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What to Do If You’ve Had Your Thyroid Gland Removed

No thyroid gland, now what? My approach for helping patients with thyroidectomies.

In this video, I’m addressing what to do when you no longer have a thyroid gland and can’t find a dose of medication that helps you feel well. This is for anyone who’s had a thyroidectomy, or even anyone who’s been diagnosed with hypothyroidism and is on medication but is still struggling to find the “magic” dose.

Video Transcript

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Today we’re talking about what to do when you don’t have a thyroid gland anymore – whether you’ve had it irradiated, if you’ve had a thyroidectomy, or if it’s atrophied over time. 

I’ve had probably five calls in the last two weeks from people who’ve had thyroidectomies. They no longer have a gland and they can’t find a dose of thyroid medication that makes them feel good. 

I’ve been asked on those discovery calls, “What dose should I take? What do I do if I’ve tried these doses and it doesn’t work?”

So I thought I’d do a Thyroid Thursday video on this topic. This can help people who’ve had a thyroidectomy or even people with an atrophied thyroid gland from so much damage over so long that they really do need some thyroid replacement. It can even help those who have been diagnosed with hypothyroidism and are on medication but they’re still struggling to find the “magic” dose. 

(00:54)

So let’s get into this. If you’ve had your gland removed, the general idea would be that, okay, the gland was damaged for some reason, and let’s assume that everything away from the gland is working.

Thyroid transport is working. There’s no cell stress, or cell danger going on. So the cells are rapidly converting T4 to T3 in what we call a homeostatic low-stress condition, what we might consider normal physiology. So in that case, the gland is the only thing that was damaged or destroyed, and everything else downstream is working properly. 

Let’s assume the person’s in optimal health (which you probably aren’t, if you had something that caused damage to your thyroid gland) but let’s just assume that everything else downstream is working. 

In that case, how much thyroid hormone should somebody need without a thyroid gland? 

(01:53)

Well, the thyroid gland makes somewhere between 80-100 micrograms per day of T4. So somewhere in that range is about an appropriate replacement of T4 medication. The thyroid gland also makes about 5-10 micrograms of T3 per day. 

So my opinion, and I don’t prescribe medication, this is just like a teaching point, but if you destroy the gland or remove the gland and you’re trying to replace what the gland would’ve done…

The starting point is probably somewhere between 80-100 micrograms of T4, and probably somewhere between 5-10 micrograms of T3. That would be a great starting point.

(2:45)

Now we do run into a challenge, and that is the absorption of the medications can be an issue. The range of T4 absorption has been recorded at about 17-93%. Why is that?

Well, it depends on the individual. What kind of challenges do they have going on in their GI tract? Do they produce stomach acid? Do they have malabsorption issues? Do they have dysbiosis? Do they have inflammatory processes going on? 

So there are a lot of things that can affect the absorption of T4, but on average, it’s thought that probably 60 to 80% of the T4 medication you take is absorbed. 

It can be a little bit higher if you’re taking a liquid form of it. But when you’re taking just traditional T4 medication, it’s thought that probably 60 to 80% of that’s being absorbed. 

So what do we do in that situation? 

I would still recommend that somebody start with that 80-100 micrograms, and then potentially work, start increasing that dose to try and find a dose that’s appropriate. 

(03:46):

For T3, it seems to be more absorbable based on the literature, maybe 93%. 

But I think the same thing applies here, which is that people who have gut, GI digestive issues, and malabsorption issues, may still have some challenges. So this is a good starting point for T3, and then we might have to titrate up. 

So somebody may need to take somewhere between 20-40% more T4 than the starting point of what the gland would typically make. And the person who’s taking T3, they might actually need an extra 5-10 micrograms of T3. 

Now, keep in mind that oftentimes, people are doses much higher than these. And when they start working with a functional medicine practitioner or they start following some of the principles in the The Thyroid Debacle Book, and they start to improve their gut function, they often absorb more of their medication. So their absorption rate goes up and they could become hyperthyroid on their medication because the dose that was appropriate when they had more dysfunction is no longer appropriate because they’re now absorbing more medication!

(04:56):

Now, the second question would be, do you take a glandular – Armour, NP Thyroid, something along those lines – or should somebody take T4 and T3 medications separately? 

Well, there are lots of opinions on this, and the typical animal glandulars were things that were done even before Synthroid was available. And so that was kind of the standard, the original standard. And now people are still using Armour and NP thyroid sometimes in these situations, or sometimes for anybody who’s diagnosed with a thyroid problem.

The challenge is the human thyroid gland makes about 90-95% T4, and 5-10% T3, and most of these glandulars are 75% T4 and 25% T3. So they don’t really match human physiology. 

If all we had were the animal glandulars, then I would probably defer to the glandulars. But because we have the ability to take T4 and T3 separately and closer match what the thyroid gland would typically make and manipulate T4 and T3 separately, I typically recommend to my clients who’ve had thyroidectomy when they’re talking to the doctor instead of the glandular, go with the T4 and T3 separately. And that way you can tweak one of them up without modifying the other.

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The next question I usually get asked is, “Listen, I’ve tried all the doses, I’ve tried all the recommendations. There is no dose of thyroid medication that I’ve found so far that makes me feel good. If I increase my T4, I don’t feel good, I get hyperthyroid symptoms. If I increase the T3, I really don’t feel good.” But if they don’t take enough, then they start having more hypothyroid symptoms. 

So they’re like, “I just need to know, what is the magic dose?” 

But there isn’t a magic dose. And in that situation, I think two things are probably going on. 

One, they have a gland that’s been destroyed. So the solution then is to replace as close to what the gland would make to begin with. 

And then the second thing you need to do is address what’s going on, what we call cell danger response or thyroid allostasis. 

(7:35)

So making thyroid hormone at the gland is only part of the whole thyroid process. The gland makes the T4, it makes a small percentage of T3. Most of the T3 that gets to the tissue that’s in circulation is made by the peripheral tissues that convert T4 to T3. 

If you give T4 and you give T3, can you normalize the blood levels of T4 and T3 with medication? Sure. You hear people in functional medicine talking about optimizing T4 and T3 in the blood. That’s their first step. They want to give T4. Then they want to make sure they’re giving T3 to normalize the T3 in the blood, and they assume that’s a great starting point. 

And they assume that the T3 they’re giving the patient is going to have the desired impact inside the cell. But the cells get to make the decision. 

Cells, if they’re in a stressed state from infection, toxins, emotional stress, trauma, or hypoxia, they perceive danger. There are inflammatory chemicals in the bloodstream that stimulate and send danger signals to a cell. That cell is going to want to slow down its metabolism. 

So T4 is going to get deactivated to reverse T3. T3 is also going to get deactivated to something called T2, and the person is probably still not going to feel great if they have a persistent cell danger response. 

(08:49)

So if you’re the person who’s tried T4, T3, or T4/T3 glandulars, and you just can’t find the magic dose, the problem is probably not the dose…

My first recommendation in those situations is to get your dose closer to what the gland would actually make.

The second recommendation would be to pick up a copy of The Thyroid Debacle Book and start following the recommendations in Part 3 of the book to start reducing the stressors that cause the cell stress, cell danger response, and the thyroid allostasis at the cell and tissue level. 

And then recommendation three would be, if you’re still struggling, that’s when you reach out to a functional medicine practitioner who’s going to work with you to help identify what those stressors are that are creating that cell danger response. 

A good practitioner should help you work to reduce or eliminate those so that the T4 and T3 medication that you take does what it’s supposed to do, increases the metabolism without increasing your anxiousness and your anxiety in your insomnia.

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Hi, I’m Dr. Eric Balcavage, owner and founder of Rejuvagen. If you’re struggling with health issues or have questions, let’s chat. You can schedule a 15-minute call with me to get started.