Thyroid Tidbits: Men with low iron, Reverse T4 (yes, I said it correctly), Inflammation in thyroid patients, plus more

(No, the tatoo isn’t mine. It belongs to a gal who says STTM helped changed her life. Amazing and brave! 🙂 )


I’ve seen a few hypothyroid men who have found themselves with low iron. In fact, either iron anemia is growing in men, or we’re just hearing from them more thanks to the internet.

And remarkably, it has become personal for me. Turns out my own husband is very low, which explains the fatigue he had been experiencing lately. Sadly, taking iron pills gives him a headache, so he will eat high-iron foods daily, and will be exploring Floradix, a liquid herb-based iron. Men, get all the needed iron labs!

REVERSE T4 (yes, I said it correctly)

I’ve been having an email chat with a scientifically-minded guy named Brian who also has a sister with a major in bio-chemistry. And something dawned on both of them concerning “levothyroxine” which is the synthetic term for T4. The prefix LEVO means the “left-hand” version of a molecule, and thyroxine is the biological term for the real T4. Says Brian: “Levo-thyroxine means it has exactly the same atoms in exactly the same order, but not the same shape (handedness), so if enzymes or proteins have to chemically “fit” it to work, they may not be able to. He concludes this can be one reason being on synthetic T4-only does not work, and knew it was alluded to by Dr. Mark Starr.

But Brian continues: In just the same way that levothyroxine is the mirror-image or “left-handed” version of regular thyroxin, RT3, or Reverse T3, is the mirror-image or “left-handed” version of T3. If we were consistent with our terminology, in other words, levothyroxine would be known as “Reverse T4”. Says Brian, just as Reverse T3 is biologically inactive , so is Levothyroxine, thus “Reverse T4”. I love it!


In a facebook discussion, a female medical transcriptionist has had a realization. Namely, in almost every report she is transcribing into text or digital format, a patient with the diagnosis of hypothyroidism also has a medical history of depression and/or anxiety. You can read about depression & anxiety here. Of course, no patient who is informed is surprised! They are HYPOTHYROID symptoms. And she then notes the prescription ordered by the doc: Synthroid. WAKE UP DOCTORS. You are only dooming your patients to a lifetime of depression, anxiety and far more.


One thing I see a lot when doing phone consultations, as well as on thyroid patient groups, is evidence that someone has low-grade inflammation. In fact, research has already shown that a large body of folks with hypothyroidism have higher levels of CRP (C-Reactive Protein) which is a lab test marker of inflammation. That inflammation, in turn, puts you at a higher risk of heart disease.

Another clue that you have an inflammation problem is having higher ferritin levels (i.e. ferritin looks great, or is too high) along with poor iron serum/% saturation lab results. In other words, in the presence of chronic inflammation, your iron will be diverted to your ferritin iron storage, and less will be in your serum and saturation. You can also find yourself with very low TIBC (Total iron-binding capacity). The TIBC is measuring the protein “transferrin”, made in your liver, and which transports your iron through your body. If this is the case, you can’t take high levels of iron supplementation, as explained on the above ferrritin page and more in the book.

What do you do? 1) Treat your hypothyroidism properly–a huge step in lowering that inflammation–with desiccated thyroid, NOT Synthroid. (Read the Things We Have Learned page on STTM, or even more details in Chapter 3 in the new Revised STTM book). 2) Treat proven low cortisol with HC or hydrocortisone. Don’t guess! Do a saliva test!) If saliva testing reveals you have adrenal dysfunction, cortisol supplementation will help counter inflammation. (Read the Adrenal Info and How to Treat page on STTM, or more details in Chapter 6 in the new Revised STTM book.) 3) Use Krill Oil as a supplement. Krill Oil is an even better marine fish oil with rich amounts of Omega 3 fatty oils, and research with even a low dose of 300 mg proves that it does a bang-up job in reducing inflammation as well as pain in joints associated with rheumatoid and osteoarthritis. My own husband is on 1000 mg a day.


I am frankly extremely proud of the Revised Second Edition of the STTM book. In spite of being a lot of hard work, it is good to see all the additions, details and corrections throughout the entire book. There is much more on labs and how to read them, ferritin and iron, adrenal dysfunction and how to treat it, reverse T3 and how to treat it, plus a completely new chapter on good supplements and foods. I added a little more hidden humor, which was fun. There are now 36 more pages, too, and at the same price. You can see more about the book here. The book is ideal since you can bring that right into the doctor’s office with the information highlighted and bookmarked. As far as Kindle or other readers, yes, I’m already aware that some of you have requested it. But right now, it’s the book only. But I’ll make announcements in the future as to what might be coming up.

P.S. Seeing this blog post via the email notification? If you have a comment to make, click on the title, which will take you directly to this blog post on the net, and comment there.

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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13 Responses to “Thyroid Tidbits: Men with low iron, Reverse T4 (yes, I said it correctly), Inflammation in thyroid patients, plus more”

  1. tess

    I was wondering If we have iron labs that all run mid range except for ferritin (very low)should we still supplement with iron?

  2. Carol Nelson (Venizia)

    Wait, I have the second addition of the STTM book, you are saying there is a REVISED addition to the second book??

  3. SunnySky

    You said
    “I’ve seen a few hypothyroid men who have found themselves with low iron. In fact, either iron anemia is growing in men, or we’re just hearing from them more thanks to the internet. And remarkably, it has become personal for me. Turns out my own husband is very low, which explains the fatigue he had been experiencing lately. Sadly, taking iron pills gives him a headache, so he will eat high-iron foods daily, and will be exploring Floradix, a liquid herb-based iron. Men, get all the needed iron labs!”

    This fits my husband. While he was diagnosed hypo, he also has low ferritin (42); I make sure he takes iron supps now, but he complains that he hurts to the bone when he uses the Bluebonnet 27 mg chelated iron. Why the pain?

  4. Paul R Lundy

    From Wikipedia
    From Wikipedia, the free encyclopedia
    Levothyroxine, also L-thyroxine, synthetic T4, or 3,5,3′,5′-tetraiodo-L-thyronine, is a synthetic form of thyroxine (thyroid hormone), used as a hormone replacement for patients with thyroid problems. The natural hormone is chemically in the chiral L-form, as is the pharmaceutical agent. Dextrothyroxine (D-thyroxine) briefly saw research as an anticholesterol agent but was pulled due to cardiac side-effects.

    From Dr. Barnes “Hypothyroidism: The Unsuspected Illness, Page 191
    “When nature produces a compound for use in living organisms, the compound always has the characteristic of rotating polarized light to the left. When the chemist synthesizes a compound in the laboratory, he may obtain equal amounts of two forms of the compound, one rotating polarized light to the left and the other rotating it to the right. Very often, the compound rotating light to the right–and known as the dextro form–has less physiological activity than the natural or levo form. Sure enough, when the dextro form of thyroxine, a thyroid hormone, was synthesized, it proved to have only one-tenth to one-twentieth of the metabolic activity of the natural Levo-thyroxine.”

    My sister and I think the problem with the synthetic version is that it lacks the co-factors present in the desiccated form. We also don’t think that they have fully identified all the co-factors present in the desiccated form. Dr. Barnes used the synthetic T4 when it first came out. His observation after using it for awhile was that the desiccated seem to clear up more symptoms than the synthetic T4. After the synthetic had been used for awhile Dr. Barnes noted two symptoms that he commonly saw in patients on synthetic T4, dry skin and a retention of fluid by the tissues. When the patients were switched to desiccated both symptoms disappeared. He wrote an article about his experience called, “Is There A Third Hormone In The Thyroid Gland? Which Preparation Should Be Used For Treatment? If you would like a copy I would be happy to mail one to you. I just need to know what address to use. And which is the correct email address for you?
    As my sister would say. “Stereo-chemistry is critically important in biological systems. Another factor is how effective one’s liver is at de-toxification processes.”
    Regarding synthetic T4; “It is possible that some of the dextro rotary form is present as an impurity which may cause problems.”

    This is an illustration of the problems that can be caused by not paying attention to stereo-chemistry from Wikipedia.

    “An infamous demonstration of the significance of stereochemistry was the thalidomide disaster. Thalidomide is a drug, first prepared in 1957 in Germany, prescribed for treating morning sickness in pregnant women. The drug however was discovered to cause deformation in babies. It was discovered that one optical isomer of the drug was safe while the other had teratogenic effects, causing serious genetic damage to early embryonic growth and development. In the human body, thalidomide undergoes racemization: even if only one of the two stereoisomers is ingested, the other one is produced. Thalidomide is currently used as a treatment for leprosy and must be used with contraceptives in women to prevent pregnancy-related deformations. This disaster was a driving force behind requiring strict testing of drugs before making them available to the public.”

    If you would like to read up on stereo-chemistry Wikipedia is a good place to start. I would suggest these searches: stereo-chemistry, levorotation and dextrorotation, enantiomer, and chirality [chemistry].

    Although my sister and I have used desiccated for years, and my sister suffered needlessly for some years because they banned the desiccated in the UK during the 1970’s, I have read that there are some people that cannot take the desiccated, for them the synthetic is a viable option. There are also apparently a lot of people that have problems with too much T4 creating too much RT3 and they survive on synthetic T3. I know you are aware of the situation with rt3. Although I favor leading with the desiccated instead of the synthetic version, I am not in favor of eliminating any of the options available to the patient. Sometimes the angst that we all experience from dealing with an incompetent medical system causes us to blame all the components of that experience. The TSH test is just another problematic test in a long line of problematic tests going back to the 1930’s and the BMR. The fact that it has taken such a long time for doctors to begin to realize that it is crap, and during this time millions of us have suffered needlessly because of the false assumption that it is a highly accurate diagnostic tool, is not the fault of the test, but rather the human beings using the test and not paying attention to the patients standing in front of them. I think it is best for the patient to have as many options for treatment available as possible. In the end, the objective is to find what works best in the patient’s body, not what works best in the doctor’s mind.

  5. Liz Medina

    In 2002 I was living with my mother in Northern Calif when a nurse practitioner saw me (I had a sore throat, flu symptoms) and thought I might have a thyroid problem. I returned to Chile and by 2004 had gotten overweight, and longtime bronchial and stomach problems continued to intensify. In end-2005 I learned about Biomagnetism and attended Dr. Goiz’s Level 1 seminar. I detected my thyroid problem and started treating myself, and other symptoms from December 2005 on. Began to improve, lost 8kgs over a 7-month period. I met a naturopath dentist in 2006, he removed my mercury fillings and advised me to start taking 3 drops of Lugols every morning to keep my thyroid healthy. Have done it ever since. No longer thin blooded, I have more energy, no more tendency to melancholy or depression.

  6. Brian

    Janie, FYI, (yes, this is the Brian you were talking to), I have had a discussion with both my sister and an author since we last corresponded on this topic of “Reverse T4”, and I have found additional research papers that claim that the Levo- or left-handed version of the molecule IS the most abundant form produced naturally by the thyroid. This would seem to fly in the face of the idea that the body produces mostly right-handed molecules.

    To quote from this author (James K. Rone, MD), “Stedman’s Medical Dictionary, 28th ed., the standard in the field, states: “The L-isomer [i.e., the “levo” form] is the active iodine compound existing normally in the thyroid gland….” Synthroid’s FDA-approved package insert states that it is identical to the human hormone. Werner & Ingbar’s The Thyroid, 8th ed., probably the foremost authoritative thyroidology text, states that the major product of the thyroid gland is 3′,5′,3,5-tetraiodo-L-thyronine (note the “L”). The same text lists the potency of L-thyroxine as 6-fold greater than D-thyroxine…”

    Additionally, “”regular” T3 and reverse T3 are totally different compounds, not simply mirror images of each other: Both have three iodines distributed between two aromatic rings, but “regular” T3 has two on the inner ring and one on the outer ring, whereas reverse T3 has one on the inner ring and two on the outer ring…Levothyroxine, synthetic or not, does NOT amount to “reverse T4” as you claim. The whole reverse thing has to do with which carbon ring gets 2 iodine atoms, and which gets 1. Since T4 has 4 iodine atoms, each ring gets 2-there is no “reverse” T4.”

    So, it appears I was barking up the wrong tree. However, the jury is still out as to why the natural dessicated version of the hormone works so much better for so many of us. I guess the answer may lie in the other factors, such as the T3, T2, T1, calcitonin and so on—or even undiscovered factors. In any case, I wanted to set the record straight.

  7. Brian

    Nice post Janie! I developed low iron and anemia at the same time I was diagnosed hypothyroid. I later learned that experiments on rats proved low body temps can cause this (it’s in the Broda Barnes book):

    The bones in the rats’ tails, which are cooler, have white marrow and don’t produce red blood cells. Transplanted into the body cavity, the marrow turns red and produces blood cells. The only difference is a few degrees of temperature. This might explain why hypothyroid patients (including men) so often become anemic: the low body temps produced by hypothyroidism shut down your marrow.

    John is right about levo- and dextro- forms of thyroxine; it’s an assymmetric molecule so it’s always one or the other. Most beneficial natural molecules, as Dr. Mark Starr pointed on on this website, seem to have the dextro-or right-handed orientation.

    The discussion about converting levo-T4 (levothyroxine) into dextro-T3 (good T3) is an intriguing one, because it would seem easier to convert levo-T4 into levo-T3 (reverse T3), and dextro-T4 (natural thyroxine) into dextro-T3 (good T3), but I don’t have the research to back that up. I only think that because in both cases, it would require less reshuffling of bonds.

    In any case, I think he’s right that many people can’t do the levo-T4 into dextro-T3 trick very well. I’m still looking for more information on whether the body even produces any levo-T4 at all; I don’t believe it does, but I haven’t verified that claim. If not, it would then stand to reason that it wouldn’t necessarily have the enzymatic bag of tricks needed to hammer it into something it could use.

    In short, natural still seems best…

    • John Sowinski R.Ph.

      I don’t like the word natural that is used for porcine thyroid gland extract aka desiccated thyroid. There is no question, at least in my mind, that it is natural for a pig. That being said, with the goal being better outcomes, I believe there is lots of evidence that we get better outcomes from using desiccated thyroid vs just levothyroxine. For those that don’t want to use an animal product or have a pork allergy t4 and t3 combinations can be made by a compounding pharmacist. Of course correcting the cause of poor conversion of t4 to t3 conversion is the first place to start.

  8. John

    Shouldn’t you use the term levo-thyroxine and dextro-thyroxine to be consistent. Levo-Latin for left dextro-Latin for right. reverse would be the term used to mean the opposite of the other. For example when the body doesn’t covert levothyroxine correctly to liothyronine(t3) the excess goes to reverse t3. That is the process for why levothyroxine doesn’t work for everybody. They don’t convert levothyroxine to liothyronine very well.

    • John Sowinski R.Ph.

      I’ve been told that it really isn’t dextrothyroxine that is formed. I believe that the wrong Iodine is removed when the change is made from levothyroxine to liothyronine, My stereo chemistry is rusty but that is what I’ve been told.


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