The Miracle of T3

It is not very often that doctors refer to any medical result as a miracle.  I have been debating the point with myself but I keep hearing words from patients who have used T3 and “a miracle” has been said many times, so I am quoting my patients and I don’t pretend to be working any miracles.

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Quite the opposite actually.  T3 has been around for years and to quote the FDA mandated package insert warnings, “T3 is not to be used to treat hypothyroidism.”  No argument from me, until I recently came across the following concept while researching fibromyalgia.  The reference was to “the inability to convert T4 to T3.”  I had never heard of such a thing in my (excellent) medical training decades ago, nor had I heard of such an idea since.  The concept was totally new to me.  It didn’t take long to realize the results of having such a condition.  The person would be dramatically hypothyroid (under-active thyroid), a couple of the symptoms of which are inability to lose weight and chronic fatigue.  Obesity is now “the number one health problem in the USA today”.  It is widely implied that such obesity is the result of a sedentary lifestyle and over-eating.  No doubt this is a factor, but amongst all those people who have been referred to as lazy and self-indulgent, there is an important subgroup who can’t lose any significant weight no matter how “correctly” and vigorously they try, and it has nothing to do with being a lazy over-eater, it’s because they “can’t convert T4 to T3”.

What is this fool talking about? Some of you are probably thinking.  What is T3 and why is it “a miracle”?  T3 is the active version of T4.  T4 is the standard thyroid hormone produced by the thyroid gland, and its active form T3 controls the metabolic rate of everything in the body.  Metabolic rate is the rate at which your body burns fuel (food or fat) to carry out the background automatic things it does such as digestion, brain function, body temperature, etc.  With low thyroid effect, the metabolic rate is low and the body does everything very slowly, requiring minimal calories.  With high thyroid effect, the metabolic rate is high and the rate of background calorie consumption is increased to fuel this higher rate.

Another important symptom of hypothyroidism is chronic overwhelming fatigue, which is immediately fixed by T3 if “inability to convert T4 to T3” is the reason, which is often the case.

Overweight people have often been referred to as having a slow metabolism.  This is usually correct.  What’s been left out is the fact that metabolic rate is easily adjustable upwards.  Speed it up and guess what?  You CAN lose weight.  Can this be done safely?  Yes.  Can it be done inexpensively?  Yes.  What tests are required periodically?  Pulse.

Problem is, when these people get tested for hypothyroidism the results are for T4, which is usually normal, and they are told that there is nothing wrong with their thyroid and they should eat less and exercise more.  Truly motivated people do this and experience minimal weight loss despite sometimes heroic efforts to diet and exercise.  Some actually get treated with T4, usually for excessive fatigue, and get no significant response.

This is a classic case of one of the terrible things that has happened to health care during my professional career, namely doctors treating lab tests instead of the patient.

When I trained for my MD it was not possible to get blood hormone levels.  To evaluate the thyroid we had to order a PBI (protein bound iodine) and surmise about what the thyroid level was, and decide whether or not this surmising agreed with what we found when we examined the patient.  It seemed truly “a miracle” when medical labs could give us actual thyroid hormone levels.  This made all the previous tests and tedious evaluations obsolete.  The lab value became the absolute truth and doctors stopped listening to and actually examining their patients because they no longer needed to.  They could just get a blood test.  Well, those who (unknowingly) couldn’t convert T4 to its active form T3 were not well served by this new “miracle” lab test, and their hypothyroidism went undiagnosed and untreated their entire lives.  No amount of patient complaints could win an argument against a normal lab value of T4.

Introduce the “can’t convert T4 to T3” concept and all of a sudden it becomes obvious that at least these patients were right all along.  They really CAN’T lose weight.

Well, just give them T3 instead.  Seems pretty obvious to me.  That is what I am doing.

While my main purpose is to attack the number one health problem in the country today, obesity, there are many other symptoms of chronic hypothyroidism that are “cured” by using T3 instead of the routine T4.  Prominent among these are chronic unremitting fatigue and physical weakness.  Chronic fatigue syndrome is more and more getting lumped together with fibromyalgia, as chronic fatigue is one of several problems occurring with fibromyalgia.  I recently started a friend with this problem on T3, anticipating an eventual daily dose similar to T4, 100 – 200 mcg, but started very cautiously with a tiny dose of 10 mcg.  An hour after the first 10 mcg pill she vacuumed her whole house.  No question about cause and effect.  No double blind studies needed.

How do I you find out if I can’t convert T4 to T3?  Well, that’s a good question.  There is no lab test, and the only findings on examination are the same as hypothyroidism.  If you have been treated with T4 and had no significant improvement the diagnosis is likely.

Essentially, you find out if T3 is what you need by response to therapeutic trial.

I don’t care what anyone calls the problem, I just want to fix it.  If you have no conditions or physical exam findings (mainly those of hyPERthyroidism) that make such a therapeutic trial unsafe or unwise, there is no reason why anyone who has any possible symptoms of hypothyroidism (obesity, fatigue) can’t undergo a therapeutic trial and see what happens.  I’ve already told you the word most commonly used by patients to describe their results.  And we are talking about the number one health problem today.

9 Responses to The Miracle of T3

  1. Annie Conway says:

    Now, my question, upon reading this is: why do I REMAIN hypo although I’m taking 60 mcg T3 in 3 doses through the day? I’ve tried splitting those into 10mcg doses by breaking the pills in half (a feat in itself!) but it’s made absolutely no difference? My weight is static, my anxiety and depression levels remain sky high, aches and pains and NO energy – either mental or physical and VERY irritable

    • Brenda says:

      I have the same weight issue and was recently diagnosed with Hashimoto’s Thyroiditis, which is an autoimmune disease that is the precursor to Hypothyroid. I was also achy, low energy, brain fog and slight depression until I upped my T3. Now I take 100-125mcg of T3 only, every 4-6 hours in 25mcg doses. So far, I have only released 7 pounds in the last 3 months. On the other hand, I have more energy, sleeping well, blood pressure is stable and actually able to do more than go to work and back home everyday. The weight issue is frustrating, yet I know there is something else that needs to be addressed. For me that is Leaky Gut Syndrome.
      Autoimmune diseases generally begin in the gut. If the gut has inflammation and/or is acidic, the T3 is not able to be properly absorbed. To fix this, I have begun a regimen of vitamins and minerals including: 250mcg L-Glutathione, 3 tablespoons Coconut Oil, 500mcg Krill Oil and 500mcg Garlic tabs. To help me sleep I take 250mcg Magnesium when I get in bed and usually asleep in 10 minutes. I wake up the next day at 5:30 without an alarm clock and ready to go.
      I am on a gluten-free diet, as well as eliminated dairy, sugar, corn and definitely no soy.
      So you may have some underlying issue also that has not been discovered or addressed yet. Just don’t give up and keep looking for answers, it’s not easy but it is so worth it to get your life back.

    • Michael Morris M.D. says:

      because appropriate, ie functional, dose is 3-6 times that amount

  2. ava says:

    What are your thoughts about using the reverse T3/Free T3 ratio as a way of finding out if a person is able to convert Free T4 to usable Free T3? Thanks

  3. Marion says:

    Annie, I just very recently found out that sometimes a person doesn’t do well on generic liothyronine compared to brand name Cytomel. That does seem to be what happened to me. I am seeing others say that generic is junk and just does not work for them. When its not working your levels and daily temperatures will remain erratic and you will still feel awful. I hope you will take this into consideration when treating people who do not seem to be responding to T3 when its in generic form Dr. Morris. I changed to a brand name and did fabulously for about two weeks and then went back to taking the generic tablets for 3 doses and all of a sudden my temperatures took a nosedive and I became very ill feeling again just like I had before.

    • Michael Morris M.D. says:

      No doubt about brand name superiority. Many generics worthless or unreliable in dose control. Cost is outrageous, at least in USA. Do you remember the brand generic(s)?

  4. Lisa says:

    Dr. Morris, You are SO right about T3 and its effect on the metabolism (of course, given your training and length of experience practicing medicine). I am one of those patients who cannot convert T4 properly. It took 15 doctors to finally find one who was not afraid to prescribe T3. And 13 of those doctors refused to admit that any such thing as a conversion issue even existed.

    A recent trial of adding Armour thyroid back to my medication protocol (natural dessicated thyroid that has both T4 and T3) made it clear that even now, I do not convert normally. Conversion issues are often attributed to issues with low iron/ferritin or adrenal fatigue, or some underlying infection or illness. Even with those items treated, I still “crash” when I take T4.

    I read that you say there is no test for thyroid conversion disorders, but I believe there actually is a way to test it. As you know, when the body converts T4, it converts to either T3 or Reverse T3, the inactive form of T3. According to Dr. Kent Holtorf (also in southern California), Reverse T3 is one of the best measurements of thyroid hormones at the tissue level. By drawing labs for Free T3 and Reverse T3 at the same time, and then determining the ratio between the two, you can tell if a patient is converting adequate amounts of T4 to T3, or converting excessive amounts to RT3. According to Dr. Holtorf, the ratio should be 18 or higher.

    I hope you find this information useful. Our country needs more doctors like you who still listen to the patient, conduct clinical examinations, and seek to get the patient well rather than simply making the lab numbers look good. Kudos to you, Dr. Morris. I know you are making a wonderful difference in the lives of the patients that you treat.


    • Michael Morris M.D. says:

      Armour has T4 also. I don’t put any confidence in most lab tests. The test I’m interested in is does the patient feel better? I rather strongly disagree with the experts, esp as regards rt3.