that could be the thing that gets the person from feeling absolutely crappy to feeling great, and they don’t do it.
Dr. Westin Childs: And that’s what matters, right? At the end of the day, it’s getting thyroid patients to feel better, and I think you and I are both very passionate about that. Well, we have kind of reached our time limit here, but I’ve had a really good time talking with you, Paul. I’m really glad that we could get together and do this, and I’d love to do it again, because I think we still have so much more to talk about. What I’d like to do though, Paul, is if you could tell people where can they find out more about you, how can they purchase your books, because this is really just the tip of the iceberg here. We have brushed over topics that we could talk about for hours each. So tell us a little bit more about how people can get in contact with you, or read your information and whatnot.
Paul Robinson: Okay. Well, I’d recommend starting with my website really, and my website’s called paulrobinsonthyroid.com, and it’s a really easy to use website. It’s very searchable and there’s a great blog there and there’s a little spyglass in the top and they can search for any topics. That’s just a great open place to start looking. My books are available on any internet bookseller, including Amazon. And the best book to start with probably is my more general one, called The Thyroid Patient’s Manual. And that covers lots of things, includes all the different treatments, T4, T4/T3, natural desiccated thyroid, and T3 treatment. Not in as much detail as they would need it. We’re really going to set their hearts in going T3 only, but it’s a great book to start with. And I’d probably start with those two, to be honest.
Dr. Westin Childs: Okay. What I’ll do is I’ll put the links to those books on Amazon, and then the link to your blog so that people can get to those real easily. So those will be down in the description below, if you guys want to do that. And so check out Paul’s blog and we’re really excited to have him here and we’ll have to do this again. So if you enjoyed this conversation, let me know below, and otherwise, that’s all I got for you guys today. So thanks, Paul.
Paul Robinson: Thank you very much.