Trouble with “t4 only” Therapy in Texas

Here is a question from our member nBarnard in Texas, about the failure to achieve an adequate clinical response to t4 treatment, and what to do about it. My response follows.

Hello Dr. Pepper,
I just found your blog and decided to join. I admire you for helping so many people this way. As with many people on this board, I have hypothyroidism. They removed my thyroid due to Hashimoto’s Thyroiditis a few years ago. It took a very long time before I started to feel better after taking the generic T4 meds. I was much heavier than I am now, since having started a special diet program where I lost 100+lbs. During my weight loss experience, I felt my best ever when I was down 60-80lbs. At that time, I was taking 250mcg Levothyroxine daily, with 25mcg every other day. (also taking maxzide 25mg, levonorgestre, and calcitriol – due to the parathyroid glands malfunctioning). Now I am down 100lbs and feel like I did before they removed my thyroid and I cannot lose any more weight. I am on a program where I should be losing everyday and nothing. My current dose is 200mcg per day. The doctor did blood work and they stated the levels were too high, so she lowered my thyroid medication. At the same time, I had to lower my blood pressure meds. My concern is that as the days go by, I feel worse and worse. My hypothyroid symptoms are so bad, that I cannot function. I am tired, cannot concentrate, dizzy, depressed, and on and on. I live in Texas and need a heater by my desk because I am so cold. I talked to the doctor about this and we did another blood test. She said the level dropped from 20 to 16 and that is an indication the med change is working. In the past when my numbers were too high, the doctor raised my medication. I am very concerned that this might be wrong dosage direction. I have appointments to see her, but cannot get in for a few months. In the mean, time, I am researching what can be done to help my situation. Any help would be appreciated.

Dear nBarnard:

As you know I can’t provide medical care or advice over the internet. I can make some general comments I hope you find useful.

First, congrats on losing all that weight! That is never an easy job. You mention your “levels” dropped from 20 to 16. Which levels: T4, or TSH ? That is a crucial piece of information.

At we have extensively reviewed the pro’s and con’s of using Armour Thyroid. In my medical practice I have found that hypothyroid symptoms that fail to respond to traditional t4 treatment often respond to Armour. It is my thought, shared by many, that the combination of thyroid hormones in Armour, particularly the presence of t3, is the reason Armour is superior to t4 only. Perhaps you can approach your physician about trying Armour, or alternatively adding some t3 (liothyronine) to t4.

Keep us posted and good luck.

Dr. G. Pepper

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  • shetur

    Dear Dr Pepper,

    Thank you for letting me subscribe to your web site. We need your help, and the help of as many of your members as is possible. We need those people who have found that taking T4-only (e.g. Eltroxin/Synthroid etc) therapy has left them still suffering with symptoms of hypothyroidism, yet who found, after changing to a T3 hormone containing product (e.g. Liothyronine, Cytomel, natural thyroid extract) that their symptoms became better, many regaining normal health.

    We are in the process of creating the worlds first ‘REGISTER OF COUNTEREXAMPLES TO LEVOTHYROXINE ONLY THERAPY’ in order to show the Medical Boards, once and for all, that T4-alone does not work for everybody. Medical Schools refuse to acknowledge the scientific evidence that has been available to them for over 40 years. Sufferers of the symptoms of hypothyroidism are now in a position NOT to prove that something is right – but to prove that something is WRONG. We will soon be in a position to do just this.

    Patient counterexamples are those who fare poorly under the medical prescriptions (T4 –only) yet fare well under the medical proscriptions (T3). These counterexamples demonstrate that there is no medical problem – only a political and/or legal problem. Consequently, the endocrinologists are WRONG. The prescription of T4 -only is illogical and unethical. It has counterexamples amongst testifying patients and in peer-reviewed medical science journals.

    In the UK, part of the problem surrounding all of this is the two physiologically different definitions of ‘hypothyroidism’ given by the British Thyroid Association (BTA) and the Royal College of Physicians (RCP), which cause concern and confusion. The confusion in the definition is one of the main causes for over quarter of a million sufferers in the UK alone) being improperly diagnosed and improperly treated. If this issue were fixed, the National Health Service alone would save millions of pounds and medical boards throughout the world, probably billions – and millions of patients would no longer be left suffering so unnecessarily.

    The RCP define ‘hypothyroidism as “the clinical consequences of insufficient secretion by the thyroid gland” – meaning ‘hypothyroidism’ is ONLY associated with the thyroid gland. This definition is the correct and narrow definition.
    The BTA define hypothyroidism as “the clinical consequences of insufficient levels of thyroid hormones in the body”. This ‘broad’ definition is associated with peripheral metabolism and peripheral cellular hormone reception, which produces insufficient thyroid hormones in the body.

    If the first definition is correctly called “hypothyroidism”, this should be treated with T4. Therefore, the second definition should not be called ‘hypothyroidism’, but should be defined as ‘Clinical Euthyroidism’, ‘Type 2 Hypothyroidism’ or ‘Euthyroid Hypometabolism’ – and peripheral thyroid hormone deficiencies would be treated with T3 and NOT T4.

    It does appear, that to avoid suggesting that T3 is needed, the diagnostics recommended for the symptoms of hypothyroidism focus only on the thyroid gland. When these symptoms continue, because they are caused elsewhere, i.e. peripheral thyroid hormone deficiencies at cellular level, they are not treated. Instead, if a patient continues to complain of symptoms, s/he is given the bogus excuse of “you are suffering from a functional somatoform disorder” – “your symptoms are non-specific” or “its old age”. The result of these continuing symptoms is a reduction in the patient’s ability to function, or to resist the dangerous consequences of low thyroid.

    If the owners of all thyroid web sites and Internet thyroid support forums worked together, we can present a massive Register of Counterexamples to the T4-only therapy to every medical board throughout the world. Please will you post the following link to the very short questionnaire on your web site, and urge those members who remained ill on T4 only, yet fared better with a T3 hormone product (either synthetic or natural) to take part.

    All responses will be collated automatically online.

    Thyroid Patient Advocate

  • Hi.. just to chime in a bit! I had been on Armour and then switched to Nature-throid and also have used Westhroid both natural combos of T3 and T4, with good results. Apparently being on hormone therapy (“The Pill”) can increased binding globulins and bind up your thyroid hormone (and other hormones) and make it ineffective. As we know so many things can interfere with the conversion of T4 to T3 and leave us deficient of T3 even when taking T4. There is an excellent book called “Why Do I Still Have Thyroid Symptoms?
    When My Lab Tests are Normal?” by a Dr. Datis Kharrazian. I have taken several Functional Laboratory Assessment courses with him (for continuing credit) and was really impressed. You can check out his book

  • So so true.