Thyroid UK
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Which thyroid hormone is best for us?

I thought I would post this as I feel it might be significant - or not.

This was posted on the STTM FB forum yesterday.

The part I find interesting is this and I wonder just how significant it is as we're always being told that if NDT isn't working it could be our Iron or Cortisol, well maybe that's not all.


If your thyroid problem is auto-immune, do not use glandular (animal tissue) products to treat the disease, but ask your doctor to find an appropriate synthetic thyroid replacement (like Synthroid, synthetic T4, plus Cytomel, synthetic T3. The combination usually works better, and requires lower dosing, than Synthroid alone). If your low thyroid problem is not auto-immune, then I like Armour Thyroid for my patients.'

So this Dr is stating that if you have hashi's you shouldn't use NDT (have I read that right?)

Anyway I have emailed her and am awaiting a response


33 Replies

Well, I think this is a gross over-simpification. We're all so different, whether we have auto-immune or not, that I really don't think you can generalise like that. Just because one auto-immune hypo doesn't do well on NDT, doesn't mean none of them will.

I don't think you can ask : which treatment is best for US. You have to ask : which is best for ME. I have tried most things: levo alone, levo + T3, T3 alone, Armour, Armour + T4, Armour + T3, etc etc etc. And at the moment I like what I'm taking now i.e. a small amount of nature throid + a large amount of Cytomel (T3).

Actually, after a couple of years, I wasn't doing to badly on levo + T3. Except that my hair continued to fall out. On Armour, it started growing again, even though I started putting on weight... What you gain on the roundabout you lose on the swings! I'm hoping that I've reached the right balance now, but time will tell.

Personally I wouldn't take too much notice of doctors that pontificate about 'one size fit's all' cures. We're in our bodies, not them.

Hugs, Grey


I agree with you.


Grey, are you saying on Armour the hair you lost with levo has regrown? If that is the case I need to speak to my doctor! Being female and having what looks to be male pattern baldness is no fun at all!

I agree with you, we are all different and what is good for one, isn't good for another.


Yes, it did start to regrow on Armour. Then Armour became impossible to get hold of so I switched to... can't remember what, and it started to fall out again, and then I changed to something else and it's been up and down ever since Armour changed its formula. So I don't know if Armour would make it grow now. At the moment I'm on nature throid and it is growing a little bit but I honestly don't have much left!

But I wasn't recommending Armour for hair growth, just giving an example of how things can affect us differently. You'd have to try it for yourself to see how it worked for you.



Oh I realised you weren't recommending it for hair regrowth, it just actually interested me.


This is something I have been wondering about for a while.

When thyroid auto-antibodies are measured, they usually look for two types...thyroid peroxidase (TPO), which is an enzyme used to make thyroxine, and thyroglubulin, which is a large protein found in the thyroid gland. People can have antibodies to one of these or both, but I think antibodies to thyroglobulin are more associated with goitre - they make the thyroid gland swell.

On STTM last year, they wrote about the fact that one of the big differences between levothyroxine and NDT is the fact that the thyroxine in NDT comes wrapped in these big thyroglobulin molecules. If you have a high level of antibodies to thyroglobulin, then it possible that ingesting large quantities of thyroglobulin from the NDT might feed the auto-antibody attack. I have no idea if that could be the case, and I don't know if it's ever been investigated, but I do think it's something that is worth consideration.

(Note: thyroglobulin is not the same as thyroxine-binding globulin, which is the stuff that carries the T4 and T3 around in the blood, the part that is not "free".)

Even if this was the case, then it won't affect all people with Hashis' because not everyone with Hashi's makes thyroglobulin antibodies.

Does my reasoning sound right or wrong?


But what would the antibodies attack? They wouldn't attack the thyroid - which is what causes the problems - because the thyroxine wouldn't be coming from the thyroid... It doesn't sound like a reason for saying that some people shouldn't be taking it, as he did.

That's a very interesting point. I wonder if any research has been done into it...


I'm not sure I understand why the autoantibodies wouldn't attack the thyroid gland itself. Once primed, I think they would attack thyroglobulin whereever they found it, whether in the thyroid gland or the stuff that's part of the NDT.


Well, yes, I guess they would, but we're talking about ingesting thyroxine contained in a thyroglobulin molecule, which does what? Goes into the stomach? It doesn't go into the thyroid, so why would the autoantibodies attack the thyroid?

When the thyroid is producing the hormone itself then yes, the antibodies attack the thyroid. But surely not when you are taking it orally.

But don't quote me on this! lol I don't know anything about this bit. I'm just surmising. And expecting Rod to jump in at any minute and tell us all how it's really done.

Sorry if I've confused you by not explaining myself correctly, Grey


If drugs were all fully digested into something else completely in the stomach then nothing taken by mouth would work, even levothyroxine... but clearly drugs of all kinds do get through.

Like you, I really don't know the answer to this one. However, I think I've outlined a possible reason that this doctor might shy away from NDT in Hashi's patients - she's playing it safe.


Well, actually, I wasn't talking about digestion of the hormone, but never mind...

Yes, I agree, you have outlined a very good possible reason for her way of thinking. I just thought it would be interesting to enlarge on it, that's all. I wasn't criticising you in any way.



That is interesting. I would be interested to hear from people with autoimmune thyroid disease to see what suits them best. Perhaps we'll have to do a poll. I know NDT suits me but I have no idea whether I have thyroglobulin antibodies or not.


I think a poll will be a good idea actually.

I have some antibodies both Tpo and TgAb, but they're small like 10 and 6.

I've been on selenium now for 3 months and NDT for little over a month and I wonder what my antibodies will show.

I did think that maybe I shouldn't have bothered taking the selenium as they are so low and have always been so. (Never more than 10 for either)

I will retest this week so looking forward to the results, but it might be too soon to show the true picture for the NDT, but I need to check my iron levels and I'm a pain to get blood out of so thought I might as well check the Free's and Anti-b's while I'm at it.


Selenium is a good idea even if you don't have antibodies. It can help with the conversion of T4 to T3 and is generally thought to be good for us :)

I hope the NDT works for you.

If you get chance, you can suggest a poll. If you don't get chance I might be able to do it at the weekend. It would be really interesting to see the results!


I'll leave it to you Carolyn as I wouldn't know where to start, I can't think how to ask it!


Both lots of thyroid antibodies were negative for me and Armour seems to be suiting me very well at the moment :) I am sure I have read on STTM that NDT is fine for hashi sufferers - I will have to have a look. Xx


Yes Clarebear,

There's never been a mention of this on STTM, I 'bumped' the subject a couple of times as I felt it important to discuss and no-one bothered responding so I thought I'd put it here and see what people think.


Here it says its ok - number 13 :)


Excellent, thanks Clarebear.


There does not seem to be general agreement on this. Dr. Barnes, Dr. Haskell and Dr. Starr all suggested synthetic T4 and /or T3 because they thought that caused less reaction than NDT. And of course nobody has taken the time to really study this, at least not that I have ever found. Maybe Rod has come across something. The general rule for thyroid seems to be that you always have to find out what works best in your own body. Maybe some day we will get the attention this condition actually deserves and they will start studying some of the nuances. PR


Perhaps there is no general agreement because there is no hard and fast rule.

Surely, as we are all so different, finding out for ourselves what is best for us is the best way to go. I would hate to have some jumped-up medic telling me that as I have Hashi's I HAVE TO take this or that - especially when I know it's not true.

When I still felt so ill on levo after several months, I asked my endo if levo was the only thing there was for hypo. She said yes, it was. I thought that was rediculous, there's always more than one treatment - and if there wasn't, then there should be! When I later found out she'd lied to me (did she lie or was she just ignorant?) I felt cheated and ressentful. Choice is everything! We know our own bodies, we know what makes us feel best.



I certainly have come across something.

A never-ending, unresolved discussion.

I have seen this discussed all over the place since getting into the world of thyroid. But I have not yet seen anything definitive.

I am very much less than convinced that a large thyroglobulin molecule can pass through the gut wall. Nor am I convinced that thyroid blinding globulin can. And an awful lot of protein is broken down in the stomach. So maybe there is none left to pass through the gut wall?



The immune response begins in the gut with the production of secretory IgA, and it is difficult-to-digest large protein molecules that seem to be the ones most likely to cause an immune reaction because they take longer to break down completely during digestion. Gluten is the classic example.

The antibodies don't attack the whole molecule, but they do recognise parts of it - after partial digestion certain protein sequences remain that can trigger the antibody production. There is no need for the whole molecule to get absorbed across the gut wall in order to generate an immune response.

There is also a theory that autoimmune disease is caused by increased intestinal permeability, which means that large antigenically "interesting" molecules DO manage to cross the gut wall and go into circulation, and that the antibodies, once created, may move into circulation much more easily.

I don't find the STTM rebuttal very scientific or convincing, I'm afraid. Everything I've learned so far suggests to me that this could be a real problem.


I certainly agree that the STTM rebuttal is less than sparkling.

Not sure if TG or TBG are in the "difficult-to-digest" category?


Well of course I'm not entirely sure, but I would have thought so simply by virtue of TG being a large molecule. As it's a large molecule you're more likely to end up with fragments from partial digestion than if you start from small proteins. You need plenty of stomach acid (and enzymes) to break down those proteins, but reduced gastric acidity is common in Hashimoto's patients, so digestion is more likely to be impaired as well. Hey ho.


Afraid the link you tried to post did not work. I think it should have been to this text:

If your thyroid problem is auto-immune, do not use glandular (animal tissue) products to treat the disease, but ask your doctor to find an appropriate synthetic thyroid replacement (like Synthroid, synthetic T4, plus Cytomel, synthetic T3. The combination usually works better, and requires lower dosing, than Synthroid alone). If your low thyroid problem is not auto-immune, then I like Armour Thyroid for my patients. This is an old-fashioned medicine that offers combined T3/T4 (similar to the blend produced by a normally functioning thyroid gland) derived from sheep or pig thyroid tissue, standardized to contain specific amounts of hormone. The thyroid hormones are simply a cluster of iodine molecules (3 iodine molecules make T3 — the active hormone — and 4 iodine molecules make T4 — the storage form).

No explanation - simply an assertion.

A bizarrely confused statement that reads as if Armour is sometimes made from pig, sometimes sheep.

The statement that "The thyroid hormones are simply a cluster of iodine molecules..." What? No consideration of the varied family of metabolites.

I don't think that article is worth considering.

I also emailed her several years ago. I certainly got no response - but cannot remember if her email address worked or my email did not get a reply.


Yes that's the one, thanks :)

I'll let you know what I hear, IF I do lol.


I don't think it was referring to Natural thyroid, but to thyroid glandulars. like nutri thyroid.

it seems to me that the author was saying if you have a thyroid problem caused by auto immune problems, there is no point in trying to feed the thyroid, just get on and take replacement meds (synthetic ones).

But if the problem is caused by the thyroid not getting enough raw materials, or being weak, then take extra nutrients....

I bet the author doesn't know or understand about NT being a superior replacement for synthetics.


Except that she mentions Armour by name :

'If your low thyroid problem is not auto-immune, then I like Armour Thyroid for my patients.'

Implying that she doesn't like Armour Thyroid for auto-immune patients.

I love her use of the word 'like', as if it were HER that was taking it! Pft!!!



why not use NDT if its autoimmune? As an immunologist I would have thought the opposite might be true due to something called oral tolerance - where the immune system can learn not to react to something if it is taken orally.


Thats a valid point Hashi_since_age9-1988. However what about food allergies ??? You take allergens eg gluten orally and your immune system react to it.


food allergies are caused when oral tolerance doesn't work as it should - a misfunctioning immune system resulting in disease/allergy. Hashimoto's disease is a breakdown in peripheral tolerance.


Can you explain a bit more what you mean by oral tolerance and peripheral tolerance? I have a feeling they are related in some way.


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