An Integrative Doctor’s Primer on Low Thyroid Diagnosis, Therapies and Diet

* Dr. Richard Podell is Medical Director and Clinical Professor in the Department of Family Medicine at UMDNJ-Robert Wood Johnson Medical School. A leading expert on the scientific integration of conventional and alternative therapies, he specializes in stress-related disorders, clinical nutrition, and ME/CFS/FM.

Here he briefly explains hypothyroidism (low thyroid), the medical difference of opinion on how it should be diagnosed, “mainstream” vs. “natural” treatments, the importance of selenium, and the often-overlooked Hypothyroid Diet. Reproduced with kind permission from Questions? Visit Dr. Podell’s Facebook page at


Low Thyroid, Hypothyroidism, and Natural Hypothyroid Therapies – Should we treat with Cytomel® or Armour Thyroid® even when thyroid blood tests are normal?

Mainstream Thyroid Treatments

Most “mainstream” physicians believe that one should not treat with thyroid hormone unless standard thyroid hormone blood tests are abnormal. They usually prescribe the T4 form of thyroid hormone, rejecting any role for the T3 forms of thyroid, Cytomel® (aka Liothyronine) and Armour® Thyroid. [T4 stands for thyroxine, and T3 stands for triiodothyronine – see “How Your Thyroid Works.”]

Natural Hypothyroid Therapies

Many holistic, integrative and complementary alternative medicine physicians believe that many people are effectively hypothyroid (thyroid deficient) because they are unable to make the main active thyroid hormone – which is not T4 but the form found in Cytomel and Armour Thyroid, that is, T3.

This low T3 form of hypothyroid, they assert, does not show up on blood tests, because it occurs inside our cells, not outside in the blood stream.

Rationale For T3 Natural Hypothyroid Therapies:
Cytomel or Armour Thyroid

The standard thyroid hormone medicine, T4, that most doctors prescribe, is not the active form of thyroid hormone. The thyroid makes mostly T4, and secretes this into the blood. Then our cells take up T4. But before the cells can put T4 to work, cells must convert T4 to a natural hypothyroid hormone, known as T3.

•  Synthroid® and Levothyroid®, the most often prescribed thyroid hormones, contain only T4.

•  Cytomel (generic name Liothyronine) is 100% T3.

•  Armour Thyroid (pork-derived) is about 60% T4 and 40% T3.

If the cell has a decreased ability to convert T4 (Synthroid) into T3 (Cytomel), cellular metabolism could be too low – that is, hypothyroid for lack of T3 – despite the standard blood thyroid hormone tests being normal. If the cells have trouble converting T4 to T3, then natural hypothyroid therapies have to supply the needed T3, most often by treating with Cytomel or Armour Thyroid.

Ironically, almost all mainstream experts agree that difficulties converting T4 (Synthroid) to T3 (Cytomel) can occur. However, most mainstream thyroid specialists believe that only a few individuals suffer from low T3 intracellular hypothyroid.

In contrast, most alternative medicine thyroid doctors believe that T3 deficiency within the cells is actually a common problem. Hence, their emphasis on natural hypothyroid therapies such as natural Armour Thyroid, or the synthetic T3 medicine, Cytomel.

Factors Associated with T4 to T3 Blockage

We do not yet have enough first rate studies of natural thyroid therapies, but recent research shows that there are quite a few settings in which T4 to T3 blockage may occur. For example:

•  The enzyme that converts T4 thyroid hormone into T3 requires the mineral selenium. If selenium nutrition is sub-par, the cell cannot produce as much T3. Zinc, Vitamin A, and Vitamin D may also be needed.

•  Hypothyroid diets: Certain otherwise healthful foods, in large amounts, can block the production of both T3 and T4. [More about this below.]

•  Severe physical illness can also block the formation of T3. These conditions may include such common conditions as Fibromyalgia and Chronic Fatigue Syndrome.

•  The stress-hormone cortisol (cortisone) can block T3. Both physical and emotional distress often make cortisol rise. This is especially so among persons with anxiety and depression.

In recent years, leading mainstream psychiatrists have accepted that thyroid hormone therapy for people with depression can improve mood – even among people whose standard thyroid blood tests are normal. T3 forms, Armour Thyroid and Cytomel, were used in most studies, although Synthroid or Levothyroid also may work.

Dr. C.B. Nemeroff, MD, PhD, chairman of the Department of Psychiatry & Behavioral Sciences at Emory University School of Medicine, endorsed the use of natural hypothyroid therapies as an adjunctive treatment for depression [stating]: “Augmentation of tricyclic antidepressant or selective serotonin reuptake inhibitor therapy with thyroid hormone (T3)… has been shown to be effective in open and controlled trials.”(1)

While low doses of thyroid hormone supplements are relatively safe, higher doses can substantially increase the risk of potentially dangerous cardiac rhythm abnormalities and other health problems. Such side effects should be taken into account in weighing the potential benefits versus the risks of thyroid hormone treatment, especially at higher doses.

Practical Steps: When Are Hypothyroid Diets, Cytomel
or Armour Thyroid Alternative Thyroid Treatments Indicated?

Most advocates of thyroid treatment suggest that the following factors should make you think about alternative thyroid treatments such as hypothyroid diets, Cytomel or Armour Thyroid:

•  If your symptoms “sound like” typical low thyroid symptoms – e.g., feeling cold, constipation, gaining weight, feeling tired, sluggish or depressed.

•  If before you get out of bed, you take your under-arm (axillary) temperature for five minutes and your temperature is usually below 97.6 degrees.

•  If when your doctor uses a reflex hammer to measure your ankle reflex, it takes a long time for your ankle to return to its normal position.

•  If your standard thyroid blood tests show that your pituitary gland is having to work extra hard to push your thyroid to make thyroid hormone, for example, if the TSH (thyroid stimulating hormone) blood test is higher than 3.0. [“Higher” TSH levels tend to be associated with lower thyroid production, because the pituitary produces more TSH to stimulate the thyroid.]

•  If sophisticated thyroid tests show low levels of free T3 or free T4 thyroid hormone.

•  Or if there is a high level of a thyroid blocking hormone known as reverse T3.

Contraindications for Alternative Thyroid Treatments
Including Cytomel and Armour Thyroid

There’s rarely a “free lunch.” A low dose of thyroid hormone supplement is very unlikely to cause harm, but exceptions can and do occur. More important, as thyroid treatment doses increase, so too does the risk of side-effects. These risks apply both to the standard T4-containing thyroid treatments (Synthroid and Levoxyl) and to the T3-containing alternative thyroid treatments (Cytomel and Armour Thyroid).

The most important potential risk is among people with heart disease, especially those who are prone to irregular or rapid heart beat patterns (arrhythmia) or who are at high risk for heart attacks. High doses of thyroid tend to increase risk for abnormal heart rhythms, for angina and also for heart attacks.

Be more cautious about using mid and high level alternative thyroid treatments if you have:

•  Known heart disease or a high cardiac risk profile (over 50 years of age, high cholesterol, high blood pressure, cigarettes, diabetes).

•  Vulnerability to rapid, irregular or extra heart beats including ventricular premature beats and atrial fibrillation.

•  Medication that tends to promote heart arrhythmia, for example, tricyclic anti-depressants such as Elavil/amitryptiline, Digoxin.

Hypothyroid Diets and Alternative Thyroid Treatments

Hypothyroid diets are too often overlooked in both mainstream and alternative thyroid treatments. Poor diet can harm the thyroid’s ability to make T4 thyroid hormone, as well as the cell’s ability to convert T4 (Synthroid) into the active thyroid hormone, T3 (Cytomel and Armour Thyroid).

•  Dietary deficiency of iodine was once a very common cause of hypothyroid as well as thyroid enlargement (goiter). However, since iodine has been added to most brands of table salt, a hypothyroid diet due to iodine deficiency is now relatively rare. People who eat little seafood and who take very little salt might want to check their multivitamin to be sure that it contains iodine.

•  However, too much iodine is also not good on a hypothyroid diet. Too much iodine can actually block the thyroid’s ability to make hormone, so high dose iodine supplements are not recommended.

•  Hypothyroid diets due to thyroid-blocking actions from cabbage, brussels sprouts, broccoli, cabbage and cauliflower can block thyroid if these otherwise highly nutritious foods are eaten in very high doses.

•  Certain medicines can also block thyroid hormone, such as Lithium.

•  L-Carnitine, a powerful and potentially useful energy promoting nutritional product, can also block the thyroid if taken in high doses.

Selenium and Hypothyroid Diets

Selenium may be the “sleeping giant” of natural thyroid therapies. Selenium is essential for converting T4 thyroid hormone into its active form, T3.

Selenium may also have the ability to suppress anti-thyroid antibodies for persons who suffer from thyroid inflammation or thyroiditis. Repairing a selenium deficit could, in some people, actually repair thyroid metabolism by increasing the intracellular conversion of T4 to T3.

Effective hypothyroid diets should seek a broad range of natural foods including:

•  Whole grains

•  Seafoods

•  Nuts and seeds

•  Include a broad-based multi-vitamin

•  And Vitamin D and zinc may be important.

Research on Hypothyroid Diets and Alternative
Thyroid Treatments Including Cytomel and Armour Thyroid

Mary Shomon [author of Living Well With Hypothyroidism and The Thyroid Diet] is one of the leading advocates of natural thyroid therapies and alternative thyroid treatments. Her site has an immense amount of information and links to resources on Cytomel, Armour Thyroid and other products, hypothyroid diets, and alternative thyroid treatments. Her site has additional information, including material on alternative approaches to thyroid treatment.

Dr. John Lowe’s website is an excellent source of information about health and alternative thyroid treatments Cytomel and Armour Thyroid – especially as they relate to Fibromyalgia. [Dr. Lowe is a pain management specialist and author of The Metabolic Treatment of Fibromyalgia.]


1. Nemeroff CB. “Augmentation strategies in patients with refractory depression,” Depression and Anxiety, 1996-97;4(4):169-81.

Dr. Podell has offices in Springfield and Somerset New Jersey. For more information please see  And if you have questions about Dr. Podell’s current thinking on this or other subjects, visit his facebook page –

Note: This information has not been evaluated by the FDA. It is for general information purposes only and is not meant as specific advice or to prevent, diagnose, treat, or cure any condition, illness, condition, or disease. It is very important that you keep your professional healthcare team fully informed of all medicines and supplements you are taking, and that you make no change in your healthcare plan or health support regimen without researching and discussing it in collaboration with them.

1 Star2 Stars3 Stars4 Stars5 Stars (94 votes, average: 3.90 out of 5)

5 thoughts on “An Integrative Doctor’s Primer on Low Thyroid Diagnosis, Therapies and Diet”

  1. uxordepp says:

    This is probably the most concise and accurate assessment of therapies for hypothyroidism I’ve seen.

    I am not in entire agreement with his comments about iodine deficiency being mostly eliminated by iodized salt, or about the other iodine comments (Doctors like David Brownstein and Guy Abraham have written a lot on this subject), but generally a great article.

  2. nightbloomingcereus says:

    1. How much L-Carnitine is considered to be a “very high amount”?
    2. I have read about thyroid function or medication being less effective if the patient also takes estrogen or any form of ASA. Can these interactions (including with L-Carnitine) be reduced if: 2.1 These medications are not taken concurrently with the thyroid medication — for instance 12 hours separation? and/or 2.2 The estrogen is medically prescribed bioidentical HRT (refined from soy), not pharmaceutical (refined from the urine of pregnant horses)?
    3. Where can I (my physician) locate charts that translate dosages of thyroxine to dosages of Armour or Cytomel?
    4. If Armour is a combination of T-4 and T-3 (which I have not ever read before, even on the manufacturer’s insert posted online), and if, as the manufacturer’s insert does say, Armour is twice as potent as thyroxine, how does a physician know the dosage to prescribe?
    5. As for a combination, I thought Thyrolar/Liotrix was the combination manufactured by the same company as Armour, which, according to my pharmacist, has been discontinued.
    6. If a combination of T-4 and T-3 is prescribed (2 separate prescriptions) can we assume that when T-3 is prescribed in a small amount, then the T-4 (thyroxine)dosage is reduced by twice that amount?
    Thank you.

    1. AuntTammie says:

      I have read several places that soy itself can actually block thyroid hormones, too, so I would think that bio identical estrogen would not be any better in that respect than the synthetic.

  3. J.S.Nelson says:

    as fascinating as the article is, i never know which guidelines &/or to what extent i should include myself w/regards to the ongoing struggles between t3 & t4 because my levels are solely regulated by synthroid since my thyroidectomy. (*incidentally, i once tried to switch to armor, but i collapsed with stroke level blood pressure!).

  4. humanwrites says:

    I, too, would like to know how much L-Carnitine is too much. Apparently, the right amount is helpful … too much, counterproductive. I take ProHealth’s 500mg twice a day and feel confident I’m not overdoing it but would like to know what amounts this doctor is indicating.

    An article that changed my life is on Reverse T3:

    When Dr. Podell speaks of blood levels vs. cell (or tissue saturation) of T3, here is the formula used by these other people: “T3/rT3 x 100 should be between 1.06 to 2.2 … prefer upper end.”

    I am much improved since following the guidelines provided in my linked article. I graph my blood work, including my tissue saturation levels. The rising line which indicates the increase in my Cytomel is the exact mirror image of the descending line of my Reverse T3 Dominance. My Tissue Saturation levels have greatly improved and my natural TSH is has come into remarkable balance. I use the generic Cytomel, BTW, and it’s working fine for me.

Leave a Reply