Kenneth Blanchard On Optimal Hypothyroidism Treatment

[invictus]

Dr Blanchard is not with us anymore, but his books are great.

I take T4 only, but have tried every thyroid protcol going over the years 2008-2015. Now i take T4 only at bedtime.

I find T4 works much better if taken at bedtime. I dont have any sleep issues and i just feel it fits in with when we naturally make our own T4.

TSH peaks in the nighttime, this stimulates the body to produce the T4 for the next day. This also has a knock on effect on cortsol production. T4 and cortisol work together. Low thyroid patients often record low cortisol production in the morning, when really it should be at its highest.

So giving T4 at bedtime means you are working with your circadian rhythm.

When i used T3 with the T4 i found less was much more effective. So i would use 2.5mcg approx in the morning.

My hormone journey has been a long one and in the last year i have started testosterone treatment as well. I now realise testosterone is an important factor in getting thyroid to work well. I am doing better than ever in my life and am now aged 48.

The OP has good thyroid figures, but a high TSH. How old are you ? I assume you dont feel that well, hence you are looking to try some T4.

The thyroid journey is a long descent. I mean the thyroid starts to stutter along time before it really shows up with really bad symptoms. Lots of young people dont realise they have a thyroid issue, and instead get diagnosed with mental health problems. It happened to me aged 21 and it wasnt until i was 36 that i started to look under the thyroid bonnet.

When the tsh starts to climb it can indicate the thyroid is starting to struggle and so it ramps up conversion. Hence you get good FT3 no's and FT4 is ok as well. But going forward in time the thyroid struggles even more and TSH will go higher, but maybe conversion isnt as good and you get more symptoms.

 

[Elize]

What time is bedtime for you? Did you lower or increased your dose?

 

[invictus]

I believe, from my research, that, as we age, our pituitary and/or hypothalamus begin to malfunction, creating central hypothyroidism or cellular thyroid resistance. Regarding Dr. Blanchard, I read his book a couple of days ago and he states that the daily optimal dose of T3 is 1.5 mcg, in a T4/T3 ratio of 99.5 to 1.5.

I'd been trying high dose T3 per the research of Dr. Tammas Kelly, psychiatrist and researcher, whose specialty is thyroid and mood disorders. For me, it made things worse. Now trying Dr. Blanchard's approach using literally specks of NDT every hour or two. Also ordered Dr. Broda Barnes' book, since he was the pioneer in thyroid replacement therapy and I know his work influenced Dr. Peat. It can all be frustrating and confusing, but the one phrase that I keep reading on so many forums is, 'The right protocol is the one that works for you.'

 

[Broco6679]

I believe, from my research, that, as we age, our pituitary and/or hypothalamus begin to malfunction, creating central hypothyroidism or cellular thyroid resistance. Regarding Dr. Blanchard, I read his book a couple of days ago and he states that the daily optimal dose of T3 is 1.5 mcg, in a T4/T3 ratio of 99.5 to 1.5.

I'd been trying high dose T3 per the research of Dr. Tammas Kelly, psychiatrist and researcher, whose specialty is thyroid and mood disorders. For me, it made things worse. Now trying Dr. Blanchard's approach using literally specks of NDT every hour or two. Also ordered Dr. Broda Barnes' book, since he was the pioneer in thyroid replacement therapy and I know his work influenced Dr. Peat. It can all be frustrating and confusing, but the one phrase that I keep reading on so many forums is, 'The right protocol is the one that works for you.'

Broda Barnes' book isn't all that informative unfortunately.
It mainly focuses on the symptoms of hypothyroididsm which everyone here is already familiar with, but it doesn't go into mechanisms, causes, or any physiology. There's only one chapter on how to dose thyroid, it's only seven pages long if I recall, and all it says is to start with half a grain of ndt, increasing by 1/2 grain every two to four weeks until morning temps become normal.
Problem for a lot of people is that approach doesn't always work.
Tons of people here who either notice no improvement on ndt, worsening adrenaline symptoms or the development of hyper symptoms like weakness and muscle wasting, and his book doesn't offer insight into any of that.

Dr Barry Peatfield's book does go into some of those issues, but his answer is just to take adrenal cortex extract or cortisol which again doesn't help a lot of people.

 

[Elize]

Problem for a lot of people is that approach doesn't always work.
Tons of people here who either notice no improvement on ndt, worsening adrenaline symptoms or the development of hyper symptoms like weakness and muscle wasting,

My experience as above

 

[Broco6679]

Problem for a lot of people is that approach doesn't always work.
Tons of people here who either notice no improvement on ndt, worsening adrenaline symptoms or the development of hyper symptoms like weakness and muscle wasting,

My experience as above

It's the same for most who try thyroid unfortunately.
It's really strange because every understands / can identify the problem of low thyroid / temps, but there's still zero conclusive answer on how to fix it and everyone has different opinions.
Peat says 2/3:1 T4:T3, blanchard says 98.5:1 T4:T3, Wilson / Robinson say T3 monotherapy, STTM say NDT + cortisol and modern medicine says T4 mono.
None seem to work for many.

 

[invictus]

Was wondering when/how do you take your T4? There are studies that show taking it in the evening gives better absorption than taking it 1h before breakfast, although in all these studies they still have a several hours gap between dinner and T4 intake. Blanchard on the other hand suggests taking it with food is beneficial for weight regulation, and recommends taking it with the evening meal for added sleep benefits, although he also sometimes recommends to take it before breakfast if the patient has no problem with sleep, so I'm confused as to what he actually considered ideal.

Dr. Blanchard's working methods focused on each patient's particular symptomology. In reading his book, there aren't contradictions; he didn't use a cookie cutter approach. Each person presented unique challenges and he tailored a protocol that produced positive results.

 

[Peater Pan]

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.

He states:

"The human thyroid probably secretes about a 95:5 T4:T3 mixture into the system daily. When such a patient is given a regimen with 80:20 or 70:30 T4:T3, as has occurred in many of these studies, they will gradually desaturate T4 in the peripheral tissues and then the whole metabolic effect fails."

"My general starting point is 98.5 percent T4:1.5 percent T3, but I might well shave those portions one way or the other depending on other factors. I believe that one has to respect the patient’s report that “I am very sensitive to medications” and go low on the initial dosage, perhaps 99 percent T4:1 percent T3."

For ablation and advanced Hashi's patients:

"Since patients with thyroid ablation have lost all their secreted T3, they may well need a significantly higher percentage of oral T3 in their regimen for optimal physiologic effect."

"What I do is to take the typical ablation patient on 100 percent T4 and give them about 98 percent T4:2 percent T3 initial treatment and then gradually work the T3 percentage higher over a period of time as long as the patient keeps improving. One should always keep in mind that the institution of time-release T3 improves the patient’s metabolism such that they appear to use their T4 faster."

 

[Peater Pan]

preferably in time-release capsules, combined with 25-50 mcg of T4.

This is not clear. Blanchard only used sustained release T3 but not T4 as I understand it. He advised T3 taken in the morning and T4 with food 3-5 hours before bed.

 

[Peater Pan]

Any mention of iodine / iodide in his work?

No. Not supplementally, only in regards to iodine's location in thyroid molecules, e.g., T2, T3, T4, etc.

 

[Peater Pan]

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.

His "jump start" methodology, e.g., 50% T4 increase for 3-5 days and then 10% increase, is interesting as well (works in both directions) I'm doing one now, heading in to winter…

 

[Peater Pan]

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.

Yes, the more I study, the more I realize that suppressed TSH is probably not good except maybe for cancer patients. TSH is a hormone and signals T4 to T3 conversion.

 

[Peater Pan]

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.

"KENNETH R. BLANCHARD, M.D., PH.D. is an endocrinologist certified by The American Board of Internal Medicine and The American Board of Endocrinology and Metabolism. His undergraduate degree was at MIT and he received a Ph.D. in chemistry from Princeton University. He taught chemistry at Vassar College for three years before going on to Cornell University Medical College. He trained for 2 years at New York–Memorial Hospitals in New York City and then completed a fellowship in endocrinology at the Boston VA Hospital. Dr. Blanchard also practiced general internal medicine until 2000 and now concentrates only on thyroid disease and menopausal
hormone replacement therapy. He has been in private practice in Newton, Massachusetts, from 1976 to the present time. He has done numerous magazine, radio, and TV interviews in recent years. He is the father of two sons and his wife, Rita, is also a physician. They continue to live in Newton."

He developed this method over 41 years in private practice with thousands of patients. I'd not summarily discount it as you have. And, NDT is most certainly not what is used to be.

 

[Peater Pan]

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?

Lowest T3 pill is 5 mcg.

 

[Peater Pan]

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.

Good point. Hadn't thoght of that NDT is 39/9. Divided by 7=5.57 T4/1.28 T3 per drop and you could dilute it down further with ease. Interestingly, Blanchard believed topical T3 was 2x as string as oral.

 

[Peater Pan]

Was wondering when/how do you take your T4? There are studies that show taking it in the evening gives better absorption than taking it 1h before breakfast, although in all these studies they still have a several hours gap between dinner and T4 intake. Blanchard on the other hand suggests taking it with food is beneficial for weight regulation, and recommends taking it with the evening meal for added sleep benefits, although he also sometimes recommends to take it before breakfast if the patient has no problem with sleep, so I'm confused as to what he actually considered ideal.

"Very important is that the T4 needs to be taken 3 to 5 hours before bedtime. If taken at bedtime, it appears to have very little benefit for sleep quality."

Blanchard, Kenneth. Functional Approach to Hypothyroidism.

But he'd consider what's "ideal" is that which works for each individual patient.

 

[Peater Pan]

if you grind cynomel tablets into powder, one of those red plastic microscoops is ~3mcg

Amazon product ASIN B07X1R442K

 

[Ihor]

Does anyone have an e-book version of these Blanchard's book about hypo that discussed here?

 

[Peater Pan]

Does anyone have an e-book version of these Blanchard's book about hypo that discussed here?

Amazon has it electronic for like $10.

 

[Jsaute21]

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

Sorry - need to confirm, he is insinuating the ideal ratio should be 67:1 t4/t3 ratio?