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This comments section was NOT meant to be an interactive advice forum so please do not post your lab results here expecting an answer. I feel it is unwise to give advice without knowing more about a person, so will only answer questions that may be of general interest. I'm sure some of you got in trouble by following internet advice--I did! I am also only one person--there is no team of moderators here!

Standard rules for posting apply and you should all know what they are: no profanity, no flaming, no name-calling, etc. Obvious marketing pitches and anything I deem offensive, rude, erroneous, or inappropriate will be deleted.

If you’d like to talk to me, email me directly about an affordable hormone counseling session at barb @ tiredthyroid . com. Thank you.

219) Philip H  Male
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Tuesday, July 18, 2017 04:26 PM Write a comment

Hi Barb. Just checking in again. I have been on .75 Synthroid for close to three years now and have been experiencing increasing anxiety symptoms for the last year or so. I just had a blood test. My Free T3 is 2.5, so in the low range, and my REverse T3 is 19 ng/dL. But what suprised me is that my Ferritin is 276.6, or above range of 5-244. Usually low ferritin accompanies hypothyroidism. I'm wondering if the high ferritin could be related at all to the anxiety symptoms? Should I work with my doctor to raise my Free T3 and will this help the anxiety symptoms. My TSH has crept up to 2 from below 1, so I wonder if I will need more synthroid.

I have also started supplementing with zinc carnosine and selenium per my doctor's recommendation. I do seem to feel some relief of my symptoms since I've started that and a GOS prebiotic.

Thanks and love your book,
Phil H
218) Kimberly Murphy  Female
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Monday, May 29, 2017 06:32 PM Write a comment

Hi Barbara. Ordered your book and read it right away. Thank you. Could you tell me where you got the information that a healthy, human thyroid secretes 100 mcg T4 and 10 mcg T3 a day? I can't seem to find that information myself. Thank you.

barb Tuesday, May 30, 2017 04:49 PM
This was discussed in a previous comment; please see post #167.

Kimberly Murphy Wednesday, May 31, 2017 09:02 AM
I read that post, but what I am really interested in is the citation for the information that a healthy, human thyroid secretes 100 mcg T4 and 10 mcg T3. That is a 10:1 ratio. Any information I can find on my own says 80% to 20% which is a 4:1 ratio. I find this is a big difference. I am trying to find the truth. Thank you.

barb Wednesday, May 31, 2017 11:45 AM
The book, page #, and sentence were cited in post #167. It is also discussed in my book in Chapter 20, "Prescription Thyroid choices & Dosing Protocols," page 235. SECRETION from the thyroid gland is about 10:1 of T4:T3. However, some of this T4 is then converted, leading to a 4:1 ratio in serum. If you take the 4:1 ratio found in NDT, and then have any conversion of your own, you will end up with high T3 and low T4 levels.

Kimberly Murphy Wednesday, May 31, 2017 12:37 PM
Thank you. Totally understand now!! Sorry...not at my sharpest. I had a total thyroidectomy 11 years ago and am trying to get to my optimal dose. Since I don't have a thyroid at all, I would think a good place to start would be 100 mcg T4 and 10 of T3. No one, in 6 years, has ever given me that much replacement. I am excited to give it a try soon. Thank you for bearing with me.

Kimberly Murphy Wednesday, May 31, 2017 12:38 PM
ugh...Had my TT in 2011. Not 11 years ago. Oh brother!!

barb Wednesday, May 31, 2017 12:43 PM
As I also stated in post #167, 100 mcg T4 and 10 mcg is an AVERAGE. It could be too much for you or too little. You should always increase any dose SLOWLY, or you could easily overshoot your optimal dose.

Kimberly Murphy Thursday, June 1, 2017 07:37 AM
Would you really start increasing slowly for someone without a thyroid? Right now I am on 1 grain NDT (WP Thyroid) and 17.5 mcg liothyronine. I have been on this since 5/18. I was up to 1 grain WP and 30 mcg liothyronine, but was doing that on my own and my dr did not approve. My T3 was over range and my T4 was under range. I was advised by a FB group that I was pooling and to cut my T3 in half. I now have a functional nurse practitioner I am working with. This has been so terribly hard. My main symptoms are depression and anxiety which have contributed, I believe, to a major decrease in appetite and a 37 pound weight loss. I also have had trouble sleeping. I just can't help but wonder if my body is just desperate for more thyroid hormone. I have no gland at all and am only getting 38 mcg T4 and 26.5 mcg T3. Just no way near 100 and 10. My fnp wants to wait until 6/8 bloodwork and 6/21 appt to change anything. Some days that seems like an eternity. Thank you.

barb Thursday, June 1, 2017 11:10 AM
The reason you increase slowly is to give your body time to adapt, and so that you don't crash. You say you have my book. Please read it so you can understand why your low T4 and high T3 dose may cause you to feel so ill.

Kimberly Murphy Wednesday, June 7, 2017 07:34 AM
Another question...if 1 grain of WP Thyroid has 38 mcg T4 and 9 mcg T3, why is it 65 mg? Certainly 47 mcg is not equal to 65 mg. What is all the other stuff in there?

barb Wednesday, June 7, 2017 02:15 PM
If you read the ingredient label of any NDT, there are fillers, binders, and other ingredients besides T4 and T3. Check their website for more details.

Kimberly Murphy Monday, July 3, 2017 11:48 AM
Hello again Barbara. I have kept reading your book over and over as to try to retain more. Do you have a way to take your thyroid meds the day of bloodwork so it doesn't falsely elevate or falsely lower your results. The FB groups say to take your dose between 12-15 hours before a blood draw. I believe I read your recommend after 4 hours but not as far as 24 hours. What do you do? Thanks again!

barb Monday, July 3, 2017 12:31 PM
This depends on how many times per day you take any T3. We know T3 peaks 4-6 hours after a dose, and comes back to baseline after 24 hours. Ideally, you'd want to measure the lowest point between your doses. Since I take my NDT 4x/day, I measure at the 6 hour mark, which is my trough. If I were taking it 3x/day, I would measure at the 8 hour mark.

Kimberly Murphy Monday, July 3, 2017 05:29 PM
Right now I am taking 3/4 grain WP and 12.5 mcg liothyronine at about 6 am and then 3/4 grain WP around 3 pm. Thinking about maybe switching my 3/4 grain WP from 3 pm to 6 pm. And, maybe the night before bloodwork I could take it at 8 pm and then get blood drawn at 8 a.m. Is it ok to switch times like that just for one day or not really? Also, if you measure at a trough, how do you keep from over dosing?

Kimberly Murphy Monday, September 18, 2017 02:12 PM
Hi Barbara. So I am now on 50 mcg Tirosint and 2 grains WP. I have been on this since 8/31. When do you think would be the smallest window to do bloodwork? I am feeling so poorly today...mostly depression. I honestly have hardly any physical symptoms. It's all my brain. And I don't always feel so badly. In the 6 years since my TT I have never taken more than 56 mcg of T4. On July 25 of this year I was given 76 and then 8/31 increased to 126. I pray I am on the right track. This feels just dreadful.

barb Monday, September 18, 2017 08:33 PM
For me, 2 grains is an overdose, so 50 mcg T4 on top of that would certainly be too much. You might want to get labs after 4 weeks just to make sure you haven't overshot your optimal dose.

Kimberly Murphy Wednesday, September 20, 2017 01:27 PM
Thank you Barb! I have recently read about hypothyroidism and glycogen deficiency. Have you ever taken a look at that?

barb Wednesday, September 20, 2017 04:15 PM
Sorry no, not familiar with that.
217) Jose  Male
Puerto Rico
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Sunday, May 28, 2017 06:31 PM Write a comment


Thank you for your wonderful site. It has been invaluable for us hypothyroid (hashimotos {both antibodies} but had Graves when I was in college {went to remission}) patients. I’m currently struggling with high RT3 (ratio 11-13) and will ask my doctor to prescribe Synthetic T4 and reduce the NDT dose (and divide it in two doses to spread the T3 effect of the NDT). My question is what brand of NDT and T4 are you currently using? Do you have any preference or recommended brands of NDT and T4? Do you take NDT and T4 in one dose or multiple doses? Again, thank you very much

barb Tuesday, May 30, 2017 05:05 PM
I have taken generic T4 (levothyroxine), Synthroid, and Levoxyl, and all bring my T4 up, since I don't produce any, so I can't say any one is better than the other. NDT is also available in multiple brands at different prices. Cost is a factor for some, and depending on your insurance plan, Armour can be more expensive than Nature-throid or NP Thyroid. I wouldn't base your ideal brand on any one person's experience, but try different brands out yourself. I take my T4 before waking on an empty stomach, so once per day. The NDT I take 3 or 4 times per day (some doses divide better by 3, others by 4).
216) Jane Robinson  Female
Melbourne, Australia
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Wednesday, May 24, 2017 04:37 PM Write a comment

I had RAI treatment for Graves in 1995 and went on replacement thyroid hormone treatment. Last year I approached my doctor and asked to be put on natural desiccated thyroid. I now take 1 grain per day. My doctor also prescribed iodine, selenium and ATP co-factor. My doctor has since retired. I have been trying to find out why a person who has had RAI and has no, or hardly any, thyroid left needs iodine supplements. Would you be able to shed some light on this for me. With many thanks Jane.

barb Tuesday, May 30, 2017 05:14 PM
I wrote an extensive chapter on iodine in my book if you're really interested in the topic. If you had RAI and have no working thyroid gland, then you can take all the iodine you want, but you're not going to produce any. So not sure why your doctor prescribed it. 1 grain is most likely too low a dose for you if you have no thyroid gland. You should run some other thyroid hormone tests, like Free T3 and Total T4, to make sure that those levels aren't at the very bottom of the reference range. Please see my website or book for more information.
215) Flair 
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Wednesday, May 3, 2017 05:40 AM Write a comment

Hello Thanks for your answer.

We look at my ft4 not tsh. But the tsh is like 1 and ft4 is high 19 and my ft3 did not change. I do get fast heart beat. My question is why does my ft3 not raise?

I do have now ferritine 40 but stil low serum iron below range like 9 range 10-22 and saturation is 16_%.

hope you have an answer for not raising ft3. Because you say 1 grain is not full replacement but my thyroid is workING I am subclinal hypothyroid tsh 5.5. So don t think I need more. Also my ft4 is like 14 without medication. 19 with medication range 11-22.

I also read you said 1 grain or 1.5 is everage for most people?
1 grain has 9 mcg t3. Or do I have to try t3 only wich doesnt sound good to me.

Hope you can help. Or know.

barb Wednesday, May 3, 2017 11:56 AM
The first thing you should see on this page: "This comments section was NOT meant to be an interactive advice forum so please do not post your lab results here expecting an answer. I feel it is unwise to give advice without knowing more about a person, so will only answer questions that may be of general interest. I'm sure some of you got in trouble by following internet advice--I did! I am also only one person--there is no team of moderators here!"

There is so much more to your medical history that might help explain your situation, but your situation is unique and requires much more information. This is not the place for one-on-one counseling. And no, I never said 1-1.5 grain is enough for most people!
214) Flair  Female
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Tuesday, May 2, 2017 04:18 AM Write a comment


I have subclinical thyrodism with low ft3 and t3.

I have used armour like medicine but my t3 would not go up. My dokerk did most test on t3 this was Always borderline with 1 grain.

He did 2 times ft3 this was at 25 % the same when I don t use medication.

What can this be? If rt3 does not Block t3. What can be a problem.

I do have low ferritine like 20 and serum iron borderline low also saturation is borderline low. I am suplementing iron but see no change. I do feel hypothyroid and have big weight gain with good strict diet.

Could iron be the problem. Do I need to test rt3? And how high must ferritine be of so?

barb Tuesday, May 2, 2017 11:10 AM
The problem is that 1 grain is not full replacement. On average, a normal thyroid gland secretes about 100 mcg T4 and 10 mcg T3. 1 grain only has 38 mcg T4 and 9 mcg T3. Part of your T3 comes from conversion from T4, so your T4 levels need to be good too. If this dose caused your TSH to drop, then your own thyroid gland would not produce much, and your results could be worse than taking nothing. You cannot dose by TSH if you're taking desiccated thyroid.

Your low iron levels could cause you to be hypothyroid, because iron is a component of one of the enzymes used to produce thyroid hormone. Everyone's ideal ferritin number is different, but most people start to see improvement when their ferritin gets close to 50.
213) Terry  Female
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Sunday, April 30, 2017 01:39 PM Write a comment

I just found out I have a TSI level of 1702 and TPO level of 99.. Both Graves and Hashimotos antibodies. My old doc had been reducing my synthroid regularly so now at .025mg daily...feeling absolutely awful. I have a new doc who told me my antibodies levels...She wants me to switch to Armour (30mg) TSH was .257, FT4 was 1.1 and FT3 was 2.5. I feel worse than I have felt in a very long time (Graves Diag in 2010)..I really hope this change helps. Do I need to address antibodies? Mushrooms? I appreciate your book so much Barb,.
212) Janice  Female
New jersey
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Sunday, April 23, 2017 08:20 PM Write a comment

I've just been told due to results of blood work that I have under active thyroid.
I've read that most are cold who have this.
I'm the opposite, have been most my life.
I hate summer. When everyone else is cold or happy I'm hot. I have most all of the symptoms of hashimotos except for this cold thing.
Can someone explain how this could be.

barb Sunday, April 23, 2017 10:02 PM
If you're severely hypothyroid, your body will secrete noradrenaline to compensate for the lack of thyroid hormone. This will make your heart beat faster and cause you to sweat, making you feel hot. Usually, however, your body temperature is low (below 98.6 F or 37 C), even though you "feel" hot. Someone who is truly hyperthyroid, like a Graves' patient, is physically hot, and this can be confirmed with a thermometer.
211) Daniel  Male
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Saturday, March 25, 2017 06:27 PM Write a comment

Hello Barbra, just found your site this week and it rocks wink

I was diagnosed (USA) with hypothyroidism 20 years ago and with Hashimoto, ~10 years. I'm on Eltroxin but my lab tests are always all over the place. I recently asked for T3 and was given 25mcg Cynomel per day+ 500mcg T4 per week. Lab showed TSH 2.05 (0.5-4.8); FT4 9.8 (10.3-19.7); FT3 3.83 (3.5-6.5). I was told to raised T4 to 78.57x6 days+25 T3 daily. 2nd lab test: TSH 0.04; FT4 10.3 and FT3 4.3. Next told to split T3 dose to 2 but I couldn't mange it. So I dropped T4 to 75mcg per day+25mcg T3. Latest results: TSH 0.0.3 (couldn't detect); FT4 10.6; FT3 5.37 my best ever. Now I'm told to drop T3 to 12.5mcg. Correct me, but didn't you mention that optimal ratios should be close to 1:4 ? Following my Dr advice, would yield 1:6 ratio, where's dropping T3 to 18.75 would lead to 1:4 ratio. Option 2: raise T4 from 75mcg to 85.7-87.5 = ~1:3.5 ration. I'm m concerned, since I was just diagnosed with osteopenia, after suffering unrelated multi stress fractures in December while running. On top, I am also G6PD deficient, borderline anemic/High Ferritin, so letting blood is an issue. And since my Thyroid isn't balanced, lipid profile is skewed & body temp hovers ~95 degrees. I switched to Paleo ~5 years ago and recently increase my good fats to around 70%. I know you can't dispense medical advice but your feedback would be welcomed. Best!
210) Wolfiesmom)*  Female
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Friday, March 17, 2017 12:56 PM Write a comment

Thanks to your book I"m now on NDT plus T4 and feeling better but I think my T4 med (TYROSINT) may be contributing to my migraines. I want to try another T4 but the generic meds I tried before gave me stomach issues. What are my other options for T4? I have Hashimoto's.

barb Friday, March 17, 2017 01:21 PM
Tirosint is supposed to be THE most hypoallergenic T4 med available, so don't know what to tell you. Are you sure your dose (of NDT OR T4) isn't too high or low? It's trial and error to get to the right dose!
209) Terry  Female
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Wednesday, March 15, 2017 07:02 PM Write a comment

Barb, your book has been very helpful. I feel I'm reading sections all the time....brain fog and all! I've had many blood tests run. Nothing unusual as far as my doctor is concerned. My graves antibodies test was slightly elevated but other things like ferritin and D, B12, medabolic panel all fine. I did do an adrenal fatigue saliva test which was borderline so am taking a supplement for that. I'm just not sure what to address next. Trying to stay positive, thank you so much for being here.
208) Terry  Female
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Tuesday, March 14, 2017 01:03 PM Write a comment

Hi Barb, what is frustrating is I was actually feeling better in December when my levels were- TSH -.322, FT4-1.3, FT3 - 2.8. These numbers came up from a TSH -.135,T4-1.1 and T3 - 2.6 when I did a dose reduction the previous September. I did nothing after my December levels looked pretty good...and I felt well..thinking they would stay the same at this dosage of synthroid. My hair even started to regrow! But my levels are now TSH - .136, Ft4 - 1.0 and FT3 - 2.5 and I fell pretty awful. I have changed nothing else...brain fog and fatigue are bad. I have reduced my dose again, wondering now if the RAI would I know?

barb Friday, March 17, 2017 12:21 PM
I still don't understand why you're reducing your dose when your FT4 and FT3 are on the low side. If it's to bring TSH up, that doesn't work, especially because you're a Graves' patient. It's entirely possible you could stop all thyroid hormone, yes, take nothing, and you would still have a low TSH. Dosing by TSH just doesn't work for Graves' patients.
207) Terry  Female
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Tuesday, March 7, 2017 08:06 PM Write a comment

I Diagnosed with Graves in 2009, RAI in 2010. TSH has been <.008 and T3&T4 in normal range on synthroid pretty much since 2010. Been decreasing dose all along so now on half of .050 tablet daily for 5 days and one whole tablet for 2. My TSH finally crept up to .322, I was so excited. Sat tight with no decrease for 3 months and now it is .136. I'm going to reduce another day, but wondering if I should be doing something else. This pill is the lowest dose, can I skip a day if I need to reduce more? Still wondering why this happened, thanx Barb

barb Wednesday, March 8, 2017 12:39 PM
If you have Graves', you have TSH Receptor antibodies, and your TSH will typically be lower than normal, even if you take no thyroid hormone at all! If you try to dose by TSH, you will most likely be undermedicated and suffer healthwise. Please read the Graves' page on my website or in my book. It seems that the minimum human dosage of T4 is about 75 mcg. It looks like you're taking less than 50!
206) Anne Marie McCusker 
Colorado Springs
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Monday, March 6, 2017 10:10 AM Write a comment

I am wondering where your research is when FT4 and FT3 are in perfect range, the person fills perfect and the TSH is too low and out of range? I do understand that if you are test for TSH only then you would want to be in range, but what if your doctor goes based on how you feel and the Free ranges? Thanks I did not know if you had something in your book about this?

barb Wednesday, March 8, 2017 12:32 PM
That was the whole point of my book. Most people cannot keep TSH in range when FT3 and FT4 are at levels where they feel well. I cover this in Chapter 25: The TSH & T3 Dilemma

anne McCusker Thursday, March 9, 2017 11:00 AM
Thank you, I love your book and I am glad you were able to tell me which chapter to narrow my focus on. I completley understand, from my perspective that it does not matter anymore what my TSH is, my thyroid does not work propely, so why should I care what my Pituitary is saying to it. I have a very good doctor and he is a
DO with 30 years experience. My range is exactly where it should be. Thanks for all your insights, I would like to copy that chapter and give to him, if I have permission? Blessings

barb Thursday, March 9, 2017 11:17 PM
Glad you liked the book! If your doctor is an open-minded DO, he may enjoy reading the entire book, and could certainly afford his own copy! There's even a positive review from a doctor on the amazon page.
205) Tina Dungan  Female
santa rosa, CA
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Friday, March 3, 2017 07:11 PM Write a comment

Hi, just found your site, ordered your book. I was trying to read entries on your blog but each time I clicked on a button (like to Read More) I was redirected to an error message page and couldn't continue reading. Is there something I don't know about your site? Or is there really a problem going on?

barb Wednesday, March 8, 2017 12:27 PM
You could try a different browser. It seems to work on Firefox.
204) lyd  Female
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Wednesday, February 22, 2017 11:28 AM Write a comment

I has the Cocktail Radiation to burn the Thyroid about 20 yrs ago,, today I am currently on 150Mcg of Synthroid,,which I feel tired all the time,cant lose one ouch of weight without gaining it right back, I eat as healthy as I can, and have told my doctor,how I feel and he seems to just stick to the Lab work that to me is crap, because hes not relating to my on going everyday struggles of weight gain..

barb Monday, February 27, 2017 02:34 PM
Have you considered adding a little T3 or desiccated thyroid to your dose? You are not replicating normal thyroid gland function unless you also take some T3.
203) Ororo M.  Female
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Tuesday, January 10, 2017 10:37 PM Write a comment

Hi Barb,

My doctor is concerned that a suppressed TSH leads to thyroid atrophy, and does not want to me to be dependent on a full dose of exogenous hormone. I'm on 1.5 grain NDT.

She believes a suppressed TSH is <0.1. Is there any literature to support the idea that supplemental T3/T4 with TSH less than .1 leads to the thyroid not working naturally?

barb Wednesday, January 11, 2017 04:07 PM
TSH stands for Thyroid Stimulating Hormone. Without enough TSH, even a healthy thyroid gland won't produce any thyroid hormone. This is the problem those with damaged hypothalamus or pituitary glands face. You would have the same effect if you take enough thyroid hormone and suppress your TSH that way. Theoretically, if you stop the medication, your TSH should return. They do this with thyroid cancer patients for testing. Whether or not the gland has atrophied though, I can't say.
202) Jackie  Female
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Thursday, December 29, 2016 12:15 PM Write a comment

How do I go about finding a doctor who will listen to symptoms and not just look at lab numbers? I have been chasing drs and symptoms and being told anxiety for almost 2 years. My labs are borderline low but I have heart racing episodes and lost weight one time so drs say hyper. I don't think it is hyper, I think it is on the verge of hype due to a severe case of thyroiditis. I ordered your book and another book and am trying to be prepared for my next visit for endocrinologist Feb 10. Thank you.

barb Friday, December 30, 2016 06:44 PM
Anxiety could be from hypo OR hyper. No way to know without comprehensive testing. I lost weight (looked anorexic) and had a fast heart rate when I was severely hypo. Endocrinologists typically only test TSH and T4. You may have better luck with a D.O. or even an ob-gyn.
201) Raylene Williams  Female
Cleveland Qld Australia
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Sunday, November 13, 2016 05:07 AM Write a comment

Barb - thankyou for giving me back my life. I had RAI in October 2015 and then basically went to bed - chronic pain and unable to wake up and i added 27 kilos.
All that on t4.
I then had a doctor put me on NDT alone and i failed miserably.
I was then put on t4 t3 combo and suffered horrible effects of vertigo and still sleeping and felt so awful
After buying your book I am now on 75 Mg T4 and 30 NDT morning and 30 NDT in the afternoon - i have been on this for a week now and finally starting to feel some wellness returning. Thankyou so much.

Barb Monday, November 14, 2016 02:56 AM
You're welcome. Glad you're feeling better.
200) Elaine  Female
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Friday, October 28, 2016 11:31 AM Write a comment

Hi Barb,

After posting a few weeks ago, as advised, I purchased your book last week from Amazon, I have read parts of it but not fully read all just yet as my brain fog will not take it all in.
I am presently taking 1.5 grains NDT. When I raised to 2 grains I had a bad reaction.
My blood results on 1.5 grains are TSH 0.42 range 0.35 - 4.7 - T4 7.6 range 7.8 - 21. and T3 5.2 range 3.8 - 6.0.
Obviously the ratio in NDT is not right for me and as I still have symptoms I want to try your method of medication but I am not sure how I change over from NDT only to NDT/T4 combination.
In your book Figure 20-10 shows combinations of NDT + T4 that provide a ratio that is comparable to a normal thyroid gland but I cannot see how to change over to the ratio. Can you point me in the right direction.

Many thanks Elaine.

Barb Saturday, October 29, 2016 12:53 PM
If you don't feel well raising your NDT, then try lowering it, and adding in the smallest bit of T4. Hold this dose for several weeks to give your body time to acclimate. Periodic lab work and how you feel will guide you as you continue to raise the T4 and lower the NDT.

Elaine Saturday, October 29, 2016 01:56 PM
Many thanks Barb,
as I still have symptoms now, would it be O.K. to stay on same dose of NDT and add say 12.5 mcg. T4 ?
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