A hopeful new article proposing that adding T3 to thyroid treatment is the way to go!

Screen Shot 2014-03-19 at 5.48.52 PM(This post was updated in 2015. Enjoy!)

In a recent article by thyroid patient Mary Shomon, there was mention of an interesting article by Dr. Wilmar Wiersinga that came out this year in the journal Nature Reviews Endocrinology titled “Paradigm shifts in thyroid hormone replacement therapies for hypothyroidism.” And I find this article fascinating.

I’m going to break it down a bit and add more important observations that I’ve not seen expressed elsewhere and which are important, because the truth stands out about T4-only and decades of patient experiences.

In the abstract summary of his article, he states:

Evidence is mounting that levothyroxine monotherapy cannot assure a euthyroid state in all tissues simultaneously, and that normal serum TSH levels in patients receiving levothyroxine reflect pituitary euthyroidism alone.

Informed thyroid patients can only shout Hallelujah!!

But actually, the evidence has been there all along…and the medical profession has not been listening!

For over 50 years since T4-only was pushed upon thyroid patients in the early 1960’s (not the 1970’s mentioned in the actual article), we haven’t done well on levothyroxine. But when we came into our doctors offices and complained of those pesky symptoms of continued hypothyroidism while on levothyroxine, the replies from our doctors have ranged from “You need to exercise more and eat less”, to “it’s just your age”, to “It’s part of being a busy mother” to  “Here’s a prescription for an anti-depressant/statin/BP med”….on and on.

My own mother was the classic example. She as put on Synthroid in the early 1960s in her forties. And from that time on until she died in her early eighties still on Synthroid, she paid continual and growing problems: chronic depression, rising cholesterol, heart problems, weight gain, body stiffness, inability to stand for long periods, poor stamina, dry hair and skin, and problems with her cognitive abilities. And today, informed patients know that all those symptoms are classic symptoms of continued hypothyroidism—all common in far too many patients on T4-only in their own degree and kind…sooner or later.

Stop the Thyroid Madness is the direct result of thyroid patients gathering in groups on the internet by the turn of the 21st century and proclaiming T4-only has only served to make them sicker!

Dr. Wiersinga also states in his abstract:

Levothyroxine plus liothyronine combination therapy is gaining in popularity; although the evidence suggests it is generally not superior to levothyroxine monotherapy, in some of the 14 published trials this combination was definitely preferred by patients and associated with improved metabolic profiles. Disappointing results with combination therapy could be related to use of inappropriate levothyroxine and liothyronine doses, resulting in abnormal serum free T4:free T3 ratios. 

That is a bit confusing to say “evidence suggests it is generally not superior to levothyroxine monotherapy”. What about the clinical presentation of patients shown every day in the offices of doctors over the past 50+ years?  Why have so many thyroid patients on levothyroxine for example, been put on anti-depressants, statins, BP meds, pain meds and more?

The Medical Dictionary defines “clinical presentation” this way: The constellation of physical signs or symptoms associated with a particular morbid process, the interpretation of which leads to a specific diagnosis.

Why has there been such a gap between what a doctor learns in medical school /continuing education vs. the clear clinical presentation by millions that underscores how poorly T4-only really has been?

As far as those “disappointing results” which Dr. Wiersinga mentions, informed thyroid patients have the answer: low iron and cortisol issues—both issues which all-too-many levothyroxine patients acquire due to being a poor treatment, and which either T3 or natural desiccated thyroid will reveal. Or, the patient is held hostage to the TSH lab test, leaving them underdosed, and again, many acquire either low iron and/or a cortisol problem.

Dr. Wiersinga concludes in his abstract:

However, in selected patients, new guidelines suggest that experimental combination therapy might be considered.

We agree and bravo!!

But Informed thyroid patients have a strong reply: why limit a better treatment to only “selected patients”?? Why continue to put each and every thyroid patient on one of five thyroid hormones, which more than 50 years have revealed has been an abject failure in too many, sooner or later?

Why not put the majority of your thyroid patients, not a “selected few”, on a medication which gives back the exact same hormones that one’s thyroid would be making in the first place, aka Natural Desiccated Thyroid Hormones? “Selected patients” should only refer to those who may need T3-only since they could have a conversion problem. 

The full article also describes three paradigm shifts, plus a proposed fourth one:

1)   1891, when the real gland (sheep at the time) was first used to treat hypothyroidism. bottle1

2)   1960 – 1988, when desiccated thyroid use declined and levothyroxine use increased

3)   the 1990s, when it was reported that T3 was needed after thyroid removal (but wasn’t pursued)

(See Chapters 1 and 2  in the revised STTM book for more excellent information)

And the 4th paradigm shift might occur, he explains, when those of us with poorly functioning thyroids could see regeneration from embryonic stem cells, as outlined in a 2012 study. Pretty exciting!

But I think a 4th paradigm shift has already occurred! A growing body of doctors have changed the way they treat hypothyroidism, and it’s by prescribing natural desiccated thyroid. As a southerner would say “Bless their little souls!!”

Until the possibility of stem cell treatment of our hypothyroidism becomes a reality, which may not be soon enough, we all hope to see better understanding by our physicians about what treatment really hasn’t worked well, and what treatment really does.

i.e. doctors need to return to the observation of “clinical presentation” 

Adding T3 to our treatment, and especially with natural desiccated thyroid, has changed lives. And we can at least shout “Bravo” to  Dr. Wiersinga for positively proposing that Endocrinologists consider the fact that perhaps, T4-only is NOT the way to go and adding T3 just might be for very good reasons. And by the way, thyroid patients also know that the TSH lab test is as much a failure as T4-only.  

Seize the Wisdom!

Yours truly,

Janie A. Bowthorpe

Post Script: The full article can’t be found in most places yet, but here is one place where the charge is less than others if you want to see it: http://www.readcube.com/articles/10.1038%2Fnrendo.2013.258





35 Responses to “A hopeful new article proposing that adding T3 to thyroid treatment is the way to go!”

  1. Clutter

    I was very ill on T4 monotherapy post ThyCa. T4/T3 combination has been an enormous improvement and while I don’t consider myself euthyroid yet, I do think I’m now close.

    The 4th paradigm, embryonic stem cell regeneration, sounds very exciting. Will it help Hashimoto’s and Graves’ patients too? I rather imagine that a regenerated thyroid will be subjected to fresh assaults by dormant lymphocytes?

  2. JennyAnyCat

    Thanks for this Janie – I saw the notification on the NTH Europe digest – does Dr W Wiersinga know that we approve of his research – and that you and others have blazed the trail for him? Doctors have ruined my life by a) ignoring hypothyroid for decades then when I went back six times to doctors asking for a blood test and offering to pay for it and eventually getting one …b) by providing T4 only and telling me I had just to get used to it – these doctors turned me into a moron who couldn’t even remember how to clean my teeth, never mind cook, clean or hold down a job, yet it was allegedly all my fault and I had just to learn to get used to it! I was on the verge of suicide having enduring this Hell on Earth for decades when I found this website on the net and it truly saved my life. God bless you Janie and all like you, Natural Thyroid Extract (plus Adrenal Extract and the companion nutrients) are giving me the hope that I might get some part of my life back in the end – but doctors never ever did – they just let me rot and stopped me being a useful member of society – and there are tens if not hundreds of thousands like me!

    • Janie Bowthorpe

      A lot of people read the STTM blog post, but whether Dr. Wiersinga does, I don’t know. Maybe someone can find a contact for him and send him here. And Jenny, I’m so glad you have hope again! 🙂

  3. brenda

    Thank you so much for this article. I’ve enjoyed reading this site for many years. It’s refreshing to find an honest site which isn’t simply echoing what all the other sites are saying. Keep up the GREAT work!!!

  4. virginia

    Hi there! I normally have pretty thick healthy hair that I have always been able to wear it long if desired. Anyhow, I wash it twice weekly and handfuls of hair come out each time and more when I brush it out. Interestingly I did not have this problem when I was on a little lower dose of Synthroid(81.5 mcg for 7 yrs and now 88 mcg for 1 year). So I was searching the web as to whether too much Synthroid could cause hairloss and happened upon your site. Do you think its the little higher dose this year or is it that I need T3 too and iron like your article states. I do not want to continue losing this much hair or I am going to soon look like a wet rat with thinning eyebrows!!! Please give me your honest advice and which brands and how and where to order

  5. Ashe

    I have just found out I have Hashimoto’s Disease and am looking for as much info as I can. Love the bits you have here – thank you.

  6. Alicia

    This is good news. Although Im really frustrated because I was just diagnosed with Hashimotos and I fortunately have a wonderful GYN who put me on Armour and it has started to really help me feel human again. However my Mom had her thyroid removed 4 years ago and is on Synthroid and from reading alot on your site. Which is wonderful . I asked her to talk with her Doctor about switching her to Armour and her Dr told her that the levels when using Armour dont always work as well. Needless to say I was upset because I want her to feel better too, it seems crazy that the Dr wouldnt even let her try it, even if it was better for her. She told me her Dr told her that alot of Drs are switching back to Syntroid now instead of natural desicated thyroid, Ugh just frustrated for my Mom sorry for the lengthy post.

    • Jennifer

      I have taken Armour to successfully treat my hypothyroidism for several years. My doc increased my dosage about two years ago to address lingering fatigue issues. The dosage ended up being too high and it caused my heart to go into AFIB – I was ambulanced to the hospital and spent three days in treatment to bring my heart rate back to normal sinus rhythm.. The docs at the hospital told me that, while Armour is actually one of the best medications available to treat low thyroid, it is one of the most difficult to manage proper doasage of. I learned first hand what that meant. This might be why your Mom’s doc is hesitant to prescribe Armour.
      I still take Armour, by the way, but my doc orders new blood tests any time we discuss changing the dose.

      • Janie Bowthorpe

        Jennifer! So sorry to read what you went through! It must have been scary for you!

        Actually, patient experiences overall show that their comment is quite wrong about Armour being difficult to manage. But yes, if they believe that, it could be a stumbling block. When people overreact to Armour, they either went up by too much, or the answer is here: http://www.stopthethyroidmadness.com/ndt-doesnt-work-for-me

      • Alicia Vetcher

        I have been on Armour for about 15 years with great rellief of my symptoms. On Synthroid, I couldn’t even walk, It did nothing to help me. I developed A fib also, but I never feel it. My heart rate wasv104 to125 resting. An echogram confirmed some valve regurgitation and one slightly enlarged atrium. My Armour was reduced 40%, from 450 mg. to 270 mg. Now I’m beginning to have low thyroid symptoms, again. What do I do? Feel good and hurt my heart or feel rotten until I die? This is an oversimplification of a depressed state of mind.

        • Janie Bowthorpe

          Hi Jennifer. Are u saying you felt fabulous on 450 MG of Armour with no fast heart rate or high blood pressure? If so, you need a much better doctor than one who lower the Armour like this one did. You may have thyroid hormone resistance which requires high amounts of NDT than others.

  7. Edwina

    I was taking Armour after half of thyroid was removed because of a goiter and a small speck of cancer. Then I was taken of by Gerson Therapy Clinic. When I went there to learn to eat right. When I came back I started to experience anxiety depression lots of stress my heart racing I thought I was having a heart attack. Went to too many doc I thought I was going crazy. Took many blood test saliva test. Dr told me my adrenals were weak and said that was why I had all these symtoms. Gave me also bio identical hormones and said that it would take 3months till I would get relief. Now I go to a Natural Clinic and he does muscle testing. He is not going to take me off of any med. but is helping my body detox. And supplement my thyroid bio function Gf. My endo dr is a jerk, he told me he did not need to see me but once a yr, so I am looking for another dr for my thyroid. I was put on Nature Throid at gerson and I think that is what is causing my miserable symtoms. I need a good dr that understands me.

  8. James

    Thanks for the great info, especially about the 4th paradigm.

  9. Cyn

    Please help , I have Hashimotos and I have been on Armour for a month after being on 50mcg Levothyroxine for 6 yrs , inspired by your site after an intense struggle with my doctor , he caved in and prescribed 60mg . however, I have been gaining weight and haven’t felt too great and my menstruation has lasted almost 9 days now compared to it’s usual 3 on Synthroid. Is this normal? I have an intense pressure on me to lose weight and Im feeling hopeless . I eat 800-900 calories and work out everyday. Should I add Cytomel as well? Any tips , ideas? thank you!

  10. Ellen Mapes

    I was diagnosed with Hashimotos and have been on Synthroid for around 20 yrs. Dosage was just changed from 60mg to 100mg. I am going to a regular doctor and she said that almost all of her long-term patients were increased in dosage after a period of time. I have been reading various articles and comments since last December and have gone gluten free, soy free, and especially sugar free. This seems to help my losing a little weight, especially the sugar free. I also switched to taking my Synthroid 1st thing in the a.m. on an empty stomach. I have been recently thinking of changing to Armour, as I have read that it is better choice of all Hashimotos medications. I have been tested by an endocrinologist, but T3 was not tested. I want to take care of my body and wonder if it is okay to “change horses in the middle of the stream” so to speak.

  11. Aphrodete Dimitriou

    I take 100mcg T4, for hypothyroidism. I also have full blown Hashimoto’s. I live in Greece and there isn’t any natural thyroid hormone brand here, also doctors are negative about T3/T4 combined therapy. I am convinced about incorporating T3 in my regimen. However, I don’t know what ratio is appropriate. How many mcg of T3 and how many mcg of T4 should I take?

    • Janie Bowthorpe

      Aphrodete, one grain of NDT is around 38 mcg of T4 and 9 mcg T3. It’s going to be impossible to tell you how much to take, as we all end up on different amounts and there’s really no this-for-that equivalence because of the differences in each person. But perhaps you can start on the former amounts and move each up until all symptoms of hypo are gone, plus you have achieved the right temperature, which in the morning before getting up (and holding mercury or liquid thermometer under arm for ten minutes) is 97.8F to 98.2 F…and afternoon is around 98.6F.

  12. Grecian Flower

    Have been on Armour for a year as opposed to taking just synthroid and noticed a significant difference. A great improvement. A while back on one of your blogs, I came across a supplement regimen for hypothyroidism which included specified dosages of selenium, B complex, iron and other vitamin and minerals which I am unable to locate. Could you please reprint this info. (if possible). Thank you for all that you do!

  13. Bonnie

    I am proof positive of this I tried for years to get my family doc to listen to me that something was really really wrong even though I was on levothyroxine and mind you at one pint on 300 mcg a day which was doing more harm then good and no one even Told me that high dosages can damage your bones well it took me getting a book at my wits end called the thyroid diet name is very misleading it isn’t a thyroid diet book it breaks thyroid disease down and treatments i took the book after i relocated to another state and got a new doctor and I went in and questioned her and explained look I need answers and explained im not getting better just worse she took note and realized I meant business and she changed my meds over to T4 and T3 and within 6 weeks my levels were better then they have ever been and my weight is falling off and I feel a lot better and have more energy i still have days where I am tired but fewer and farther between compared to before what people don’t realize is even though they are on T4 replacement that has to break Down and if your thyroid isn’t able to break it down and convert it to T3 you can take T4 all dam day long and it isn’t going to help that was what was wrong with me my body still wasn’t breaking it down or converting it my numbers on blood work went from one extreme high to the next extreme low i was on a human yo yo ride and quality of life sucked and my numbers now aren’t doing that and im glad I finally got my new doc to listen only took 5 years and moving to a new state and finding a new doc and questioning and demanding answers the medical community has a responsibility to listen to their patients and sorry but I’m not moving from a chair until someone listened to me for a change you have to stand your ground with doctors and make them stop and listen and don’t move until they do i know I use to walk out feeling like I had no choice well people and patients do they have a right to demand treatment and if your not getting the right treatment you have a right to demand further testing or exploring other alternatives but the main problem is people who have this disease don’t question they just follow they don’t research for themselves they just take the medical communities word. Well Ya got to stop i live in my body just as you do and if something doesn’t feel right inside your own body you need to question and keep questioning till someone listens and the Internet is an unlimited source of knowledge utilize it i have learned a lot by just researching on my own

    • Lannie

      How muchT3 did you add daily to the 300 mcgs of. t4?

      • Janie Bowthorpe

        If she doesn’t reply, patients report starting low, such as 5 mcg and 5 mcg (the second one four hours later approx), then slowly build up until they notice improvement plus a free T3 towards the top of the range.

  14. Leen Mattheus

    What is the equivalent of 100 mcg of t4 and 25 mcg of t3? Is it the same as being on 2 grains of NDT ? Want to switch to NDT but need some help, some say equivalent is different. THANK YOU

  15. debra bush

    I got up today with my fingers hurting
    And numb. Plus my arms are hurting bad to. I hsve really bad headaches plus my back hurts bad today too. I am taking synthroid. I dont think it is working. What should i do?

    • Connie Troyer

      Debra Bush – I have bad headaches also since I started having problems with my thyroid. According to my bloodwork, my thyroid level has normalized because of the synthroid I’ve been taking. But the synthroid is causing me all kinds of “side effects” if you want to call them that – extreme fatigue, aches and pains. I’ve been researching and would like to try Armour but I don’t know if my doctor will switch me to it. I will have to see when I have my appointment in August.

  16. Dr vinay mehra

    I. Think Homoeo medicine thyroidinum itself levels TSH

    • Connie Troyer

      Dr. vinay mehra – are you a general practitioner, internal medicine doctor? Is thyroidinum the name of the medicine – bought at natural medicine stores?

  17. Megan

    Hi all! I started an ndt from an online site last year & couldn’t stick with it because I was getting headaches and had no dr to help. Fast forward to this summer and I started Naturethroid with a D.O. helping me and the conversion was 3/4 of a 65mcg pill from the 75mcg of Tirosint I was on. I forget how many grains that is. The first 2 weeks I felt great & I also went gluten free & have lost weight & inflammation in my face. However, some buzzing/tingling started in my hands almost from the start & 2 weeks in I started getting some muscle twitches/spasms, a very painful left hip and peripheral neuropathy. I never had any of these symptoms prior to my Hashimotos diagnosis and treatment (Tirosint 75mcg for 4 years). Has anyone experienced this going to a t4/t3 combo med? Am I over medicated or undermedicated maybe? Thanks for your help!

  18. Emily


    So happy to have found this site, I have the book as well and have been gathering as much info as possible. I started on a grain and a half of NatureThroid 2 weeks ago after I had a total thyroidectomy due to Thyroid Cancer. In retrospect, I’m guessing that I have been an undiagnosed hypo for years but this is my first time treating it, and without a thyroid I am officially hypo. Each week I have dosed up half grain so I am now taking 2 and a half grains (morning and early afternoon). I may camp here for a bit though I am tolerating the Naturethroid well and am eager to have some more energy. Do dosing instructions change at all if you are completely without a thyroid? I started at a little higher of an initial dose for this reason and am curious if it changes any other dosing advice. I am also confused about the T4/T3 ratio. Is the desiccated thyroid the correct ratio or should I consider adding more T3? How would I know if this is necessary? Thanks so much for any advice.


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