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T3 T4 Vs T4 Alone

Why T3-T4 medications may be the first choice for Adult Thyroid Therapy

Because they work better! This is what patients and physicians firmly believed after trying both types of medications T3-T4 and T4 alone preparations. Following certain physicians, T4 alone preparations seem to work well in patients with thyroid deficiency but at doses that suppress TSH, the hormone that stimulates the thyroid gland to produce thyroid hormones. No solid studies exist to our knowledge, which show T4 products to work clearly better than T3-T4. Some studies show a better tolerance, but not efficacy.
Reasons why T3-T4 medications may be superior to T4 alone medications

T3-T4 medications work better than T4 medications in the following areas:
1. Lowering the total cholesterol.
2. Restoring a normal Achilles tendon reflex.
3. Prevention of goiter formation.
4. Improvement in overall symptoms (at least in some – not all – studies.

There are no studies that really show T4 preparation to work better than T3-T4. Some studies do show better tolerance, but not efficacy.
T3-T4 medications achieve better T3 tissue levels in the following areas:
5. In blood, T4 medication must increase serum T4 to the upper reference value to obtain an average blood level of T3, while this is not the case for T3-T4 medications.
6. In target tissue, (heart, lungs, spleen, muscle, adrenal, ovaries): In hypothyroid rat studies T4 supplements alone fail to obtain T3 –euthyroidism, contrasting sharply with T3-T4 treatment that brings the tissue T3 concentration to a healthier T3-euthyroidism level.

T3-T4 medications may be more stable in potency:
7. Higher potency: T3 is relatively stable, whereas the potency of T4 preparations can vary.

The intestinal absorption of T3, which is found in T3-T4 medications, is better and more constant than that of t4, which is the sole active ingredient of T4 alone preparations.
8. The absorption of T4 is poor and variable (35-67%), whereas T3 is very well absorbed (95%)
T3-T4 medications may better improve the conversion on T4 into T3 and thus provide higher T3 tissue levels:
9. Many conditions inhibit the conversion of T4 to active T3 such as aging, hormone deficiencies (including deficiencies, stress, digestive troubles, etc.) and make it unlikely for T4 preparations to be sufficiently converted to T3. Interestingly, researchers have demonstrated that a minimal amount to T3 is necessary to convert sufficient amount of T4 to T3. For these reasons, it is justifiable to add T3 to T4 in the thyroid medication to assure minimal T3 levels and a good T4 to T3 conversion.

T3 is the most important hormone not T4:
10. T3 is the active hormone in target cells, not T4. Moreover, T3 is the dominant thyroid hormone in all body cells with a five times greater distribution volume than T4.
11. Mortality studies in humans and animal show that it is, in general, the level of T3 – not of T4, which determines survival.

Reference: THE HORMONE HANDBOOK Thierry Hertoghe, MD International Medical Books – Publications Page 131