Becoming Resistant To Thyroid T4/NDT Dosage?

Guacamayo

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Mar 4, 2018
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For the past few months I've been taking NDT and T3 (Tertroxin here in Australia) and getting my FT4, FT3 and TSH checked every 4-5 weeks. I've had autoimmune hashimoto's for the past several years but have only needed to start taking meds around 2 years ago. And after a year or two of haphazard experimentation with T4, NDT, and T3, it was only several months ago that I finally realised that I need both T3 and T4, or T3 and NDT since I'm unable to produce either T3 or T4 in sufficient quantities, and when I take NDT by itself then I just get a buildup of T4, without a similar buildup of T3.

Initially I started off on 100mcg of T3 per day, but over time I've had to up that to around 150mcg to get my T3 levels within the upper part of the normal range.

Anyway, the main issue for me isn't the FT3, but the FT4. I've been taking the Ancestral Supplements NDT thyroid at a dose of around 8 capsules/day for the past several months. Each capsule contains 30mg beef thyroid and 470mg beef liver. Initially during the first 2 months, at the 8/day rate I was able to get my FT4 in the upper half of the normal range, which meant that along with the healthy levels of FT3 I was actually feeling quite well. However, over time (specifically these last few weeks), my FT4 levels have been dropping, despite maintaining the same dosage. Right now they're at the very bottom of the normal range and it's causing all my old hypothyroid symptoms to return (cracking skin, constipation, lethargy and fatigue, lack of mental clarity, etc.)

Now my question is, is it possible to become acclimated or resistant to a certain T4/NDT thyroid dosage over time, which would require me to constantly continue increasing it ad infinitum, or is there something else at play? I know a lot of people who start off on thyroid meds, be that T4, T3 or NDT initially feel great and then after several weeks or months, the old symptoms set in and they need to increase their dosage - but in many instances that doesn't work since an increased dosage provides symptom-relief for another few weeks and then it stops working again.

In my case, I've narrowed it down to the FT4, so I know it's not the T3 medication that I'm becoming used to. If it is a case of becoming resistant to NDT/T4, would the best course of action be to stop taking NDT for a certain period of time so that sensitivity to it is restored, or just increase the dose again?

Would there be any underlying issues (e.g. chronic infections, etc.) that could cause the body to severely downregulate FT4 levels whilst consistent levels of T4 medications are still being taken?
 

Kartoffel

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vitamin a toxicity from all that liver?

All that liver:
470mg x 8 capsules a day = 3760 mg/day
3760 mg /1000= 3,76g a day
That's ~ 2000 I.U. per day. A truly poisonous amount.
 

olive

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May 17, 2018
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It’s likely you’ve slowly been depleting your body of essential cofactors like selenium, potassium, etc. Download cronometer and start tracking your micronutrient intake.

No one should need more than 50mcg of T3 per day. If you need to take more than that your body simply isn’t utilising it. Taking more will just further stress your body.

Before I get attacked, consider the fact that a healthy person makes the equivalent of ~30mcg T3 per day. Ask yourself why you need to take 5x that amount. Probably because your diet and lifestyle is not aligned with your bodies best interests.
 

Spondive

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Oct 13, 2014
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It’s likely you’ve slowly been depleting your body of essential cofactors like selenium, potassium, etc. Download cronometer and start tracking your micronutrient intake.

No one should need more than 50mcg of T3 per day. If you need to take more than that your body simply isn’t utilising it. Taking more will just further stress your body.

Before I get attacked, consider the fact that a healthy person makes the equivalent of ~30mcg T3 per day. Ask yourself why you need to take 5x that amount. Probably because your diet and lifestyle is not aligned with your bodies best interests.
One caveat some may need to take more if absorption is not 100%
 

lampofred

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Feb 13, 2016
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Increase sugar intake. Honey, sugar or dates.

+1

I think thyroid requires a lot of sugar and nutrients at first until your tissues are depleted of PUFA to the extent that all of your glucose goes to CO2 again like it does in a child.
 

Momado965

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Aug 28, 2016
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A nice way to keep exogenous and endogenous thyroid working is SUGAR. Get it from any source you prefer.

You can try b1, b3, b6 combo in powder form. Pills suck ****. My dosages are 500-1000mg b1, 300mg b3 and about 150mg b6. Other B’s I get from redbull or diet (mainly eggs and liver or other offal). B vitamins will be your game changer.

Low fat intake 0-50g is what I found to be helpful plus I learnt I do enjoy eating low fat as the flavour of food really comes to life.
 

sweetpeat

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I would guess with that much t3 that your thyroid/TSH is pretty much suppressed. Which means you might be making little to no t4, therefore becoming deficient in t4. Some people's physiology seems to do ok with this and they simply increase the t3 until symptoms resolve. So these would be people who do well with t3 only treatment. This doesn't work for everyone though. If you don't do well with t3 only, then you probably need to keep increasing the t4, possibly to replacement levels since TSH is suppressed. I doubt that you would need to keep raising indefinitely.

You do need to realize that it takes up to 6 weeks for the body to get used to a new t4 dosage. That's why you feel good for a few weeks, then symptoms return. That's the body adjusting to the new dose. Eventually though, you should reach a dose that works. You also may find you're able to lower the t3 as you raise t4, depending on how well your body converts t4 to t3.
 
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I don’t doubt that you could use more sugar but these are not right.

After you have T4 at some point often your body produces rT3 and you need to raise the T4 (or NDT) dose. Or you can opt for T3 itself.

Dr. Peat has discussed in an interview how someone needed a huge dose of T4 (or NDT), I seem to recall 800mcg or something outrageous (of T4) and then her body started producing T3 instead of rT3 and her temperatures maintained.

I started on NDT and it was fine at first, but then my temperatures plummeted and I was at 3 grains of NDT. I decided instead to do T3-only therapy per Dr. Denis Wilson’s protocols
 

Dobbler

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Jun 19, 2016
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It’s likely you’ve slowly been depleting your body of essential cofactors like selenium, potassium, etc. Download cronometer and start tracking your micronutrient intake.

No one should need more than 50mcg of T3 per day. If you need to take more than that your body simply isn’t utilising it. Taking more will just further stress your body.

Before I get attacked, consider the fact that a healthy person makes the equivalent of ~30mcg T3 per day. Ask yourself why you need to take 5x that amount. Probably because your diet and lifestyle is not aligned with your bodies best interests.
Isn't it 30 mcg of T3 and 120 T4 what body makes daily? Now how much of that T4 converts to T3 , all of it or half, that's the question.
 
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Guacamayo

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I've been getting plenty of B vitamins through supplements, overall diet, brewer's yeast, etc. As far as sugar is concerned, I'm getting enough of that in terms of fruits, dried fruits, sugar and honey, and I usually consume carbs with each meal. My mineral status is fine, except for slightly below average zinc and low potassium (I've been supplementing and eating a diet focussed specifically on getting those 2 minerals up - coconut water, potatoes, bananas, oysters, veal and beef steaks, etc.) Absorption is an issue, however as I mentioned I've been on the same dose of T3 for the past few months and my FT3 levels are still in the top part of the normal range - it is only my FT4 which is falling and requiring that I increase my NDT dosage. And yes, my TSH has been suppressed as soon as I started on the T3 meds, whereas NDT only suppressed it moderately.

@sweetpeat I know that some people do increase their T4/NDT dosage until they eventually reach a level that works for them in the long-term. But there are also cases of people who keep increasing their T4/NDT dosage to insane levels because the hypo symptoms keep returning. That's basically why I was unsure on what the best course of action would be, and also why I was curious as to what the mechanics or reasoning is behind my body becoming accustomed to the NDT dosage I'm taking and pulling my FT4 levels down, but the same thing not occurring with my FT3 levels and the T3 dosage I'm on.
 

sweetpeat

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I've been getting plenty of B vitamins through supplements, overall diet, brewer's yeast, etc. As far as sugar is concerned, I'm getting enough of that in terms of fruits, dried fruits, sugar and honey, and I usually consume carbs with each meal. My mineral status is fine, except for slightly below average zinc and low potassium (I've been supplementing and eating a diet focussed specifically on getting those 2 minerals up - coconut water, potatoes, bananas, oysters, veal and beef steaks, etc.) Absorption is an issue, however as I mentioned I've been on the same dose of T3 for the past few months and my FT3 levels are still in the top part of the normal range - it is only my FT4 which is falling and requiring that I increase my NDT dosage. And yes, my TSH has been suppressed as soon as I started on the T3 meds, whereas NDT only suppressed it moderately.

@sweetpeat I know that some people do increase their T4/NDT dosage until they eventually reach a level that works for them in the long-term. But there are also cases of people who keep increasing their T4/NDT dosage to insane levels because the hypo symptoms keep returning. That's basically why I was unsure on what the best course of action would be, and also why I was curious as to what the mechanics or reasoning is behind my body becoming accustomed to the NDT dosage I'm taking and pulling my FT4 levels down, but the same thing not occurring with my FT3 levels and the T3 dosage I'm on.
Ray Peat has also mentioned of people needing up to 12 grains of NDT, so I agree there are people who seem to need a lot. Probably some kind of thyroid resistance. I wonder if they needed that amount indefinitely though, or were able to eventually lower the dose once they overcame the resistance. Either way, I think it's a small minority who need that much.
 
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It’s the reverse T3 that is created.

That’s why I am enjoying Dr. Denis Wilson’s T3 only therapy. T3 only does not create rT3.
 
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Guacamayo

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As I mentioned before, I actually need both T3 and T4/NDT. T3 alone only raises my FT3 and does nothing to increase my FT4 levels which remain stagnant at the bottom of the range - which is where they've currently returned to with the same NDT dose that kept those FT4 numbers at the top of the range previously. And the hypothyroid symptoms all return whenever I have a low FT4 count.

I also discovered yesterday on STTM What does pooling mean? - Stop The Thyroid Madness that there is an issue of pooling which can affect some people. This is where, when taking NDT, the FT4 levels remain low whilst the FT3 levels remain high or at least in the top part of the range - it is as if the T4 is preventing the T3 from getting into the cells, but keeps it pooling in the blood. The suggested course of action is to stop taking the NDT for a period of time and be on T3 only, so that the body can better utilize the T4.

There is no clear explanation as to why pooling occurs, but some theories are that it has to do with chronically low cortisol and iron stores. The last time I checked my daily cortisol was around 1.5 years ago and I found that I had a slightly elevated cortisol level throughout the course of the day (morning, day, and night) and a low level of DHEAS - therefore a low DHEAS/cortisol ratio which is also indicative of some sort of chronic stress. So if the low cortisol theory doesn't apply to me then maybe it's low levels of iron, which I'll get tested for soon. If anyone else has any other theories that could explain FT4 pooling then I'd be interested to hear them. I should mention that I was surprised at having slightly elevated cortisol, given that I usually feel fatigued after breakfast and lunch (high fat usually makes it worse) and need a coffee to return to normal functionality.

Regarding rT3, I think it's more of a symptom (probably one of the same symptoms that causes a pooling of FT4 and a blocking of T3 from getting into the cells) instead of a root cause of a poorly functioning thyroid. Which isn't to say that I am suffering from FT4 pooling, it's just that it's one of the possible explanations.

@Kartoffel regarding the vitamin a toxicity, I was under the assumption that 3.8 g of liver per day wasn't that much of a poisonous amount. I know that Masterjohn, Peat and others recommend eating liver a few times per week, which I assume would come out to at least 200g of cooked liver/week.
 
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As I mentioned before, I actually need both T3 and T4/NDT. T3 alone only raises my FT3 and does nothing to increase my FT4 levels which remain stagnant at the bottom of the range - which is where they've currently returned to with the same NDT dose that kept those FT4 numbers at the top of the range previously. And the hypothyroid symptoms all return whenever I have a low FT4 count.

I also discovered yesterday on STTM What does pooling mean? - Stop The Thyroid Madness that there is an issue of pooling which can affect some people. This is where, when taking NDT, the FT4 levels remain low whilst the FT3 levels remain high or at least in the top part of the range - it is as if the T4 is preventing the T3 from getting into the cells, but keeps it pooling in the blood. The suggested course of action is to stop taking the NDT for a period of time and be on T3 only, so that the body can better utilize the T4.

There is no clear explanation as to why pooling occurs, but some theories are that it has to do with chronically low cortisol and iron stores. The last time I checked my daily cortisol was around 1.5 years ago and I found that I had a slightly elevated cortisol level throughout the course of the day (morning, day, and night) and a low level of DHEAS - therefore a low DHEAS/cortisol ratio which is also indicative of some sort of chronic stress. So if the low cortisol theory doesn't apply to me then maybe it's low levels of iron, which I'll get tested for soon. If anyone else has any other theories that could explain FT4 pooling then I'd be interested to hear them. I should mention that I was surprised at having slightly elevated cortisol, given that I usually feel fatigued after breakfast and lunch (high fat usually makes it worse) and need a coffee to return to normal functionality.

Regarding rT3, I think it's more of a symptom (probably one of the same symptoms that causes a pooling of FT4 and a blocking of T3 from getting into the cells) instead of a root cause of a poorly functioning thyroid. Which isn't to say that I am suffering from FT4 pooling, it's just that it's one of the possible explanations.

@Kartoffel regarding the vitamin a toxicity, I was under the assumption that 3.8 g of liver per day wasn't that much of a poisonous amount. I know that Masterjohn, Peat and others recommend eating liver a few times per week, which I assume would come out to at least 200g of cooked liver/week.

Dr. Peat has said eating liver every week or so is a good idea. I’ve never heard him say more often than that.
 

Elize

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Jan 25, 2016
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Could we take the thyroid meds with fruit juice instead of water since. glucose helps to convert T4 to T3 as per another thread in today's newsletter?
 

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