Tuesday, July 7, 2015

Free T Guide

This describes a method to look into for potential help ONLY for only those doing poorly after total thyroidectomy (TT). If doing completely well on current treatments, this is overkill and you need not read further.

It also is primarily geared for those who experience some aspect of HYPER and HYPO simultaneously from replacement hormones and the information is geared around that. This generally only happens for people without thyroids.

For those who experience only HYPO conditions/medication side effects, or those who still have a thyroid, this information is not that much geared for you though it may overlap in many areas. Although hard, one can generally find help when only HYPO issues are the problem from replacement hormones. It is a much differing story if you get mixed HYPER/HYPO symptoms where almost nobody will help. This includes sources working around Free t3 and the HYPO point of view.

Thus this is geared for thyroid cancer survivors post thyroidectomy, doing poorly or very poorly, and who generally experience some aspects of hypothyroidism and hyperthyroidism from replacement hormones.

Modify as needed to suit your needs and situation.

Sorry if I don't always follow up, this is a purely voluntary effort.

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Should I work with a doctor on all this?

Yes absolutely, and you must do that. Using labs, data, and information about how T3 and T4 work are methods to help you work closely with a physician and not a system meant to work outside of any medical care system or healthcare system. Nothing here is medical advice. What is described in the Free T guide, FAQ, Thyroid cancer websites, and in discussion groups are information to help you work with your doctor, but they are information only and not meant as medical care or replacement for medical care.

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Is this a discussion about advocating natural thyroid?

No. This is about the kind of actual thyroid hormone levels that likely will get you back to feeling normal, and also about some of the side issues that interfere with this from happening. It is not an advocacy system for anything but getting back to normal so you can go back to the things that are important in life.

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My endocrinologist said my numbers look "good" and I feel sick, what is going on?

What an endocrinologist means when they say something like numbers are "good", means you are TSH suppressed for cancer recurrence prevention. TSH does NOT help you feel well. It has nothing to do with that. To feel well a person has to look at carefully timed Free T levels, plus vitamins, minerals, etc.

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What are the first steps?

Start a high quality vitamin and get a lot of labs.

See if a primary care or other doctor can order:
Free t3, Free t4, Reverse t3 (rT3), TSH, Ferritin, Total Vitamin D, B-12, CBC, CMP

Additional tests that may help find problems too:
Cortisol 4x a day (canary club easiest way to get but you pay), full iron panel added to just the ferritin, and any/all of the sex hormones.

I would suggest a super quality vitamin that has a very good amount of active B vitamins, D with K, selenium, zinc. I would not say to take this every day the rest of your life, but see if a high end vitamin improves things and if not at least you tried one, then if it does help decide if taking it daily is actually needed or just occasional boosts every so often:

A good option that is whole food based and active B forms, but 8 daily:
http://shop.mercola.com/product/1008/1/whole-food-multivitamin-plus-tablets-240-per-bottle-30-day-supply

Dr Vita six daily some synthetic (not all active B complex):
http://www.drvita.com/products/six-daily-advanced-multivitamin

Sometimes a swap of the T4 medication is a worthwhile very first step, e.g. swap to Levoxyl from Synthroid. This helps many.

Ferritin (storage iron) has to be tested before you supplement. I would not take a multivitamin with iron for raising ferritin if you need it, but one needs to test it first anyway before supplementing.

Then learn about Free t levels. The quickest way to boost levels with significant T3 is to switch to natural thyroid, but any method you use, synthetic T3 and T4, or NDT it is wise to familiarize yourself with numbers that work for you.

Some conservative doctors will suggest these labs are not going to help.


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Two common problem areas and some symptoms often faced post TT
As thyroid cancer survivors, having no thyroid, we are fairly unique medically in that we can experience both an excess (hyper) and a deficiency (hypo) simultaneously.

HYPER (most common with a high FT4 post TT on high levels of T4, but can be from too high a FT3 too) symptoms include mood changes and swings, irritability or a short temper, headaches and migraines, anxiety, palpitations,
shortness of breath and/or breathlessness, too fast a GI system and in some more on the constipation side, sleeplessness in some and in some the opposite or sleeping 12 or 15 hours at a time, body aches and pains like joint pains and shoulder issues, weight changes due to excess hunger with little or no satiety, lots of pre-migraine and migraine aura effects (can include thyroid ocular aura disorders -TOADs) even if you never get or have never had a migraine in your life. 

HYPO (most common with low FT3 even if TSH suppressed) all the symptoms of hypothyroidism, but common are the brain fog, depression, loss of attention span (forgetting things), skin issues, hair loss, fingernail issues, feeling dog tired, Sleeping lots, slowing metabolic rate leading to inability to lose weight despite honest effort, medication sensitivities, irritable/sensitive GI, inability to do things like we used to, food intolerances, allergies, just can't focus on work or family, when very HYPO a differing kind of irritability and headache than the HYPER one. A very low Free T3 can also cause bradycardia, palpitations in some, and many types of cardiac issues are possible. Many more issues are common when HYPO and can be found on internet searches.

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Quick explanation of goals on Free T labs

For proper levels of FT3 and FT4 you should be on same medication for at least a month, and not taken your medication for at least or a minimum of 7 hours before the blood draw for those doing half in AM and half in afternoon of any T3 taken, one can also do 40% of dose in AM and 60% in afternoon.

What counts the most is the FT3 at a reasonable or moderate FT4. A good FT3 at high FT4 can leave a person quite sick still. So a good FT3 at moderate FT4 is the goal.

There is variation in all individuals so learn what works for you, and change this model to your liking. Note that some do well at the lower numbers and some do well at the upper numbers. Only by trying will you find out what works for you.

Natural thyroid has significant T3 and can be a quick way to get significant T3, but even so knowing the levels that are good is important.

Once you get levels to something like the below best you can, and if you still don't feel the effects of better T3 at moderate T4 levels that is an indicator to examine side issues such as reverse t3, iron, anemia, etc. But try lower and upper numbers listed, some people like the higher numbers mentioned some like the lower.

USA based lab explanations - Timed for those who get both hyper and hypo issues, not for the hypo only person

For a Free t labs drawn say 7 to 12 hours out from taking thyroid meds (and half, or 40%, of T3 you may take) you would want the Free t3 to test well over 3.25 pg/mL (ideally around 3.5 to 4.4) when the Free t4 is between 1.0 and 1.4 ng/dL. If the Free t4 is over 1.4 that is generally about the start of problems and crowds the Free t3 making it less valid. Definitely a Free t3 less than 3.25 will present issues. However if you have cardiac risk, palpitations, or continue to have issues such as migraines from the higher FT4 consider trying the FT4 from 0.8 to 1.2 ng/dL bringing it down slowly to find optimal values where issues go away while at same time keeping the FT3 up with T3 increases as best as possible.

Better looking labs done with T4/T3 combo with intent of feeling more normal but keeping TSH suppressed, this is a person coming in having too many HYPER symptoms and also having HYPO symptoms at the same time. The goal they took was to reduce the T4 level and boost the T3 level:

Example1: A person who lost the HYPER issues after reducing T4 and adding T3 (everyone is individual so only you know if you still have HYPER issues)
Free t4: USA: 1.2 ng/dL
Free t3: USA: 4.0 pg/mL

Example2: A person still having moderate HYPER issues at above numbers(example 1) and still had to reduce the T4 level
Free t4: USA: 1.0 ng/dL
Free t3: USA: 3.5 pg/mL

Example3: A person still having moderate HYPER issues at above numbers (example 2) and still had to reduce the T4 level
Free t4: USA: 0.9 ng/dL
Free t3: USA: 3.25 pg/mL

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International units (SI) based explanations - Timed for those who get both hyper and hypo issues, not for the hypo only person

For a Free t labs drawn say 7 to 12 hours out from taking thyroid meds (and half, or 40%, of T3 you may take) you would want the Free t3 to test well over 5.0 pmol/L (ideally around 5.3 to 6.75) when the Free t4 is between 12.87 and 18 pmol/L. If the Free t4 is over 18 pmol/L that is generally about the start of problems and crowds the Free t3 making it less valid. Definitely a Free t3 less than 5 will present issues. However if you have cardiac risk, palpitations, or continue to have issues such as migraines from the higher FT4 consider trying the FT4 from 10.3 to 12.87 pmol/L bringing it down slowly to find optimal values where issues go away while at same time keeping the FT3 up with T3 increases as best as possible.

Better looking labs done with T4/T3 combo with intent of feeling more normal but keeping TSH suppressed, this is a person coming in having too many HYPER symptoms and also having HYPO symptoms at the same time. The goal they took was to reduce the T4 level and boost the T3 level:

Example1: A person who lost the HYPER issues after reducing T4 and adding T3 (everyone is individual so only you know if you still have HYPER issues)
Free t4: Outside USA: 15.44 pmol/L
Free t3: Outside USA: 6.14 pmol/L

Example2: A person still having moderate HYPER issues at above numbers (example 1) and still had to reduce the T4 level
Free t4: Outside USA: 12.87 pmol/L
Free t3: Outside USA: 5.38 pmol/L

Example3: A person still having moderate HYPER issues at above numbers (example 2) and still had to reduce the T4 level
Free t4: Outside USA: 11.58 pmol/L
Free t3: Outside USA: 5.00 pmol/L

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Important lab based goals and supplements to discuss with your doctors:

Total Vitamin D (25-Hydroxyvitamin D): 70 ng/mL (USA), 174 nmol/L (International)

B-12: 800 pg/mL (Best to use an active B complex only for raising B vitamins)

Optimized values for Ferritin, (ONLY for thyroid medication users):
Male around 100 ng/mL
Female 80 or 90 ng/mL
Ferritin is just storage iron or one type of iron measure. This is NOT the same as a person not taking thyroid medications, where a ferritin level about 60 ng/mL is fine.

One can take Selenium and Zinc to help the T4 convert to T3. Check all your vitamins before adding as you do not want to go too high, or have the selenium level checked via lab first to see if you are low. Suggested dose if low/light:

Selenium (selenium yeast or selenomethionine) up to 200 mcg but suggest testing levels if possible as not all are deficient, OR several Brazil nuts that were actually grown in Brazil though this can be difficult to determine.
Zinc 30 mg

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When to get Free t labs:

Try to determine your symptoms as to HYPER/HYPO, or only HYPO, as a guide.

Labs tell you what your measurements are at that time. No time is right or wrong for the most part, however never take all your daily cytomel/T3 or NDT at once and test soon after as this will be the only way to really get data that does not work well or be comparable. If you take all NDT at once perhaps morning readings might be the only thing you can get to work as it will be hard to find the middle ground.

The time you chose may depend on your symptoms (see some of symptoms of hyper and hypo above). Break it down to several questions. Do you tend to get hypo/low free t3 type symptoms? Do you get hyper symptoms (like high Free t4 gives)? Do you have both, or a mix of hyper and hypo symptoms, like many get after a thyroidectomy? This can also be described as, levels run too low and are hard to raise, levels that run too high, or a mix of some of your levels run too high (like free t4) while other levels tend to run too low (like free t3)? It might depend what you have as symptoms as to what way you work and then time your labs.

Summary:

a1) Not recommended at all: Taking all daily cytomel/T3 or NDT at once, then doing labs anywhere near or anytime soon after. Taking all NDT at once = morning labs before taking only.

a2) Similar and not really recommended either: splitting cytomel/T3 or NDT but testing soon after either dose. This would end up being a method that would work off the absolute maximum values of the day on both Free t4 and Free t3. It may be difficult to work over time on improvements that way, and it isn't easy to compare to others. In some circumstances you might be able to use this information, but it will be hard.

b) HYPO Only issues - some do it this way: Doing labs the next day before taking thyroid medications. This  would end up being a method that would work off the lowest values of the day. Those who always deal with HYPO symptoms ONLY (e.g. hard to raise or low Free t4 and/or low Free t3) sometimes prefer this time to know their lowest levels of the day and work off daily low values. For those who also get HYPER (headache, mood swings, anxiety, etc) symptoms it may be difficult to work over time on improvements that way as a high Free t4 can cause issues for these people and we may need to know daytime FT4. This is quite common post thyroidectomy and sometime hide from those working only from a hypo standpoint. So basically this may not work that well for the HYPER case, but for some it works well as they get only HYPO issues.

c) HYPER and HYPO both: Mid day values and right before second portion of any T3 source (but NEVER taking all the daily NDT or T3 at once), often works as a method for those looking at both HYPER and HYPO issues, such as many get post TT. This does not occur, or would rarely occur, in people with thyroids as a general statement.

Trouble with almost everything on the internet about thyroid testing is it is for people WITH a thyroid where it is totally different than us post TT. People with thyroids, due to the way things fluctuate, have to do it based on waking and fasting where activity and food change the levels. They still have a feedback system in place. We differ. We take all our medication either once a day or two time a day as there isn't a regulated thyroid dispensing the hormone. It depends on how long any T3 acts in you specifically but Free t levels rise fairly quickly, then start a decline. In general without a thyroid cytomel/T3 or NDT should not be taken all at once.

For many who can have both high (usually T4) or low levels (usually T3) what works is to aim more for the declining or mostly declined time to get that point measured and work on it. You don’t want to optimize labs based on 3 hours out as at 10 hours out you might not feel too well. Similarly aiming for 24 hours out becomes too complex to negotiate the high level issues (HYPER) that can happen and cause issues. Basically if you are a person whose levels can easily run too high, such as a person who gets high Free t4 symptoms (HYPER) you probably don't want to be the person measuring levels at the lowest point of the day since your issue is too high a number and you need to have a handle on that.

For those who want to work off mid point values and can have both high issues or low issues plus you take T3 several times a day, right before the second dose of the T3/NDT seems to work to monitor both sides of the issue. I'd suggest 7 to 12 hours to blood draw for people who want to take T3 portions two times a day, and then right before the second T3. But never take all daily cytomel/T3 or NDT at once then test.

If you take just T4 and want the best mid point readings I'd suggest 7 to 15 hours, otherwise first thing AM is fine too if you don't get HYPER issues and want to know the lowest value of the day and work off that.

If you are a person who always runs low on Free t3 AND Free t4, so no hyper symptoms and you are very certain of that, it is possible to work off the lowest point of the day which would be 24 hours out and before taking anything.  Sometimes there are  those who work off morning readings who show mild anxiety and other indicators of a high Free t4 during the day, but don't think they have these issues until they lower the Free t4 on a medication change and see how much better they actually feel. This is not uncommon.

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Is there a simple way to help myself over time?

Table or spreadsheet to use at each lab. Over time include these columns or rows:

1 Date & Time of day of blood draw
2 Thyroid medications (T4 and T3 in mcg) and time taken
3 Free T3
4 Free T4
5 TSH
6 Notes

Other labs to make a separate spreadsheet on

1 Ferritin level and other iron levels at last lab (no iron for one week prior), amount now taking if any
2 Vitamin D at last lab, amount now taking if any
3 Vitamin B-12 at last lab, amount now taking if any
4 Other vitamins and minerals taking: selenium, zinc, iodine, etc
5 Symptoms I am having at this date, and/or rating of how feeling & issues.

Make a cancer lab spreadsheet too
1 Date
2 TSH
3 TgAB
4 Tg
5 Assay used for Tg lab, call lab if not listed so you know

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Example Spreadsheet with goals, history

POTENTIAL GOALS:
FT4 1.1, FT3 3.7, TSH Suppressed, no HYPO or HYPER issues.

HISTORY:
1/1/15 3 PM, 150 mcg T4, 0 mcg T3, FT4 1.95, FT3 2.75, TSH 0.35 - on synthroid
Notes: Weight gain, irritability, brain fog. Hyper/Hypo both. Next I plan to get docs to replace 25 mcg T4 with 5 mcg T3

3/15/15 3 PM, 125 mcg T4, 5 mcg T3, FT4 1.5, FT3 2.65, TSH 0.6
Take 125 mcg synthroid AM, half of cytomel in AM, half at 3 PM labs and were before this second half.
Notes: Still having weight gain, doing worse. 5 mcg T3 was not enough as T3 falling behind, TSH also going wrong way. Still Hypo/hyper. Will try 2.5 grains NDT

5/1/15 3 PM, 95 mcg T4, 22.5 mcg T3, FT4 1.1, FT3 3.7, TSH 0.1 –
Take 2.5 grains Nature-throid, 40% in AM, 60% at 3 PM and labs were before this second half.
At goals, feeling better.

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General info on Free T’s (laboratory test):

One learns that Free t's, not TSH are the most critical thing to feeling well. It's not that we ignore TSH, because that is important for cancer prevention but TSH does not help you feel well. Free t's should be your guide to feeling well. Most doctors don't bother checking Free T labs carefully, they just look at TSH and assume you are ok even though the Free t's may be super out of whack and unfortunately you will be too.

One also has to look at vitamins, minerals, cortisol, iron, B-12, and others. Importantly, if T3 levels are good and Free t4 not too high, yet problems persist, that is a very important signal to look at reverse T3 and related issues such as iron.

Free t ranges are in a state of change. Free t4 ranges coming down, Free T3 ranges coming up over last 5-10 years. Ranges were designed around people with a thyroid, we need higher Free T3 post TT because we no longer have an on demand system and generally speaking the pituitary makes its own T3 from T4 so we want to be sure the rest of the body has an adequate supply in the post TT world where T3 issues cause most of the problems that happen because doctors take the T4 high making the pituitary supplied but the rest of the body not.

Because I use that as a method, I reference people carefully doing Free T labs at about midpoint from thyroid meds. Midpoint is not close to taking medications, and not too far from medications.

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FREE T3 – Active hormone
A better Free t3 range in US (traditional units) post TT would be something like 3.0 to 4.4 pg/mL (roughly 20% added to bottom of the range). One can get Free T3 related hypo symptoms well into the mid 3's particularly with no thyroid. If you are generally above 3.25 pg/mL and have no other issues such as vitamin, mineral, adrenal/cortisol and sex hormone related it is possible to feel ok. Official ranges vary but often much lower, an example range semi-updated would look like 2.4 to 4.4 pg/mL, but I would love to see the bottom raised. Definitely aim for above 3.25 pg/mL, and if you can get to 4.0 pg/mL that is better. Generally speaking if one optimizes all issues such as vitamin and mineral and other mentioned above, and the FT3 is low the only way to raise it is a long term cytomel prescription or natural thyroid containing T3.

For system international (SI) including Canada, or mostly non-US based labs: Conversion factor pg/mL to pmol/L is 1.5362.

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FREE T4 – storage hormone only no merit to making it high.
Older Free t4 ranges in US often went as high as 2.0 ng/dL but some places have taken the top down to 1.5 ng/dL now, and if not that then maybe 1.7 or 1.8 ng/dL. I don't like my Free t4 over 1.4 so I can let T3 do its job. I am fine at moderate Free t4, or 1.2 ng/dL but people vary where they feel well and some like it a bit higher, some like it lower. An example range reasonably updated would look like 0.75 to 1.5 ng/dL. If you test above 1.4 the only way to reduce this number is to reduce your T4 medications, and if your TSH is not where needed you need a long term cytomel prescription or switch to natural thyroid.

For system international (SI) or non-US ranges: Conversion factor ng/dL to pmol/L is 12.87.

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Where to get Free t labs:

If docs won’t order, first look for a doc that does, but you can order your own:

Posted on Inspire by reneeh63
http://www.healthonelabs.com/pub/tests/test/pid/167

There is also mymedlab.com :
https://www.mymedlab.com/thyroid/thyroid-basic-panel

Canary Club which is great for cortisol and others, but their thyroid labs are too differing to compare to LabCorp for example:
http://www.canaryclub.org/

posted on Inspire by Nature_throid:
https://www.directlabs.com/

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What are T4 and T3?

T3 is the active thyroid hormone utilized in the body. The thyroid makes very roughly 20% of the T3 in the body though some people it likely makes way more than this amount. This is the portion that is not converted from T4. The rest of the active T3 comes from conversion from T4, this occurs in many places in the body though many places depend upon the liver and other places to convert it for them. The thyroid makes other things too, but mainly T4 or the storage thyroid hormone. T4 cannot be used anywhere in the body so it is considered inactive or storage only. It can only be converted to active hormone before being used. This is kind of like crude oil which isn't gasoline, and crude oil doesn't fire in the cylinders of the car, only gasoline does but of course we do need crude oil to get gasoline (called refining not conversion).

After thyroidectomy most doctors give T4 only despite knowing the thyroid made more than T4.

T3 is in a prescription called cytomel, this is synthetic T3. Cytomel is often sold in 5 mcg (low amount) or 25 mcg (high amount) pill forms so it is difficult to titrate a long term dosage. T3 is also in natural thyroid prescriptions (from animals). There are 9 mcg of T3 in each grain of natural thyroid. T3 has very rapid effects.

T4 is in a prescription called Levothyroxine, Synthroid, Tirosint and other names. These are the synthetic forms. It also is in natural thyroid prescriptions (from animals). In natural thyroid there are 38 mcg of T4 per grain of natural thyroid. T4 tends to change things slowly.

Animal based thyroid hormones do contain thyroglobulin (Tg). This can make it past the digestive system to the bloodstream. Tg is the lab based cancer marker used for checking for cancer recurrence after TT, and a rising Tg (at similar TSH) is indicative of cancer recurrence. For those who get a change in Tg from natural thyroid when getting a Tg lab one can swap in synthetic (T4 and T3 if you like) for 2-4 weeks ahead of Tg labs if considering a natural thyroid replacement for long term. Basically 2 weeks is ok, 4 weeks if extra worried about the Tg level accuracy. It isn't hard to overcome the positive Tg caused by natural thyroid using this swapping method. The mean half life of Thyroglobulin in the bloodstream is 65 hours. Taking away 5 half lives comes out around 13 to 14 days actually.

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How do I give this information to MY doctor?
The NAH website is geared exactly around giving a physician the clinical information they need to help those who do not do well on T4 only. I would give these two links to your doctor:

NAH – National Association of Hypothyroidism. The best clinical resource found:
http://nahypothyroidism.org/

Hope for the future, BiancoLab
http://deiodinase.org/

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Links to doctor lists

When you get to the actual physician list click on a heading like "state" to sort by state or province, etc. Scroll down to your state. Kind of not the best web interface to a list, as some have trouble getting to doctors in a specific state, but work with it a bit and you will get the doctors in your state:
http://www.thyroidchange.org/list-of-doctors.html

RLC labs links
http://getrealthyroid.com/get-real-now/find-a-doctor/

Posted by emmaleah, finding docs by prescribers:
http://projects.propublica.org/checkup/
One way to make it work is go to say "Armour" or "Liothyronine" in the "Top Drugs" list, then go into that by clicking into it, then click on your state on the left and it shows the most to least prescribing doctors of that exact thing. So if you want Armour in your state you have a list of docs that do it. But they have to do at least 50 prescriptions of it I guess.

Slightly older and no longer updated, but still valuable:
https://www.verywell.com/thyroid-disease-top-doctors-directory-3231612

Functional Medicine, Select MD/DO, enter zipcode. Posted by snova68
https://www.functionalmedicine.org/practitioner_search.aspx?id=117

Some osteopathic physicians will look more into T3 and T4, some but not all
http://www.osteopathic.org/osteopathic-health/Pages/find-a-do-search.aspx

Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
http://www.naturopathic.org/AF_MemberDirectory.asp?version=2

Hypothyroid mom lists
http://hypothyroidmom.com/30-online-resources-to-find-a-good-thyroid-doctor/

Thyroid Nation list
http://thyroidnation.com/thyroid-friendly-doctors/

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Links to more info and sources of much of info

These are all websites, some by book authors who are well known for their work/research/papers/books. Dr Shames, Dr Holtorf, Dr Bianco, Mary Shomon, etc

NAH – National Association of Hypothyroidism - great graphics. The best clinical resource found:
http://nahypothyroidism.org/

Hope for the future, BiancoLab
http://deiodinase.org/

Mary Shomon – outstanding author
https://www.verywell.com/thyroid-4014636

Dr Shames related – one of original authors on more than just T4
http://thyroidpower.com/

Dr Holtorf related links
http://www.holtorfmed.com/

http://www.hormoneandlongevitycenter.com/thyroidtreatments1/

Great reviews with many links (see under thyroid)
http://hormonerestoration.com/Evidence.html

Thyroid help - general

T4 to T3 summaries
Dr Mercola on using Free t’s instead of TSH as primary labs (Dr Mercola is not addressing thyroid cancer patients but lays out case for Free t's):
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

posted by MtDenali:
http://www.thehealthyhomeeconomist.com/thyroid-disease-as-a-psychiatric-pre tender/

More
http://www.naturalendocrinesolutions.com/articles/do-you-have-a-t4-to-t3-co nversion-problem/

Reverse T3 links

http://thyroid.about.com/od/t3treatment/a/Reverse-T3-triiodothyronine-RT3-T hyroid.htm

https://groups.yahoo.com/neo/groups/RT3_T3/info

http://www.custommedicine.com.au/health-articles/reverse-t3-dominance/

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My doc doesn't want any of this, what should I do?

You can always look for another doctor, in the mean time all the issues mentioned under supplements and lab based goals section can be worked on with a primary care.

You can also switch around the T4's as a very first step, sometimes it can help quite a bit. Even conservative endocrinologists will usually be open to changing to alternate T4’s.