Thyroid for dummies, need help

[Zarati]

I want the basics of thyroids, this is what I've gathered

so high TSH is bad, it needs to be close to 1. High means hypo, low means hyper

Free T4 and free T3 is all that matters on a blood work, now I'm confused, high Free T3 is good or bad? What about high Free T4?

 

[JOKER]

It’s not that simple. Let’s start with, show us your labs and we can go from there. High tsh is not always hypo, same, low is not always hyper.

 

[vlf23]

Not OP, but I'd appreciate some feedback. Last test (before the one below) was about a year and a half ago, had TSH right around 4 (barely in range). Thinking about trying out T4 at 50 mcg/day, thoughts?

Test Name Result Flag Reference Range Lab
TSH 2.310 NORMAL 0.450-4.500 uIU/mL 01
Thyroxine (T4) 4.3 LOW 4.5-12.0 ug/dL 01
T3 Uptake 32 NORMAL 24-39 % 01
Free Thyroxine Index 1.4 NORMAL 1.2-4.9 01
Triiodothyronine (T3) 61 LOW 71-180 ng/dL 01
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.23 NORMAL 0.82-1.77 ng/dL 01
Reverse T3, Serum 18.3 NORMAL 9.2-24.1 ng/dL 02
Triiodothyronine (T3), Free 2.9 NORMAL 2.0-4.4 pg/mL 01

 

[NattyNuts]

You have normal free T3, so what problems are you having? You have a good metabolism.

 

[Crazy_jay]

Your Functional Medicine Guide To Underlying Thyroid Dysfunctions + How To Heal - Dr. Will Cole

Your Functional Medicine Guide To Underlying Thyroid Dysfunctions + How To Heal - Thyroid Health Foods for thyroid health

drwillcole.com

Not OP, but I'd appreciate some feedback. Last test (before the one below) was about a year and a half ago, had TSH right around 4 (barely in range). Thinking about trying out T4 at 50 mcg/day, thoughts?

Test Name Result Flag Reference Range Lab
TSH 2.310 NORMAL 0.450-4.500 uIU/mL 01
Thyroxine (T4) 4.3 LOW 4.5-12.0 ug/dL 01
T3 Uptake 32 NORMAL 24-39 % 01
Free Thyroxine Index 1.4 NORMAL 1.2-4.9 01
Triiodothyronine (T3) 61 LOW 71-180 ng/dL 01
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.23 NORMAL 0.82-1.77 ng/dL 01
Reverse T3, Serum 18.3 NORMAL 9.2-24.1 ng/dL 02
Triiodothyronine (T3), Free 2.9 NORMAL 2.0-4.4 pg/mL 01

I dont your thyroid is your problem, if you're having a problem. https://drwillcole.com/why-your-lab-results-could-be-lying-about-your-thyroid-health/

 

[muscle96ss]

Not OP, but I'd appreciate some feedback. Last test (before the one below) was about a year and a half ago, had TSH right around 4 (barely in range). Thinking about trying out T4 at 50 mcg/day, thoughts?

Test Name Result Flag Reference Range Lab
TSH 2.310 NORMAL 0.450-4.500 uIU/mL 01
Thyroxine (T4) 4.3 LOW 4.5-12.0 ug/dL 01
T3 Uptake 32 NORMAL 24-39 % 01
Free Thyroxine Index 1.4 NORMAL 1.2-4.9 01
Triiodothyronine (T3) 61 LOW 71-180 ng/dL 01
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.23 NORMAL 0.82-1.77 ng/dL 01
Reverse T3, Serum 18.3 NORMAL 9.2-24.1 ng/dL 02
Triiodothyronine (T3), Free 2.9 NORMAL 2.0-4.4 pg/mL 01

Nothing stands out as being abnormal. But at the same time, you can be in the normal ranges and still need a small boost. The key really is what are your symptoms, can they be attributed to something other than thyroid, and how bad do they effect your ability to function or quality of life?

 

[nothuman]

Not OP, but I'd appreciate some feedback. Last test (before the one below) was about a year and a half ago, had TSH right around 4 (barely in range). Thinking about trying out T4 at 50 mcg/day, thoughts?

Test Name Result Flag Reference Range Lab
TSH 2.310 NORMAL 0.450-4.500 uIU/mL 01
Thyroxine (T4) 4.3 LOW 4.5-12.0 ug/dL 01
T3 Uptake 32 NORMAL 24-39 % 01
Free Thyroxine Index 1.4 NORMAL 1.2-4.9 01
Triiodothyronine (T3) 61 LOW 71-180 ng/dL 01
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.23 NORMAL 0.82-1.77 ng/dL 01
Reverse T3, Serum 18.3 NORMAL 9.2-24.1 ng/dL 02
Triiodothyronine (T3), Free 2.9 NORMAL 2.0-4.4 pg/mL 01

I've been struggling with severe symptoms and hypothyroidism is right at the thick of it. May I ask what your symptoms are?

2.9 is not a normal free T3. The "normal" ranges are garbage. You want it closer to 4 or slightly higher

FT4 is good. TSH isn't particularly useful in most cases.

Where are your antibodies? You want to make sure you don't have hashimotos (more common in women though).

Reverse T3 of 18 is high, which means T4 isn't properly converting to T3. Mine has been in the 30s and I could barely get off the couch or stand straight without wobbling around. "Not clinically relevant" my ass. People without thyroid problems love to point out it's useless, but my personal experience as well as others say otherwise. If you have brain fog, I wouldn't be surprised. If not now, you may eventually get it if left untreated.

There are multiple reasons why T3 isn't properly converting to T4. You need to have adequate levels of iron (the full panel including ferritin), selenium, D3, iodine, cortisol, Zinc, copper, and b vitamins in order for your thyroid to function optimally. One or more of these deficiencies will probably lead to thyroid problems.

Too many blood donations (please don't do these) will cause iron deficiency, which is dangerous if untreated. It's also terrible for the thyroid.

Your cortisol levels are also relevant here. I personally have low cortisol which I am treating and it's all connected. I had low iron for a long time for listening to the dangerous advice that bodybuilders parrot about needing to donate blood all the time on AAS/TRT. Yes, it can be useful in certain situations but this every two months nonsense is dangerous, as I learned the hard way.

I'm not a doctor but most endocrinologists have no idea how to treat the thyroid, sadly. A combo of T3/T4 or T3 alone would be my first option with those numbers. I used T3/T4 and my reverse T3 got worse, while the other numbers didn't change. Granted, my other co factors like cortisol weren't perfect, which prevents the medication from working properly. I'm currently on T3 only because I need to get my RT3 down since it's insanely high, in order for my FT3 to reach optimal levels. I also want my FT4 to come down, although you don't have that problem.

There is something going on in your body that is causing sub optimal thyroid. Check the co factors I listed above (for cortisol, you need a 24 hour saliva test unless you have adrenal insufficiency). You need all those things to be optimal for thyroid medication to work best.

 

[Crazy_jay]

I've been struggling with severe symptoms and hypothyroidism is right at the thick of it. May I ask what your symptoms are?

2.9 is not a normal free T3. The "normal" ranges are garbage. You want it closer to 4 or slightly higher

FT4 is good. TSH isn't particularly useful in most cases.

Where are your antibodies? You want to make sure you don't have hashimotos (more common in women though).

Reverse T3 of 18 is high, which means T4 isn't properly converting to T3. Mine has been in the 30s and I could barely get off the couch or stand straight without wobbling around. "Not clinically relevant" my ass. People without thyroid problems love to point out it's useless, but my personal experience as well as others say otherwise. If you have brain fog, I wouldn't be surprised. If not now, you may eventually get it if left untreated.

There are multiple reasons why T3 isn't properly converting to T4. You need to have adequate levels of iron (the full panel including ferritin), selenium, D3, iodine, cortisol, Zinc, copper, and b vitamins in order for your thyroid to function optimally. One or more of these deficiencies will probably lead to thyroid problems.

Too many blood donations (please don't do these) will cause iron deficiency, which is dangerous if untreated. It's also terrible for the thyroid.

Your cortisol levels are also relevant here. I personally have low cortisol which I am treating and it's all connected. I had low iron for a long time for listening to the dangerous advice that bodybuilders parrot about needing to donate blood all the time on AAS/TRT. Yes, it can be useful in certain situations but this every two months nonsense is dangerous, as I learned the hard way.

I'm not a doctor but most endocrinologists have no idea how to treat the thyroid, sadly. A combo of T3/T4 or T3 alone would be my first option with those numbers. I used T3/T4 and my reverse T3 got worse, while the other numbers didn't change. Granted, my other co factors like cortisol weren't perfect, which prevents the medication from working properly. I'm currently on T3 only because I need to get my RT3 down since it's insanely high, in order for my FT3 to reach optimal levels. I also want my FT4 to come down, although you don't have that problem.

There is something going on in your body that is causing sub optimal thyroid. Check the co factors I listed above (for cortisol, you need a 24 hour saliva test unless you have adrenal insufficiency). You need all those things to be optimal for thyroid medication to work best.

Ugh, I became iron deficient within a year of donating blood because I thought it was what I was supposed to do. I never fully got my self trt dialed in and found out months later I was iron deficient which made dialing in trt impossible. I've struggled ever since trying to figure out if the way I felt was estrogen or iron and to this day am still working on dialing it in. After years of changing things up, hashing and rehashing, think I know where I need to be. I do believe that having estrogen out of whack can mimic thyroid issues.

I've done quite a bit of research on the thyroid as I wondered if it was why I always felt off, based on my bloodwork, it definitely possible as my results were odd but as I play with my ai dose, every once in a while, I catch a day of feeling amazing. Would think if I was hypo, I'd ever feel good. Cant remember my numbers exactly, I do have the lab work saved on my phone where but, tsh was was around 2.5, free t4 was just above low and free t3 was actually high just outside range but definitely felt hypo. Think my issue is more estrogen related as I believe I am hyper sensitive to estrogen but I guess to my point, I also believe that the best way to treat hypothyroidism is with t3. We dont treat treat low t with a prohoromon, why would we treat hypothyroidism that way. One can produce plenty of t4 but have liver issues that dont properly allow the conversion of t4 to t3, causing hypothyroidism, why not avoid it altogether.

 

[fitzchivalry]

No reason to worry about reverse T3 or even test for it, imo. I was using NDT but still eventually felt horrendous on it due to the free T3 rising and free T4 lowering. Too much of an emphasis is placed on T3. I've tried it all at this point and pretty much was going to give up until I took the advice of a knowledgeable person and began to emphasize Free T4 more.

Free T4: 1.4-1.8 ideal
Free T3: mid to upper range
TSH: Doesn't matter

 

[muscle96ss]

No reason to worry about reverse T3 or even test for it, imo. I was using NDT but still eventually felt horrendous on it due to the free T3 rising and free T4 lowering. Too much of an emphasis is placed on T3. I've tried it all at this point and pretty much was going to give up until I took the advice of a knowledgeable person and began to emphasize Free T4 more.

Free T4: 1.4-1.8 ideal
Free T3: mid to upper range
TSH: Doesn't matter

Huh? Please explain your rationale?

 

[nothuman]

No reason to worry about reverse T3 or even test for it, imo. I was using NDT but still eventually felt horrendous on it due to the free T3 rising and free T4 lowering. Too much of an emphasis is placed on T3. I've tried it all at this point and pretty much was going to give up until I took the advice of a knowledgeable person and began to emphasize Free T4 more.

Free T4: 1.4-1.8 ideal
Free T3: mid to upper range
TSH: Doesn't matter

I am not quite sure where you got this info but it just highlights how misunderstood thyroid health really is when everyone reports different information.

Free T3 is what gives us energy (the gasoline). We get free T3 from free T4. If free T4 doesn’t convert properly, it turns into Reverse T3, also known as “the brakes.” It’s true that TSH doesn’t mean much.

Free T3 is the most important if have to pick favorites, but we really want to know all of them (FT3, FT4, RT3, and TPO antibodies) to get a better picture of the thyroid. Then the co factors I mentioned in the last post will explain why something is off if one doesn’t have hashimotos.

 

[fitzchivalry]

Huh? Please explain your rationale?

Clearing up the Confusion about Reverse T3: Part 2. The Role of Reverse T3 in Thyroid Assessment | ZRT Laboratory

As more health care practitioners have understood the need to assess thyroid function based on what is going on at the cellular level, there has been an increasing demand for testing of reverse T3 (rT3), a hormone sometimes referred to as the “hibernation hormone.” However, there is also much...

www.zrtlab.com

Everything You Never Needed to Know About Reverse T3 - hormonesdemystified

I’m kicking today off with a mea culpa. Last year, I published The Ultimate Guide to Thyroid Function Testing – Hypothyroidism Edition. In that post, I…

hormonesdemystified.com

Pretty sure Stewie believes the same.

 

[fitzchivalry]

I am not quite sure where you got this info

Got it from the function of the thyroid.

My point in saying that Free T3 is overemphasized was that it is looked at as almost the be all and end all to many. Free T4 has functions as well. I used to believe as you did as well until I tried them all. You do need a combo (as you stated) but in no way would I ever use T3 only. It would be a rarity to be optimal on that alone. You might feel good for a bit, but long term most will not.

You can keep doing what you are doing, and keep asking questions as you have been doing, wondering why it isn't working or try it as I did and symptoms are now resolved. If what you are doing is working then go ahead and keep doing it. T3 only was terrible for me, NDT was better in the beginning but then went to bad again longterm.

Higher T3 is linked to lowered cognition, etc. You need a balance of both.

 

[nothuman]

Got it from the function of the thyroid.

My point in saying that Free T3 is overemphasized was that it is looked at as almost the be all and end all to many. Free T4 has functions as well. I used to believe as you did as well until I tried them all. You do need a combo (as you stated) but in no way would I ever use T3 only. It would be a rarity to be optimal on that alone. You might feel good for a bit, but long term most will not.

You can keep doing what you are doing, and keep asking questions as you have been doing, wondering why it isn't working or try it as I did and symptoms are now resolved. If what you are doing is working then go ahead and keep doing it. T3 only was terrible for me, NDT was better in the beginning but then went to bad again longterm.

Higher T3 is linked to lowered cognition, etc. You need a balance of both.

LOL. I tried both T4 and NDT. My RT3 got as high as 38 as a result without any increase in FT3. If only you knew what the past few months have been like for me.

Different people need different treatments.

 

[nothuman]

Clearing up the Confusion about Reverse T3: Part 2. The Role of Reverse T3 in Thyroid Assessment | ZRT Laboratory

As more health care practitioners have understood the need to assess thyroid function based on what is going on at the cellular level, there has been an increasing demand for testing of reverse T3 (rT3), a hormone sometimes referred to as the “hibernation hormone.” However, there is also much...

www.zrtlab.com

Everything You Never Needed to Know About Reverse T3 - hormonesdemystified

I’m kicking today off with a mea culpa. Last year, I published The Ultimate Guide to Thyroid Function Testing – Hypothyroidism Edition. In that post, I…

hormonesdemystified.com

Pretty sure Stewie believes the same.

Reverse T3 is not very complicated. It increases when T4 isn't being converted properly to T3. No one is forcing anybody to get it checked, but I'd like to use a really high RT3 as a signal that something isn't quite right. All this controversy over it seems silly to me. Don't get it tested if you don't want to.

If someone posts a lab panel of 4.0 FT3, 1.3 FT4, then yea, doesn't really matter what the Reverse T3 is in that case as it will likely not be out of wack. But different people have different problems.

 

[nothuman]

Higher T3 is linked to lowered cognition, etc. You need a balance of both.

No one is advocating for high FT3. It's optimal that everyone should want, for both T3 and T4. Hypothyroid leads to cardiomyopathy and diastolic dysfunction. Hyperthyroid leads to similar problems. No one wants either.

 

[nothuman]

Got it from the function of the thyroid.

My point in saying that Free T3 is overemphasized was that it is looked at as almost the be all and end all to many. Free T4 has functions as well. I used to believe as you did as well until I tried them all. You do need a combo (as you stated) but in no way would I ever use T3 only. It would be a rarity to be optimal on that alone. You might feel good for a bit, but long term most will not.

You can keep doing what you are doing, and keep asking questions as you have been doing, wondering why it isn't working or try it as I did and symptoms are now resolved. If what you are doing is working then go ahead and keep doing it. T3 only was terrible for me, NDT was better in the beginning but then went to bad again longterm.

Higher T3 is linked to lowered cognition, etc. You need a balance of both.

One last thing. As much as it wasn't cool for you to talk to me in the manner in which you did on a personal level without knowing anything about what I have gone through, I didn't come back to this forum to argue. Petty arguments is why I stopped posting for a few months to begin with.

So I am asking you nicely not to be argumentative if you do respond. We are all trying to learn and improve here. Cheers.

 

[fitzchivalry]

One last thing. As much as it wasn't cool for you to talk to me in the manner in which you did on a personal level without knowing anything about what I have gone through, I didn't come back to this forum to argue. Petty arguments is why I stopped posting for a few months to begin with.

So I am asking you nicely not to be argumentative if you do respond. We are all trying to learn and improve here. Cheers.

You stated that you were not quite sure where I got that info like I was an idiot.

Your posts in this thread of trying to come off as an expert when you don't have it figured out for yourself would generally make one more inclined to question what they are posting as set in stone. You have given no indication of doing so.
There is not one question that you have asked in any of your posts. Generally, those looking to learn would be asking and inquiring. Not making statements of fact.

You've already contradicted yourself several times in this thread. "No one is advocating for high FT3"- You are by saying you potentially want it 4 or higher. Just one example.

The study in relation to the post I made about cognition was not even up to 4 but you didn't care enough to ask what that study was. You just assumed because you have your mind made up.

You have it figured out. There is no point in continuing further with you. Enjoy your time on STTM and making a simple process complicated.

 

[nothuman]

You stated that you were not quite sure where I got that info like I was an idiot.

Your posts in this thread of trying to come off as an expert when you don't have it figured out for yourself would generally make one more inclined to question what they are posting as set in stone. You have given no indication of doing so.
There is not one question that you have asked in any of your posts. Generally, those looking to learn would be asking and inquiring. Not making statements of fact.

You've already contradicted yourself several times in this thread. "No one is advocating for high FT3"- You are by saying you potentially want it 4 or higher. Just one example.

The study in relation to the post I made about cognition was not even up to 4 but you didn't care enough to ask what that study was. You just assumed because you have your mind made up.

You have it figured out. There is no point in continuing further with you. Enjoy your time on STTM and making a simple process complicated.

I was simply asking where you got the information you posted, and pointed out that so many conflicting opinions is why thyroid health is so misunderstood. Get the sand out of your vagina.

I also just remembered you're the same person who said something truly awful to me a few months ago which I ignored. At least I am pretty sure that it was you. I'm glad this site has an ignore button for real. Goodbye

 

[muscle96ss]

Clearing up the Confusion about Reverse T3: Part 2. The Role of Reverse T3 in Thyroid Assessment | ZRT Laboratory

As more health care practitioners have understood the need to assess thyroid function based on what is going on at the cellular level, there has been an increasing demand for testing of reverse T3 (rT3), a hormone sometimes referred to as the “hibernation hormone.” However, there is also much...

www.zrtlab.com

Everything You Never Needed to Know About Reverse T3 - hormonesdemystified

I’m kicking today off with a mea culpa. Last year, I published The Ultimate Guide to Thyroid Function Testing – Hypothyroidism Edition. In that post, I…

hormonesdemystified.com

Pretty sure Stewie believes the same.

Those links are very interesting and present a school of thought I hadn't heard or really thought of before and am appreciative. With that said, I think you an agree that having high RT3 is not something that is the norm and most likely is significant in that it is a sign that something is off. Even if we were to assume that it is harmless and does not cause any problems, its still indicative of a larger problem somewhere; irrespective of its thyroid effects. So, for me, that's why its important to have both a TSH and a RT3 along with the others(FT4, FT3, etc..). The more information you have and the more pieces of the puzzle you have, the easier it is to understand what the body is doing.