Screen Shot 2015-08-19 at 10.23.44 AMHave you ever discovered that your free T3 lab result was very high and/or over-the-range with continuing symptoms or a low free T4??

This phenomena is what we, as thyroid patients, call “pooling”.

Pooling means your free T3 isn’t making it well to your cells, and instead, is hanging out in your blood, going higher and higher as you raise your T3-containing medication like Cytomel or natural desiccated thyroid.

You may or may not know it’s happening at first. But sooner than later, pooling ends up promoting excess adrenaline and hyper-like symptoms as a result. It seems to also eventually result in higher RT3 since we are also raising the T4 in NDT, we’ve seen, if patients keep raising NDT in the presence of low iron or a cortisol problem.

What are symptoms patients experience due to pooling, which pushes excess adrenaline?

They are individual. Some people notice nothing. Others notice symptoms such as anxiety, panicky feeling, shakiness, heart palps, higher heartrate, higher blood pressure, etc.  Other issues can cause those latter excess adrenaline symptoms, too, but we do notice them when pooling, too.

What causes pooling?

For most thyroid patients, it’s because of two problems: inadequate levels of iron, and a cortisol problem, whether too low, or too high. Also accompanying pooling sooner or later, and if you are using Natural Desiccated Thyroid or T4 in your treatment, is rising Reverse T3 (RT3)–the inactive hormone that if in growing amounts, contributes to the “pooling” since it’s competing for the same cell receptors as T3, and blocking the door! T4 in higher amounts converts to RT3 if you have an iron or cortisol problem!

A high FT3 will also mean your RT3 ratio can look good, but it may not be!

But my iron is normal/fine/good, as is my cortisol!

Lab results have nothing to do with just falling in the normal range. They have to do with where they fall in those ranges. Your doctor probably doesn’t yet get this, so you don’t either.  Additionally, we learned the hard way years ago that cortisol testing needs to be the 4-point saliva test, NOT blood, as the former will measure what is available to your cells, plus at four key times during a 24 hour period.  Always compare your results to this Lab Values page.

Do pooling and a high Reverse T3 come together?

Not always. From looking at each other’s labs, some will see pooling first without having an excess of RT3. Later, if they continue to raise NDT, the RT3 dominance can occur.

If I have no symptoms of pooling, yet it’s very clear with labs, do I not have a problem?

No, you still have a problem and need to treat the pooling, we’ve discovered, which is usually always about inadequate iron or a cortisol issue.

What is the treatment solution?

First and foremost, we discover and start treating the causes of pooling by ordering a 24 hour adrenal saliva test and all four iron labs, here. And we found repeatedly that that results have nothing to do with falling in the normal range. They have to do with “where” in those ranges they fall. See //

In the meantime, patients lower their Natural Desiccated Thyroid or T3 only, sometimes more than half, allowing the pooled T3 to fall, and which can happen within a week if lowered enough…and may take longer to fall if one is only on NDT. Patients then report they can add back in a small amount of straight T3 (i.e. T3 to the lowered NDT they were now on, or T3 to the smaller amount of T3 they were now on), and raise in small increments to alleviate symptoms of hypo. How much added T3? 10 mcg T3 is a good starting dose to add back in, or half a 25 mcg tablet to equal 12.5 mcg if you only have the larger tablets. As symptoms of hypo return, patients may add smaller increments of T3. But it’s important to remember that your T3 will pool again if you haven’t treated the reasons for it, so judicious use of the added T3 is important. 

Bottom line

We’ve learned how very important it is, before raising NDT or T3, to see where our adrenals stand, and all four iron labs, by comparing the results to the Lab Values page, then treating if we see a problem. Or at the least, to test more often as we are raising to catch it!