A Healthy Thyroid Gland Can Compensate for Poor T4 to T3 Conversion – Implications for Thyroid Treatment

Dr. Tania S. Smith of Thyroid Patients Canada has written a technically excellent article entitled Thyroid T3 Secretion Compensates for T4-T3 Conversion. I will attach two links at the end of this introduction.

Dr. Smith’s article is an analysis of the classic 1990 thyroid science article by Alessandro Pilo and team, and it supplements it with insights from more recent thyroid science.

The article debunks the commonly held view about the 20/80 origin of T3 hormone in the body. It also disproves that view that, on average, our T3 supply arises from a 20:80 secretion to conversion ratio. The reality is more wide-ranging and diverse. It also reveals the flexibility of the healthy HPT axis.

My own main interest is always about what a scientific paper means in terms of proper and effective thyroid treatment. Well, it will be obvious to the reader who reads the summary that Dr Smith has written and the full article that for some people who are on thyroid treatment Levothyroxine (T4) therapy is never, ever going to work. It should also be clear that for some people the loss of some or all of the thyroid through Hashimoto’s, thyroidectomy, or other adverse conditions, that simply adding a little T3 to the T4 treatment is also never going to be enough.

Those thyroid patients who have had a thyroidectomy or have lost significant thyroid tissue due to other causes, like Hashimoto’s or Atrophic Thyroiditis, are at a huge disadvantage to other patients. This group of thyroid patients are more likely to find difficulty in resolving all their symptoms with T4 medication alone.

It is important to be aware that the diversity of individuals is such that some are far more reliant on their thyroid gland to compensate for poor peripheral tissue conversion than others. When these people develop a thyroid condition they will only ever return to being healthy by being given a significant amount of T3 in their treatment. Well, of course, many of us are well aware of the variation between people, but sadly the majority of the medical profession operates as if all our thyroid glands and thyroid hormone processing are identical. We are treated as if we are identical robots that have come off a production line. This is not true as the article carefully and methodically explains.

One of the big implications of the article to me is that T3 (Liothyronine) treatment must always be an option available for use if the patient does not respond symptomatically to T4 treatment. We really do need a new paradigm for thyroid treatment. The old one is utterly broken and leaves many thyroid patients highly symptomatic and in some cases extremely ill.

The article is quite long and has three separate parts to it. It is definitely worth spending the time to read it. However, Dr. Smith has also kindly written a summary of the article for those who are short of time or want a good idea of what it is about before reading the full version.

Here’s the link Dr. Smith’s summary of the article:

Here is the full article (but it is also linked from the summary above):

Best wishes,


Paul Robinson

Paul Robinson is a British author and thyroid patient advocate. The focus of his books and work is on helping patients recover from hypothyroidism. Paul has accumulated a wealth of knowledge on thyroid and adrenal dysfunction and their treatment. His three books cover all of this.

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