Another perspective on NDT dosing.: I'm still... - Thyroid UK

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Another perspective on NDT dosing.

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I'm still experimenting(self-treating) using Thiroyd and the issue of taking it 1 hour before eating or 2 hours after eating has another perspective. It's from an article I read on The Weston Price Foundation site, from a psychiatrist in Arizona; Dr. John Dommissee, who not only uses NDT in his practice, but also has hypothyroidism. In the article, he states that thyroid should be multi-dosed and taken with meals in order to ensure a steadier level through the day and night.

As has been written by many others; how best to take our medication is based on our response, whether once daily, multi-dosed, taken with or without meals, as long as one is seeing improvement in physical and mental health.

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9 Replies

Interesting to read about a completely different perspective...! Do you like Thiroyd so far?

in reply to

I've been using it for several months, in a conservative manner, since I was living in a state where I couldn't order my own labs, but now I'm living in Florida, which allows self ordered labs, though I am going to see a new primary physician.

As to how effective it is, I began to push my dose to see if I could overcome long standing depression. At 5 grains, my mood temporarily improved, but after two days I became moderately manic, hypersexual, restless and hot. I stopped for three days and am now trying 2 grains. Don't feel anything on that dose and know that I must proceed with caution as I raise the dose.

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Clutter

Tropicaldaze,

Advice is usually to take thyroid medication away from food and drink because the T4 and T3 binds to proteins which reduces absorption.

Advice to multi-dose is to even the spread of T3 to avoid large peaks experienced after taking one dose.

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shawsAdministrator

For me it is too much of a bother and doesn't give me a free life as I'd be bound to times and doses. One daily dose of whatever and I'm happy and well. I don't want to feel bound up with times/pills/empty stomach. Life is too short as it is as it's probably taken ages or forever to be diagnosed in the first place. Then the long journey to find out what suits you and makes you well.

Why take levothyroxine or other thyroid hormones with meals as it probably means we are not getting the dose we think as it will be bound up with food, as far as I've read.

in reply to shaws

I know, even among clinicians who prescribe desiccated or T3, there are various opinions on how best to to take medication. Dr. Dommissee, from my read, has extensive experience in the use of NDT. All I was doing was passing along what I thought was an interesting article by a medical practitioner. As we all know, YMMV.

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jkozlow3 in reply to

I've read Dr. Dommissee's articles in the past with great interest. Just an FYI - he's retired now (I reached out to him recently, as I live in the U.S.).

I am not sure I agree with his taking the meds at meals approach - at least not with NDT. NDT is bound to thyroglobulin which delays the absorption by itself, as the thyroglobulin protein must be broken down by the body before the T3 and T4 are "free".

Taking NDT with meals throws a big wildcard into the mix, as each meal will interfere with absorption differently depending on what you eat.

Other docs who I respect greatly have stated that they often have patients take the entire 2-4 grain dose once a day! (although I think it makes more sense to spread the dose out to 2x/day). Note that 2-4 grains is the average NDT dose range for most patients according to MULTIPLE docs whose opinions I respect including: Dr. John Lowe, Dr. Henry Lindner, Dr. John A. Robinson, Dr. Dean Ward, Dr. Mark Starr, etc.

I have a Word doc with hundreds of quotes from different docs based on hundreds (if not thousands) of hours of research I've done over the years and all of these docs state that 2-4 grains is the average dose when dosing by symptom relief (not blood tests) and watching for irregular pulse, blood pressure, basal temperature elevation, etc.

Interestingly, many people seem to end up on much smaller doses than the 2-4 grains these docs use and they remain symptomatic - especially when their doctor is using TSH values to adjust dosage. TSH will be suppressed if you are on a high enough dose of thyroid medication - it is impossible for most people to have a Free T3 value in the top 1/3-1/4 of the range while on thyroid medication without a suppressed TSH. Taking thyroid meds orally is NOT physiological (natural). If/when you take enough meds, your levels will spike and your pituitary gland SHOULD therefore stop signaling to your thyroid (via TSH) to make more hormone! If your pituitary gland is still calling for more thyroid hormone after you've flooded your body with high doses of oral hormone 1-2x/day, you probably aren't on a high enough dose! You break your body's natural feedback loop as soon as you introduce an external source of thyroid hormone into the mix, especially when taken only a couple of times a day (vs. a slow infusion 24 hours a day like what our own thyroid glands would produce). This makes TSH testing invalid once hormone replacement has begun. Many doctors don't seem to understand any of this.

in reply to jkozlow3

Thank you for sharing your knowledge, insights and experience. One doctor you mention, Dr. Henry Lindner, is most interesting. He, like Dr. Dommissee, is the type of doctor we'd all like to have. Another practitioner is Dr. Jory Goodman in Beverly Hills, CA. He's a psychiatrist who knows a great deal about thyroid and other hormones, as well as stealth infections, which can present symptoms that look like a psychiatric illness.

As I wrote, at 5 grains, I did not feel good, physically, and I didn't want to risk bringing about a severe health crisis, yet it was the first time in many years where my mood and libido improved, that is, until I started to feel moderately manic. I have treatment resistant rapid cycling bipolar, non-combat PTSD and sleep problems and on 5 grains I knew I was heading into dangerous territory. For the moment, dropped my dose to 1 grain 2Xdaily but I think I need to go a bit higher.

I'll be seeing my new primary next week. He had an impressive career in military medicine and, from what I read, takes an integrative approach to health care. I can only hope he's good, but I've been disappointed before, as we all have. I'll post after my appointment.

shaws profile image
shawsAdministrator in reply to

We can post whatever we think is helpful and what suits one person doesn't always suit another. I was putting my perspective on what made me well and gives less stress :)

in reply to shaws

Absolutely agree. I found Dr. Dommissee's clinical experiences different from most other doctors. Ultimately, each of us has to find the most effective way of taking our medication that provides the most benefit.

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