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Mary Shomon

Dr. Ken Blanchard on the T4/T3 Issue

By October 20, 2003

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Dr. Ken Blanchard, MD, PhD, is author of upcoming book What Your Doctor May Not Tell You About Hypothyroidism, which will be published in January 2004. Blanchard has these thoughts about the T4/T3 studies.

* * *

The Australian study replaced 50 mcg of T4 with 10 mcg T3 -- patients took 50 mcg less T4, then took either 1) 10 mg T3 or 2) 50 mg T4 (identical capsules). They spent:

1) 10 weeks on T4 or T4/T3
2) 4 weeks on their usual T4 dose
3) Then crossed over to the opposite of whatever protocol they followed in the first 10 week period

Just as with the Bunevicius study, they used too much T3, which leads to poor T4/T3 balance. The Bunevicius study was only 5 weeks -- the longer patients take T4/T3 that is imbalanced toward T3, the more likely they are to feel poorly at the end of the study, because T4 tissue levels fall slowly when there is too much T3 in the T4/T3 prescription.

Note that they seem surprised that TSH was significantly higher on the T4/T3 -- I would have been very surprised if it had NOT been higher.

The Canadian-American study cut usual T4 doses by 50% and added T3 12.5 mcg twice daily (vs. placebo, twice daily.) Once again, the dose of T3 is ridiculously high -- at least they assessed patients at 2, 4, 6, 9 12 and 15 weeks. They maintained TSH in the "euthyroid" range by dose adjustments -- fundamentally wrong assumption that TSH is the absolute arbiter of thyroid function levels.

In short -- any T4/T3 study that does not give T4/T3 in about a 98%/2% T3 T4/T3 ratio and does not give T3 in time-release form will not come close to reproducing normal thyroid physiology.

These studies are like doing placebo injections of saline, versus 5 units MPH insulin in diabetics, finding both groups had very high blood sugars and then concluding that "insulin is no better than placebo."

Note: Dr. Blanchard is in private practice in Newton Lower Falls, Massachusetts, and can be reached at his office at 617-527-1810.
August 9, 2006 at 12:16 pm
(1) Ellen says:

“MPH”? Does this person have any knowledge of diabetes whatsoever?

February 7, 2008 at 1:55 pm
(2) Carol-Ann says:

Ellen, Yes,Dr.Blanchard has a superior knowledge about diabetes.Perhaps a typo error as the M is next to the N.Also,he might not have done the typing.He has 30+ years of experience in endocrinology and has people coming from several different countries to receive his treatment.He is my doc.

August 8, 2008 at 7:26 am
(3) Marlene says:

I live in Crete Greece and have read the book by Blanchard. Are we still able to contact him for advice and how do I do it ? Please help.

May 19, 2009 at 12:32 am
(4) Karen says:

I’m on 120 of armour, had thyroid removed because of goiter. I feel terrible, light headed, I go up and down and can’t sleep, I can’t do anything to exhaust myself or I get a dizzy spell, I’m out of balance.
I go to nutritionists and holistic and MDs, I try and tell them what I’ve read in your book and can’t get anyone to listen. I’ve had blood tests which are in range, but my antibodies are 1000, my progesterone was very low I’m on the cream, my estrogen was rock bottom, I don’t know what I should take to correct my condition.

June 21, 2011 at 11:10 am
(5) rachel says:

This is in response to Karen’s comment. I too am on Armour, but only 60 mg due to tumors on my thyroid causing hypothyroidism. I tried 120 for a week and felt bad at that level, though I have low energy and other unresolved symptoms at 60 mg. I began the Armour at he same time I started bio-identical hormone replacement therapy. I use compounded cremes of testosterone, estrogen and progesterone. with regular blood testing I’ve learned that my THS levels are still not optimum, my progesterone was low at typical replacement doses and the other hormone levels were in good ranges. (good ranges means optimal, not “normal”. Its normal for a 40+ year old woman to have low sex hormone levels, but NOT optimal) So my provider has upped my progesterone dose to quite a bit higher and I’m doing so much better. feeling better, sleeping better, good mood protection. Some women need a lot more progesterone to get good lab numbers and relieve symptoms than others. Though with progesterone, its not the numbers that guide dosing, its how your’e feeling. If your progesterone is so low, its no wonder you feel bad. I am on BIO-IDENTICAL HORMONE REPLACEMENT THERAPY. Not the molecularly altered forms that are usually prescribed by by doctors. There is a huge difference.
As for my poor THS levels and unresolved thyroid symptoms I am looking for a provider that understands the 2 % solution and will give me a trial on it. Like looking for a needle in a haystack. Patients who have had thyroid removed have also lost their parathyroid gland as well and no longer absorb some absolutely essential nutrients, such as b complex and some trace minerals. This might be a contributing factor for you as well. I hope this info is helpful.

August 4, 2009 at 5:44 pm
(6) gvflower says:

After 10yrs of complaining to my doctors about my symptoms, I started to do my own research and learn about T3. Now I have added T3,but I would like to know if 75mcg-Levoxyl with 10mcg Cytomel equals the 80%/20% that Dr. Blanchard discusses in his book?
Thank you

September 14, 2009 at 12:07 pm
(7) Anna says:

GvFlover, 10 mcg of T3 on 75 mcg of thyroxine is more than 10%. 10% of 75 is 7.5, half of that is 3.75 and half of that (=2,5%), that is, less than 2 mcg of T3, is what Dr. Blanchard recommends.

If you are on 100 mcg of thyroxine, 2% is 2 mcg of T3 daily.

January 7, 2010 at 2:07 pm
(8) vanessa says:


You said you put yourself on T3…Was it prescribed by a doctor? If not, where did you get it and do they have a website?


March 12, 2010 at 10:45 am
(9) Migdalia Vaca says:

I had been diognosed with Hashimoto Thyrodiditis. I had seen different doctors trying to find a sloution, but the medication (fibrothyroxine)is not doing to much for me. I will like to contact Dr. Blanchchard for a consultation. I live in New York and it is far from his office but, we can work out a way and a plan for treatment. Is this possible?

August 18, 2011 at 5:42 pm
(10) Thyroid Sufferer says:

Migdalia Vaca, how are you doing now? Did you visit Ken Blanchard?

April 15, 2010 at 12:54 pm
(11) donna besant says:


September 9, 2010 at 2:50 pm
(12) Mary says:

My daughter is 18 and has been on thyroid meds since she was 11. I read Dr Blanchards book after being frustrated with the treatment she was receiving. I talk to my general doctor and she read the material and agreed to try her on the T3/T4 combo that Dr Blanchard suggested. It took awhile to get her balance right and then started seeing a local endo and she has continued her on this treatment. It improved her nausea and energy alot, she still deals with headaches but overall is better. She is currently taking Synthroid mgs 67.5 daily and Cytomel 5mcg and alternating with 2.5. every other day. Im not sure if this is 80/20 but her levels are good. Her weight is pretty stable overall. It takes a long time to balance out everything, and there are so many factors involved like hormones, if there is pregnancy, menopause, birthcontol pills involved then thyroid hormones have to be adjusted. Cytomel can deplete the bones of calcium so you should take a supplement and also Vit D plays a role in autoimmune so have that checked too. Dr Blanchards book changed my daughters quality of health. It pays to read, read, read and reserch for yourself. Dont give up!

February 4, 2011 at 10:14 am
(13) Kathy says:

I have recently be diagnosed with hypothyroidism. I had severe itching with Synthroid. I was changed to the generic form, Levothyroxine. Same severe itching. My local doctor sent me to an endocrinologist at Vanderbilt. He put me on cytomel only. My joints are less painful but my energy level has not changed much.

Anyone on T3 only?

August 18, 2011 at 5:44 pm
(14) Thyroid Sufferer says:

Kathy, I am in the same boat as you. I wondered how you are doing now with your thyroid issues?

August 19, 2011 at 12:02 am
(15) Kathy says:

Hello Thyroid Sufferer!
It has been almost 6 months since I have been on the cytomel only regieme. I have not felt better in 10 years. It took a while to adjust to the cytomel only. I continue to have terrible hot flashes. I am 58 and have already gone through menopause. I am learning to adjust. I put a cold compress around my neck when I am outside, sometimes when I am inside if I just can’t get cool. I am on 37.5 mcg per day. I take the entire dose in the morning since I don’t sleep well at night if I take a night time dose. My TSH is 0.7. The endocrinologist from Vanderbilt, Dr. Wolfe, told me he had never heard of anyone being alergic to synthroid! I am an RN so I knew lots of patients had a sensitivity to sythroid or the generic version. Aside from that, I knew my itching was so severe that it was intolerable! I took his suggestion about cytomel and went back to my internst. Be sure you have a good primary care doc who is not intimidated by your personal research! He and I worked until we got my levels right. I didn’t know I had felt so bad for so long, until I got on the meds. Please email me back and let me know how you are doing. Very few of us are on cytomel or T3 only. Very few are alergic to synthroid but we know it is real!

August 19, 2011 at 12:23 am
(16) Kathy says:

Thyroid Sufferer,
Did you get my response? I posted a long comment but don’t see it listed here. Please notify me if you did not get it. I really would like to talk to you more about this, especially if we are in the same boat.


August 24, 2011 at 2:02 pm
(17) joani says:

does anyone know of a good doctor with the same philosphy as Dr. Blanchard but in Ohio. Over the past 17 years, i have been to 4 Endocrines, and 3 Internists. No one gets it. finally i had a Pediactric doc (friend) that had a father with Thyroid and he wrote me a script for Armour. Have been taking it for at least 7 years. For the last two years, i have slowly been weaned off of premanin, and i now feel like i did before Armour. (weight gain, tired, can’t sleep, cold, etc…..)
Is the good Dr. Blanchard still taking new cases?
any suggestions out there.

February 20, 2012 at 4:53 pm
(18) Susan says:

I’ve had Hypo for 22 yrs. now. TSH levels are normal but not ever feeling “normal”. Mood swings, hair loss, cold tolerence, dry skin, weight gain, the whole deal. I’ve been taking synthroid most of the years and tried armour but seemed to make things worse. Now Im on levo, not sure how I feel on it. For the past couple years I’ve noticed an annoying dry cough and an itchy feel in my throat. Went to my doctor and she’s not even sure what it might be. Ruled everything out as far as Respiratory infection, ect. She did mention that I could have nodules growing on the back of my thyroid causing pressure on it to make me cough. If thats the case, shouldnt there be Warnings on some of these thyroid medications? Has anyone ever been told what the circomstances might be by taking some of these thyroid meds? My life has been in termoil since I was 16 yrs. of age. I wood like to have a somewhat normal life and to be happy. I think my family deserves that. My labido has gone from little to nothing at all! I too have read Dr. Blanchard’s book and I am very hopeful on trying the 80-20 method.

March 16, 2012 at 1:42 pm
(19) Linda says:

I had my thyroid removed many years ago – I have also continually struggled with medication and dosage. I am currently taking 60 mg armour and 50 mcg levoxyl. My TSH is off-the-charts low at .005, Free T4 high normal at 1.62 and total T3 slightly high at 181.9). My doctor thinks I am HYPER-thyroid, ignoring the fact that I am gaining (not losing) weight and still having symptoms of HYPOthyroidism.
Any ideas? When I initially started this Armour/levoxyl combo I lost 10 pounds, but now I have gained that back and more. VERY disturbing!! A few months ago I switched from 100 mcg of Levoxyl to 50 per doctor’s orders, but TSH has stayed exactly the same.

April 6, 2012 at 3:24 pm
(20) Marilee says:

I have just begun using Armour, started on 30mg with the same symptoms. I just started with 60 mg with 112 mcg of synthroid. I have heard that there is some new medicines that have replaced the Armour. If that is so can you tell me where I can purchase them in my area.

April 12, 2012 at 10:31 am
(21) Drina says:

I am a patient of Dr. Blanchard’s as well as my teenage daughter. He prescribes very small doses of Levoxyl as well as a compounded T3. I am taking 50mcg M,W and F and half a tab on the other days with 4mg of the T3 everyday. It took a few years to get to that dose. He monitors it carefully and adjusts based on bloodwork AND symptoms. I think most Dr’s are prescribing way too high Levoxyl (syntheroid) doses and too high cytomel (t3) dosages.

April 16, 2012 at 12:21 pm
(22) Marilee says:

I have started using Armour for the second month. I started with 30 mg and now doing 60mgs. I have heard that there is another drug that can be used but in Minot ND my physician is not sure where it can be purchased. Is there any information that you can give us.
I am not sure if the pill is a good one for me or not. Still have most of the symptoms such as : tired, cold, lack of energy, breaking of nails and of course gaining weight. I would appreciate any information that you can give me.
Thank you
Marilee Petz

May 2, 2012 at 4:12 pm
(23) nina says:

i am trying to call the practice using the number listed but it is not working. do you have any ideas.

June 28, 2012 at 3:33 am
(24) Susan says:

I went to my primary with what I thought was Bronchitis or the flu. After bloodwork, an Uptake Scan, and an ultrasound of my Thryoid I was told that I had mutiple Nodular Goiters my TSH was .230 my Free T4 was 1.07 my primary sent me to an Endocrinologist. My Endo did bloodwork again which shows my T3 at 2.5 my TSH at 1.04 and my Free T4 at .97 first tests were done in March of this year I was told that I am within normal range so no treatment is needed. I have hair loss, heart palpitations, cold all the time, fatigue, sleeplisness, constipation, dry skin, hoarseness, etc.

June 25, 2013 at 5:16 am
(25) Arron says:

i really hard to gain weight even i tried n tried…
i had take fusion mass…ultimate mass…anabolic peak mass…
but my saiz still same.
then i went to checking my whole body,blood test and etc…
result shown that everything is fine.just my T4 is a bit higher.
then i go to met Doctor.Doctor said my TSH is normal,just T4 a bit higher.
Doctor said my heart beat also normal,no need do any treatment.
i’m 178cm tall and weight 63kg.i still want increase my weight.
even i eat too many n healthy food,my weight still same.Dr.said my metabolism may is high.
so, do u hv any suggestion to help me reduce my T4 and increase my weight to 70-75kg?
actually my dream is 75kg.
thanks a lot ya…

January 25, 2014 at 1:15 pm
(26) Marie Staab says:

Find a doctor who will really listen to what you are saying. I have dumped one PCP after another. There are problems such as secondary and tertiary hypothyroidism, also, due to “Pituitary/ Hypthalamus Axis” issues. Here are some docs around the country who are practicing outside the box of standard medicine, often to the negative comments of their peers. You can google any of them for info and websites:
Dr. Ridha Arem, Houston TX; Dr. David Marquis, San Luis Obispo, CA;
Dr. Roy Kerry, Portersville, PA(Pittsburgh area) (724) 368-3558;
Dr. Kent Holtorf, Torrance, CA, Foster City, CA, Salt Lake City, UT; Philadelphia, PA; Atlanta, GA.

February 20, 2014 at 12:20 pm
(27) Ed Arnold says:

Blanchard’s T3:T4 ratio of 2:98 seems ridiculous. It is completely at odds with those of us who take substantial doses of T3 at night to support a T3 circadian rhythm which allows us to sleep. The fact that he does not give a clear rationale for this ratio is a red flag to me; there are plenty of practitioners who suggest other ratios.

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