When is T4 supplementation needed?

Published: April 17, 2013

Where TSH is steadily rising now at 2.8 and Free T4 is always low around 12 (range 10 - 24) but Free T3 is high 6.9 (range 0.5 - 5.7) would this still indicate the need to T4 supplementation? If conversion is doing so well what would be the point? This is in conjunction with SIBO, hair-loss, fatigue etc but with gluten,dairy and sugar free diet already in place. No antibodies, adrenals, vit d, ferritin and B12 all ok. Your thoughts would be most appreciated.


In this setting in my patients, the first question is are they taking any T3 containing products. If yes, then the test is meaningless and I would likely increase the thyroid dose if symptoms overall are suggestive in any case. If on no T3, I would check a reverse T3 level and if high, suggests that T3 is the preferred form of thyroid. If not, Armour thyroid. But again, much more info and your doctors experience would be needed to move forward properly with treatment in your case.

Dr. T

Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. His newest book (June 10, 2024) is You Can Heal From Long COVID. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.

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