What is this doctor really saying about NDT and... - Thyroid UK

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What is this doctor really saying about NDT and reference ranges?


I find the following article interesting in that the situation described applies to me: more is not always better when it comes to NDT, and I ended up having serious trouble as a result of excessive FT3 levels after doing the exact thing he tells us to avoid: that is, to keep raising the dosage resulting only in short-term improvement, but problems further down the road.

I also find what he says about normal vs optimal ranges interesting as I find normal ranges too broad.

However, if I understand him correctly, he is basically saying that you should always have an in-range TSH (not below 0.36) even on NDT, and that a suppressed TSH causes problems (unlike what other doctors prescribing NDT argue):


For me, it's impossible to taken any amount of T3 without suppressing my TSH. Ten years ago, before switching to NDT, I took Thyroplex Women along with T4. The tiny amount of bovine thyroid in that product (the equivalent of 1/4 grain) was enough to suppress my TSH below 0. My FTs remained in range.

Have I misunderstood something in this article? Has someone else read more by this doctor and knows more about his way of thinking? He advocates NDT, but like I said, it seems he considers the TSH to be just as - if not more - important than the free Ts...and my understanding is that many users of NDT only feel well once they reach TSH-suppressive doses.

12 Replies

NDT has been used, successfully, since 1892 when it was the only replacement hormone and saved lives. There were never any blood tests at that time and it was all about 'how the patient felt' on particular doses, which was slowly increased until all symptoms resolved. These patients from then on did not die a horrible death.


Nowadays it all revolves around a blood test result and as they were introduced along with T4 only, if we add T3 or take NDT, the results do not correlate.

Hidden in reply to shaws

Yes, that makes sense. What surprised me was that a doctor advocating the use of NDT also recommends an in-range TSH as I thought that was almost impossible to achieve (unless you take micro doses of NDT), as it seems any form of T3 will suppress TSH to 0 when optimally dosed.

shawsAdministrator in reply to Hidden

Considering it was only for levothyroxine that the blood tests were introduced. So if we add or take anything other than levo the results cannot equate.

Hidden in reply to shaws

And thank you for posting this great article, it offered some very interesting insights into thyroid disease diagnosis and treatment!

I now realise that my recent problems with NDT (suddenly seeming unable to tolerate it, whereas I had done great on it for years) started after I had weaned off prescription drug Medrol for adrenal fatigue. The author of this article mentions hydrocortisone or even prednisolone for adrenal fatigue (while many other practitioners only advocate the use of glandulars). I think I will try to go back on Medrol (4 mg daily on which I felt fine for years) and see if I can reintroduce NDT.

My TSH is completely haywire and seems to track FT4 instead of being the opposite. If my FT4 goes up, so does my TSH (a bit anyway), below range FT4 gives me under range TSH. My FT3 stays about the same, mid range, whatever FT4 and TSH do. So I can't see how that can apply to people with dodgy pituitary glands.

Hidden in reply to Angel_of_the_North

I have not read anything by this doctor before so am wondering how reliable he is...are there any US members who know anything about him?

This fellow is still captivated with TSH as a reliable guide in therapy. He unequivocally warns about the consequences of low or undetectable TSH. However I can parade my wife who has had the results of Hashimoto's destruction for 50 years and counting, and has never had a detectable TSH except on one occasion when trying to achieve a measurable value and becoming hypothyroid immediately. She is lucky enough to manage on T4 only, but I suspect she is on the cusp between managing and not - hence the undetectable TSH. I suspect there are many others like this. She has never had an FT3 done or offered. I find this doctor far too constricted in his opinions and additionally much too simplistic in his explanations.

Hidden in reply to diogenes

So true, thank you for this!!!

I had an undetectable TSH for years on T4 only because my doctor back then believed patients with Hashimoto's needed a suppressed TSH to reduce antibody attacks (he said the TSH is what triggers autoimmune attacks in Hashi patients). That required 200 mcg daily in my case. I felt OK but never great. Of course, if a person on T4 only cannot convert it to enough T3, no amount of T4 will do the trick.

When reading the article above again, I feel this doctor is not helping patients on or wanting to try NDT as he is basically saying that they need to watch their TSH and keep it from going below 0.36. So, according to him, a patient feeling great on NDT but with a TSH lower than needs to decrease the dosage. On second thought, I cannot see the logic behind his reasoning...!

hels333 in reply to diogenes

My TSH on 3 and half or 4 grains of NDT a day is usually around 0.01. I've always considered that normal for me as I know TSH is suppressed on NDT. My Free T3 and Free T4 I try to ensure are near the top of the range as that's when I feel wellest, thyroid-wise.

I usually have to pay privately to check my Free T3 levels, although last year, I managed to persuade the NHS nurse to add it to my annual NHS thyroid blood test as I told her I was taking T3 and felt my FT3 levels should be checked!

Hidden in reply to hels333


Do you take your NDT in one go, or multi dose it?

hels333 in reply to Hidden

Hi thecat68

I take 2 grains before breakfast, then a second dose of 1 and half or 2 grains [depending on season + health] about 2-3pm. I've found that works for me.

I used to take my NDT over 3 doses throughout the day, but I so often forgot the 3rd dose, which was a pain, therefore, 2 doses works for me now.

Hidden in reply to hels333

Thanks a lot, that may be what I did wrong to begin with....that is, taking it all in one morning dose, and ending up hyperthyroid in the morning, with fluctuating energy levels throughout the day...it's nice to know that taking it twice daily (instead of three or four or five times a day) works nicely for some people! It also sounds much easier than spreading it out throughout the day as I know I'd always forget to take it at some point...!

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