This is where I answer questions from you. If you want my input on your labs, please look under “Contact” for my mail address and what I need of info from you. I need good info to be able to give good answers. Remember to cover name and birth date on your lab papers. You must  always confer with your doctor. I can only share what I would have done in a similar situation. 

Hashimotos without Anti-TPO?

6th of March 2021

Hi Liv,
I just read your story. Thank you for being brave and publishing your story!!!
I go to doctors only for diagnosis, tests and referrals when such are required for insurance. I scrutinise and read and double-check everything they say when I can and have time. Because they just don’t care if they screw your life while following “protocols”.
I had subclinical hypothyroidism in my first and second pregnancy and I fought with doctors not to get levothyroxine because I felt great in both pregnancies (no nausea et al, just a bit more tired) and because the published studies don’t support medications for my levels. And my two babies are all good and healthy. And also, because I have read some people need time to get used to the side effects of the medication over time, if they can get used to it.
But now 6 months after the second baby my TSH jumped from 4 to 50. So I got a bit panicked and started searching for possible causes, vitamin and mineral deficiencies, that is how I happened upon your blog.
I was severely sleep deprived for almost a month now and I have naturally low functioning thyroid. In my pregnancies I did the anti-TPO and it was always negative. And in my second pregnancy I had a spike of TSH to 8 after a sleepless week. So I think when I am sleep deprived TSH spikes to keep me awake. After this test, I immediately started on Magnesium, Selenium and Zinc on top of the usual Iodine. The vitamin tests are expensive (not very, but not in my budget right now), but my diet has been poor and I suspect a deficiency.
I will have another test in one week or two weeks time to check for all the thyroid markers, not just the TSH and I will think what to do next. I would like to have one more baby one year from now so I know my thyroid hormones have to be in check by then.
I also now (after reading your blog) suspect that my mom has had low level myxedema, or how you call it 1/2 myxedema. She has had her legs swollen and it looks like in the pictures. She could never figure it out why. And my grandmother who passed away I also suspect had myxedema. I learned of the term from your blog. So now I suspect that we have naturally low functioning thyroid. So when we are stressed, overworked, and deficient in minerals and vitamins from a poor diet our body naturally gives up. 
I will read what you have on the blog too!!
Many thanks and I wish you have a great and peaceful time ahead! So happy you found a good doctor. That is so rare!
Sending good thoughts from Moldova!!!!

Hi A!

So nice to hear from Moldova. I have never been there, but my brother has many times, as he lives part time in the Ukraine. 

I don’t actually think there is such a thing as naturally low thyroid. Low thyroid is hypo thyroid. Healthy people have quite similar levels. Women have a little lower FT3 and young people have a little higher levels than older people. I hope you will look at my post on optimal levels. There you will see what are normal levels, based on 3800 healthy people,  Optimal thyroid levels.

The “normal” ranges are not normal at all.  I hope you will note these ranges and compare with the labs you will have shortly. I believe your FT4 will be way too low with a TSH of 50. I don’t think resisting taking thyroid meds is a good idea. Every day we have a low FT3 damages us. A ft3 much under 4,5 pmol/L is not a normal FT3. If they use other units in Moldova, you can find a units converter on the net.  

So take meds if your levels are lower than  FT4 around 40% or range and FT3 around midrange. A normal TSH is around 2 for a young person, 1,5 for a grown up. 

The myth that one’s own thyroid stops producing hormones when one takes meds, is just a myth. You can continue to try to improve your own thyroid with Iodine and supplements. Remember that iron and magnesium are also very important. If your thyroid then starts producing more, or you convert better , you can decrease the medicine dose. 

Many do not have side effects from T4 meds. And there are different meds you can try out. I think you must have some alternatives also in Moldova. If you don’t feel good on them, after giving them a chance, you could try NDT. If it’s difficult to get that in Moldova, you could buy Thai thyroid meds. See my post on meds, Our thyroid medicines. But do give the T4 meds a chance. You might do well on them. I am sure you need meds with a TSH of 50. And read under optimal levels what are good levels when taking T4 medicine. 

Myxedema is really when one is very, very sick and hypothyroid. It will be difficult to function. 

I suspect you and your mother both have autoimmune thyrioditis. It is typical that it blossoms during and after pregnancy.  And for many, it will become a chronic condition. 90% of people with Hashimotos have Anti-TPO. So 10% do not.  Anti-TPO and Anti TG are the two main Hashimotos antibodies. I would urge you to have TG or Anti TG tested. That is thyroglobulin or Anti  thyroglobulin. If you have one of those over range, there is damage to the gland. You can read more about these tests here, for the thyroid newbie  . There are also people who have Hashimotos who don’t have antibodies at all.  This is a study on it, You see, that some patients have no antibodies. But when one looks at their glands with ultrasound, there is damage to it. These people have a milder form of Hashimotos., writes, that antibodies destroy the gland.  That is not correct.  It’s mainly b and t lymphocytes that cause the destruction. So you can have damage done by b and t lymphycytes to your gland even though you don’t have anti bodies.

I don’t know if you can have an ultrasound in Moldova. But both you and your mother should have one. I suspect your mother also needs thyroid meds. 

I hope this helps you. Iodine deficiency is a main contributor to hypo thyroidisme, also Hashimotos. So Iodine is VERY important. The 150 recommended mcg is too little. Testing iodine must be done in urine, not blood.  You are maybe at a disadvantage, living in Moldova.  When it comes to testing. But you are awake and aware, so I am sure you will do ok. 

Blessings Liv

Nr.2: W/41 Iodine deficiency?


I came across your blog as I am trying to get my head around my thyroid issue.
I have been suffering from the symptoms of hypothyroidism for 7 years and have never taken NDT but have decided to try to research and find out about it as other diets/ supplements are not improving things .
Would you be able to read my bloods and recommend? It would be really appreciated as I feel very lost .. I am happy for you to put this on the blog – if it helps others too 
My bloods were done at 8.30am and I am female (41)
my symptoms are inability to lose weight – I am on a very restrictive diet , tiredness , hair loss, dry skin, amongst others things

My reply:

Hi R!

I told you to please have a look at my post on optimal levels, here, in order to see what are NORMAL levels. If you have, I am sure you have seen that your levels are not very low. BUT your TSH is a bit high and your FT4 is a bit low. You don’t have Hashimotos, as neither Anti-TPO nor Anti-TG are over reference. Though I have just read a study saying, some few people have AIDT without antibodies. But it is quite seldom. I don’t think this is the case with you. It’s very good news that you don’t have antibodies. 

Instead I believe you suffer from iodine deficiency. Unfortunately, you forgot to answer my question about whether you  supplement iodine or not. But I don’t think you do. Iodine deficiency is the main reason for AIDT. but it can take a long time to get to there. I hope you will read my post Iodine for beginners. It’s a good thing to test for iodine deficiency. A 24 hours urine test would be best, next best a urine spot test. Serum is no good. But read up on iodine and symptoms, and see what you think. Your FT4 should be around 40% of range, and your FT3 could be a little higher. If I am right, the iodine def would give symptoms in itself, as well as making your thyroid levels a little low. I actually had very dry skin, very brittle nails, did not sweat, pale, very tired in the upper back, having fibromas in breasts and uterus even though I had optimal thyroid levels. Some people claim, iodine deficiency symptoms are just thyroid deficiency symptoms. These people must believe, that the thyroid is the only organ in the body that needs iodine. This is not the case. 

The other issue I want to address, is your very restricted diet. If this means, calorie restricted, this is the worst thing you can do. The body will go into save modus. In the first couple of weeks, the body produces a lot of reverse T3 .  This is to get FT3 down to save on energy. That normalizes, but FT3 will stay low.  A low carb diet will be much better for you, I think. I like Kris Kresser on this. Have a look at his blog.

You ask about NDT. In general, if you feel my iodine theory are correct, I would give that a few months, and test my thyroid levels again and see. If the TSH then still is a little elevated, then try a little T4 medicine and see if that helps. But don’t stop the iodine! You really don’t need medicine that contain T3, you convert very well. It is at 0,32. That is a very healthy conversion. Some people, myself included, have side effects from the synthetic T4 meds. But don’t worry about that before it happens. If you don’t like the most co.mmon T4 meds, you can try Tirosint But one step at a time.

You need some B12 and folate. B12 can be at 1000. Mine is. Both of these are very important for iron uptake. Your Vit D could be higher, as could your ferritin. I am not a believer of very high ferritin though. But if you menstruate, it should be higher than this, Iron is actually very important for the thyroid function as well. Your selenium needs to be high, it can actually be a little over reference, at 3 ng/dl say some Norwegian scientists.  3,5 ng/dl is toxic. Your zinc also needs to be good. So a restricted diet is NOT a good idea.

I hope this helps you,

Blessings, Liv

Nr 3: Fatigue on high dose iodine

Hi Liv,

I hope you are enjoying your weekend. I have been relying on your blog over the last few weeks to help get some direction on my healing journey.

I’m a 29yo male from the UK who fell chronically ill 5 years ago. It started with IBS like symptoms and led to crippling fatigue. Since then I’ve tried numerous different things to varying degrees of success.

Six weeks ago I started taking iodine as I saw others online had benefited in terms of fatigue. It has been a miraculous few weeks that has unfortunately started to lose its magic.

At the beginning I felt great and only starts on 1-2mg lugols iodine. I went straight back to the gym and energy only improved. I then worked my way up to 8-10mg daily before exercising and this felt like the optimal level.

More recently I’ve had crippling fatigue again where I’m unable to finish a workout and just want to sit about all day.

I’m writing to you to see if you had any insight into what may be happening. I’m exhausted and irritable/angry all the time.

Granted it may not be the iodine, but I haven’t introduced anything else over that time period and it seems like the likely culprit.

I will be honest I have no done any testing and I know you firmly advocate for that. It’s kind of tricky here in the UK as my doctor doesn’t seem keen on doing a blood test because I’m choosing to take iodine, so I’m totally in the dark. I eat a lot of meat (high selenium) and sometimes brazil nuts but most foods are a problem for me due to my illness.

I also supplement magnesium, but nothing else in relation to the protocol. Again, this is mostly due to having reactions to different vitamins due to gut issues.

Undoubtedly you will tell me to get tested and take all supplements in the protocol, but still I wanted to pick your brains and see if you had come across others who it helped at first and then maybe caused fatigue.

Your thoughts/insights would be greatly appreciated.

Thanks in advance

My reply

Hi L!

You are right about that, I will tell you to test. I think it is foolhardy to start high dose iodine without testing. If you don’t, you will never know what is what if there are thyroid issues. 

I don’t think you need to tell a doctor like that, that you are taking iodine. A doctor should see to a patients health. Not run a campaign. But you have a lot of online labs in the UK. It costs a little money, but I hope you can afford it. Your UK doctor will probably not test your FT3 anyway, as a lot of doctors there don’t. UK and Denmark, where I live, are among the worst countries when it comes to thyroid issues. You really need a thyroid test. You have been tired for 5 years, and low thyroid is one major cause of fatigue. You can read here what are normal thyroid levels, look at the numbers for younger people,  Optimal thyroid levels Younger people have a little higher thyroid levels. If you take such a home test, be sure to do it before 9AM, as TSH becomes lower after that time.  Do not massage the finger after you have pricked it, as this will destroy the sample. Let the blood drip into the vial. Get the large thyroid test the first time, which need to include anti-TPO and anti-TG. 

If you cannot afford a test, many are struggling  these days,  take your temperature and pulse. Actually, these are the best indicators. But you do need to test for antibodies. If your temp is under 37 C in the middle of the day, your levels are too low. If your pulse is also low, then you are hypo for sure. Athletes can have a low resting pulse.  But not the rest of us. The post FOR THE THYROID NEWBIE is a good introduction to thyroid issues, and why and what one needs to test.

Now to your question, I had the same issue. I became terribly tired after a few months, so tired as to HAVE to lie down. People in the Iodine protocol group helped me, they told me, it was my adrenals. And it must have been, because when I stopped the iodine, I felt better. I stopped for a few days, and then started up on a low dose. I believe it was 2,5 mg.  Some days I took nothing. I gradually built up to 25 mg, backing down whenever I felt the tiredness coming on. I stayed on  25 mg for a few months, maybe 6. Then I felt my weak kidney starting to hurt. And I have now been taking “only” 2 mg for months. 

So it can be your adrenals, or it can be your thyroid levels that have come down. If you feel totally tired, very foggy, then I believe it’s the adrenals. If you feel more general fatigues, it could be your thyroid levels.   Iodine can actually lower thyroid levels. It has for me. I have had to increase my medicine dose. And I have seen it in other people in the groups, plus it is well know in the literature. I find it strange, that Dr. Brownstein does not address this in his iodine book. He must have come across it.  

So reduce your iodine dose, and go by how you feel. Test your thyroid levels. As you have been sick for 5 years, I think that either you are hypo thyroid or your cortisol is low. You should also check your testosterone. Gut issues can be connected to iodine deficiency, as we get low stomach acid when we are iodine def. And low acid is often the start of digestive issues. Digestive issues and auto immune thyroid disease are also connected. 

When there is fatigue, fibromyalgia can also be a possibility. Just keep it in mind if everything else is normal. LDN is great for fatigue. If thyroid levels are good, and one is still tired. Men also get fibro. I have a post on LDN as well.

I won’t be telling you you need to supplement with this and that. I don’t think you would listen even if I did. I think you need to find out what is really ailing you. And then take it from there. You are not well. A young man should not be so tired. There is something wrong. I don’t think taking iodine will solve everything. As you have a thyroid, it can be better to start low. If your doctor does not take you seriously, get another one. If you have been tired for 5 years, and the doctor has not tested thyroid levels or cortisol or testosterone, he is incompetent. 

I hope this helps. And that you get help and that you figure out what’s the matter. 


Blessings, Liv

Nr.4: W, 53. Feeling hyper despite low levels

Hi Liv,

I recently came across your site/blog and it is very informative. So refreshing as compared to STTM who I find very dogmatic without any real science behind them.

I’m very puzzled with my latest blood tests which don’t match my symptoms. The doctor who I use for hormone (BHRT) and thyroid meds after seeing these results says my meds aren’t working and I have to switch. That seems a sweeping statement and in general I don’t really trust him to give me the best advice and protocol.

Here’s all the info. Hope you can offer some insights.

I’m 53 years old. Post menopause. Live in Israel.
I Have had Hashimoto’s for 24 years. Took Synthroid for 20 plus years. Been on Naturethroid NDT for the last few years.
My protocol before doing this latest blood test was:

3 1/2 grains Naturethroid NDT.
In Israel we were able to get what I believe was a private label of NT called BioThyroid for some time after they stopped producing NT in the U.S. Several months ago they also stopped manufacturing the BioThyroid but I was able to stock up for the next few months.

Since I know sex hormones could affect thyroid, including those too.

2 1/2 Evorel 50 Estradiol patches twice per week
1/2 applicator 8% Crionone Progesterone daily
7 mg Testosterone cream daily
3 mg Melatonin nightly

I have recently been feeling hyperthyroid. Racing heart, high blood pressure, weight loss, trouble sleeping, waking up hot. But according to my results the FT3 is on the low side and FT4 below range.

There is no RT3 blood test available in Israel.

TSH – under 0.03. They don’t give a specific number when it’s that low. I always get the same result.
FT4 – 9.7 pmol/l (range 11.5-22.7)
FT3 – 4.8 pmol/l (range 3.5-6.5)
TPO – (last checked Sept 2021) over 1300 (they don’t give a specific number above that). It’s always this result.
Iron 118 micg/dl (range 60-180)
Ferritin – 37 ng/ml (range 10-120)

B12 and Vit D they will only test every 3 years. These are the last results as of June 2020. I supplement both.
B12 – 477 pg/ml (range 211-911)
Vit D – 48 ng/ml

FSH – 11.5 lU/l
E2 – 501 pmol/l
Progesterone – 28.6 nmol/l
Testosterone (as of Nov. 2021) 8.2 nmol/l

I lowered my NDT dose yesterday by half a grain to 3 grains. I always divide the total dose up to twice per day. Starting to feel better. Less heart racing and normal blood pressure.

Hope I didn’t overload you with too much info.

What would you suggest?


My reply:

Hi C!

There are many thyroid blogs, some good and some , not so good. STTM has had a big impact, good and bad. What I don’t like about what she is doing, is that she is spreading fear and worry. She has misunderstood the role of revese T3 and made a whole lot of people stressed about it. You can read my take on it here. You for one, probably have no RT3 issue, as your FT4 is so low. 

She is also spreading worry about NDT, and don’t seem to know the standards for NDT. I have two posts on that topic,  HAS NDT GONE BAD? and Quality of NDT

It’s good that you have included a lot of info, otherwise it’s difficult for me to give a good answer. There is one bit of info missing though, how long since last dose blood was drawn. I suspect you have gone too long medicine fasting before labs, and that FT3 for that reason looks lower than it actually is. 12 to 13 hours is the proper interval for someone taking meds with T3.  The half life of T3 is 24 hours.   You can read more about how T3 behaves here,  FT3 UPS AND DOWNS IN T3 THERAPY  

If  it hasn’t been too long before labs, you just have to go by blood pressure, pulse and temperature. Those are the best measurements, and what I myself rely on. I do take blood tests, but dose after my vitals.  I do think, people need to have FT3 at at least 5,5 pmol/L when taking T3 containing meds. I need it at 6, and many need higher than that. The doctors comment is just BS. There is nothing wrong with the medicine, it’s a dosage issue. Dividing in two is also too little for most people. I divide in 3, and I take my last dose as I go to bed. You get a higher FT3 peak the larger the dose. But read the post. 

The FT4 does not matter that much, as  long as your FT3 is ok. Some say, one can get a bit tired if FT4 is very low, but I don’t know. I have had as low FT4 myself. 

Cortisol issues can also cause difficulties with tolerarting a high FT3. I am not saying you have that, just mentioning it. 

Your Vit D is way too low on that test, needs to be at least 70. I go for 100. We don’t synthesize vit D like other people, and need higher levels. Your vit B12 could be 1000, and you need to take folate as well. Imortant for iron absorbtion. Because your ferritin is too low. Low ferritin can make it difficult to tolerate a high FT3. Some say it needs to be at 70, but I think maybe 50 is enough for us who don’t menstruate. I have read, that thyroid patients have felt much better with a higher ferritin. Must not become very high, of course.   

Magnesium and Vit K2 and healthy levels of progestrone are important for calming the heart. We women often have a strong or rapid heart beat. 

Those are high antibodies after so many years. You should really try to bring them down. Gluten is no no for us. Check if you have a leaky gut and check for food intolerances. Selenium is very important in this, and you can take as much as 300 mcg. I have a comment on new info on selenium here. 

Your hormone levels seem way too high to me. We don’t have those units for estradiol, so look at the ranges yourself. But the progesterone and testestorone are both way over our ranges in Norway. For prosterone and testosterone both, our refernce is under 3 nmol/L for post menopausal women.  As far as I know, max dose for T for women, is 5 mg/day.  It’s very important to use natural progesterone, I write about that here.

As far as I know, one can get NT again now. You find other options here Our thyroid medicines. 

I hope this will help you. 

Blessings, Liv


Nr 5: S, male, 44 years old. Iodine deficiency and low thyroid levels


Good morning Liv,


I hope this email finds you well.


I’m hoping you may have some insight or advice on my bloodwork results since I’ve started taking iodine earlier this year (2022). Here’s the info you requested:


I’m a 44 year old male.


All blood work was done first thing in the morning, between 8-8:45AM (all results attached – dates of tests at the top of each report)


I’ve never taken thyroid meds


I’ve dosed iodine in varying amounts, most recently (the past three months) I’ve been on 1 drop of Lugols 2%, 5 days a week (Monday to Friday) and I take a break from it Sat/Sun.


I started taking iodine to try and help with the tinnitus I developed in 2020, as well I used to experience random fight or flight type panic attacks where my heart would start racing for little reason. After much research, including reading your blog, I decided to give iodine a go. I find iodine has helped calm me down in general, and I don’t recall the last time I had a panic attack since I started on it. 


A brief history… I did the 24hour iodine urine collection test in Dec 2021 (attached), which indicated I was deficient so I started iodine low and slow on February 26th, 2022, AFTER the first set of thyroid test results from January (attached). Before starting iodine, I salt loaded, I took Magnesium for a full year, found a good B complex, changed diet, started using near infrared light, exercise, etc. etc. I started with 396 mcg kelp supplements mid-Feb and gradually increased (doubled) the dose each week, then graduated to 2% Lugols drops, slowly worked my way up to 5 drops (12.5mg) where I remained constant with my daily dose through the first week of July. Pre-July I did noy take selenium every day, in fact I rarely supplemented it. Based on my lab results in January, with Selenium being in the good range, I figured I get enough from my diet that I don’t need to supplement. Occasionally I took 30 mcg of a liquid selenium drop in the morning, but very rarely, maybe once or twice a week. I find I start to lose more hair when I take selenium. During the 2nd week in July I started backing off of my 12.5mg dose, because I started to experience a noticeable tightness in my throat, most noticeable when I’d swallow, in the vicinity of my Adam’s apple. There was no significant additional physical difficulty when swallowing. It felt like a sore throat similar to what one would get at the onset of a cold, however not as pronounced. Anyway it spooked me enough when I got my 2nd thyroid test results back (attached) in June and noticed my TPO antibodies had gone up, that I gradually backed off my dose to 1 drop of 2% 5 days a week, and added taking a 200mcg of selenium once every 7-10 days. I also got my second iodine level test back in July which was a representation of my iodine levels when I was taking 12.5 mg seven days a week. To me it seemed my iodine levels were way too high and I figured it meant my body wasn’t using it or didn’t need it.


My third set of results (attached) from October 17 show my TPO antibodies have gone down, which is good, however my TSH and Thyroglobulin have been on a steady decline since my pre-iodine tests, and I’m not sure if I should be concerned? 

When I was taking 12.5mg per day, I did notice much more energy and I’d wake up feeling fully rested and ready to go. Now, after three months at 2.5% I don’t feel the same energy, I don’t feel exhausted by any means, but I do notice sometimes I’ll feel sleepier when sitting on the couch in the evening, as early as 9PM. 

I’d love to hear your thoughts on my situation. Please let me know if there’s any other details I could provide which would help you better assess my situation.

I look forward to hearing from you.

Kind regards,

My reply

Hi S!

Thanks for providing me with the info I need. And I love that men are taking care of their health.

It doesn’t look like you have an AITD. But you can get one. Look at my post on anti-TG, Antibodies, part 2, Anti-thyroglobulin for more info on this antibody and iodine. Thyroglobulin coming down is only good. It’s normal to have a little anti-TPO and anti-TG. You find info on that on my antibodies posts.

I would say you have been, and probably still are, hypothyroid. Men have higher FT3 levels than women, you can see that here Optimal thyroid levels. I would say yours is still a little low, and it was quite low. Iodine has increased your thyroid hormone production, and will hopefully increase your levels more. You convert very well; T4 to T3. It’s the production that is the problem. If your FT4 level doesn’t  increase, I think you should take a small dose of Levo. Take your body temperatur, rectally in the middle of the day. Should be 37 C/98,6 F.

Yes, your TSH is a little low. It was better if it was a little higher. TSH increases as the body tells the pituary, I need more hormone. I can’t explain the relatively low TSH. But there is individual variation, and it’s not very low. You are not hyper, so it has nothing to do with that . Black people have lower TSH than white people. 

I  suspect your hair loss is more to do with low thyroid levels than selenium. It’s only at toxic levels that selenium causes hair loss. Though I can’t say your are not right. I hope you look at my comment on selenium here, odds-and-ends I think you should take way more selenium, your levels are low. Selenium is very important for hormone production and for protection of the gland against autoimmunity.

Your panic attacks probably stemmed from a low FT3. Tinnitus is common in both hypo and hyper thyroid. The sensations in your throat could very well be a goiter. In the iodine groups and in Dr Brownstein’s book, it is claimed, that this swelling is the iodine soaking up iodine after being deficient. And that it will come down again. That may be, but many also get a goiter permanently.  the increase in anti-TG at higher doses is also an alarm clock. I would stay at your current dose for now, and then maybe increasing again after a while. Better safe than sorry, that’s my motto when it comes to iodine. I love iodine, but I see people damaging themselves with too high doses too fast. Some people should never do many mgs.

The body never utilize many mgs. It will be excreted, and this can be hard on the kidneys. The rationale behind  taking very large doses, is to detox other halides. And the iodine doctors claim that the Japanese get 12,5 mg/day. But they don’t.  I have studies on this on the Protocol post, scroll to the Japanese flag. They get between 1 and 3 mg, not 12,5.  On my Nerds post I have several newer studies, and some important iodine scientists say we need between 1 and 3 mg molecular iodine. Lugol’s contain both iodide and molecular iodine.    

So in short, I think you are on the right track. Be aware that both men and women who suffer from hypothyroidism have lower testosterone levels than other people. Maybe check your levels. I write about that here, Male hormones

Best of luck, Liv

Nr.6: Woman, 54 hypothyroid and has lupus. Anxiety.

Hi Liv,
I am writing you today because I have received comments from you on my posts to Tania’s Canadian Thyroid Group on Facebook and I also enjoy your blog.   I have been struggling with NDT and/or combo therapy for years and just don’t seem to get anywhere near feeling optimal.  
My latest labs are crazy and just make things even more complicated.  
I suffer from a lot of anxiety and that was under control, and I felt so calm and grounded with the 5/21 and the 11/22 T4 at 30% or lower, but as soon as I add more T3 my FT4 increases, and I feel unwell.  I didn’t feel terrible on 88/6.25 but I was still hypo just without anxiety.  After playing around with higher T4 doses and higher T3 doses, I tried to recreate that with 94/6.25 and it worked for a while.  I had the productive calm feeling of low T4 but my T3 kept dropping and I ended up a cold and depressed emotional mess.  More T3 with the T4 doses I tried thus far brings stress, constipation, headaches, OCD, back pain etc.
I’ve also tried NDT twice.  The first time was the most successful. It was Naturethroid about 4 years ago when they were recalled.  I took 90 mcgs and did well for about 4 months. I think it was the lower T4 that made it feel so good at first. 
My labs on NatureThroid (and these labs were not done properly – back then I didn’t know to wait 12-13 hours after dosing or to even split my dose) 
1 1/2 grains
.85 TSH
2.81 FT3 (2.5-4.3)
.8     FT4  (.8-1.7) 
4.32 TSH
3.47  FT3
.8     FT4  
I also did a brief trial with Armour with the same results.  It seems that I cannot increase NDT without having bad reactions to that much T3 and my TSH seems to be ruled by T4 because both times it increased. 
I am a 54 year old female, already through menopause.  I don’t take any supplements because they all make me feel terrible.  
My Doc did run my Anti-thyroid Peroxidase last year and it was 14.5 (0 – 33).  I had my thyroid removed 16 years ago because of a large goiter and Hashimotos.  I have positive ANA and many lupus markers including Antiphospholipid Syndrome.  
I hope I have included all of the info you need.  All of my labs on the attached document are done correctly 12 hours after last dose.
If you have any thoughts about my situation, I would be very grateful for your input.
Thank you so much,

My reply

Hi K!

There are many numbers and a lot of info. To people reading this, K has sent me 2 more mails. I will refer to them. 

I think you are underdosed all along. Your FT3 from November is very low for combination teraphy. For European readers, it’s 4.5 pmol/L.  When it’s 3.5 pg/ml, that is 5.4 mol/L. I think this is too low. You do need T3 medicine, you convert very poorly. From your numbers on T4 mono, I have calculated your conversion ratio to 0.20, which is low. And I think with such a low CR, you at the very least need FT3 at 3.6 pg/ml. I need it at 3.9 pg/ml or 6 pmol/L. Other need it higher.

You write that you don’t react adversly to T3 in the normal sence, as you don’t have heart palpitations and so on. Well, that is because you are never hyper, you are rather hypo. It’s difficult to understand what is really the problem here. The fact that you are always hypo makes it difficult to know if THAT  isn’t the problem. Constipation is a hypo symptom. I find it strange that adding T3 should increase your FT4. And that should make you feel so bad. I think your FT4 is quite good, at mid range. You just need more T3 in my view. You say, it’s not good for you when FT4 is too high. I wonder if it’s the synthetic meds that are not good for you. I know I can’t take the synthetic thyroid meds. You write me, that you can’t do T3 mono. So i won’t suggest that.

I think having reverse T3 tested would be a good idea here. You have had a high FT4 and low FT3 when on T4 meds only. You could very well have a too high RT3. And that could cause problems. If your Ft3 had been higher after you started on T4/T3, I wouldn’t suspect it to be a problem. But your Ft3 has been low also on combination theraphy. The treatment for a high RT3 would be a higher FT3. Some people even take only T3 for a few days, in the hope to flush it out.   

You are taking a very low dose for someone without a gland. I think you should try NDT again. And take a larger dose. 90 mg is very little. I would think you need at least 120 mg. I think you should not give up on NDT , but give it a real chance, tweaking the dose. 

As for fluctuating thyroid levels, I have had this from day 1. One just has to accept it, and work with it. I do that by following my temperature and pulse, tweaking often.  The less of a problem you make it, the less of a problem it will be. The temperature needs to be 98.6 F in the daytime, 37 C. I need it to be at least 97.7F, 36.6 C,  first thing in the morning. I don’t believe those saying, it’s normal to have a sub 98.6F in the daytime. I never see anyone hypothyroid doing well with a lower temperature. It’s temperature, pulse and blood pressure that tell you what T3 the cells actually get. And symptoms. 

The reason you don’t have elevated anti TPO, is because you don’t have a thyroid. All thyroid antibodies are made inside the gland. I don’t know if you ever had Hashimotos , but if you have, the antibodies will disappear once the gland is gone.

I asked you if your anxiety got worse at meno pause. You didn’t really answer, you just wrote, I can’t do HRT, as I probably have Lupus. I would have liked to know. As I wrote you, I got so nervous at meno pause. It was only when I started taking some estradiol gel that I felt like myself again. But because your FT3 is too low, it might be the culprit. 

I am not sure HRT is out of the picture with Lupus. I think it’s mostly conjugated estrogen and synthetic progesterone, gestagen and progestin, that can cause blood clots. I have two posts on HRT, with a lot of the well known studies on HRT. If you google it, you will find articles on HRT and Lupus. If your issues got much worse at meno pause, I would talk to a good hormone doctor. Some women are very sensitive to lowering estrogen levels, and I don’t know if anything but estrogen can allivate it. 

I think you need to focus more on the Lupus part. I don’t know much about it, but my intuition said, Mast cells. And I was correct, people with Lupus have too active Mast cells, releasing too much histamine. I have too active Mast cells myself. 1500 mg Quercetin/day has helped me immensely with that, my itching and hives. I see studies on Quercetin being beneficial for Lupus’s patients. 

Many with Mast cell issues have a lot of issues with taking supplements and food. If you are not in Mast cell groups, and Lupus groups, I think you should join. Either on FB or internet forums. I think maybe your flares have to do with Lupus/Mast cell issues. 

It’s a real problem that you can’t take supplements. I hope your absorbtion of nutrients is good. I need a lot of supplements myself. I eat good homemade food .  But still I get low on many things. It’s so important we are optimal on vitamins and minerals. I hope this will resolve itself for you. 

Your cortisol might also be low, seeing as your FT3 is low. I would take a larger meds dose at night, in order for the body to have enough T3 to produce cortisol in the early hours. I take my NDT morning, 5 PM and going to bed. 

You write, that you have had some trauma in your life. You have been taking SRRI for years. As a psychologist, I can say, this is very wrong. SRRI is not meant to be a long term medication. It’s meant to be taken for 6 to 12 months after it has taken effect. To elevate the serotonin levels in the brain. Taken long term it becomes negative in my opinion. It dulls the emotions, and one becomes less in thouch with oneself. The sexuality is affected. I hope you will be able to wean off it. Better to take som CDB oil for your anxiety.

Anxiety is telling us, there is something  going on. Something we don’t really want to, or are not ready to face. You are a grown woman, so you have probably done a lot of work on yourself already. But we ofen have to work on ourselves much more than we ever dreamt we would have to. I know that is true for me. I have a lot of baggage as well. It’s difficult to feel one’s anxiety, one wants to run. But for me, once I was able to just feel it and let it be, it kind of got easier. Maybe you should see someone? 

I hope you can use some of this. In short, get optimal on your thyroid levels and look into the Lupus. Feel your emotions, get help if you need it.  

Blessings, Liv

Nr 7: Woman 61, not AITD, but low FT3. Asks about iodine.


I found your website on one of the Facebook iodine pages.  I feel like the more I read, the more confused I am.
I thought about supplementing with iodine, but then Brian Haviland said I probably needed medication, then others say I should start with Selenium, then iodine, then medication.  So, very confused to say the least.
I know you’re quite busy, but if you could steer me in a direction that makes sense, I would be so grateful.
I am female, age 61 and do not take any thyroid medication.  I’ve attached various blood tests, including the thyroid panel.
Also worth noting is that my WBC is below the normal range and I have had swollen lymph nodes in my armpit, neck and groin for 9 months.  However, my GP does not seem concerned about any of this.
Thank you in advance for any help you can offer.

Hi Valerie!

Good news, you do not have an autoimmune thyroid disease. You don’t have elevated anti-TPO or anti-Thyroglobulin. One can have lymphocytic thyroid disease without thyroid antibodies. But this is pretty rare. So I think it’s safe to say, you don’t have a problem with the thyroid gland itself. But you are still hypothyroid.  

How can that be? Your free T3 is too low. You must have symptoms of hypothyroidism. Tired, cold. You didn’t share how you feel. Selenium and Zink are both very important for the conversion of T4 to T3. And I agree, you should take Selenium. But I don’t think that will be enough. I think you need some T3 medication. You could try supplementing for a few months first, and test your thyroid levels again. But I believe you will need some T3. Some people excrete little T3 from their thyroid. We excrete both T4 and T3 from the thyroid, but most of the T3 our bodies use in a day,  we get from converting T4 in the body tissues. Very much in the liver, some in the kidneys and some in the gut. So the health of these organs matter for the conversion. But some people also have a gene defect that makes them poor converters. This can be tested for, but it is quite costly. 

Your FT3 should be at least 2.9 pg/ml. Probably a little higher. Thyroid healthy people often have a FT3 around 3.2 pg/ml. 

Your FT4 and TSH are quite normal for a woman of your age. Supplementing iodine could increase your FT4 some. But I don’t think it will increase enough for the FT3 to get high enough. In stead of taking T3 medication, you can take T4 medication. That will increase your FT4, which will increase your FT3. But as you are a poor converter, I would go down the T3 route if I were you.

I think you can safely supplement iodine, as you don’t have elevated thyroid antibodies. I think it’s always wise to start low and increase over time. You don’t sound like you are that into iodine, into high dose iodine. You can do smaller doses, maybe up to 5 mg Lugol’s. With larger doses, one needs to study. But this is up to you. Iodine won’t increase your conversion though. But can increase the thyroid hormone production somewhat. Iodine can help your health in many other ways though. I take iodine every day, and feel much better for it. I also take thyroid meds. I have hardly any gland left, so I don’t take iodine for my thyroid hormone production. 

There are lots of good levels on your blood test. I have only included the thyroid panel. But as you say, your white blood count is low, under reference. This in combination with your swollen lymph nodes should be taken seriously. I don’t know what it could be, but I would want to find out if I were you. 

Your sodium is also low. I don’t know if you don’t eat salt. But I would eat some good sea salt if it was me. Salt is very important for digestion. We shouldn’t be afraid of salt.

I would also supplement calsium. At our age, we need to have good levels of Calsium. But don’t take heaps. Our colon can’t absorb more than 600 mg at a time. And it’s important to not take too much calsium that ends up in the wrong places. It’s important to have good vitamin D and K2 levels when supplementing Calsium. 

Now I see, you write GP, so I believe, you live in the UK.  If you don’t, just skip this part. It’s difficult to get T3 medication there. If you can’t get it, you could get some Metavive online. Or Thyroid S. Or Vitalithy.  Metavive would be the easiest to get. I think it would help you. It contains both T4 and T3. Join some thyroid FB groups in your country. You find some info on these products on my medicine page, Our thyroid medicines. 

Read on my optimal thyroid levels page for info on good thyroid levels on the various thyroid medications. You have a lot to learn, and will need to read some, Optimal thyroid levels 

I hope this was helpful. I have outlined some options for your thyroid. You must decide, what’s best for you. 

Blessings, Liv