Pooling does exist. Pooling is when rt3 become too high and blocks the entryway into the cells. Because of this ft3 cannot enter the cells and pools in the blood. Symptoms are pretty much the same as the original thyroid problem but worse. The way to know if you are pooling is to get a reverse t3 test. The lowest 3 numbers of a rt3 are in the normal range. Rt3 comes from the t4 hormone which is why patients who are on t4 only therapy are more prone to getting it.
A little pooling: Pooling does exist. Pooling is... - Thyroid UK
A little pooling
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Lily365
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But rT3 doesn't block T3 receptors. It has its own receptors.
It does. That’s why you get your hypothyroid symptoms back. The t3 hormone cannot get into the cells and pools in the blood.
That's what used to be thought. Now we know that's just not true. Science has moved on.
That may be the thinking in the UK but it’s not in the US.
Show me a scientific study from the last 10 years that illustrates that the same receptors are used for rT3 and T3.
I am confused.
T3 receptors are within cells.
If T3 cannot even get into cells, it matters little whether the T3 receptors are blocked or not. (Though, if T4 can nonetheless get into cells, and then get converted to T3, the availability of T3 receptors would be important.)
Is there possibly some confusion between T3 transporters and T3 receptors?
SeasideSusieRemembering
Welcome to the forum Lily365
Is your post in response to a particular post that you have read? If so you should reply directly to that post on that thread otherwise the member who you are responding to won't see your message.
One reason for high rT3 is an excess of unconverted T4; however, that is just one of many reasons for high rT3, the others being complete unconnected to the thyroid. Other reasons for high rT3 can include:
Chronic fatigue
Accute illness and injury
Chronic disease
Increased cortisol (stress)
Low cortisol (adrenal fatigue)
Low iron
Lyme disease
Chronic inflammation
Selenium deficiency
Excess physical, mental and environmental stresses
Long term use of certain betablockers
Physical injury
Illnesses like the flu
Starvation/severe calorie restriction
Poorly treated diabetes
Cirrhosis of the liver
Fatty liver disease
Renal failure
Fever of unknown cause
Detoxing of high heavy metals
As for pooling, this has been discredited and I think our member greygoose has information about this.
I agree with the cortisol & iron but not the rest. If that were true most everyone would have it but that is not the case.
I am sorry but what you have described has been disproved by more recent research. Reverse T3 does not block T3 receptors. Reverse T3 has its own role to play. People typically have over 40 times as much rT3 as they do T3 . Reverse T3 is converted into T2.It is complicated but well explained here drchristianson.com/whats-th...
Be careful with the relative amounts of rT3 and ‘T3’ because you are comparing total rT3 with fT3 not with total T3.
Free t3 is the t3 that is available in the blood. I am working with an intergrative doctor and we are in agreement. I am going thru pooling myself at this time.
The half-life of T3 is about 24 hours in the blood. It doesn't have time to pool.
So T3 doesn’t go into the body only once a day. It’s a continuous process.
If you have a working thyroid, yes, it's a continuous process. Continuously in, continuously out - or, rather, converted to T2. But, I've never heard anyone with a healthy thyroid say they are suffering from 'pooling'.
You are correct. When you have a healthy working thyroid you will not pool. When you have an autoimmune disease and supplementation is necessary you can pool. Pooling is more likely from the t4 only supplementation. In my case I was using t3 & t4 supplementation for 5 years without problems not knowing that I also had estrogen dominance which complicated the issues. The hashimotos I have is seronegative Hashimoto’s which does not show up in an antibody test. So for decades I have had estrogen dominence which is likely genetic and Hashimoto’s both of which went undiagnosed until the last year.
I think Jim is aware that Free T3 is the unbound T3 in the blood.
But, so far as I am aware, all reverse T3 testing measures the Total rT3 - bound and unbound. (Somewhere around 99% is bound.)
Hence, attempting to compare numbers is not straightforward. (Indeed, the actual rT3 assay process is not that simple. Last I specifically checked, there was no rT3 test approved in either the USA or the UK.)
I'll also add that propranolol can increase rT3.
The rt3 is a very common test in the US for hormone issues.
However common it is, I am not aware of any approved rT3 test.
For example, Mayo Clinics list this:
Test ID: RT3
T3 (Triiodothyronine), Reverse, Serum
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.
Actually I’m not. I just know where my fr3 & ft4 levels should be and where my rt3 should be. I also have a condition called estrogen dominence which is the source of my Hashimotos which is also being treated.
Again, oestrogen dominance is not something that is accepted here in the UK. It's an American construct and has little to do with anything. Our hormone levels change all the time. When in perimenopause we start to have erratic levels of progesterone so supplementing some might help smooth us out. But oestrogen dominance just isn't a thing. Wait a few years, you will be longing for more of it. Also, there's no way oestrogen causes Hashimoto's. Rather falling oestrogen levels as we age allow autoimmune diseases to flare up.
Estrogen dominance is not just hormones changing. It is an imbalance between estrogen and progesterone. The two hormones are supposed to move in tandem. When they don’t it’s called estrogen dominance. You can have either high estrogen or low progesterone. It can be caused by stress or genetics. In my case it was low progesterone and I believe it is caused by genetics. I know I have had it for at least 53 years. It can cause a multitude of issues because it is a hormone imbalance. Thyroid issues are prevalent in my family and although my daughter does not have thyroid issues yet she also has estrogen dominance which has caused other issues.
I'm afraid it's just not considered a condition by our hormone experts because hormones move around all the time. Every month in a fertile woman's life the shift between high oestrogen, high progesterone and low levels of both occurs in a flowing rhythm. If you tested hormones every day for a month we would see this clearly.
If you don't have enough oestrogen to keep your bones strong then you have problems so we need to have regular blood levels over 250 when we are older. That's what's worth focussing on, keeping oestrogen levels healthy.
You’ve missed the point. The hormones are going to move but they must move in tandem.
I would disagree with you. My doctor went back to get additional training on the homeopathic side of medicine after becoming an MD. She wanted to get to the origins of an issue rather than just treating the symptoms. I had never heard of estrogen dominance before going to her but it makes sense. Pooling may not be accepted in the UK but it is here. I have actually found the STIM books to be quite accurate and how can it not be since it’s information comes from actual patient experience. From what I have gathered from the posts we have much easier access to some of the tests required for a diagnosis such as RT3.
I don't understand how homeopathic training helps identify the origins of an issue.
Would you, please, help by explaining?
Do males never suffer from pooling? (I don't remember reading of a male with estrogen dominance.)
We have easy enough access to tests - including rT3. The problem isn't access in itself, it is the cost and time delay as at one time all of them were shipped to the USA for the assay.
Indeed, we do not find that tests are legally proscribed from direct patient access as is sometimes the case in the USA:
However, New York law generally prohibits such “direct access testing,” and instead requires that laboratory tests be performed only at the request of licensed medical providers within their scope of practice.
Most if us here have already learned enough to understand the science, and so you are unlikely to be able persuade anyone that pooling exists.... but if you're happy believing it, that's OK.... hopefully your doctor can improve your health and it doesn't cost you too much time or money. If you'd like to understand more about thyroid hormone action and receptors i can recommend this site thyroidpatients.ca/home/sit... it's very helpful and comes with clear pictures.
Best Wishes for your recovery.
T3 may not bind to receptors due to resistance (rare) or endocrine disruptors or T4 to T3 conversion not taking place or low T3 levels. Except in incredibly rare cases of cellular transport mutations T3 always enters cells, not least because all T4 to T3 conversion takes place within cells.
'pooling' is the wrong concept but you can get similar effects by for example having insufficient type-2 deiodinase, T4 to T3 conversion deep within cells which regulates local T3 levels.
I'm just trying to keep the science on course as misconceptions don't help us move forward even if the treatment is th same.
Not sure I understand all this but I can say my husband had relapsed NH lymphoma and therefore alot of inflammation/ chronic/ acute illness. He was taking 150mcg tertroxin and 20 mcg tertroxin but could never increase the T3 which was always below the normal range (2.2 range 4-6.8). He had taken this for about 4 months and General Physician wanted him to reduce the Eltroxin because he didn't like the fact that the TSH was so very low (not measureable). Wasn't interested in T4 being just lower than the normal range so far off optimal). I assume he had really high reverse T3 but maybe that was incorrect. Reverse T3 testing is not available in NZ. Not sure if this is helpful but comments would be appreciated. Thanks Sue long
Sorry to hear about your husband. I think you meant to write '150 mcg levothyroxine and 20 mcg Tertroxin'.
In severe illness like this there is a condition called 'low T3 syndrome'. Lots of changes take place in the body to reduce T3 levels - it is assumed this might be to help the body, at least initially but perhaps not after a few weeks. This happens by central mechanisms such as the hypothalamus producing less TRH which leads to less TSH with less potency. There are also local effects that reduce T3 in local tissues. Nobody understands this, noone knows whether this is a harmful or protective effect - it might be a bit of each. In these cases rT3 is increased considerably. rT3 testing wouldn't really help, it might show high numbers but doesn't tell you how to treat it.
As regards treating your husband now I don't think anyone can be certain how to proceed. If it were me I'd go largely by my signs and symptoms with a view to at least attaining normal fT3, fT4 levels. All this is well beyond the scope of a GP and indeed most endocrinologists. Please note I'm a patient not a doctor.
Forgot to mention low T3 syndrome is usually known as 'Non-Thyroidal Illness (NTI)' which means getting abnormal thyroid blood test results that are caused by an illness rather than a problem with the thyroid. NTI used to be called 'Euthyroid Sick Syndrome (ESS)', this term is now obsolete but you do see it used sometimes.
Isn’t treatment and resolution the whole point? Sometimes we can get to far into the weeds.
Lily, people may be tangling with you over the terminology or how you’ve conceptualized the physiological experience, but I understand what you’re saying and I agree in principle. It feels awful. It’s what happens when we try to treat my hypothyroidism with Levothyroxine. My deiodinase enzymes aren’t converting the pharmaceutical product into the useful form of hormone and I get a debilitating fatigue that feels like I’m going to die. The measurable rT3 26 hours after the last dose of Levothyroxine is above clinical range for “normal”. I don’t know what the clinical experts call it, but it sucks.
Sorry you attracted a storm of opposition. Better luck next time.
You have a different problem going on Rocky. You are failing to convert Levo properly (like me) because of an enzyme problem. We can cope with some Levo, albeit with wildly different results from one test to another sometimes, but we can't push past a certain point, it seems to shut down the diodinase process further and make us more hypo. We need T3 adding to our treatment. There's no way around it really. T3 is necessary to us. Most of us have to buy our own. But it's the only way to raise T3. More Levo is horrible. Never the answer. But that's not the same issue Lily was talking about.
We've moved on from pooling now. It was a Stop The Thyroid Madness idea. But science is always moving forwards.
So you are recommending what Stop the Thyroid Madness recommends but the science has moved past it?
Which is why t3 & t4 supplementation is the best way of treating hypothyroidism and Hashimoto’s since t3 is the active form of the hormone. I have found the STIM books to be helpful and accurate. Since the information in them if from thyroid patients how can it not be. It doesn’t get into the weeds like grey goose does but main goal is treatment that helps the problem and makes one feel better not a microbiology degree.
Lily There are many thyroid patients with lots of experience, and some who are also working in the medical sector, on this site. So the information on here is also from thyroid patients. Why is what we are saying not also helpful and accurate? How can it not be? We speak from experience.The author of Stop the Thyroid Madness has an M.Ed which is I believe a degree in Education.
Well, we geese like weeds!!!
I'm not quite sure what you mean, though. What weeds have I got into? Did I deny you're sick? Of course I believe you are, I believe you're suffering. It's just your interpretation of why you're suffering that I disagree with.
If it suits you to believe in oestrogen dominance, pooling and rT3 blocking your receptors, despite all the evidence to the contrary, fine. What counts IS feeling better, who could deny that? But, coming on here and stating all this as fact is just confusing to those that are just starting out, and I don't think it's fair.
And personal criticism is not how we do things here. It's what people ressort to when they run out of valid arguments. There was absolutely no need to compare me to STTM! I haven't written a book on the subject! Nor do have any sort of degree, and never said I had. So please be kind enough to keep your disagreeable comments to yourself. Thank you.
Consider you 'geese like weeds' comment 'liked ' 
Thank you.
I find interesting that some people want to get into the weeds about it when the whole purpose is to find resolution and relief even though the treatment is the same. I personally don’t care about “how the clock is made.” I just want to know what time it is.
That’s why the recommendation is that t4 and t3 treatment is the best treatment since t3 is the active form of the hormone. With t4 only there can be conversion issues or issues like you have. The additional t3 would go a long way in making you feel better which is the ultimate goal.
T3 does get into the cell, however it needs to be able to be used effectively in the cell, for that you need good cortisol and iron. With out these it just wont work properly.
You can get a situation where your blood test looks good, FT3 well up in range but still very hypo or even worse than you did before.
This is usually down to low cortisol or iron .
It does not pool in the blood and rush in once cortisol and or iron is corrected its always been there but just not being used properly due to these being low.
What ever chose to think of it as , pooling or being bio available in the cell, or it all comes down to these two things, inadequate cortisol and or iron.
That's very interesting AS14. My ft4 and Ft3 are the best they have ever been on a combo dose of levo and NDT. Ft3 near top of range FT4 just over range so reduced levo to hopefully get lower FT4. Thing is I still have to endure hypo symptoms (hypothyroid brain as jimr111 put it) have no energy. I have no thyroid. In my case everything leads back to inadequate cortisol ( low morning, below range noon high evening onwards.
Have no idea how to deal with my cortisol problem, have tried and failed in the past. Just hoping, given time, good thyroid levels, FT4 and FT3 might improve my inadequate cortisol.
HiGood looking blood tests with continuing hypo symptoms are practically always low cortisol or iron. They both do different things to stop T3 working, but either will stop the hormone working dead in its tracks.
Im very unwell with hypo, and after a brief disastrous trial with T3 I came away even sicker ( which I didnt think was possible) but hey my blood tests looked great.
Probably one of my lowest points, it just didnt make sense, how could I be even sicker have great looking blood tests and be taking the T3 I desperately needed.
Long story short I found the answer, low cortisol and or low iron. I found out my cortisol was low 6 months ago and only recently found out my iron is low too. I think I may have had some progress with the cortisol and will be testing soon and will check iron in a few weeks as Ive been supplementing.
I have no access to meds other than levo, Ive been trying Thyrogold and at first had a little improvement but I tend to think theres little hormone in it. I cant say for certain if thats true until I check cortisol and iron again but Im becoming more hypo all the time.
I need ndt, catch is I cant afford a private prescription even if I could find a doctor to prescribe it. Thyroid s and the like seems impossible to get. I have no idea what to do.
There is a way to raise your cortisol using your ndt its called ct3m developed by Paul Robinson, lots of people have used with great success, Im sure theres people in this forum have.
I highly recommend Paul Robinsons books Recovery with T3 and the other is the ct3m handbook. Brilliant books they explain literally everything you need to know.
Paul Robinson is a thyroid patient who had to figure this all out himself and has been fit and well for years now. He has a website and fb age.
Stop the thyroid madness seems to bring out some conflicting opinions, I tend to believe pretty much most of their advice apart from the pooling and RT3 idea. However still plenty of good information , check out their youtube video on problems raising ndt, think its around 4 minutes long.
It by no means goes into the detail and explanation as Paul Robinson but its definitely worth watching.
I should add keeping T4 will taking ndt isnt a good idea, ndt has enough T4 in at and adding to it can create problems
Can ask what ndt you take ? .
A reply.
Scrumbler the author of Thyroid Madness has a degree in Education. I have 2 degrees in education, should I write a book on thyroid?😁 Just asking!
Maybe you can interpret this sentence just lifted from STTM?
T4, of which is the main ingredient in certain hypothyroid medications, is a thyroid storage thyroid.
You should, obviously, write two books.
So thyroid patients that live with the issues every day and the doctors treatments that help them are unreliable? I would say that more Doctors are unreliable since many of them remain entrenched in ideas taught in medical schools decades ago. The STIM books are basically a “clearing house” of what works and is supplemented with a website that is updated when needed. You can’t get more current than that.
Make that a PhD! Doesn't get you jobs though, does it! lol
helvellaAdministrator
I have already reported the issue.
It seems that if you click, then refresh the page, it just might have worked. If not, try again.
There are days when I’m not sure I exist, let alone pooling.
The author of the pooling statement on STTM admits it’s a private theory and that it isn’t scientifically substantiated.
Everything I’ve seen here on this Thyroid U.K. forum has confirmed for me that pooling doesn’t actually happen.
No one here will argue that hypothyroid patients may need liothyronine (T3) to feel well. Unfortunately, here in the U.K. it can be next to impossible to persuade doctors to prescribe it.
Suit yourself but I’m getting better. Are you?
helvellaAdministrator
What browser do you use? Version as well, if you could.
And, for that matter, is it Windows 10?
I've had a reply from HU support and they are looking now.
helvellaAdministrator
You surely can't be using Safari! Apple dropped Safari for Windows years ago, so far as I can remember.
It’s on iPhones - I use safari for here. Weird not being able to like anything, isn’t it.
I find I am able to Like.
First click, the little box gets an almost invisible grey surround. Refresh the page - and the Like has been ticked, the number gone up by one.
😉 worked first time... once I twigged how to refresh a page on the iPhone. A mine of useful information as ever helvella 😁
Most mines, you have to extract vast quantities of rubbish in order to find and refine the tiny amount of what you actually want.
The rest ends up in a gigantic spoil tip.
helvellaAdministrator
Afraid we just have to keep trying and see what happens. I just hope it is sorted before the weekend.
I hate weekends with major issues on HU.
Right...
All you have here is an echo chamber. You don’t learn anything from that. One person says something and you all agree. Yet I haven’t seen anyone here who has the stripes to comment with an education to back them up. We don’t all have to agree but unless you are part of the echo chamber you are dismissive of other peoples ideas and experiences. Just remember Jagger didn’t have his heart surgery in London he had it in the US for a reason.
Well, it was Janie’s opinion, I suppose. Stated as fact.
Oh, it’s not just my phone? This site is behaving really weirdly on my phone today.
Oh, that Jagger. 
Lily365 , Mick Jagger is a long term resident in the United States, and a very rich one at that. He could easily afford to have his heart surgery performed there so it is simple common sense that he would have his heart procedure performed there.
Had he been resident in the United Kingdom when his heart condition manifested, he could have had the operation performed here, to as high or even a higher standard by United Kingdom surgeons in a private hospital, no doubt covered by private health insurance.
I’m seriously not sure what point you’re trying to make. How does rabbiting a pet theory about pooling relate to the choice of heart surgeon made by an aging British rocker?
Consider this reply well liked.
Well, we do all have terrible teeth.
🤣 Cheers—I laughed out loud!
Hidden I'd like to second Lalatoot's 'well liked' to your reply.. p.s i once got 9/10 on a spelling test , so please can i come and play with you two when you write a book ... i don't know if this qualifies as enough of an education to qualify me as a thyroid writer .. but if it helps, i still have most of my own teeth, and Mick Jaggers Brother once had a cup of Tea in the back of my truck.......
ooh , please tell me you've still got one of those 'teachers desk' pencil sharpeners with a handle, that work like a mincer.
You mean the ones where you get a new pencil and sharpen it to the end in 10 secs.....don't think our budget could supply enough pencils but am happy for you to bring your own.
Yes , well i must confess that did happen quite a bit . That's OK ,i've got loads of pencils , and coloured crayons.. My dad seemed to have purloined rather more than a lifetimes supply from the office.
helvella has found us one , which i would like to 'like' but i can't , or at least it seems i can only 'like' it if the wind is in the right direction.
helvellaAdministrator
On IOS as on an iPhone or iPad, you touch the circle-with-an-arrowhead symbol at top right of screen.
Screenshot of refresh button
Can’t see one of those on the iPhone I have to reload using the return in the keyboard on the top menu showing the url. Good to know HU are making the site easier to use 😆😆😆
I lie!! I’ve just spotted it 🤪 saves going to the keyboard! helvella delivers yet another gem of information 🤓
No, my miscreant phase came later in teenage it was self destructive in essence rather than wanton vandalism. I was never easily lead 🤣🤣🤣 in fact I was a dab hand with a pencil - still am I do like them sharp tho for art work! I especially like a 2B 👍🏽
Billie asleep on Dad’s chair
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