BEWARE! The Thyroid...(rather, Low T3 Syndrome)

by Tara Shimer

Disclaimer: I am not yet a medical professional. This blog should not be construed as medical advice, nor diagnosis. I am writing this blog for Thyroid Awareness Month (January). It may include references to peer-reviewed scholarly articles, as well as books by my favorite health authors. It may also feature a casual, conversational, satirical and/or rhetorical tone of voice, criticism of the current standard practice of care in Western Medicine, advocating for the ketogenic diet, my own experience with thyroid hormone imbalance and treatment, and advertisement of my own company’s products. It could also include none of those; we’ll see. Thanks for reading.

What is the Thyroid?

This, I will hardly cover because I take it as unlikely that you would find yourself here without knowing the basics, but if you do wish to know more about the thyroid in the context of normal, or healthy, function, you can find more information using my recommended literature list near the end of this blog; I don’t wish to waste your time by being redundant of folks who have far greater credentials than I, nor reaffirming something you either already solidly know or don’t care about. 

By the way, at the very end of this blog is a section in which I penned a mildly-endearing anecdote showcasing my neurotic inquisitiveness, but feel free to leave the page before you get that far.

Why Does it Matter So Much?

To be brief: the thyroid gland regulates metabolism & stimulates organismal growth

The cells that make it up are the only cells in the human body that can absorb iodine, to which they then combine the amino acid, tyrosine, and together with the enzyme thyroid peroxidase (TPO), produce T4 (thyroxine). T4 is like the “storage” or inactive version of T3 (triiodothyronine), and it is the synthetic version of T4 (Synthroid, etc.) that is most often prescribed to hypothyroid patients; assuming that the body will have no issues converting T4 to T3 as soon as it’s needed, synthetic T4 may suffice. 

However, as I’ll get into later, the conversion of T4 to T3 process is another story, entirely. It relies on the enzyme 5’ deiodinase and cofactors like selenium, Vitamin A, Vitamin D and zinc, but is also a sensitive process that can be downregulated easily. In short, this is invariably important because T3 is essential for life, being that it makes the emboldened/underlined things, (aforementioned above), happen.

The takeaway: Thyroid homeostasis is vital to the production of ALL cellular energy. Therefore, ALL organ systems will be negatively impacted by impaired thyroid homeostasis.

Ignorance is NOT Bliss: My Story

From the above, you can probably already infer just how expansive the impact that having even remotely altered thyroid function and/or thyroid hormone can have on your body. Just add the phrase “lack of,” “irregular” or “suboptimal” in front of each and every organ system, all at once; this should lead you to the conclusion that I experienced firsthand: an overall sub-optimal state of being. Granted, the thyroid is just one piece of an incomprehensibly intricate puzzle, and I had and still have more work to do, but I do not say it lightly that this is homeostatic imbalance at its most epitomical...and not to mention, most glaring. Symptoms are, after all, our bodies crying to us for help.

Following was my symptomatic experience:

  • Acid Reflux/GERD & IBS
  • Menstrual Irregularities (premenstrual dysphoric disorder (PMDD), followed by dysmenorrhea, followed by total loss of a cycle, i.e. amenorrhea)
  • More Mood Irregularity    (everything from weepiness to rage)

  • Sleep Disturbance (I could fall asleep just fine, but staying asleep was no longer a thing)
  • Decreased Libido (and less satisfying climax)
  • Hair Loss (to the point that I was vacuuming my bed daily)

  • Dry Skin, Brittle Nails, Acne

  • Recurring Infections
  • Joint Pain (everywhere)
  • Unexplained Weight Gain (20 lbs. in one month)
  • Fatigue (I had to crawl around on the floor to get ready for work)
  • Muscle Weakness & Soreness (that did not recover with rest)

  • Low Blood Pressure & Edema
  • Polycystic Ovaries (diagnosed with PCOS)     
  • High Blood Sugar (insulin resistance)
  • Brain Fog (exacerbated ADHD, including low productivity, forgetting and losing things, and detrimental hyperfocus/obsession)

But perhaps the most alarming one of all was Suicidal Ideation...

Throughout the three years of my steady descent into madness...whoops, that may be a tad dramatic... Although, I truly had felt as though I was under attack, that my body was betraying me, and that no one would ever figure out what was wrong with me, (it changed from day-to-day, which attitude was driving me). I scoured the internet, pouring over blogs and chat forums; overconsuming health podcasts and videos; reading every book I could find within the integrative medicine and paleo/keto spheres. In desperation, I sought out an endocrinologist, but would soon discover that getting the tests that you know you need run, no matter how deeply you know it, is an incredibly difficult task. 

A word of caution: if you are an undiagnosed, but educatedly-guessing, potential thyroid patient seeking a “full thyroid panel” from a baselessly arrogant, run-of-the-mill endocrinologist, you may be met with...resistance. In fact, I was told that “that would be a ridiculous test to run,” and that she “refuse[d] to have [her] name attached to such a preposterous test!”

The “full thyroid panel” I had hoped for, as recommended by my only hope and guidance at the time,

  • Free T4
  • Free T3
  • TSH
  • Reverse T3
  • Thyroid Antibodies: 
  • Thyroid Peroxidase (TPO) Ab
  • Thyroglobulin antibody (TGAb)
  • Thyroid stimulating hormone receptor antibodies (TSHRAb), including thyroid stimulating immunoglobulin (TSI) and thyroid binding inhibitory immunoglobulin (TBII)

Instead, I got this:

These results were deemed normal, of course, and I was told that my thyroid was not the problem

Now, while technically that was true - I did not have a problem with my actual thyroid gland, no Hashimoto's nor Grave's disease, no iodine deficiency - I'll explain shortly why this was a dangerous misdirection. On the other hand, my testosterone came back at 212, about SEVEN times the normal mid-range value for a woman of my age. So, she figured she'd found the answer. I left there with a referral to the 5th floor for confirmation of Polycystic Ovarian Syndrome (PCOS). I’ll admit that at that point, I would have been happy and relieved to find out I had any diagnosis, but...

I knew in my gut that PCOS was secondary to hypothyroid, if not to something even higher in the pecking order, because:

  1. I had none of the typical PCOS symptoms. 
  2. I had most of the typical hypothyroid symptoms, and even some of the more advanced, less common ones. 
  3. I had worked hard to learn that testing TSH & T4 only, as a screen for hypothyroidism, relied on an assumed linear but totally erroneous corollary based on the idea that hypothyroidism has only two causes worth considering: 

  • Hashimoto’s Thyroiditis (the autoimmune disease that causes hypothyroidism) 
  • Iodine deficiency (an incredibly difficult problem to come by in the Western world)

I would NEED to see a handful of other doctors before finding one who was willing to run the litany of tests I needed... 

...and not limited to just those ones I listed above, but many more, too. Over the course of the next two years, I was able to finally get a mostly full picture of the web of anomalies my body had seemingly become.

The test result that finally shook the tree was that of FREE T3:

.If this result had been just 0.1 pg/mL higher, my new doctor might have clung to the within-reference-range-means-normal concept, just as everyone I had seen previously had proven they would, but who also had not even been willing to run this simple test. Instead, my body was given the hand it needed, had shown its cards, and in the face of this number - 2.2 - and, in conjunction with my symptoms, my new doctor decided to fold. I was prescribed Natural Dessicated Thyroid (NDT) that day, and within three days, my wellbeing increased tenfold.

Potential Causes of Low T3 Syndrome (a.k.a. Euthyroid Sick Syndrome):

  • Poor conversion of T4 to T3 by progesterone deficiency: could point toward the “Pregnenolone Steal” effect, whereby pregnenolone is being shunted toward the adrenal pathway, rather than the steroid (sex) hormone pathway, and turned into cortisol instead of progesterone
  • Poor conversion of T4 to T3 by elevated cortisol via chronic stress: see above
  • Poor conversion of T4 to T3 by deficiency in cofactors: gut dysbiosis yields low absorption of nutrients from food via lack of diverse microflora, Small Intestinal Bacterial Overgrowth (SIBO), a parasitic or otherwise pathogenic infection, etc.; also can occur via chronic poor nutrition (low nutrient density) and chronic stress
  • Poor conversion of T4 to T3 by inflammation via elevated cytokines: chronic viral infections, chronic Lyme Disease, toxic mold or chronic inflammatory response syndrome, and so many other potential things...also, again, chronic stress
  • Poor conversion of T4 to T3 by HPA Axis dysregulation via deficient peripheral serotonin or dopamine
  • Poor conversion of T4 to T3 by inflammation via elevated testosterone (in women)

it turns out THAT I, AN INDIVIDUAL, need to have my free T3 above the reference range to feel like myself:

For the last three years, I’ve experienced all kinds of twists and turns along my path to feeling “optimal.” I learned that I have (and had) other conditions. For example, this year I found out that I, (as well as my father and brother), have hypermobile Ehler’s Danlos Syndrome (hEDS, or EDS Type III). Continuing backwards, chronologically: I was diagnosed with Chronic Lyme Disease and thereby, Chronic Inflammatory Response Syndrome, (CIRS), took cholestyramine and heavy metal chelating agents, did routine infrared sauna, glutathione injections, B12 injections, the Shoemaker protocol, etc. I even took a dessert sabbatical, then purchased and moved into a van! I recovered from SIBO using herbal antibiotics for six months, as well as a keto/low-FODMAP blended diet. I went down the food sensitivity rabbit hole, followed by the rabbit hole that is epigenetics, SNPs, and the things that 23andme doesn’t tell you. I recovered from Hypothalamic Amenorrhea (HA) using the Carnivore diet. I recovered from Polycystic Ovarian Syndrome (PCOS) and Insulin Resistance (IR) with plain, old, keto and intermittent fasting, which I still do today, and have now for six years. It’s been a heck of a ride.

At some point, though, NDT stopped working for me. I experienced “T3 pooling” and had an abnormal free T3/reverse T3 ratio. Having realized that the doctor who first helped me could not take me any further than she already had, I had to find someone even more adept at integrative/functional medicine. For now, I stay on the max dose of Cytomel, but that doctor wants to start looking at whether or not I can begin stepping down my dosage. Speaking candidly, I’m terrified. 

I may not ever figure out exactly, with 100% certainty, what caused low T3 syndrome to manifest in me, but I do know that every single one of the causes I listed above were a part of my profile at one time or another. I will continue to learn more in trying to befriend my body, and if that means that one day, I will not rely on medication to live, it will all have been worth it; if not, that’s okay, but I have dedicated my life to truth seeking and grown passion from desperation as a result of this journey. 

In the face of much adversity, I have been my body’s best friend in healing itself. Throughout all of this time, I have remained nothing short of an informed patient. I have persevered, tenacious as ever. I have never settled and sheepishly agreed to my “doctor’s orders.” I have always fought for what the most recent, unbiased research has shown to be true. I have sought to use my desperation for good - to teach others. And I have not been too scared to leave tens of “fired” doctors in my wake. 

Hell, I would be proud if that was the only thing written in my obituary.

My journey with low T3 syndrome is just an anecdote that I share with others experiencing the same or a similar cascade of symptoms but with little hope to continue on with, just as I once had. 

Perhaps I’m writing this blog to myself from five years ago? 

Regardless, no matter the context of pathology, subclinical hypothyroid, (i.e., the term used to describe patients whose test results are hardly out of “normal” range), patients will ostensibly feel wrong enough to tell, for themselves, if thyroid homeostasis - in all of its extremely sensitive glory - is disestablished.

As such, here is a different corollary for you: if that is true, then shouldn’t it make sense that treatment would be leveled by the symptomatic experience of the patient, alone? After all, hyperthyroidism and thyrotoxicosis, (i.e., high and toxically-high level of free serum thyroid hormone, respectively), if not more so than hypothyroidism, are both quite ostentatious problems in their own right. As in, they are not disorders that go undetected easily, especially when hormone replacement is a known factor. 

Individual thyroid patients, like humans in general - across any attribute or characteristic - each have their own unique version of what optimal looks like on paper. I’m sure that if you saw Dwayne "The Rock" Johnson walking down the street and didn’t recognize him, (or at least, missed the part where his 15,000 calorie/day diet went viral), and someone asked you how many calories you thought he should eat per day to maintain his current physique, you would probably guess a number less than half - if not one fifth - of what his peak season intake is.

No one would blame you, either. We see others through our own experiences, and thereby, opinions, which I’m sure makes sense in the context of “herd mentality;” it may even be what’s allowed the human race to survive this long - I don’t know. However, as individual as is total daily energy expenditure (TDEE), and as autonomous as feeding oneself is, (or should be), so, too, is thyroid hormone replacement therapy and so should be judged the need for it, whereby symptom abatement, as an indicator of the reestablishment of homeostasis, is the only goal.
Be your own patient advocate. 

Do not settle for “normal." Do not be a sheep.

Recommended Literature for Educating Oneself

Primal Body, Primal Mind by Nora Gedgaudas
Why Do I Still Have Thyroid Symptoms? When My Lab Tests are Normal, by Dr. Datis Kharrazian, PhD, DHSc, DC, MS, MMSc, FACN
Stop the Thyroid Madness: A Patient Revolution Against Decades of Inferior Treatment by Janie A. Bowthorpe, M.Ed.
Stop the Thyroid Madness II: How Thyroid Experts are Challenging Ineffective Treatments and Improving the Lives of Patients by Janie A. Bowthorpe, M.Ed.
Undoctored by William Davis, MD
Epi-Paleo Rx by Dr. Jack Kruse
Lies My Doctor Told Me by Dr. Ken D. Berry, MD, FAAFP
Deep Nutrition by Catherine Shanahan, MD with Luke Shanahan

The image below is of a diseased thyroid gland. If you ask me, it quite looks like the Batman symbol, and I suppose this could be why I was inspired to title/stylize this blog as if it were “The Blob.” However, the thyroid is far from villainous; aside from serving as an advocate for your life, it’s an incredibly important component of your body, but more on that below. It wraps around your throat, as it were, and, not at all like the antagonist of a monster B-movie, it is most commonly characterized as being shaped like a butterfly. In fact, whenever I see someone with a throat tattoo - which, admittedly is something I totally want, but will probably never get - I cannot help but think “I wonder if the tattoo needle is long enough to pierce the outermost cell layer of the thyroid?” (For the record, I know it’s not, but like…neck skin is awfully thin, so…) That thought is then followed in quick succession by “If so, I wonder if that kind of damage is at all akin to the damage that is done by the body’s own immune system in the context of the autoimmune diseases Hashimoto’s and Graves’?”


Now, not to be terribly presumptuous, but in case you were also thinking it: yes, I am an inquisitive nerd.

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