Retired ex-patriot from USA living in Costa Rica.  Recent hip and knee replacements, colon cancer with recurring formations - two resections, dozens of colonoscopies with polypectomy and biopsy.  

Thyroid problems, high TSH with difficulty transforming T4 to usable T3. History of chronic allergy triggered pneumonia, Rheumatoid Arthritis strongly suspected, but not positive by blood tests.  Hair analysis shows high levels of lead, arsenic, and aluminum (suspect insecticidal contamination of fruits and vegetables) low zinc, low Mg, low calcium, low Vit D. Type II diabetes, controlled solely by diet and herbal supplements. Recent weight loss of 40lb (over 2 year period following hip replacement). Taking no pharmaceuticals, but supplemental B complex vitamins with B12  sublingual methlycobalimine and folate,¿.  

Self prepared capsules of Boswelia (1000 mg 4 x day) and powdered Neem leaf (1250 mg 3x day) for blood sugar control and daily ingestion of Curcumin with raw cocoa, cinnamon and coconut oil as a "fudge" prepared with Xylitol - 1" square eaten 3 x a day. 

14 Replies

  • Welcome to the forum, McEnerny.

    What are your TSH, FT4 and FT3 levels and ranges (the figures in brackets after results) and what dose, if any, Levothyroxine, Liothyronine or NDT are you taking?


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • TSH         5.5 uUI/mL     (0.30 - 3.0)

    FT3          2.3 pg/mL       (2.0  - 4.4)

    Total T3    98 ng/dL       (80 - 180)

    Total T4    6.6  µg/dL     (4.5 - 12.5)

    The lab inadvertantly left off the FT4  (??) so I do not have that - sorry, I know it is important. I was put on .25mcg of Thyroxin with orders to retest, including FT4 in 6 weeks.

    I had the initial tests ordered on my own and also got a hair analysis which shows very low calcium, D3 and zinc, but high chromium, potassium, sodium and iodine, as well as high lead, aluminum and arsenic (which I attribute to high levels of pesticide use here - I eat mainly vegetables and legumes. some meats, but no dairy and few grains as I am gluten and cassein sensitive) I do use lots of nuts and fermented foods.  

    Two years after my right hip replacement and one year since my left knee replacement, I am still experiencing lots of pain, stiffness, muscle spasms and have difficulty with stairs and walking more than a block or two in spite of physical therapy.  Still have a lot of swelling in the knees and zero energy.

    I think my digestive system has been significantly compromised from several colon resections and treatments for duodenitis and I do not seem to be able to process the nutrients I consume.

  • McEnerny,

    TSH 5.5 is high, and it's high because your FT4 and FT3 are low.  The pituitary gland increases TSH in response to low T4 and low T3.  When Levothyroxine starts working your T4 and T3 will rise and TSH will drop. 

    In the UK patients >50 and anyone with heart disease are usually started on the lowest dose which is 25mcg.  Your dose will probably need increasing to 50-75mcg in due course.  Dose adjustments are usually in 25mcg increments every 6-8 weeks.  Arrange an early morning blood draw when TSH is highest, and fast (water only) as TSH drops after food and drink.  Levothyroxine should be taken after the blood draw.

    For maximum absorption Levothyroxine should be taken with water 1 hour before or 2 hours after food and drink, 2 hours away from most other medication and supplements, and 4 hours away from iron, calcium and vitamin D supplements.

    Hypothyroid patients are often low in vitamins and minerals and it seems likely your colon and duodenitis problems will exacerbate this.  I don't know how accurate hair analysis is so I would suggest you have calcium, zinc, ferritin, vitamin D, B12, and folate blood tests to determine your levels.  If you post the results with ranges in a new question members will advise whether to supplement and how much.

    I know nothing about heavy metal metal toxicity but there are posts you may find useful in and arsenic in is a useful resource for checking what high levels of potassium, sodium and iodine may mean.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Welcome to our Forum and am sorry you have a multitude of medical conditions. Re being unable to convert T4 to T3. If you post your most recent results as Clutter suggests, with the ranges, members will respond.

    When your blood tests for thyroid hormones are due, get the earliest possible appointment and fast (you can drink water). Leave around 24 hours between thyroid hormones and the test and take afterwards (if you take any at all at present). This allows the TSH to be at its highest as it drops throughout the 24 hours.

  • Thanks!  It is really hard to get the complete testing done here in Costa Rica  they do not do RT3 at all. I will try to get the Thyroid antibody tests done as well and hope they do not leave off anything - they do that here if they run out of needed agents.

  • I don't think that RT3 is important. If you are not on thyroid hormones yet, get TSH, T4, T3, Free T4, Free T3, iron, ferritin folate, B12 and Vit D.

  • McMenerny,

    rT3 isn't tested on the UK NHS.  If one wants it tested one has to order private tests which are shipped to the USA for analysis. High rT3 is caused by unconverted T4 so it's highly unlikely you will have rT3 as you've recently been prescribed Levothyroxine.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • I am not understanding this logic.  I was prescribed Levothyroxine because we cannot get anything else (good T3) here, which is what my Dr. says I need. I have read that some mineral and nutrient deficiencies and hi levels of metals can block T3 production from T4  - (high lead, arsenic, etc... low zinc , calcium, Mg and D3 which my body cannot get from compromised digestive system and high iodine and iron which also is not being converted by the Thyroid as needed.  As a result, it is my fear, and admittedly uneducated guess that  the T4 may be just converting to RT3 - I am trying to get the metals out and the minerals in balance without going through digestive route. I have lost over 50 lbs in spite of being hypothyroid because of malabsorption and have to inject b12 and do all supplements sublingually or by injection. I am desperate to stop losing weight and get my system functioning normally. I guess I will find out with the next batch of tests in another month whether the Levothyroxine is working. 

    Thanks so much for your input - it does help to have somwhere to vent and bounce stuff around.

  • McEnerny,

    T4 converts to something like 80% of T3 and around 20% of rT3.  rT3 is the body's brake on producing too much T3 and becoming hyperthyroid.  rT3 may rise during serious illness to reduce T3 level which makes the body slow down for recovery.  It's highly unlikely that you will develop high rT3 on 25mcg of Levothyroxine.  Hypothyroid symptoms you are currently experiencing will be due to low T4 and low T3 because you are not yet adequately medicated. 

    Malabsorption may mean that you are not absorbing the full 25mcg dose, which is probably inadequate anyway, so you'll need dose increases until TSH, FT4 and FT3 serum levels are optimal and symptoms resolve.  It's about time a transdermal form of thyroid replacement was devised for patients with malabsorption.

    Hypothyroidism doesn't always cause weight gain, there are several hypo members who experienced weight loss.  I suspect your weightloss is due to nutritional malabsorption however.  I experienced considerable unwelcome weight loss after thyroidectomy and more when I was switched from T3 to Levothyroxine.   Coeliac disease causing malabsorption was ruled out so I was advised to eat frequent small meals and supplement a revolting meal substitute called Complan to aid weight gain.  Couldn't abide the Complan but I've recently been using a protein shake which can be mixed with milk or water which is helping visibly although I haven't weighed myself yet to see how much gain I've made.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • It is really complicated!  I had read that the high levels of lead, arsenic and aluminum in my hair mineral test results could be blocking the conversion and the medication level is so low it will be forever before I can expect any real results or know what is or is not happening - I am really considering getting some T3 glandular - I have so little energy it is almost not living. I am hoping going on a significant dose of sublingual D3 K2 will crank things up a bit , at least get some calcium and transdermal Mg into my system. 

  • McEnerny,

    25mcg is a starting dose and is unlikely to be the dose you will end up on.  Thyroid hormone needs to be introduced gently and gradually, particularly in elder patients.  It's very likely you will need a dose increase to 50mcg in a few weeks and that will improve FT4 and FT3 which should improve your energy.

  • I also lived in Costa Rica for 2 years! In which part are you, if I may ask? I never had problems with doing tests there, they did everything I asked (and paid) for, but yes they don't do RT3. Other problem is medications, you have to find exact pharmacies that are willing to sell drugs without prescription, most of them ask for it, it was getting on my nerves a bit because they are not that kind of country but they try so badly to do everything USA tells them to do.

  • Gosh, you've certainly got a lot going on and tricky to know what to address first.

    Just really wanted to throw in my current experience of having heavy metal toxicity which was tested using urine.  My health has been deteriorating to such an extent that I feel my (high dosage) T3 meds aren't working at all as hypo symptoms have returned and am struggling to function.  My private (American) doctor has said it's all due to this toxicity of lead, mercury etc.  Currently chelating with DMSA.

    Haven't a clue about hair testing and how it compares with urine testing though.

  • Yes, the heavy metals do seem to wreak havoc with your Thyroid system, according to the information I got with my hair sample results.  I did the hair test because it is something that I was able to accomplish by mail, without having to actually get to a lab and worry about getting the speciman delivered from Costa Rica within the 24 hour time frame. It is just a helpful indication of the state of your minerals and toxic chemicals for the past 3 months.  It is very hard to know what you actually need to be supplementing and there are a gazillion snake oil sales pitches out there saying you absolutely need their product. It was very informative for me!  I had no idea I was deficient in calcium,  zinc and magnesium, since I have been taking those recommended  trace minerals daily, but also am high in chromium, boron and sulfur, also taking daily for diabetic support. Because of multiple surgeries and treatments on my digestive system I do not absorb a lot of things very well.  I was disturbed by the presence of high levels of lead, arsenic and aluminum - I am assuming that is from eating lots of fruits and veggies that are not organic. It is very difficultlt to get OG produce here, because of the huge number of pests and disease, and no winter to kill stuff off.


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