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British Thyroid Doc Does About Face on Issue of T3 Treatment
Treatment of Hypothyroidism is About to Come Full Circle” Says Anthony Toft

from Mary Shomon

June 2002 -- The 21st Joint Meeting of the British Endocrine Societies in April 2002 was the occasion for a surprising about-face from Anthony Toft, one of the UK’s most prominent thyroid experts, as he expressed an apparent shift in opinion on the use of T3 as part of hypothyroidism treatment. Toft went from being a sometimes adamant opponent of the use of supplemental T3 as a thyroid therapy, to indicating that the addition of T3 may in fact be the superior therapy.

According to Toft’s presentation at the meeting, animal thyroid extract was introduced in the late 1800s. He claims that due to “variable potency,” it was widely replaced by synthetic T4 from the 1960s, but that doses tended to be higher – in the 200-400 micrograms daily level – as a way to compensate for lack of T3, because a “significant minority of patients only achieve the desired sense of well-being if serum TSH is suppressed.” According to Toft, a dose of 100-150 mcg. daily would in reality be enough to restore TSH alone to normal levels. The elevated dose needed for better patient well-being, however, increases the risk of osteoporosis, atrial fibrillation, and heart disease.

According to Toft:

  • patients who became hypothyroid after hyperthyroidism who take a T4-only drug gain more weight than those who do not become hypothyroid.
  • in studies of hypothyroid rats, it was found that it was possible to restore universal tissue euthyroidism (normal circulating thyroid hormone levels) only using a combination of T3 and T4 and not on T4 alone
  • in patients on long-term T4 therapy who were given an equivalent combination of T3 and T4 scored better in various neurological and psychological tests.
According to Toft, “It would appear that the treatment of hypothyroidism is about to come full circle.”
It would appear that the treatment of hypothyroidism is about to come full circle...
--Anthony Toft
This is a dramatic departure from Toft’s editorial, in the February 11, 1999 isssue of the New England Journal of Medicine, titled "Thyroid Hormone Replacement — One Hormone or Two?" This editorial accompanied the groundbreaking research published in that same issue of the journal that found that the majority of patients feel best with the addition of T3, findings which were controversial to endocrinologists, but already well-known to patients and holistic thyroid experts. In his editorial, Toft claimed that one of the reasons physicians should not add the T3 hormone to the treatment until study findings are confirmed by additional research, was, as he claimed:

...most, if not all, of the currently available combined preparations of thyroid hormones contain an excess of triiodothyronine as compared with thyroxine.
To say that this was a reason not to advocate the use of T3 was highly illogical. It is true that Thyrolar and the natural desiccated T4/T3 products (such as Armour and Naturethroid) have a higher percentage of T3 than that used by the researchers in their study. But Cytomel, a T3-only drug, was and is readily available, and compounding pharmacies almost anywhere can easily prepare time-released T3.

In his editorial, Toft also claimed that the desiccated thyroid extracts were “considered obsolete for some time by all but a few practitioners, who are often thought by their colleagues to be practicing on the fringes of medicine.”

Toft also argued that the majority of patients taking thyroxine "have no complaints about their medication." Here, Toft was actually directly contradicting the findings of iresearch conducted by the Thyroid Foundation of America that showed that the majority of post-Graves' disease hypothyroid patients still suffered a variety of symptoms when on levothyroxine.

Until this seeming reversal of his previous opinions, Dr. Toft has been a quite active proponent of the "normal range constitutes treatment" philosophy of hypothyroid management that has left so many countless millions of patients undiagnosed, undertreated, or maltreated.

It’s encouraging to see that someone who was so clearly not in tune with the needs of thyroid patients has “seen the light” so to speak, and realizes that sometimes, patients do know best, and that some of the best patient care may actually be taking place on the “fringes of medicine!”


Toft, Anthony. “T3/T4 combination therapy,” Endocrine Abstracts , 3 S40,

Toft, Anthony, MD. "Thyroid Hormone Replacement — One Hormone or Two?" New England Journal of Medicine, Volume 340:468-470 February 11, 1999 Number 6.

Bunevicius, et. al., "Effects of Thyroxine as Compared with Thyroxine plus Triiodothyronine in Patients with Hypothyroidism" New England Journal of Medicine, Volume 340: February 11, 1999 Number 6. (For more information, read: T3 Triiodothyronine Drugs Improve Quality of Life for Hypothyroidism.

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