Did you know….

  1. that you will always have, or will develop problems on NDT, T4/T3, or T3, if your iron and/or cortisol are not OPTIMAL? It’s NOT about just being anywhere in those ranges!
  2. that is it common to have messed up iron and/or cortisol if you’ve ever been on T4-only, or if you stay under-dosed on T3 or NDT (which is far too common due to doctors not understanding how to use them)?

So if I’m having problems, or inevitably develop problems on NDT or T3, it’s not directly related to either NDT or T3?

Not at all. They are just revealing, or will reveal, the problem. And sadly, patients or their doctors who aren’t informed about these two important sidekicks, tend to falsely proclaim “NDT (or T3) doesn’t work!” or “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.

What do we notice if iron is not where it should be when raising NDT or even on T4-only?

The most common observed result if iron is too low (when raising NDT or T4/T3) 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. You can read more about RT3 here. And as RT3 rises, T4 starts to fall lower, sooner or later.

What do we notice if cortisol is not where it should be when raising NDT or T3, (or even when still on the lousy T4-only)?

The most common observed result if cortisol is too low is overreacting to the raising of NDT or T3. 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, while T4 stays low in most. This is common with too low cortisol, or a mixture of lows and highs. 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.

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.

But my cortisol and iron are great, yet I’m still having problems when raising NDT or T3 (OR I just don’t feel any better)!

To the contrary, they probably are NOT great.

Iron and cortisol lab results have nothing to do with just falling in the normal range, as unfortunately doctors don’t understand. 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 or cortisol levels, and it was pretty consistent where they fell. It still is!!

What should I do with all this??

  1. Get all FOUR iron labs. They are serum iron, % saturation, TIBC and ferritin–it’s about all four, NOT just ferritin. Once you get your results, do NOT go by the 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.
  2. Do the Discovery Steps to see what is going on with your adrenals. This is your page to do just that: https://stopthethyroidmadness.com/adrenal-info And after doing those steps, it’s clear you need to do a saliva test, do NOT go by the ridiculous normal range when you get your results back. Go by what you see on this page: https://stopthethyroidmadness.com/lab-values then CORRECT what you see. Here’s a page about correction: https://stopthethyroidmadness.com/adrenal-wisdom Plus, Chapter 6 in the revised STTM book explains how to use cortisol supplementation to replace what you are not getting–it’s the only way to get out of your hypothyroid state. You’ll see mention of prescription hydrocortisone, but all the info in that chapter applies to over-the-counter Adrenal Cortex in the 50 mg capsules, too.

Miscellaneous but important questions…

Can I just do blood testing for cortisol?

Nope. Blood is measuring both unbound (available for use) and bound (unavailable for use) cortisol, but the highest percentage of blood cortisol is bound!! Useless. Plus you miss out on the needed results at four key times during the day and evening that saliva testing gives us

Are there other causes for the high RT3?

Yes, but always see if it’s 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 (or inflammation). And the latter will fester, cause symptoms, and prevent you from feeling great even on T3-only. Plus, T3-only is a much rougher treatment than NDT.

Bottom line, get both iron (all four iron labs, NOT just ferritin) and cortisol tested, then treat what you discover!! This will enable you to eventually get back on NDT, by the way, and soar.

And always compare your lab results to this page: https://www.stopthethyroidmadness.com/lab-values


More about problems raising NDT or T3 here: https://www.stopthethyroidmadness.com/ndt-doesnt-work-for-me

All about iron: https://www.stopthethyroidmadness.com/iron

Several ways to discern if I have an adrenal problem: https://www.stopthethyroidmadness.com/adrenal-info

Wisdom about adrenal treatment after saliva is done: https://www.stopthethyroidmadness.com/adrenal-wisdom

(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.