If you have a thyroid issue and want to feel better, then increasing your T3 level to the optimal range is the single most important thing that you can do.
Because T3 is the active thyroid hormone.
Most people have lower than optimal free T3 levels even if they are taking thyroid hormone medication.
So how do you increase your T3 level? That is the critical question.
I will try to give you all of the tools you need in this article to start increasing your T3 level and get you feeling your best. Some are simple and straightforward while others are more difficult.
Here we go…
Let’s start with a quick tutorial about the thyroid which will help you understand some of the terms I will be using and what they mean.
The thyroid gland is a factory. It’s job in the body is to make thyroid hormone.
The thyroid depends on the pituitary gland in the brain to tell it how much thyroid hormone to produce. The pituitary does this by secreting Thyroid Stimulating Hormone (TSH).
The majority of hormone that the thyroid makes is T4. T4 is inactive and is basically the transport form of thyroid. It serves as a reservoir that the body can draw from when it needs more T3.
A small amount of T3 is also made directly by the thyroid, but most of it is produced outside of the thyroid gland by converting T4 to T3. This is done by an enzyme called a deiodinase.
T4 can also be converted into Reverse T3. Reverse T3 is the anti-thyroid hormone. It will bind to thyroid receptors in the cells but does not trigger any function. It therefore effectively blocks that thyroid receptor.
Too much reverse T3 can result in a substantial reduction of thyroid function in the body. Therefore in most cases it is best to have as low of a reverse T3 level as possible (<15). Click here to read more about reverse T3.
Most T3 in the blood is bound to a protein. When T3 is bound, it is unable to attach to the thyroid receptors in the cells.
A very small percentage of the total amount of T3 in the body is not attached to a protein. We call that the free T3level. Since it is not attached to a protein, it is free to attach to the thyroid receptors in the cells and trigger the functions that it is designed to trigger.
Therefore, the free T3 level is actually a measurement of how much active thyroidhormone is present in the body.
In my practice, I like for the free T3 level to be >3.5 if possible.
As you can tell from this illustration, there are 4 main areas that should be optimized in order to maximize your T3 level:
Addressing all 4 of these areas will increase your chances of getting your T3 level optimized.
Let’s break these areas down further, plus I will discuss some other things that you can also do to get your thyroid working at optimal efficiency:
There are over 15 nutrients that are necessary for normal thyroid hormone production.
Most of them are usually found in adequate amounts in the Standard American Diet. However, it is common to be deficient in some of them.
Iron and iodine are two of the nutrients that are necessary to maximize thyroid production and it is common for people to be deficient in them.
Iron is completely intertwined with the thyroid.
If the iron level is low, thyroid medication doesn’t work as well, and conversion of T4 to T3 is reduced.
Conversely, thyroid hormone is needed to properly absorb iron.
So when thyroid levels are low it leads to iron deficiency which in turn worsens thyroid function, creating a vicious cycle.
Iron is also required for proper adrenal function. When the adrenals aren’t working it puts an increased strain on the thyroid which can lead to adrenal fatigue and other issues.
To find out if you are low in iron, you can ask your doctor to order a CBC, serum iron, TIBC, and ferritin level. If you are low, then treatment with a supplement may be necessary.
As a general rule, thyroid patients tolerate liquid iron better than pills. It causes less constipation and is usually better absorbed.
If the liquid iron is not adequate to raise the iron levels, it may still be necessary to switch to an oral tablet such as this one.
Remember, low iron is often due to a deficiency in your diet, but it could also be a sign of blood loss. If your iron is low (especially if you are anemic), you need to see your doctor about it. You could have gastritis, a stomach ulcer, or some type of lesion in your small intestine or colon that is causing the blood loss. It could be life-saving to have this investigated.
Iodine is a tricky subject when it comes to the thyroid, especially if you have Hashimoto’s Thyroiditis.
Many experts are adamant about the importance of iodine while others are afraid to use it.
The fact is, iodine is required for thyroid hormone production. Adequate amounts of iodine are necessary if you want to have optimal thyroid function.
So if you decide to use it, I would use this as a guideline:
Start with 325mcg of iodine per day and continue that for 10-14 days. You can then increase the dose by 325mcg daily every week as long as you are noticing improvement.
If you notice worsening symptoms then stop it immediately.
Click here for the supplement that I recommend.
Make sure that you monitor your thyroid antibody levels if you have Hashimoto’s.
Efficient T4 to T3 conversion is critical for normal thyroid function.
Most conventional doctors are taught to only check the TSH and occasionally the T4 level when monitoring thyroid function.
This assumes that the T4 to T3 conversion process is working normally. However, in my experience, that just isn’t the case.
Chronic inflammation in the body (arthritis, diabetes, obesity, etc.) impairs the conversion process. So does some nutrient deficiencies.
That may be why you are still having typical symptoms of hypothyroidism even though your TSH and T4 levels are in the normal range.
The following list is far from complete, but it includes what I have found to be the most common reasons why T4 to T3 conversion is impaired. Click on each nutrient for my preferred brand.
Inadequate zinc levels typically results in more T4 to reverse T3 conversion and result in worsening thyroid function. Zinc is also a powerful anti-inflammatory and helps regulate your immune system. It also is good for your skin.
Selenium is also essential for normal T4 to T3 conversion. It also helps to regulate the immune system and can help reduce thyroid antibody levels if you have Hashimoto’s. I typically recommend taking 200-400mcg daily. Click here to read more.
Even though I will discuss this is more detail later, it should be listed here as well.
Reducing the T4 to reverse T3 conversion will mean that the T4 is being channeled into converting into T3 instead.
This may surprise you, but up to 20% of the T4 to T3 conversion occurs in the gut!
The amounts and types of gut bacteria play a huge role in thyroid function.
With that in mind, this shouldn’t surprise you: Most thyroid patients have at least some level of gut issues.
Why? Because when the thyroid is low it makes your intestines move slower which can lead to constipation. It can also increase your risk of developing SIBO (small intestinal bacterial overgrowth), yeast overgrowth, and acid reflux (GERD).
Low thyroid also causes less stomach acid to be produced which further reduces the absorption of nutrients.
All of this also predisposes you to develop increased intestinal permeability, better known as leaky gut syndrome.
A leaky gut then allows foreign proteins to enter the bloodstream. One such protein is called LPS.
LPS has been shown in studies to lower T3 levels in the blood.
Have I convinced you how important gut health is to thyroid function?
So what can you do to improve your gut function?
The first step is to make a proper diagnosis. That can usually be done with a thorough history.
Pharmaceutical companies want us to think that almost all of us produce too much stomach acid.
If you are having heartburn after eating dinner, it’s because you have too much acid, right?
Wrong! The problem is not too much acid, instead the acid is going to the wrong places (your lower esophagus instead of staying in your stomach).
In reality, many people don’t produce ENOUGH stomach acid, also called hypochlorhydria.
Studies show that up to 40% of people over age 40 have hypochlorhydria. By the time you reach 60 years of age that number goes to over 50%! In fact, up to 30% of people over 60 have achlorhydria, which means they don’t produce stomach acid at all.
So take that information and just imagine how much worse those numbers get when you add proton pump inhibitors, H2 blockers, and antacids that so many people take on a daily basis.
Remember, stomach acid is critical for 3 primary functions:
If you want to read more about this subject in detail, I highly recommend the book “Why Stomach Acid Is Good For You” by Dr. Jonathan Wright.
Okay, so what can you do about this?
I would suggest a trial of Betaine Hcl with Pepsin.
Betaine is actually a capsule containing a small amount of hydrochloric acid. Pepsin is a digestive enzyme.
Start by taking 1 capsule at the beginning of each meal. If you are tolerating it without side effects, then after a few days increase your dose to 2 with each meal. You can continue to add a capsule every few days until you begin noticing a mild burning in your stomach. When that occurs, decrease your dose by 1 capsule from what you were taking when the symptoms occurred.
In my experience, most people need 1-3 capsules per meal. However, if you have a long history of PPI, H2 blocker or antacid use, you may need more.
If you are currently taking a PPI, H2 blocker, or antacid on a regular basis, I would suggest trying to wean off of those before trying the Betaine.
If you are on a PPI such as Nexium or Prilosec, try converting to an H2 blocker such as Zantac or Pepcid. It will be easier to wean off of those medications than it will be a PPI.
Also, if you currently have an active stomach ulcer, I would not recommend a trial of Betaine until after the ulcer has completely healed.
Digestive enzymes help to break down food which allows your body to extract the vital nutrients in the food.
They also help break down immune complexes in the blood which helps treat autoimmune conditions.
Click here for my preferred brand.
High potency, multi-strain, multi-species probiotics cah greatly reduce local inflammation in the gut as well as reduce systemic inflammation. I always recommend a probiotic to all patients with hypothyroidism (especially Hashimoto’s) for at least 2-3 months.
It is somewhat controversial whether you should take probiotics on a daily basis. Many experts feel that is unnecessary.
I usually break it down to whether the patient has any gut issues or not. If they do, they should take a daily probiotic. If they don’t they can probably used them only during times of sickness or severe stress.
Click here for my preferred brand.
If after reading this you believe you may have other gut imbalances such as SIBO, SIFO (small intestinal fungal overgrowth), or leaky gut, those issues will need to be addressed if you want to optimize your T3 level.
That will require sitting down with a doctor that is familiar and comfortable with those conditions.
Reverse T3 and T3 are inversely proportional to each other. As one rises, the other will fall and vice-versa.
That is because they both are produced from T4.
So reducing your reverse T3 production will mean that more T4 is being converted into T3.
So how do you do it?
Think of the reverse T3 level as indirect marker of inflammation in the body. Any inflammation will typically cause the reverse T3 level to rise.
Therefore, most of the things I list below address various forms of inflammation.
High levels of insulin and leptin tell your body to create MORE reverse T3.
It will be very difficult to lower your reverse T3 levels unless you address these issues.
Adding HIIT exercise to your regular routine will create a demand for more thyroid hormone in your body.
In effect, it will push your T4 conversion more down the T3 pathway and reduce your reverse T3.
Calorie-restricted diets will put your body into “starvation mode.” When that happens, T3 production is rapidly reduced and reverse T3 levels soar.
This is one of the ways that excessive calorie restriction damages your metabolism. Click here to read more.
Besides insulin resistance and leptin resistance, there are other sources of chronic inflammation that will result in an elevated reverse T3 level.
These can include other autoimmune conditions, environmental toxins, and even obesity itself.
It is critical to get a thorough history and physical exam including blood work to identify all possible sources of inflammation in your body so that each be addressed directly.
There are some blood tests that you can request from your doctor that are nonspecific markers of inflammation in your body.
The most common tests are the erythrocyte sedimentation rate (ESR) and the c-reactive protein (CRP). If either is above the reference range, it is a sign that there is unidentified inflammation in your body that should be addressed.
The quickest way of lowering the reverse T3 level is to take a T3 only medication.
This bypasses the conversion process altogether. Your need for T4 will decrease which will also result in a dramatic decrease in reverse T3.
The adrenal glands and the thyroid gland are closely linked.
As cortisol levels increase, so does the TSH, which makes the thyroid function worse.
Also, as thyroid function decreases, this puts even more stress on the adrenals to make up the difference.
Eventually, the system can no longer keep up and adrenal fatigue results.
In my experience, literally ALL hypothyroid patients have some degree of adrenal fatigue.
That is why I recommend that most hypothyroid patients take an adrenal supplement.
For the sake of this article, I would suggest a few basic things to help manage adrenal issue:
If you feel you need to learn more about this, click here for my article on adrenal fatigue.
Up to 60% of thyroid conversion occurs in the liver.
Obviously, making sure your liver is healthy and functioning well is critical if you want your T3 levels optimized.
Your liver can be assessed by having your liver function tests monitored. The primary test are AST and ALT.
If either test is >20, it is a sign that you have some liver impairment.
By far, the most common cause of liver impairment is insulin resistance. The insulin resistance can result in excessive fat deposits in the liver resulting in a fatty liver.
Reducing any liver dysfunction may result in the single greatest increase in your T3 level of any therapy that we have discussed.
The foundation of any successful health plan always includes 5 things:
If that foundation isn’t established, all of the supplements, medications, and other therapies will fail miserably.
I realize that this is easier said than done, but it is critical if you want to feel your best.
In the case of this article, you must be eating healthy, exercising, sleeping well, and managing your stress in order to maximize your T3 production.
If you need a simple place to start, consider the Whole 30 Diet or the Ketogenic diet.
If you are having trouble with those or if you feel you need more instruction, I would recommend hiring a nutritionist for some one-on-one instruction. You are worth it!
I would also recommend hiring a personal trainer that will give you a personalized exercise program that will be safe and effective.
Raising the T3 level is easy for some people and hard for others.
The key to success is identifying WHY yours is low and addressing the root causes.
These can include poor diet, lack of exercise, nutrient deficiencies, and excess stress.
There could also be unidentified sources of inflammation in your body or your liver and gut might not be working as efficiently as they should be.
Finally, it may also be the situation of needing a different thyroid medication.
Find a doctor that is willing to investigate all of these potential causes and is open to trying different thyroid medication.
Now it’s your turn…
What have you tried to increase your T3 levels?
What has worked and what hasn’t?
Leave any questions or comments below.
Liothyronine (T3) is the most potent thyroid hormone that you can take.
It is rarely prescribed by most doctors, which is unfortunate, because it can significantly improve your hypothyroid symptoms and overall quality of life.
The symptom improvements can include improved energy, weight loss, and even a reduction in depression.
Learn who could benefit from using liothyronine, how to use it safely, and lots more in this article…
In order to understand liothyronine, it is important that you understand the basic physiology of the thyroid. You can read more in depth about it by clicking here.
Liothyronine is T3. T3 is one of the 2 main circulating thyroid hormones in your bloodstream.
T4 is the inactive thyroid hormone. The vast majority of hormone made by the thyroid gland is T4.
T4 itself has no activity in the body. In order for it to become an active hormone, it must be converted into T3. An iodine molecule is cleaved off of the T4 by an enzyme called a deiodinase, which results in the production of T3.
T4 can be looked at as the storage reservoir for thyroid hormone in your body. When your body needs more active thyroid hormone, it can convert the T4 that is circulating in the blood into active T3.
By understanding that T4 is the inactive form of thyroid and T3 is the active form, it then makes sense why oral T3 medication is much more potent than oral T4 medication. In fact, it is about 3-4 times more potent.
If Liothyronine is so powerful, then why don’t more doctors prescribe it?
Most doctors simply were not taught how to prescribe T3 medication and manage patients that are taking it. They were also not taught which labs need to be monitored and how to interpret those test results.
I was personally NEVER taught about T3 medications in my many years of training. I have had to learn about it myself through attending multiple medical conferences, reading tons of literature, and asking doctors with experience prescribing it how they use it.
It is simply assumed by most doctors that all patients have no issues with converting T4 to T3. If that was the case, every patient could just take a T4 only medication such as Synthroid, levothyroxine, or Tyrosint and it would seamlessly be converted to T3 when the body needed it.
Wouldn’t that be easy?
However, most people with thyroid issues have a reduced ability to convert T4 to T3. Instead, much of the T4 is converted into the anti-thyroid metabolite reverse T3 which results in a condition called reverse T3 dominance. This is usually due to chronic inflammation in the body and/or a deficiency of nutrients such as iodine, selenium, or zinc.
That is why you may be on a good dose of a T4 only medication which results in a normal TSH and T4 level, yet you still have symptoms of hypothyroidism.
In those situations, when used and monitored properly, liothyronine can be a safe and extremely effective medication to treat your hypothyroidism and improve your symptoms.
One study showed that replacing T4 with T3 resulted in weight loss and greater thyroid action on lipid metabolism, without an increase in side effects.
Not everyone who takes thyroid medication necessarily needs to take liothyronine.
Besides having hypothyroidism, if you are otherwise healthy, energetic, and feel great, your conversion of T4 to T3 is probably adequate and you may not need to change from your T4 only medication.
Now, for the other 99% of you (ha!), you may want to get a complete thyroid panel so that you can truly assess the T4 and T3 levels in your body:
You should also consider getting a sex hormone binding globulin level (SHBG), which can also help give you an idea of the thyroid levels in your body (if you are on oral birth control pills or estrogen or if you smoke, this test will not be helpful).
If your reverse T3 level is >15, your free T3 level is <3.5, and/or your SHBG level is <20 in men or <60 in women (who aren’t taking oral estrogen), then your T3 level is inadequate and you may want to consider adding T3 in some form to your regimen.
Below is a general list of people who may need to add T3 to their thyroid medication regimen:
This is by no means an exhaustive list, but it includes the majority of patients that may benefit from taking T3.
If you are currently taking a T4 only medication (Synthroid, levothyroxine, or Tyrosint), changing to an NDT medication such as Armour Thyroid, NP Thyroid, or Nature-throid may be the easiest thing to try to increase your T3 level. In fact, that is usually the first thing I will do for patients.
NDT is about 80% T4 and 20% T3. While that is certainly better than a medication with 100% T4, that may still be too much T4 which could result in a high level of reverse T3.
If you are taking an NDT medication and your reverse T3 levels are too high and your free T3 levels are too low, you may need to reduce your NDT dose (at least temporarily) and add a small dose of liothyronine in order to “flush out” the reverse T3 which will allow the T3 levels to rise to optimal levels.
Liothyronine may cause weight loss but it should NOT be used as a weight loss medication.
If used for weight loss in patients without thyroid dysfunction, it could cause some unpleasant and even dangerous side effects.
However, liothyronine may help with weight loss in patients with hypothyroidism.
T3 may cause more weight loss than T4 because of how it interacts with fat cells and other hormones in the body.
T3 directly increases mitochondrial energy production and increases thermogenesis and fat burning potential.
Liothyronine can also reduce symptoms of depression.
Low thyroid levels (hypothyroidism) are known to commonly result in symptoms of depression.
What you may not know is that adding liothyronine to an antidepressant can improve mood and cognitive function even when the thyroid function is normal.
The exact mechanism is not fully understood, but it is believed that some patients with depression may have subclinical hypothyroidism that is not bad enough to be detected on standard lab tests but still causes typical symptoms of depression.
Therefore, by treating those patients with liothyronine, it may correct those subtle thyroid abnormalities in the brain which will help resolve the depression symptoms.
T3 has also be shown to increase the receptor sensitivity to serotonin and increase the synaptic concentrations of serotonin.
Since the most commonly used antidepressants are only successful in treating depression in about 50% of cases, the addition of liothyronine is a viable option to consider, especially in “treatment resistant” cases.
If you are on a T4 only thyroid medication and are still suffering from depression, adding liothyroinine to your T4 medication may significantly improve mood and neuropsychological function.
The whole point of even discussing liothyronine is because we want to raise the active thyroid levels (T3) in the body to optimal levels.
Taking T3 medication (liothyronine) will obviously accomplish that goal. There are also some natural things that should be considered that will result in increased levels of T3. Let’s discuss those as well as how to take liothyronine…
The conversion of T4 to T3 is dependent on a few nutrients.
It is common for people to be deficient in these nutrients because they may be lacking in their diet or they may have gut issues such as leaky gut that reduce the absorption of the nutrients.
Some of the most important nutrients include:
Another way that you can raise T3 levels and improve its function is to lower reverse T3 levels.
Remember, reverse T3 is the anti-thyroid metabolite that binds to thyroid receptors on the cells but blocks their function.
By reducing the amount of reverse T3, it will in effect improve T3 function.
So how do you do it? Address the issue that is causing the reverse T3 level to be increased in the first place.
Easier said than done, but below is a list of common issues that result in elevated reverse T3 levels:
Cytomel is the brand name for liothyronine, but over the past few years generic versions have become available that are less expensive.
Liothyronine is available in 3 strengths – 5mcg, 25mcg, and 50mcg. I personally have never prescribed the 50mcg dose.
Typically, the 5mcg dose is prescribed first, then it may be increased to 10mcg (2 tablets) depending on the patient response and labs. If more is needed, usually 1/2 pill of 25mcg is given, then possibly a full 25mcg tablet.
This is by far the most common way that liothyronine is used. Fortunately, medical providers are becoming more comfortable using it so its use is expanding.
Liothyronine is added to the patient’s current dose of T4 medication (levothyroxine).
Remember, liothyronine is 3-4 times more potent than levothyroxine, so you will need to be aware of any side effects and your labs will need to be monitored closely.
If your TSH is suppressed excessively, it may be necessary to reduce your dose of levothyroxine.
Most physicians will not be comfortable prescribing liothyronine by itself.
This is because most medical committees recommend using a T4 thyroid medication as first-line treatment of thyroid issues.
However, many patients with weight loss resistance, leptin resistance, and other hormone imbalances may benefit from using T3 by itself.
T3 medication can be used temporarily to boost the body back into action or it can also be used long-term.
As long as it is used correctly and monitored closely there should not be any long-term consequences in using it.
If you are interested in using it, you must find a doctor with experience in prescribing it, and you must be willing to get regular lab tests and follow-ups with your doctor.
Occasionally patients may be extremely sensitive to T3 medication. In those situations, it may be necessary to have a compounding pharmacy make a sustained-release form of T3.
The sustained-release formulation will allow the T3 to be released gradually over a longer period of time which will reduce the side effects that the T3 may cause.
Some patients tend to be very sensitive to T3 medication. This usually causes them to feel jittery or anxious when they start the medication.
If you have a history of being sensitive to other medications, you need to let your doctor know before starting T3. You can probably still take it, but you will need to go “low and slow” with it.
As a general rule, I have found that women tend to be more sensitive to T3 than men, although there are certainly exceptions with both.
The side effects of liothyronine seem to mirror those caused by hyperthyroidism. These include:
If you develop any of these symptoms you should notify your prescribing doctor and discuss treatment options.
Liothyronine is a T3 only medication.
It is the most potent thyroid medication available.
When used correctly and closely monitored, liothyronine is extremely effective in treating hypothyroidism and reducing symptoms. It typically causes some weight loss as well.
It can also be used to treat resistant depression.
Now it’s your turn…
Have you ever taken liothyronine? If so, what were the results?
Leave any questions or comments below.