Intro to Ferritin/iron
Ferritin is stored iron in the body that is released over time. Ferritin can be high or low, and both can be bad. Be sure to have your ferritin tested before supplementing with iron. Do NOT take any iron supplements for one week before any type of iron lab work if just starting, later on you can look at ferritin rises differently but to get a baseline start without taking iron.
Ideally ask for the full iron panel PLUS ferritin. Labs have differing groupings but usually put ferritin as a separate lab that is outside the iron panel. Hopefully your physician will order all to work with you on this area.
Optimized values for Ferritin, (ONLY for thyroid medication users):
Male around 60-90 ng/mL
Female 60-80 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 50-60 ng/mL is fine.
Although ferritin issues are the most common thyroid medication connected to iron levels issue, you should also consider getting your doctor to run a full iron panel. This has additional checks for anemia, iron deficiency and more. A percent saturation of less than 33% or elevated TIBC or UIBC are iron deficiency indicators. But again do NOT take any iron supplements for one week before any type of iron lab work. Other things that change the iron panel results making them invalid can include birth control pills, consuming lots of meat before the lab, and various inflammatory conditions. Iron testing has to be done very carefully with some considerable preparation, it is not uncommon to not be informed on how to prepare properly for an iron panel. The other iron labs can have error fairly often and can need repeating.
Aside from low Free t3, low ferritin or storage iron often connects to hair loss, low energy, poor thyroid medication utilization and many other issues. When storage iron is low, such as a ferritin level of 10 or 18 or other low value, the body creates reverse t3 out of T4 and it goes straight to T3 receptors. This is particularly true in places like hair follicles, but generally everywhere in the body. The reverse t3 blocks up t3 receptors and you feel off. This is because the body is thrown into a kind of preservation mode from low iron stores. This is most linked to ferritin, even if the other iron tests are better or more normal values. Importantly this happens even at the so called "low normal" of the ferritin range, though I don't think there is an exact value it is known to start happening.
If the ferritin is quite low, IV iron infusion is the easiest way to boost.
Real easy to buy iron and works super well:
Also to buy: cast iron pans or cookware, use them.
Iron to avoid: ferrous fumerate, ALL multivitamins with iron.
Note that long term taking of multivitamins with iron is associated with colon and GI cancers. The idea of boosting iron is boost awhile and go off awhile, thus supplement with something other than a multivitamin. Decades of taking multivitamins with iron increases colon and GI cancer risk.
If you are iron deficient you should have a complete blood count (CBC) with Hemoglobin and Hematocrit to check for anemia:
If ferritin is too high donate blood, this can bring the levels to those mentioned above. If it is extremely high that is a condition called hemochromatosis.
Here is a link to Uptodate (used by many docs as a reference) info on hemochromatosis:
It is common amongst southern European/ Mediterranean descent individuals. Here is the key statement from UptoDate:
"Ferritin levels greater than 300 ng/mL in men and 200 ng/mL in women support a diagnosis of hemochromatosis. However, ferritin levels can also be increased by many common disorders other than hemochromatosis"
What is rT3?
Reverse t3 (rT3) is a primal response of our bodies sensing something wrong, and forcing a slowing of metabolic rates in an attempt to create a somewhat hidden self preservation mode of sorts. Basically your body attempts to slow metabolism when it senses you are ill, deficient in iron, minerals, vitamins, other hormones, or otherwise have something off or wrong. Having a high metabolism when ill would not be a good thing in general, so we developed an internal system to slow metabolism at these times. Symptoms sometimes may include hair loss and fatigue not resolved by raising FT3 alone.
Basically rT3 blocks T3 receptors all over the body and the Free t3 can't get in. So you will feel quite poor, sometimes even presenting with a good FT3. rT3 looks similar to T3 to the body but it can't function like T3 at all. It blocks the active thyroid (T3) hormone from being used since receptors are blocked up by the rT3 molecule. We then expend less energy, but we won’t feel well. All people have rT3, one can never get rid of all of it. However when rT3 is really high, that is when our body has kicked into its mode of forcing a slowing metabolism. We can potentially correct situations of high rT3 by finding the source of the problem.
The most common source of the rT3 issue is iron deficiency or storage iron deficiency (ferritin) and any related anemia's even if mild. Storage iron (ferritin) when deficient or even just low can cause the body to go directly into preventing thyroid hormone utilization, or the metabolic preservation mode. Add to that problems in hematocrit, hemoglobin, RBC counts, and we might end up with anemia as well. The body starts with sensing that something is wrong with low ferritin, and then rT3 spikes up till iron stores go back up (better diet that includes iron). But in the mean time we feel off sometimes even with a good FT3 because our body is in a hidden self preservation mode.
Introduction to Cortisol from a naturopathic through medical point of view
Cortisol is at its peak 30 minutes after you awake and declines all day so to see an issue you need multiple samples. Many of us try the salivary cortisol test which is done 4x a day from Canary Club (mail order). There is natural variation and one can see that in a graph where normal has upper and lower for any time point on the graph.
Just be aware many naturopaths and even a few doctors will try to treat cortisol without good testing. I would never advise that. If you go to a doctor or a naturopath and they try to treat cortisol levels without a real substantial set of testing that was carefully done you should not take their advice. Cortisol can be high or low, so the wrong treatment will make a bad situation much worse. Nor should you just buy any kind of adrenal booster or adrenal support product without being certain what the problem is, how much of a problem there is, and which items in the product are known to help. There are hundreds of these products out there and many people take them without this information, this is not generally a good thing to do.
If cortisol is modestly low at points of the day one can take licorice as a tea or supplement for awhile , please note that is not long term.. The licorice must have glycyrrhizic acid as some sold that is removed. This will stimulate a re-start of the adrenal system. Licorice can raise BP for some people. The length of time people take licorice varies by various sources of recommendation, but one should not take it indefinitely. See more on licorice below.
If cortisol is really low you have to see a doctor to check for Addison’s disease or adrenal insufficiency:
Adrenal insufficiency test (very low cortisol)
b. How does licorice work?
Licorice/glycyrrhizin is used to raise cortisol. Lots of articles about it, they all differ in amounts, how long to take, etc. Licorice mimics desoxycorticosterone or ACTH, thus one gets a cortisol boost from it. The theory is when a person has low cortisol you stimulate with an ACTH like effect for several weeks/ or month with licorice and the body kicks back in and resumes its more normal cortisol cycle and you discontinue licorice. It is a kick to the system basically. One should never take licorice for long periods, this is why candy can't be sold with real licorice because long term use is dangerous.
This does not cover it all but covers how it mimics ACTH or the theory of what is used and described in many articles and books for using licorice to raise cortisol. This is a published article so it does not cover an implementation but essentially the method of action, mimic ACTH:
Reader12 posted this on a general intro to licorice:
Oppositely if cortisol modestly high you can take Holy Basil which is a supplement to lower modestly high cortisol levels. Holy Basil got is name because monks in India wanted to de-stress or remove cortisol.
If cortisol is very high you have to see a doctor to check for Cushings syndrome:
Cushings syndrome test (very high cortisol)
Vitamin D Basics
Total Vitamin D (25-Hydroxyvitamin D): 70 ng/mL (USA), 174 nmol/L (International)
Vitamin D conversion reference:
Total vitamin D: ng/ml to nmol/L multiply USA gravimetric unit by 2.496
So in USA a good/solid Vitamin D of 70 ng/ml is the same internationally as 174 nmol/L
When Vitamin D is high in the range, T3 levels seem to stay more steady over the whole of the day. One generally feels lively or overall much better with a very good normal vitamin D. However, never go too high on Vitamin D as this is dangerous.
There is no standard dose that I know of for Vitamin D as it depends upon sun exposure and weight. A total Vitamin D at levels like 25 to 35 is hugely low. These days the newer type guidelines recommend something like 50, and for cancer patients 70. Some people may need for long term 1000 IU, some need 2000 IU, some need 5000 IU, some need 10000 IU as it depends on you as an individual. Sublingual Vitamin D is good.
Many people need large dose of Vitamin D to get levels up but again it varies not only on weight like other medications but sun exposure. Many people during low sun exposures need lots of Vitamin D supplement as routine, but far less or no supplemental Vitamin D during periods of larger sun exposure.
Do get sun exposure or tans. Get small amounts with small incremental build up. Never get too much. I am a person who believes sun tan lotions are the cause of skin cancer against most people in the world who think it saves them, so I think I would not use them for myself instead use my brain to say I should limit excess sun. Sun and tans are super great, burns and too much sun are super bad. There is a sort of bell curve. Too little sun/tan is the left of the bell curve and bad, too much is the far right and bad. Find your just right, depends on your skin and if you have red hair and so on where the bell curve is.
Good D info, lots of reading:
Mercola on Vitamin K
Be sure to tell your doctors such as cardiologists if adding a new vitamin K supplement, or D3 with K2 supplement. Particularly if getting, or about to get, a blood thinner/anticoagulant prescription.
See on right the summary: Story at-a-glance
Vitamin K2 is an important fat-soluble vitamin that plays critical roles in protecting your heart and brain, and building strong bones. It also plays an important role in cancer protection
The biological role of vitamin K2 is to help move calcium into the proper areas in your body, such as your bones and teeth. It also helps remove calcium from areas where it shouldn’t be, such as in your arteries and soft tissues
The optimal amounts of vitamin K2 are still under investigation, but it seems likely that 180 to 200 micrograms of vitamin K2 might be enough to activate your body’s K2-dependent proteins to shuttle calcium to the proper areas
If you take oral vitamin D, you also need to take vitamin K2. Vitamin K2 deficiency is actually what produces the symptoms of vitamin D toxicity, which includes inappropriate calcification that can lead to hardening of your arteries
If you take a calcium supplement, it’s important to maintain the proper balance between calcium, vitamin K2, vitamin D, and magnesium. Lack of balance between these nutrients is why calcium supplements have become associated with increased risk of heart attack and stroke
Vitamin B-12 Basics
B-12: 800 pg/mL
Vitamin B-12 is the energy vitamin, when it runs low or low in range you may feel off. Low values can lead to fatigue and anemia. Similar to Vitamin D when Vitamin B-12 is high in the range one seems to feel more steady over the whole of the day. One generally feels much better with a very good normal vitamin B-12. Methylcobalamin is the active form and is more absorbable, sprays and sublingual’s are recommended. As with all B vitamins suggest the active B forms. Mary Shomon covers it well:
What about Selenium?
Selenium and Zinc are supplements helpful in converting T4 to T3. At the start of the process be sure to have someor test normally before supplementing. Be sure you do not have a multivitamin with sodium selenite or selenium selenate as these are not just bad but harmful to the process. Be sure if your vitamin has it that it is selenomethionine or selenium yeast (and a few newer ones), or buy as a separate supplement. I would not overdo selenium or selenium supplements, as excess is bad.
Much variance in amounts to take in articles. One brazil nut has roughly about 90 mcg IF it was actually grown in Brazil and is unprocessed (raw), but if it was grown somewhere else it might not have that much. Many articles mention 200 mcg a day as a supplement, but this may actually be too much if you get plenty with food already. I would say 25 to 50 mcg is fine, unless you test low.
Post TT there is no consensus on amounts to take, or if it truly helps. As is so often the case in thyroid related issues, more a lack of good articles if you want scientific ones following clinical needs and goals such as for a thyroid patient or thyroid cancer patient who just needs to know what to do.
Selenium is the first thing I ever tried when I was super high Free t4 and just not feeling well after TT. It might have helped a bit, I don't think it really pushed my T3 way up. At most I got a minor bump on T3 levels. So I don't think it was my issue but it is just one thing we can do amongst many. Selenium deficiency is more connected to Hashimoto's as far as I can tell, and I never had that. But there are many general links one can read.
Chris Kresser (type of integrative medicine practitioner) info in link below. He is positive somewhat on selenium overall, has some references, but also some warnings on selenium:
A solid NIH reference
You probably got thyroid nodules because you had a low iodine condition at points in your life. Nodules or goiters are associated with low iodine and this has been known for over 100 years. People get low iodine, not only because our diet is low in iodine in the US but because fluoride and bromines block it in our body.
Iodine isn't just used by the thyroid but it isn't used in a process like a vitamin or glucose. Outside the thyroid it is most commonly linked to mammary gland and clearing calcifications, thus a removal type process. Deficiency is often linked to fibrocystic breast tissue. Iodine reading and discussions are unfortunately in two camps, the ultra mega-dosing though it can benefit a few, and those who say only the thyroid needs it. Try to avoid those camps at first reading if wanting to read where you fit in.
If you take iodine, you should also take adequate selenium, or try to be sure you are not selenium deficient. Iodine without sufficient selenium levels is associated with autoimmune thyroid disorders.
People who will most benefit from looking into iodine are those with breast tissue issues and those with prostate issues.
Good references on iodine:
Good discussion on iodine interference and endocrine system disruptors:
----- BONE and JOINT----------
--- NDT versus T4 only discussion, is T4 only the best for bones? Probably not.
Just to illustrate the difference in the amount of thyroid hormones there are in a T4 regimen versus an NDT regimen here is an example of sorts
T4 only taker, type of results one might see: FT4 of 1.8, FT3 2.9, TSH 0.3
NDT taker, type of results one might see:: FT4 of 1.0, FT3 of 3.8, TSH <.001
Now say both stopped taking thyroid meds:
One DAY later:
NDT taker estimated: FT4 of 0.9 (or maybe less), FT3 of 2.5
One WEEK later (or more actually):
T4 taker estimated: FT4 of 0.9, FT3 of 2.5
One day on NDT versus one week or more for the T4 taker to get the same amount of thyroid hormone readings.
Obviously, the T4 taker is taking massively more thyroid hormones than the NDT taker. So to the bone loss concerned, is it TSH or is it the massive amounts of thyroid hormones you take? My example can't say but it is a pretty good estimate of what would happen to show the massively higher amounts of thyroid hormones one takes by taking T4 only.
The place you like the FT4 to avoid issues is person specific to an individual but the higher the FT4 goes the more bone and joint issues you likely will get. Some who exercise extensively or work on a farm may like it slightly higher than others, but there is no reason to keep the free T4 super high permanently since one can also take T3 or NDT and moderate the FT4.
What about issues of bone density?
If you get joint/bone issues after a TT I would look into several things.
1) Thyroid meds for simple joint pain issues.
a) Fillers in thyroid meds can sometimes cause these issues. Try changing to a differing thyroid medication.
b) Look into where your Free t4 tests, when too high it will exacerbate a simple joint issue into a much more painful issue when it comes to these joint and bone issues. I like my FT4 below 1.3 (same as 16.7 pmol/L in international units) or generally around 1 to 1.1 ng/dL (US labs or 12.87 pmol/L international) to avoid issues. I have found minor rotator cuff issues become much larger issues when my FT4 is higher.
2) Calcium, PTH
a) know your calcium level (have tested) and if it tests over 10, get a parathyroid check (PTH). See http://www.parathyroid.com/
b) Calcium usually fluctuates around, but it should not steadily rise over the years. If calcium is rising steadily from the past (map out your whole calcium history for years or even decades if you have it), but is good/normal and PTH normal, look into D, magnesium and trace minerals to stop bones from losing calcium.
c) If calcium is normal or low normal, and PTH pushes high or over range, try taking calcium as your PTH pushing high by itself might indicate poor dietary calcium
d) If calcium isn't rising and is normal look at rheumatoid arthritis and osteoarthritis, comparison at:
3) Probiotics Take these fairly often if we have or get occasional GI changes from thyroid medications as these GI changes influence our absorption of minerals.
4) Vit D + Vit K, Magnesium + Potassium. Many of us have to look at boosting vitamins and minerals, being sure the osteoblasts get plenty of what we need to deposit new bone. That means: aside from knowing calcium know the Total D level (have tested). Get good Magnesium too. However, taking magnesium can lead to a feeling of HYPO if you don't have good Potassium levels. If you take magnesium think about also taking potassium or eat bananas and spinach.
Best D supplements are a vitamin K2 with D3.
For Vitamins D+K here is one that seems to work well
5) Trace Minerals for bone. Potentially get additional trace minerals in your diet that include: Zinc, Silica, Strontium, Boron, Manganese, Chromium as these will help your body do its job and make new bone. Opt for testing of levels if possible, and I would never recommend over-doing supplements personally.
6) Additional help. I also suggest collagen to try for anyone with these issues, often taken for skin it helps a lot with joint and bones as well. Some brands (click):
Reservage expensive collagen
Less expensive collagen
7) Onions (courtesy pvs58). Articles:
b) Mulbauer, R.C., and Li, F. 1999. Effect of vegetables on bone metabolism. Nature. 401:343-344
Some of the issue lies in that replacement thyroid hormones can change our GI system + absorption of nutrients and trace minerals. Secondly, some after TT have parathyroid issues to deal with. Finally, anyone on complete replacement thyroid hormones tends to sweat more than others do, this also changes our body chemistry particularly Potassium and Magnesium.
Post TT we all need to worry about our gut (probiotics from time to time) since that gets changed at times, plus worry about trace minerals for bone. Here is a good breakdown on trace minerals that get harder to absorb, or the gut changes we get influence negatively on these and we have to be sure we get them more so than others since we are on replacement hormones:
It is not hard to find vitamins or bone density boosters that include:
Calcium (but only if you test low do you need it)
D3 and K2 - often sold as a combination these days
Mildly difficult to get a sufficient amount include
Adequate Zinc and adequate Chromium, good quality and enough magnesium
Particularly difficult to get good supplementation from either vitamins, or even formula's sold for bone density include:
Silica, Strontium, Boron, Manganese
Some examples of the harder to get items
Life Extension Trace Minerals (check anywhere vitamins sold)
Strontium (check anywhere vitamins sold)
Ionic Boron(check anywhere vitamins sold)
This is a single supplement that does have the trace minerals, but also provides a lot of calcium, K, etc. It is almost a multi-vitamin that is oriented around bone/joint. I would not take this with a multivitamin as you may get too much of some things, as this has quite a lot of things added. It does not provide as much of any of the trace minerals in the betterbones guide above suggests, but it is a single source that includes at least some of all the trace minerals:
Solary Bone tone (no link check anywhere vitamins sold)
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
There is also mymedlab.com :
Canary Club which is great for cortisol and others, but their thyroid labs are too differing to compare to LabCorp for example:
posted on Inspire by Nature_throid:
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:
Hope for the future, BiancoLab
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:
RLC labs links, location keeps changing on website making this link difficult to give. See Find a doctor:
Posted by emmaleah, finding docs by prescribers:
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:
Functional Medicine, Select MD/DO, enter zipcode. Posted by snova68
Some osteopathic physicians will look more into T3 and T4, some but not all
Naturopaths in some states can give prescriptions, select Adrenal/endocrinology disorders and enter zip code
Hypothyroid mom lists
Thyroid Nation list
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:
Hope for the future, BiancoLab
Mary Shomon – outstanding author
Dr Shames related – one of original authors on more than just T4
Dr Holtorf related links
Great reviews with many links (see under thyroid)
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):
posted by MtDenali:
Reverse T3 links