Low triiodo-L-thyronine hypothyroidism can cause or aggravate a number of otolaryngic disorders including otoneurologic diseases (meniere’s syndrome, vertigo); neurologic problems (neuralgias, headaches, migraine), immune problems (allergies - especially to multiple foods or are difficult to control in spite of standard therapies, and recurrent infections - stomatitis, sinusitis, bronchitis); and dermatologic problems (hives, urticaria, eczema, dry skin, hair loss). When these problems present with typical hypothyroid complaints (excessive tiredness, excessive coldness, brittle nails) or there are also problems of autoimmune disease, chronic fatigue/fibromyalgia, constipation or depression, low triiodo-L-thyronine hypothyroidism is likely contributing or causing the disease.[i] These patients do not adequately convert tetraiodo-L-thyronine into triiodo –L-thyronine – the main thyroid hormone, which is four times stronger than tetraiodo-L-thyronine in elevating metabolism. Some of these patients are already on tetraiodo-L-thyronine  (Levothyroxine or Synthroid); however, they too continue to have a lowered metabolism because of their inadequate conversion to triiodo-L-thyronine.  Also, supplementation with tetraiodo-L-thyronine is significantly converted to its biologically inactive isomer - reverse triiodo-L-thyronine, which further dampens metabolism.  Therefore, analyzing metabolism by traditional methods in which only thyroid stimulating hormone and tetraiodo-L-thyronine levels are considered is insufficient and misleading.  Emphasis should be placed more on triiodo-L-thyronine analysis and treatment should be with triiodo-L-thyronine primarily, since it cannot be converted into its inactive isomer. 

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