McCall McPherson explains why some hypothyroid patients can skip T4 entirely if they still produce it naturally, but those without a thyroid need T4 for a 24-hour hormone reserve. Poor converters may do fine on T3 alone; everyone else needs the right balance to avoid symptoms from too little or too much.
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Does everyone need T4? So I heard I caused quite a bit of a ruffle in the thyroid community. So I wanted to come on here and clarify. Now two different things. So people kind of got a little bit up in arms about a video I posted about a person transferring to care with me over medicated on T3 that was post thyroidectomy. And I said she was on no T4, which in and of itself isn't. Isn't correct. So does everyone need to take T4 medication? No. I have tons of patients who are on only T3, only active thyroid hormone, cytomel or lyothyronine. Those people are very poor converters. They produce enough of their own endogenous T4, enough of their inactive hormone, but they can't activate it. So it creates this biochemical cascade of symptomology. And so often I treat those people with exclusively T3. Totally fine with that. Do it all day, every day. However, when someone is post thyroidectomy, they do not produce their own T4. Okay, so putting these people on one dose of T3, this patient in particular was on T3 once a day, which that medication lasts peaks and troughs in about three to six hours in its usable form. So this person didn't have active thyroid hormone or inactive thyroid hormone to pull from for like 18 hours of her day. Not okay. So even if she was on multiple times a day dosing of T3, which people need to be on T3 again, is too short. Acting in between your doses of active thyroid hormone, your body needs to have enough inactive hormone to pull from. And my response that I got over and over was, well, I get worse on T4. Yes, a lot of people actually get worse on T4 because they have too much T4 that overload and inactive hormone dumps into an inhibitory hormone and it keeps you from getting well. What I want you to understand is too much is not good. Not enough is not good. It needs to be just right. And this is what I preach to you guys all the time. Your thyroid hormones need to be perfect. My definition of perfect is margins that are this wide. Anything less than perfect and it's not good enough. So. So when someone doesn't have enough T4 to pull from and their T3 runs out or in between doses or overnight, that can cause massive issues. Diabetes, pre diabetes, weight gain, hair loss, hormone disruption, temperature regulation, poor libido, the things that your body needs, 24 hour access to hormone massively get disrupted if you don't have any T4 and you're depending only on a very short acting active hormone. So do you need a lot? No. Do you need some? Yes. Does it need to be balanced? Absolutely. Same with T3. So I hope that offers some clarity for you guys. Take this to all the other places that everyone was discussing it and share it. Appreciate you all.
