Years ago, we as hypothyroid patients due to any cause, noticed a phenomena we call pooling. It means T3 going high in the blood and not making it to the cells. We noticed this when, in trying to raise T3 in our treatment, it was causing heart palps, or a higher heartrate, or any hyper-like symptoms. It’s usually due to a cortisol problem, whether too low or too high cortisol. Check out the information below and see what you think. Also share the information with your doctor ~Janie, hypothyroid patient and site creator.

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 thyroid medication, whether you use synthetic T3, or the T3 in a working desiccated thyroid.

Why does pooling happen?

Pooling, or T3 going way too high with accompanying hyper-like symptoms, seems to always be associated with having a cortisol problem, we as patients have noticed over the years. It mostly happens with having low cortisol, but can also happen with a mix of highs and lows, or mostly highs! When cortisol is off, it can’t distribute T3 to the cells well. So the T3 goes high in the blood with continued symptoms.

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

They are individual. But the most common symptoms are heart palpitations or a rising heartrate. Some people notice nothing. Some notice increased hypothyroid symptoms, which can include fatigue, depression, etc. Others notice hyper-like symptoms such as anxiety, panicky feeling, jittery, shakiness, heart palps, higher heartrate, higher blood pressure, etc.

Are there other ways patients figured out they are pooling??

For those who aren’t yet experiencing the typical heart palps, rising heartrate, or anything hyperish, the free T3 can reveal it. It can look high, yet we continue to have hypothyroid symptoms.

What causes pooling and what have patients done about it?

For most hypothyroid patients, the causes are pretty clear: stressed adrenals, which can include inadequate or improper levels of cortisol, first and foremost, usually too low cortisol, but can happen with a mix of highs and lows, and even all high. So we realize either of those will need to be discovered and treated before we can comfortably raise T3 in our treatment. We find that the best way is doing a saliva cortisol, which is measuring what is available and unbound. Blood on the other is measuring what’s bound and unavailable. And blood results do not always fit what our symptoms tell us. Plus a blood cortisol test is only at ONE TIME, and you miss what’s going on at other times. You can click below to order a saliva cortisol test.

When you get your saliva results

When you get your lab results back, compare them to the information on the lab values page. The latter is based on where patients fall who don’t have a problem. This may be information you’ll have to teach an open-minded medical professional.

Do pooling and a high Reverse T3 come together?

They can, but usually only if you also have “high” cortisol in your saliva results. High cortisol is one of three reasons RT3 will go up. Two other causes of rising RT3: Inflammation and low iron

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

Patients still see a problem and need to treat the pooling, we’ve discovered, which is usually always about a cortisol issue.

My doctor wants me to move back over to T4-only, claiming the T3 in NDT is just too much for me, thus why it’s high. Is that the solution?

Beware: doctors don’t get pooling at all or what causes it!! So they tend to send us back to an inadequate treatment with T4-only. But we found it’s NOT the solution and only makes the reasons for your pooling WORSE.

What is the treatment solution for pooling, say patients?

REMEMBER: this page is just information based on all we’ve learned. It’s not telling you what to so. Work with a doctor.

First and foremost, patients report learning over the years to treat the causes of pooling by ordering a 24 hour adrenal saliva test, since either low cortisol, or a mix of highs and low, or mostly highs can do this. A cortisol test for us is never blood testing! Blood is measuring mostly bound, unusable cortisol. Saliva measures what is useable.

In the meantime…

a) Some do fine temporarily keeping the pooling as it is, as long as we don’t have symptoms…but we’ve learned repeatedly that we still need to discover and treat the cause of the pooling. Discovering it is via the saliva test. Treating it is by treating the cortisol problem, which is explained in chapter 6 of the STTM book. This is information to use with a doctor.

b) Some because of symptoms of the pooling end up lowering their T3 until any hyper-like symptoms stop. But we again learned we have to do the saliva test to see what needs to be treated. Without treating, we can’t raise a product with T3 to get out of our hypothyroid state.

c) We learned the HARD way to never, never start on cortisol treatment if we pooling. We learned we have to lower that high FT3 before starting on cortisol for any low cortisol issue as discovered via the saliva test. Again, Chapter 6 in this book. Starting on cortisol for low cortisol will cause that high level of T3 to RUSH into the cells like a son-of-a-gun and give horrible hyper.

d) For those who go down on their T3 containing thyroid meds to lower symptoms of pooling due to a cortisol problem…patients have reported doing down by half or more, allowing the pooled T3 to fall, and which can happen within a week if lowered enough. Some are able to go back up in teensy amounts as long as pooling doesn’t start again. Treated the cortisol problem is then paramount, patients report learning. If 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, which is about a cortisol problem, so judicious use of the added T3 is important.

REMEMBER: this is just information as learned by patients. Work with a doctor.

Bottom line

We’ve learned how very important it is, before raising a working NDT or T3, to see where our adrenals stand using this: We use saliva cortisol testing, and compare the results to the Lab Values page, then treating if we see a problem. Treatment of a cortisol problem is completely explained in chapters 5 and ESPECIALLY chapter 6 of the updated revision STTM book. Teach your doctor.

This research explains the “altered interaction between T3 and cell receptors:

**Read more about IRON AND CORTISOL. It’s important. 


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.