Getting well as a hypothyroid patient (whether Hashomoto’s, thyroid removal, and so many other causes) s multi-facted and means you need to have your ducks in a row! First study Part One–they are key. But you might also have issues in Part Two that need discovery and treatment.

NOTE: treatment of the below are also important to successfully wean off cortisol, and not see adrenal stress return!

PART ONE–6 key issues:


    For your ducks in a row, the most important thyroid hormones for testing are the Free T3 and Free T4, plus RT3. And we have to be OPTIMAL, not just “on” our thyroid meds, we have observed for years.

    Optimal seems to put our free T3 towards the top of the range and free T4 mid-range—BOTH. And we’ll feel good before optimal, but it backfires on us sooner or later. Thus the need to do those labs.

    And the most important meds are either a working natural desiccated thyroid (NDT) like Armour, or T4/T3, or just T3 (for those who have high RT3, or a mutation affecting conversion). But…some may need to correct #2 and 3 below before they can get optimal on NDT or T3. Why?? Because if you raise in search of your optimal dose with inadequate iron and/or a cortisol problem, you’ll have problems, as we have seen repeatedly over the years. Chapters 2 & 12 in the updated revised STTM book .)


    Bringing cortisol to right amounts is key to achieve #1 above. And if there are any suspicions of a cortisol problem (having hyper-like symptoms when raising meds like a higher heart rate, palps, anxiety, feeling defensive, angry, overreactive, etc), we order and do a saliva test. Then compare to the Lab Values page. If cortisol is low, thyroid hormones can’t get to our cells well and will instead pool as we raise NDT or T3. If cortisol is high, RT3 goes up and keeps us hypothyroid (and can also contribute to poolin. So, if cortisol is low as proven by a saliva test, patients gives themselves back the cortisol they need, whether through the use of Adrenal Cortex or HC, or the T3CM for minor low cortisol in the mornings only. This is where it’s IMPORTANT to study Chapter 6 in the updated revised STTM book on how we do it all. If HIGH cortisol, we lower those levels. NOTE: you will not be able to find your right amount of cortisol via one’s Daily Average Temps if Aldosterone is low. So we have to test and treat that, too

  3. IRON

    Patients discovered, upon seeing so much lab work, that they needed optimal levels of iron, not just “in range”. (See Chapter 13 in the updated revision STTM book) And without optimal amounts, raising a working Natural Desiccated Thyroid or even T4/T3 (because of the T4) will cause one’s RT3 (Reverse T3—the inactive thyroid hormone) to go too high.

  4. B12

    Should be in the upper quarter of any range, patients reported by the elimination of low B12 symptoms. Lower and they could have symptoms which resemble hypothyroid. (See Chapter 13 in the updated revision STTM book)


    Lots of opinion out there, but patients wanted to be at least 50, but even better, 60-80 of the 25-hydroxyvitamin D test. (see Addendum C in the updated revision STTM book). Low vitamin D can cause achiness, fatigue, in some. You also need two Vitamin D tests…see this.


    Thyroid patients tend to have low stomach acid if on T4, or underdosed even with T3 in their treatment. Aging can also cause this. And low stomach acid equals poor absorption of nutrients. So patients discovered that putting approx. 2 teaspoons of Apple Cider Vinegar or lemon juice in the drink used to swallow supplements will enhance absorption. Or the use of Betaine (man-made hydrochloric acid). It’s key for the low stomach acid which too many thyroid patients have.

PART TWO: If you still have issues, even after correcting 1-6 above, or aren’t weaning off cortisol well, or see it come right back, then it’s time to explore these below. They are not in any order. Remember: having all your ducks in a row is multi-faceted. Be open to all that might apply to you. 🙂

  1. Re-activated EBV (Epstein Barr Virus) or any other viruses/bacteria: Reactivated EBV is very common for hypothyroid patients under stress. My Med Lab tests this. And it means fatigue, for one.
  2. Lyme disease: Can put your immune function into overdrive and in many, raise the RT3. The lab IGeneX or DNAConnexions can give more accurate lab results than does the Western Blot and ELISA labs from Lab Corp. Another clue you may have Lyme: having reactivated signs of any of these–EBV, HHV-6 and Cytomegalo (CMV) virus.
  3. Mold exposure: This can cause an immune system in overdrive, aka Chronic Inflammatory Response Syndrome (CIRS), plus adrenal stress, and can harm your thyroid.
  4. MTHFR mutation or any methylation problem: this results in the failure to break down either b12, iron, selenium, lead, mercury, etc… And the failure to break down B12 or iron puts you in a low state of either, with problems. Also this:
  5. Uncontrolled Hashimoto’s attack: Yes, this will keep you with problems, as it keeps inflammation up. Get those antibodies down. This is where you need the book Hashimoto’s: Taming the Beast, as there is information totally based on what Hashi’s patients have learned in bringing those antibodies down. .
  6. Chronic inflammation: can usually be discerned by too-high ferritin with lower iron. You need to get inflammation down no matter the cause-—it can not only spread, but affects your HPA axis messaging negatively. And treat the CAUSE!!
  7. Excess Candida: promotes inflammation, can stress adrenals, raises RT3, negatively effects energy, etc
  8. Stomach/gut issues These can also stress Hashimoto’s, but even with non-autoimmune Hashi’s, these can make you feel bad. This area includes…
    a) Poor levels of good bacteria (can be from antibiotic use, poor nutrition, alcohol drinking, etc. Probiotics important.)
    b) SIBO–Small Intestinal Bacterial Overgrowth i.e. it moves into the small intestine, potentially causing bloating, gas, pain as the bacteria digest carbs.
    c) Gastritis (inflammation, irritation or stomach lining),
    d) H-pylori
    (harmful bacteria in stomach),
    e) Celiac or gluten intolerance..or intolerance of any foods you eat. This will harm getting those ducks in a row, as either result in chronic inflammation! And for Hashi’s patients, they will push antibodies up.
  9. High copper, low zinc, low ceruloplasm (messes up iron; inflammation; brain issues)
  10. Blood sugar problems
  11. Sex Hormones: low levels can make you feel bad. Also look into PCOS.
  12. Parathyroid issues here.
  13. Iodine levels are actually important for us all. And for Hashi’s, iodine supplementation alone has helped lower antibodies in many…low and slow to counter detox.
  14. Chronic personal stress: Yes, this can keep you sick. So we all have to figure out how to cope better, find me time, and relax.

All of the above ducks in a row can be shared with your doctor! Let’s teach them what we’ve learned.

TO FURTHER UNDERSCORE MOST OF THE ABOVE, HAVE THE UPDATED REVISION STTM BOOK ON HAND for further reading! We all have to be informed to counter doctors!

  1. Updated revised Stop the Thyroid Madness book (for all causes of hypothyroidism)–A patient-to-patient guide to how to get well!
  2. Hashimoto’s: Taming the Beast book here: It’s CRUCIAL THAT YOU BECOME INFORMED to counter the poor knowledge of too many doctors.

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.