Thyroid Hormone: T3
Sufficient thyroid hormone is essential to our health and our quality of life. Thyroid hormone
regulates the rate of metabolism of every cell, in every tissue and organ in the body. It
determines the number, size, and activity of the energy-producing mitochondria in every cell. Low
thyroid levels/effects in the body causes a reduction in all essential functions of the body.
Symptoms of hypothyroidism include cold extremities, weight gain, fatigue, need for excessive
sleep, high cholesterol, muscle aches and stiffness, ankle edema from reduce cardiac function,
dry skin, constipation, scalp and eyebrow hair loss, high blood pressure, depression, and
mental slowness. In some persons, thyroid insufficiency produces a different clinical picture--
anxiety, palpitations, insomnia, and attention-deficit disorder. There are many other symptoms
that can be seen in persons due to their unique constitutions and their body's attempts to
compensate for the low thyroid levels. Hypothyroidism also has long-term health consequences.
Even mild hypothyroidism increases one's cholesterol levels and one's risk of atherosclerosis
and heart attacks. Young persons up to age 25 have higher thyroid hormone levels than those
over 25. Since we begin to deteriorate around age 25, which level do you think is better for our
health? After age 25 there is a steady decline in our thyroid hormone levels, our sensitivity to
thyroid hormones, and our own TSH-response to low thyroid levels.
Unfortunately, the medical profession clings to a false system of ideas regarding thyroid
insufficiency. Medicine is failing, on a grand scale, to both diagnose and properly treat
hypothyroidism. Doctors are that all they need to do is look at the TSH (thyroid stimulating
hormone) level--that this one blood test tells them all they need to know about the person's
thyroid hormone status. Dr. Lindner calls this the "Immaculate TSH Doctrine". This belief in the
TSH level is not justified by any evidence and is contrary to basic principles of physiology. The
level of TSH secretion from the hypothalamus-pituitary system is every bit as fallible as any
other bodily function. Indeed, the hypothalamus is a kind of grand central station of the brain,
affected by its connections to all parts of the brain, by neurotransmitter imbalances, biochemical
disorders, toxins, aging, etc. Because of the Immaculate TSH,most doctors check only a TSH
level to "rule out" hypothyroidism and also adjust thyroid replacement doses to "normalize" the
TSH. In Dr. Lindner's experience, "central" thyroid insufficiency with a "normal" TSH but low
thyroid hormone levels within the reference ranges is much more common than primary
hypothyroidism where the thyroid gland is not working well and the TSH is high. This partial
central hypothyroidism is frequently the cause of depression, obesity, high cholesterol, chronic
fatigue, and fibromyalgia. The TSH level can never be trusted. A doctor must always look for
symptoms first, and look at the free T4 and free T3 thyroid hormone levels second. In Dr.
Lindner's experience, people with hypothyroid symptoms and free T4 and/or free T3 levels in the
lower halves of the laboratory reference ranges benefit tremendously from thyroid hormone
optimization. When both are in the lower third of their population ranges, the person generally
has severe hypothyroidism, regardless of the TSH level.
It is inappropriate to rely on the TSH to adjust thyroid hormone dosing, as the TSH production
may have been weak to start with, and the TSH-production system did not evolve to deal with
once-daily oral T4 replacement. Taking all one's thyroid hormone by mouth once daily produces
highly unnatural T4 serum level spikes that over-suppress the TSH for many hours. Studies
have shown that TSH-normalizing T4 treatment leaves many persons with residual signs and
symptoms of thyroid insufficiency (Saravan 2002, Samuels 2007). A landmark study was done
where four experienced thyroidologists adjusted levothyroxine (T4) doses according to purely
clinical criteria (symptoms and physical exam). The patients were then tested and it was found
that their TSH levels ranged from <0.01 (suppressed) to 20mIU/L. Only the free T3 level
correlated well with clinical euthyroidism. (Fraser, 1986). Such a study has never been repeated.
All other research in the thyroid literature is based upon the assumption that a "normal" TSH
means that the patient is "euthyroid". All that research is therefore confused and misleading.
Even when doctors do prescribe thyroid hormone, they usually prescribe only the prohormone
T4 (Synthroid®, Levoxyl®). It must be converted to T3 to become active. They give T4 in low
doses that just "normalize" the TSH to any value within the reference range. The result is an
almost universal undertreatment of thyroid insufficiency. One cannot assume that there will
be sufficienc T4 to T3 conversion with this unnatural replacement. It has been repeatedly
demonstrated that with the usual TSH-normalizing T4 therapy, free T3 levels remain relatively
low (Escobar-Morreale 1996). Often they are lower than before the T4 therapy was started
leaving a patient more hypothyroid than before therapy! Yes, small doses of T4 can make the
hypothyroidism worse because the reduction in TSH reduces both the thyroid gland's output,
and the body's ability to convert T4 to T3!. When the TSH is reduced by thyroid replacement, T4-to-
T3 conversion is reduced throughout the body. (Kabadi 2006)
Endocrinologists increasingly practice "Reference Range Endocrinology". Most doctors fail
to understand that the laboratory ranges are just population ranges. ; they just tell us where
the values of 95% of all adults tested by that laboratory happen to fall. They do NOT represent
the optimal range for that person or for our species in general. With these broad ranges, you
can only be judged to be hypo or hyperthyroid only if you're in the extreme lowest or highest 2.5%
of the entire population. It is a fact that far more than 2.5% of the population have sub-optimal
thyroid levels, so the reference ranges are excessively broadened towards the low end.
Consider the tremendous breadth of the reference ranges. For free T4 the range spans a factor
of 3 from bottom to top (often 0.6 to 1.8 ng/dl), and for free T3 a factor of 2. Can a person have the
same health and quality of life if their thyroid hormone levels drop to 1/2 or 1/3rd their previous
level? Won't a person feel very differently when their thyroid hormone levels are doubled or
tripled--yet still remain within the reference ranges? The fact that all "normal" values are not
ideal is evidenced many different studies have shown clear benefits to having T4 and T3
levels within the upper third of the reference ranges. These demonstrated benefits include
lower cholesterol levels, reduced weight, reduced tendency to form blood clots, reduced risk of
atherosclerosis, and alleviation of depression. Adults with hypothyroid symptoms but "low
normal" free hormone levels often respond very well to adequate thyroid supplementation
(Skinner, 2000). The only 95% population reference ranges that could be used to diagnose
thyroid sufficiency would be ranges based upon a study of perfectly healthy, vigorous 20-25 year
olds.
However, even the free serum FT3 and FT4 levels cannot tell the whole story. Human physiology
is much more complicated than that. There are many mechanisms by which relative resistance
to thyroid hormones can occur. In the best tradition of clinical medicine, a physician should
prescribe thyroid hormones for persons whose symptoms, physical signs, and/or blood
tests indicate that they may have inadequate thyroid hormone effects for optimal health and
quality of life. Persons with symptoms of hypothyroidism and relatively low FT4 and/or FT3
levels deserve a trial of thyroid optimization. If they do not need the thyroid supplementation, they
will feel no better, or may feel worse from excessive thyroid levels. Thyroid optimization for those
who need it improves mood, energy, and alertness and improves many parameters of health. If
they feel better, they needed higher thyroid levels than their system was producing. End of Story.
The thyroid gland produces both T4 and T3, so it makes sense to supply both hormones in
adequate amounts to produce all the benefits of thyroid sufficiency. Providing a substantial
amount of T3 assures that the patient will get some benefit, even from low doses. Armour®
thyroid is dessicated porcine thyroid gland and it contains the prohormone, T4, and the active
hormone, T3. Fortunately, the pig's thyroid hormones are identical to ours. Dessicated porcine
thyroid has a safety and efficacy track record spanning many decades. It is produced using the
latest technologies to assure consistent T3 and T4 content in every tablet--it is held to the same
standards as synthetic T4 products. In addition, it provides other hormones and nutrients from
the thyroid gland (calcitonin, T2, iodine, etc.). When we decide to take over the function of the
thyroid gland by supplying thyroid hormone orally, it makes sense to replace everything that our
thyroid glands make. Dessicated thyroid is much higher in T3 than is our normal thyroidal
production. This is advantageous as T4 to T3 conversion is poor with oral thyroid replacement
and especially when the TSH is suppressed with therapy, as it often is. Every symptomatic
person deserves a trial of gradually increasing doses of dessicated thyroid hormone to see if
this will eliminate the symptoms without causing any signs or symptom of excess dosing.
There is a great deal of irrational fear among physicians about optimizing hormone levels,
especially thyroid levels. Most doctors are afraid to prescribe any thyroid hormone to someone
whose TSH level is within the laboratory reference range—even to people with obvious
symptoms of hypothyroidism and relatively low or even low free T4 and T3 levels. Dr. Lindner
has seen patients with severe hypothyroid symptoms and LOW free T4 levels dismissed by
other doctors because the TSH was normal. Doctors are taught to think that the TSH is always
right, so that if they give any additional thyroid hormone to that person they will cause
hyperthyroidism with bone loss, cardiac abnormalities, and muscle loss. This is, again, the
Immaculate TSH Doctrine at work. However, a low or undetectable TSH levels on thyroid
replacement therapy do not equal hyperthyroidism. A doctor would have to give grossly
excessive doses of thyroid hormone to produce hyperthyroidism and all its associated
problems. Muscle loss occurs only with free T4 and T3 levels that are 2 or more times greater
than the upper limit of the reference range such as occurs in Grave’s disease (Riis 2005).
Increased bone loss with higher thyroid levels occurs only in persons who are already in a bone-
losing state, because thyroid hormones increase all metabolic activities in the body. So if you're
losing bone you will lose it faster when your thyroid levels are raised. Cardiac abnormalities like
a rapid heart rate, thickened heart wall, and slow diastolic relaxation can occur with excessive
thyroid replacement, but usually such persons are uncomfortable, the pulse is high, and
lowering the dose will reverse the problem. People do not feel well on excessive doses of
thyroid hormone. Atrial fibrillation (a rapid, irregular heartbeat) is unfortunately more likely to
occur in people with naturally higher thyroid levels, and with higher thyroid levels on replacement
therapy. It occurs only in susceptible persons, and thyroid hormone levels are usually still within
the reference ranges. Fortunately atrial fibrillation is reversible and its recurrence can be avoided
by medication and lower thyroid doses. The fear of triggering atrial fibrillation in the few
susceptible persons is not a sufficient reason to withhold thyroid hormone optimization from
all the persons who would benefit.
The Immaculate TSH Doctrine is causing tremendous damage to patients and to the
reputation of the medical profession. Undiagnosed and undertreated patients are organizing
and educating themselves through websites like Stop the Thyroid Madness. One day, this TSH-
based delusional system will be abandoned and physicians will go back to treating diagnosing
and treating thyroid insufficiency by clinical criteria--according to the patient's symptoms first, and
the free T4 and T3 levels second. Doctors will return to using their medical intelligence rather
than relying on carelessly-produced laboratory ranges to make the diagnosis or determine
appropriate treatment.
To see the evidence from scientific studies for yourself, read Dr. Lindner's thyroid hormone
abstracts.
Sufficient thyroid hormone is essential to our health and our quality of life. Thyroid hormone
regulates the rate of metabolism of every cell, in every tissue and organ in the body. It
determines the number, size, and activity of the energy-producing mitochondria in every cell. Low
thyroid levels/effects in the body causes a reduction in all essential functions of the body.
Symptoms of hypothyroidism include cold extremities, weight gain, fatigue, need for excessive
sleep, high cholesterol, muscle aches and stiffness, ankle edema from reduce cardiac function,
dry skin, constipation, scalp and eyebrow hair loss, high blood pressure, depression, and
mental slowness. In some persons, thyroid insufficiency produces a different clinical picture--
anxiety, palpitations, insomnia, and attention-deficit disorder. There are many other symptoms
that can be seen in persons due to their unique constitutions and their body's attempts to
compensate for the low thyroid levels. Hypothyroidism also has long-term health consequences.
Even mild hypothyroidism increases one's cholesterol levels and one's risk of atherosclerosis
and heart attacks. Young persons up to age 25 have higher thyroid hormone levels than those
over 25. Since we begin to deteriorate around age 25, which level do you think is better for our
health? After age 25 there is a steady decline in our thyroid hormone levels, our sensitivity to
thyroid hormones, and our own TSH-response to low thyroid levels.
Unfortunately, the medical profession clings to a false system of ideas regarding thyroid
insufficiency. Medicine is failing, on a grand scale, to both diagnose and properly treat
hypothyroidism. Doctors are that all they need to do is look at the TSH (thyroid stimulating
hormone) level--that this one blood test tells them all they need to know about the person's
thyroid hormone status. Dr. Lindner calls this the "Immaculate TSH Doctrine". This belief in the
TSH level is not justified by any evidence and is contrary to basic principles of physiology. The
level of TSH secretion from the hypothalamus-pituitary system is every bit as fallible as any
other bodily function. Indeed, the hypothalamus is a kind of grand central station of the brain,
affected by its connections to all parts of the brain, by neurotransmitter imbalances, biochemical
disorders, toxins, aging, etc. Because of the Immaculate TSH,most doctors check only a TSH
level to "rule out" hypothyroidism and also adjust thyroid replacement doses to "normalize" the
TSH. In Dr. Lindner's experience, "central" thyroid insufficiency with a "normal" TSH but low
thyroid hormone levels within the reference ranges is much more common than primary
hypothyroidism where the thyroid gland is not working well and the TSH is high. This partial
central hypothyroidism is frequently the cause of depression, obesity, high cholesterol, chronic
fatigue, and fibromyalgia. The TSH level can never be trusted. A doctor must always look for
symptoms first, and look at the free T4 and free T3 thyroid hormone levels second. In Dr.
Lindner's experience, people with hypothyroid symptoms and free T4 and/or free T3 levels in the
lower halves of the laboratory reference ranges benefit tremendously from thyroid hormone
optimization. When both are in the lower third of their population ranges, the person generally
has severe hypothyroidism, regardless of the TSH level.
It is inappropriate to rely on the TSH to adjust thyroid hormone dosing, as the TSH production
may have been weak to start with, and the TSH-production system did not evolve to deal with
once-daily oral T4 replacement. Taking all one's thyroid hormone by mouth once daily produces
highly unnatural T4 serum level spikes that over-suppress the TSH for many hours. Studies
have shown that TSH-normalizing T4 treatment leaves many persons with residual signs and
symptoms of thyroid insufficiency (Saravan 2002, Samuels 2007). A landmark study was done
where four experienced thyroidologists adjusted levothyroxine (T4) doses according to purely
clinical criteria (symptoms and physical exam). The patients were then tested and it was found
that their TSH levels ranged from <0.01 (suppressed) to 20mIU/L. Only the free T3 level
correlated well with clinical euthyroidism. (Fraser, 1986). Such a study has never been repeated.
All other research in the thyroid literature is based upon the assumption that a "normal" TSH
means that the patient is "euthyroid". All that research is therefore confused and misleading.
Even when doctors do prescribe thyroid hormone, they usually prescribe only the prohormone
T4 (Synthroid®, Levoxyl®). It must be converted to T3 to become active. They give T4 in low
doses that just "normalize" the TSH to any value within the reference range. The result is an
almost universal undertreatment of thyroid insufficiency. One cannot assume that there will
be sufficienc T4 to T3 conversion with this unnatural replacement. It has been repeatedly
demonstrated that with the usual TSH-normalizing T4 therapy, free T3 levels remain relatively
low (Escobar-Morreale 1996). Often they are lower than before the T4 therapy was started
leaving a patient more hypothyroid than before therapy! Yes, small doses of T4 can make the
hypothyroidism worse because the reduction in TSH reduces both the thyroid gland's output,
and the body's ability to convert T4 to T3!. When the TSH is reduced by thyroid replacement, T4-to-
T3 conversion is reduced throughout the body. (Kabadi 2006)
Endocrinologists increasingly practice "Reference Range Endocrinology". Most doctors fail
to understand that the laboratory ranges are just population ranges. ; they just tell us where
the values of 95% of all adults tested by that laboratory happen to fall. They do NOT represent
the optimal range for that person or for our species in general. With these broad ranges, you
can only be judged to be hypo or hyperthyroid only if you're in the extreme lowest or highest 2.5%
of the entire population. It is a fact that far more than 2.5% of the population have sub-optimal
thyroid levels, so the reference ranges are excessively broadened towards the low end.
Consider the tremendous breadth of the reference ranges. For free T4 the range spans a factor
of 3 from bottom to top (often 0.6 to 1.8 ng/dl), and for free T3 a factor of 2. Can a person have the
same health and quality of life if their thyroid hormone levels drop to 1/2 or 1/3rd their previous
level? Won't a person feel very differently when their thyroid hormone levels are doubled or
tripled--yet still remain within the reference ranges? The fact that all "normal" values are not
ideal is evidenced many different studies have shown clear benefits to having T4 and T3
levels within the upper third of the reference ranges. These demonstrated benefits include
lower cholesterol levels, reduced weight, reduced tendency to form blood clots, reduced risk of
atherosclerosis, and alleviation of depression. Adults with hypothyroid symptoms but "low
normal" free hormone levels often respond very well to adequate thyroid supplementation
(Skinner, 2000). The only 95% population reference ranges that could be used to diagnose
thyroid sufficiency would be ranges based upon a study of perfectly healthy, vigorous 20-25 year
olds.
However, even the free serum FT3 and FT4 levels cannot tell the whole story. Human physiology
is much more complicated than that. There are many mechanisms by which relative resistance
to thyroid hormones can occur. In the best tradition of clinical medicine, a physician should
prescribe thyroid hormones for persons whose symptoms, physical signs, and/or blood
tests indicate that they may have inadequate thyroid hormone effects for optimal health and
quality of life. Persons with symptoms of hypothyroidism and relatively low FT4 and/or FT3
levels deserve a trial of thyroid optimization. If they do not need the thyroid supplementation, they
will feel no better, or may feel worse from excessive thyroid levels. Thyroid optimization for those
who need it improves mood, energy, and alertness and improves many parameters of health. If
they feel better, they needed higher thyroid levels than their system was producing. End of Story.
The thyroid gland produces both T4 and T3, so it makes sense to supply both hormones in
adequate amounts to produce all the benefits of thyroid sufficiency. Providing a substantial
amount of T3 assures that the patient will get some benefit, even from low doses. Armour®
thyroid is dessicated porcine thyroid gland and it contains the prohormone, T4, and the active
hormone, T3. Fortunately, the pig's thyroid hormones are identical to ours. Dessicated porcine
thyroid has a safety and efficacy track record spanning many decades. It is produced using the
latest technologies to assure consistent T3 and T4 content in every tablet--it is held to the same
standards as synthetic T4 products. In addition, it provides other hormones and nutrients from
the thyroid gland (calcitonin, T2, iodine, etc.). When we decide to take over the function of the
thyroid gland by supplying thyroid hormone orally, it makes sense to replace everything that our
thyroid glands make. Dessicated thyroid is much higher in T3 than is our normal thyroidal
production. This is advantageous as T4 to T3 conversion is poor with oral thyroid replacement
and especially when the TSH is suppressed with therapy, as it often is. Every symptomatic
person deserves a trial of gradually increasing doses of dessicated thyroid hormone to see if
this will eliminate the symptoms without causing any signs or symptom of excess dosing.
There is a great deal of irrational fear among physicians about optimizing hormone levels,
especially thyroid levels. Most doctors are afraid to prescribe any thyroid hormone to someone
whose TSH level is within the laboratory reference range—even to people with obvious
symptoms of hypothyroidism and relatively low or even low free T4 and T3 levels. Dr. Lindner
has seen patients with severe hypothyroid symptoms and LOW free T4 levels dismissed by
other doctors because the TSH was normal. Doctors are taught to think that the TSH is always
right, so that if they give any additional thyroid hormone to that person they will cause
hyperthyroidism with bone loss, cardiac abnormalities, and muscle loss. This is, again, the
Immaculate TSH Doctrine at work. However, a low or undetectable TSH levels on thyroid
replacement therapy do not equal hyperthyroidism. A doctor would have to give grossly
excessive doses of thyroid hormone to produce hyperthyroidism and all its associated
problems. Muscle loss occurs only with free T4 and T3 levels that are 2 or more times greater
than the upper limit of the reference range such as occurs in Grave’s disease (Riis 2005).
Increased bone loss with higher thyroid levels occurs only in persons who are already in a bone-
losing state, because thyroid hormones increase all metabolic activities in the body. So if you're
losing bone you will lose it faster when your thyroid levels are raised. Cardiac abnormalities like
a rapid heart rate, thickened heart wall, and slow diastolic relaxation can occur with excessive
thyroid replacement, but usually such persons are uncomfortable, the pulse is high, and
lowering the dose will reverse the problem. People do not feel well on excessive doses of
thyroid hormone. Atrial fibrillation (a rapid, irregular heartbeat) is unfortunately more likely to
occur in people with naturally higher thyroid levels, and with higher thyroid levels on replacement
therapy. It occurs only in susceptible persons, and thyroid hormone levels are usually still within
the reference ranges. Fortunately atrial fibrillation is reversible and its recurrence can be avoided
by medication and lower thyroid doses. The fear of triggering atrial fibrillation in the few
susceptible persons is not a sufficient reason to withhold thyroid hormone optimization from
all the persons who would benefit.
The Immaculate TSH Doctrine is causing tremendous damage to patients and to the
reputation of the medical profession. Undiagnosed and undertreated patients are organizing
and educating themselves through websites like Stop the Thyroid Madness. One day, this TSH-
based delusional system will be abandoned and physicians will go back to treating diagnosing
and treating thyroid insufficiency by clinical criteria--according to the patient's symptoms first, and
the free T4 and T3 levels second. Doctors will return to using their medical intelligence rather
than relying on carelessly-produced laboratory ranges to make the diagnosis or determine
appropriate treatment.
To see the evidence from scientific studies for yourself, read Dr. Lindner's thyroid hormone
abstracts.
For Health and Quality of Life
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