“Pooling” in Hypothyroid Treatment: A Patient’s Insight

For those managing hypothyroidism, the phenomenon of “pooling” can be particularly challenging. This term refers to a condition where free T3 levels in the blood increase without effectively reaching the cells. When patients attempt to raise their T3 levels through medication—whether using synthetic T3 or desiccated thyroid containing T3—they may experience symptoms typically associated with hyperthyroidism, such as heart palpitations, increased heart rate, and anxiety.

What is Pooling?


Pooling occurs when your free T3 is not adequately absorbed by your cells but accumulates in your bloodstream. This can result in increasingly high levels of T3 as you adjust your medication dosage, accompanied by symptoms that can mimic hyperthyroidism.

Causes of Pooling

The root cause of pooling is often linked to adrenal stress, which can manifest as low or high cortisol levels or low aldosterone levels. Identifying and addressing these underlying issues is crucial before any adjustments to T3 medication can be successful. Traditional blood tests for cortisol may not provide accurate insights, as they only reflect cortisol levels at a specific moment and mostly measure bound, inactive cortisol. Instead, a saliva cortisol test, which can be performed at home, offers a better measure of active, unbound cortisol levels.

Symptoms and Diagnosis

Pooling can be subtle and may not be initially evident. However, typical signs include an elevated free T3 level alongside persistent hypothyroid symptoms such as fatigue and depression, or hyperthyroid-like symptoms such as anxiety, shakiness, and elevated blood pressure. To diagnose this condition, patients might consider a 24-hour adrenal saliva test to assess cortisol levels and a blood test for aldosterone.

Managing Pooling

Once diagnosed, managing pooling involves addressing the adrenal issues. Treatment strategies may include adjusting T3 medication to reduce hyper-like symptoms temporarily while exploring adrenal support therapies as detailed in medical literature and patient-shared experiences.

For comprehensive management, it is advised to consult with a healthcare provider who understands the complexity of thyroid and adrenal interactions. Educate them about saliva cortisol testing and the significance of treating adrenal insufficiencies to effectively manage T3 levels.


Pooling is a complex but manageable aspect of hypothyroid treatment. Understanding and addressing the adrenal components of this phenomenon are essential. For more detailed guidance on the treatment and management of pooling and related adrenal issues, referring to resources like the Stop the Thyroid Madness (STTM) book, particularly chapter 6, is recommended. These resources provide invaluable insights into effectively navigating the challenges of hypothyroidism treatment.

For further reading on the interaction between T3 and cell receptors, visit this research link.