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 updated revision STTM book 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: A working Natural Desiccated Thyroid, or adding T3 to that T4 as a second choice and getting those frees optimal, is a much better way to go than being on nothing but T4, according to years of worldwide patient experiences

A working 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.

Click on the graphic to order an excellent saliva cortisol test.

Important note: STTM is an information-only site based on what many patients worldwide have reported in their treatment and wisdom over the years. This is not to be taken as personal medical advice, nor to replace a relationship with your doctor. By reading this information-only website, you take full responsibility for what you choose to do with this website's information or outcomes. See the Disclaimer and Terms of Use.

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

  1. E says:

    I think this is my problem. Both Iron and Cortisol are off. But high cortisol mainly. My questions is do you have to resolve those issues completely bf going on NDT again. I find i cannot tolerate it w/o feeling extremely unwell at night.

  2. I answered this on your other post. Not sure you saw it. The ratio issue is NOT a problem.

  3. Mark, there is a lot of research that comes to ridiculous conclusions. Yes, there’s a higher amount of T3 in pig thyroid than in human thyroid. But that fact doesn’t mean we go so high with the porcine NDT that we get into trouble. And we don’t start seeing resistance. I’ve been on NDT for 16 years now and in fact, am on slightly less than when I started due to being in menopause (lower estrogen, which means less being bound). There are some out there that have been on NDT for decades–blows me away that they didn’t get caught up in the love affair with the lousy Synthroid. And they are still doing great. Understand that people have been successfully using NDT since the 1890s. It works beautifully if you understand how to use it. http://stopthethyroidmadness.com/natural-thyroid-101 And I strongly recommend Chapter 2 in the revised STTM book for more info about the history and use of NDT: http://laughinggrapepublishing.com

    • Mark, for some reason, you have sent four comments with basically the same info. So I’m just going to comment here again:

      1) “…many in the alternative medical community to warn against prescribing” NDT…

      That discounts approximately 120 years of the successful use of NDT by many, many patients. Doctors tend to ignore the experiences of patients and lean more on empty “opinion” or faulty studies.

      2) “…the T3 [in NDT] is way too high, and thus the cell membrane, doing its work, shuts down admittance of more of this hormone, becoming resistant

      Totally false. I already commented in this.

      3) “…This makes dosing difficult as displayed by several studies which have shown supraphysiological T3 doses post dose, fluctuating T3 levels during the day and more hyperthyroid symptoms in subjects taking DTE compared to LT4 monotherapy.”

      120 years of successful patient use of NDT is again overlooked. Studies are faulty; studies are not 120 years of successful experiences. No, we do not achieve “supraphysiological T3 doses.” Optimal simply puts the free T3 in top part of the range with a midrange T4…both. And it works. Some people see their free T3 go super high on lower doses…and that is about having low cortisol that needs to be treated. http://stopthethyroidmadness.com/pooling

      And no, dosing is NOT difficult, if doctors understand NOT to go by the TSH (which other than detecting hypopitutiary along with a low free T3, is USELESS), and understand that one has to have the right amount of cortisol and iron to raise successfully. Doctors overall are pretty clueless about all the latter.

      “Hyperthyroid symptoms” on NDT are due to the release of adrenaline when raising NDT in the presence of a cortisol problem. And in others, from staying underdosed, which pushes adrenaline up in alarm and causes “hyper-like symptoms?….another area that most doctors are totally ignorant about. Study: http://stopthethyroidmadness.com/ndt-doesnt-work-for-me

      4) “….patients not satisfied on LT4 monotherapy which makes up a small subset of all their patients on LT4”

      That is so ridiculous. If doctors paid attention to what is really going on with their T4-only treated patients, and understand that the weight gain, depression, rising blood pressure, anxiety, rising cholesterol, hair loss, dry skin…and numerous more symptoms…ARE about forcing the body to live for conversion alone (UNNATURAL), it would definitely not be a “small subset of all their patients”. This is exactly why Stop the Thyroid Madness exists…because of inane and idiocy in the medical field.

      5) “…roughly 15% of the population has an inborne deiodinase polymorphism causing an inability to adequately convert T4 to T3 in which case they may do better on more T3 and Less T4 (as with NDT) – or in severe cases, T3 monotherapy?”

      I personally did NOT convert T4 to T3 well at all when I was on T4-only. I was very, very hypothyroid for 20 years because of that, while NUMEROUS doctors totally dismissed me. I was forced to start applying for Social Security Disability. But luckily, I found out about NDT and moved over to it and have done fabulously.

      There are others with the mutation who stay on a very small dose of NDT, and add in plenty of T3…and in fact, their free T3 is often over range. And they are totally fine.

      I will repeat: there is now 120 years of successful use of NDT by itself if someone gets optimal…AND has the right amount of cortisol and iron. You know why so many do NOT have the right amount of cortisol and iron (which will manifest itself by having hyper-like symptoms on NDT? Because of their use of the CRAP promoted by AACE and other harmful organizations–i.e. Synthroid and Levothyroxine. And by the way….those who have tried the two synthetics, and moved over to NDT, have frequently reported better results with NDT. Chew on that.

      P.S. Raising NDT is not about “going slowly” if you mean raising every few months, or raising after many weeks. You are risking the rise in your own adrenaline, and thus problems. Study: http://stopthethyroidmadness.com/natural-thyroid-101

  4. Kristina says:

    Hi Janie,

    My hair is still falling out and I cannot raise NDT past 1.5 grains. i still feel pretty bad in the AM’s mostly (suspect high Cortisol in AM..) I just did both the saliva cortisol test you suggested and the iron panel, trying to rule out one or the other. Iron just came back – Ferritin was 66, total iron 115, Iron binding 290 and % saturation was 40. Would you say I can rule out an iron issue and wait for those cortisol tests to come back or do you think my % Sat is a bit high? you recommended 35 be the target for that. My Ferritin seems a tad low as well, but being on the NDT has raised it from 57 a year ago, to 66 now. Thank you!!

    • Yes, you can rule out low iron. % Sat is high because your TIBC is low. Probably your saliva results will give you an answer as to why you can’t raise past 1 1/2 grains.

      • Kristina says:

        Thank you Janie! Excited to get those saliva results. I’ve been tempted so many times to just go back to the T4 only, but my determination to get to the core of the issue won’t let me. Thank you for giving us so much good information. It keeps us motivated and hopeful!!!

        • Good for you! Too many times, I see people return to T4-only, not at all understanding that their reaction to NDT was either due to staying on too low a dose, or due to inadequate iron or a cortisol problem! So I’m glad for YOU that you are willing to find the CORE of why. It’s VERY treatable!

          • Kristina says:

            Hi Janie,

            One more follow up question I forgot to ask. I am still waiting for those saliva results! In the meantime, would you recommend staying on my split dose of 1.5G? My hypo symptoms are coming back fast and furious..dry skin, palps, nauseated, light-headed, numb pinky fingers. And once I find out what is wrong with my adrenals, do i just stay on this dose while addressing them? I’m sure you have information somewhere on this site on how to know when to raise the NDT while treating the adrenals. Thank you!

          • It’s always a hard guess. If your cortisol is high, moving up will cause RT3 to go up. If cortisol is low, moving up can cause pooling.

          • Kristina says:

            Hi Janie,

            Just thought I’d follow up with you. Got my saliva results back!
            Waking 7.6 (3.7-9.5)
            11AM 1.8 (1.2-3)
            5 PM 2.1 (0.6-1.9)
            bedtime 0.6 (0.4-1)

            Interestingly, this is pretty much the same result I got from my DUTCH panel over a year ago. And i have the same lightheadedness that I had back then..Especially in the AMs, which i thought was from HIGH cortisol..seems it is from low? Dr. never told me it was Low if it is indeed. Just said it was in range and optimal ;( Do you have some ideas on fixing this?

          • Yes, if you compare these to this page http://stopthethyroidmadness.com/lab-values, it’s low, low, high, high. So we would be taking something like Holy Basil to lower the highs, which will naturally help raise the lows. http://stopthethyroidmadness.com/ps

          • Kristina says:

            OK. I didn’t think to look at it from the perspective of lowering the highs. Was too concentrated on increasing the lows. Excited to tackle this. THANK YOU so much!

  5. Elizabeth says:

    Interesting idea! Thanks again.

  6. Elizabeth says:

    Thank you again Janie! That is interesting about the mold and lyme, as have been trying to get rid of fungus (candida) for many decades, and probably mold is at root (I grew up on many mold-based antibiotics due to constant bronchial infections…which all stopped when I went on T4 in my 20’s, the one benefit). Also do have lyme, but did not 25 years ago when tried the NDTs. I have been trying to get my iron levels up per your great info here; I hope it will help. The cortisol IS a mess; did the test through your lab & it’s night high, but SeriPhos did not help (I can’t sleep until normally at least 4am now, often later! And adrenal-type rapid heartbeat with it). Been struggling with increased symptoms and slow weight gain for about 10 years; holistic doc was not helping. So 2 years back went to mainstream M.D. that everyone around here loves. I was getting more and more sensitive to T3, so she tapered me off and tried various T4s at various doses. She kept insisting on Tirosint ; as soon as I went on, gained 20 pounds in 30 weeks and, though went back to a different T4, have continued to gain. Seems to have wrecked metabolism for now. It’s been beyond awful (severe, serious depressions too). Sensitive to so many things and really in a pickle. Reading and re-reading everything here and attempting follow through. If, from reading these additional last details, perchance you have any last thoughts on any other angle(s), I would love to hear it. Thank you again for all that you do here.

  7. Elizabeth says:

    Hi Janie, thanks for all the good work here!
    I am wondering if you would have a notion on why my thyroid has begun to perform SO well for a few weeks on several different substances at various times, then completely “given out” so to speak, and “turned off” so intensely that I could not get out of bed? Over the past 25 years, this has included 2 different NDTs, Synthroid, and even iodine! So I have been living a “half- life” for decades as I have to just stay on things that don’t make it work “too well!” (Usually Levoxyl and T3). It is maddening. My labs and conditions have of course varied over this time, so that info would not be really accessible nor possibly relevant. Consistently have never shown antibodies though. Thanks so much for any thoughts on the cause and how to remedy this!

  8. Christine says:

    Thank you! I’m not sure what he was thinking for cortisol so I will double check!

  9. Christine says:

    Thank you! We are going to check my cortisol levels this next week too! Do you chew your np or swallow it hole? I was worried that more t3 would cause more heart palpitations but I know I need to get that number up too!

    • Hi Christine. Hopefully you mean saliva cortisol at four key times, not blood. Blood doesn’t work. http://stopthethyroidmadness.com/saliva-testing

      Many do NP sublingually; some swallow. The main reason T3 causes palps is explained in #2 on this page: http://stopthethyroidmadness.com/ndt-doesnt-work-for-me

      • Christine says:

        Hi Janie- Question for you… it seems like I am going the opposite direction and heading back to hyper now. The odd part is I still have puffy eyes in the morning and tired in the afternoon along with super super dry skin that I have now had to see a dermatologist for because my neck is getting like wrinkly and dry (and I am 31). My most recent results after being on NP Thyroid for 6 weeks is TSH .747 (.358-3.74), T4 Total 7.3 (4.5-12.5), FT3 5.4 (2.2-4.0), FT4 .72 (.76-1.46), Anti-TPO <10.0 (0.0-35.0), Anti Thyroglobulin Ab <20 (ND-40), Thyroglobulin 16.0 (<=55), Thyroxine binding globulin 25.9 (14-31), and RT3 13.6 (9.0-27.0). Is it possible to have hypo symptoms even though my FT3 is really high? I was having issue not converting so my RT3 was on the higher end with low FT3 of the range until I switched to NP from Synthroid. Thank you in advance!! 🙂

        • Hi there Christine. You are pooling. Read this to see the reasons: http://stopthethyroidmadness.com/pooling

          • Christine says:

            I did ask about the cortisol testing and he did run the blood test so I will have to ask about the saliva test instead. My blood test came back 17.5 (4.0-22.0) – that was the range given for the time I had the blood drawn which was in the morning. I know my Iron has been lower and last time he ran full Iron panel but this time the test said 4 Iron SerPl-mCnc 112 (40-190) so I am not sure if that is getting better or not. I will look more into this pooling though and see what I can do about it 🙂 Thanks!

          • Christine says:

            Do people ever have to lower their NDT and add t4 to correct the ft3 pooling?

          • Hi Christine. It’s more about correcting the cause of the pooling, not adding in T4. Look at your iron and cortisol: http://stopthethyroidmadness.com/iron-and-cortisol Most of the time we notice a cortisol problem as the main cause, but we don’t neglect looking at iron, as well.

          • Christine says:

            Hi Janie
            Do you ever hear of people having luck with iodoral or iodine? My holistic Dr wants to add that to see if that helps at all. Thank you!

          • Iodine has been a great supplement for many. For example for me, it totally took away my fibrocystic breast disease. There have also been many Hashi’s patients who said that iodine alone lowered their antibodies. But if you mean will iodine alone be enough to treat hypothyroidism and be enough for a long time…the answer is for the majority, no.

          • Christine says:

            Thank you! I am staying on NDT just adding low dose (pill is 12.5 but I may cut it in half at first). My iron has been climbing but still having hypo symptoms with high ft3 yet. He is hoping it helps level things off little more so I was just wondering if that’s common 😊

          • High Free T3–if you mean above range, or a high Free T3 and low Free T4, this may help: http://stopthethyroidmadness.com/pooling

          • Christine says:

            I think he was hoping that the iodine would help balance things out since my iron is getting closer to optimal and cortisol was good blood wise. I do still need saliva test yet but I am hoping iodine helps somewhat!

          • Christine says:

            One last question..if I end up finding out my iron and cortisol levels are good (and optimal)..do you lower your ft3 by lowering NDT dose and adding t4 or lowering your NDT dose and adding t3? I’m just curious as I know I have hypo symptoms yet. Thank you again!

          • You won’t find yourself with optimal iron or cortisol if free T3 is high and free T4 is lower.

            If there are no symptoms with the high, you can just work on the reason for the high. If you do have symptoms with the high, people just lower NDT a bit.

          • Christine says:

            Hi Janie-
            Quick question for you. I was on 60 NP Thyroid and ended up dropping my dose down to 48.75 (switched to Naturethroid). After being on that for 5 weeks I had my labs rechecked as my FT3 was out of range high on the 60mg NP. My new lab results on the 48.75 look like I am hypo again. My TSH was 2.0 (.3-4.2), FT3 2.9 (2.8-4.4), FT4 .9 (.9-1.7), RT3 13 (10-24), Vit D 32 (20-50), Iron S 129 (35-145), and Ferritin 25 (13-150). I am getting a saliva test for sure done now as my blood cortisol came back ok but I know that its important to get saliva done. I am just frustrated as I can’t seem to find a happy medium on NDT. Do some people end up doing better on taking Synthroid with Cytomel? I just started on 65mg of Naturethroid this last week as I was dragging on the lower dose so I have been now taking half in the morning and half in the afternoon. I was surprised my RT3 didn’t budge much. I was also surprised that on the higher dose of NP way back that my TSH was still .7. Any advice would be greatly appreciated!!! Thank you!

          • http://stopthethyroidmadness.com/pooling explains what was going on when your FT3 went high on 60 mg. i.e. you have things to treat!

          • Christine says:

            Thanks Janie! It appeared like my Iron and Vitamin D are good so I guess I will have to wait and see what my saliva test comes back to then correct? Thanks!

          • Good meaning optimal?? http://stopthethyroidmadness.com/lab-values.

            If so, yes about saliva.

          • Christine says:

            When you split dose an NDT how do you go about taking Iron supplements? I want to still work on getting my levels a little higher but I just started split dose and talk half in the morning and the other half a couple hours after lunch (around 2-3pm) and then I know Iron isnt supposed to be taken within 4 hours of thyroid medicine correct? Thank you!

          • It may be okay to keep iron 2 hours away, not 4 hours. i.e. 2-4 hour range.

          • Christine says:

            Hi Janie-
            One quick question on the saliva adrenal test. I have been reading your site about what to do/not do before and during the test and I read the list of medications but just wanted to clarify that you can still take your thyroid medicine while doing the test correct and also birth control? I just didn’t want to “hinder” the results so to speak and want them to be accurate! 🙂 Thanks!

          • Yes about thyroid meds. If workable, info we read implies it would be better to be off birth control pills for at least a week before doing saliva, since the hormones could alter cortisol levels. We always want to see what our cortisol levels are without influence, because that’s what we treat.

          • Christine Worke says:

            Hi Janie-
            I am now on my second week of the higher dose of Naturethroid (was 48.75 now 65). I progressively have been feeling worse and worse. I know the other dose was way too low but now I am currently dealing with major stomach issues…bloating/cramping to the point where it doesn’t even feel good to eat and I have the heating pad at night. I do now have the kit to do the saliva test so I plan on doing that Sunday and I think it takes about a week for results but in the meanwhile my question is based off experience do stomach issues on NDT typically have to do with the fillers or more with adrenal and other gut issues? I didn’t have these issues to this extent on Synthroid but I am trying my hardest because I don’t want to have to go back on that and if I do I definitely know I will need a little T3 for sure. I was hoping to try WP to see if it could be filler related but that doesn’t seem to be available anywhere yet! I have also tried NP. Thank you!

  10. Christine says:

    Hi Janie-
    I had an endo that wasn’t really listening to the way I was feeling so I switched over to a holistic Dr. who ran tests that my endo wouldnt. We ended up finding out I was in the very bottom range for FT3 and upper range RT3 so he reccommended switching from Synthroid to NDT and due to shortages I was reading about we opted for NP Thyroid. I was on 75 mcgs of Synthroid so we started with a few days of 30mgs and then I did 30mg in the morning and 30mg in the afternoon and now take the full 60mgs in the morning. My Vit D was low and so were my ferritin/iron ranges so I am working on those as well but I don’t feel well at all. I will have my labs re-drawn this week since its been 6 weeks now to see where things are at. I have had spotting mid cycle, cramps, super dry facial skin, puffy eyes (I used to get this when I changed Synthroid doses but it would go away and this hasn’t). I also have had mild heart palpitations/chest pains and heart rate when I workout gets really high. I am trying to be patient but hard when I was so hopeful this would work right away. Do some people do better just adding T3 (cytomel) and taking lower dose of Synthroid? I dont like the heart issues so I am hopeful to get this working on NP. Thank you for all the information you provide on here!! Its been great resource for me! 🙂

    • Hi there Christine. When RT3 is high like that, we have learned repeatedly it’s about staying low with NDT (since raising it with it’s T4 is going to raise RT3 even more), and adding in more T3 until the free T3 is towards the top of the range. But only if one isn’t pooling. This isn’t about using all three i.e. NDT, Synthroid and T3. Bigggg mistake, as NDT is 80% T4 anyway. Start here: http://stopthethyroidmadness.com/reverse-t3

      • Christine says:

        Thank you Janie! I spoke with my holistic Dr. and we are going to do labs this next Tuesday and see where things are at. I know NP doesn’t have the next dose down (3/4 grain) so if thats the case and I need to drop I may see if NatureThroid/WP is back in stock here or not because I think they have a (3/4). I didn’t really know any better when I started NP but I have been swallowing it hole and I see alot of people are chewing them or taking them sublingually. Is that something that is neccessary to do? My last labs were RT3 19 (10-24), TSH .6 (.3-4.2), FT3 2.9 (2.8-4.4), FT4 1.2 (.9-1.7), Thyroglobulin Antibody S <1.8 IU/mL (<4.0 IU/mL), Thyroperoxidase Ab S <0.3 IU/mL (<9.0 IU/mL). I have always come back ok on antibodies as my thyroid issues started with a benign hot nodule resulting in a partial thyroidectomy 3 years ago. My new holistic Dr also tested me for the MTHFR gene and it was negative. Those labs were while I was on Synthroid (right before I was switched). Thanks for the advice!!

        • Hi. You don’t have to change just because NP doesn’t have a 3/4 grain, though. Patients have dropped down to 1/2 grain when RT3 is way too high, then add in T3 and raising it until they get more optimal. Your free T3 is miserably low. Optimal always seems to put the free T3 toward the top of the range…but also in the presence of optimal iron and optimal cortisol. The latter two are important.

        • Christine says:

          Hi Janie-
          I got my cortisol levels back and they are rather confusing. I am actually good through most the day except the morning is elevated at 36 (13-24 range). DHEA is 3 (3-10), Progesterone 36 (22-100). The problem is my fasting insulin came back great but they tested my non fasting insulin and it is 47 (6-25) so it is very high. I workout 6 days a week. My question is is there a relationship between non fasting insulin and morning cortisol being high? Thank you!

          • High cortisol can cause high blood sugar, and the later can put the insulin up. Hopefully you have compared your results to this page: http://stopthethyroidmadness.com/lab-values

          • Christine says:

            Would that be the case though when my high cortisol was just the first one of the day and also when my insulin was ok yet? My insulin (nonfasting) came back high when my cortisol was normal later in the day. My morning fasting insulin was >3 but then it shot up during the day.
            6-8am 36 (13-24)
            11-1pm 7 (5-10)
            4-5pm 7 (3-8)
            10-midnight 3 (1-4)

            Thank you!!!

          • Compare your results to the link I gave you, ok? You’ll see you have more problems than just morning.

          • Christine says:

            Janie-Sorry if this message goes through twice, I tried submitting it but it didn’t look like it went through. Could that still be the issue though when my high cortisol is when my fasting insulin is good but then when my cortisol is normal my non fasting insulin goes high? Fasting insulin was >3 and my non fasting insulin was 47. Thank you!
            6-8am 36 (13-24)
            11-1pm 7 (5-10)
            4-5pm 7 (3-8)
            10-midnight 3 (1-4)

          • It went through. Already replied to it. 🙂

          • Christine says:

            Thank you! I’m just worried about the high non fast insulin too so if one gets fixed maybe it will help the other is what I am hoping?

  11. Susie Palmieri says:

    Have you heard about anyone having issues with Nature Throid since they restarted production? I take Nature Throid and had good results but over the last 4-6 months it seems to not work anymore and the only thing I can think of that has changed was they were out of stock due to updating their production equipment and recently got back into production. Perhaps they changed the binders/fillers for the medication?

  12. pesho says:

    Hello Janie,
    I cant find how to contact you so i am writing here. Could you please tell me how can i contact Chris Jackson who wrote this info
    I want to ask him if interpretation of long acth test using synacthen depot is the same as short test. Also on your site i cant understand what is the difference between healthy people and secondary adrenal insufficiency people – https://stopthethyroidmadness.com/acth-stim/ it seems both groups at least double their cortisol levels?


    • Hi Pesho. I don’t have Chris’ email anymore–he wrote that page for STTM a long time ago. But I did add some info to the page–that many opinions seem to feel that the short is fine to diagnose either Addison’s or Hypopituitary, but the long can possibly be even better to confirm Addison’s. And there is great detail about what both will do with cortisol levels after the ACTH stim test that might help.

  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 .

  14. 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?

  15. 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.

        • It doesn’t sound like it, but you have to do your free T3 and free T4 to know for sure. When optimal, our free T3 is towards the top of the range and free T4 is mid-range.

  16. 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.

  17. 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.

  18. 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?

  19. 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.

  20. Karen Redd says:

    Thank you Janie and Im 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. Im not happy with Thyroxine at all and I badly want and need something that will work.

  21. 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. Im 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 dont 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!
    Im a follower of Ayurvedic and natural medicine, but in this instance, and thank you for predicting my ill health, Ill 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.
    Its 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, Id 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 didnt 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 its not cheap, but well worth the investment. Im not a doctor or a salesperson for them. I never comment, but there are natural ways when you feel like medication doesnt 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.

      • Ploog says:

        Suzanne, your experience does not address people with no thyroid tissue because of removal or lab-shown thyroiditis and your assumption that it is safe for everyone reading to think there are natural ways “when you feel like medication doesn’t work for you anymore” is irresponsible. While I do believe, and would celebrate (for your sake, not my hashimoto’s sake) that some “thyroid issues” are suboptimal functioning that can be addressed with nutrition, chiro, cleanses and the like, I must insist that you and readers realize that for factual medical reasons named above (removed thyroid, hashimoto’s) most of the thyroid patients struggling with this must take replacement hormone profile of some kind as a simple matter of life or death. Its just like when recently I had a friend who’s daughter was diagnosed with Type I diabetes and a bunch of Type II diabetes advice that is not bullshit if you are Type II but is only marginally helpful if you are Type I appeared on Facebook. Its not just ignorance at work here, but a touch of arrogance about alternative medicine. Now hear this: I have used natural medicine to avoid surgery and I know its value, and lab results to prove it. My doctor was amazed. But to assume your advice applies to another person who’s problem you have not taken time to understand is arrogant and dangerous.

    • Ayla says:

      Hi Melissa,
      I am from Montreal, seeking a good thyroid endocrinologist – can you recommend your doctor?
      I have had a total thyroidectomy and struggling with weight issues now…

    • Hello Melissa, I am so sick. I have been on NDt for 3 years and was fine but now I am dizzy, weak and shaky with interior tremors all the time and gut issues. None of the doctors can figure it out except that I have hashimoto’s. I am now up to 2 grains of NDT and am feeling so anxious with a ton of pain that I have to be on xanax and starting paxil soon. Did you have any of these symptoms that I have? If so, did t4 only meds help that? I know that NDT is supposed to be the best but it is making me so anxious, i feel worse. I don’t know what to do or who to believe. I have a naturepath and an endo and they both the tell me the opposite of each other. Is it possible the NDT was ok for 3 years and then I have a reaction to it or it is not treating the hashimoto’s right?

  22. 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. Ive 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 Erfas 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! Ive been back on Synthroid and at an appropriate dose, and lo and behold, I feel great! Why shouldnt 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.

    Lets look at the porcine industryits disgusting how these poor animals are fed and treated. It isnt the same as it was some time back. It is a super industry with a lot of sick and badly treated animals. Ive 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 dont abuse alcohol and Im 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? Im certain. I have no thyroid function but Im 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.

    • Jamie says:

      my reply was meant for Melissa

  23. 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

  24. 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.

  25. 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 didnt really care because I had started gaining weight. I couldnt go walking anymore because I need hip replacement surgery but then I convinced a dr to put me back on it. I walked, I didnt 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.

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