Acne on T3-only therapy for hypothyroidism

This article does not review research articles. It only details my careful personal experience and N=1 trials with acne while on T3-therapy for hypothyroidism.

(For the reasons why I had to switch to T3-only, see some of my other posts.)

Phase 1: Transitioning through T4/T3 combination therapy

As soon as I started transitioning from T4-only (Synthroid) therapy to T3-only (Cytomel) in April 2016, I started getting acne rosacea, within days of starting T3 at 5mcg while still on 100mcg T4. Every two weeks I increased T3 by 5mcg and lowered T4 by 20mcg. While my overall health gradually improved, my acne got worse in phases.

Phase 2: Adjusting T3-only dose and timing

Eventually after the 2-month gradual transition, I was finally on T3-only, and my acne gradually improved as I slowly increased my 3 daily doses in increments of 2.5 micrograms/day every two weeks. I stopped increasing T3 doses when my careful daily measurements of body temperature, heart rate, and other direct signs of hypo/hyper-thyroidism showed that I had reached an ideal T3 replacement dose. By that time, the general skin redness had almost disappeared from the “butterfly zone” and I was experiencing fewer and less frequent outbreaks of tiny whiteheads.

However, even on the ideal dose of T3, some acne still remained on chin, nose and forehead. The red little dots left in the skin after gently popping whiteheads still took too long to heal, and I was still getting occasional breakouts of whiteheads.

Guessing that perhaps the fluctuation in T3 levels was irritating my skin, I experimented with 4x/day dosing instead of 3x/day for at least two weeks. However, spreading the daily total dose over 4x/day actually worsened my acne and hypothyroid symptoms like low body temp. I recalled that Paul Robinson (author of T3-only therapy books) had said that in his experience, each dose of T3 needed to be large enough to be a “wave” that powerfully pushes into the bloodstream, and that slow-release T3 or smaller & more frequent doses could be ineffective.  I switched back to 3x a day and experienced improvement in overall health and acne.

During phase 1 and 2, the acne could not have been due to a change in diet or any other supplements, since those remained constant.  The acne only responded to T3 dosing and dose timing.

Phase 3: Facial creams & makeup

After those two phases, I entered a third phase to see what else I could do. Changes in facial creams & makeups made a small improvement:

  1. I had been using a dermatologist-prescribed cream for my acne (Metronidazole) and suspected it might be interfering with my natural skin bacteria that can be beneficial in preventing acne. I switched to coconut oil mixed with a bit of tea tree oil, lathered on, rinsed with warm water, and towel-dried. This did improve my facial health somewhat, and also mosturized very well. Coconut oil did not show any evidence of “clogging” pores as some people have suggested it would.
  2. I had beein using drugstore makeup to conceal the acne at work and social events. I switched to an organic brand (Gabriel) from a natural health store, and this also improved my facial health, but very slightly.  I took many “days off” from makeup during holidays, and I removed the makeup soon after coming home, but acne still remained.  Acne did not seem to get any better or worse when I used this new makeup or took holidays from it.  At least the new makeup was not worsening the acne.

At this point when I was feeling great on T3 otherwise, but I still had some acne, so I started to wonder what element my skin might be lacking in order to heal itself.

Phase 4: Investigating iodine balance

Online, I saw controversy regarding the helpful or harmful role of iodine in acne, and general agreement on both sides that iodine levels can directly influence acne.

I remembered that T3 and T4 were composed of IODINE molecules, and considered that perhaps my iodine metabolism had changed as I changed my thyroid medication and hormone levels.

  • T3 has one less iodine molecule than T4.
  • In addition, I now take lower quantities of T3 (50mcg/day) than I had previously taken of T4 (112/125mcg / day).
  • My latest lab test results showed extremely low T4* and low TSH.* This likely meant that my iodine “(re)cycling” through thyroid hormone metabolism/catabolism/production no longer involved my (damaged, tiny) thyroid gland.
    *this lab result of low T4 and Low TSH is not a signal of thyrotoxicosis or hyper-thyroid state; it is normal for a person whose thyroid gland does not need to produce anything because the body is getting enough T3 directly via Cytomel.

However, I was afraid to supplement with iodine since I had been frightened away by literature that cautioned Hashimoto’s/Autiommune thyroiditis patients to stay away from iodine, telling me that for me, taking iodine (at least, without sufficient selenium) would be like throwing kerosene on a fire.

I also thought that before I try taking iodine, I should do my best to reduce any existing chemical interference with my iodine metabolism.

Phase 5: Reducing bromide intake from mineral water

I learned that bromide can block iodine from being effective.

My favorite bottled mineral water, Gerolsteiner has some bromide in it.  I decided to stop taking that bottled water and go with tap water and teas.

My acne didn’t improve much, but at least I became more aware of bromide issues.

Phase 6: Iodine from kelp

Next step: conservative and careful iodine supplementation.  I figured I would start first with iodine from foods.

First I started eating “seaweed snacks:” those salted thin wafers of seaweed that you can buy as snacks.

I found that it did bring an improvement to my face.

Then I started taking 2-3 pills of Norwegian Kelp by Natural Factors per day. Each pill contains 750 micrograms of iodine.  It has brought even more improvement.

I’m going to try increasing iodine gradually in small amounts and see if it reduces my acne further.


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