It’s common for people with hypothyroidism and Hashimoto’s Thyroiditis to have low levels of triiodothyronine, also known as T3. Sometimes the T3 levels will be within the lab reference range, but less than optimal. On the other hand, sometimes they will be outside of the lab reference range. Either way, the goal is to try to bring the T3 to an optimal level, and in this blog post I’ll discuss seven ways to increase low T3 levels.
Before I discuss the seven ways to increase low T3 levels, you might wonder why I’m not talking about T4 in this post. In 2016 I did release a blog post entitled “7 Causes of Low T4 Levels”, and while some of the same factors will cause low T3 levels, there are different causes as well. In addition, I usually recommend to test for the free T3 levels, and from an optimal perspective you want to see these levels between 3.0 and 3.5 pg/ml, although some sources will suggest a tighter range (i.e. between 3.2 and 3.5 pg/ml).
It’s also important to mention that not all medical doctors will test the T3 levels. Many will only test the TSH and T4, while some will test the TSH alone. The reason for this is because in most cases the T3 isn’t going to change their recommendations, as most medical doctors will 1) base their recommendations off of the TSH, and 2) prescribe synthetic thyroid hormone to just about all of their patients with a hypothyroid condition. If this describes your doctor then you might want to consider switching to a different doctor, or another option is to try to order free T3 on your own.
With that being said, let’s go ahead and look at the seven ways to increase low T3 levels. Please keep in mind that I’m not listing these in the order I recommend.
1. Take synthetic T4. Although I’m starting with synthetic T4 because this is the most common recommendation by medical doctors to address both low T4 and low T3 levels, this isn’t my first preference. And the reason for this is because while taking thyroid hormone replacement is necessary at times, this doesn’t do anything to address the underlying cause of the problem. In addition, Synthroid is the most common brand of synthetic thyroid hormone medication recommended, and it has a lot of fillers, along with artificial ingredients. As a result, if someone absolutely needs to take synthetic T4, they should look into a more hypoallergenic form, such as Tirosint.
Some reading this might wonder how taking synthetic T4 will increase low or depressed T3 levels. Well, T4 converts into T3, and so if someone has healthy levels of T4, then they should be able to convert the T4 into T3. However, if someone has a problem converting T4 to T3 then taking synthetic T4 won’t be effective in raising T3 levels.
2. Synthetic T3. If someone has low or depressed T3 levels, then it might make more sense to take synthetic T3 rather than synthetic T4. Synthetic T3 is also known as liothyronine, with Cytomel being a common brand. A recommended starting dosage is 25 mcg per day, although some will start with lower doses (i.e. 5 mcg). While some medical doctors will recommend synthetic T3 if someone has low T3 levels, since T3 is the active form of thyroid hormone, many are cautious about doing this out of fear that the person will develop hyperthyroid symptoms.
Earlier I mentioned that it might make more sense for someone who has low or depressed T3 levels to take synthetic T3 instead of synthetic T4, although it depends on the situation. For example, if someone has depressed levels of both T4 and T3, then it wouldn’t make sense to only have the person take synthetic T3. In fact, as I mentioned previously, if the person is able to convert T4 to T3 then in this scenario they might be fine just taking synthetic T4, although in some cases taking both synthetic T4 and T3 might be warranted. On the other hand, if someone has normal levels of T4 and low or depressed levels of T3, then this might be a good indication that synthetic T3 is needed.
However, just as is the case with taking synthetic T4, synthetic T3 doesn’t do anything to address the cause of the problem. And so while taking synthetic T3 might be necessary in some cases, the obvious goal should be to fix the conversion problem and/or address the autoimmune component (for those who have Hashimoto’s), which I’ll discuss later in this post.
3. Natural thyroid hormone. If someone needs to take thyroid hormone replacement, desiccated thyroid hormone should be considered. Brand names include Armour, Nature-Throid, and WP Thyroid. These all include T3 and T4, along with other thyroid cofactors (T1, T2, and calcitonin). This type of thyroid hormone replacement can especially be helpful if someone has low or depressed levels of both T4 and T3. Although over the years I have had many patients take Armour and do fine, I prefer Nature-Throid and WP Thyroid because they are hypoallergenic. And while many people do fine taking synthetic thyroid hormone, some people don’t do well on this, yet thrive when taking desiccated thyroid hormone. On the other hand, a small percentage of people don’t do well on natural thyroid hormone, and actually do better when taking synthetic thyroid hormone replacement.
4. Thyroid glandular supplements. For those who are unable to get a prescription for Armour, Nature-Throid, WP Thyroid, or a different brand of natural thyroid hormone, there are thyroid glandular supplements that contain desiccated thyroid hormone, and don’t require a prescription. Some of these thyroid glandular only include T3, while others have both T4 and T3. It’s common for these thyroid glandular supplements to also include nutrients and/or herbs that support thyroid gland function. Common nutrients included include selenium, tyrosine, and zinc, and ashwagandha is an adaptogenic herb that is added to some thyroid glandular supplements.
5. Compounded thyroid hormone medication. Compounded T4/T3 is made by a compounding pharmacist, and is another option to consider. One advantage of compounded T4/T3 is that the doses can be customized. Another advantage is that the product can be formulated to be hypoallergenic. Some compounding pharmacists can also put together a custom formulation using desiccated thyroid. However, getting T4/T3 through a compounding pharmacy can be considerably more expensive.
6. Correct the conversion problem. So far I have focused on different types of thyroid hormone replacement. But even if you need to take thyroid hormone, it makes sense to address the cause of the problem. I mentioned earlier that ideally T4 should convert into T3, but many people have problems converting T4 to T3. If someone’s thyroid panel reveals normal T4 levels and low or depressed T3 levels, then this is a pretty good indication of a conversion problem. However, it’s also possible for BOTH T4 and T3 to be low and to have a conversion problem. When this is the case it can be more challenging to determine if the person has a problem converting T4 to T3, although reverse T3 may be elevated in this situation.
There are numerous factors that can interfere with the conversion process, but three of the more common reasons why people have a problem converting T4 to T3 include 1) liver problems, 2) gut dysbiosis, and 3) elevated cortisol levels. As a result, these are the primary areas I focus on, and while most of the time doing so will correct the conversion problem, in some cases this can be challenging. For more information I would read my blog post entitled “6 Factors Which Can Affect The Conversion of T4 to T3”.
Should Someone Take Thyroid Hormone Replacement While Fixing The Conversion Problem?
As for whether someone who has a conversion problem should take thyroid hormone, this depends on the person. While the cause of the problem needs to be addressed, we also need to remember that T3 is the active form of thyroid hormone. As a result, if someone has very low or depressed thyroid hormone levels then we don’t want these to be low for too long. The reason for this is because thyroid hormone affects every cell and tissue in the body.
In addition, while sometimes the T3 levels will increase relatively quickly while addressing the cause of the problem, this isn’t always the case. Sometimes it can take many months to correct the conversion problem. There can be a few reasons for this. One reason is because it can take time to address the liver, gut, or adrenal imbalance which are responsible for the conversion problem. Another reason is because sometimes we greatly improve the health of these areas, only to find another factor is responsible for the poor conversion of T4 to T3.
7. Detect and remove the autoimmune trigger. Most people with hypothyroidism have Hashimoto’s Thyroiditis, which is the reason behind their low or depressed T4 levels, and low or depressed T3 levels are common as well. So when someone has low T3 (and T4) levels as a result of Hashimoto’s, the goal is to do everything necessary to detect and then remove the autoimmune trigger. This is easier said than done, and over the years I’ve written many articles and blog posts on some of the different triggers, and I also talk about this during my free webinars. In my upcoming book on Hashimoto’s I’ll go into even more greater detail about triggers, including an entire section dedicated to how to detect all of the different triggers, and another section that focuses on removing your triggers.
While some people with Hashimoto’s don’t need to take thyroid hormone replacement, others need to take it while addressing the cause of the problem. And there are those who need to take it on a permanent basis. It depends on how much damage to the thyroid gland has taken place.
Can There Be Other Factors Responsible For Low T3 Levels?
Although having Hashimoto’s and/or a conversion problem are the most common reasons why someone has low T3 levels, there can be other factors. I’m not going to get into great detail about these here, and ideally you want to work with a natural healthcare professional to address this. But here are some other potential causes of low T3 levels:
Dysregulation of the hypothalamic-pituitary-thyroid (HPT) axis. Although T3 is produced during the conversion process, some T3 is also produced in the thyroid gland. TSH is a pituitary hormone, and it is responsible for signaling to the thyroid gland to release T4 and T3. The hypothalamus communicates with the pituitary gland. As a result, if there are problems with the communication between the hypothalamus and pituitary gland, this in turn can affect the communication between the pituitary gland and thyroid gland, which can result in low T4 and/or T3 levels.
Direct inhibition of the thyroid gland. Although most cases of hypothyroidism are a result of Hashimoto’s, some factors can directly inhibit thyroid hormone production. For example, certain environmental toxins such as mercury can inhibit thyroid hormone production, although sometimes environmental chemicals can cause an immune system response. Either way, in this situation the goal should be to reduce your toxic load.
Some people are concerned about goitrogenic foods inhibiting thyroid hormone production. Although I would be cautious about eating soy, eating cruciferous vegetables usually won’t cause any problems. I spoke more about this in a blog post entitled “5 Things To Know About Goitrogenic Foods”.
Problems with T3 binding to the carrier proteins. Both T3 and T4 are carried through the bloodstream bound to certain proteins. Thyroxine-binding globulin (TBG) is one of these, although it has a higher affinity for T4 than for T3. Both T4 and T3 bind to serum albumin, although these hormones have a higher affinity for TBG. So for example, if the TBG level is low due to a person taking corticosteroids, this will result in lower levels of thyroid hormone in the blood.
In summary, many people with hypothyroidism and Hashimoto’s have low or depressed levels of T3. Unfortunately many medical doctors don’t test the T3 levels, as they will only test for the TSH, and perhaps T4. Ideally you want to increase T3 levels by addressing the cause of the problem, which is usually either damage to the thyroid gland caused by the immune system, or a problem converting T4 to T3. However, thyroid hormone replacement can also increase the T3 levels, and some of the different options include synthetic T4, synthetic T3, desiccated thyroid hormone, thyroid glandular supplements, and compounded T4/T3.
Many many thanks from France.
I have had hashimoto for some years and I take ayurveda herbs and now my levels are ok.
I do not eat gluten any more and no dairy ( difficult when you live in a country where there are so many cheeses)
thank you again.
Dr. Eric says
Thank you for reading the post Garance, as I’m glad the herbs helped you, along with going gluten and dairy. I realize it can be challenging to avoid dairy when there are so many cheeses!
Hey can you please tell me what herbs you are taking
Effue Willians says
Thank you for this concise summary. If only doctors really deeply cared about the immune system…enough to release fear first in their sufferers and to work observantly….
Dr. Eric says
You are very welcome Effue. I agree that it would be great if more doctors focused on helping patients improve their immune system health.
What natural supplements do u recommend for thyroid if u cant get a prescription?
Debbie Esterline says
This is a very informative article written about ways to raise low T3 levels. I was diagnosed with hypothyroidism thru a complete thyroid panel that my very smart and wise gynecologist at the same time that I was diagnosed with stage I uterine cancer. At that time my TSH was 5.75 with low T3 and low T4 and high antibodies, but I put off taking medication for it until after my cancer surgery. When I went back to my doctor after surgery to have another thyroid panel done, my TSH went from 5.75 to 25 after only 6 months. By this time it was very necessary to go on medication, and my doctor suggested NatureThyroid. I believe that my auto-immune thyroid condition was brought on my cancer experience, and was made worst after surgery and radiation. My TSH, T3, and T4 are stabilized after being on NatureThyroid for over 5 years, but I’m wanting to be able to reverse my condition so that I won’t have to be on medication. I’m not sure what triggered my hypothyroidism nor how to reverse it, but I’m working on it.
Dr. Eric says
I’m glad that you enjoyed reading the post, and I’m also glad that you are doing well with the Nature-Throid! Although some people do need to stay on thyroid hormone replacement, hopefully you will eventually be able to wean off or at least reduce the dosage. Either way the goal should be to try to address the cause of the problem, which it sounds like you’re trying to do.
Some people have a genetic predisposition to low T3. After taking a genetic test, I found out the reason for being tired and sleepy since childhood: I have a number of gene snp’s that cause poor conversion of T4 to T3. It has been just sub clinical until after menopause. After menopause, the hypothyroidism became debilitating.
Dr. Emily Lipinski, ND says
Awesome article Dr. Eric! I have definitely seen some great improvements with improving T3 in patients by addressing “leaky gut” and/or “SIBO” as well as using selenium and zinc. And addressing stress is so crucial! Thanks for sharing- great read!
Dr. Eric says
Thank you for sharing your experience about your patients Dr. Lipinski! Without question addressing stress is very important.
Kia A. says
I was diagnosed with hypothyroidism in 2013 when I were trying to conceive my now 3 year old son after the doctor prescribed me levothyroxine for a few months. Is there anything I can take or eat over the counter to build my T3 and T4 hormones.
Dr. Eric says
Kia, it depends on what the cause is for the hypothyroidism. If it happens to be due to nutrient deficiencies then eating foods rich in tyrosine and other nutrients essential for thyroid hormone production can help. But for most people this isn’t the primary cause of their hypothyroidism, and when this is the case then you need to find out the cause of your condition.
I’m a 40-year old female current wondering if I have t4 to t3 conversion problems; I’m working on cleaning my liver and eradicating 2 strains of Geotrichum spp from my lower intestine.
With that said, do you believe that low free t3 and / or conversion problems can cause severe brain fog? I’ve been plagued for months to no avail.
Also, I’m trying to find a local and trustworthy endo ( not through my hmo-they’ve all brushed me aside saying my labs are “ normal”) who will test a full range of thyroid hirmones. What tests do you recommend? Money is no object.
Thank you fir your time, care, wisdom, and insight.
Dr. Eric says
Laura, there is no question that if someone has low T3 levels due to a conversion problem that it can cause brain fog. But of course there can be other factors as well, which I’ve discussed in the following article I wrote on the topic:
As for thyroid-specific tests, I always recommend TSH, free T3, free T4, thyroglobulin and thyroid peroxidase antibodies, reverse T3 is a good idea. These are the main ones, although some will also choose to get the total T3 and total T4, and T3 uptake.
Meera G says
Hi Dr. Eric,
My free t3 levels are just below the cutoff, but my free t4 is within normal range. I had it tested twice, about 3 months apart and the result was the same. However, my doctor says free t3 levels are not reliable as they breakdown so fast. What do you say about that? I have a lot of food intolerance issues, acid reflux, as well as infertility.
Dr. Eric says
Meera, I disagree with your doctor, as while T3 does have a shorter half life than T4, you should see healthy free T3 levels on a blood test. If your free T4 is normal and your free T3 is a little low then this suggests a conversion problem.
Thank you for very interesting information. I have trouble converting T3 and have been taking synthetic T3, but the side effect of my hair falling out is really depressing. I noticed you mentioned, ‘ Some of these thyroid glandular only include T3’, I have been looking for a natural form of T3 only to take instead, but can not find anything. Can you advise where to find some? I also take NDT.
Dr. Eric says
Paula, I have recommended a product called GTA from Biotics Research, which has T3.
Mandy Brookes says
Hi how can i get the supliment that you recommend my t3 is 3.8 and tsh and t4 in low end of normal hairloss and tiredness is my concern thanks
My problem seems to be elevated reverse T3, with normal TSH, T4, and T3. My doctor said it’s a conversion problem, but won’t put me on any medication due to everything else being within range.
My most recent labs:
rT3 – 31.2
Free T3 – 2.6
Free T4 – 1.3
TSH – 1.48
TPO Ab – 121
So there seems to also be an autoimmune element, but my doctor said the antibodies are still pretty low.
I’m exhausted. I’m 34 years old and cannot even carry groceries inside without being completely wiped out. I’d like to treat this. It seems like T3 would benefit me to help lower the reverse T3, but I’m worried about self medicating. What is your advice? Thank you!
Dr. Eric says
Kathyrn, I agree that your free T3 is a little less than optimal, and so it does look like you might have a conversion problem. And even though the antibodies are lower than many others this doesn’t mean they should be dismissed. While taking T3 might help, it probably is best to first focus on your adrenals, gut, and liver. Here is a blog post I’ve written on conversion problems:
Hi dr eric ..iv been diagnose wtih hypothyriodsm 5 monts ago but when i turn back in past i came to conclussion that the the disease started 10 years ago and more..as the time past i havent any kind of symptoms related with with hypo.but at late 2013 my consciousness start decreased whas the first symptom iv been dealin with..but after several years more precisely 2017 i started gain weight , i have increase appetite, i felt more anxious , depressed , my legs starting to shake as result of lack of coordination and balance , poor memory , lack of focus or difficulty with concretation , cold intorlerance low body temperature heart palpation thingling in thr arms and legs muscle weakness , pain in the joints, double and blurred vision and the list goes on..i do blood test 4 monts ago and doctor describe me synthetic t4 ..my tsh was 6.6 uU/mL my free t4 was 15 , TPO antiboides was right..after several monts on euthyrox my tsh lvl got 4.4 and t4 was good 15 pmol/L ..but i have same symptoms as before i take the medecation ..then after months of research on internet from one side to another and trying to find out whats the cause if my doctor says ur blood results are fine and thats in ur head though about all symptoms i mention above to him..after hours of researching why im still feeling same with normal tsh and free t4 , TPO antibodies good TG good , then i founs out that free t4 does not always convert to free t3 ..then i found my self in all those symptoms iv been experience with cause of low free t3 or free t4 doesnt converted to free t3 ..what do you suggest me , only fre t3 replacement hormone , or mixed t4 with t3 , but cause my t4 is normal range though just t3 would be more beneficial correct if im wrong , plus adding zinc and sellenium plays crucial role in conversion from t4 to t3 as all other sites i visit the recommended those to minerals ..last but not least is my problem is life long though about been on medication till rest of my life or once the symtpoms goes away ill cause i have been living with this disease 10 plus years and didnt find till 5 months ago ..i rly appreciate if u give some answers to my questions so i can know what should do to save my life and live without symptoms iv been dealin aith 5 years..Ty again and i wish u all the best to u and ur family , and most important thing health ..
Hello Dr. Eric,
I have been reading a few articles you have published and I wanted to get your opinion of my doctor’s treatment plan. I have been diagnosed with thyroid hormone resistance and my doctor has steadily increased my medication over the years . I have been seeing him for 4 years now and he has prescribed me t3 triiodo-l thyronine 30 mcg. I started out with 15 mcgs and now I take 30 mcg. I have seen an improvement with my energy levels , but my weight has increased since being on the 30 mcg and I have been having more mood swings. I have also been having more brain fog .I have tried to explain this to my doctor ,but he feels based on my blood work my resistance has gone down while on 30mcg.
He doesn’t want to adjust my medication. I don’t know what to do. My diet has not changed since being on the new medication and I exercise regularly. Do you have any advice or recommendations on any natural alternative methods I could try?
Dr. Eric says
Ann, have you read my blog post on thyroid hormone resistance:
My t3 level- 0.6
T4 level -5.10
And TSH -1.42
I believe I have hypothyroidism but can you pls tell me what is its cause ? ( is it related to nutrient deficiency ?)