I have just discovered Dr. Toft and will continue to update this post as I learn more about him.
I first read about him on the Health Unlocked Thyroid UK group. Everyone in that group was up in arms because he has conflicting ideas in regards to TSH suppression. He feels that it is acceptable to have a below range (very suppressed) TSH on T4 mono therapy, but when on T4/T3 combo therapy it is important to stay within the accepted laboratory range. As you can imagine, his statements are causing a lot of opposing opinions.
Dr. Toft is an author and retired endocrinologist in the UK. His book, Understanding Thyroid Disorders, is quite old but he has revised it numerous times as his views on current thyroid treatment and laboratory testing parameters have changed.
From what I have discovered thus far, he is an advocate of high T4 doses that push FT4 to the top or above references ranges in order to restore FT3 to mid range. He also thinks that it is acceptable for TSH to be below the reference range on T4 mono in this situation. This is interesting to me because this was my treatment before menopause and often times I wonder if I should have stuck with it. I took 175 mcgs of Levo up until 2018 with FT4 at 110% of range, FT3 at 38% and a TSH of .01. Yes, I had anxiety that I was treating with Lexapro but I was thin and had great energy and motivation. Now, since reducing my Levo dose and adding T3, I still have anxiety that I treat with Celexa AND Klonopin and struggle with my weight and energy.
He is not opposed to combination therapy T4/T3 treatment if patients do not respond well to Levo only. He suggests a rather large reduction in Levo and only advocates adding up to 10 mcgs of T3. But here is the caveat: “While taking both hormones it is important serum TSH is normal and not suppressed.” So he definitely puts the brakes on a buried TSH while taking T3 with T4. Which I would think limits us to very little T3 in addition to our T4 dose. If I had to guess, for me, I think I would still have an in range TSH on 88/5. I actually did that combo once a few years ago and my stats on 88/5 were: FT4 40% of range, FT3 at 47% and a TSH of ( .4 ). But of course, I was only focused on increasing my FT3 because at the time I believed more T3 was the key to no-thyroid nirvana so I didn’t give that dose much of a chance.
I have supplied some links below so that you can read more about Dr. Anthony Toft. I think his opinions are worth a read. I know that it has made me examine my past labs and doses and wonder if a heavier T4 option is maybe what my body wants.
An interview with Dr. Anthony Toft on the Thyroid Patient Advocacy website.
A book review of Dr. Toft’s book.
An article below by Dr. Toft that highlights his frustration with current thyroid treatment.
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