Low Free T3

[garden2020]

I wrote this forum about 3 years ago and received great advice. Any thoughts now would be very welcome. I am worried about Thyroid medication and bone loss. I broke my hip April of 2024 and the hospital said my TSH was too low and that could be the reason for osteoporosis. I know that probably isn't the reason but is worrisome. I am working with a functional doctor with diet and supplements. He said 1.8 on TSH is optimal, mine is 0.013. He said I am not converting T3. I don't have Hashimoto's or Celiac and am on a gluten free diet. I do have inflammation and high glucose even though I eat very healthy. The functional doctor has me doing an elimination diet. I don't feel horrible except a little tired and osteoarthritis but am gaining weight with no changes in diet or exercise. Testing was done according to all the forums suggestions i.e. testing early no food or medication. My ferritin was high in old post but think I put the incorrect ranges. I am currently taking 120 mg (2 grains) of NDT.

Ferritin 195 ranges 15-150 ng/mL

Folate 26.0 ranges 4.6-34.8 ng/mL

B-12 1639 ranges 204-1245 pg/mL

Vit D 113 ranges 30-100 ng/mL

Free T4 0.68 ranges 0.82-1.77 ng/dL

Free T3 1.8 ranges 2.0-4.4 pg/mL

The functional doctor can't prescribe and my primary is a DO and doesn't want to change my dose to synthetic thyroid meds ,T3 included, as suggested by the functional doctor. I was wondering what are thoughts on supplementing with T3 from someplace that doesn't need a prescription? Or would this be a mistake?

This isn't the only medical diagnosis that has conflicted views from doctors. I want to take the matter into my own hands as per the book "The Paleo Thyroid Solution".

Very grateful for any input.

[FallingInReverse]

Are you in the US? How old are you? What insurance do you have?

How many times have you had antibodies tested, and when was the last time?

What was your CRP-hs result, or if you don’t have one how do you know you have inflammation ?

What does “DO” stand for?

Your Free Ts are horribly low, both of them, have they always consistently been? You must feel awful.

Why is your doctor going on a wild goose chase instead of fixing your free Ts first?

[garden2020 in reply to FallingInReverse]

Yes in the US, age 71. I have United Healthcare and Medicare. Last test was January this year. Have had antibodies tested 3 times once a year.

Do you mean CRP (C reactive protein) that is 0.5 range is <0.5 mg/dL

The ANA by IFA Rfx Titer/Pattern was positive >1.80 (doctor said is an indication of autoimmune/inflammation) Was tested for Hashimoto's but that was negative.

A DO here is a doctor of osteopathic medicine, also known as a D.O., is a fully trained and licensed doctor. He follows a more holistic type of medicine.

Free Ts were not tested until I asked my primary this last year and it was high 5.7 range 2.0-4.4. All he said was if I start having (Hyper symptoms to back off the NDT); that's when I decided to go with a functional doctor (he's a chiropractor and can't prescribe) that deals with endocrine system. Within the last 10 months are so Free T3 dropped and that's when I started feeling worse and gaining weight.

I wrote and asked primary about the synthetic T3 and T4 that the Naturopathic doc wanted me to have but my primary just ignored me. I have an appointment in June, going to see what's going on with my request. Hard to get in to see him.

[greygoose]

You'll find post after post after post on here repeating the same thing: TSH has nothing to do with bones! A low TSH will not cause osteoporosis. The cause of your osteoporosis is far more like to be caused by your low FT3. Good bones need good hormone levels.

But you don't have to change your thyroid hormone replacement to synthetic. Why don't you just increase your NDT? That will raise both your FT3 and your FT4 (to a lesser degree).

[garden2020 in reply to greygoose]

Thank you. I was wondering if I could increase my NDT without a doctor approval as it is a prescription here; it seems more like a supplement. Is it because it's not a synthetic like Levothyroxine and Liothyronine? Those 2 are what the chiropractor wanted me to take.

[greygoose in reply to garden2020]

NDT stands for Natural Dessicated Thyroid. It is made from the dried thyroids of pigs and it contains T4 (levothyroxine) and T3 (liothyronine). Do you have enough to increase yourself? If so, do so, but other than that tell your doctor you want an increase in dose and that's all there is too it. You are grossly under-medicated and your doctor is being negligent in not increasing the dose. You're probably going to need a couple of increases before your Frees come up to a decent level.

[garden2020 in reply to greygoose]

Thank you so much. I do have enough to do so. Should I increased it by half a tablet. I have read on here not to increase too much too soon, but that might have been the synthetic?

[greygoose in reply to garden2020]

Same goes for NDT. Increases should only be 1/4 grain every two weeks maximum.

[garden2020 in reply to greygoose]

Thank you. You have been a great help and answered what I needed to know. This board is amazing. So many helpful people.

[greygoose in reply to garden2020]

You're welcome.

[FallingInReverse in reply to garden2020]

Garden, how do you have enough to increase without telling your doctor? How much extra do you have and how long will it last before you have to confront your prescribing doctor to change your prescription?

If you have to have that conversation at some point , why not just ask your doctor for an increase in NDT now?

[garden2020 in reply to FallingInReverse]

Thanks I will.

[FallingInReverse in reply to garden2020]

Great! Per your earlier question - NDT is indeed classified as a prescription drug in the US. It is not in any way a supplement, it has the same restrictions as synthetic thyroid hormones (Levothyroxine (t4) or liothyronine (t3).

Although there may be some people who get them from other countries through the mail, it is illegal, and there’s a chance of US Customs seizing and destroying whatever comes in.

Therefore - whatever thyroid hormone replacement you need more of (NDT, or t4/t3) you will need to persuade your doctor to write the prescription and get it the usual ways through a pharmacy.

Please make sure you don’t increase without a plan. You should avoid zig zagging doses because of poor planning. It can keep us unwell longer than we need if we don’t do low, slow and steady changes.

So it does sound like you need to deal with your prescribing doctor.

[garden2020 in reply to FallingInReverse]

I called him today. He prescribed Armour. But....I am taking 120 mg now and he said to add 60 mg which seems high. Everyone on this board said to start with a quarter grain. So that would be 180 mg. To test again in 6 weeks.

[FallingInReverse in reply to garden2020]

Success! You should fill and pick up the prescription monthly but don’t feel the need to start taking it all at once.

Please read the above from others in this post to see how others on this forum have increased their NDT low and slow.

However you increase, once youre on a stable dose you then wait 6 weeks on that stable dose before you need to test again. Testing before a full 6 weeks won’t be accurate - so keep us posted and we can weigh in along the way.

I’m so glad your doctor got you what you need!

[garden2020 in reply to FallingInReverse]

Thanks so much for your input. I appreciate it.

[FallingInReverse]

Did your free t3 drop along with a reduction in your NDT? Or gave you been on 2 grains consistently with no change?

[garden2020 in reply to FallingInReverse]

I didn't reduce dose. I split 120 mg for a few months last year and have been on the whole dose in the AM.

[FallingInReverse in reply to garden2020]

How many hours before each test was the last dose of your NDT?

[garden2020 in reply to FallingInReverse]

12 hours in am

[FallingInReverse in reply to garden2020]

Have you figured out what changed in the last year that your FT3 tanked so steeply?

So these two results are on the same dose of NDT tested under similar conditions:

Now: Free T3 1.8 ranges 2.0-4.4 pg/mL

Vs

last year: 5.7 range 2.0-4.4.

Any idea what changed?

[garden2020 in reply to FallingInReverse]

I wish I knew. That's what I am trying to figure out and it is so frustrating. Especially since the medical profession isn't exactly helpful.

[Sasah]

Whatbis NDT please?

[helvella in reply to Sasah]

See reply earlier by greygoose:

healthunlocked.com/thyroidu...

For almost any abbreviations here, my document might help:

helvella - Abbreviations, Acronyms, Latin

A document containing a list of many of the abbreviations, acronyms and Latin terms you are likely to find when reading documents about thyroid. This is very frequently updated. Don't assume an old copy is up to date!

Direct link to document:

dropbox.com/scl/fi/jks8k4c3...

Last updated 10/02/2025

Link to blog:

helvella.blogspot.com/p/hel...

[DippyDame]

He said I am not converting T3.....did he mean T4?

It is T4 that is converted to T3

Your Frees are miserably low so you need to increase your dose

NDT comes in grains. Generally, 1 grain is 60mg and contains 38mcg of T4 and 9mcg of T3. Some brands have 65mcg .

2 grain = 76mcg T4 and 18mcg T3 which is not providing what you need

You need more hormone

You could try increasing NDT in increments of 15mcg/ quarter grain every 2 weeks and slowly build your FT4 and FT3 levels.....it will take some time....until your symptoms resolve. Don't increase beyond 3 grains without testing and ensure your Frees remain within the ref ranges

Weight gain is a symptom of undermedication!

TSH does not affect bones so don't fall for that.

TSH is basically a signal to the thyroid gland to produce more or less hormone

The important numbers are FT4 and FT3.....especially FT3 which becomes active once it reaches the nuclei of the cells and attaches to the various T3 receptors.

T3 is key! If FT3 level is wrong that will affect everything else

It strikes me that these medics are flying by the seat of their pants. i.e with lack thyroid knowledge!

Try increasing NDT slowly to 3 grains then test. The results will point to the way forward

Post your new labs for advice

Good luck

[garden2020 in reply to DippyDame]

Thank you for responding and the advice on increasing dose. Yes I meant T4 not converting to T3. Also the ANA by IFA Rfx Titer/Pattern test the doctor had me take was positive wondering if that has something to do with conversion. He said it's the inflammation causing problems? A "positive ANA by IFA reflex titer pattern" means that a blood test detected the presence of antinuclear antibodies (ANA) in your blood, which can indicate an autoimmune disease, but further investigation is needed to confirm a diagnosis as a positive ANA alone is not definitive and can occur in healthy individuals as well; the "titer" indicates the concentration of these antibodies, and the "pattern" provides additional information about the specific type of autoimmune disease that might be present based on how the antibodies bind to cells under a microscope."

I was tested for Lupus, Celiac and Hashimoto all negative.

Will post new result when I retest in late March.

[Brightness14]

Your FT4 and FT3 are much too low for you to feel well. I would have said that you need an increase. Which NDT are you taking?

I have no Thyroid and have taken NDT since 2016. My bones are perfect and I am 78 years old. My TSH is always supressed.

I don't use diets and eat healthily and have never been overweight.

I do take Vit d plus K2, Vit c and Omega 3 fish Oil for about 8 years now.

Take Care.

[garden2020 in reply to Brightness14]

Thank you. I am taking NP Thyroid manufactured by Acella Pharmaceuticals.

Armour Thyroid and NP Thyroid are not exactly the same, but they are both brand names for the same type of medication called "desiccated thyroid," which is a natural thyroid hormone derived from pig thyroid glands, meaning they are very similar in function and composition, but may differ slightly in inactive ingredients and manufacturing processes."

Are you taking Armour? For some reason it was harder to get Armour or supply always iffy so I have been taking NP thyroid for maybe a few years.

I also take vit d, k2, ca and fish oils. My new alternative practitioner is from Red River Health and Wellness (out of pocket). "At RedRiver Health and Wellness Center, we focus on helping patients with Hashimoto's disease, low thyroid, and autoimmune conditions. Because each person is unique, we design custom care plans that focus on the individual. Our goal is to improve health, well-being, and quality of life." I went here because mainstream doctors just keep going by TSH which I know is false.

He also has me on an anti-inflammatory diet and additional supplements. Are you in US or UK and use a traditional doctor?

[Brightness14 in reply to garden2020]

I live in France. I had my thyroid removed back in 2015 and have been taking NDT Thyroid s ever since.

I don't have Hashimotos and never had a thyroid issue until I was 68 years old, so different from most on the site. All my treatment and medications are free here but I personally don't believe too much in GP's and medications and prefer natural if possible.

Inflammation is bad I know and most of my problems stem from my overactivated vagus nerve. I use a Nurosym each day now to calm and reset m Vagus Nerve it is also very good at lowering inflammation too.

You sound as though you are in good hands I wish you well.

[momindenver]

Have you considered adding BHRT (bioidentical hormone replacement therapy) such as estradiol, progesterone, and testosterone? This could build your bones, as well as help cardiovascular and brain health.

[garden2020 in reply to momindenver]

Thanks, I do take BHRT hormone therapy for the past 17 years. My grandmother had very bad osteoporosis even though she ate very well and lived on a farm; maybe it's genetic?

[momindenver in reply to garden2020]

Yes, could be genetic influence. What are your hormone levels, and Vitamin D level?

[garden2020 in reply to momindenver]

Her daughter my mom had great bones.

Vitamin D 113 range 30-100

b-12 1639 range 204-1245 pg/mL

Progesterone 3.10 range <0.20 ng/mL

Estradiol 58.4 range 2.0-21.0

Testosterone wasn't tested last labs

[Hypotennisnut7 in reply to momindenver]

I take all three HRT hormones and have had great success! I’m an addicted tennis player -

[momindenver]

The estradiol and progesterone seem a bit low to me. Worldlink medical uses a goal of estradiol 100, progesterone 10 for Quest, 3.5 for LabCorp.

[Sphenoid]

can you please any past labs prior to being on thyroid meds: TSH, free t4 and free t3 (when they included it).

[garden2020 in reply to Sphenoid]

I got prior labs before thyroid meds, but, they were so long ago I don't think I could find them. I started meds at least 17 years ago.

[Sphenoid in reply to garden2020]

Request a switch to liothyronine (the active thyroid hormone) if you aren't converting.

[garden2020]

Thank you. Doctor upped my dose and am hoping to feel better. If not I will definitely want him to prescribe T3. My appt is in June but if I don't get better in a few weeks I am calling him!!