Have you ever felt like T3 in your treatment wasn’t working…whether a working NDT, or T4/T3, or T3-only? Or you got a bad reaction when raising? We as hypothyroid patients figured out why that happens. Check out the information below and see what you think. ~Janie, hypothyroid patient and site creator

Here are examples expressed by certain patients pertaining to having T3 in their treatment:

  • It does nothing for me. 
  • It just stopped working.
  • It felt no different than just being on T4.
  • I feel worse on it!
  • It makes me anxious, shaky, or nervous.
  • My heartrate or blood pressure goes too high.
  • I get heart palps on it.
  • My hair falls out since on it!
  • I’ve had panic attacks! 
  • I’ve gotten nauseated.
  • I get headaches.
  • My T3 is high but I still feel bad. 
  • I have a high level of reverse T3 (RT3)!
  • I’m having insomnia and trouble sleeping now.  

We, as patients, have found there are very explainable and correctible reasons why T3 in our treatment, whether adding it to T4, or using T3 by itself, or the T3 in a working Natural Desiccated Thyroid (NDT) like Armour, doesn’t seem to work or causing problems, as reported by patients over the years.

1) Staying on too low a dose

When we stay on a non-optimal dose too long with T3 in our treatment, whether synthetic T4/T3, T3-only, or a working NDT (most American made NDT’s aren’t what they used to be–only Armour is still working), we have noted it usually results in worsening symptoms…sooner or later. Why? Because we are “suppressing” our feedback loop more than “replacing” for our daily, weekly, monthly needs. So symptoms come back with a vengeance. That’s why it’s extremely important to get to be optimal. <—–Read the page that this links to.

NOTE: If the problem is being underdosed, patients start feeling better as they raise, and will NOT see pooling of that T3, or rising RT3, or worsening symptoms. If we do NOT feel better upon raising, or have the pooling of T3 or high RT3 (high RT3 with T4 in your treatment), see #2 below. 

2) Having either inadequate levels of iron or too low/too high cortisol

If upon raising a thyroid treatment with T3 in it, such as a working NDT like Armour, or T4/T3, or T3-only, and we note having hyper-like symptoms, that can point to the T3 revealing a cortisol problem. i.e. cortisol isn’t getting to the cells well due to that cortisol problem and moving high in the blood.

Examples of “hyper-like” symptoms when raising T3 in our treatment can include one or more of the following: anxiety, shakiness, fearfulness, racing mind, simply feeling racy, heart palps, high heart rate, even insomnia or nausea, or any strange problems. They are all due to a cortisol problem.

Or if we have a rising or high RT3 when using a treatment with T4 in it, that can point to low iron (also inflammation or high cortisol).

In other words, it’s not a case of “everyone is different” or the need to return to T4-only, patients report discovering. i.e. T3 isn’t directly causing the hyper-like symptoms; it’s “revealing” a cortisol problem which is causing those hyper-like symptoms.

Equally, T4 converting to RT3 can also reveal the problem of low iron (or inflammation or high cortisol.)

And by the way, if your response is “But my cortisol or iron labs were normal!”, note that labs have nothing to do with simply “being in range”.

FYI: 2020 saw recalls of NP Thyroid, Naturethroid, and WP Thyroid.

Need to know if you have a cortisol problem and how? Patients have found great value in doing a saliva cortisol test. Click on the graphic to order. Once you get your results back, compare to what’s on this page.


STTM graphic How Low Iron is a problem when raising NDT
Summary: patients note repeatedly that iron has a high risk of going low with undiagnosed hypo, or being poorly treated with Synthroid or Levo, or kept on too low dose of NDT. The reason? Low stomach acid. T3 tends to pool high in the blood when iron is low. Low iron can decrease the deiodinase activity i.e. conversion of T4 to T3, favoring reverse T3 (RT3) the inactive hormone.

What do I test to see if my iron is causing my issues on NDT or T3??

We have found it’s NOT just about ferritin. Testing for iron is with FOUR labs: ferritin, serum iron, % saturation, TIBC. Then results can be compared to where healthy people fall here…which again has NOTHING to do with just being “normal”.  If iron is definitely not optimal, here’s how patients treat it, plus more in the Odds and Ends Chapter of the revised STTM book. Please share all this info with your doctor!


STTM graphic How cortisol can cause problems when raising NDT
Summary: Being undiagnosed, or treated with T4-only like Synthroid or Levothyroxine, or undertreated with NDT, stresses the adrenals, resulting in too high cortisol, low cortisol, or mixed–all which cause problems when working to raise NDT or T3 to find our optimal dose. Problems include pooling (T3 going too high in the blood & not making it to the cells, or rising RT3 the inactive hormone. Symptoms of a cortisol issue include, but are not limited to, insomnia, waking up often,  feeling unrefreshed when getting up in the morning, anxiety, fearfulness, paranoia, shakiness, etc.

Two important truths about cortisol testing

  1. We can’t go by blood. Blood results are measuring a combination of bound and unbound cortisol, and gives no clue what’s in our cells, looking high when it’s not (or even low when it’s not, as reported by some patients).
  2. We have to do the 24 hour adrenal saliva test as explained right hereYou can order your own saliva cortisol test here. And again, these results have nothing to do with “falling in the normal range”. They have to do with WHERE they fall, as explained here.

But I worked on both iron and cortisol and still didn’t do well on NDT!  

Note that “improved” doesn’t equal “optimal”, we found out over the years. And just “being in the normal range” also doesn’t equal “optimal” we especially saw in ourselves!  As far as iron, we have learned precisely how to raise iron and where it needs to be, which you can learn about here or at the beginning of the Odds and Ends Chapter in the revised STTM book for additional details (pages 181 – 187 in the English version).

As far as cortisol, a person can fail to correctly treat their cortisol issues as follows:

  • thinking that taking only adaptogens can do the job (they frequently aren’t enough if you have low cortisol).
  • not understanding how to use cortisol (many take too little, or dose it wrong, or fail to do Daily Average Temps to find the right amount, or fail to stress dose once they do find the right amount…plus more details (Chapter 6 of the revised STTM book has the best details anywhere on how to use cortisol-containing products)
  • thinking that avoiding stress can do the job (helpful, but often not enough)
  • thinking that a change in your diet can do the job (it’s not enough)
  • failing to understand where your saliva cortisol results need to fall as explained here (for those who aren’t on anything yet)
  • not understanding the correct way to do the T3CM or that it’s mostly just for low morning levels
  • and more….

Should I stay on T4-only while correcting my low iron/low cortisol?

We haven’t found that necessary, or even desirable!! Many who tried it tended to convert to too much RT3 while on T4-only because of their low iron. We learned instead to either be on a small amount of NDT/natural desiccated thyroid (such as 1 1/2 grains or less) or T3-only in small amounts, or a combo of T3 and very low T4. We are looking for the amount that isn’t causing either pooling or high RT3 symptoms.

What if I still can’t tolerate my treatment?

For a few rare individuals, they may have inherited a faulty deodinase enzyme (meaning you can’t convert T4 ever)…the best solution for these individuals appears to be T3-only, multi-dosed about 3 times a day, with a fourth smaller dose at bedtime, for example.

There are others who could be allergic to pig, which would also show up when eating bacon or ham! An alternative, in that case, is using the two synthetics, which do work well if you get your frees optimal.

Finally there are could some who have a reaction to the fillers in the brand they are using. Switching to a different brand has solved that for them.

If I get the above-mentioned hyper symptoms while raising T3, T4/T3 or a better NDT product, do I lower them?

Most of us do to a dose that didn’t cause the overreactions. And immediately.

What about Lyme disease and tolerating your thyroid treatment?

There are some with Lyme who report doing well on T4/T3 or a better NDT. But there are many others who find the Lyme and related co-infections are driving their T4 to excess RT3, possibly due to the high or low cortisol response. This may need lowering of T4 in their treatment and adding in straight T3….or being on T3-only. Another smaller group with Lyme are finding it makes them quite sensitive to red meat…but haven’t yet gotten evidence that they would react to NDT. We’ll see.

A side comment about heart palps

Some of us with Mitral Valve Prolapse (MVP) could notice heart palps when starting on T3 in our treatment or when raising, not due to an iron or cortisol problem, but due to MVP sensitivity. Janie Bowthorpe has MVP and heart palps due to it when starting and raising T3, but the palps went away after a few days on each raise.

You just have to learn what T3 in your treatment is telling you when it doesn’t work well, and treat those issues correctly. Because unlike T4 with its history of problems, you may not want to miss out what T3 can do for you…whether T4 and T3, T3-only or even a natural thyroid supplement like Thyrogold, et al.

*** Need a good doctor to work this information with? Go here. But you have to be informed and expect to teach even the better doctors.

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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.