Right after I started this patient-to-patient movement, we found out the hard way that if our iron is too low, or our adrenals are stressed, we had problems. And EITHER were common if we had only been on nothing but T4 to treat our hypothyroid state, or were underdosed with either a working NDT, or T4/T3, or just T3. Check out this important information below! ~Janie, hypothyroid / Hashimoto’s patient and site creator

So if I’m having problems raising a T3 containing medication (anxiety, fast heartrate, palps, jitteriness, etc), it’s not directly related to that thyroid med???

Not at all. Your treatment is just “revealing” (or will reveal) the problem, which is usually about stressed adrenals (aka a cortisol problem of being too high or too low, and / or low aldosterone. Any of the latter three issues will cause problems raising). And sadly, patients or their doctors who aren’t informed tend to falsely proclaim “My treatment meds are not working!” or “T3/NDT is not for everyone!”.

Now while it’s true that certain genetic thyroid mutations like the DIO1 gene mutation can result in problems converting T4 to T3, this real mutation issue is definitely not always the case for the majority who have had problems raising NDT or T3 and notice “hyper-like symptoms”.

What do we notice if iron is not where it should be when raising a T4-containing thyroid medication?

The most common observed result if iron is too low is rising levels of Reverse T3 (RT3)…and that means you can still feel very hypo. RT3 is an inactive hormone, and the higher it goes, the more hypothyroid we get, as it blocks T3 from getting into your cells. You can read more about RT3 here <—-READ. And as RT3 rises, Free T4 starts to rise, then will fall, sooner or later.

What do we notice if cortisol is not where it should be when raising a T3-containing thyroid medication?

The most common observed result if cortisol is too low or high, plus aldosterone is too low, is overreacting to the raising of a T3-containing medication. That can be different between individuals, but could include anxiety, palps, higher heartrate, shakiness, problems sleeping and more. A smaller minority just notice that they aren’t achieving the feel-good results that others achieve.

Or, you could see your free T3 go too high, called pooling. In other words, without adequate levels of cortisol to raise your cellular levels of glucose1, the latter which seems to work with cell receptors, ATP and mitochondria to receive T3 from the blood to the cells, you will pool and still feel hypothyroid. Low aldosterone, another steroid, causes pooling, too.

Or you could also see RT3 go up–this is common if your cortisol is way too high–the early stage of adrenal dysfunction which leads to eventual low cortisol.

Here’s a saliva test you can order on your own to see what’s going on.

But my cortisol and iron are great, yet I’m still having problems when raising T4/T3, T3, or NDT!

To the contrary, they probably are NOT great.

Iron and cortisol lab results have nothing to do with just falling anywhere in the normal range, as unfortunately doctors don’t understand. Same with your aldosterone level. We, as thyroid patients, learned this years ago in the early patient-to-patient Stop the Thyroid Madness movement. i.e. due to observing so much lab work, we saw that it’s “where” we fall in those ranges that means something, not the fact that we fall in them anywhere. How do we know that? Because we were seeing where people fell who didn’t have an issue in their iron, cortisol or aldosterone levels, and it was pretty consistent where they fell. It still is!!

What should I do with all this??

  1. We find it important to get all FOUR iron labs. They are serum iron, % saturation, TIBC and ferritin–it’s about all four, NOT just ferritin. It’s NOT about hemoglobin or hematocrit, etc. They are too general. Once we get our results, we learned it’s NOT about going by the entire ridiculous normal ranges. Go by what you see on this page: https://stopthethyroidmadness.com/lab-values then CORRECT what you see. Here’s the iron page to help you with that, too.
  2. We do the Discovery Steps to see what is going on with our adrenals. This is the page to do just that: https://stopthethyroidmadness.com/adrenal-info And after doing those steps, and it’s clear we need to do a saliva test and test Aldosterone with blood, we do NOT go by the ridiculous normal range. We go by what we see on this page: https://stopthethyroidmadness.com/lab-values then CORRECT what we see. Chapter 6 in the updated revision STTM book (STTM I) explains how patients and their wise doctors learned in the use of cortisol supplementation to replace what we are not getting–it’s the only way to get out of our hypothyroid state. Plus this chapter mentions aldosterone. You’ll see mention of prescription hydrocortisone (HC) for those with low cortisol, but some mention of over-the-counter Adrenal Cortex in the 50 mg capsules for those with very minor low cortisol. Most end up needing the strength of HC, though.

CLICK HERE to order your own saliva cortisol test.

Miscellaneous but important questions…

As far as our adrenals, can I just do blood testing for cortisol?

We have often found blood testing to be unhelpful for our kind of adrenal issues. The highest percentage of blood cortisol is bound and unusable!! Useless. Plus you miss out on the needed results at four key times during the day and evening that saliva testing gives us.

Since low iron will start raising RT3, are there other causes for the high RT3?

Yes, but always see if it’s low iron or high cortisol first–they are the most common. Another cause is chronic inflammation.

Can you give me more information if my labs show high iron results?

Here you go: https://stopthethyroidmadness.com/high-iron

If my RT3 is too high on NDT, can’t this all be solved by just going on T3-only?

Not exactly. Yes, you will solve the high RT3–it will fall on T3-only. But…you will STILL have that low iron, higih cortisol, or inflammation-the three causes of rising RT3.

Bottom line, get both iron (all four iron labs, NOT just ferritin) and cortisol tested via saliva, plus test aldosterone, then treat what you discover!! This will enable you to eventually get back on NDT, by the way, and soar. Treatment is detailed in Chapter 6 of the STTM I book, shown right below.

If you don’t have the Stop the Thyroid Madness books , you should consider them to be informed. They are excellent patient-to-patient reference books.

The first is the updated revision of Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Treatment.

  • Full of patient-to-patient information
  • Considered the bible of patient experiences and wisdom
  • To read more, click on cover here.

If you have Hashimoto’s disease, there is an excellent, patient-to-patient companion book to the above called Hashimoto’s: Taming the Beast. Click on the cover on the following page to read about it, here.

Footnote: (1) https://sites.dartmouth.edu/dujs/2011/02/03/the-physiology-of-stress-cortisol-and-the-hypothalamic-pituitary-adrenal-axis/

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.