Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

Get Accurate Lab Tests While on Thyroid Medication

How To Get Accurate Lab Tests When Taking Thyroid Medications

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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Thyroid hormones are “Goldilocks” hormones: the dose has to be “just right” for us to feel optimal. Doses that are too high or too low can result in symptoms.

I get tons of messages from people who report that they had begun to feel hypothyroid symptoms after having their thyroid medications reduced, based on a faulty lab interpretation.

One lady began to lose her hair in clumps; another became nearly bedridden!

Upon reviewing their labs and history, I realized that both had something in common: they had been feeling great on a regimen of T4 and T3 medications, but were found to have low TSH levels, which suggests hyperthyroidism or thyroid medication overdosing.

This finding prompted their doctor to reduce their medications.

To prevent this from happening, I recommend doing a full thyroid panel to get the full picture of what’s going on with an individual’s thyroid function. In order to get accurate lab tests, however, there are several factors that should be taken into consideration.

This article presents an in-depth discussion on:

  • Recommended thyroid lab tests (and WHEN to test for accurate results)
  • How to get accurate results with T4, T3, and T4/T3 combination medications
  • Supplements and medications that may affect lab results
  • What to do if you get a questionable lab result

Recommended Lab Tests

When first initiating treatment with thyroid medications for hypothyroidism, guidelines recommend testing thyroid function about four to six weeks after the start of the treatment, to determine if the dose of medication is correct. It may be prudent to run these tests sooner and more often if a patient is experiencing symptoms of hypothyroidism, hyperthyroidism, or both.

In addition to looking out for symptoms of hypo- or hyperthyroidism, I also recommend monitoring thyroid levels regularly to ensure the medication dose is still appropriate.

I recommend the following thyroid tests to measure your response to medications:

  • TSH (Thyroid Stimulating Hormone) – TSH is a pituitary hormone that responds to low or high amounts of circulating thyroid hormone. People with Hashimoto’s and central hypothyroidism (a rare type of hypothyroidism) may have a normal reading on this test. In advanced cases of Hashimoto’s and primary hypothyroidism, this lab test will be elevated, as the body will signal the production of more TSH to cope with the lack of thyroid hormone. (Read this post about interpreting the TSH test for more information.) In Graves’ disease and hyperthyroidism, TSH levels will be low.
    • Optimal reference range: between 0.5-2 μIU/mL
  • Free T3 and Free T4 – Triiodothyronine (T3) is our primary biologically active thyroid hormone. About 20 percent of our T3 hormone comes from thyroid secretion directly, while the remaining 80 percent is produced when the thyroid hormone thyroxine (T4) is naturally converted to T3 within our bodies. While T4 is 300 percent less biologically active than T3, it is critical to our body’s ability to produce adequate and healthy levels of the needed T3. T3 is sometimes called our “go” hormone because it tells our body to boost metabolism, grow hair, and create more energy. Free T3 and T4 tests measure the levels of active thyroid hormone circulating in the body. When T3 and T4 levels are low, but TSH tests are in the normal range, this may lead your physician to suspect central hypothyroidism.
    • Optimal T4 reference range: 15-23 pmol/L
    • Optimal T3 reference range: 5-7 pmol/L

If your doctor does not order these tests for you, you can pay out of pocket and order them yourself through a company like Ulta Labs.

Optimal Reference Ranges for Thyroid Top Thyroid Tests

If your thyroid labs appear to be within the “normal” conventional ranges, but are not in the optimal reference ranges as noted above, you may still experience thyroid symptoms. (You can learn more about each of these tests and optimal ranges in my article on the top tests for diagnosing and monitoring Hashimoto’s.)

Please note, however, that depending on the type of thyroid medication you are taking, you may need to time your lab draw and intake of thyroid medication, in order to ensure you get the most accurate lab results. (More on that in a minute!)

Optimizing Thyroid Medication Absorption

Before we talk about timing your lab draw, let’s review how to take thyroid medications for proper absorption.

I recommend that you take your medication consistently at the same time each day, with a glass of water, at least 30 minutes before food. (Most doctors and pharmacists recommend taking them in the morning, upon waking.) Avoid taking acid reflux medications, magnesium, calcium, and iron supplements within four hours of taking thyroid medication, as they can impair thyroid medication absorption.

Absorption may also be impaired by foods such as soybean, cottonseed, walnuts, and fiber.

Beverages (not including water) can impair absorption as well. Of note, coffee can reduce the absorption of T4 in the intestines. (The T4 medication Tirosint may be an exception to this — please see my Tirosint article for more information.)

However, hot lemon water is an exception. Taking your thyroid medication with hot lemon water can offer the acidity needed to aid absorption (and is also great for helping the liver to detox).

Timing Thyroid Medications for Optimal Lab Results

Optimally absorbing your thyroid medication will help to ensure the body is getting adequate thyroid hormone, and may improve results when you do test your labs. However, even if you are getting adequate thyroid hormone and the body is absorbing it, there are factors that may lead to abnormal lab results, and steps you can take that will ensure accuracy.

The first step to consider is when to take thyroid medications, if you are planning on heading to the lab. The timing of your thyroid medication may affect the accuracy of your thyroid test results, depending on what type of thyroid medication it is.

The recommendations for timing thyroid meds differ depending on the type of medication you take. Let’s dive into the recommendations for each type of medication.

Recommendations for Those on T4-Only Medications

T4-only medication (such as Synthroid, Levoxyl, Tirosint, Eltroxin, and generic levothyroxine) has a five- to nine-day half-life, which means that once you have become stable on the current dosage, it can take up to nine days for 50 percent of the dose to clear the body. T4 has a slow and steady release and won’t produce many fluctuations that can make a person feel like they’re on a thyroid roller coaster.

Whether you take your T4 medication right before your lab tests or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test.

The same goes for free T3 levels when you take a T4 medication. The free T3 level will also be relatively constant.

Levels of free T4, however, will peak two hours after your T4 medication is taken.

So let’s say you take your T4 medication at 8 am and have your blood test at 10 am – your thyroid labs may show that your T4 is falsely elevated. This may result in your doctor lowering your medication, when in reality, your T4 levels may be within range for the rest of the day, with the exception of that two-hour, post-dose peak.

In most cases, taking a T4 medication the morning before your lab test will not be an issue, as most doctors adjust the dosages according to the TSH, which stays stable after T4 dosing.

However, to get a reading of your T4 levels that is reflective of most of the day, you would want to postpone your T4 medication until after the lab test.

Thus, when taking T4-only medications, I generally recommend delaying your thyroid medications until after your lab test. For best results, schedule your thyroid labs early in the morning, and bring your thyroid medications to the appointment to take them right after the lab draw.

Recommendations for Those on T3-Containing Medications

If you’re taking a T3-containing medication (such as Cytomel or liothyronine) to optimize your free T3 levels, the timing of your tests matters.

Right after a dose of T3-containing medications, free T3 levels tend to rise, then peak at around the four-hour mark.

T3 has a typical half-life of 18 hours to three days. That means it could take less than a day for T3 levels to start rapidly declining in your body!

So, if you were to take a T3-containing thyroid medication a few hours before your thyroid lab tests, your lab results might show that you have too much T3, even when you may be accurately dosed. Or, they may be in the normal range, when you are actually under-dosed.

T3-containing medications can also temporarily alter TSH levels. Researchers who monitored the levels of TSH, free T3, and free T4 in people with hypothyroidism who were taking combination (T3/T4-containing) medications over a 24-hour period, found that TSH levels may be falsely suppressed.

This is because, right after taking a T3-containing medication, TSH levels drop and stay suppressed for around five hours. TSH levels will then increase until around 13 hours post-dosage, where levels will stabilize.

So in order to get an accurate reading of your TSH levels on a T3-containing medication, you would need to wait at least 13 hours after taking your T3-containing medications before testing!

Again, for this reason, I generally recommend delaying your thyroid medications until after your lab test. For best results, test thyroid labs early in the morning, and bring your thyroid medications to the appointment to take them right after the lab draw.

Recommendations for Those on T4/T3 Combination Medications

If you’re taking a combination medication that contains both T4 and T3 (such as Armour Nature-Throid, WP Thyroid, or compounded T4/T3), the timing of your tests does matter and may make a huge difference in getting you on an appropriate medication dose.

As mentioned above, taking any medication with T3 will first drop TSH levels for around five hours before they start rising again. Thus, it is usually best to postpone taking your T4/T3 combination medication until after you get your lab tests done.

So again, with this medication type, I recommend getting your thyroid function tests done first thing in the morning before taking your medications, bringing your medications with you, and taking them right after you complete your thyroid tests, to ensure that you get the most accurate lab results.

*Please note: The half-life of T4/T3 combination medications may vary per formulation (this can vary depending on the formulation and whether it is an immediate or sustained release version), so some people may have a falsely suppressed TSH, even at the euthyroid state (or the state of normal thyroid function), when taking T3-containing medications.

This is when free T3 and T4 testing will come in handy, as thyroid health can be assessed through optimal levels of free T3 and free T4. Thyroid health can also be determined by assessing one’s list of symptoms. 

Supplements and Medications That May Interfere with Thyroid Lab Results

It’s important to note that there are some supplements and medications that can interfere with lab results, that you should be aware of before getting thyroid lab work done:

  • Biotin — The American Thyroid Association recommends that patients stop taking biotin for at least two days before a TSH test. Biotin can result in falsely high levels of T4 and T3, and falsely low levels of TSH on lab results. Biotin supplements (taken at 5-10 mg/day) can interfere with thyroid labs and cause a false appearance of hyperthyroidism. There are case reports of people taking biotin and having low TSH, high T4, high T3, and elevated TSH-receptor antibodies (in the absence of hyperthyroid or Graves’ symptoms) show up on lab results. That said, lab values do normalize after seven days of being off biotin. If you’re going in for a thyroid lab draw, skip the biotin for two days beforehand, to ensure that it doesn’t interfere with the results.
  • Supplements containing estrogenic compounds — Supplements that contain estrogenic compounds such as soy, can lead to falsely elevated TSH levels. However, please note that I do not recommend products containing soy to those with Hashimoto’s, as it is one of the most common food sensitivities seen in those with the condition.
  • Medications that interfere with thyroid test results — In addition to supplements, there are certain medications that can interfere with thyroid lab test results and may lead to false readings. This type of interaction is known as a drug-lab interaction, and two common types of medications that interfere with thyroid labs include:
    • Glucocorticoids, dopamine, dobutamine, and octreotide – These can lower TSH without indicating true thyroid dysfunction.
    • Certain NSAIDs (nonsteroidal anti-inflammatory drugs) of the salicylate subclass (specifically, salsalate, diclofenac sodium, and naproxen) – These have been found to decrease serum T3 and T4 measurements).
  • Drug-drug interactions — False alterations of thyroid labs are not to be mistaken with drug-drug interactions, which occur between thyroid hormones and certain medications, and lead to actual changes in thyroid hormone levels. Simply stated, there are medications that interfere with thyroid lab results by actually interfering with thyroid hormone function — this means they cause real alterations in thyroid hormone levels. Some of these alterations are clinically significant and may require a dose adjustment of your thyroid medications when taking the two medications concurrently. I’m working on a separate article that goes in depth about these medications, so stay tuned!

What to Do if You Get a Questionable Lab Result

If you feel that you may have received an inaccurate lab result (perhaps you’ve realized the timing of your thyroid medication may have interfered with its accuracy), there are steps you can take to receive a more accurate result.

First, try to determine if the timing of your medication in relation to your thyroid lab tests could be a factor. Writing down the details about timing and dosages of medications may help pinpoint if and/or how your thyroid medication may have affected your lab result(s). It may also be helpful to determine if you consumed additional medications and/or supplements mentioned previously, around the time of your thyroid testing.

If you find that the timing of your medications and/or other factors mentioned in this article did indeed lead to inaccurate lab results, it may be necessary to retest.

Retesting may involve some planning around when you take your thyroid medications, and possibly delaying other medications and/or supplements by a few hours, so that there is no interference when you do draw your labs.

If after receiving accurate results, you still feel hypothyroid, are still experiencing debilitating symptoms, or if your lab results do not fall within the optimal ranges (as discussed earlier in this article), be sure to re-read the “Optimizing Thyroid Medication Absorption” section of this article (above) to ensure you are taking your thyroid meds away from foods that can inhibit their absorption. If you are, then it may be time to have a conversation with your doctor about adjusting your medications.

This may involve:

Please note, however, that there have been recalls in the past, so make sure to discuss this with your doctor, and check out this article on thyroid medications to review all available options on the market. While trying to get on the right dosage of medication, you will want to test your thyroid labs every four to six weeks to ensure your labs are within range.

Once you become stabilized on your new thyroid medications, you can start testing thyroid levels every three months to one year for ongoing monitoring.

I have a free, downloadable eBook, Optimizing Thyroid Medications, that provides further guidance on this optimization process.

Next Steps

As mentioned above, if you are following all the steps for accurate lab results but they are still coming back abnormal, talk to your doctor about a dosage adjustment.

I recommend that you also investigate the possibility that something else is interfering with the absorption of your thyroid medication, such as fillers like gluten, or certain supplements that you are taking.

While some supplements can result in false readings of thyroid levels, others reflect a true change in thyroid levels — this change may be an improvement or worsening of levels depending on the supplement. Examples of such supplements include aloe vera, cordyceps, vitamin A, and ashwagandha, which all lower TSH. (I’m working on an article on supplements that can help lower TSH naturally — stay tuned!)

In addition to medications that cause false alterations in thyroid lab results, there are also medications that have actual drug interactions with thyroid hormones, and the altered labs are a real reflection of how the addition of a new drug impacts the activity of thyroid hormones in the body.

In my training as a pharmacist, I learned that there are some medications that have a multitude of drug interactions — one of these medications is thyroid hormone! Some of these drug interactions may be clinically significant, meaning that they can alter the absorption, distribution, metabolism or elimination of the thyroid hormones, necessitating a dosage change in thyroid hormones while the person is taking both medications.

A person who has been stable on thyroid medications but begins experiencing symptoms of hypo- or hyperthyroidism following the addition of a new medication, should inquire about potential drug interactions and request lab tests.

I’ll be sharing more information about significant drug interactions with thyroid hormones in the future, but for now, I recommend checking with your pharmacist whenever you start a new medication to see if your dose of thyroid medication needs to be adjusted.

In summary, receiving accurate results is important to ensure no ineffective changes are made to your current medications, and to assess how your thyroid is currently functioning. Once you’ve identified and addressed things that could be affecting your TSH or T4 lab results, consider retesting with the proper timing of medications and/or supplements for accuracy.

Should You Take Your Thyroid Meds Before or After Your Lab Tests?

I hope this helps you on your healing journey!

P.S. You can download a Thyroid Diet Guide, 10 thyroid-friendly recipes, and the Nutrient Depletions and Digestion chapter of my first book for free, by signing up for my weekly newsletter! You will also receive occasional updates about new research, resources, giveaways, and helpful information.

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References

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  2. Food and Synthroid Drug Interactions. Drugs.com. https://www.drugs.com/drug-interactions/lemon-with-synthroid-2993-0-1463-869.html. Accessed June 9, 2021.
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  5. Ardabilygazir A, Afshariyamchlou S, Mir D, Sachmechi I. Effect of High-dose Biotin on Thyroid Function Tests: Case Report and Literature Review. Cureus. 2018;10(6):e2845. Published 2018 Jun 20. doi:10.7759/cureus.2845
  6. Clark CD, Bassett B, Burge MR. Effects of kelp supplementation on thyroid function in euthyroid subjects. Endocr Pract. 2003;9(5):363-369. doi:10.4158/EP.9.5.363
  7. Otun, J., Sahebkar, A., Östlundh, L. et al. Systematic Review and Meta-analysis on the Effect of Soy on Thyroid Function. Sci Rep. 2019;9(3964). https://doi.org/10.1038/s41598-019-40647-x
  8. Koulouri O, Moran C, Halsall D, Chatterjee K, Gurnell M. Pitfalls in the measurement and interpretation of thyroid function tests. Best Pract Res Clin Endocrinol Metab. 2013;27(6):745-762. doi:10.1016/j.beem.2013.10.003
  9. Bishnoi A, Carlson HE, Gruber BL, Kaufman LD, Bock JL, Lidonnici K. Effects of commonly prescribed nonsteroidal anti-inflammatory drugs on thyroid hormone measurements. Am J Med. 1994;96(3):235-238. doi:10.1016/0002-9343(94)90148-1
  10. Liewendahl K, Majuri H, Helenius T. Thyroid function tests in patients on long-term treatment with various anticonvulsant drugs. Clin Endocrinol (Oxf). 1978;8(3):185-191. doi:10.1111/j.1365-2265.1978.tb01493.x
  11. De Luca F, Arrigo T, Pandullo E, Siracusano MF, Benvenga S, Trimarchi F. Changes in thyroid function tests induced by 2 month carbamazepine treatment in L-thyroxine-substituted hypothyroid children. Eur J Pediatr. 1986;145(1-2):77-79. doi:10.1007/BF00441860
  12. Cooper JG, Harboe K, Frost SK, Skadberg Ø. Ciprofloxacin interacts with thyroid replacement therapy. BMJ. 2005;330(7498):1002. doi:10.1136/bmj.330.7498.1002
  13. Trifiro G, Parrino F, Sultana J, et al. Drug interactions with levothyroxine therapy in patients with hypothyroidism: observational study in general practice. Clin Drug Invest. 2015;35(3):187-195.
  14. Irving SA, Vadiveloo T, Leese GP. Drugs that interact with levothyroxine: an observational study from the Thyroid Epidemiology, Audit and Research Study (TEARS). Clin Endocrinol (Oxford). 2015;82(1):136-141.
  15. Liwanpo L, Hershman JM. Conditions and drugs interfering with thyroxine absorption. Best Pract Res Clin Endocrinol Metab. 2009;23(6):781-792.
  16. Sachmechi I, Reich DM, Aninyei M, Wibowo F, Gupta G, Kim PJ. Effect of proton pump inhibitors on serum thyroid-stimulating hormone level in euthyroid patients treated with levothyroxine for hypothyroidism. Endocr Pract. 2007;13(4):345-349. doi:10.4158/EP.13.4.345
  17. McConnell RJ. Abnormal thyroid function test results in patients taking salsalate. JAMA. 1992;267(9):1242-1243.
  18. Aanderud S, Myking OL, Strandjord RE. The influence of carbamazepine on thyroid hormones and thyroxine binding globulin in hypothyroid patients substituted with thyroxine. Clin Endocrinol (Oxf). 1981;15(3):247-252. doi:10.1111/j.1365-2265.1981.tb00662.x
  19. Isojärvi JI, Turkka J, Pakarinen AJ, Kotila M, Rättyä J, Myllylä VV. Thyroid function in men taking carbamazepine, oxcarbazepine, or valproate for epilepsy. Epilepsia. 2001;42(7):930-934. doi:10.1046/j.1528-1157.2001.042007930.x
  20. Sodium salicylate and synthroid interactions. Drugs.com. https://www.drugs.com/drug-interactions/sodium-salicylate-with-synthroid-2094-0-1463-869.html. Accessed October 14, 2021.
  21. Gamstedt A, Järnerot G, Kågedal B, Söderholm B. Corticosteroids and thyroid function. Different effects on plasma volume, thyroid hormones and thyroid hormone-binding proteins after oral and intravenous administration. Acta Med Scand. 1979;205(5):379-383.

Note: Originally published in August 2015, this article has been revised and updated for accuracy and thoroughness.

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Dr. Izabella Wentz

Dr. Izabella Wentz, PharmD, FASCP, is a clinical pharmacist, New York Times Bestselling Author, and a pioneering expert in lifestyle interventions for treating Hashimoto’s Thyroiditis.

She received a Doctor of Pharmacy degree from the Midwestern University Chicago College of Pharmacy at the age of 23, and has worked as a community pharmacist, a clinical consulting pharmacist, as well as a medication safety pharmacist. She is a Fellow of the American Society of Consultant Pharmacists and holds certifications in Medication Therapy Management and Advanced Diabetes Care.

Dr. Wentz has dedicated her career to addressing the root causes of autoimmune thyroid disease, after being diagnosed with Hashimoto’s Thyroiditis in 2009. As a patient advocate, researcher, clinician and educator, she is committed to raising awareness on how to overcome autoimmune thyroid disease.

Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Brenda combs says

    My tsh is .110. My t3 is 1.93. My free t3 is 5.06. And t4 is 5..93 do do i need increase or decrease. I am on armour thyroid but going to switch to combination different. Feeling slugish sleepy tired and hot
    Reply

    • Dr. Izabella Wentz says

      Brenda- I’m afraid I can’t comment on your lab results due to liability. I can tell you that while reference ranges of what’s “normal” may vary depending on the lab that produces the test reports, most thyroid patients feel best with a TSH between 0.5-2, and with Free T3 and Free T4 in the top half of the reference range. There are quite a few options for thyroid medications. In my experience, what works for one person may not work for another. If your doctor will not prescribe the medication you are looking for, ask your local pharmacist for doctors in your area who prescribe the medication you are looking to try. Have you read these articles?

      WHICH THYROID MEDICATION IS BEST?
      https://thyroidpharmacist.com/articles/which-thyroid-medication-is-best

      TOP 11 THINGS YOU NEED TO KNOW ABOUT THYROID MEDICATIONS
      https://thyroidpharmacist.com/articles/top-11-things-you-need-to-know-about-thyroid-medications

      Reply

      • Monique says

        I’m pregnant and when I took my thyroid test I was sick and hadn’t eaten breakfast yet. My TSH was 0.07 which seems pretty low. My free T4 came back at 1.5.
        Should I be worried?

        Reply

        • Dr. Izabella says

          Monique – Thank you for following this page. Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. Every six weeks is usually a good schedule for testing your thyroid hormones.

          These are the recommended labs from my book, page 32.

          RECOMMENDED THYROID FUNCTION TESTS

          * TSH
          * TPO Antibodies
          * Thyroglobulin Antibodies
          * Free T4
          * Free T3
          * Reverse T3 (Optional)

          Have you read my book, Hashimoto’s The Root Cause? Here’s the link in case you’re interested:
          http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

          Hashimoto’s Protocol:
          thyroidpharmacist.com/protocol

          Reply

  2. Marie says

    Not a doctor, but that freeT3 is REALLY high. Sounds to me like you need to decrease. Especially if this test was done before taking your dose.
    Reply

  3. Tammy says

    Question: My 6 year old does experience the peak on Synthroid. What would that indicate to you? She is taking very low doses (alternating days 6.25 and 12.5 mcg) and it is controlling her tsh, t3 and t4 are great and prolactin is now in normal range as well. (She has already tried natural Erfa and it caused her t3 to elevate and her liver enzymes as well.)
    Reply

  4. Marilyn B says

    Question: Have you written any articles addressing the issue of natural thyroid meds and their effective suppression of TSH? It would be very helpful to have some credible sources supporting the idea that it is not always dangerous to have a very low TSH. I ask because my doctor has reduced my dose of Nature-throid several times over this last year, trying to bring my TSH into the “normal’ range. The problem is she is ignoring symptoms in pursuit of this number. I know there are thousands of patients out there like me, being kept sick because the AACE/ATA have decided that we all must fit into their arbitrarily constructed limits, without regard to real need. And many doctors are facing legal repercussion for thinking outside those limits. It would help all of us to have resources we can use in construction of the argument for health.
    Reply

  6. Mary Eckert says

    I was just wondering why I get anxiety so bad when I take levothyroxine. I’m wondering if it’s too much medicine but now I’m down to cutting 50 mgs into four pieces and taking it 4x a day but still having heart palpitations and anxiety! I Started 20 years ago with hyperthyroid and now hypo it’s so frustrating!!
    Reply

  7. sally says

    It is likely your adrenals are in great need of support. Low adrenal output is common with low thyroid and visa versa. It is important to take the necessary vitamin, minerals and herbs and sometimes it is necessary to have either DHEA, Pregnenolone or Cortisol too but these should be taken under medical advise. Cortisol at physiological doses only. Once the adrenals receive appropriate support you will tolerate better the thyroid hormone and the anxiety will improve. Look up Adrenal Fatigue…..a book Adrenal Fatigue A Desk Reference by Dr Salmaan Dalvi is an excellent resource providing detail about the necessary vitamins and minerals, herbs etc. Dr Barry Durrant-Peatfields book will describe detail of adrenal support using physiological Cortisol. Start by having a 4x diurnal salivary test which tests Cortisol and DHEA. This problem happens to many of us with low thyroid hormone – physical, emotional and psychological stress including illness will impact the Adrenal glands. Furthermore, The adrenal glands need thyroid hormone to function and with low thyroid hormone as well as greater pressure due to body stress the adrenal glands cannot cope and suffer fatigue. Best of luck
    Reply

  8. Diane says

    This is very interesting. I am taking T4 meds. I have had T3, T4, and TSH tested by my endocrinologist. She would not test my rT3, so I got that ordered by my naturopath who told me not to take my meds the morning of testing. Is she correct? What I understand from your article is that it shouldn’t make a difference b/c it is only T4, not a combination. I have always taken my meds on the day of the draw b/c no one has ever suggested otherwise. Thank you.
    Reply

    • Dr. Izabella Wentz says

      Diane- Whether you take T4 right before your lab tests, or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test. 🙂

      Reply

  10. Michael says

    i was diagnosed with pvc premature ventricular contraction ,i been on 112 mg of levothyroxine for years never had this but i feel as if i get upset or nervious or eat something i get these so called palpitations …any recommendations ?
    Reply

  11. Paulita says

    I’m interested in your thoughts on taking Nature-Throid at night, as well. My APRN wanted me to try switching from Synthroid 100mg to Nature-Throid. I have Hashimoto. My previous Dr. kept my TSH suppressed in order to prevent the growth of two nodules in between the butterflies of my thyroid. In fact, my latest ultra-sound this spring showed they were completely gone. My first dose of Nature-Throid was 65mg. My first six week test results showed my TSH jumping from .861 to 3.840. My T3 (L-010389) went up to 4.7. She then dropped my NT to 48.75. This is a little scary to me. I’ve been doing this dose for about three weeks. I’m afraid I may end up a mess. I would like to know your opinion, as well. Thank you.
    Reply

  12. denise Paranich says

    I’m interested in your thoughts regarding my thyroid issues. Has anyone else experienced this problem? I have been feeling more depressed every month and just didn’t feel normal for the last few months. I’m just miserable with myself! I recently had labs drawn and was in total shock when I saw my numbers on the report! T3 levels should be between 71-180… mine is 48. T4 levels should be between 0.82-1.77….mine is 0.77. TSH levels should be between 0.450-4.500.. mine is 13.230!! My doctor feels that I’m not absorbing my Synthroid now. I’ve been taking Synthroid for 23 years. Have you ever heard of this and what can I do to try to help my body to absorb the meds??
    Reply

  13. Karla says

    How long should one wait to recheck labs between dose adjustment. On WP Thyroid. ALL levels were low: T3, T4, TSH high, Free T3 low, etc. Dr wants to wait 3 months???
    Reply

    • Dr. Izabella Wentz says

      Karla- Usually the person is started on a low-dose thyroid medication and
      the dose is increased gradually to normalize TSH, Free T4, and Free
      T3. This is to avoid a shock to the body of a huge, dramatic change
      and to determine the appropriate amount needed. After the initial
      starting dose, the TSH and Free T4/T3 are measured again in four to
      six weeks to see if they have improved. Testing TSH, Free T3 and Free T4 will help determine if you will need to have your dosage of medication adjusted. Testing TPO antibodies every 1-3 months may be helpful in determining progress from interventions. I hope you also check out my book! Here’s the link in case you’re interested.

      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  14. Jackie says

    I’m so confused. I found out a little over a month ago that I have Hashimoto. I’ve been on Levothyroxine 112 MCG for about 5 years. My hair is coming out, weight gain and no energy. Luckily all my labs are online so I keep a record of all changes. My sister is the one that said she thought I had Hashimoto and I asked my doctor to run labs. Also very swollen face. So now I’m on Armour Thyroid. First month 60MG and now increased to 120MG. My labs seem very strange after the first month. Ferritin went up some 26.90 ng/mL. TSH ultra sen dropped some 0.959 mIU/L. Free T4 drooped 0.64 ng/dL Free Triiodothyronine pg/dL 4.6. Reverse T3 10.5. And before starting on Armour my antibodies 276 IU/mL. I’ve read Root Cause too. Great book!! I just don’t really understand all my labs. I’ve researched for hours. I’m just starting gluten free and dairy free. I just want to feel better, get this weight off, hair back and enjoy life! Yes, depressed too. The more I try to figure out all this, with not much results, the more upset I get. My GP is the only dr I’ve been to so far. I need to find an endocrinologist but I have no idea who to go see either. Any help would be greatly appreciated!
    Reply

  16. Melanie N says

    I take my medication at night, because it makes me nauseous in the morning. Should I not take them the night before my annual test?
    Reply

    • Dr. Izabella Wentz says

      Melanie- Whether you take T4 right before your lab tests, or haven’t taken it for up to 48 hours, your TSH value should be the same. Thus, you will get an accurate representation of your TSH value whether or not you take your T4 medication before a lab test. Or if you take a combination…if you were to take your thyroid medication within 5 hours of getting your thyroid function tests done, your lab results may show that you are overdosed, even when you may be accurately dosed, or they may show your labs to be within normal limits, when you may actually be under-dosed. Thus, it is usually best to postpone your combination medication until after you get your lab test done. I recommend getting your thyroid function tests done first thing in the morning, bringing your medications with you, and taking them right after you have your thyroid function tests to ensure that you get accurate test results.

      Reply

  17. Sheila says

    My PCP told me I had the highest hashimoto lab value he had ever seen! Due to biopsy of abnormal cells I had a total thyroidectomy. I recently was told by a different physician that if my thyroid was out I do not have hashimoto anymore. Very confused! Wouldn’t I still have symptoms!?! I am talking Nature throid.
    Reply

    • Dr. Izabella Wentz says

      Sheila- Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.

      HASHIMOTO’S ROOT CAUSE BOOK
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  18. Mary says

    I am so glad I came across this web .I have been hypothyroid for over 20 years . About a year and a half ago I really start to have problems with my thyroid after being on oral and inhaled steroids for bronchitis it seems to have thrown my thyroid for a loop and we can’t get it back under control. I started to loose weight very rapidly , hair falling out ,I dropped 15 lbs in 2 weeks sure enough my TSH was way off then they started changing my doses and It has been a roller coaster ride since . They cannot get my thyroid doses under control .I started to get bald patches on my head ,my skin is so dry and now I have been having bouts of awful fatigue .My weight came back to where it was an then I gain 10 lbs more. One other symptom I start feeling pressure almost in my chest kind of anxiety like symptom I guess.( Docs tested for heart issues all came back negative) It only happens once in a while but this symptom is the pits really feel physically awful and can flair up off and on for days then go away for many ,many months I feel like I am having symptoms of hyper and hypo at the same time .

    Reply

    • Dr. Izabella Wentz says

      Mary- Did you know that if you live in the United States, the UK, Australia, Europe and most developed countries that add iodine to the salt supply and take thyroid medications, there’s a higher probability that you do have Hashimoto’s?

      Depending on the source, estimates are that between 90-95% of those with hypothyroidism have Hashimoto’s.

      But most doctors will never tell people that they have Hashimoto’s, or that their own immune system is attacking their thyroid. People are told that their “thyroid is sluggish”, and that these things happen with age and “Just take this pill, you’ll be fine.” Hair loss is a distressing symptom experienced by women with Hashimoto’s. For women, our hair represents our femininity, and losing our hair is a constant reminder that something is off and that we are not well. Have you read these articles?

      HAIR LOSS AND YOUR THYROID
      https://thyroidpharmacist.com/articles/hair-loss-and-thyroid
      10 MOST HELPFUL DIY INTERVENTIONS FOR HASHIMOTO’S
      https://thyroidpharmacist.com/articles/10-most-helpful-diy-interventions-for-hashimotosaccording-to-my-clients

      Reply

  19. Carla says

    Have you ever heard of this I went from 1 grain all the way up to 3 grains of ndt over the course of 2 years. The only thing that went down was my tsh the t3 and t4 stayed the same! I was tested for rt3 and antibodies both came back negative. No one has a clue

    Reply

  20. Andy says

    Hi, I am on 150mg of Thyroxin for my Hashimoto’s. I am overdue for my yearly blood test but forgot to take my medication for two days recently, I then took 200mg on two consecutive days. how long should I wait for the blood test to ensure my levels have stabilised. I see you mention 4-6 weeks after starting medication the levels will have stabilised, is this a good guide for me to wait before my blood test? Any advise would be appreciated? Andy

    Reply

  21. lillie says

    I have only been on Nature Thyroid 48.75 for 2 days only, How long does it take to effect my levels, I had another blood test did this morning, I did not take a pill this morning before I had another series of blood work done for a second opinion to see if I was hypothyroid.will it effect the results?

    Reply

  22. lillie says

    I have only been on Nature Thyroid 48.75 for 2 days only, How long does it take to effect my levels, I had another blood test did this morning, I did not take a pill this morning before I had another series of blood work done for a second opinion to see if I was hypothyroid.Will it effect the results? Also I am suppose to have an ultra sound did Monday which is 4 days away, If I continue with meds will that effect outcome of scan ?

    Reply

  23. matthew says

    Thank you I only recent found out I have hypothyroid at 57. Just increased to 125 MG of generic senothyroid misspelled forgot to take my labs the morning of the blood test doctor said we needed to up the mess to 125 MG based on what you wrote missing the one dose wouldn’T change anything . Thank you.

    Reply

  24. Sam Sam says

    Hi,

    May I ask please, I wanted to know, it takes TSH test six weeks to converge to it’s true value after changing the dose of T4 medications, from the first week of changing the dose of Levo till the end of the sixth week, how does TSH behave in this interval?

    If I am slightly hyperthyroid with only 50mcg per week more than what I need and reduce the dose, by how much does the TSH increase each week until the six weeks interval?

    If there is no exact answer to this question, can give something close to exact!?

    Thank you very much,

    Reply

  25. Aimee says

    My question is I think my thyroid tests have increased over the years. At what point even though they say your results are good do you push the issue of the them climbing? My T4 was 1.17, my TSH 3rdGen results have been 4/2003 2.080, 5/2005 2.693, 6/2007 1.844, 6/2008 1.600, 10/2012 .964, 5/2013 2.030, 9/2013 2.096, 3/2015 1.005 (was diagnosed with AIH at this time), 3/2016 2.375, 1/2017 3.382
    On 1/2017 was diagnosed with Fibromyalgia but I don’t believe thats whats going on here. Cant thyroid issues have the same symptoms of fibromyalgia? I also was diagnosed March of 2015 with Autoimmune Hepatitis.

    Reply

  26. Tammy wells says

    What about us persons with thyroid cancer. I often wonder how accurate our labs are being we had a thyroidectomy.?.
    I’m on tirosint and low dose cytomel. Recently my endo (whom I’ve now fired), lowered my tirosint because “you’re too high.” Her words. I understand thyroid cancer patients are kept suppressed as part of cancer tx. And fully disagree with my med reduction. I lost my job now, am not functioning 80%. And getting worse as the weeks go by.
    My pcp agreed to take over my meds but wants to wait the 6-8 weeks to get an accurate reading. Feb 22nd is in that time frame. I fear I cannot wait that long as my thoughts are getting darker….but, I am going to skip my meds that morning and take after my labs. Do you have any “suggestions” (I’m not ok with NDT, Armour etc…not yet)

    Reply

  27. Iren Virag says

    Hi.
    I am on 112,5 mg of Levothyroxin for my Hashimoto’s.
    Please help me how to interpret this lab results?
    TSH 0,9330 mUI/L
    FT4 1,20 ng/dL
    FT3 2,87 pg/mL
    ATPO 750,0 UI/mL

    Thank you!

    Reply

  28. Mary-Jane K. says

    I am taking Cytomel (T3) only at midnight, no T4 at all. Since I’m not a morning person, I don’t see myself having blood drawn before noon. Should I skip my Cytomel dose the midnight before my test to get an accurate free T3 lab test? Or will taking Cytomel at midnight be OK since the test will be at least 12 hours since my last dose? Will taking a midnight dose of Cytomel affect a TSH level drawn at least 12 hours later? Thanks for your reply.

    Reply

  29. Rachel says

    I live in a very small town without access to a functional medicine doctor. I have the Thyroid Secret Gold, Love it! and I’m committed to healing. I’m allergic to most foods, have multiple chemical sensitivity, Sjogrens and Raynaud’s with Hashi’s, at the end of the line. Can’t afford to lose more foods. My GP is happy to run tests for me but admits he can’t interpret them (he likes your book!) What do you suggest? Oregano oil, bone broth, lemon and ACV, essential oils, proteins, even the capsules from Seeking Health supplements give me a reaction (pine cross reactive with peanuts I’m told.) At this point my husband doesn’t believe tests are worth the finances or stress, with no one to interpret them and nothing I try helps. Considering working with a doctor from “The Thyroid Secret” but who to choose? Clearly the typical diets and treatments don’t work for me. Do you think you could help me heal, are you taking patients one-on-one, is there someone else you can direct me to? Thanks.

    Reply

  30. Kathy says

    I just started WP thyroid less than 1 month ago prescribed by my primary care physician (based on TPO antibodies confirming Hashimoto’s & TSH being 3.88 – I’ve had Hashi’s since 2012 but never been prescribed thyroid medication). I felt GREAT the first week (lost 4 lbs doing same eating plan/exercise plan I’d been doing for previous 3 months), energy back, joint pain almost gone & swelling/puffiness down. But within 1 week, all symptoms back. I thought maybe a dose increase was warranted, but the PCP won’t increase the dose so I started seeing a Naturopath who is requesting full panel of blood work and specifically said she wanted me to take WP the morning of my blood work. I told her what I’ve read online (your article, Dr. Alan Christiansen & others) – who all say test before taking the thyroid medicine. The NP said that’s normally true but in this case they wants to see what the medication is doing to my body (they didn’t say what specifically they are looking for). Is there ever a time when you would test labs within 3-4 hours of taking the medication or does this NP sound like they may be mis-informed and/or just trying to run a bunch of labs to make money?

    Reply

    • Dr. Izabella Wentz says

      Kathy – Please, understand that due to liability issues, I am unable to answer specific medical questions.

      A couple of years after my diagnosis, I found Hashimoto’s 411, a closed Facebook group run by Alice Berry McDonnell. This group is amazing! It is comprised of an army of highly motivated, smart, supportive women and men (now 45,000+ strong), and each of them sharing ideas of what worked for them, things they were planning to try, and offering support to one another. The comfort I received from knowing that there were others going through the same challenges as I, was enormous.

      https://www.facebook.com/groups/hashimotos411/

      Ask questions. Post your thoughts. Scan the files. It is an absolutely amazing resource. Best of all it’s kept private from spammers.

      Reply

  31. Emily says

    I had been stable on naturethroid for the last 4 years. This past November my doc suggested I try a compounded t4/t3 formula. I felt great on it but my TSH wouldn’t stabilize and was at 5 last time we checked even tho we had previously increased the dose. We switched me back to naturethroid as I’m trying to conceive and TSH needs to be at 2 or lower. I’m feeling absolutely terrible after switching back. It’s been about 7 days sinced I switched. Would appreciate any insight into why my TSH wouldn’t stabilize on the compound and why I feel so bad after switching back. Many thanks for any thoughts.

    Reply

    • Dr. Izabella Wentz says

      Emily – thank you for following this page.

      Please, understand that due to liability issues, I am unable to answer specific medical questions.

      In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  32. Megan says

    Hello,

    Thanks for the helpful information. I am currently prescribed Nature Throid and I am scheduled to have my thyroid levels re-tested. The previous tests showed suppressed TSH (0.14 and 0.02). My doctor was mildly concerned but didn’t change my dosage. I have begun experiencing hypo symptoms again, and I think my dosage might need to be increased. However, I am afraid she won’t increase it if my TSH is suppressed. Do you think skipping my dose on the morning I get tested will help it not be so suppressed? Or would I need to skip it for a couple days leading up to the test for it to not be as suppressed?

    Thank you!

    Reply

    • Dr. Izabella Wentz says

      Megan – thank you for following this page.

      Please, understand that due to liability issues, I am unable to answer specific medical questions.

      In order to self-advocate, it’s important to understand the ins and outs of thyroid medications. There are many reasons why your thyroid levels might not be optimal and my Optimizing Thyroid Medications eBook will give you those answers as well as give you a full explanation of the different options that are available to you! I want you to be empowered, so I’m giving this eBook away as a FREE download this week! Download it for FREE Optimizing Thyroid Medications eBook!

      This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  33. Tammy wells says

    What about patients who have/had thyroid cancer and do not have a thyroid? How do we know we are properly medicated for optimal living if doctors (I’ve been to over 15 now in 2 years because they are focused on tsh only) are tsh only focused? Do we take our meds before tests?

    Reply

  34. Carlotta Lee says

    I am going for a physical in a few weeks & I am wondering exactly which tests I need to request that my doctor have done for an accurate account on my thyroid. I have been taking medication for hypothyroidism for over 25 years. I did go to an endocrinologist until 2 years ago-he retired. I’ve always had my TSH & T3 & T4 tests run. What else should my doctor be testing? Thank you.
    Carlotta

    Reply

  35. Tammy says

    In your book, you mentioned that you’ve suggested to some of your patients taking thyroid meds at bedtime. I have started doing this with great results. I even sleep better. Thanks for the tip!
    Is it okay to take the nighttime dose prior to a blood test the following am? I am on Nature-Throi.

    Reply

  36. Cynthia says

    Wait, Cytomel may be cross-contaminated with gluten, is this currently still the case? I seem to have issues with conversion (relatively high in free T4 and low in free T3) and just started with Cytomel. First days I felt great! But than this horrible pain in my belly started (including problematic stools) with fatigue, which I associate with gluten contamination. I thought that I was contaminated on a birthday party, but could it relate to the intake of Cytomel?

    Reply

  37. Lianne Simon says

    “People with Hashimoto’s and central hypothyroidism may have a normal reading on this test.”

    One of the biggest risks for those of us with Central Hypothyroidism is most doctors’ obsession with TSH levels. When my free T3 and free T4 are at the bottom of the normal range, my TSH will still be close to zero. The TSH test simply isn’t a reliable indicator of thyroid function for us. But in 25 years of being hypothyroid, I’ve never been able to get an endocrinologist to order a thyroid panel.

    Reply

  38. Leslie M says

    I missed 3 days in a row of my Levothyroxin 175mg that I have been on for over 10 years. I need to get blood work done soon, but I was wondering how long I needed to wait after missing those doses. Thank you for your help!

    Reply

  39. Jennifer N says

    Is there an optimal time to test thyroid function in relation to a woman’s menstrual cycle? I know that the optimal time to test for other female hormones is usually around the 19th or 20th day of a woman’s cycle. I have read that progesterone can affect thyroid sensitivity at the cellular/receptor level, so one would think that the fluctuations in progesterone during the menstrual cycle could influence thyroid function?

    Reply

  40. Rebecca says

    Hello,

    I just finished reading your article about accurate thyroid testing. My hubby skipped his NDT dose the day before and the morning of his thyroid blood test. He takes it in the mornings usually. Normally, he just misses the dose the day of testing and takes it after the blood is drawn. However, I have seen it said that because of NDT’s combined T3 and T4, that skipping the day before and day of testing is more accurate? His results are back and they are much lower all around. Actually, more relating to how he feels. Which is leading him to increase his meds. Thoughts on this?

    Reply

  41. Jen says

    Hello,

    I wae dx last September with hashis and hypothyroidism. I was put on NP thyroid for hypo, and I still have not hit a maintance dose. I split my dose daily at 7 am and then at 3 pm. I normally do my labs at 7:30 am, and hold my meds until after my lab. My last set of labs was done 8 hrs after my am dose because the nurse practioner said me.waiting till Am would give faulty readings. What is the appropriate time to do my labs for the most accurate reading, since I split my dose.

    Thank you,
    Jen

    Reply

  42. Catherine says

    Hi
    Thank you for all the useful information you send.
    In the article above I am confused by this sentence:”So in order to get an accurate representation of your stable TSH on a T3 containing medication, you would need to postpone your T3 containing medications until after your test—or wait 13 hours after testing!”
    Should it be “wait 13 hours “before” testing!” ? Or am I misreading here?
    Thanks.

    Reply

  43. Anne Ho says

    Hi, I m Anne. I m having hypopituitarism. Recently my hypothyroid became hyper. My cortisol went up to 729. At the moment having second test after redused lower dosage for both meds.

    My

    Reply

    • Dr. Izabella says

      Anne – thank you for following this page. Unfortunately, I don’t have any current information available on this topic. However, I recommend working with a functional medicine doctor for Hypopituitarism. I also suggest talking with your practitioner about pituitary glandulars – like Cytozyme PT/HPT by Biotics. Graves and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto’s, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people)-Hashimoto’s results in hypothyroidism and is usually treated with Synthroid and replacement hormone.

      The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves have hyperthyroidism, and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on Synthroid as well.

      Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.

      We need to rebalance the immune system to prevent this (sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      You may also find this article helpful.
      ARE YOUR ADRENALS SABOTAGING YOUR HEALTH?
      https://thyroidpharmacist.com/articles/are-your-adrenals-sabotaging-your-health

      Reply

  44. Mary says

    Hello,

    I do not have access to Armour or any other T3, so I am using compounding T3 but having problems with it. It gives me stomachaches. Is it a common side effect from this medication? What might be happening?

    Reply

  45. Lauren says

    Dr. Wentz,
    I was diagnosed with subclinical hypothyroidism and given NDT. The first time I tried the NDT I took 1/4 grain a day and felt hyper so I stopped completely for over a year. I finally decided to try again because my labs got worse. So we started very slowly. Half a 1/4 grain every other day, then moved up to half a 1/4 grain a day. The goal was to move up to a whole pill. I felt pretty wound up a couple weeks ago and started working out really hard. After a really hard workout I got a migraine and basically crashed for several days. I then started feeling better again and attempted to take a whole pill. It was too much so I went back down but still feeling a little wound up. So I went to get labs again. My TSH has gone UP! From 3.05 to 3.9. My T3 and T4 have also gone slightly down. What the heck?? I’m so confused and frustrated. My practitioner said it sounds adrenal related and maybe I should take an adrenal supplement and don’t increase my dose due to the hyper symptoms. I’m so lost. Thoughts?
    Thank you!

    Reply

  47. Momna says

    hello Thank you so much for this worth full info.

    Can you please tell me if want to see the level of :
    Vitamin A , E
    bacteria level (e.g. for which i should use Probiootics 50B) and selenium, which tests i should do or ask in Lab.

    Regards
    Momna

    Reply

  48. Anna says

    Interesting article that I just found! So much useful information!
    I am on NDT, and my latest labs showed FT3 levels of 3.6 (ref 1.7-3.7) 24 hours after taking any meds. Although that’s in range (just below upper normal limit), I have read that you should assume that FT3 levels were ca 20% higher on the previous day, meaning they were out of range…does that mean that I am currently overmedicated, although I feel absolutely fine and show now signs of hyperthyroidism? FT4 levels came back midrange and TSH suppressed.

    Reply

  49. NARTIA says

    Hi,
    I have been hypothyroid for 17 years and taken desiccated thyroid. At present I am on N.P. Thyroid since they first came out. For many years now even when my TSH and FT3 are in normal range my FT4 runs consistently at the lowest number in the range or 1 point lower. The only time it is in the normal range is when my TSH is high. My dr. tried to raise my meds to increase it but with disastrous results. So happy I found your website! Thank you.

    Reply

  50. Lauren says

    Dr. Wentz,
    I’ve been struggling for several years to get to the bottom of my fatigue. Started with ferritin and B12 and then tried a tiny dose of NDT with a functional doc who doesn’t like to give T4. I tried many times to do the NDT even after a year of Ashwaghanda and I still get too amped up on it. I went to a regular endocrinologist and they gave me Synthroid and then Levothyroxine. The Synthroid made me so exhausted I was practically dead and the Levo is just so so (surprisingly). I don’t know what the heck is going on. I haven’t been able to get pregnant for 2 years with no known fertility issues. My TSH fluctuates between 2.5 and 3.1 and went up to 3.9 after 3 weeks on NDT. I’m thinking about doing a salivary cortisol test to see if that can give any insight. I’ve had cortisol and DHEA blood tests and they’re normal. Will a salivary cortisol test be accurate after I’ve been messing around with all these thyroid meds?

    Reply

  51. Judee says

    What about taking iodine before a TSH test? I have been taking a supplement that I found out has a high level of iodine and I am suppose to have my TSH tested this week. Will that affect the TSH test?

    Reply

  52. Catherine says

    Very interesting article, thanks!
    I am doing well on Erfa Thyroid after suffering for years on T4 only drugs…it turned out I’m a poor converter, leaving me with insufficient T3 levels despite high-in-range FT4 levels.
    However, I only see my thyroid doctor once a year, and my family doctor is constantly telling me I need to go back on T4 only without delay to normalize my TSH (suppressed since starting NDT).
    Does what you say in this article mean that if I go to the lab more than 13 hours after taking medication containing T3, and the TSH is still very low (below 0), then I am in fact overmedicated (I take 5 grains daily and feel well on that, no signs of being overmedicated)?
    If, just to calm my family doctor down, I went off Erfa long enough for my TSH to rise to above 0.4 (ref ranges for my lab 0.4-4.0), how many days – or weeks – would that approximately take? I realize that, when you’ve had a suppressed TSH for a long time, it can take time for the TSH to rise…
    Also, if I decide to go down this road, would the best thing be not to take any thyroid hormone at all for a week or so (I guess FT4 levels would remain more or less stable during that time, or at least not decline dramatically?), or go back to T4 only? In both scenarios, how long do you estimate it would take for the TSH to rise above the lower normal limit? Sorry if this question sounds stupid, but I cannot take much more of this from my family doctor who keeps telling me I’m at risk for osteoporosis and heart disease…I just want him off my back!!!

    Reply

  53. Char says

    My TSH is at 16.16 now, down from 97 in June. My G.P. Doesn’t test for T3 or anything other than TSH and in Aug. TPO which was 427. I was started on Synthroid 50, upped every 3 months to 100 by Nov. And yesterday to 125. I told him the near constant muscle pain and weakness, worse after waking and standing and when walking was getting me down. I fell into a closet the other day at work bruising my arm after standing up and taking a few shuffling paces until my legs entirely ‘stopped working’. He is not as concerned as I am about this, or about my weight still being 251lb. despite my best efforts, after ballooning to 266lbs. between Jan and June when diagnosed. He said I list more weight than he has following Weight Watchers since Apr. and to feel proud as it is so hard to lose when hypo. I think a lot was water, I’m not as puffy, and I’m not happy it feels like forever to lose an oz. I fluctuate from 254-248 up and down since Nov. Dry skin, hair loss back too. If I’m doing so well as per the Dr. Why do I feel so much worse and struggle so hard?

    Reply

    • Dr. Izabella says

      Char – thank you for reaching out. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.

      We need to rebalance the immune system to prevent this (sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:

      Hashimoto’s Root Cause
      https://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Reply

  54. Char says

    Also, I read that t4 meds have. 5-7 day half life, and you shouldn’t notice a missed dose or two. My Dr says it shouldn’t matter if you miss a dose. I haven’t but I have been late on taking it. I work 4 nights 11pm-9am (since Nov. I had been on 5 – 11pm-7ams for past 5 yrs) and am on call otherwise. I usually must have coffee when I get up, so I take my med 2 hours after I finish it, 1-2am, and eat 2 hrs later from then around 3-4am. Occasionally I am late if it is really busy, and swear I ‘know’ if I have forgotten to take it by how I feel physically. Is this because I still have a high TSH (16.16 down from 97) or is this all in my head? I swear it can’t be because sometimes the only way I know I didn’t take it is how ‘off’ I feel, which is different than the brain fog induced ‘did I take my med yet’ where I need to check the bottle.. I put 4 pills in the bottle when I work, 3 when on days off to keep track easily, with the remainder in a dark closet until needed. I originally would take the med @ 7:30am at home after work, as I was told to take it in the morning, but by 4:30am at work was almost non-functional from brain fog, muscle pain, and fatigue. My coworker with Graves reminded me my morning starts at 9:45pm. Through trial and error and worry about brain fog, coffee or food affecting the med the above works for me albeit a bit different than the norm. I don’t know if this is why I still feel as bad and sometimes worse than before I was diagnosed. I really seem to need coffee to get myself going, I have tried the med on waking up, coffee later, but don’t seem to function as well and have cut back drastically from 8+ cups a day before Dx to 2 when working, 0-1 when not. There is no difference in the way it feels if I have coffee or not if I am late taking my med. I sure can tell, usually after 2 hours I know it, but the Dr doesn’t believe this is possible.

    Reply

  55. Anita says

    Hi there,

    I´m taking Erfa since a couple of years.( I have Hashimotos and PCO/ lack of Progesteron and a low function of my adrenal gland) My former doctor always did the blood test in the morning before I took medication. The results were always fine to a bit to low regarding the T3. after pushing my adrenal gland it has been perfect.
    So far…

    As I´m now pregnant I was at the hospital recently. They took my blood 4 hours after I took my thyroid medications. The T3 was way to high. 10 Point something!! It doesn´t worried me that much as two weeks before at my doctors clinic my T3 levels were a bit to low 24 hous after my last medication. It seems that after taking medication I have too much T3, after 24 Hours I have a bit too less of it…

    it raised following question:
    This peak or overdose in the morning can´t be that good/healthy, right? I don´t feel any overdose symptoms but I´m pretty sure a healthy thyroid would not produce such peaks – so it can´t be that good? I think normally you should have a stable amount of it in your blood or is there a pattern regarding the time of day?
    Wouldn´t it be better if I split my medication in two portions? One for the morning, One for evening or bedtime? That could perhaps avoid peaks and low points?

    Second question:
    My TSH has always been supressed since I´m on medication. 0.1 or even lower. But my doctor said that´s fine while being on medication because he thyroid just has nothing to do when it gets the hormones from outside. Why should it produce stimulating hormones?
    Would you agree?

    thanks for your comments

    best

    Anita

    Reply

    • Dr. Izabella says

      Anita – thank you for following this page. When you take your thyroid medication on the morning of your thyroid blood work and you are taking T3 medication, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning). It’s always best to speak to your functional medicine practitioner to evaluate your specific case, and whether you need more testing. Here is a research article which might help further:
      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  56. Lisa says

    I normally take my NDT at 7 am. If my labs are usually at 9 am, is that too long of a wait (26 hours) if I wait to take my NDT after labs? Or should I take them the night before (13 hours prior)? Sorry, I’m a little confused.

    Reply

    • Dr. Izabella says

      Lisa – thank you for reaching out. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      TOP 10 THYROID TESTS AND HOW TO INTERPRET THEM
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  57. Morgan says

    When taking a combination medication T4/T3 what is the appropriate amount of time between last dose and blood draw? I’m really looking for a concrete time frame not just “don’t take medication morning of the lab draw”. Because that could be different person to person. Some may take meds once in the morning and some may take meds several times throughout the day. Someone who takes meds throughout the day will have t3 in their system closer to the next morning lab draw than the person who took a single dose the morning before. I hope I’m making sense. Thank you.

    Reply

    • Dr. Izabella says

      Morgan – thank you for following this page. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      Reply

  58. Amanda says

    I have recently started taking armour. I have an appointment to get my levels re-checked, it will be 6 weeks after beginning armour. However the only time they could see me to re-test was 4pm!! It seems from this article you are saying I should not take my armour that day? Even though the test is not until 4pm? Thanks so much for the clarification. I just want to make sure I do the right things to get the right dosage.

    Reply

    • Dr. Izabella says

      Amanda – thank you for following this page. When you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning). This book will help you understand your thyroid lab results and how to optimize your thyroid hormones!!
      https://thyroidpharmacist.com/checkout/?product_id=4702

      Reply

  59. Ghada.M.Kamel says

    can I ask about doing the glucose tolerance test in patients taking thyroid hormone replacement, I mean should he/ she stop taking medications or just fasting but continue their medication even if the morning dose is 1 hr before the start of the test?

    Reply

  60. jessica tyson says

    Hi,
    I have a question regarding t3 medication, cytomel. I have been on it for about 5 months now and have felt so much better on it along with tirosint. My question is: can taking a t3 medication make your tsh number not show up correctly even when your free t4 and free t3 are in normal range? I didn’t take my t3 medication before bloodwork and my tsh number was still 0.02.

    Thank you!

    Reply

  61. Cheryl says

    I have seen in some articles that being on thyroid medications can raise the cholesterol levels. By how much can it raise it? Is there a range?

    Reply

  62. tonya says

    Hi, I have been having symptoms for over three years and not knowing it could be my thyroid. First time was when I went to a gastroenterologist with severe stomach issues and after a colonoscopy and endoscopy finding ‘nothing wrong’ because I tested positive for celiac and crohns. My sister is celiac and my other sister has lupus. So he specifically said not to go gluten free, I did. I felt better Lost much needed weight and had energy for days! Then about 8-12 months later, started feeling tired again, thinning hair, irregular periods, very moody and hot flashes and night sweats. Went to my gyno and she put me a low dose birth control and again felt great! Energy for days again, everything seemed to be back to normal. Well after about the same time as before I started to have the same issues, tired, cold hands and feet(also this time episodes of shivering), migraines, forgetfulness, dry skin, irregular periods, bloating, weight gain, just to name a few. I have had my blood taken every year for three years. The last two tests show only my tsh and it was 2.114 uIU/mL then went to 1.640 uIU/mL and tested nothing else associated to my thyroid. Should I just ask for a referral to see an endocrinologist? I know this is a lot of information, but I am seriously just tired! I am a mother of 6 kids and I know when I am tired, this tired is just different and can’t catch a break and I don’t think I can handle my doctor telling it’s my age again! Thank you in advance.

    Reply

  64. Cheryl says

    Does it make a difference if you are on a T3/T4 medication as to whether you are fasting or not fasting? First time I did fast although they did not require it.

    Thank you.

    Reply

    • Dr. Izabella says

      Cheryl – thank you for reaching out. If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3/T4 medication until after you do the test to see (try to schedule the test in the morning).

      Reply

  65. Grace says

    Hi
    I had thyroidectomy 17 months ago (pap cancer) and everytime I have labs my TSH drops to near non-existent and my FT4 and FT3 never change both sit in lower end of lab ranges. Everytime my TSH drops my Endocrinologist gets fruity telling im going to die from heart disease or have crumbling bones …. this freakish behavior comes from a Dexa Scan I had showing mild osteopenia….in fairness I had hysterectomy 15 yrs ago cancer and I was a heavy steroid user for autoimmune disease. This whole time I’ve felt fine no issues with hyper or hypo symptoms….Endo keeps lowering Synthyroid and I get more Hypo….Sick and tired of this any idea what or Why TSH keeps dropping?

    Reply

    • Dr. Izabella says

      Grace – thank you for reaching out. Most conventional physicians use the TSH test to determine if one has a thyroid disorder and to dose thyroid medications. However, this test can often times be misleading, as levels of circulating hormones may fluctuate at different times, such as in Hashimoto’s, where the person affected may fluctuate between highs and lows. Additionally, when scientists first set the “normal” ranges of TSH for healthy individuals, they inadvertently included elderly patients and others with compromised thyroid function in the calculations, leading to an overly lax reference range. This resulted in people with underactive thyroid hormones being told that their thyroid tests were “normal,” based on this skewed reference range.

      WHAT TO DO IF YOUR TSH IS NORMAL AND YOU ARE ANYTHING BUT
      https://thyroidpharmacist.com/articles/what-to-do-if-your-tsh-is-normal-and-you-are-anything-but/

      Here are the tests you need for diagnosis. Most endocrinologists don’t run them all so you will have to request them. Make sure to request a copy of your labs as well.

      TOP 10 THYROID TESTS AND HOW TO INTERPRET THEM
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Reply

  66. Amanda says

    Thank you for the article. From now on o will schedule my bldwrk for the morning as the bldwrk being correct is so important. My next apt is in two days as I’ll be out of meds and it’s at 330 Pm. I’m on a np, my dr said to take it but after reading this I’m thinking maybe I would get more accurate results if I didn’t.
    Also I’m wondering if my bldwrk was possibly interpreted wrong previously. I was previously put on cytomel and my hair starting falling out by the handful and I thought it was the medication but maybe it was actually the dose. Unfortunatley It’s also the first time I’ve been able to drop a couple of pounds since my hashimotos diagnosis 5 years ago. I had the Mrs switched because I didn’t think my poor hair could handle it.

    Reply

  67. Jamie Hamilton says

    Thank-you so much for all the information that you share. I do have a question though . . . what effect, if any, does Cytomel meds have on a FT4 lab? Just curious.

    Reply

    • Dr. Izabella says

      Jamie – you are very welcome! Cytomel is T3 so it will read as Free T3 on your thyroid labs, it does not really have any direct effect on your Free T4 lab work. Taking T3 hormone replacement therapy will suppress your TSH. There is information about this available from the medication manufacturer. I hope that helps.

      Reply

  68. Cheryl says

    Wondering what would cause a free T 4 to always be low in the lab ranges while the TSH is normal or in a better range and the free T 3 is either above the mid point or in the higher ranges. My free T 4 always seems low. Yes have hashimotos. I am on NP thyroid. Will increasing the dose increase the T 4 or no?
    I have not had any iron tests done nor any saliva tests for cortisol issues.

    Thank you.

    Reply

    • Dr. Izabella says

      Cheryl – thank you for sharing your journey. I don’t know your health history so, I cannot advise you. This is a great conversation for you to have with your healthcare provider. <3

      Reply

  69. Ingrid says

    Am currently on 90mg ERFA thyroid. I understand normal thyroid lab values will be different while on any NDT. Comments?
    RAI 39 years ago resulting in 38 years of Synthroid. Have not felt well for years. Nobody believed me until I started researching last year. When I went on NDT, it seemed to exacerbate latent illnesses. At a loss.
    btw – also have low saliva cortisol 4 out of 4 amongst many other symptoms Insomnia, Hypothyroidism, AFS, CFS, EBV reactivation, Essential Tremors, bacterial vaginosis, GA granuloma anulaire, muscle aches, arthritis, extreme fatigue, brain fog, anxiety, incapable of handling stress. Very proactive and self advocating in my illnesses but I am exhausted and desperately want to move forward to healing.

    Reply

    • Dr. Izabella says

      Ingrid – thank you for reaching out and sharing your journey. I understand how hard this all is. <3 Most people feel best with a TSH of around 1 or lower and with a Free T4 and Free T3 in the upper half of the range. It is expected that your TSH will be very suppressed when optimal on NDT medication. How much thyroid replacement therapy is needed is unique and different for each person, so it's important to work with a functional medicine practitioner or a doctor, who can closely monitor your dosage and your progress. Every six weeks is usually a good schedule for testing your thyroid hormones. Here is a research article which might help further:

      TOP 10 THYROID TESTS FOR DIAGNOSIS
      https://thyroidpharmacist.com/articles/top-6-thyroid-tests/

      Without going into too much detail, the first of the crucial defining moments in my disease development may have started during my undergraduate studies at the University of Illinois. Due to the communal living setting of dormitories (and less than stellar hygiene habits of most college students), I had recurrent strep throat infections and even contracted mononucleosis, a viral infection caused by the Epstein-Barr Virus (EBV), which is implicated in triggering many autoimmune conditions. I received multiple courses of antibiotics as well as flu shots (which may be associated with EBV infections) and started birth control for menstrual cramps.

      Animal fats, broths, soups, and stews support the body’s ability to suppress the viruses. Monolaurin or lauric acid, one of the components of coconut oil, has been found to be active against the Epstein-Barr virus. Replication of many viruses including Epstein Barr is inhibited by glycyrrhizic acid, an active component of licorice root. Quercetin, Co-Enzyme Q10, N-Acetylcysteine, and glutathione were also reported to be helpful in chronic fatigue syndrome because of their anti-viral properties. It is my belief that this combination had a profound impact on my gut flora, and thus my immune system.
      I have an entire protocol dedicated to eradicating EBV in my new book, Hashimoto’s Protocol, starting on page 329, that you may want to check out!

      HASHIMOTO’S PROTOCOL
      http://amzn.to/2B5J1mq

      Reply

  70. vijaya says

    hello I have small doubt about when to give blood test done before taking or after taking medication
    on fasting or with out fasting
    please kindly reply me by today I completed 6 wk medication as I recently diagnosed with slight raise in tsh

    Reply

  71. Jody says

    After years on tirosint for Hashimoto s, I started on Armour thyroid 3 months ago. My T 3 has always been low and the TSH most recently around .1. My doctor has ordered a tsh test to monitor me now. When I asked about a t3 she said she doesn’t monitor t3 for Armour patients. Does this sound right, it doesn’t make sense to me. I thought we whold want to see if the Armour improved my conversion of t4 to t3 and check those levels.

    Reply

    • Dr. Izabella says

      Jody – thank you for reaching out. <3 I understand how frustrating this can be. Here are the tests I recommend for diagnosis. Most endocrinologists don't run them all so you will have to request them.

      ¨ TSH
      ¨ TPO Antibodies
      ¨ Thyroglobulin Antibodies
      ¨ Free T4
      ¨ Free T3
      ¨ Reverse T3 (optional)
      ¨ Thyroid Ultrasound (optional)

      I highly recommend that you work with a functional medicine clinician to be a part of your own health care team. It’s an entire medical specialty dedicated to finding and treating underlying root causes and prevent serious chronic disease rather than treating individual disease symptoms. I believe that everyone needs to find a practitioner that will let him/her be a part of the healthcare team. You want someone that can guide you, that will also listen to you and your concerns. You want someone that’s open to thinking outside of the box and who understands that you may not fit in with the standard of care. It's a good idea to ask some standard questions when contacting a new doctor for the first time. Something else to consider is you can work with a functional doctor remotely, via Skype. You could also contact your local pharmacist or compounding pharmacy, who may be able to point you to a local doctor who has a natural functional approach. But I encourage you to keep looking for the right one for you! Here are some resources you might find helpful.

      CLINICIAN DATABASE
      https://thyroidpharmacist.com/database-recommended-clinicians/

      FIND A FUNCTIONAL MEDICINE CLINICIAN
      https://ifm.org/find-a-practitioner/

      COMPOUNDING PHARMACIES
      https://thyroidpharmacist.com/database-recommended-compounding-pharmacies/

      Reply

    • Nina says

      My ND is first doctor EVER to suggest taking T3 before my labs and then taking labs 6 hours after my dose. But you do say it can falsely suppress TSH for 5 hours so maybe 6 hours is okay? Not really
      Understanding her reasoning but she was very firm to get it at the 6 hour mark. Any reason you can think of the 6 hours being so important? I’ve never taken it before labs before so I’m curious.

      Reply

      • Dr. Izabella Wentz says

        Nina – thank you for reaching out. When we take a T3 medication, or a combination of T3/T4, T3 has a shorter half-life so our blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. I generally recommend delaying thyroid medications until after lab testing, that said I also recommend discussing this with your practitioner to determine what works best for your needs.

        Reply

  72. Tessa says

    My T-3 levels were a a little low a couple of years ago. I am now on Cytomel. At the time my levels were initially low, I was not in good health with multiple injuries. I have osteoporosis and hence and concerned about taking too much T-3, if my “natural” T-3 levels have gone up since I am now in good health and without injuries. With my doctor’s permission, the last time I took my blood test I skipped my Cytomel for 48 hours, and my T-3 was normal. My doctor felt that meant all was well and that I should keep taking the Cytomel. I have on my own started taking 75% of my prescribed dose due to my concerns, and I feel fine.

    Would it be better for me just to skip Cytomel for only 24 hours and focus more on the TSH levels? Is it possible to have high normal TSH levels and still be causing bone density harm with T-3? What do you recommend to make sure I am not taking too much Cytomel for my osteoporosis?

    Thank you

    Thank you

    Reply

    • Dr. Izabella says

      Tessa – thank you for reaching out and sharing your journey. <3 Please understand, I am not able to advise on what would be appropriate for you and your specific health needs without a comprehensive health assessment. I recommend that you discuss this with your personal doctor.

      Reply

  73. Lily says

    Dr. Izabella,
    I am getting thyroid labs in 4 weeks to see if I need to remain on Cytomel. My naturopathic doctor says I should not take my Cytomel the morning of the test. However, my general practitioner says I need to be off of Cytomel for 4 weeks to get accurate labs. Who is correct?
    Thank you,
    Lily

    Reply

    • Dr. Izabella Wentz says

      Lily – thank you for following! ❤️ If you are taking a T4 only medication, you can go ahead and take your medication in the morning before the test. T4 medication has a long half-life, and your levels will be stable regardless of when you take it. If you take a T3 medication (such as Cytomel) on the other hand, or a combination of T3/T4, T3 has a shorter half-life so your blood work may not be reflected accurately. It will appear that you have more thyroid hormone on board than you do. Thus it may be helpful to delay your morning dose of a T3 or T3/T4 medication until after you do the test (try to schedule the test in the morning).

      Reply

  74. Susie says

    Dear Dr. Wenz,
    Am I missing something? Your reference readings don’t compare to what the diagnostic company is using. My reference ranges say:
    TSH 1.04 mIU/L
    T4, Free 1.3 ng/dl ?
    T3, Free 2.7 pg/ml ?
    T3, Reverse, LC/MS/MS 20 ng/dl ?
    Can you help me compare my readings correctly? Thanks

    Reply

    • Dr. Izabella Wentz says

      Susie – thank you for reaching out. ❤️ Different labs will have different ranges, a good general guideline is to get your Free T4 in the top half of the range, your Free T3 in the top half to top quarter of the range and your TSH around 1.5 or below.

      Reply

  75. Wendy m durkin says

    I was disgnosed at age 35 with hypo now at 65, 1.5 years ago at 63, I suddenly became hyper? and dropped 45 pounds, good thing, but don’t know why this switch happened, still feel hypo — tired/fatigue/no sleep in 5 years/anxiety/depression/brain fog — any info. on this? as to why? or what to do? I don’t even know what questions to ask anymore. Thanks! W.

    Reply

  76. Emma Wallis says

    Hi,
    i have recently struggled with not feeling well, i had a full blood profile done and had elevated TPO which i was told indicated Hashimoto disease. I then read your book and realised all of the illnesses i had in the last year matched up to hashimoto, eg; carpal tunnel, skin rash, fatigue, joint pain, weight gain and struggling to lose weight, anxiety/depression, irregular periods and difficulty getting pregnant(even though i fell pregnant first time round)
    my doctors have told me they can’t put me on medication because everything else is within normal range. Is there anything i can show them to explain that it will benefit me to go on medication.
    thank you

    Reply

    • Dr. Izabella Wentz says

      Emma – thank you so much for reaching out. Antibodies are a sign of an autoimmune attack on the thyroid, which indicates an autoimmune thyroid disease like Hashimoto’s or Graves’. If the attack on the thyroid gland persists, the damage done to the thyroid will progress, and symptoms may appear as you progress from the early to later stages of Hashimoto’s. But the good news is we can reverse this progression and put autoimmune disease into remission by addressing the underlying root causes of it, such as food sensitivities and infections. Here is an article you might find helpful as well.

      5 STAGES OF HASHIMOTO’S THYROIDITIS
      https://thyroidpharmacist.com/articles/5-stages-hashimotos-thyroiditis

      Reply

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