Kenneth Blanchard On Optimal Hypothyroidism Treatment

[Collden]

I just read his book Functional Approach to Hypothyroidism and he seems to integrate well the mainstream perspective with alternative views like STTM including why many do not do well long-term on NDT or high amounts of T3 either.

The crux of his argument is that pure T4 therapy is optimal only for a minority, but going too high with T3 supplementation in relation to T4 is also bad long term and will cause people to crash as it pushes TSH too low and depletes T4. He thinks the ratio in NDT is way too high for most and for most the optimal ratio to supplement will be closer to 67 : 1 than 5 : 1 T4/T3.

This also means that ideal amounts of T3 will be far lower than what is found in most pills, this is the reason many studies find no benefit of added T3 since the dose is at least 10-fold higher than the ideal. He thinks most people should not get more than 0.5 - 1.5 mcg T3 per day, preferably in time-release capsules, combined with 25-50 mcg of T4.

Also that the main reason why people feel bad with too much T4 is that it suppresses TSH too much which reduces tissue T4->T3 conversion, its not related to rT3.

Also thinks its better to take T4 at dinnertime to improve sleep and reduce tendency to weight gain.

Thoughts on his book? Has anyone tried his approach to treat hypo? He's also big on time-release T3 capsules but these seem not to be that readily available.

 

[LeeLemonoil]

Any mention of iodine / iodide in his work?

 

[Collden]

Any mention of iodine / iodide in his work?

No, it's mostly about hormone therapy itself and how to optimize it, little about nutrition and lifestyle. You think iodine is important? Peat does not seem to think much of it.

 

[Wilfrid]

I have read the book and found it very insightful.
And up to now, it still remains my reference book on thyroid dosage supplementation.
I sometimes jointly use a software (called SPINA Thyr.) when I take only the T4 hormone, just to figure out how effective is my T4 to T3 conversion and TSH response. And I use body temperature and pulse as well.
The amount of T4 and T3 recommended in this book works like a charm for me.

 

[mrchibbs]

That's interesting, thanks for sharing I will go and read that book.
Although Ray has presented enough evidence (I've got a few studies/references on this) to show that TSH by itself is inflammatory and the culprit behind many problems of hypothyroidism, I really don't think it's a case of "suppressing TSH" too much. I could always be wrong though.

 

[thomas00]

Sounds like a a lot of unsubstantiated claims. If NDT was so inappropriate how come it was used with such great success before quality issues rendered it a poor choice?

I think he's panicking about t3, has probably seen a few patients done well with as little as 1mcg (entirely plausible) and decided it's appropriate for everybody. There are anecdotes and case studies of people taking large amounts of t3 for long periods of time and they didn't 'crash', whatever that means.

This business with the sustained release version of t3 is hooey. None of the compounded concoctions recommended by Wilson and the like have any pharmacokinetic data behind them to prove they are doing what is claimed. The preparations used in published experiments haven't made it onto the market and probably never will.

It's a real bummer there isn't a 1mcg pill or liquid formulation on the market. I've nagged Haidut,as have others, but to no avail.

 

[sweetpeat]

He's been mentioned on the forum before, especially by @marsaday. So you could do a search and find more reviews/discussions.

I found his book very helpful, especially the part about adjusting your thyroid dose for the seasons. I don't follow his ratio recommendations, but I'm not following Peat's either lol. I would say his book gave me the courage to experiment more to find the dose that works best for me.

 

[Collden]

Sounds like a a lot of unsubstantiated claims. If NDT was so inappropriate how come it was used with such great success before quality issues rendered it a poor choice?

I think he's panicking about t3, has probably seen a few patients done well with as little as 1mcg (entirely plausible) and decided it's appropriate for everybody. There are anecdotes and case studies of people taking large amounts of t3 for long periods of time and they didn't 'crash', whatever that means.

This business with the sustained release version of t3 is hooey. None of the compounded concoctions recommended by Wilson and the like have any pharmacokinetic data behind them to prove they are doing what is claimed. The preparations used in published experiments haven't made it onto the market and probably never will.

It's a real bummer there isn't a 1mcg pill or liquid formulation on the market. I've nagged Haidut,as have others, but to no avail.

Well he's mostly basing this on his clinical experience, he says higher ratios of T3/T4 up to NDT is more likely to be beneficial the more damaged the thyroid, most beneficial for those who had total thyroidectomy. Perhaps in the past there were more severe cases and less mild/subclinical cases, or perhaps NDT appeared better in the past because there was no other treatment.

There are also plenty of accounts just on this forum of people having problems with T3-heavy therapy.

Supposedly the half-life of T3 is 24 hours, so I honestly don't understand why you'd even need a time-release preparation. It seems just taking it once or at most twice daily should be enough to keep relatively steady levels, or perhaps minor fluctuations matter that much?

 

[jmojo]

Where are you guys getting your T4 from?

 

[sweetpeat]

Where are you guys getting your T4 from?

I've been getting my t3 and t4 from Mexico.

 

[Collden]

I have read the book and found it very insightful.
And up to now, it still remains my reference book on thyroid dosage supplementation.
I sometimes jointly use a software (called SPINA Thyr.) when I take only the T4 hormone, just to figure out how effective is my T4 to T3 conversion and TSH response. And I use body temperature and pulse as well.
The amount of T4 and T3 recommended in this book works like a charm for me.

Cool, so how are you managing to dose such a small amount of T3? Seems difficult when the lowest standard pill is 25mcg. NDT looks easier since there are capsules that go down to 3mcg. Are you using timed-release capsule or regular T3?

 

[jmojo]

Cool, so how are you managing to dose such a small amount of T3? Seems difficult when the lowest standard pill is 25mcg. NDT looks easier since there are capsules that go down to 3mcg. Are you using timed-release capsule or regular T3?

You just take small nibbles off the pill and estimate that you probably are getting around .5 to 1 mcg with the smallest nibble.

 

[Wilfrid]

Cool, so how are you managing to dose such a small amount of T3? Seems difficult when the lowest standard pill is 25mcg. NDT looks easier since there are capsules that go down to 3mcg. Are you using timed-release capsule or regular T3?

I used to order the T3 from a compounding pharmacy in Italy but during the past few months the price went up like crazy. So now I used a 3-day split dosing of Metavive I.
Last month, I bought a NDT from allergy research group and found it effective and helpful but within days I developed nasal congestion from it....I never used the so-called timed-release product and I prefer using the T3 thrice a day, with food. Taking the highest doses in the early morning and late afternoon and the lightest one at midday. For the T4 I use the IBSA brand and in the past I used to get a liquid T3 called Liotir from the same company as well.
For one month (30 caps) supply of compounded NDT at 2,4 mg dosage, I paid (in 2018) 22,40 euros (without the shipping fees.):

 

[Wilfrid]

Any mention of iodine / iodide in his work?

He mentioned briefly iodine and selenium needs and supplementation in his other book: What your Doctor May Not Tell You About Hypothyroidism: A Simple Plan for Extraordinary Results.
He warned against unphysiologic dose supplementation of both elements.

 

[Collden]

I used to order the T3 from a compounding pharmacy in Italy but during the past few months the price went up like crazy. So now I used a 3-day split dosing of Metavive I.
Last month, I bought a NDT from allergy research group and found it effective and helpful but within days I developed nasal congestion from it....I never used the so-called timed-release product and I prefer using the T3 thrice a day, with food. Taking the highest doses in the early morning and late afternoon and the lightest one at midday. For the T4 I use the IBSA brand and in the past I used to get a liquid T3 called Liotir from the same company as well.
For one month (30 caps) supply of compounded NDT at 2,4 mg dosage, I paid (in 2018) 22,40 euros (without the shipping fees.):

View attachment 17825 View attachment 17826

Thanks, been considering IdeaLabs products too. Unless my calcs are off, one drop of TyroMax would be the equivalent of 1/7 of a grain of NDT so would be a pretty good fit for this protocol.

 

[Elize]

What would a physiological T4 dose be?

 

[Wilfrid]

What would a physiological T4 dose be?

According to the late Dr Blanchard, any dose starting from 12,5 mcg and up to 25 mcg.

 

[Elize]

Wow thanks. For years I have been telling my endo endo that I feel hyper and each time am told that I should have more than 75 mcg. No wonder I can't get my weight up.

 

[empoweredliving]

I just read his book Functional Approach to Hypothyroidism and he seems to integrate well the mainstream perspective with alternative views like STTM including why many do not do well long-term on NDT or high amounts of T3 either.

The crux of his argument is that pure T4 therapy is optimal only for a minority, but going too high with T3 supplementation in relation to T4 is also bad long term and will cause people to crash as it pushes TSH too low and depletes T4. He thinks the ratio in NDT is way too high for most and for most the optimal ratio to supplement will be closer to 67 : 1 than 5 : 1 T4/T3.

This also means that ideal amounts of T3 will be far lower than what is found in most pills, this is the reason many studies find no benefit of added T3 since the dose is at least 10-fold higher than the ideal. He thinks most people should not get more than 0.5 - 1.5 mcg T3 per day, preferably in time-release capsules, combined with 25-50 mcg of T4.

Also that the main reason why people feel bad with too much T4 is that it suppresses TSH too much which reduces tissue T4->T3 conversion, its not related to rT3.

Also thinks its better to take T4 at dinnertime to improve sleep and reduce tendency to weight gain.

Thoughts on his book? Has anyone tried his approach to treat hypo? He's also big on time-release T3 capsules but these seem not to be that readily available.

View attachment 17789

I read that book, viewed it as 5 Stars on Amazon then asked Haidut aka Georgi Dinkov to read it and hopefully make a formula close to it. For many people, T3 alone or high T3 is going to aggravate Adrenaline Dominance.

 

[Elize]

I read that book, viewed it as 5 Stars on Amazon then asked Haidut aka Georgi Dinkov to read it and hopefully make a formula close to it. For many people, T3 alone or high T3 is going to aggravate Adrenaline Dominance.

Yeah that's great news. Hope Haidut will make such a formula