NDT sublinguall or swallowed ?

NDT sublingually or swallowed ? I had been taking 1/2 grain in split doses daily sublingually due to chronic malabsorbtion problems, but after reading P Robinsons book i switched to crushing and swallowing it with a large glass of water to get it to where it is naturally meant to be gut wise. I found within 1 week quite alot of previous symptoms were back and after 2 weeks ALL  debilitating symptoms were back , especially  the gut pain , the nausea ,and poor digestion .

Would anybody know if i had upped the dose that i swallowed, would it have been a better result or are there just some of us who will always have to take NDT sublingually if we have severe gut problems ?

I must admit i do have concerns sticking hormones directly under the tongue to the same area every day. Is there a risk ?

If anyone has any thoughts i would appreciate your comments,many thanks and best wishes to you all G.

30 Replies

  • I have been taking my thyroid meds (all of them.. different brands) sublingually for 10 yrs or more with no problem.  When I am not in a rush, I let them dissolve.  When in a rush, I chew, let 'em dissolve a bit and chew again.  The inside of my mouth is fine. 

     If you are considering chewing/swallowing/drinking water afterwards and increasing your dosage to offset the absorption differences, maybe track your daily body temp and heart rate so you don't overdo?  The increase may or may not alleviate your returning hypo symptoms.  But... if letting the meds dissolve is working for you, you may have to return to that protocol.  Either way,  consistency  is very important and do give any increases time to work before you increase again... usually not sooner than  every 10 days to 2 weeks.

    Oh... just had a thought.  I read where someone who was having problems with the 'new' Erfa, had good results by crushing their Erfa meds to a fine, fine powder, then consuming it and washing it all down with water.  Maybe that might be an option and you would  avoid holding your thyroid meds in your mouth for an extended period of time?

  • Hi Phoenix23002,

    Thank you for your reply,yes i agree and do try to be consistant with everything im doing and trying, its a minefield out there !

    Im glad yo hear you have not had a problem sublingually over a long period of time, thats reassuring.

    Im on Armour,everytime i move up a dose ,the bigger the tab, the larger the filler (which i believe from the suppliers is corn starch ) and can take a while to dissolve under the tongue.

    When i crushed it and swallowed it with a very large glass of water i thought the idea was to push it past the stomach bag and into the small intestines to be absorbed, i see from other replies ive got that wrong and that thyroid meds can only and need to be absorbed via the stomach.

    Must study harder !!

    I find that very confusing,i know crushed and swallowed my temps and pulses drop, and sublingually go up 1/2degree and 10 seconds more, so somethings getting through .......

    All best wishes to you G.

  • Yes, it is all so confusing and, unfortunately, we often end up being our own 'guinea pigs'.  Do continue to keep a log of your body temp/heart rate (nothing fancy), dosage and how you are feeling each day.  Finding that 'sweet spot' can be a real challenge.  When all else fails you may have to get your own labs done privately if your doc won't cooperate in order to see how well whatever protocol you finally settle on is working for you.  Knowledge is power

  • aah thank you ,what a lovely thing to say ,i will hold that thought 'the sweet spot' . Yes i do the diary,temps, pulses, BP,food/reactions,supps,private tests to wave at my GP who is one ray of light amongst the other 5. A  lovely woman who said she believed 'we' have failed you, and that she is learning alot from me plus 4 other patients with Hashi's in her practice, and even took the time 6months after she had poo pooed a saliva cortisol/dhea test as airy fairy, to ring me at home just saying she now reckognised that saliva cortisol test were the gold standard for accurate cortisol readings and just wanted to apologise for her original comments.

    Its a small positive step, and i hope she creates the ripple effect and passes the info to her colleagues, im confident she will.

    As you say, knowledge is power, i think we probably all have a book in us or two !!

    Every best wish G.

  • The same to you, my friend.  What would we do without each other to lean on and to share the tears and the joy.  Your doc sounds like a keeper. :)

  • Yes i think so, a gem,one of those with the capacity to listen,stay calm,and i just know she will make her point  re 'us' to her colleagues at the right time with impact . Im giving her a copy of Dr P's book + Dr John Lowes, i dont know whether she will accept it, but she feels she knows less than me on the subject and is constantly looking into it.

    I just daydream that just maybe she reads the books and leaves them out for her colleagues to pick up.... the ripple effect. For every hundred medics that discard the books, there has to be at least one that is as interested as her.

    I might not be physically active anymore but i cant sit still and shut up over this, so this will be my contribution to our cause until i recover !

    Take care too,every best wish G.

  • Some people do try crushing etc. But thyroid hormones aren't developed to be sublingual (the molecules in them are too large to go through the tongue) and are dissolved in the stomach.

    You take thyroid hormones with a full glass of water when you get up (or at bedtime if you prefer as long as you've last eaten about 2.5 hours previously. Food interferes with the uptake of hormones.

    I would start from the beginning again. Are you only taking a half grain per day or half grain twice daily?

    Go to the date on this link - January 30, 2002


    Half grain is around 40 to 50mcg of levo. 1 grain between 75 and 100mcg levo. Quite small doses.

  • > the molecules in them are too large to go through the tongue

    Acella, Thiroyd and Erfa in the STTM listing are "sublingual"

    Where do those large molecules go after trying sublingual (in vain)?

  • We answer that question very often and some do follow directions believing it is better and people can please themselves. 

    Not all suggestions are the best. As stated above, NDT is made to be digested in stomach another excerpt:

    To explore the issue further, Geri Rybacki, Executive Director of the Coalition for Better Thyroid Care and I both talked to a variety of doctors, drug companies and other experts, to get a sense of the professional perspective on the issue.

    The consensus? The active ingredients in thyroid medication have molecules that are so large that it is difficult for them to pass through the mucous membranes. Most of the dissolved/crushed medication ends up swallowed, and moves through the digestive system in the usual way. Other factors also affect sublingual absorption, including oral pH, and salivary enzymes. 

    Thyroid expert Kenneth Woliner, MD in Boca Raton, Florida said that some medications are designed to be taken sublingually -- for example, drugs that need to be fast-acting, and when where seconds count (like nitroglycerine, used to treat angina and heart attacks) -- and have a molecular structure that lends itself to sublingual absorption. But thyroid is not one of them, according to Dr. Woliner.


  • Could just be that you need an increase in dose. You're only on a very tiny dose at the moment.

  • Hi Greygoose, Thank you for your reply. Yes it is a low dose, just had my thyroid test results plus have compiled all the vit/min ones, should i post a new post for that ? It looks as tho im nearly optimum meds wise,but maybe adding a little t3 might make my gut happier.

    Did you work up slowly to your 70mcg t3 ?

    I note i always smile when i see the goose pic come up....all best wishes to you G.

  • Thank you, Gillybean.

    Yes, I did work up slowly, but can't remember the détails, now, I'm afraid.

    Yes, it would be better to put your results in a new post. Not many people are going to look at this thread now, because it's low down on the list, now. Don't forget to put the ranges! :) 

  • Ok Greygoose thank you i will do.

    Every best wish for now G.

  • Hi Gilly,

    I needed to increase my NDT by a 1/4 or 1/2 grain, after initially feeling 1 to be beneficial. I think it's common to have an improvement on a low dose, then that becomes insufficient, so there's a need to increase again to find what's right.

    I've just started adding a little T3 to my NDT, which feels good, & helps me get a more accurate dose for what's right for me.

    I swallow the tablets with water, as early as possible, then don't eat for at least 3 hours.


  • You can eat after 1 hour as that's the professional advice. I'm glad you're doing so well although I know of a professional who took his dose in the middle of the night - obviously no food disturbing his hormone uptake.

  • Thanks Shaws!

    If I'm awake erly morning, as is my norm, I take it then.

    4 am this morning, 5 am yesterday. Today I took my extra bit of T3 at 9, but had my daily coffee fix soon after, then ate. I didn't get my afternoon slump, which is later & greatly reduced since taking NDT, but think the whole dose early, with a 4-5 hour food/meds gap seems to get the most benefit.

    It's still trial &, hopefully not too much, error!


  • Coffee and thyroid hormones don't mix too well I'm sorry to say.


  • I know, & I usually leave it for 3 hours before my daily fix, yesterday being unusual.

    Is the low caffeine in green & white tea ok? I drink that more frequently, but the caffeine's only in the first pot.

  • Hi Leverette

    Thank you for your reply,yes initially i got the power surge after 1hour into my first ever dose of Armour about16months ago with just a 1/4 grain sublingually then ! im sure i stayed on that dose way to long largely  due complex gut.

    Im up to 3/4 grain sublingual am 1-2hrs before documented food, and vit/min supps etc, looking at latest thyroid test im pretty optimum i think but gut has different idea !

    What dose  T3 did you start adding? ive got a 5mcg tablet to try with acceptable fillers for me, so think i will give it ago too.

    All the very best to you G.

  • Hi Gilly,

    It took several days on a whole grain, before I noticed any difference, & weeks before started to warm up. Then I ruined it with a month on  Thyro-Gold!

    I started with 1/4 of WP, & increased every two weeks. I didn't realise that food & other supplements & hormones interfere with the uptake for 6 months, or I'd've probably noticed feeling better on a lower dose. I ate soya milk & tofu every day too, which was even worse! Now I know about the meds, food, meds gap, & cleared my fridge of the bad stuff!

    Some of these articles might be of interest to you:



    chriskresser.com/kefir-the-... I have this every day with fruit.


    I've been taking 1 grain of NDT & 12mcg of T3, some days, & 1/2 grain of NDT & 25mcg of T3 others. No noticeable difference, though I suppose I should stick to one then another for a few weeks at a time, but then the warming weather would affect my temperature.

    Blood tests soon, so it'll be interesting to know if & how they've changed from a year ago, & hearing what the "experts" have to say.


  • Hi Leverette, thank you for your reply. Yes i havnt had a Chris Kessler fix for a few months, he is great, thank you for nudging my foggy head in his direction.

    I am aware about soya too, i still have some but only because i am gluten,dairy free which helped on several levels, but found  all grains to be an issue so much so that the last one i eliminated ( and i love) was rice. Doesnt leave alot of choice when you have gut pain/nausea and difficulty digesting.

    I think soya will have to be totally eliminated for me, it may just be the ingredient that caused so many problems, even though i dont necessarily see a gut reaction after consumption, but then i think thats half the problem of accurate detection of problematic  foods becauase as i understand it,' mostly' but not  'always' we ingest the food  day one, if there is an immune response to that food, the cell reaction is the second day ie friend or foe, and the inflammatory response is the third day/attack, which may or may not be visual, functional etc. might just give fatigue or joint pain ,the list is endless.

    I think i will try tweaking the NDT dose with additional T3 too. Gut function loves T3 im told and maybe it will help with the massive increase in temperature the last 2 days, im completely flawed by it, air hunger ,weakness, and muzzy head all back and im freezing.

    Take care, hope your results are on positive move, with very best wishes G.

  • Hi Gilly,

    I signed up for his emails a few years ago. Not everything is relevant, but some interesting reading & good advice.

    I was heavily soya dependent, & no wonder I became worse not better. I'm going to have miso & tamari now & again, but I'm missing my tofu & portabello sandwiches. It's hard to tell what's right when a bad reaction takes days. I avoided processed soya in vegan products as I got mouth ulcers in 20-30 minutes, so a sure sign something is very very bad for me as even my biannual bag of chips don't do that to me.

    How horrible that you can't eat grains. I'd thought rice was good for food intolerant people. Even organic brown rice? :(

    I hope your T3 helps, & you're feeling better soon!


  • Hi Leverette, I think that on a flare up day when the 'itis'/ 'inflammation ' is there, then quite alot of  foods/drinks which were ok the day before become a bit of an irritant too.

    My understanding is that its a 3day response. We eat the suspect food Day 1, Day 2 inflammation markers react, Day 3 we see the negative result be that bloating,rashes, joint pain etc, which makes it very difficut to pinpoint which food group irritates the small intestines.

    When you get a fast reaction in your mouth within 20-30mins with ulcers its a very useful warning that has protected you presumably from swallowing anymore. I suppose the thing we dont really know yet when we are having these powerful reactions is, is the response a skewed response and if so why.

    No doubt as more and more unfolds on the 'Gut as a 2nd Brain' we with unravel this issue.

    Have you come across York Testing ? UK based you pay about £15 for a blood pin prick at home,send it back to them, and only if that produces a ' positive' result you can then (after you have robbed a bank !) proceed to be tested against approx 140 different foods and drinks for a further £200 i think. You have to be eating  the foods being tested for 6weeks, so Gfree/DF/SF people ,those parts wouldnt be accurate, but i guess it cuts to the chase re suspect foods. Apparently they are very thorough and endorsed by a couple of TV Gp,s.  I  just wish it wasnt so expensive.

    Yes really miss rice, i daydream about finding the culprit food thats caused me this immune  havoc,eliminating it and stuffing my face with rice.....as my reward, childish or what !

    Love the biannual bag of chips, take care with that, if it comes from the chippy, they are coated in flour before freezing and its not always cornflour or tapioca starch. Same deal if you buy them from supermarkets im afraid.

    Nothing wrong with chips, could you do your own ? If you do, dont do them in sunflower oil, this stuff is deadly when heated to high temps, we cant digest it well + its carcinogenic when high heated, we can cook chips in rapeseed oil to high temps or lard or dripping (pig and beef) these despite what we have been told incorrectly for 3 decades are the fats we need and can process.

    All good wishes to you, G.

  • Interesting stuff, & I agreeing you about the cost of testing being too high, & therefore prohibitive. I was fortunate that my NDT experiment proved positive, as I don't think I can get TRH testing done anywhere. 

    I've avoided sunflower oil, & artificial fats for a long time. NDT aside, I'm veggie, so use coconut or rice bran for cooking, butter or olive oil for cold foods. My occasional chips are from a chippy, sometimes coated in a toxic layer of curry sauce, but with no immediate adverse affects other than weight gain.  It's only soya "meat", cheeses & ice-cream that causes mouth ulcers, & soya mince/tvp is the only food that causes abdominal pain & bloating. A big pain when people cook me a special veggie meal. 

    I was diagnosed with coeliac as an infant,so should go gluten free, but I last a month, then see something I can't resist. You have much more stamina than me! :$ I've been joining the dot's with regard to auto-immune diseases, of which a pituitary adenoma can be the result of, so it's a chicken & egg situation.

    Hope you have a lively weekend!


  • Hi Leverette, you made me laugh with the toxic curry. I hear myself some days saying "eat that and your gonna regret it " childhood treats and comforts still there.

    Have you come across FODMAPS yet? If not check out Monarsh University Australia Low Fodmaps. This is the original work from Prof Peter Gibson Gastroenterologist and Dr Jane Muir available free on the biggest breakthrough re IBS. Sue Shepherd at Shepherdworks does recipe books on it. In UK St Thomas hosp site charge for the info.

    All good wishes to you, G.

  • Hi Gilly,

    The occasional bad thing is ok, if I'm good 99% of the time, which I am. I am convinced my happy gut bacteria will protect me. :) This weekend I felt guilty for buying a salad which had about 10 edemame in, which I love, so chose not to pick out. No noticeable adverse side effects, so I think I got away with it.

    I could end up eating air if I went down the FODMAPS route, which suggests avoiding most foods I eat. Starches aside, my IBS like symptoms are generally stress related. I keep putting off going gluten free.


  • Hi Leverette,

    Fear stops us is in our tracks with anything and everything in our lives. The big question is "what will happen to me IF i do this " ? Rather than being free when ive done it.

    We are curious beings.......and me very cautious.

    best wish G

  • I am on Armour and I crunch it up with no water or I will occasionally have a drink of filtered water.

  • This is a previous post and NDTs are made to be swallowed with a glass of water.


  • Hi Glynisrose Thank you for your reply, did you try various ways too ?

    Best wishes G.

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