Thyroid correction: The woeful prevailing standard

Rich has been taking Synthroid or levothyroxine for many years.

When Rich came to my office for continuing management 10 years after his bypass surgery, I checked his thyroid panel:

TSH 7.44 uIU/L

Free T4 1.88 ng/dl (Ref range 0.80-1.90 ng/dl)

Free T3 2.0 pg/ml (Ref range 2.3-4.2 pg/ml)

Rich's thyroid hormone distortions--high TSH, low T3--are sufficient to account for a tripling of heart attack risk long-term.

As Richs' thyroid was being managed by his primary care physician, I notified this doctor of Rich's panel. He therefore increased Rich's levothyroxine from 75 mcg per day to 100 mcg per day. Another thyroid panel several months later showed:

TSH 0.98 uIU/L

Free T4 2.38 ng/dl

Free T3 2.0 pg/ml

As you would expect, increasing the intake of the T4 hormone (levothyroxine) increased free T4 and suppressed TSH.

But what about T3? It's unchanged.

Indeed, Rich says that he feels no better and, in fact, wakes up in the morning foggy and requires a nap in the afternoon.

In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.

Rich's increased levothyroxine dose decreased (calculated) LDL cholesterol by 10 mg/dl. Based on my experience, I'll bet that his lipid panel would likely be further improved with T3 correction.

What I find incredible is the absolutely rabid resistance waged by primary care physicians and endocrinologists against this notion of T3, mostly due to fears of the remote likelihood of inducing atrial fibrillation and osteoporosis, while they are ready to prescribe lifelong statin drugs without a moment's hesitation.

Comments (16) -

  • William Trumbower

    7/28/2009 9:46:33 PM |

    Dr. Davis    You are so right!  I always check Ft3 as well as thyroid antibodies for Hashimotos.   If the antibodies are elevated, the patient probably has gluten induced autoimmune disease.   I also suggest checking reverse T3 if they have been on L-thyroxine.  If elevated, they are converting their T4 into reverse T3 instead of T3.   Keep up the good work.  Bill Trumbower MD

  • Ross

    7/29/2009 12:50:40 AM |

    Follow the money.  Synthroid (T4 only)is a highly profitable drug being actively pushed by drug reps.  Armour Thyroid (T3 and T4) is cheap and profitless.

    Where was that recent article on how drug companies (and their sales reps) shamelessly said anything needed to get doctors to prescribe their higher-profit lines?

  • Dr. William Davis

    7/29/2009 2:52:49 AM |

    Dr. Trumbower--

    Thanks. I'd like to continue the conversation.

    I can be reached through

    Plenty to share!

  • Dr. William Davis

    7/29/2009 2:54:24 AM |


    You've hit at the essence of the problem.

    The depth of this rabid adherence to the drug company-induced dogma is incredible. Endocrinologists will turn blood-red arguing that Synthroid is the only means of correcting thyroid and that iodine deficiency no longer exists.

    Believe me--I've seen it happen first hand.

  • Anna

    7/29/2009 4:52:03 AM |

    This is a littke off-topic, but still about thyroid health so I hope it's ok.  

    The word is getting out in some of the online hypothyroid forums (STTM & Mary Shomon's forums) that many hypothyroid patients are not happy with the recent reformulation of Armour desiccated thyroid.  Apparently, the new Armour formula no longer dissolves well for those who prefer to take it sub-lingually.  Additionally, many (who take it sublingually or swallow it) are finding the change in binder formulation (sugar was also reduced) coincides with a return of some symptoms, so perhaps the hormone absorption has changed.

    And of course, the continued shortage of Armour in some doses continues with no end in sight.  

    I heard about this reformulation issue just before I planned to change from Levoxyl (T4) & Cytomel (T3) combo therapy to Armour, so I asked my doctor to write the Rx for Naturethroid instead of Armour.  

    It's been a very smooth transition from synthetic T4/T3 once a day to 1/2 grain Naturethroid natural desiccated thyroid hormone twice a day, with a huge improvement in the "afternoon slump" that was still a prominent feature even after several years of tweaking my T4/T3 treatment.  In fact, now I have to set a reminder on my phone to remind me to take the second dose, because I don't often have the afternoon slump "reminder".

  • Tom

    7/29/2009 11:57:20 AM |

    Question please:  does it make sense for those of us without known thyroid issues to take an iodine supplement such as kelp?

    Thank you for any thoughts.



  • Mar

    7/29/2009 12:36:55 PM |

    Dr. Davis,

    I think that your article is so correct re: the need to have both Free T4 and Free T3 corrected.  I can remember arguing with the endocrinologist that we needed to check a Free T3 level too.  He finally checked it, but only one time.  I continue to have low Free T3.  I pay for my own test since he doesn't do it. I am gluten sensitive and my replacement T4 works better now that I am GF, but my Free T3 is still low.

  • kris

    7/29/2009 8:23:37 PM |

    It is hard to find a doctor who would understand desiccated thyroid medication never mind prescribing it. To add injury to the insult, the medical system in Canada doesn’t cover desiccated medication to begin with. people with affordability problem, continue to stay on synthetic medication and in the long run it cost the medical system lot more in order to correct the spinoff of thyroid issue through other diseases.

  • Anne

    7/30/2009 12:30:54 AM |

    I seemed to be doing fine on Synthroid. My TSH was .8. I then changed to a generic med and I watched my TSH slowly rise to almost 4 and my energy decline. Of course my doctor was unconcerned, but I insisted on getting a free T3 done too - it was low.

    I am now back on Synthroid and will be getting my TSH, free T3 and free T4 retested soon.

    I am gluten free x6yrs and now grain free. I hope it is just the generic that caused the worsening TSH.

  • Anonymous

    7/30/2009 8:53:21 PM |

    In British Columbia, Canada it's almost impossible to get a prescription for desiccated thyroid hormone. Synthroid gives me a backache, T4 compounded alone gives me migraines. Severe incapacitating chills started in 2000; it took several years to get a possible diagnosis and start on desiccated, but that doctor has moved away. The chills are 80% improved but get worse with any stress. Would iodine or kelp or Lugols or Iodoral help? My health fell apart with quitting smoking, systemic Candidiasis, hypoglycemia, diabetes, severe depression, menopause, etc and I can now digest very few foods, supplements, etc. Also most foods and all hormones cause migraines. Any suggestions would be appreciated.

  • William Trumbower

    7/31/2009 11:09:49 AM |

    Dr Davis     I went to the site you mentioned, but I could not find how to reach you.  Sorry I must not be very experienced to figure it out.   Dr. Trumbower

  • Jim

    7/31/2009 12:19:34 PM |

    I stumbled on this article with tons of citations about a possible cause of the apparently huge increase in thyroid problems at

    The first quotation from an expert was, "Today, many people living in fluoridated communities are ingesting doses of fluoride (1.6-6.6 mg/day) that fall within the range of doses (2 to 10 mg/day) once used by doctors to reduce thyroid activity in hyperthyroid patients. This is of particular concern considering the widespread problem of hypothyroidism (under-active thyroid) in the United States. Symptoms of hypothyroidism include obesity, lethargy, depression, and heart disease."

    Paul Connett, PhD
    Co-Founder, Fluoride Action Network"

  • Dr. William Davis

    7/31/2009 2:52:15 PM |

    Dr. Trumbower--

    You could try this: Cut and paste following web address:

    Hope to see you there.

  • scall0way

    11/10/2009 8:18:11 PM |

    I'm going back and reading all your thyroid related posts after getting diagnosed yesterday with Hashimoto's. It gets depressing reading about the state of thryoid treatment in the US - total tunnel vision. The Dr. I was absolutely and utterly will not prescribe dessicated thyroid, only the synthetic T4s. I'll start out there but if it doesn't seem to help I'll have to look outside my network somewhere I guess.

  • buy jeans

    11/3/2010 12:21:38 PM |

    In my experience, the majority (approximately 70%, but not 100%) experience subjective improvement when T3 is added in some form and the free T3 level is increased. While the data (summarized here) are conflicted on whether there is objective benefit to T3 management and supplementation, there seems to be a poorly-quantified subjective improvement.