(Important note: STTM is an information-only site based on what many patients have reported or learned in their treatment. Please work with your doctor. This is not meant to replace that relationship or guidance, and you agree to that by reading this website. See the Disclaimer.)

When the patient-to-patient Stop the Thyroid Madness movement started years ago by Janie Bowthorpe (even before the STTM name had been created), patients were quick to discover and report how important it was to have OPTIMAL, not just “in range”, iron and cortisol levels.

Why “optimal”??  Because we’ll have problems, or just not feel better when raising NDT or T3 in search of our best dose…if our levels are NOT where they should be. 

Why the importance of iron and cortisol?? Why should I test them before raising Natural Desiccated Thyroid or T3?

Because if either iron or cortisol are off and not where they should be, patients have reported problems with raising Natural Desiccated Thyroid (NDT) or T3, and/or we will have problems getting fully out of our hypothyroid state.

And today, when patients or their doctors aren’t informed about these two important sidekicks, they 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 optimal when raising NDT or T3?

The most common observed result if iron is too low when raising NDT or T3 is rising levels of Reverse T3 (RT3).  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, as does T3, sooner or later.

Pooling is another result of having low iron, but not as common as rising RT3.

What do we notice if cortisol is not where it should be when raising NDT or T3?

When saliva testing (not blood, which is inadequate) reveals too high levels of cortisol, RT3 can rise all over again, just as it does with inadequate levels of iron. As RT3 rises, hypothyroid symptoms increase, since RT3 is an inactive hormone. And as cortisol goes up, so can our adrenaline levels, causing anxiety in some.

When saliva testing (not blood, which is inadequate) reveals too low levels of cortisol, there is a strong interrelationship between cortisol and the ability of thyroid hormones to get to our cells. Namely, adequate levels of cortisol raises your cellular level of glucose1 , the latter which seems to work with cell receptors, ATP and mitochondria to receive T3 from the blood to the cells. So without the right amount of cortisol, you remain hypothyroid.  Equally, what one sees in the presence of low cortisol as they raise NDT or T3 is pooling, meaning the T3 you are giving yourself goes high in the blood without getting to the cells. 

Symptoms that your cortisol is low while raising NDT or T3? Anxiety, shakiness, feeling wired, feeling worse, on and on. It’s individual to each person. But it’s STILL important to do saliva testing to see exactly what is going on when.

More about discerning your cortisol status here: https://www.stopthethyroidmadness.com/adrenal-info/

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!!

Where should my iron level be? Where should my cortisol levels be?

For iron, it’s about four iron labs shown here, and comparing them to the lab values page.  For cortisol, it’s NOT about blood. It’s about saliva testing like this one…and comparing the results to the former lab values page.

Once we get our labs back, what are patients doing to correct these issues

  • If iron testing (four iron labs), plus the lab values page, reveals that our serum iron is too low, we get that serum iron back up. See here.
  • If iron testing (four iron labs), plus the lab values page,  reveals that our serum iron is too high, we find out why and correct it. See here.
  • If saliva cortisol testing reveals we are too low in cortisol two or more times, we learn here.
  • If saliva cortisol testings reveals we are too high in cortisol two or more times, we learn here.
  • It’s saliva testing reveals a see-saw result, like high, low, high, low and vice versa, we learn from here.

Always compare your lab results to this page: http://www.stopthethyroidmadness.com/lab-values 


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

All about iron: http://www.stopthethyroidmadness.com/ferritin

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

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


(1) http://dujs.dartmouth.edu/fall-2010/the-physiology-of-stress-cortisol-and-the-hypothalamic-pituitary-adrenal-axis