Adding T4 to NDT…and more mistakes we had to learn from!

STTM 2006 to 2015Update: The blog post below was originally written in 2006, when I, Janie, was learning just like the rest of you!

But there are five key points that I, and all of you as fellow thyroid patients, had to learn that go against what I originally said below.

Those points involved iron labs like ferritin, your FT4 lab result, adding T4 to NDT, and what menopause can do to your optimal amount of Natural Desiccated Thyroid (NDT.)

 

Here are five corrections to my original 2006 blog based on a myriad of patient experiences and wisdom since then:  

1) You can never just go by Ferritin alone

Ferritin is your iron storage hormone. Yes, it can be low along with low serum iron. But we’ve discovered it can also be low from having HIGH iron (aka hemochromatosis), or having high heavy metals from the MTHFR mutation. And you wouldn’t know if you have either of the latter if you ONLY went by you Ferritin lab result. You’ll see all the iron labs we found were important on the Recommended Labwork page. 

2) It’s not a good idea to get your free T4 towards the top of the range (along with that free T3) 

This was a huge discovery based on many of our experiences, including mine! i.e. the higher in the upper part of the range we got our Free T4, the more likely our bodies were going to start converting that T4 to Reverse T3 (RT3) to clear it out. RT3 is an inactive hormone. So as your body starts making that RT3, you will find yourself more hypo and/or with hyper symptoms. For me, upon getting my FT4 higher, my BP started rising!

3) Conversely, it has NOT been a great idea for most of us to add synthetic T4 to our Natural Desiccated Thyroid

Instead, we found it important to simply raise NDT high enough to get rid of our hypothyroid symptoms, and it has worked great for the vast majority just by itself. NDT is 80% T4 anyway! There may be individual cases where adding T4 to NDT has worked, but one has to be very careful, since you you risk having the T4 turn to RT3, the inactive hormone.

4) Ladies: The amount of NDT that worked for you before menopause may not work afterwards

I’m a good example. I was at 4 grains before full menopause (and even experimented with 4 1/8 grains) in 2006 and did fine. But that’s because I was severely estrogen dominant at that time (which binds some of those thyroid hormones). When I ceased to be estrogen dominant after meno, 4 grains was too high for me, and even caused a buildup of RT3. I did much better at 3 1/2 grains.

5) There are many great brands of NDT besides Armour to consider (it was the most popular in 2006, but there are now many great brands to look at).

All those brands are listed here. Besides, in 2015, Armour tripled in price and some patients also reported it had changed since their symptoms were coming back. See this blog post about the 2015 problems with Armour.

And here are key points I wrote about below in 2006 which are STILL TRUE today:

1) An optimal amount of NDT puts the TSH below the range (and we don’t experience bone loss or heart problems, as some clueless doctors will proclaim)

2) An optimal dose of NDT seems to put our free T3 towards the top of the range and our free T4 around mid-range, and it works great for most.

3) Going through peri-menopause can confuse things.

4) Most patients report it worked well for them to completely drop their Synthroid/T4 medication when starting on NDT…or to drop it fairly soon after starting NDT.

JanieSignature SEIZE THE WISDOM

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P.S. Here’s my original 2006 post below. What you see in RED represents information that our experiences and wisdom corrected, which is above.

When I switched from Levoxyl to Armour on one day in July of 2002, the difference in my well-being was so stunning that I never looked back. In fact, I was so stunned that I started an internet talk group about natural thyroid hormones in August of 2002. I went from someone who couldn’t even sand a small wood project without being debilitated (Yes. Really. With a “normal” TSH and on Levoxyl)…….to someone who could eventually own her own store and stand ALL day. I am now on 4 grains, multi-dosed and sublingually, plus 1/8 grain at night. I have a free T3 at the top of the range, and a suppressed TSH.

Along the way, I’ve had to correct low Ferritin. Additionally, I’ve had to deal with some serious peri-meno issues caused by a plummeting progesterone level with a still high estrogen level.

All in all, my thyroid treatment with Armour alone has been a HUGE success story! I can work on my feet all day and wake up refreshed the next. And I haven’t needed a nap in years.

But…there has been one phenomena that has made be ponder. Namely, if I do several back-to-back days of busy activity, or, if I do something of high physical intensity in one day, I don’t recover as “speedily” as my friends who do the same with me. In other words, they will wake up refreshed, and I may need another day to do so.

And the above has made me ponder. Is it due to cellular damage from being on the lousy T4-only treatment for 17 years? Is it due to a need for adding a bit more Armour when I do excessively physical activity? Is it due to my body’s poor reaction to entering the meno-phase of my life? Or, is it due to my mid-range free T4?? I do remember that Dr. Dommisse of Arizona would seek to optimize BOTH free’s in his patients. And, I’ve heard that a doctor in California is doing the same. And I’ve wondered: does the higher free T4 provide what is needed due to conversion for recovery purposes??

So…I have decided to try an experiment…adding a small amount of T4 to my 4 1/8 grains of Armour. Remember: Armour as pig thyroid is approx. 80% T4/20% T3 (as compared to the human thyroid 93/7), and several patients on Armour tend to only get their free T4 to mid-range…even with an optimal high-range free T3…and I’m one.

I’ve been on 25 mg. thyroxine for over 6 weeks now. After 4 weeks, I “thought” I’d noticed a difference. But alas, I am also dealing with the effects of my stressful entry into menopause. So, it’s hard for me to tell what’s going on with adding T4! I also haven’t done labs yet to SEE where I’ve gotten my free T4, but will be seeing my doc soon.

Bottom line: though I am reporting my experiment to the readers of this blog, I honestly can’t discern yet with clarity what positive effects it’s having because of my peri-meno issues. But that is not taking away of the possible benefits of getting BOTH your free’s towards the top of the range. Dommisse of Arizona states the following:

“The brain seems to need to receive thyroid hormone in the form of T4 as well as T3, and then converts T4 to T3 INSIDE the brain cells. e.g., Patients on the so-called Wilson’s T3-only approach get good relief of physical symptoms but retain their brain fog, memory loss, concentration problems, etc.. The other reason it is a good idea to have your “reserve” of the T4 thyroid hormone as high as possible (as long as that is without any adverse effects)- so that, if you miss a dose of T3-containing preparation, you can possibly convert T4 more readily to T3 than if the T4 level is not as optimal.”

NOTE: if you are new to using Armour, please note that I am NOT advocating that you pressure your doc to add ANYTHING to your Armour…yet. That can only complicate your goal to find your optimal dose. If you still have problems on Armour, it’s a strong sign you simply aren’t on enough, or have low cortisol or low Ferritin. Remember: I feel GREAT on Armour–need NO naps, have excellent energy, no weight gain issues, etc.

I have also noticed that some STAY on their T4 when starting Armour. That may not be a bad idea since it would help you bridge over, but it can also end up confusing the issue of where your optimal dose is down the line!! As a thyroid patient advocate, I have noted that those that use their T4 one day, and get on Armour the next WITHOUT the T4, generally have an easier time finding their optimal dose down the line without confusion. And do know that some on Armour alone obtain that high-in-the-range free T4. I am just not one of them.

 

47 Responses to “Adding T4 to NDT…and more mistakes we had to learn from!”

  1. Ellie Doe

    Oh, Janie, do I ever know what you’re talking about with the poor recovery from exercise. Whatever it is that’s out of whack, when it’s out of whack, I can have sore muscles for DAYS from the wimpiest bit of exercise. Is it just the thyroid – not enough T3 making it into the cells, and therefore the mitochondria can’t do their work? Is it an insulin-resistance thing? Is it an adrenal thing?

    All I know is, that when I’m feeling good, I can exercise and have just a normal amount of soreness after. When I’m not feeling good, a 15 minute exercise video can leave me sore for days, to the same degree that I was sore after climbing a mountain when I was well!

    And the worst thing? When my uber-fit H tells me I’m just sore because I’m “out of shape”. Grrrrr!!!

    Ellie

    Reply
  2. Administrator

    I think when anyone has recovery problems, they need to answer to themselves a few key questions: 1) Is your free T3 towards the top of the range? 2) Are you adrenals strong, or are you giving yourself cortisol?? 3) Is your Ferritin optimal (i.e. 70-90)? 4) Are you going through any other stressors (like myself with not entering menopause like a lamb)?? And if you can verify all the above with a resounding yes, 5) where is your free T4? I say “potentially” because I don’t know yet whether raising my free T4 is the answer. Still waiting to see.

    Reply
  3. Kelly

    Janie:
    Thanks so much for your site! This info has been more helpful than the multitude of docs I’ve known. 15 months ago I learned my T3 was very low, T4 and TSH were okay. I was given Cytomel, lost 10 lbs like that (snap fingers). About 7-8 months later, here we go again, weight gain, tired, yada yada. Doc misread lab work (T4 was almost zero!) All he said to do was cut back Cytomel, obviously no results. Another doc gave me Synthroid, cut back Cyto again didnt even do a free T3. Not working. Went back asked for Armour. Started at 30mg, seemed too low. I increased (tripled oops) gained weight. Went back to Synthoid only. Nothing. Contacted first doc, he said he recommended Armour otherwise use Syntho with NO CYTO! What?!?!? Armour includes T3, why would you not incorporate Cyto WITH the Synto? I read your website, ding! Light bulb went off. Started including Cyto with the synth and guess what? Yep, lost 2 lbs, had a ton of energy, feel great! A little hyper so I think I may cut back just a little. My point is while these docs are “educated” and well paid so many of us are finding answers and treatment with the help of each other. People like you and others who are fed up with the yo-yo of these docs just pacifying us without listening. I’m with you, heck with the TSH, mine is only 0.031 but my T3 and T4 are back up and I FEEL good. Isnt that what matters? Thanks for your site, its a lifesaver to know we are not alone in seeking how to feel good—-no thanks to the “professionals”
    One question: I’m taking 125 synt + 25 Cyto (multi-dosing) per day. If I venture back to Armour whats the equivolent dose and whats your opinion if it’ll work? I did gain when I was on it but could that be the affect of too much? Thanks again

    Reply
  4. Janie

    Hi. I will tell you hands down that Armour is far better than even a synthetic T4/T3 combo. Why? Because patients who switched from the combo to Armour stated over and over that they notice a difference. How much to take? It’s all individual and there’s no way to give you an equivalence, because something about Armour is so much better. You gained while on it before because you weren’t on enough. For further help, please go to the Forums…and anyone else, please do the same if you need individual help. 🙂 Lots of moderators there ready and willing to help!

    Reply
  5. Robert

    There are reasons that armour and synthroid work on different patients. Armour treats primarily T3 and synthroid treats T4. If the T4 is low and that is the CAUSE of the low T3 then synthroid is the replacement to use. If the T4 is great but the T3 is low then Armour is the replacement. The only problem is that when you replace T3 you will eventually lower your T4 through what is a negative feedback system. Cytomel (T3) lowers the TSH way more than Armour thus Armour usually is better for replacement. You guys are totally playing around with your system and it is hit or miss. Armour is not right for all neither is Sythroid yet both have the place. I have thousands of patients on both and combinations are sometimes the answer. Be careful when experimenting with your thyroid replacement. It is always best for an objective person to be in control such as a Doctor or Practitioner.

    Reply
  6. Janie

    Sorry, Robert, but your comment reveals you are very uninformed and failing to listen to patients. Synthroid does treat T4 because it’s a T4-only medication. But treating the T4 alone doesn’t result in adequate amounts of T3 from the conversion. We have learned from experience, Robert, that direct T3 is needed. And Armour is far more than simply “treating the T3”. Armour is everything one’s own thyroid puts together–T4, T3, T2, T1 and calcitonin. It gives back the whole spectrum which is lacking in a T4-only treatment.

    And if some of those “thousands” of your patients are on thyroxine alone, you haven’t done your homework to find out how they’re really doing. Because bar none, every single one of them is going to have some symptoms of an inferior & inadequate treatment, including chronic low grade depression, or dry skin or hair, or less stamina than others, or weight gain, or difficulty losing weight, or high cholesterol…it’s an endless list, which you can also see on the page SYMPTOMS of HYPO. Because everything listed are recorded symptoms of patients while on thyroxine with a so-called normal TSH.

    And Robert, to say the best objective is for a doctor or practitioner to be “in control” is frightening. It’s our bodies, not yours. We live in them, and we feel them. If a patient’s wisdom and intelligence about his own body can’t be part of the doctor-patient equation, it’s tragic. It’s akin to the thousands of thyroxine-treated patients who come into your office, feel like crap, and the doctor says “Sorry, your labs are in range. You’re normal”. i.e. toss the anti-depressant scrip at the patient and ignore obvious symptoms which reveal that the TSH range, and thyroxine alone, suck.

    Reply
  7. Becky

    Janie, I’m just cheering at your reply to Dr. Robert. Totally spot on! You are more of an advocate to us HypoT people than any single doctor ever has been, at least to me. Keep up your amazing work, spreading the word – you’ve helped countless people come to WELLNESS.

    Reply
  8. caligirl

    Hi Janie,

    I am finding that my best thyroid dosage is a combination of Levoxyl and Armour. I am on 100 mcg. of levoxyl and 45 armour (15 3x per day) I wasn’t able to find “stability” on just armour and my free T4 was in the lower half of normal range. Once I got my free T4 bumped up into the upper half of normal range (I am currently 1.57 on a scale of .78 – 2.19) I started to feel MUCH better. It feels like the levoxyl gives me a solid platform to stand on and keeps me feeling much more stable with my energy and sense of general well being. And then the Armour keeps me sharp and happy. But I definitely felt more sluggish when my free T4 wasn’t making it into the upper range. The doctor also told me to take selenium to help with T4 conversion. I don’t think my current dosage is perfect just yet but I’m getting really close. I feel better than I have in years!

    Reply
  9. Janie

    Caligirl, as you continue working to find your optimal amounts, do remember that you want your free T3 to be towards the top of the range. If it’s not there, upping your Armour, and slightly decreasing the Levoxyl, will help. Glad you are getting close! 🙂

    Reply
  10. becky burton

    I too am on a combo of sythroid and WEsthroid. I take one yellow synthroid and 3 grains of the westhroid which is like armor. I was on more armor but I was itching so bad I couldn’t handle it. I am an avid exerciser. I go to the gym and do cardio 4-5 days a week. I use to jog an hour a day. I want to lose the weight and I am steady but it would be nice to lose the extra 5lb’s. Thank you for the oportunity to express myself.
    Becky from Washington

    Reply
  11. Jennifer from Missouri

    I just read all your comments and it’s good to know, finally, that there are others that have had the same experiences that I’ve had (ie. bad doctors, bad suggestions, bad advice, etc). All the comments are so helpful and I finally realize that I am not alone and that there are resources out there where people can help me get through this (and shake my doctor’s mis-diagnoses).

    To Janie and her peri-meno phase: I recently read this on wikipedia under melatonin. I’ve been taking melatonin for months now and it has really helped me to feel rested and wake up not feeling as tired. In addition, I read this (hope this helps)…

    Recent research has concluded that melatonin supplementation in perimenopausal women produces a highly significant improvement in thyroid function and gonadotropin levels, as well as restoring fertility and menstruation and preventing the depression associated with the menopause.[25]

    Reply
  12. Dixxie

    Hi all…First…thank you for all the great info I have discovered here. I have had a really bad summer trying to get my thyroid meds straight. I even went to Colorado to see Dr.(s)Lowe for metabolic fibro…I also have cfs/epsBarr/had Hep C for 20 years…did two rounds of treatment and have been non detectable for five years. Problem…when I did my first round of treatment the doc I was seeing sent me to an endo as my thyroid went hyper during treatment…the radiation (which we now know should never had been done ) fried my thyroid and damaged the rest of my endocrine system. I am now thinking my parathyroid is involved…while in Colorado, in July, way up in the mountains, I was able to get optimal sunshine…When I returned home to VA it was too hot and muggy. My vit D levels were so low I was suicidal. I was put on high doses of vit D and am still taking it…what I have discovered since is my cortisol is low…ferritin…am going to have checked immediately…but the vit D has helped my conversion of t4 so much that I went insanely hyper so I am now back on T4 only for now.

    During my research I discovered that NO two t4 products are alike…and several of them… mainly generics…contain sodium lauryl sulphates which is a carciogenic as well as not metabolised in the liver. I do not understand how the FDA can let a drug company use a known cancer causing agent be put into a medication at any cost.

    I have also found through saliva testing that I am estrogen dominant and I take a compounded progesterone everyday. I also have low cortisol levels which we are now watching. I have been to 8 different endos and none of them have come up with the same answer..now I work with my pcp and we are trying to keep my free t3 and t4 levels in the high range…we don’t pay much attention to the tsh. I did notice that the inactive ingrediants in synthroid are way different than any other t4 med…I apparently am allergic to one of them as my gums and liver became inflamed after three days…and it containes periodine???which could explain why I can only take 100mg of it vs 150 of levelthyroxine??? Any additional info is greatly appreciated.

    Thanks for the wonderful info I have found here…I have been able to get rid of the pain meds, the anti-depressants, and all other RX’s after learning what I have from this site…I am finally able to resume my gardening and excercising…have lost six dress sizes and actually have a sex life after 5 years of nothing…keep up the great work…Blessings Dixie

    Reply
  13. Lou

    I am on Armour and have had troubble getting my meds increased so it is like being on a roller coaster. I finally got a referral to an Endocrinologist, but she is afraid to throw me into hyper so she won’t increase my meds either. I have taken it upon myself to do so and I am finally feeling somewhat better after two months at 180mg. She wanted to switch me to a synthetic and I refused. Why is it so hard for them to understand lab results are different for everyone? I may be in what she thinks is the norm, but my symtoms say otherwise. Frustrated!

    Reply
  14. Carla

    I too am at my wits end! I could explain my history but all you have to do is review the others to know mine.

    At age 44, I am in menopause, high cholesterol, 50 lbs overweight, no libido, cannot focus, pain all the time, exercised so much by running/jogging started to bleed from the intestines….I knew this was madness when it took me several days to recover from a colonoscopy that went wrong a few months ago. I was called to do yet more tests-I went to my dr who in the past appeared to be listening. She said the TSH was normal and states something about calories in and calories out- even people in the concentration camps lost weight-not sure what that was supposed to mean but I knew in her eyes she was not listening at that time nor was she ever.

    I said ok-the weight is my fault, I am not doing enough. What about the other symptoms. She said that she suspects it is some type of long term virus and we have not isolated it yet. Long term virus?? I have been fighting this for 6 years. I find it hard to believe any virus lasts 6 years.

    Most of my life, I was always a health nut, knew about reading labels and understood them long before it was popular. I served in the military for 4 years and found it invigorating to be so active. I was also very active before and had always went to the gym. Was out of the military for 8 years prior to onset of symptoms and was very active. My dr has me feeling sloppy and lazy to tell me it is my fault. She also told me to stay under 1200 cals. I spent these past 4 days on low cal diet. I went into freak mode. I was just about out of my mind about midnight last night. I got up, ate some cereal and was able to eventually sleep-at least it stopped the dizziness. Today, I am eating very small meals 4 x. I feel much better. Some symptoms are still there. But the worst have subsided. I plan to try levoxyl and armor every other day to see how this goes. I appreciate this site as a sounding board but also very valuable information. I see a glimmer of hope.

    Reply
  15. Pamela

    I just have to add my name to this growing list of unhappy thyroid patients. Why are so many endocrinologists unwilling to accept the fact that the current mode of treatment is inadequate? Why is it so hard to get a free t3 test? I had always had some mild hypo symptoms but then was told that everything was normal because my TSH was 1.8. But due to a goiter, they recommended surgery. After surgery, I sank into a deep hole. I was completely incapacitated with all the hypo symptoms I had before surgery except now they were extreme symptoms. My TSH was 8.5 with a t4 of .8 and i was put on 80mcg Synthroid. When I reported that after 4 weeks I was still feeling horrible. I was told to see a psychiatrist. That doc refused to do a free t3. Thanks to this site, I immediately shopped around for a new doc and found one to prescribe Armour. I felt better the next day. I still have problems with weight gain, but my mental state is much closer to normal now. I think I may have an adrenal problem though and am going for new blood tests after being on Armour for 5 weeks. I know that if I didn’t find this site, I would still be free falling on Synthroid and still unable to work. I was even reluctant to leave the house! After 6 weeks on 80Synt. my TSH was 2.5 (t4??). 2 weeks later I was prescribed more Synthroid. But by that point I had already switched to another doctor that gave me Armour. That first doc dismissed all of my symptoms. How is any endocrinologist supposed to evaluate a person’s mental or physical state in a 15 min. office visit. If I say “I don’t feel normal”, “I’m avoiding people because I know i’m not normal” shouldn’t the doctor at least look into it? I’m sure my chart says “crazy” on it, but at least now I can laugh about it because I don’t have to see that doctor again. I can credit my health to this site and the information on how to get better, unfortunately, my doc with all that training did nothing but make me feel worse.

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  16. shawna

    Dear Carla:
    Actually the long-term virus or chronique virus diagnosis is NOT a bunch of hoak. NIH is currently funding a HUGE study on Chronique Fatigue Syndrome with the premise that it is cause by chronic viruses. Before there was no way of testing for a virus after the first 6 weeks of getting sick as all patients who were sick with a virus will register having antibodies whether he/she has come out of the sickness or not. Recentl however, with the advent of DNA of virus tests, docs can actually test for the DNA of a virus in the blood and tissue of patients and most who have a normal TSH and normal blood tests results across the board have tested positive with DNA results. In some cases (as with Parvo-virus b-19), they have been given IVIG treatment and then retested and yes the DNA test registers negative and the smptoms of pain and fatigue are gone. Most of these Chronic fatigue syndrome patients do respond positively to t3 treatment with Armour or ERFA as the disease effects t3–in other worddds the fee better-ie functional–on T3 or t3/t4 meds but not symptom free. The still have pain, intestinal problems and still get tired after excercise.

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  17. Jackie

    I have Hashimotos Hypothyroidism and have been treated with T4 only meds. Two yrs ago I saw Dr Peatfield privately as I had become increasingly more ill. He advised T3 medication as well as T4. Advised that I reduce the high dose of T4 and also take an adrenal support. This has worked well for me except that my blood pressure has remained borderline high now for some years. I am checking out if my GP will put me on Armour. She has in theory agreed but had only prescribed it once before and was unsure of the dose. Not sure if this was a way of putting me off but I am persevering. I am currently on T4 50mcg and T3 50mcg. I have been on 100mcg T3 but went into a massive 3stone weigth loss (very nice but not to continue with). My question is to check what dose of Armour would this suggest I start on. I am used to being aware of my own body and symptoms and adjusting, though its hard to convince my Doctor of this. Affording Private is no longer possible as I have retired. Affording T3 medication is a problem too as my Doctor would only prescribe T4 and I have to purchase all supplements. I am hoping Armour will help but need to understand the dosage. Can you help?

    (Here are great thyroid groups to give you feedback: http://www.stopthethyroidmadness.com/talk-to-others)

    Reply
  18. Monica

    Interesting information! When I switched doctors a year ago I had a mid-range FT4 and a very low FT3 on the highest dose of thyroxine my doctor at the time felt comfortable prescribing: 200 mcg daily. Now, I’m on 300 mg of Armour, have slightly out-of-range FT3 levels and still only mid-range FT4 levels. It seems I cannot get them above 1.1 without adding T4. I have thought about adding some T4 to the mix, but I have read that FT4 levels are not supposed to exceed 1.4, or the risk of reverse T3 increases? Is that correct?

    (From Janie: Most do fine with a mid-range FT4 on desiccated thyroid.)

    Reply
  19. traci

    I couldn’t be more confused. I’m on 150mg of armour. Recently got labs because I’m still feeling blah. T3 was 5.1, TSH was .04, T4 was within range. I honestly don’t know what it’s going to take for me to feel better, but all my doc does is keep upping my dose.

    Reply
  20. Eleni

    I just converted from Synthroid/Cytomel (112/10) and the endo put me on alternating doses of 60mg/90mg of Armour. Just took my blood test after 8 weeks and my TSH was 57! My TSH on the Synthroid/Cytomel dose was .04. The Endo followed the conversion chart – why is there such a huge difference in dosage? The Endo is now upping my dose to 120mg of Armour a day. Has this happened to anyone else?

    Reply
  21. Debbie

    Im not sure if this has a lot to do with what you all have been discussing, but I have taken Armour Thyroid for about 15 years. All of a sudden a new dr. Wanted to change me to Levoxyl, so like a dummy, I agreed. After about 2 to 3 weeks, i started having headaches, among a whole lot of other issues. I went through menopause around 50, I’m now 58 and let me tell you, I feel like I’m going theough it all again. I went back to her. She asked me if I wanted her to change me back. I said yes, so she did and increased the dose. It’s now been 3 weeks and i still feel lousy. The headaches and depression is awful. I’m very fearful and afraid I’m going to die. I pray that God gets me through this. There are times that I feel I’m losing control. The dr. Insists its nothing serious, and iisn’t real concerned. I have switched drs again but can’t get in to see her until April 14th. Hope i can get thriugh until then. I just need some encouragment and maybe some counseling.

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  22. Helen

    Janie, just wondering if you continued with adding T4 to your NDT dosage? My doctor is trying that with me now. I’m a little hesitant about it as I’ve heard it can cause reverse t3 issues. My RT3 ratio is very good right now. I was researching the internet to find information on this approach and was surprised to see that you had tried this too and am interested in knowing more about your experience with it. I’ve been following STTM and am a member of the FTPO groups. Thanks!

    Reply
    • Janie Bowthorpe

      Be hesitant!! It’s a mistake to do it. This was originally written in 2006–we’ve learned a lot since then. Remember that NDT is 80% T4 anyway. When people start adding T4 to NDT, you greatly increase your risk of having too much T4, which will then cause your body to rid of it by converting to more and more RT3, the inactive hormone.

      Reply
      • Linda

        My doc just did this to me – I was so happy on 90 of Armour – she lowered it to 45 with a50 of leboxyl. I’m trying desperately to find an Armour savvy dr. In MA/RI WITH NOT MUCH SUCCESS. Been hashis since 1987.

        Reply
  23. susan

    I am a 57 year old menopausal female. Have has Hasimotos disease for 22 years. Am on 2.25 Grains of Armour Thyroid, Biest 1.25 mg and Progesterone 50 mg and Prinival/Bystalic for Blood Pressure.. Jan 2015 I had a harsh “flu like ” virus. April 2015 (along with the rest of my family) I had a mild “flu like” virus lasting about a week. Day 5 into the “flu” I noticed severe pain in my right shoulder joint and upper shoulder muscle, with pain going up into my neck on the right side, muscle weakness all over, my thyroid area pained and the skin over it flamed red. In May I further developed frozen shoulder in the same arm, muscle/ joint pain all, 96.2- 96.6 degree low morning body temp, joints crackle and pop. Currently I have frozen shoulder, dry mouth, neck pain on the right side and shoulder blade pain when I lay down on the opposite side, joints crackle. (I have to lay flat as as my right shoulder collapses/ severe pain.) On 7-9-2015 I got blood work back. All CBC with Differential tests are completely normal. Liver and Kidney function chemistries are completely normal except for Glucose 115 (range 74-100),
    Magnesium 1.8 (range 1.9 – 2.7)
    T3, Total 0.85 (0.87 – 1.78)
    T4, Total 5.59 (6.09 – 12.23)
    TSH 0.04 (0.34 – 5.60)
    (Previous to this in 2013/2014 my TSH and Free T4 was out of range low, Free T3 was low normal range). Suggestions please, I feel like I aged 20 years in 4 months. Susan

    Reply
  24. Kellie

    Hi Janie,

    I would love your thoughts on the following; I was diagnosed 25 yrs ago with Hypothyroid (Hashimotos?). Antibodies have been found previous, but not with every test. I was on Synthroid up until Sept 2011. This is an example of one of my last tests with Synthroid, TSH 2.86 (.30-5.6), FT4 12 (9.2-21.0), FT3 4.6 (2.9-6.0). Since I switched to NDT, my FT4 has always been on the very low end of the scale, in fact my last recent test is TSH 1.29 (.35-5.00) and FT4 9 (12-22) FT3 not captured. A year prior, my TSH was .07 so my physician reduced my prescription by 30 mg a day. My TF4 looking back since starting NDT in the fall of 2011 has ALWAYS been on the low side, and often outside the range, with the FT3 in the mid to upper. My Functional Dr at the time said that was not an issue. In April of this year I woke up one day like a truck hit me, flu like, lactic acid weak burning muscles, muscle cramps, pulled muscles. Achy at times. I have gained 30 lbs, I have dry eyes and mouth, I am a hot mess. I am still waiting on a dx, Fibro is the word of the day. Could my low FT4 contribute to these symptoms? Could it be affecting my Adrenals, or possibly my Pituitary gland may be dis-functioning. I appreciate any educated information you can provide. I have gone from a normal, fit and strong physical person to waking one morning almost disabled. I should mention I’ve been tested for Lyme twice by our local Public Health with both tests negative. I will not go home and remain this way like it has been suggested, I refuse! Thanks many. Kellie 🙂

    Reply
    • Janie Bowthorpe

      Kellie, based on all we’ve learned, if a free T4 is that low, we found it implies being on too little of NDT. The TSH also implies it, because when we are optimal, the vast majority of us get a TSH below 0 (mine is always .004 or .009, just as one example)…and we have to fight a practitioner who lowers our meds based on that TSH result. This explains what we’ve learned: http://www.stopthethyroidmadness.com/tsh-why-its-useless i.e. going by that TSH keeps us sick!!! And yes, if we stay underdosed due to TSH-obsessed doctors, our adrenals have to kick in, and they become stressed too. We’re learned to also do an RT3 test along with the FT3 to see if that’s a factor, too. http://www.stopthethyroidmadness.com/reverse-T3

      Reply
      • Kellie

        Thank you so much Janie for your prompt, knowledgeable reply.

        In fact when I was at .07 I was surprised as I thought perhaps I was hypo yet I agreed with the Dr. to allow her to lower my dosage. I worry that if I am in a hyper state (from lab results) it could affect my heart and bones. We have agreed to increase my dosage from 90 to 120 five days a week and recheck in 8 weeks. The only reason though we are raising it is to see whether surpressing the thyroid can eliminate my hives/angiodema.

        Can I ask what would an ideal panel look like for an avg person? Where should the free T4 be in the range, along with the FT3?

        Do you think my test results are enough to make me this sick and disabled? Can you actually wake up one day totally shifting in health, this sudden? I have no motivation, I am emotional, depressed, gone are the days of being physical, energetic, driven and joyful, I no longer recognize myself. Its really disheartening.

        You are a blessing, many thanks. 🙂

        Reply
        • Janie Bowthorpe

          Like doctors do, you are misunderstanding the TSH lab result. It’s with Graves disease, the hyperthyroid of the coin, that one sees potential bone loss and heart problems along with that low TSH. Read, read: http://www.stopthethyroidmadness.com/tsh-why-its-useless

          And here’s where the majority of see our thyroid labs when we are optimal on NDT: http://www.stopthethyroidmadness.com/lab-values

          The symptoms of still being hypo are different from person to person, but depression and lack of energy are two very common symptoms of still being hypo.

          Reply
          • Kellie

            I suspect I have more than just hypo going on, perhaps some severe adrenal fatigue with additional hormonal issues. One knows that they are dealing with a serious medical crises when they have to rest after making the bed, so sad, I must find some answers as this is no way to live. 🙁 Working with a naturopathic or Functional physician hopefully will make all the difference in my world. I will review the links shared, thank you again!

  25. Rebecca

    What do you make of these labs? Two separate doctors are concerned about the FT4 being so low. I am on 90mg Armour and 75mcg Cytomel (split 50am and 25pm) I FEEL GREAT!!! No palps, no shakiness, no sweats, BP good. I started the Cytomel because of reverse T3 problems. Couldn’t go higher than 120mg Armour without hypo symptoms coming back. One doc suggested I add synthroid – told her no way and she said fine stay on current doses. Another doctor suggested I cut back on the Cytomel (I consult with him in another state for LDN) but wont that cause hypo symptoms to return? Idk, I’m at a loss if anything even should be done. I certainly don’t want to do myself harm in the long run. Admins at STTM on Facebook all say my numbers look good and I should just stay the course on current meds and dosages. Thoughts?

    FT3 3.9 (2.3-4.2)
    FT4 0.37 (0.61-1.12)
    TSH 0.035 (0.34-5.6)
    RT3 5.6 (9.2-24.1)

    edited to add: adrenals are being taken care of with adrenal cortex – I do have hashi’s last TPO 59.8 – iron/ferritin are optimal – D and B12 optimal and supplemented

    Reply
    • Janie Bowthorpe

      Well, from what we’ve observed in each other (which is what STTM is about), it may be that you are converting the T4 you are giving yourself quite well, plus 90 mg is not very high. So perhaps that’s why the T4 is so low. We haven’t seen it being a problem in other patients, as long as the free T3 is in the upper quarter, where yours is, and we feel great with everything else like BP and heartrate being good, too. P.S. if you were getting high RT3, it’s usually either a cortisol or iron problem that needs discovery and treatment.

      Reply
      • Rebecca

        So, just to clarify, the low FT4 really isn’t a big deal and I should just stay on current meds, especially since I am feeling great. If hypo symptoms come back or something changes then re-evaluate. Wonder why the docs freak out so much about this?

        Reply
        • Janie Bowthorpe

          It hasn’t been a big deal for others, especially those on T3-only–that’s just what I’m communicating. So it’s up to you. Why do the docs freak out? Poor training in our opinion, and it may be more about your TSH. A TSH goes low with Graves disease…and Graves disease often sees bone loss or heart problems. So they mistakingly thing that OUR low TSH on the right amount and right kind of meds equals the same, and we definitely do NOT see that. In fact, our bone and heart health improves!!

          Reply
  26. Stacey Roberts

    Hi Janie,
    thanks for the awareness that you bring to the importance of looking at thyroid differently than most professionals do. It is great that women and men are being educated on how they can become empowered and communicate with their physicians more effectively and find physicians more supportive of their choices. There is one thing though that I have noticed in my clinic over the last decade that is something you may want to consider. Some women on desiccated thyroid experience gradually lowering t4 levels, so much so that their menstruation stops and/or they have their symptoms of hypothyroidism come right back. If NDT is raised to try to compensate they have palpitations or feel unwell. This happened to me personally. So I switched to and have found a combo of T4 and T3 more beneficial for me. Not everyone needs to be on T4/T3 combo, its just what worked for me. So there is a percentage of people that the desiccated thyroid doesn’t seem to work well for. Also you say in the article above that we shouldn’t aim to have t4 levels at the top of the range because that will only encourage t4 to convert to reverse t3. This isn’t true for patients on my program UNLESS their adrenals are not functioning optimally. If their adrenals are fatigued or exhausted the person will likely convert T4 to RT3 to help the body conserve more energy. So if the adrenals are addressed women do very well with T4 at the upper end of the range unless they do not have the nutrient base to help convert T4 to the active form of T3. But everyone is different and feels better at different levels so a very individualized approach is necessary.
    With over 2 decades of working in health care what I know for sure is everyone is different.
    thanks again for all that you do.
    Stacey “the Baby Maker” Roberts PT, Naturopath

    Reply
    • Janie Bowthorpe

      Hi Stacey. Glad to have you post. Yes, empowerment is crucial when we face so many who keep us sick.

      But there are things you are missing and I hope you will be open to learning. First, gradually lowering T4 is usually because the person is still underdosing, thus the T4 starts to convert like mad to give them the T3 they need…and falls. We see that all the time. Second, another common reason for that T4 to decline is due to it converting to too much RT3, and the latter is due to having a cortisol or iron issue. Same truth if they raise and start to see palps and feeling worse, Stacey. Time to learn from us:

      1) How we raise: http://www.stopthethyroidmadness.com/natural-thyroid-101 and
      2) Why people see palps and/or feel worse when trying to raise (#2): http://www.stopthethyroidmadness.com/ndt-doesnt-work-for-me

      i.e. the T3/T4 combo seems to work for these people because it takes away what NDT reveals via symptoms (inadequate iron or a cortisol issue) but it’s still not as great a treatment as NDT when one corrects the iron and/or cortisol issues. The latter is not my opinion about feeling even better on NDT–it’s based on years of reported patient experiences.

      And finally, sorry but it is true by many, many reported experiences that the higher we push our FT4, the more it’s going to convert to more and more RT3…and that doesn’t have to occur with adrenal issues. It has even occurred with people who had great adrenal function. It has even occurred when FT4 was at 1.5 with the top of the range at 1.7.

      Reply
  27. Ann

    I have a teen who is on WP Thyroid. The endo is concerned about her Free T4; it was below range. He orders Total T3 (not free T3). My daughter is still having hypothyroid issues, including weight gain. The endo wants to add Levoxyl to the WP if her next lab work in a month does not have her Free T4 within range. He has said the ratio of the NDT versus what we as humans have aren’t the same and over time it creates low free T4 in people who take NDT. I do not want to add Levoxyl, but I am at a loss as to what to do next. These lab results were when she was taking 1 grain daily (her dose was recently increased by 1/4 grain). I’d appreciate your words of wisdom!

    Here are her labs:
    Free T4: .60 (.80 – 1.7) [done by dialysis]
    TSH: 2.67
    T3: 89 (71-180)

    Reply
  28. Ann

    Thank you, Janie. I think the hardest thing is figuring out “how” to relay the needed information to the endo without ticking him off since he has a medical degree and may not be open to hearing what works in these situations. It is quite frustrating.

    Reply
  29. R.m

    I’m one of these people whom has declining t4 levels. Dr wants to add t4 to my current dose of ndt as it is well below range. All 4 iron levels are low but my adrenals were fine 12 months back but I can’t cope with the current hypo symptoms whilst I wait for iron to increase and or/adrenals to mend. So what do you suggest I do until Levels are right to increase ndt. Feeling lost on this one.

    Reply
  30. Hadassah

    Janie , can one split (cut) with a pill cutter 1gr. NDT into quarters with out diminishing or lowering the potency of the NDT ? I was given script for 1gr. and I find splitting is much easier for me to dose .

    Reply

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