Recently we were having a discussion about thyroid matters and I was having a hard time understanding the rational for the higher ratios like 20 to 1 or even 50 to 1. Diogenes was kind enough to walk me through the arguments and how the numbers were arrived at. Diogenes is worried about the effects of high T3 and is in favor of the higher ratios and also of using time release medications. I pointed out that I knew of no studies showing damage from the 4.22 to 1 ratio of NDT over its 119 year history and that some studies using the higher ratio showed no preference by patients. I thought this was due to the low amounts of T3 used. Every time I have a discussion with Diogenes I always learn something and he is always challenging me to think and grapple with new concepts.
I just finished a book by an endocrinologist who has been doing exactly what Diogenes proposed and has apparently achieved highly satisfactory results. Dr. Kenneth Blanchard is an endocrinologist with a PhD in Chemistry from Princeton and he is not your usual endo. "In summary, I would state that there has never been a situation in the history of medicine where fundamentally wrong teachings have held sway for so many years and hurt the quality of life of so many patients." He believes that about 20% of patients on T4 monotherapy do quite well and that about 80% would improve their QoL with the addition of a little T3, and I do mean little. He is using T4 at a 98.5 % and T3 or thyroid extract at a 1.5% plus or minus about 0.5% on either side. He is also using time release on the T3 or thyroid extract portion. He has treated about a 1000 patients or more and I believe his results are credible. He is a doctor who looks for results in the patient, not the blood tests.
Mary Shomon did a piece about him back in Oct of 2003 thyroid.about.com/b/2003/10... but I had completely missed his earlier book and the work he has been doing. It is next to impossible to read everything in a given field although Rod does a better job of keeping up with the journal articles than anyone else I have ever come across.
Now he did make a comment, "I don't think that anyone is well served by using T3 only" that Dr. Lowe reacted very strongly to. thyroidscience.com/Criticis... But I don't think that detracts from what Dr. Blanchard has accomplished. One thing that is interesting to note is that he adjusts for seasonal variation in many of his patients. This is not uncommon in thyroid patients but seems more prevalent in Dr. Blanchard's patients. For those that enjoy exploring the many facets of the thyroid world I strongly suggest reading his small (111 pages) book. He has quite a few interesting ideas expressed in it. It is available on Amazon UK. Dr. Kenneth R. Blanchard "The Functional Approach To Hypothyroidism"