Help Assessing Results - Low T3, Low Folate - Thyroid UK

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Help Assessing Results - Low T3, Low Folate


Hi all, first post for me, and what a wonderful and supportive forum this is. So happy I found it.

I’m hoping some of the experienced thyroid analysts could come out and offer their thoughts on my blood work.

My Dr. flagged a few things, among which was low T3, and low folate, and said some conventional labs would already consider me Hashimoto. This was a revelation as I thought I was fighting Candida or other boogeymen over the years (though maybe I was). He wants to try some supplemention first, but I’m curious to hear your thoughts on what you think might be going on and how to address it (or if that’s even possible)

To note, I have never taken thyroid horomone before. I have for nearly 8 years been dairy and gluten free, no-to-lower carb seesaw mostly, and eat by many standards a whole food diet with starches, not grains as primary carb source lately (sweet potatoes, squash, etc). I do binge drink alcohol on weekends, more than occasionally, not sure if that’s a major no-no.

Because my digestion has been extremely poor over the years I supplement with 4 sprays of bitters, 2 Thorne bio-gest (mix of enzymes and HCL), 2 Pure Encapsulations Digestive Enzymes Ultra, and 1 Thorne betaine HCL with pepsin pill each meal, just to prop myself up enough to get by (or not want to cut my stomach out).

And with that, here goes:

Serum Iron (85-130 ug/dL): 75

Ferritin (male: 100-236): 235

TIBC (250-350 ug/dL): 272

Iron Saturation (15%-55%): 28%

TSH (1.8-3 mlU/L): 2.110

T4 (6-12 ug/dL): 6.7

Free T3 (3-4 pg/mL): 3.0

T3 Uptake (28%-38%): 30

T3 (100-180 ng/dL): 95

Free T4 (1.0-1.5 ng/dL): 1.42

Reverse T3 (25-30 ng/dL): 19.9

FTI (1.2-4.9 mg/dL): 2.0

TPO Ab (0-34): 10 - lab shows high

TAA Ab (>1.0): <1.0 - lab shows high

Homocysteine (< 7 umol/L): 10.1

Vit D25 (OH) (50-100 ng/mL): 43.6

B12: 978

Folate (< 8): 6.6

What to make of this? Is this more dire than I’m giving it credit? Any help would be appreciated.

14 Replies

Your FT3 is very low, yes, which accounts for your TSH being higher than is strictly desirable. Your conversion isn't very good. But, that could be due to your low carb diet. You need a certain amount of carbs to convert. But, I'm not convinced you have Hashi's because just saying your antibodies are over 1, is not really a result. Several things can raise Tg antibodies. It's when they are very high over-range that it indicates Hashi's. And, we don't really know how high they are over-range, do we? :)

Grey goose thanks for writing back!

Unfortunately I don’t have the lab sheet with me, only the pictures I took of my doctors written notes transferred to his functional medicine reference range sheet, so I’ll get back to you on the TAA as that “greater than / less than 1” is all he lists. So not sure I’m reading that right.

TPO, I believe the general reference range he wrote is 0-34, I scored a 10. I was told anything at 9 or over the conventional lab would say I’m Hashi. Does that sound right?

What do you make of the low T3? Are there any suspected reasons for that being so low, and recommended ways to correct it?

No, that doesn't sound right at all. What's the point of having a range if you're going to say that it's positive when it's not even half way through?

As I said above, your T3 could be low due to your low carb diet. You need carbs to convert. Your FT4 isn't too bad, you're just not converting it.

Thanks GG!

I think I’ll look to see how to work more carbs into my diet and see if it helps. That’s new info for me as lots of Hypo folks suggest going grain free, etc. Are there suggested foods to up carbs safely?

The TPO reference range from the lab actually shows 0-34, but some functional medicine practitioners (and Dr Wentz) suggest 2 and under is the ideal. My doctor alluded to conventional labs starting to talk hypo/hashi at 8, 9.

Regarding Tg the reference range from the lab is actually 0.0-0.9, and the report says mine is <1.0. So I’m not sure if mine is actually 1.0, or somewhere well beyond that.

Hypo folks suggest cutting a lot of things out of your diet, that doesn't mean it's a good thing to do. The more you cut out, the more nutrient deficient you are likely to be. By all means try cutting out grains, see if it makes you feel better. If it doesn't then there's no point. As for 'suggested foods to up carbs safely', I wasn't aware that carbs were dangerous. But, no, there are no suggested foods that I know of. And if anyone 'suggested' any to me, I would be deeply sceptical. Eat what agrees with you, and don't sweat it. If eating something makes you feel bloated or sick or whatever, stop eating it. People make too much fuss about food, but if it's good clean food - minimum of processed foods, artificial sweeteners, soy - and it agrees with you - then eat it.

Antibodies fluctuate. That is a given. Ranges are a guide. If your antibodies are well over the top of the range, then you definitely have Hashi's. But, when they are in range, it doesn't prove anything - certainly doesn't prove you don't have it. Quibbling over numbers is pointless. The proof of the pudding is in the eating, as they say. If your blood hormone levels swing from hypo to hyper then there's no doubt you have Hashi's. If it's a steady descent into hypothyroidism, then you probably don't. If it's necessary to prove you do have it, then have an ultrasound. That will show up the damage done by Hashi's. But, even if you know you have it, there's not much you can do about it. And all that humming and hawing just goes to show that all this fuss about reducing antibodies is a red herring. No matter how much you reduce them, you're still going to have Hashi's, because the antibodies are not the disease. All you can do is take thyroid hormone replacement to replace the hormones your thyroid can no-longer make enough of. And, you'd have to do that whether your hypothyroidism is caused by Hashi's or something else. :)

in reply to greygoose

Agree, GG, except you mentioned soy as a source of carbs. Doesn't soy have a bad effect on thyroid levels? Though maybe OK if not taken anywhere near thyroxine?

Personally I hate the taste of the stuff anyway :-)

in reply to Jnetti

I didn't mention soy as a source of carbs, I mentioned soy as something to avoid - but if it's good clean food - minimum of processed foods, artificial sweeteners, soy - and it agrees with you - then eat it. Perhaps not very well expressed, but I wasn't recommending people eat processed foods, artificial sweeteners or soy, quite the contrary.

But, let's be quite clear about soy and what it does. Soy is a goitrogen, which means it impedes the uptake of iodine by the thyroid. Goitrogens are only really a problem for people not taking thyroid hormone replacement. However, unlike other goitrogens, soy has an effect at a cellular level, by impeding the uptake of thyroid hormone by the cells. So, it doesn't have an effect on thyroid levels, but what it means is that you can have good levels of thyroid hormone in the blood, but it won't be getting into the cells. And, it doesn't matter how close to or far away from thyroid hormone you eat it, it will always have the same effect. And that's why it should be avoided as much as possible.

I hate it, too. :)

in reply to greygoose

"I didn't mention soy as a source of carbs, I mentioned soy as something to avoid"

Sorry, read too fast and thought you recommended it!

in reply to Jnetti

Lord no! I'd have it banned by law, if I could!

I wouldn't worry about the antibodies so much, (your first assessment may be correct, that you are fighting something off. My thoughts are H Pylori due to your issues with low stomach acid ?) I dealt with that, & also take one of the digestive enzymes you take.

I also took Olive Leaf Extract by Designs for Health for the H Py, and had some yeasty "output" - maybe I had Candida ? so that is something for you to look into trying.

People with more knowledge of iron hopefully will respond but your high ferritin/low iron, and low folate jumped out. a link to read; scroll down to see the Iron section


"If your ferritin is much higher along with less than optimal iron, it can point to INFLAMMATION, i.e. inflammation causes iron to be thrust into storage, and inflammation is common with certain thyroid patients for a variety of reasons. In less common cases, higher ferritin can be from liver disease, alcoholism, diabetes, asthma, or some types of cancer. But for most of us, it’s just about inflammation from hypothyroidism, or gluten issues, or unknown. So we need to lower the inflammation before taking iron supplements."


- Inflammation from fighting off whatever you may be fighting off?

One of my doctors told me that high ferritin can mean your liver is over-storing iron or can't get rid of/use excess, so work on your liver health. Possibly related is to make sure you are getting enough folate by eating vegetables; avoid the fake folic ACID in white floured foods & supplements as many ppl. have a defect that prevents the conversion to the active, usable form (MTHFR). Folate helps your methylation - helping the body to get rid of metals & toxins.

Note discussion of Homocysteine:


"When it’s all working right (and it can be for awhile even with the mutation), the MTHFR gene begins a multi-step chemical breakdown process, aka methylation, which is like this:

- The MTHFR gene produces the MTHFR enzyme.

- The MTHFR enzyme works with the folate vitamins (B9, folic acid), breaking it down from 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate

- 5-methyltetrahydrofolate helps convert the amino acid homocysteine down to another essential amino acid, methionine, which is used by your body to make proteins, utilize antioxidants, and to assist your liver to process fats. Methionine helps with depression and even inflammation.

- Methionine is converted in your liver into SAM-e (s-adenosylmethionine), which is anti-inflammatory, supports your immune system, helps produce then breakdown of your brain chemicals serotonin, dopamine and melatonin, and is involved in the growth, repair and maintenance of your cells.

- i.e. a proper methylation pathway like the above is will eliminate toxins and heavy metals, which can reduce your risk for cancer, heart disease and other health issues, and put less stress on your adrenals."


The alcohol is probably not helping liver. Are you having mood issues? Do you have a "mood hangover" the day after the alcohol use? A lot of T4 converts to T3 by the liver.

It can be a circular thing also - if you don't have enough T3, organs in your body do not work as well i.e. digestion, liver, thus causing less T3 etc.

If you are eating starchy carbs, why not throw in some gluten-free whole grains i.e. buckwheat, quinoa, organic brown rice.

Just some thoughts.

Sarosent, thanks for the tremendous reply and the great links.

My doctor didn’t seem to think I had H Pylori as the Neutrophils reading would be higher I think. That said, he did write the script for doing a test cause you never know and it would be best to rule it out 100%.

I have done tests in the past where I tested positive for bacterial overgrowth but negative for h pylori but this is years ago now. Tests can sometimes be fickle but up for making sure on all fronts.


Welcome to our forum.

TSH is fine for someone not medicating, FT4 is fine but FT3 (that brings well being) is low indicating poor conversion.

Iron is paramount in making thyroid hormones work whether medicated or not, as is key for conversion of T4- T3. Low iron levels are associated with low levels of T3 as impair thyroid hormone synthesis by reducing activity of thyroid peroxidase which is heme-dependant. This means you could be hypothyroid and yet appear “normal” according to standard TSH and T4 thyroid labs and become a self perpetuating cycle as low active thyroid hormone can cause changes to the stomach acid levels so altering iron absorption.

Your iron is low, although ferritin is high which could be due to inflammation caused by possible elevated thyroid antibodies. (Ferratin is a well known inflammation marker). Your gut supplements are good as address the possible low stomach acid but you may want to have a stool test to rule out possible gut infections and/or parasites.

Elevated homocysteine levels are common in people with low thyroid hormone and increase in the body when the metabolism to cysteine of methionine to cysteine is impaired. This may be Vitamin B6, Vitamin B12 deficiencies, low thyroid hormone levels or/and genetic factors (MTHFR) that affect the body's absorption.

Your folate is low but it is important to test the amounts of folate that are in the red blood cell, as opposed to just in serum. More accurate tests would include RBC glutathione, RBC folate, Methylcobalamin levels and riboflavin levels. Also get Vit B12 and Vit D tested. If I were you I would supplement iron (with Vit C and retest in 3 months) but also selenium which is important for good thyroid hormone synthesis, and investigate possible elevated thyroid antibodies.

Alcohols main effect is on the liver which converts T4 to T3, and detoxifies all the unwanted hormones, etc, and adrenal glands in that it influences blood sugar levels as is a carbohydrate. Weak adrenals can compromise good thyroid hormone levels, and the gut & immune system.

Good reading would be “The Root Cause” by Isabella Wentz and “Your Thyroid And How To Keep It Healthy” by Dr Barry Peatfield.

in reply to radd

Hi Radd thanks so much, and also for the thorough reply! I appreciate it.

I’ll definitely look into the more detailed red blood cell tests.

I do want to note I did have D and B12 tested and I was low in D at 43.6 when the healthy range is 50-100, and high in B12 at 978 when the upper end is I believe low to mid 900’s.

My Doctor wants me to take a folate supplement so I am doing 5-MTHR. Just started today. Won’t that help with being able to use iron (as well as breakdown and use/eliminate other metals)? Or do you still suggest iron supplementation?

Thanks again for your input!

in reply to wrestlehealth


Iron can be so tricky and relooking at your results, I don't know if you should supplement iron. Serum iron is divided by total iron binding capacity (TIBC) to give TS as a percentage and the normal average is around 30% so both your TIBC and TS are fine.

However, your available iron for use in making thyroid hormone (serum iron) is still under range. Also, an iron-containing protein should be present in large amounts within the adrenal cortex to be able to help make corticosterone. Therefore, low available iron levels can lower your cortisol levels that are also required for good thyroid hormone synthesis.

Iron regulates how much we need for normal function, but also has a withholding defence system that stops harmful pathogens getting at excesses of iron. Think of white blood cells going to the site (inflammation) and high ferritin which will leave less iron available to make red blood cells.

Perhaps you should see how the folate helps, as with the Vit B12 should help create and regenerate red blood cells and hopefully make iron work better. Also try reducing thyroid antibodies, that will reduce inflammation, that will reduce ferritin levels and free up more available iron.

L-5MTHFR is good as is more easily absorbable so takes any risk of MTHFR genetic mutations into consideration. (Good info from sarosent above). This should reduce your elevated homocysteine levels.

If you suspect you have this faulty gene it may be worth asking for the active (holotranscobalamin) B12 test (HoloTC), that measures only the active unbound B12 that is available for use.

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