NDT or T3 doesn’t work for me!
It does nothing for me.
I feel worse on it!
It makes me anxious, shaky, or nervous.
My heartrate or blood pressure goes too high.
My hair falls out!
I’ve had panic attacks!
I’ve gotten nauseated.
I have a headache now.
My T3 is high but I still feel bad.
I’m having insomnia and trouble sleeping now.
There’s a very explainable, and very correctible reason why NDT or T3 didn’t work for you and/or caused you problems!
1) First, there are a certain percentage of you who have stayed on a starting dose too long or have simply stayed on too low a dose, thus a worsening of your hypothyroid situation and symptoms.
A starting dose is usually one grain (60-65 mg), and we have learned repeatedly that we meant to raise from that approximately every two weeks or less by 1/2 grain, slowing down a bit somewhere in the 2 grain area…or as you near 3 grains, to start fine tuning to find your optimal dose. NOTE: If this is the case, you will start feeling better as you raise. If not, see below. The highest percentage of thyroid patients aren’t optimal until they are in 2 grain area and/or HIGHER. Some end up in the 3-5 grain area before optimal. You need to read the section on finding your optimal dose on the Natural Thyroid 101 page.
2) But for the rest of you reading this, especially if you are having symptoms of “anxiety, shakiness, heart palps, high heart rate, insomnia, nausea, a high FT3, a low FT4, increased hair loss, and/or etc”…you probably have one or both of the following which NDT is now revealing: low cortisol and/or low iron.
Both of the above (iron and/or cortisol problems) are very common reasons why someone doesn’t do well when raising NDT or T3, In other words, NDT isn’t “causing” your problem; it’s “revealing” your problem. And by the way, if your response is that your cortisol or iron labs were normal, not that labs have nothing to do with simply “being in range”. more below.
Iron–what does this have to do with it?
Hypothyroid patients frequently find themselves with inadequate levels of this important metal. Why? It’s usuallyl all about your stomach acid, which falls too low thanks to being on T4-only, or being undiagnosed, or being undertreated. As a result of that lowered stomach acid, you absorb less nutrients like iron, and thus, your levels aren’t optimal and problems ensue.
Without adequate levels of iron, the T3 in desiccated thyroid (or T3-only such as Cytomel) will build higher and higher in your blood, unable to get to your cells well. This is called pooling. You can then start having symptoms similar to hyper–shakiness, anxiety, high heart rate, etc. Or, you just won’t feel a thing from the T3. Often, you will have a low FT4.
Cortisol–what does this have to do with it?
Just like iron, we learned that if we don’t have enough cortisol to keep adequate levels of blood sugar in our cells (one role of cortisol), T3 will simply miss the turn into our cells and build higher and higher in the blood, causing the same hyper-like symptoms mentioned above. Or, you will feel nothing from the direct T3 in NDT. Or T3 will go high. The same will occur with high cortisol!
And we found two important truths about testing cortisol:
- We can’t go by blood. Blood results are measuring a combination of bound and unbound cortisol, and gives no clue what’s in our cells, looking high when it’s not (or even low when it’s not, as reported by some patients).
- We have to do the 24 hour adrenal saliva test instead, which will reveal our cellular levels at four key times during a 24-hour period. You can order your own saliva testing here. And again, these results have nothing to do with “falling in the normal range”. They have to do with WHERE they fall, as explained here.
But I worked on both of these and still didn’t do well on NDT!
Note that “improved” doesn’t equal “optimal”. And “being in the normal range” also doesn’t equal “optimal.” As far as iron, we have learned precisely how to raise iron and where it needs to be, which you can learn about here or at the beginning of the Odds and Ends Chapter in the revised STTM book for additional details (pages 181 – 187 in the English version).
As far as cortisol, a person can fail to correctly treat their cortisol issues as follows:
- thinking that taking only adaptogens can do the job (they frequently aren’t enough if you have low cortisol).
- not understanding how to use cortisol (many take too little, or dose it wrong, or fail to do Daily Average Temps to find the right amount…plus more details (Chapter 6 of the revised STTM book has the best details anywhere on how to use cortisol-containing products)
- thinking that avoiding stress can do the job (helpful, but often not enough)
- thinking that a change in your diet can do the job (it’s not enough)
- failing to understand where your saliva cortisol results need to fall as explained here (for those who aren’t on anything yet)
- not understanding the correct way to do the T3CM or that it’s mostly just for low morning levels
- and more….
Are there other mistakes I could have been making to cause NDT not to work well, even with optimal iron and cortisol?
Definitely! They’ve been made by many and learned from each other the years. A common one is not raising NDT high enough because your doc keeps you hostage to the TSH lab test, or your doc isn’t familiar enough with NDT to raise it high enough, or your doc starts adding in synthetics when raising is usually enough. But…you still have to have good iron and cortisol levels to even raise successfully. Read about all the mistakes patients make in their treatment.
Should I stay on T4-only while correcting my low iron/low cortisol?
It’s not necessary. In fact, it’s not desirable. Patients tend to convert to too much RT3 while on T4-only. We learned instead to either be on a small amount of NDT (such as 1 1/2 grains or less) or T3-only in small amounts. You are looking for the amount that isn’t causing either pooling or high RT3 symptoms.
What if I can’t even tolerate the lowest doses of NDT?
For a few rare individuals, they may have inherited a faulty deodinase enzyme (meaning you can’t convert T4 ever)…the best solution for these individuals appears to be T3-only, multi-dosed about 3 times a day, with a fourth smaller dose at bedtime, for example. The vast majority reading this are simply having their low cortisol and/or low iron being revealed, and those are treatable!
What about Lyme disease and tolerating NDT?
There are many with Lyme who report doing well on NDT. Others find the Lyme and related co-infections are driving their T4 to excess RT3, possibly due to the high or low cortisol response. This may need lowering of NDT and adding in straight T3. Another smaller group with Lyme are finding it makes them quite sensitive to red meat…but haven’t yet gotten evidence that they would react to NDT. We’ll see.
Bottom line: NDT has always been shown to give the best results–just like a healthy thyroid would do! You just have to learn what it’s telling you when it doesn’t work well, and treat those issues correctly. Because unlike T4 with its history of problems, you just don’t want to miss out what NDT can do for you…or even adding T3 to your T4.