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Dr Peat says more T3, but Dr Blanchard says more T4. Then you have the T3-only people & the T4-only people, and they all sound equally intelligent.Well 3 1/2 grains = 108 T4 and 31.5 T3
The issue with NTH is that you have to take T4 and T3 in a SET ratio. This cannot be easily altered.
Some people need this ratio, but many people actually need much less T3 in relation to the T4, but they never try this out.
Dr Blanchard in his functional thyroid book thinks most people need a ratio of 98:2. Even 1mcg T3 is very powerful. So many people are over using T3.
Now the thing to understand is that we are all different. So i am NOT saying a low dose T3 protocol will work for you, but it is important to understand the different protocols out there.
This is why i prefer T4 / T3 synthetic because you can work out your own ratio. My ratio is about 95:4.5
I thought Dr Peat often recommended NDT & then adding some extra T3 in most cases.Dr P doesn't say more T3, he says to use some as opposed to T4 mono therapy which is the standard approach by doctors all over the world.
Most patients will benefit from the intro of some T3. This is why so many patients like NTH. But the magic ingredient is the T3.
All the above approaches are just different protocols which will work for different people. There is not one standard approach which gets patients fully better because we all have specific requirements.
Forums like this allow us to try different approaches, but in the future medicine will be tailor made to suit a specific patient. It is already happening in certain areas of medicine, but i can't remember the specifics. So one day we will get analyses in a different way and a doc will be able to say you need x T4 amount and x T3 amount plus more vitamin D and you should get fully better.
So you are taking 172mcg T4 and 18mcg T3. Did you know how much thyroid medication was in 1 grain of NDT ? Lots of people don't seem to know what they are actually taking.
What are the labs ?
When do you take the thyroid meds ?
What is your adrenal system like ? Have you had a 24h spit test done for cortisol ?
I thought Dr Peat often recommended NDT & then adding some extra T3 in most cases.
Yes, I know how much T4 & T3 I'm taking.............I have it all in a spreadsheet. I first tried NDT & monitored my temp & pulse.
Nothing changed so I tried Elaine Moore's approach of optimizing Free T3 & Free T4, and I did that by adding the T4. But still no change in temp & pulse. I have noticed my dizziness has been a little better most days.
I've been on this new dose for 2 1/2 months. I take 1/2 in the morning, 1/2 at night.
TSH 0.006
Free T3 4.3 (2-4.4)
Free T4 1.84 (0.82-1.77)
Total T4 7.1 (4.5-12)
Cortisol Test (February 2017)
DHEA 5.7 (2-23)
Cortisol AM 6.8 (3.7-9.5)
Cortisol Noon 2.6 (1.2-3.0)
Cortisol Evening 2.1 (0.6-1.9) - High
Cortisol Night 0.7 (0.4-1.0)
I heard you mention of a 1:3 or even 1:2 T3 to T4 ratio as more optimal than a 1 to 4 ratio. When would the 1:2 be preferred to 1:3; is it only in a particular type of person (older for example), or would it also be preferred in a younger person?
Dr. Peat: "Women and older people generally have reduced conversion of T4 to T3, but anyone with liver malfunction is similar.
"An effective way to use supplements is to take a combination T4-T3 dose, e.g., 40 mcg of T4 and 10 mcg of T3 once a day, and to use a few mcg of T3 at other times in the day."
"An effective way to use supplements is to take a combination T4-T3 dose, e.g., 40 mcg of T4 and 10 mcg of T3 once a day, and to use a few mcg of T3 at other times in the day.
Is this for me?
I have never mentioned 1:2 of T4 to T3 usage. IT is the opposite and i am really quoting DR Blanchards approach of using a 98:2 ratio of T4 to T3. So basically mostly T4 and a little T3. This certainly suits me much better.
Dr Blanchard says T3 is really powerful and an ideal starting dose would be 0.1mcg, but no one makes such small sizes. Many people think a starting dose of 6.25 (1/4 tablet) of T3 is small, but it is actually a big dose. The smallest size i can get my T3 down to is 1/8th, so 3mcg approx. This is a good starting dose.
I would also recommend taking the T3 or T4 at bedtime. The effects on the interactions with cortisol production will be much better than taking the T3 in the daytime.
Thanks for the help & the information..........I think I'll get another adrenal test done & then try some progesterone to see if it helps. I'll also try your other recommendations & see what happens.I suppose you still feel unwell. I don't pay much attention to temps and HR, unless i am ill.
My HR will never raise and i am well and temps are fully normal. But HR will not come up from a 44 resting area. Always been low even before i had thyroid issues. I don't think i can base my entire health system on this one measurement though.
Your TSH is very suppressed and for me this says you are not absorbing the thyroid hormones well enough. Only once the conveyor belt of thyroid uptake improves will the TSH raise. Mine was suppressed for many years on different protocols and i wasn't well. It wasn't until i paid attention to the adrenal system that things improved. Specifically i started on progesterone and this has supplied me the missing cortisol i needed. Ever since my TSH has stayed at a healthy 0.3.
A TSH of 0.5-1 is the desirable goal, but 0.3 is fine by me.
So after i started the progesterone the TSH raised. This tells you that the uptake of the T4 has increased and so the conveyor belt of thyroid has started to work correctly (TSH will go up when the body thinks it needs more T4/T3 because it is now using it up more).
Dr P does use NTH, but he also uses T3 only, T4 only etc. He looks at the patient and goes from there. I saw him many years ago, but he couldn't help me as i was doing everything he was recommending anyway. Bit of a wasted consult really. He was still learning off his patients and asked me to let him know want worked for me as time went on.
My mistake in the early days of thyroid treatment was going to high to quickly on NTH. I got up to 5 grains back in 2008. Ever since then my body was using high T4 and T3 doses either in NTH or T4/T3. I did high T4 only, high T3 only. Anyway it has taken me many years to figure out my body likes T4 mostly, but also needs a little T3. The smaller T3 dose is a key addition. Using T4 to get the FT4 into the top 1/3 of the range or just over is a key goal as well.
It was only last year that i stumbled on Dr Blanchards book and he was advocating the protocol i had been using for a good while.
I actually got my new blood back today and TSH is 0.3 and Ft4 is just over range, but FT3 is in the top 1/3 of the range, but not over. So these are good results and i feel good, so all ok.
Your results similar to mine, but the difference is very subtle. Your FT3 is over range and TSH is suppressed. This tells me you are not sucking up the T3 efficiently (as mentioned above). So maybe have a look at some progesterone in small doses. 3mg per day may be enough to make a huge difference. This is all i take nowadays, but previously i was using 6mg per day (ProgestE).
Your cortisol profile looks ok. The shape is good ( a declining curve). Ok so you have a little jump in the late afternoon, but this is fine. DHEA is lower in range and this is common for thyroid patients. I would say you need a higher morning cortisol reading though and agin this is common with thyroid patients. We make thyroid hormones at bedtime in the first part of the night and we then make a corresponding cortisol amount in the second half of the night. So it is important to take thyroid meds at bedtime, or certainly a good percentage as you are currently doing.
So you take 50 T4 and 1 grain at bedtime. This = 86 T4 and 9 T3.
I would look at using all the T4 at bedtime and 1/2 grain. So 118 T4 and 4.5 T3 at bedtime. Then take the remaining 1 1/2 grains around noon the next day.
The timings of your doses and ratios are important, but i cannot say what specifically will work best for you. Trial and error is the way forward. If you trail any doses amounts out stick with it for 2 weeks before modifying the dosing.
Dizziness was a major issue when i first became ill. I don't think it is thyroid only, more likely thyroid/adrenal. So you want the thyroid and adrenal system to start working together more effectively. Again bedtime dosing should aid this.
Finally what is your waking temp usually ?
It's for you and it's for all. Plenty of doctors have been recommending high ratios of T4:T3 or only T4 forever. Peat generally recommends higher t3 then most doctors. This is the Dr. Ray Peat forum, not the Dr. Blanchard forum. Trying to keep things in perspective.
By the way my plan is to stop taking the thyroid pills after a while. Do you think that is even remotely possible?
I only started because I wanted to get out of the hypo state so that my body would stop producing TSI antibodies which showed up on my blood test & may be blocking my thyroid hormone.
Apparently being hypo encourages TSI antibody production.
I have a really strange case. I stupidly took a 6.25 mg Iodine supplement for 2 1/2 years thinking it was a good thing to do.
I read that was a bad idea, so I stopped. A week or 2 later I became severely hyper (possible Grave's Disease). That died down, & then I went hypo.
So there was nothing wrong with me until I played around with the iodine. My TSH was 1.5 when I was normal.
I was hoping to get things humming along back to normal with the thyroid meds & then just slowly back off & hope my body doesn't notice.
I suppose you still feel unwell. I don't pay much attention to temps and HR, unless i am ill.
My HR will never raise and i am well and temps are fully normal. But HR will not come up from a 44 resting area. Always been low even before i had thyroid issues. I don't think i can base my entire health system on this one measurement though.
Your TSH is very suppressed and for me this says you are not absorbing the thyroid hormones well enough. Only once the conveyor belt of thyroid uptake improves will the TSH raise. Mine was suppressed for many years on different protocols and i wasn't well. It wasn't until i paid attention to the adrenal system that things improved. Specifically i started on progesterone and this has supplied me the missing cortisol i needed. Ever since my TSH has stayed at a healthy 0.3.
A TSH of 0.5-1 is the desirable goal, but 0.3 is fine by me.
So after i started the progesterone the TSH raised. This tells you that the uptake of the T4 has increased and so the conveyor belt of thyroid has started to work correctly (TSH will go up when the body thinks it needs more T4/T3 because it is now using it up more).
Dr P does use NTH, but he also uses T3 only, T4 only etc. He looks at the patient and goes from there. I saw him many years ago, but he couldn't help me as i was doing everything he was recommending anyway. Bit of a wasted consult really. He was still learning off his patients and asked me to let him know want worked for me as time went on.
My mistake in the early days of thyroid treatment was going to high to quickly on NTH. I got up to 5 grains back in 2008. Ever since then my body was using high T4 and T3 doses either in NTH or T4/T3. I did high T4 only, high T3 only. Anyway it has taken me many years to figure out my body likes T4 mostly, but also needs a little T3. The smaller T3 dose is a key addition. Using T4 to get the FT4 into the top 1/3 of the range or just over is a key goal as well.
It was only last year that i stumbled on Dr Blanchards book and he was advocating the protocol i had been using for a good while.
I actually got my new blood back today and TSH is 0.3 and Ft4 is just over range, but FT3 is in the top 1/3 of the range, but not over. So these are good results and i feel good, so all ok.
Your results similar to mine, but the difference is very subtle. Your FT3 is over range and TSH is suppressed. This tells me you are not sucking up the T3 efficiently (as mentioned above). So maybe have a look at some progesterone in small doses. 3mg per day may be enough to make a huge difference. This is all i take nowadays, but previously i was using 6mg per day (ProgestE).
Your cortisol profile looks ok. The shape is good ( a declining curve). Ok so you have a little jump in the late afternoon, but this is fine. DHEA is lower in range and this is common for thyroid patients. I would say you need a higher morning cortisol reading though and agin this is common with thyroid patients. We make thyroid hormones at bedtime in the first part of the night and we then make a corresponding cortisol amount in the second half of the night. So it is important to take thyroid meds at bedtime, or certainly a good percentage as you are currently doing.
So you take 50 T4 and 1 grain at bedtime. This = 86 T4 and 9 T3.
I would look at using all the T4 at bedtime and 1/2 grain. So 118 T4 and 4.5 T3 at bedtime. Then take the remaining 1 1/2 grains around noon the next day.
The timings of your doses and ratios are important, but i cannot say what specifically will work best for you. Trial and error is the way forward. If you trail any doses amounts out stick with it for 2 weeks before modifying the dosing.
Dizziness was a major issue when i first became ill. I don't think it is thyroid only, more likely thyroid/adrenal. So you want the thyroid and adrenal system to start working together more effectively. Again bedtime dosing should aid this.
Finally what is your waking temp usually ?
I didn't take my 1/2 grain NDT until after the blood test.Thyroid looks ok but tsh is suppressed. Did you take any thyroid meds before the blood draw?
If not you need a little more help using the thyroid meds. You would then get a more raised tsh. 0.5-1 to a good place as it shows the body is using the meds and still wanting a bit more.
Cortisol is often the issue. Your cortisol profile is good but the dhea is low which is typical in thyroid patients. The balance of cortisol to dhea wants to be 4:1.
Use cholesterol is higher. Thyroid shunts cholesterol into the steroid hormones and so cholesterol is another indicator for low thyroid.
Before looking at using more t4 I would try some progesterone. Use ProgestE as you can dose in 3mg amounts. One drop may really help you out.
Testosterone is low and this maybe the main issue. Progesterone can boost testosterone but not a huge amount.
I think you need to see if progesterone can help the thyroid performance and get a blood test.
If you take anti depressants this will crash testosterone.
The testosterone wants to be looked at as it can often be a more separate issue to thyroid. Thyroid will raise it but not that much and you are low in the range.