Thyroid UK

Thyroid Hormone Replacement

Thyroid hormones: The correct dosage has an enormous impact on the quality of life

Thyroid replacement hormones need to be available in small dosages

The quality, stability and availability of the medication must be guaranteed------

2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism-----

5 Replies

Bomap, My endo instructed I take 20mcg T3 am and 10mcg at bedtime whereas ETA recommends (11) Whereas L-T4 can be given once daily, the daily L-T3 dose should be divided (if possible) in two doses (one before breakfast and the largest one before sleeping) (2/+00). Looks like he hasn't done his thyroid homework :o

The final sentences make it clear that long term effects of T3+T4 on bone and cardiovascular health are unknown and further research is needed. Makes me wonder why so many GPs and endos state categorically that T3 will damage bones and heart.

Finally, the long-term efficacy and safety of L-T4 + L-T3 combination therapy should be assessed. The consequences, if any, of prolonged L-T4 + L-T3 combination therapy for bone and cardiovascular health are unknown [50]. Likewise, the safety of L-T4 + L-T3 combination therapy is unclear in patients with cardiovascular diseases other than cardiac arrhythmias.


I agree very much with the first article.

The second, I disagree with, and one doctor in particular keeps repeating the same mantra i.e. levothyroxine alone. As we know some do not feel any better on levothyroxine and some of us worse. The problem is they are not scientists and I don't know how they arrive at their theories. I assume it is the promotion and monetary incentives by the pharmaceutical companies.

The fact is that so many patients are unwell on levothyroxine, either undermedicated by being kept within 'normal' range or unmedicated but are willingly prescribed additional medications for their symptoms rather than alternative or additional thyroid hormones. They make no mention of other diseases we may develop if not properly medicated.

This is a link which is self-explanatory.

1 like

Another sideswipe to the use of NDT by the supporters of levo and the manufacturers that pay them!!


Thank you for your interesting contribution. I think many people on here are educating themselves with the quality information available on the Thyroid UK website. The problem is that internet information is often generally dismissed, regardless of the source. Of course the idea is to read everything critically. I had a good experience at the hospital in that the list of symptoms I had ticked was added to my notes without judgment but I fear this does not happen as a general rule.


I am writing as a patient and have found that there is available, at the click of a button, instant access to a plethora of top quality research and well balanced opinions from doctors, endocrinologists and clinicians who are concerned at the chasms between differing, existing opinions within the field of endocrinology. I assure you, I do have great respect for these dedicated doctors who are trying to address the balance within the escalating controversy.

Respect is a two way process. There are thousands of thyroid patients who are not shown respect, and have been reduced to tears. I am one of them.

The web has enabled patients to learn about long term conditions and is empowering them to question the platitudes to which they have been subjected for many years, by many endocrinologists. Learning is a slow process.

One of the first elements of the World Health Organization's (WHO) vision in primary health is that, 'The people have the right and duty to participate individually and collectively in the planning and implementation of their health care".

I have also great respect for Professor Wilmar M Wiersinga who is co-author in the second link, which gives me, as a patient, some hope. ‘The Recommendations’ at the end of the article re Suggestions for the future: (a) (c) (d) is a start.

He has also written and co-authored numerous articles i.e. ‘Do we need still more trials on T4 and T3 combination therapy in hypothyroidism?’ European Journal of Endocrinology (2009) 161 955–959 ISSN 0804-4643 and ‘The environment and AutoImmune Thyroid Diseases’ ---Invited

Interview European Journal of Endocrinology 2004; 150: 605-618.

One of the many non-profit organisations on the web is The National Academy of Hypothyroidism is a multidisciplinary medical society dedicated to the dissemination of new information on the diagnosis and treatment of hypothyroidism. Sections on deiodinases and thyroid transport etc are written especially for patients and are easy to follow.

Noel R. Rose, M.D., Ph.D. Chairman Emeritus, AARDA National Scientific Advisory Board; Professor of Pathology and of Molecular Microbiology and Immunology; Director, Center for Autoimmune Disease Research, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD has an excellent section ‘The Common Thread’ --- this is most informative on auto- immune disease, providing an insight into the connection between specific diseases affiliated to thyroid disease.

Choosing Wisely focuses on encouraging physicians and patients to think and talk about medical tests and procedures prior to their use------- Participating groups include American Academy of Allergy, Asthma, and Immunology; the American Academy of Family Physicians; the American College of Cardiology; the American College of Physicians; the American College of Radiology; the American Gastroenterological Association; the American Society of Clinical Oncology; the American Society of Nephrology; and the American Society of Nuclear Cardiology.

Anger in itself is non- productive. Channeling it by searching for the truth produces results. ‘Dishonesty in Medicine Revisited’ Texas Heart InstituteVolume 35, Number 1, 2008 is just one example of this approach.


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