I have CFS and I have been on T3 only, for almost 3 years. (T4 does not work for me we tried 3 times with my Dr.) I pretty much tried every dosage from micro to several hundreds of 100mcg... but never reached anything near a comfortable state. But without T3 it is even worse, especially energy. At the very beginning micro dosing helped me a lot and I wonder if I could go back there, maybe with a slow release version. (at the moment I'm on 22.5 mcg, I can't tolerate more since a couple of months maybe because of a histamine issue connected to my T3 intake)
My questions:
Do you think Dr Blanchard's method might work without T4 as well?
And do you think it might work for me to go back to a micro dosing regime or will it be "too late" for me?
Cheers
Lukas
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Adventurer8
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You have misunderstood Dr. Ken Blanchard's approach. He believed that the "average daily dose of T3 that results in sustained long-term improvement is about 1.2mcg daily in time-release form"He was against T3 mono-therapy as he stated that this led to T4 depletion at tissue level which made patients feel worse. He states that patients coming to him on "a good T4 dose are usually about the same or slightly higher on their T4 dose a year later after T3 or thyroid extract is added, and they are still doing very well with normal laboratory values."
This information and quotes are taken from ' The Functional Approach to Hypothyroidism' Kenneth R. Blanchard, PH.D., M.D.
Thank you for the quotes! I conclude from your statement, that Dr Blanchard never prescribed T3 only, even in micro doses. Any hint in his book for people who do not tolerate T4? (it seems this issue is not that rare, I would guess he must have encountered it as well with some patients)
22.5 mcg T3 is in no way a high dose for someone on T3 only. I take around 60 mcg at the moment.
I don't know anything about Dr Blanchard's method, but it doesn't sound very promising. Did he say that when taking T4, only take a small amount of T3 or something? How would that work when taking T3 only? You need what you need, and if you need 22.5 mcg, reducing your dose is not going to work. Why would it?
Yes greygoose he liked his patients to be on an good dose of T4 and then usually 1.2mcg T3 but in slow release form. As someone who only takes 7.5 mcg lio added to 100mcg levo I was interested to read his view.He does make some good points in his writings even though we may not agree with his dosing. My favourite statement of his concerns the fallacy that 1mcg T3 is metabolcally equivalent to 4mcg T4 and that this "fundamentally wrong teaching" was being used to work out combo doses. He gave the example that some doctors told patients that you had to reduce T4 dose by 20mcg daily to add a 5mcg daily dose of T3. He said:
"To me, this is like saying if you want to reduce meat consumption by one pound per week, you should substitute 4 bananas. It does not compute!"
lol That's a wonderful comparison. And I agree with him. However, the point is that this micro-dosing think cannot work when on T3 only, because you haven't got the back-up of the T4 converting to T3.
But, that raises another question: does he also recommend that micro-dosing for people who are poor converters? Because I can't see how that would work.
Also, I think slow-release T3 is a bit hit and miss, you can never be completely sure how much you're going to absorb because it depends on the speed of your transit.
Another thing about slow-release tablets for anything is that certain substances are only absorbed in certain parts of the intestines. If the slow-release pill moves on past the point at which it gets absorbed then the patient may only absorb a small amount of what has been taken.
I don't know whether this applies to thyroid hormones but I would want to know before I took anything described as slow release.
I think this is a problem with iron, and it could explain why people find it so hard to raise their levels. Someone with a slow gut might absorb plenty of iron from supplements and food, but someone with a fast gut might not.
My knowledge of Dr. B´s method comes from Mary Shomon´s book "Living well with hypothyroidism" where there is an interview with him. Dr. B stresses that:
- only synthetic T3 and T4 should be used as NDT contains too much T3;
- T3 should be sustained-release to avoid peaks of T3;
- patients should take mostly T4 and 2-5% T3 to better replicate normal thyroid output.
First of all, I abhor statements such as: "NDT contains too much T3" as it raises the question too much T3 for whom??? NDT may contain too much T3 for some patients, while others do great on it. You simply cannot generalise like that.
I am not saying patients have not had success with Dr. B´s method. But, like many other doctors, he is trying to fit patients into a mold. They should take 95-98% T4 and only tiny doses of T3. That may work for patients with optimal conversion, but is doomed to fail in patients with impaired conversion. Also, he assumes that a hypothyroid patient will automatically recover with the same hormone ratios we see in euthyroid people. But we know it is not that simple, or nobody would need NDT or T3 only.
I cannot see how his method could work with T3 only as it is based on the assumption that thyroid patients need mostly T4 and only tiny doses of T3. If on T3 only, it would seem logical that you need higher doses as you have no T4 to convert.
What is the reason you would like to switch to Dr. B´s protocol?
A problem I see with Blanchard's approach is that levothyroxine often contains some T3.
I think the specification of levothyroxine in both the UK and the USA technically allows up to 1% of T3 as an impurity. (Whether that is because it was there when the tablet was manufactured, or is a breakdown product, I can't say.)
In reality, it is unlikely that the T3 content will be that high. It would be too close to the limit and might indicate an issue with the manufacturing processes.
But someone taking a dose of 1.2 micrograms of T3 (slow or quick release) could, quite reasonably, get another 0.5 micrograms from their levothyroxine. Given that many slow release products don't fully absorb, we could easily suggest that their T3 dose effectively increases by 50%. And that could change completely from one lot of levothyroxine to another.
Most of the times I followed Paul Robinson's protocol (splitting dose in three) A few weeks back I tried it with single doses in the middle of the night (surprisingly it didn't change much for me, but constipation was clearly worse in the evening)
But yes I take it always at least 1 hour before meal.
I believe that one of the most knowledgeable of experts (we've not too many I believe) was Dr John Lowe - Scientist/researcher/doctor and expert on the use of T3. He was also an Adviser to Thyroiduk.org.uk.
He, himself, took his dose in the middle of the night so that nothing interfered with his one daily dose. He was able to be a scientist/researcher/doctor, He stated that one daily dose saturated all of the T3 receptor cells and then sent out 'waves' throughout the day.
I follow his method and thankfully I've had no symptoms and I've also reduced my dose of T3 (going by how I 'feel' on a dose). I've been on mine for a long time now. I feel well, body feels completely at ease and I have no unpleasant symptoms that I had on levo.
Unfortunately for us he had a bad fall that caused a bleed on his brain that caused his demise. He worked up until his last day, even when bed-bound.
I'm impressed of all those quick answers. Thank you very much!
A few clarifications to better understand my case
The reasons I think Dr Blanchard's method might work for me on T3 only as well is:
- when I started my T3 only career at the beginning I started with 1mcg capsules (which I opened and took several bits during the day) This alone had tremendous effects on my energy level and other hypo symptoms. (Definitely no Placebo effect, I didn't take any T4)
- my initial blood levels for TSH and T4 were normal and T3 slightly below reference range.
- I do not have any organic issue with my thyroid.
- For the reasons above but also for additional ones (readings, further blood results) I do not believe I have a T4 to T3 conversion issue (I would even guess, that this issue hardly exist) My view (at the moment ) is that my hypo issues are due to regulation problems only. (my body deliberately shutting down T3 production) for me this seems to be a difference...
- I do not have any organic issue with my thyroid.
So, do you think your thyroid is still working normally?
My view (at the moment ) is that my hypo issues are due to regulation problems only. (my body deliberately shutting down T3 production) for me this seems to be a difference...
And, how would it do that? And why? And why don't you think it's a conversion problem? And, if this is the case, have you not considered that maybe you don't need to take T3 at all?
Of course, all this is highly hyperthetical, because we don't have any of your numbers. Just saying that your FT4 and TSH are 'normal' is meaningless, because there's no such thing as 'normal' where thyroid is concerned. So, perhaps if you gave us some numbers - results and ranges - we might be better able to understand your problems.
Thank you for the concerns. I won't reply in detail, as my questions were basically answered.
But in short: I believe my hypo symptoms come from a suppressed thyroid system, which is caused by mechanisms linked to my diagnosis ME/CFS. My body is locked in a chronic "illness mode" where energy delivery and production does not work properly. I believe even tiny amounts helped me (at least in the beginning), because they stimulated the system (thyroid and others as well), that's why I wonder whether it might still be a possible approach. (as I said I can not tolerate high amounts of T3 anymore )
Well, I'm pretty sure it doesn't work like that. Having ME/CFS - if, indeed, you really do - would not 'suppress' the thyroid. More likely that your thyroid is failing causing ME/CFS-like symptoms. But, if you're happy with the answers you've had on here, all the better.
Are you in the US? Because I have never heard of 1 mcg T3 capsules in Europe. The only doctor I know of who recommended them is Ray Peat.When you say that your TSH and FT4 were normal prior to taking T3, do you mean while on levothyroxine only, or without any thyroid hormone replacement?
I'm in Switzerland, my Dr. (probably the only one in the country prescribing T3) orders them in a compounding pharmacie here in Switzerland (but it is quite a expensive solution )
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(it seems this issue is not that rare, I would guess he must have encountered it as well with some patients)
) is that my hypo issues are due to regulation problems only. (my body deliberately shutting down T3 production) for me this seems to be a difference...
Endo switching me from T3 only to NDT.
Need help switching from T4/T3 to T3 only
Help with switching from NDT to T3 only
T3 only advice please. Should I start adding NDT back? rT3 was elevated (I'm NEW here)
TSH still really high and causing anxiety
