Feel better on T4 than you did on Natural Desiccated Thyroid?

Occasionally, hypothyroid patients will exclaim with conviction and truth that they outright feel better on Synthroid or Levothyroxine (T4-only meds) than they did when they tried Natural Desiccated Thyroid (NDT) or even T3-only.  And we believe them.

But…there is an explainable reason which does not mean T4-only is better for you. It really isn’t. Bear with me and read on…

Years ago, as many of us were starting on NDT after being on T4, we were seeing our lives change in a huge way, far more than T4 did! It was like a miracle! Those five hormones really made a difference.

But some others were having problems when raising something so miraculous for others. Huh?? We didn’t get that.

It took awhile longer to finally see why and to answer the “huh?” i.e. we began to see that there were three strong and correctible reasons why someone was not seeing the miracle of NDT as others were, and instead, were blaming the NDT (or T3) and moving back to T4-only…

The three main and correctible reasons why NDT, which gives all five thyroid hormones, seems to fail…

1) NOT BEING “OPTIMAL” WITH YOUR NDT DOSE (it’s NOT about just being in range and not about being held hostage to the TSH)

We all have had a tendency to believe that our doctors know what they are doing with NDT or T3. But, the majority do not. They tend to leave you on too-low doses, and/or pay attention to the lousy TSH. Thus, due to the natural suppression of the feedback loop (hypothalamus to pituitary to thyroid), you will get worse on those lower doses, sooner or later. i.e. you will get more hypo, and/or have rising adrenaline, cortisol, anxiety or other. And because of that, some exclaim “NDT didn’t work for me!” and they rush back to T4-only.  But NDT, with all five thyroid hormones, could have worked well IF you had known to be more optimal. Optimal puts the free T3 towards the top of the range and the free T4 mid-range, and puts the TSH below range…all three…and removes all symptoms. What amount does that is very individual—some start to achieve that in mid-2 grains, others are in the 3-5 grain area, others may be higher.

What if you tried to raise to be optimal, but had worsening problems? Read #2 and #3 below.

2) NOT BEING OPTIMAL WITH YOUR IRON LEVELS (it’s not about just being in range)

When this is brought up to patients who once tried NDT and failed, they will exclaim with all sincerity “But my iron levels were great”. We know that a very small percentage may have had good iron. But what is common with the majority is they did NOT have good levels “Falling in the normal range” does not equal a good level of iron. It’s WHERE one falls that tells the story.

For example, with two types of ranges for serum iron (NOT ferritin):

a) When the range is approx. 40–155: women who have optimal serum iron tend to be close to 110, or 109, or 108, etc. They are NOT in the 90’s and definitely not lower when optimal. Men tend to be in the upper 130’s.
b)  When the range is approx. 7-27: women are optimal around 23ish; men are towards the top.

If they are lower than the latter examples, it messes up the ability to raise NDT and feel great without issue. Why? Inadequate iron levels tend to raise the reverse T3 (RT3) as one is raising their NDT.  As the RT3 goes up due to inadequate iron, you will feel worse. And because of that, some exclaim “NDT didn’t work for me!” and they rush back to T4-only…but if they had had optimal iron, NDT WOULD have worked…as long as they also had optimal cortisol (See #3 below) and were working to find their optimal dose of NDT (see #1)

See more details about iron here: http://stopthethyroidmadness.com/ferritin

3) NOT BEING OPTIMAL WITH YOUR CORTISOL LEVELS (it’s not about just being in range, and it’s NOT about blood cortisol)

We noted years ago that at least 50% of those with hypothyroidism had a cortisol issue as revealed by saliva, not blood. What does a cortisol issue mean? Either their cortisol was too high (due to the stress of being undiagnosed, poorly treated, or being on T4) or was too low (due to the stress of being undiagnosed, poorly treated, or being on T4), or had both high and low (due to the stress of being undiagnosed, poorly treated, or being on T4).

And what happens with a cortisol issue when you are trying to work with NDT? Either RT3 will go too high (the inactive hormone), or one’s T3 will pool in the blood and not make it to the cells, or both…and you won’t feel well or have bad reactions like excess adrenaline, anxiety, shakiness, feel-bads.

And because of having a cortisol issue, some exclaim “NDT didn’t work for me!” and they rush back to T4-only…but if they had…

a) done the 4-point saliva test, not blood
b) compared the saliva results it to the lab-values page (it’s not about that normal range)
c) CORRECTLY treated it (see this page, plus Chapter 6 in the revised STTM if saliva is VERY low, which also applies to Adrenal Cortex),

….they would have soared on NDT…along with good iron and being OPTIMAL on NDT (or T3)

Note: it’s always about the results of a saliva test, NOT blood cortisol.

Bottom line, it’s not as simple as “feeling better on T4”. It’s more about that you are NOT experiencing the side effects that you did on NDT from any of the above three problems, which were all correctible. That is different.

“That all sounds like too much trouble–I’m staying on T4-only!”, you may be exclaiming….

There is a big problem with that reasoning that I hope you will be open to….Namely, T4-only outright…

  • CAUSES low iron
  • CAUSES a cortisol problem
  • CAUSES many other issues like lowered B12, lowered Vitamin D, rising blood pressure, rising cholesterol, depression, anxiety, heart issues, bone thinning, chronic pain….and more. The individuality is in who gets which…but T4 users do get problems of their own kind, sooner or later.

Please note that the above is not an empty strong opinion. It’s based on years of reported patient experiences from many who were on T4! i.e. most of the following hypothyroid symptoms were experienced by T4 users!! They were still hypo!

Now you may state “But I know people on T4 who do not have those problems!”.

First, some outright DO have some of those problems, but don’t realize it or they deny it (while others see it in them). Adrenal issues, even those denied, can make certain people awash with defensiveness, argumentativeness, denial, anger, paranoia towards others observations, low patience, moodiness, etc.

Yes, some on T4 do, in fact, do better than others. But you know what we have observed? The longer they stay on T4-only, the more problems WILL, in fact, raise their ugly heads eventually…like either adrenal issues, or low iron, or low B12, or depression, or rising cholesterol, or rising blood pressure, or heart problems, or dry skin and hair, or chronic pain, or bone loss, or rising illnesses…..on and on. Forcing the body to live for conversion alone backfires….sooner or later.

Summary: Natural Desiccated Thyroid, or adding OPTIMAL T3 to that T4 as a second choice, is a much better way to go than being on nothing but T4, according to years of worldwide patient experiences

NDT gives you all five thyroid hormones, and does NOT force you to live for conversion of T4 to T3 alone, i.e. some of NDT is direct T3. Additionally with T4-only, some people have genetic mutations which hinder the conversion of T4 to T3 and may not realize it.

There is a good reason that millions of patients found out that T4-only is not the way to go for many reasons, and NDT is the way to go if you correct the reasons you did NOT to do well...or even adding T3 to your T4 in an OPTIMAL amount. But you will still need optimal iron and cortisol!






P.S. The above three reasons are the most common for not doing well on NDT (or T3) and should be considered first. A 4th less common reason: chronic inflammation of any cause. Read about inflammation. If this is true for you, the sad part is that T4-only will also backfire, as it raises RT3.











Mold exposure can also effect conversion.

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33 Responses to “Feel better on T4 than you did on Natural Desiccated Thyroid?”

  1. Karen Redd says:

    A few years ago I was probably a week away from being in a wheelchair because my back hurt so bad. I had gained so much weight. One day I made myself get up and I started walking every day and around the same time I had talked a doctor into putting me on Armour thyroid. Skip ahead a year and I had lost 70 pounds and could walk up to 3 miles a day. Three years later a new doctor took me off of it and I didn’t really care because I had started gaining weight. I couldn’t go walking anymore because I need hip replacement surgery but then I convinced a dr to put me back on it. I walked, I didn’t lose weight, then the other day I had a reaction to my level being extremely high. It was HORRIBLE, I literately had sweat dripping off my face and BURNING hot and weak and unbelievably sick. – I had my dr take me off of it, and I doubt I will take it again. I was very very disappointed, I had thought before that it was a miracle, now I wonder if it was just the walking that caused me to lose the weight.

    • Hi Karen. I think you need to study what I wrote better. Because a lot of hypothyroid people have doctors who don’t understand what being optimal means, and thus one is underdosed, even if they at first see great results from NDT. And being underdosed can eventually backfire, even causing the very adrenal isue I also described, which your eventual bad symptoms resembled. Also, Armour went through a change in the way it was made, and that, too, could have done that.

  2. Susan says:

    I am a total convert to the absolute necessity of using iodine (Lugol’s, Iodoral, etc) if you are taking thyroid hormone. I think iodine is necessary for the conversion of T4 to T3, as I have seen my T4 levels steadily drop with the use of iodine. Prior to using iodine, T4 levels seemed “normal” but T3 levels were low (within range, but low). My T3 levels have risen as my T4 levels have dropped; I am having the opposite effect of many people taking iodine, I actually need to increase my NDT intake. This may be due to aging and the incredible stress I continually suffer, but I do agree with those who say iodine is critical for hypothyroid people.

  3. sam says:

    thank you for the visual diagram for the saliva test for adrenals for us visual ones ,can understand that one right away thank you jamie ! no wonder im still tired and have so much trouble losing weight![ even though my adrenal cortisol saliva test came back finally in the “normal” range is no where near where should be[have been taking thyrogold for years now dont know what i’d do with out it]

    now i know have to get adrenals better so that can take enough thyrogold to feel less tired and lose weight .now if take enough have a too high pulse rate so hav e to take less for a while but then gain weight and am more tired

  4. Melissa Vejins says:

    While I understand that it may be a touchy subject for some, a collegial, scientific and open-minded approach to problem solving is helpful. I’ve been on thyroid medication for 17 years. And yes, at first, undertreated with Synthroid and not told how to take it, for the first several years.
    I completely understand how porcine thyroid contains a wider range of hormones closer to that of humans. I was on Erfa thyroid for 6 years. Strangely, out of those, I developed Level 1 heart block and strange palpitations I never had before. Erfa also proved to be absolutely unreliable, changing from batch to batch. I even phoned Erfa’s head office in Montreal and did not receive much help other than asking me what lot number.
    I have read a sick amount of information about thyroid health, and what diet, what habits and what exercise and lifestyle will do to help.
    After one last bout with a bad batch of Erfa sending me spiraling into symptoms, I called my amazing endocrinologist in Montreal and said, enough! I’ve been back on Synthroid and at an appropriate dose, and lo and behold, I feel great! Why shouldn’t I? I eat well and my liver is doing a good job converting the T4 into T3.
    I have a medical condition. That means I will never be 100% like a human who has never had thryroid issues. Same as a diabetic person or anyone with a similar endocrine disorder. But instead of blaming my poor thyroid gland and my doctor, I am focussing in sending light to my throat chakra and thinking positively.

    Let’s look at the porcine industry—it’s disgusting how these poor animals are fed and treated. It isn’t the same as it was some time back. It is a super industry with a lot of sick and badly treated animals. I’ve always been aware that there are some possibilities of danger derived from taking a desiccated animal product. From a humane standpoint, I never felt good relying on animals I do not eat, being mostly vegetarian.
    I am fine. I am happy and I am fit. I don’t abuse alcohol and I’m grateful that modern medicine has come up with a synthetic medicine easy to take and carry on a trip. It may not be perfect, but I wonder if those who are unwell are looking at their whole health.
    I am disturbed by the enmity towards endocrinologists, many of whom have endocrine disorders also and who have spent years in university. Many good studies have come out regarding T4 only meds. New ones are coming out. Can they improve? I’m certain. I have no thyroid function but I’m so happy to be back on something I can count on. Happy to not take part in the slaughter of animals to care for my condition.

    • Hi Melissa. Yes, Erfa has been problematic for a few years now, and sadly, they deny it. Unbelievable. We’re also very glad you feel you are doing well on Synthroid. Some do, in fact, do better than others. But it doesn’t take away the fact that there are numerous reasons why it will eventually fail you–there’s a graphic in the article explaining just some of them. The body is simply not meant to live for conversion alone, no matter how well you are doing now. That is not strong opinion–it’s just based on the reports by a large body of people over the years who found out the hard way.

      As far as those “good studies”…studies are based on those who run them. And what we’ve noted too many times is that the “observations” of the “efficacy” of T4 does not fit the real life experiences of a large body of patients worldwide. Another good example of the fallacy of studies is the one done on NDT by Walter Reed Medical Center. The results of the study stated that 48.6% preferred NDT. At first blush, that appears to be good news for NDT. Yet, we know for a fact that that would have been much higher IF those who ran the study understood that 1) you cannot go by the TSH range when dosing (they did), and 2) they needed to understand, thus rule out, participants who had low cortisol and/or inadequate iron. (They didn’t). Each of the latter problems mean that study was not solid.

      In other words, those studies you praised are often based on shoddy parameters and/or very poor analysis of what they were seeing.

      Or take peer review that is part of published studies. One medical journal decided to test peer reviews by putting mistakes in a particular study, and they noted that the majority of reviewers didn’t even spot the mistakes. That says a lot.

      They have also found that a large body of research that did NOT meet the hypothesis of the researcher is never published or seen. Can’t prove it, but makes you wonder how many T4-only studies had NEGATIVE outcomes (just as patients have had) and we’ve never seen them.

      Anywho, just beware.

  5. Melissa Vejins says:

    Thank you for your response. You refute a scientific approach, but say that your opinions are based on reports by a large body of people who found out over the years the hard way. I’m definitely sorry anyone has suffered, as I have, but you did not adress the persistent and seemingly pervasive dismissal of endocrinologists and GPs (some who may very well need to be educated about TSH), I don’t dispute that. Probably the only way is to discuss it with them. I am not a doctor or biologist, but the liver transforms many of our enzymes hormones and whatnot. You completely bypassed my comments, not based on opinion or hearsay but fact, that the porcine industry is ailing. Pigs have been sick and I just do g want to imagine what the stress of knowing they are going to die, and live in these horrible, confined, environments, does to their adrenals and general hormonal health. No wonder Erfa and other producers are having a hard time!
    I’m a follower of Ayurvedic and natural medicine, but in this instance, and thank you for predicting my ill health, I’ll pick thinking positively, working on bringing my thyroid back, eating healthy and bring even choosier about my thoughts, than obtaining dessicated thyroid from a stressed out animal. This is not rural farmland anymore.
    I do not impose my opinions, but when I hear that opinions have been form via an amalgamation of comments and not formed under careful control and study, it worries me. I am no narcissist to think that any of the professionals involved in this study are sub qualified or have some other, bizarre pursuits or motives.
    It’s an interesting read.
    Best wishes and I wish everyone with thyroid issues to find the balance. I felt a lot happier when I got rid of the thermometer and cultivated positive thoughts. My past obsessing over my thyroid health in fact, made me worse. If I was in America, I’d spend way more time advocating for fluoride free water and less pesticides in agriculture.
    Melissa Vejins https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267409/#__ffn_sectitle

    • Sorry Melissa, STTM is not about opinions. It’s a compilation of what has been reported repeatedly, solidly and worldwide by patients over the years. And the “persistent and seemingly pervasive dismissal of endocrinologists” is simply the overt frustration that too may patients have had with Endos who repeatedly keep them sick. As Endos dismiss their patients/their continuing symptoms/their continued poor health on Synthroid, patients are going to continue dismissing Endos, and with no apology. As far as the way pigs may be treated, this has been discussed before and we’ve all said we hope to see that changed. But it has not currently negatively affected our treatment with NDT and for that at least, we are glad. And if you think that “thinking positively” will somehow override what T4/Synthroid has done to patients for over 50 years, good luck. P.S. the link you posted is EXACTLY why we can’t stand the ATA and rightly so. You will sadly have to learn the hard way about the “preferred” T4 you are on. 🙁

    • Suzanne says:

      I have struggled with thyroid issues for the 10 years as has my daughter. Finding an open minded doctor is key. I found a good doc a year ago, but before that I became desperate to feel better and I went to see a chiropractor who also is a believer in a holistic natural approach. He put me on a purification program for a month by Standard Process. Believe it or not by the time I was done with my purification I didn’t need my thyroid meds and my doctor was shocked at how well my thyroid was functioning without Armour. Mind you I cut out all gluten, processed foods, and I only ate fish as my meat. I continued to use their plant based supplements and there mix for fruit/veg. Smoothies. You have to get this from a health practitioner and it’s not cheap, but well worth the investment. I’m not a doctor or a salesperson for them. I never comment, but there are natural ways when you feel like medication doesn’t work for you anymore. We all respond differently to what works with our own bodies. I believe everything that STTM has stated is true, but you have to find what works best for you.

  6. Karen Redd says:

    Thank you Janie and I’m sure you are very right, many doctors I have seen thru the years have been interns just learning. But Monday I will see an ENT or whatever they are called nowadays and I have faith that she will set my problem straight. I’m not happy with Thyroxine at all and I badly want and “need” something that will work.

  7. Rita Evans says:

    Can i please weigh into this conversation, as it brings up one issue that i’ve not found answers to. Moral issues aside, sourcing any animal product for medicinal use carries some risk, however small, of transmission of viruses. Whether the product is compounded in a pharmacy or bought as a glandular (supplement), both porcine and bovine sources would carry that risk, or am i mistaken?

    • Patients chatted about this once, and we decided this: nearly everything in our life carries risk. i.e. the foods we buy, driving down the street, the water we drink, the air we breath….you get the drift. And we concluded that feeling so much better is worth any small risk. Additionally, since the turn of the century, we have never seen one single report that NDT caused someone to have a virus. Finally, NDT powder meets the strict guidelines as set up by the US Pharmacopeia. Hope that all helps.

  8. the_pan says:

    Have you ever run into people who can’t do temps properly cause of the type of work they do? I’m constantly dealing with clients and can’t get away to stick a thermometer in my mouth for even a minute, much less the recommended ten. Even if I could, in the winter months I’m constantly going outside in minus 30 weather and then getting in a poorly heated car (they never heat properly until you’re driving) which means my temperature plummets to 95 no matter what amount of adrenal cortex I’m on (you recommended 5 a day based on my saliva testing and I’m on 6 now). I’m outside for like 30 seconds and that’s enough to screw me over. I’ve been trying for months to get 3 temps a day but always seem to miss at least one, usually completely forgetting it cause I don’t hear the alarm or I’m with a client and then end up being very late with taking it. Usually I can manage an afternoon temp but it’s never “on time.” Can one temp a day be used to get a decent idea of whether I’m on enough AC or am I just totally screwed?

  9. the_pan says:

    Sucks it has to be 5 days in a row, guess I’ll have to find a way… I take 3 AC in the morning and 3 at noon. You had suggested just 2 at noon but it doesn’t feel like I’m making a dent in my temps so I raised it to 3 recently. Switched from T4 to NDT recently and had a hyper reaction.

    • You don’t go by single temps like that to raise cortisol/ACE/HC. You go by DATS. The single temps are about your hypothyroid state, which you can’t measure right now until you find the right amount of cortisol, and have good levels of iron.

      • the_pan says:

        Right, just thought I’d try to get away with less. I don’t see much info on how to dose with AC in the book, only HC. I’m just wondering how high is safe to go, don’t wanna shut off my adrenals. I’m 105 lb, whats the most I can take for a morning and noon dose? Is the advice for HC similar to AC?

        • No one gets away with taking less than their body needs. It will backfire sooner or later due to the feedback loop. And no, none of this “shuts off” the adrenals. That why we do DATS in the first place…it helps us find our right physiological amount—the amount our body needs daily. And by the way, Chapter 6 info also applies to ACE.

          • The_pan says:

            Ok but the book says if you take more than 10 mg of HC it can shut ACTH down too much. What is the equivalent of 10 HC to AC then?

            Also where do you buy mercury thermometers??? I’m having an impossible time, which is also why I’m trying to get info in the meantime about AC dosing cause I’m already on it.

          • No, the book says if a woman takes more than 10 MG for their first morning dose, it does that. With ACE, we use the 50 MG tablets and a starting total daily dose is 3, 2, 1, 1. Any liquid thermometer works.

  10. Rob says:

    Hi Janie,
    Using NDT are you only going to feel your best if you do the suppression therapy – keep raising your dose until you completely turn off whatever your thyroid was putting out? Bringing your TSH close to Zero. Is working in conjunction with your thyroid just too hard to manage? Like trying to fill in with a 1/4 or 1/2 grain along with what your thyroid is putting out? Also, I found that 5am mind pop awake insomnia is proportional to the amount of NDT I take. I do Keto so it shouldn’t be blood sugar, sea salt helps diminish it but not sure why? Taking less NDT helps push out the time and lessen the effects but then feel hypo. Taking more NDT makes it more pronounced.

  11. Laurie Empen says:

    I know I have to switch doctors and am working on that – my core body temperature is NEVER at 98.6 upon rising.
    Dec 30th 97.81
    Dec 31st 98.26
    Jan 1st 97.2 (97.96 at noon, 97.96 at 5pm, 97.78 at 10:30pm)
    Jan 2nd 97.45
    Jan 3rd 97.19
    Throughout the day, it may climb to 98.03 or 98.3

    I have increased by a 1/2 grain, especially when I was constipated for 4 days – just raising it to 72 mg – was in the bathroom the next morning for 4 hours!! That was back in November, and my doctor wanted me to go on Linzess. I KNEW it was thyroid, so I increased my dosage. And when my energy started to leave, appetite gone, sleeping for 10 hours, I increased to 90, and then again at 120. I have been at 120 for 8 weeks and feel it’s time to increase again.

    The last labs my doctor did, he only did TSH, when he HAD done the Reverse T3, Reverse t4, etc. He forgot, I suppose.

    But am I still safe to increase to 150 and see how it goes? Then do labs? And do labs BEFORE I take morning meds, to get a more accurate read? I am on NP Thyroid, currently. Thank you.

    • Hi Laurie. Rising temps are not meant to be at 98.6. They are generally between 97.9 and 98.2 first thing in the morning. It’s the afternoon when they make it up to 98.6. Yes, most of us have been very safe to raise like that. Yes about labs before taking NDT that morning.

      • Laurie Empen says:

        But am I dosing high enough yet? I am still soooo tired with no appetite, regular bowel movements are taping off, too.

  12. Ursula Lambrou says:

    Hi Janie, thank you for all your work. I read the book, have it here beside my bed all the time 🙂
    I take WP Thyroid since one year. But the fT3 level goes up to 99% and fT4 sinks to 18%. And I get heart palpitations, high pulse and weakness.
    My physician told me to take T4 again, 25 mg and cut the WP Thyroid in half. When I do this fT3 goes down and fT 4 rises, both are in the middle section after six weeks.
    I want to stay with NDT only. The physician says I would be to old. I am 74 years old. I can’t believe it. I found nothing about this in your book or here.
    What can you recommend?

  13. Ursula Lambrou says:

    Hi Janie,
    I just compared the salvia test result with your recommendations. I am far too low in the morning, a bit low around noon and far too high in the afternoon, around bedtime still high.
    All in the “normal” range except for afternoon which is too high.
    Do my adrenals need help?
    Are they the reason for not coping with NDT alone. Am I too old (74 ) for NDTs alone? That is what my physician says!
    What can I do so that fT3 does not rise up to 99% and fT4 sinks to low 18%?
    With the NDT alone (2 1/4 Grain) I get heart palpitations and heart race and weakness!I get afraid,too.
    My physician wants me to take F4 L-Thyroxin and half of the NDT (25 mg F4 and 1 Grain NDT WP Thyroid). I read your book but couldn’t find an answer. Thank you!

    • Ursula, lab results are never about just being in the normal range. They are about “where” they fall in those ranges. Compare your saliva results to this page and you’ll see your problem (which explains why you are pooling): http://stopthethyroidmadness.com/lab-values

      And no, there are people in their 70’s, 80’s and 90’s doing wonderfully on NDT. You just have to treat the low/high cortisol. Also make sure your iron is where it should be–the above page will also explain that. Because both optimal iron and cortisol are IMPORTANT to succeed with NDT: http://stopthethyroidmadness.com/iron-and-cortisol

      • Ursula Lambrou says:

        Thank you!! I will take your words to my physician. She is open to other opinions and has respect for the STTM . I am very grateful for your work and that of those who help/ed you .

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