A small dose of T3 can overcome deficits caused by a reverse T3 spike in subjects with 10-20% weight reduction.

“I remember you I think it was one night at dinner when you me Mike Rosenbaum were playing patty-cakes and and it somehow came out that in your 10 to 20% weight reduced subjects a little bit of teeth we could overcome some of the deficit and I remember having this Eureka moment because I was like wait a minute all these patients I see that lose weight have a reverse t3 spike that would exactly explain why giving them t3 rather than t4 would address the problem you give a patient with high reverse t3 t4 you just you're making them worse but you give them t3 you can bypass it”