For those of you who can read German:
natuerliche-therapie.de/sch...
What I like is the link explained by the author between long-term T4 only treatment and problems like excessive reverse T3, and how it does not matter how much T4 you take if you cannot properly convert it to FT3.
Of course, finding a doctor willing to prescribe NDT or T3 only is, as always, the big challenge...
Vielen Dank.
(Not that I read German!)
A summary:
In this article, it is said that long-term treatment with T4 only is problematic if the patient cannot properly convert it to FT3. That increases the risk of rT3 dominance, which blocks cell receptors and further aggravates FT3 deficiency at cell level, and can eventually lead to adrenal fatigue (this is the first time I have seen that connection, at least mentioned this specifically, but it makes sense to me), and that adrenal fatigue is often misdiagnosed as burn-out syndrom. As far as I know, AF is not even recognised as a proper diagnosis by conventional medicine...?
I don't know if conventional doctors even know what rT3 is, or how excessive rT3 affects us? I don't think so. But the number of posts by patients (not only here) who do not feel good on any dose of T4 is quite telling. What if most if not all of these patients are suffering from rT3 dominance that needs to be cleared before any thyroid drug can work...?
Anna69,
rT3 isn't tested by NHS. Is it something the Hertoghe doctors check?
No, normally not. However, on the lab sheet they give you at your annual visit (to use when you go to the lab next year), there is a box to tick if you want to test rT3...at least my doc is very good about that, and tells me to add tests I want to have done. But not even so called top doctors (in Belgium = Hertoghe doctors) seem to know much about rT3 and rT3 dominance...if they did, maybe they would be more inclined to prescribe T3 only to patients who do so much better on it, but don't improve on any combination of drugs containing T4.
Anna69,
Don't suppose you know whether they have to send the rT3 sample to the USA for analysis? I suspect interest in rT3 is pretty much restricted to the USA.
Interesting!
OK, but where should your FT4 levels be?!?!??!
I am asking because I used the calculator in the site you linked to and found out that while my FT3 levels were 60% last time I had labs (August '16), my FT4 levels were only 12.5%...I felt slightly sub optimally treated on the dose I was on in August so I have since raised it by 1 grain and now feel optimally treated. No hypo symptoms whatsoever. This leads me to believe that my FT3 is at least 70%.
But there is no way in h--- (pardon the expression) that I could get my FT4 levels up there as well, unless my FT3 levels went seriously out of range.
I read recently (in an article critical of NDT) that a healthy human thyroid gland will produce T4 and T3 in a 98-2% ratio, whereas pigs's thyroids produce T4 and T3 in an 80-20% ratio...the author of this article used this example to prove that NDT contains too much T3 and too little T4 for humans. I, for one, have come to believe that is not true, for several reasons: first of all, it seems T4 to T3 conversion is seriously impaired in many hypothyroid patients, and this means they need more direct T3 as their own bodies are not giving it to them. Secondly, if T4 is only an inactive storage hormone, with one function only (to be converted to FT3), and you are already getting quite a lot of T3 from NDT (or synthetic T3), why worry about your FT4 levels...?!
I could be wrong, of course, but the fact is that I seem to feel better when my FT4 levels are close to the lower normal range...
Makes perfect sense to me!
Attitude to t3 in Germany
Confusion about NDT levo equivalent 
The "wrong T4/T3 ratios in NDT: do they matter?
Interesting article
Does T4 in NDT do anything at all?
