This is not really a post. I have translated Tania Sona Smith’s article, https://thyroidpatients.ca/2019/11/25/free-t3-peaks-and-valleys-in-t3-and-ndt-therapy/ , into Norwegian.  For every Norwegian page, I want there to be a corresponding English, and vice versa.

This is just a presentation of Tania’s piece. She is looking into the reseach on how Ft3 behaves after dosing with T3 containing medicine.  Actually, there is not really any good studies on the subject . There is a study on FT3 after a single dose of T3. But that is not what most people take when dosing with T3. We do multidoses. There is no study on FT3 when multidosing, but there is one on T3, that is total T3. Where I live in Denmark, we cannot have FT3 tested. The endoes have forbidden it, they claim, FT3 fluctuates too much, it cannot be trusted. How do they know? With no studies? Anyway, FT3 and T3 follow each other in most instances . With a very important exception, when we take estrogen orally. Then both T4 and T3 becomes higher and FT4 and FT3 lower. So  VERY important to have the frees tested.

Anyway, there is a study on multi dosing and T3, showing that T3 peaks app 2 hours after intake. So pretty unstable. Except of course, the peaking is very easy to predict. At least for us patients. I don’t know if the Danish endos,( and the English) have heard about the single dose experiment (Jonklaas et al, 2015) maybe, where one sees a huge peak after intake of 50 mcg T3 in one go. If that is the fluctuation that has scared the shit out of them. And then they never got around to reading  Busnardo et al’s study(1980) on total T3 and multi dosing. Even though that study has been around for 40 years.

Tania goes into all this and more.  We really need a good study on the FT3 level through the day and night. Preferably for all three T3 containing meds, Mono T3, synthetic T4/T3 and NDT.  And with differing dosing regimes. We are many today who also take a dose of T3 at bedtime, others set the alarm 2 hours before getting up, to provide T3 for the cortisol production that takes place in the early morning.  Considering how FT3 probably peaks 2 hours after dose, that is maybe not the best time to take it. Anyway, such a study would be great.

My comments on Tania’s article

I find Tania’s article interesting and informative. I don’t agree on everything though.

She writes, that the thyroid levels in healthy people vary very much.  That is not really true. Healthy people have quite a narrow window of thyroid levels. It varies between groups, young vs older, men vs women. But within these groups, the variation is quite small considering how wide they have made the normal ranges. You can read more on that here

I also think she downplays the possible danger of a low TSH.  I don’t think the science is conclusive on this. We do know that the  high levels in hyperthyroid eat our bones. We don’t know if a low TSH in itself does damage. There are conflicting findings on whether TSH in itself affects bone health.

Thyroid-stimulating hormone (TSH) may also have a direct effect on bone formation and bone resorption, mediated via the TSH receptor on osteoblast and osteoclast precursors [7,8]; this putative effect is, however, controversial, since bone loss appeared independent of TSH levels in the experiments in mice with a loss-of-function TSH receptor [9].

Douglas S Ross, Bone disease with hyperthyroidism and thyroid hormone therapy.

Tania S Smith says, TSH is  only a signal hormone. I see many in the Face books groups say this as well. It’s not just a signal hormone. It plays a role in creating Iodine symporters, the channels where Iodine is transported into the cells. That is why TSH can become elevated in the first months of starting supplementing with Iodine. There is no need to worry about that as long as the free hormones are ok.

And as you see over, TSH can also have a direct effect of bones.

All treatment and medicine have adverse effects or side effects

I believe our argument for being allowed to have a very low TSH on T3 treatment, must be one of quality of life. We know a low FT3 is dangerous for bone health. We don’t know for sure how a low TSH with FT4 and FT3 within range affects it. We have a serious illness. As with all serious illnesses, the cure will come at a cost. All sick people must live with side effects from medications. Or the fact that there are health hazards even when one takes the necessary meds. I don’t understand why the risks of our low TSH should be SUCH a big deal. I myself have osteoporosis. I have gotten it at a relatively young age. It’s not genetic. If it’s the fact that I have lived with too low FT3 or my suppressed TSH, I will never know. Maybe it’s both. But I have no choice. I do very badly on synthetic medicine, and I don’t convert much. I must have NDT. I accept my osteoporosis as a result of my hypothyroidism. What I find harder to accept, is the fact that the Danish doctors don’t keep an eye their hypothyroid patient’s bone health and heart health. All doctors need to do that, everywhere. One can prevent so much with calsium, magnesium, boron, silica, Vit D and Vit K2. Some say also collagen.



  1. Michael

    The solution is obvious to the T3 conundrum of a short half-life. Do b.i.d.

    • Liv

      Hi Michael!
      Yes, for most people dosing twice a day is absolutely necessary. Many dose 3 times or more. I swear by a dose as I go to bed. Taking only one morning dose is a very bad idea, as one then will have one’s lowest levels in the late night/early morning. When our cortisol is being produced. I know people who take their whole dose as they go to bed.

      Blessings, Liv

Leave a Reply


Theme by Anders NorénUp ↑