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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.

19) GUADALUPE  Female
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Monday, November 7, 2011 06:07 AM Write a comment

Do you have any info about Hashimoto's and reverse T3 , I did the protocol with T3 only now switching back to Natural Thyroid and still some T3 which i found I am not tolerating , get shortness of breath , palpitations, madness etc.
On selenium, iodine , good iron levels, some Isocort
I believe I need to stop t3 and add t4 instead to my
natural Thyroid currently on one grain twice a day but feeling Hypo , hair loss , low energy, muscle aching etc,, age 62

Barb Monday, November 7, 2011 10:37 AM
Shortness of breath, palpitations, madness, hair loss, fatigue, and muscle aches can all be symptoms of both too much or too little thyroid, so it's hard to tell without labs. If you read the rT3 section, you'll find rT3 is natural and found in every healthy body. But when it goes high, it's a symptom of a problem elsewhere, so you need to investigate the possible causes and address them. Good luck!
18) gimel 
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Monday, October 24, 2011 11:57 PM Write a comment

While doing further reading on the site I noticed this statement.

"The hyperthyroid state causes osteoporosis, which is why doctors are so wary of prescribing too much T3." [3]

I assume from everything else I read that you mean by hyperthyroid is that the patient has hyperthyroid symptoms, not just that the TSH is suppressed. Correct?

Also I have read elsewhere that thyroid hormone does not cause bone loss or formation, that it only speeds up "whatever condition exists due to the levels of their combined sex steroid, DHEA, Vitamin D, and growth hormone deficiencies." What is your position on that?

Barb Monday, October 31, 2011 12:03 PM
Sorry for the delay in responding--just got back from vacation. To me, someone is considered hyperthyroid when their Free T3 is significantly over range, and they have hyperthyroid symptoms. If you read my TSH section, you know that I don't believe TSH is a good gauge of thyroid levels, at all.

If you read the osteoporosis section, you will find multiple references that link osteoporosis to thyroid levels that are either too high or too low. Bone health relies on multiple factors, and yes, those you listed are involved, but I firmly believe that thyroid should be added to that list. Adequate progesterone for women and testosterone for men are essential, along with thyroid. These sex hormones drop after age 50 in both sexes, and that is where you find the greatest incidence of osteoporosis.
17) gimel  Male
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Saturday, October 15, 2011 12:23 PM Write a comment

My previous post was too long, but I wanted to add this.

Having a background in statistical analysis and math, I was also very interested when reading about the reason the AACE revised the range for TSH over 8 years ago. Basically they made the change because it was glaringly apparent that their assumption of 2.5% of patients being hypothyroid was far too low. When they purged suspect hypo patients from the data base and recalculated the range, it changed significantly.

When I began wondering why so many patients with Free T3 and Free T4 in the lower end of their ranges still have hypo symptoms, it occurred to me that the AACE has never revised the ranges for those, even though they were originally established similar to the old TSH range. I estimate that if the data bases for FT3 and FT4 were similarly purged of suspect hypo patients and the limits recalculated, the new ranges would look more like the upper half of the current ranges. This is very consistent with what you say here on this site about patients needing to have FT3 and FT4 at the midpoint and above to relieve hypo symptoms.
16) gimel  Male
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Saturday, October 15, 2011 12:20 PM Write a comment

So glad I found this great site. It is a terrific resource for people looking for info about thyroid issues. I especially like that you provide references to scientific studies that support the info presented on the site. One study that I think you could use to everyone's benefit is this.

This study uses regression analysis to determine the degree of correlation of all the typical thyroid tests with a composite of patients' ratings of the severity of their 8 major hypo symptoms. When you consider the subjectivity of the patients' ratings of symptoms and the variability in test results, the degree of correlation is amazing for Free T3. Free T4 and TSH did not correlate. To me this is only logical when you consider that Free T3 is the thyroid hormone that largely regulates metabolism and many other body functions.

Barb Saturday, October 15, 2011 09:15 PM
Thank you gimel for your comments. I will add that reference to the TSH section when I get a chance.
15) Rob  Male
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Tuesday, September 20, 2011 12:11 PM Write a comment

I am really glad that I have found this website. I have very high RT3, but I am very intolerant to Cytomel. Even a quarter of a 25 mcg pill is too much for me to tolerate. One of my symptoms is very dry, brittle hair that falls out and from seeing how this can be exacerbated by higher doses of Cytomel, I am staying away from Cytomel. I have tried iodine and Naturethroid, but I feel terrible on both. I feel great on iodine for about a week and then I begin feeling hypo with low temps.
14) Al Klein  Female
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Sunday, September 11, 2011 10:34 AM Write a comment

Hi! thanks for your website.
In brief - I took Armour for 10 years, was fine for 9 but started going down hill last year. Read the RT3 website and forums and got some blood tests done (UK) - low RT3 and low cortisol.
Have worked up to taking HC 25 and T3 100 - spread over 4 doses.
Still not feeling great. temps avg 98.2, but increasing T3 doesnt effect the temps.
I suspect low iron, but not sure.
What woudl your advice be?

Barb Sunday, September 11, 2011 12:45 PM
Of course, get your iron/ferritin tested; that can cause problems when low. I personally cannot tolerate 100 mcg T3, and I'm not alone, so the protocol is not for everyone is all I can say.
13) Judy 
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Friday, September 2, 2011 07:49 PM Write a comment

can you tell me where you purchase Efra? I am going to ask my doctor for a perscription and would like to order Efra and try it and see if adding some to my synthroid will help me feel better.
thank you,

Barb Friday, September 2, 2011 08:15 PM
Private email sent.
12) Judy 
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Thursday, September 1, 2011 12:33 PM Write a comment

Hi, the breakage started when I changed from synthroid to cytomel. My hair became so dry and brittle from the cytomel. I still have a lot of hair just short. It;s not falling out. it never did not even on t4 only. I know that I will have to add some t3 because of the deep depression I am feeling and my dry hair. I need a balance. I was on a yahoo group and my life became a mess. I am so glad you have this website to help people I have so many things that happen to me on this protocol and sometimes I think my life will never get better. On top of the cytoeml I was on cortef for almsot two years. I finally weaned off and have been off for six months but I just don't feel the same. thank you for your help.
11) Judy 
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Thursday, September 1, 2011 12:06 PM Write a comment

my hair became so brittle and dry when I was on cytomel for over a year. I was on naturethroid for a couple of months but it did not work for me, or at least I wasn't feeling better. I am back on synthroid and I feel a bit better and my hair is not as dry...But I have a long way to go. My last labs free's are low I guess because of the change in meds. but my doctor want me to stay on synthroid for eight weeks and get tested then. I was on synthroid for over 16yrs before I decided to try amour it worked fine for a little while, then I was told I had rt3 all hell broke loose after that. My question is can or will my hair ever be the same again, will my oil glands start producing oil agan on my scalp. I am do depress witht he t3 protocol I followed. Can yo comment at all. I know you don't know, but in your opionon.thank you

Barb Thursday, September 1, 2011 12:26 PM
If your hair loss is from low thyroid, and not female pattern baldness or some other scalp condition, then it should grow back when your thyroid levels come up. I lost quite a bit of hair while on Synthroid, and it didn't improve that much on Armour either. But it started coming back this year when I combined generic T4 with Erfa to bring both my FT4 and FT3 up. That's what worked for me, so don't be afraid to combine meds if necessary. And make sure you have all the cofactors like iron, selenium, and cortisol in place too. Good luck!
10) Eileen  Female
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Tuesday, August 30, 2011 10:15 AM Write a comment

Hi Barb and thanks for a pretty informative website.

I had a total thryoidectomy in 1998-9 (two partial thyroidectomies in fact) and was doing fine on elthroxin (your synthroid) for many years although tiredness and weight gain kept creeping up on me. Eventually I had a very stressful situation totally mess me up (probably adrenals) and my genius doctor lowered my meds till all my bloodwork was in normal range (I had been suppressed due to cancer diagnosis) and it turned out that I could not tolerate the change in meds - I got to the stage where I was dragging myself through each day, barely able to smile, and only when I got a change of doctors (to an endocrinologist not a surgeon) was I told that my meds should havebeen left alone - when they were reinstated I still felt tired all the time and couldn't halt the weight gain. was eventually put on Armour and am doing better but have some joint pain and still can't lose weight.

Your site has made me think about asking for the Armour/elthroxin combo next - but will first see if they will agree to test reverse T3 here.

thanks again - really grateful to find a well informed and very easy to navigate website.

9) Milly  Female
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Friday, August 26, 2011 07:54 AM Write a comment

Thanks so much for your section on "Why you need T4 aswell" So many sites maintain that T4 only "doesn't work" as opposed to saying doesn't work for some people, and they say the only reason we're given T4 is cos of deals with drug companies! You present a far more balanced viewpoint and I agree with your conclusion at the end that different proportions of T4/T3 work for different people. Yours is the only site I've found that explains that T4 has important functions other than conversion to T3. I've tried T3 in natural dessicated and Cytomel but I get headaches - do you know why this is? (I'm def not hyper!) T4 agrees with me for alertness and hair and i don't get headaches but after a few weeks on it I still don't have enough physical energy or weight loss! Can it help with weight loss if I take it lonfger? Thanks! and thanks for great site :)

Milly Friday, August 26, 2011 11:22 AM
PS: Do you know anything about T2 supplements? I've read that this is a better fat burner than T4 or T3 but all the posts i can find are quite old, so maybe this has been discredited since? Thanks again!

Barb Friday, August 26, 2011 12:26 PM
Headaches are apparently a fairly common side effect, but I don't know why. I found this site, where people freely wrote about their side effects: []

Have you tested and gotten all the other thyroid cofactors in place: iron, cortisol, selenium, etc.? Most need to add some T3, whether desiccated or Cytomel, and small amounts throughout the day seem to work best. Even the addition of 1/4 grain 2,3, or 4x/day can do wonders. Sorry, I am not familiar with T2 supplements.

Milly Saturday, August 27, 2011 10:09 AM
Thanks very much Barb - I tried Cynomel again today and it's fine! I took it after T4 whereas before i took it before, also i upped my iron yesterday so either of those may have helped - I can certainly feel it working now and no headache!! Thanks again :)
8) kathleen  Female
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Sunday, August 21, 2011 12:42 PM Write a comment

Wow! I found your site by accident. I was diagnosed with graves 17 months ago. Before that I started gaining weight, thought it was just middle age. Went through a very upsetting and emotional three years. I became a mess lost weight heart rate went up .at that time lab results were normal. ended up in the emergency room. after many tests , they said it's not your heart but thyroid and to call my Dr. the next day .Dr. then sent me to endo. who from the very first visit said I would never go into remission and rai was my only hope. I said NO! so i take methimazole . I started on 20mg a day . he lower the dose within 2 months because white cell count was low. went back up to 20. but was forgetting to take second dose. In april he said TSH was still low but T3 T4 were normal, recent blood work thesame, family Dr. is pleased but the endo. is insissting on RAI. I know I could find another Dr. but with my insurance that will be difficult. I guess what I am asking is it normal while on meds that the TSH would still be low even though the rest is normal? Oh, and the endo. said it would be easier for HIM to treat me if I was hypo rather than hyper. I know I am ranting. BUT I am tired of this . I want to have some energy and not be aching all the time. Thanks Katie

Barb Sunday, August 21, 2011 02:08 PM
Some go into remission after taking anti-thyroid drugs, but it's a slow process, sometimes taking 2-10 years. Re your low TSH (from the Graves' section): "The antibody levels are what should determine the ATD dose, not TSH levels. TSH can remain suppressed for years in someone with Graves’ because of TSH Receptor antibodies, even when actual T3 and T4 levels have fallen below range. [2]" You should NEVER be dosed by TSH, and that reference can be shown to your doctor. If you're achy, is it possible your thyroid levels, FT3 and FT4 are too low, and that you need to add back some thyroid hormone? Healthy people tend to be close to mid-range or higher. That's covered here: [] You might want to join several different Graves' internet groups so you can hear how people have fared with all three treatments: RAI, thyroidectomy, and/or ATDs. Each has its pros and cons and which one you choose should be YOUR decision, not chosen for your doctor's convenience! Good luck!
7) Kate  Female
North Carolina
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Wednesday, July 27, 2011 05:18 PM Write a comment

Can't tell you how appreciative I am for your website and articles, especially the one about T3, rT3 and T3 as a sole thyroid replacement therapy, etc. I kept thinking there had to be other factors involved in why some people's bodies might have tendencies make higher levels of rT3 than others, and just how significant or diagnostic certain lab values of rT3 might be. I found I did not do well on T4-only or T3-only protocols (I currently take a combination). I am hypopituitary and have been on thyroid replacement for over 20 years, although diagnosed as panhypopituitary only for the last 6 years (currently on ALL known replacement hormones (TEN specific hormones per day- and tweaking to get those optimized for the last 6 years as the drs have given me flexibility to do this and of course, never have the time it would take to hold my hand and get through that).
6) Rex  Male
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Wednesday, July 27, 2011 11:27 AM Write a comment

Good reading but as with most sites you do not cover very high TSH with near normal T4 & T3 as is my case. Untreated TSH is approx 10. Treated with Armour it comes down to 5-6 but T4 goes way over the recommended. With synthetic T4 TSH hardly drops at all.
Also do you know of any side effects with the latest Armour such as stomach inflammation?

Barb Wednesday, July 27, 2011 11:49 AM
This is covered in the TSH section: "When a TSH is greater than 1.0, it may indicate some degree of hypothyroidism, and suggests a dose increase may be warranted, or that other factors like iron, cortisol, blood sugar, etc. need to be addressed." It sounds like you have conversion issues that need investigating. And no, am not familiar with current Armour side effects, though many have complained about it since its reformulation.
5) Denise  Female
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Tuesday, July 12, 2011 12:15 AM Write a comment

I am sitting at my computer in tears as I continue to go through your articles. I am angry and excited. My brain is toast but I am trying to go through them.

I have been diagnosed as hypothyroid for over thirty years and been to too many doctors to name. I have to have TSH suppressed to feel even partly normal (guess how often that was allowed), thanks for letting me know why!!!

You give me hope…

I try to research on my own (without much success lately) and read books, etc but a friend (another researcher) sent me a link to your site this morning, thank goodness.

Back to your site, THANK YOU!!!! THANK YOU!!!! THANK YOU!!!!
4) Karen 
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Tuesday, July 12, 2011 12:10 AM Write a comment

I just wanted to say thank you for your great website that I came across today. One of my dear friends sent me your link. Your website is a wealth of information and for people like me, it means a lot to be able to go there and read all the information you have so kindly shared. Thanks again!
3) Laura  Female
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Tuesday, July 12, 2011 12:04 AM Write a comment

I love what you have written. I too had RAI years ago, and I have been suffering for years. Something has caused me to have a lot more problems lately and I'm having a hard time getting through to my doc. Maybe now I can make some sense to him.

Thanks! cool
2) Samuelle  Female
Kasoa, Ghana
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Monday, July 11, 2011 11:59 PM Write a comment

Hi thank you so much i have all these problems i think am going to have a chat with my doc but i cant menstrate for the pass two years want to know if its related OMG i have done all these tests and my parents have spoilt all my college money to cure me and am still sick thank you so much for the information u have save me.
1) Jim Rector  Male
Tempe, Arizona
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Monday, July 11, 2011 11:52 PM Write a comment

Great site!! Well layed out, excellent info. Is the writing you have done on this site copywrited, or can it be used with attribution, etc.

Its great that you reference the technical articles, on each page, to support what your saying. Would love to send you some of the stuff I have written on this subject. Jim

barb Tuesday, May 1, 2012 03:05 PM
Yes, everything is under copyright. You may post snippets elsewhere, as long as you post a link back to the original page.
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