Natural Desiccated Thyroid (NDT) – Alternative for Hashimoto and Hypothyroidism
Natural Desiccated Thyroid (NDT) with T3 and T4 as an alternative to L-Thyroxine for Hashimoto's and hypothyroidism. Effects, transition, dosage and individual formulations at Aposchwan Berlin.
Important Notice: This article is for informational purposes only and does not replace individual diagnosis and treatment by a physician. Thyroid disorders require specialist diagnosis and treatment.
Despite normal blood values, do you feel persistently tired, gain weight, and feel cold? Studies show that approximately 10-15% of all patients with hypothyroidism report persistent symptoms despite being treated with L-Thyroxine and having TSH levels within the normal range. For these patients, Natural Desiccated Thyroid (NDT) – a natural thyroid extract – can be an effective alternative. We explain when NDT makes sense, how the transition works, and how you can obtain this compounded medication.
What is NDT and how does it differ from L-Thyroxine?
Natural Desiccated Thyroid is a thyroid extract from freeze-dried pig thyroid glands. Unlike synthetic L-Thyroxine, which contains only the thyroid hormone T4, NDT provides both T4 and the active hormone T3 in a natural ratio of approximately 4:1. A standard dose of 65 milligrams NDT, also known as "1 Grain," contains approximately 38 micrograms of T4 and 9 micrograms of T3.
This important difference explains why some patients benefit from NDT: they receive the active hormone T3 directly, without their body first having to convert T4.
The history of NDT goes back over 100 years. Thyroid extracts were already being used therapeutically at the end of the 19th century, long before synthetic L-Thyroxine was available. With the introduction of standardized preparations, NDT has been manufactured in the USA according to USP standards since 1985. In the United States, NDT preparations are approved as so-called "grandfathered drugs" – they were already on the market before the FDA was founded and were incorporated into the regulatory framework.
In Germany, NDT is not approved as a finished medicinal product. It is manufactured individually as a compounded medication based on pharmaceutical raw materials according to the European Pharmacopoeia or USP standards in specialized pharmacies.
Why do some patients not respond adequately to L-Thyroxine?
The answer lies in conversion, the transformation of T4 to T3. The T4 contained in L-Thyroxine is a prohormone that must first be converted in the body by special enzymes called deiodinases into active T3. About 80% of the T3 circulating in the body is produced this way.
However, in a portion of the population, this conversion process does not work optimally. Various factors can impair conversion: chronic inflammation, elevated cortisol levels from prolonged stress, selenium deficiency (since deiodinases are selenium-dependent enzymes), certain medications such as beta-blockers, or genetic factors. Particularly relevant is the Thr92Ala polymorphism in the DIO2 gene, which occurs in 13-20% of the population and leads to reduced enzyme activity. Affected individuals produce less T3, especially in the brain, where this hormone is essential for concentration, mood, and cognitive functions.
The result: Blood tests show normal or even elevated T4 levels and a normalized TSH, but free T3 is in the lower normal range or even below. Despite seemingly optimal laboratory values, these patients suffer from typical hypothyroidism symptoms such as fatigue, depressive mood, difficulty concentrating, weight gain, dry skin, and sensitivity to cold.
Interestingly, medical research confirms this patient preference for combination therapies. The Hoang study (Hoang TD et al., J Clin Endocrinol Metab. 2013;98(5):1982-90) compared the effects of pure L-Thyroxine with NDT in 70 patients in a randomized crossover design. The result: Almost half of the participants (48.6%) preferred NDT compared to only 18.6% who preferred L-Thyroxine. Patients on NDT reported better overall well-being and showed moderate weight loss of an average of 1.8 kilograms. However, individual results may vary.
Who is NDT suitable for?
NDT is not a first-line therapy for hypothyroidism. German and European guidelines continue to recommend L-Thyroxine as the standard treatment. NDT comes into play when this standard therapy is not effective enough or is not tolerated.
The main indication for NDT is so-called L-Thyroxine-unresponsive hypothyroidism: patients who continue to suffer from persistent symptoms despite correctly adjusted TSH levels. NDT can also be an option in cases of proven conversion disorder, recognizable by elevated free T4 with simultaneously low free T3. Many Hashimoto patients report improvement in their symptoms after switching to NDT, especially if they continued to have symptoms under pure T4 therapy.
Another reason for NDT may be intolerance to excipients in synthetic preparations. Some patients react to lactose, mannitol, or other additives in L-Thyroxine tablets with symptoms. NDT capsules can be manufactured with hypoallergenic fillers such as rice starch or microcrystalline cellulose.
However, there are also clear contraindications. NDT is not suitable for existing cardiac arrhythmias, tachycardias, angina pectoris, after heart attack, untreated hyperthyroidism, or untreated Addison's disease, as the directly contained T3 places more strain on the cardiovascular system than pure T4. Caution is also advised in postmenopausal osteoporosis or increased cardiovascular risk. A careful cardiological examination should be performed before starting therapy.
Why T4-to-T3 conversion doesn't work for everyone
To understand why NDT works better than L-Thyroxine in some patients, it's worth taking a closer look at thyroid hormone regulation. The thyroid gland mainly produces T4 and only small amounts of T3. T4 has a significantly longer half-life and serves as a storage hormone. Only in the body's cells is T4 converted by deiodase enzymes into T3, which is about four times more potent.
This process doesn't happen randomly but is regulated by the body according to need. In the liver, kidneys, and thyroid itself, the enzyme DIO1 is mainly active, while in the brain, pituitary gland, and brown adipose tissue, DIO2 controls the conversion. A third enzyme, DIO3, breaks down excess T4 and T3 and thus protects against overdose.
In a conversion disorder, this finely tuned regulation is disrupted. It's particularly problematic when conversion in the brain doesn't work properly. While blood values may still appear normal, there is a T3 deficiency in the nerve cells. This explains why many affected patients primarily complain about cognitive symptoms: brain fog, concentration problems, depressive moods, and slowed thinking.
Selenium deficiency is an often overlooked factor in conversion problems. Since all deiodinases are selenoproteins, a deficiency in this trace element directly leads to reduced enzyme activity. Selenium deficiency is particularly common in Hashimoto patients, making conversion even more difficult. Studies show that supplementation with 200 micrograms of selenium daily can not only reduce antibody levels but also support T4-to-T3 conversion.
Chronic inflammation, such as that occurring in autoimmune diseases, also inhibits deiodinases. In this state, the body increasingly produces reverse T3 (rT3), an inactive form of T3 that is not metabolically active. Persistent stress with elevated cortisol levels also shifts the balance in favor of reverse T3. However, the clinical significance of rT3 determination is controversial and currently has no established place in diagnostics. In situations with impaired conversion, direct supply of T3 via NDT can be helpful.
Practical transition from L-Thyroxine to NDT
The transition from L-Thyroxine to NDT requires medical supervision and should be done gradually. An abrupt change can lead to under- or overdosing, as the potency differs. As a rule of thumb: 1 Grain NDT (65 mg with 38 µg T4 and 9 µg T3) corresponds to approximately 100 micrograms of L-Thyroxine. However, this conversion is individual and must be adjusted based on laboratory values and well-being.
The classic transition method begins with a reduction of the L-Thyroxine dose by 50 micrograms and simultaneous administration of half a grain of NDT in the morning on an empty stomach. After two weeks, the first laboratory check with TSH, free T4, and free T3 takes place. It's crucial that blood is drawn at least 12 hours after the last NDT intake to avoid distorted peak values.
Based on the laboratory values and well-being, the dose is gradually adjusted. Some patients ultimately require split dosing, where part of the NDT dose is taken in the morning and another part at noon. This can lead to more stable hormone levels throughout the day, as T3 has a shorter half-life than T4.
During the transition phase, temporary symptoms may occur. Some patients report palpitations, inner restlessness, or sweating in the first few weeks. These symptoms usually subside once the individually correct dose is found. It's important not to increase the dose too quickly and to monitor closely. Experience shows it takes three to six months to achieve optimal adjustment.
A common mistake is to focus exclusively on the TSH value. Under NDT therapy, TSH is often suppressed, i.e., below the normal range, while the free hormone values T4 and T3 are in the middle to upper normal range. This constellation is typical and not automatically a sign of overdose. What matters are the free hormone values, clinical well-being, and the absence of overdose signs such as tachycardia, sweating, weight loss, or tremor.
Dosage, intake, and laboratory controls
NDT is manufactured in capsules of various dosage strengths. Typical gradations range from 5 micrograms T4 equivalent to 100 micrograms T4 equivalent, corresponding to approximately 0.065 to 1.5 Grain. This fine dosability enables precise adjustment tailored to your individual needs.
Intake should ideally be in the morning on an empty stomach, at least 30 minutes before breakfast. As with L-Thyroxine, certain foods and medications can impair absorption. Calcium, iron, magnesium, and proton pump inhibitors should be taken at least four hours apart. Coffee can also reduce absorption, which is why many practitioners recommend taking the capsule with water and only eating breakfast after the waiting period.
With split dosing, usually half or two-thirds of the daily dose is taken in the morning and the rest around noon. Intake in the late afternoon or evening should be avoided, as the contained T3 can have a stimulating effect and disturb sleep. However, some patients report that they sleep better with evening intake. The optimal intake time is individual and should be found in consultation with your doctor.
Laboratory controls should be performed every two to four weeks at the beginning of therapy, later every three to six months. TSH, free T4, and free T3 should be determined. For Hashimoto patients, TPO antibodies and thyroglobulin antibodies are also relevant.
It's important to be aware of interactions. Estrogen preparations, such as those used in birth control pills or hormone replacement therapy, can increase the need for thyroid hormones. Dose adjustment may also be necessary with weight changes, pregnancy, or changes in life circumstances.
Costs, prescription, and availability in Germany
In Germany, NDT is not approved as a finished medicinal product. However, it can be manufactured as a compounded medication on medical prescription in specialized pharmacies. For this, you need a private prescription from your doctor, which states the exact composition, dosage, and number of capsules.
A typical prescription might read, for example: "Thyreoidea siccata (dried thyroid) 32.5 mg corresponding to 0.5 Grain with 19 µg T4 and 4.5 µg T3, filler rice starch, capsules size 2, quantity 100 pieces." The exact formulation should be coordinated with your pharmacy to ensure correct preparation.
Private health insurance often covers the costs without problems. For those with statutory health insurance, the situation is more complicated: basically, there is no automatic entitlement to cost coverage, as NDT is not part of statutory health insurance benefits. In justified individual cases, especially if documented therapy failure under L-Thyroxine exists, an application for cost coverage can be submitted. The chances of success depend heavily on the arguments of the prescribing doctor and the individual health insurance company.
As an alternative to German compounding, FDA-approved NDT preparations from the USA or Canada can be imported in limited quantities for personal use. A medical prescription is also required for this. The import is subject to certain legal requirements and should be checked beforehand. Import is done through specialized mail-order pharmacies or international pharmacies.
The biggest hurdle for many patients is not availability but finding a doctor who will prescribe NDT. Many general practitioners and endocrinologists refuse NDT because it is not recommended in German guidelines and they fear recourse risk with insurance prescriptions. Private doctors, naturopaths with medical cooperation, holistically oriented endocrinologists, and doctors for naturopathic medicine are often more open to this form of therapy. Patient forums and self-help groups can be helpful in finding a doctor.
NDT at Aposchwan: Your Berlin Naturopathy Pharmacy
As a Berlin pharmacy specializing in naturopathy and individual pharmaceutical care, we at Aposchwan offer the preparation of NDT formulations. We understand that transitioning from L-Thyroxine to natural thyroid hormones requires more than just the technical production of a capsule.
Our services for you:
Individual pharmaceutical consultation: What distinguishes us from anonymous mail-order pharmacies is our personal consultation on-site in Berlin. When you switch to NDT for the first time, we take the time to explain the correct intake, point out interactions with other medications, and answer your questions.
Highest quality standards: Our NDT capsules are manufactured according to pharmaceutical quality standards. We use pharmaceutical starting materials according to the European Pharmacopoeia or USP standards and can offer various fillers. We use rice starch as standard; for intolerances, we can switch to microcrystalline cellulose. The exact dosage is individually weighed according to medical prescription.
Support for doctors and practitioners: We work with experienced endocrinologists and naturopaths in Berlin and offer support with prescription formulation. Not every doctor is familiar with the specifics of NDT formulations. We help with the correct conversion from Grain to milligrams and micrograms, advise on suitable fillers and capsule sizes, and can assign a PZN for insurance billing on request.
Holistic approach: Our holistic approach means we don't view NDT in isolation. Many of our Hashimoto patients benefit from a combination of optimized hormone substitution and targeted micronutrient supplementation. Selenium, vitamin D, iron, zinc, magnesium, and B vitamins all play a role in thyroid function and immune regulation. We're happy to advise you on sensible laboratory tests and suitable preparations to support your NDT therapy.
Quick adjustment: For dose changes, we can respond quickly and prepare new capsules promptly – an advantage of local care over long shipping routes.
Your specific benefits at Aposchwan:
- Free cost estimate for your NDT formulation within 24 hours
- Personal initial consultation on intake and specifics of NDT
- Information material to support your doctor search
- Long-term support with competent contacts
- Local availability in Berlin with quick pickup
Feel free to contact us for a non-binding consultation. We look forward to accompanying you on your path to better health.
Frequently asked questions about NDT
Is NDT better than L-Thyroxine? NDT is not fundamentally better, but better suited for certain patients. Most people with hypothyroidism are well-adjusted with L-Thyroxine. Individual results may vary.
Can I simply switch from L-Thyroxine to NDT on my own? No, the transition should always be done under medical supervision. The dosage must be individually adjusted, and regular laboratory controls are essential.
Why is my TSH so low on NDT? A suppressed TSH is common under NDT therapy and not automatically problematic. What matters are the free hormone values T3 and T4 as well as your well-being.
Will I lose weight on NDT? The Hoang study showed an average weight loss of 1.8 kilograms. However, individual results may vary. NDT is not a weight loss medication for those with healthy thyroid function.
How long does it take for NDT to work? Most patients notice initial improvements after two to four weeks. However, optimal adjustment can take three to six months.
Can I take NDT during pregnancy? Pregnancy requires special caution. NDT is not recommended by most guidelines during pregnancy, as fluctuating T3 levels can be problematic. L-Thyroxine is the standard during pregnancy. If you want to become pregnant or are pregnant, be sure to discuss this with your doctor.
What happens if I overdose on NDT? Signs of overdose are palpitations, racing heart, inner restlessness, sweating, weight loss, sleep disturbances, and trembling. If you experience these symptoms, contact your doctor immediately.
Is NDT more natural and healthier than L-Thyroxine? "Natural" doesn't automatically mean better or healthier. The advantage of NDT lies in the direct T3 content for patients with conversion problems, not in its "naturalness."
Can I get NDT without a prescription? No, NDT is prescription-only. Obtaining it without a medical prescription is illegal and dangerous.
Conclusion: Natural thyroid hormones as a valuable option for selected patients
NDT is not a universal replacement for careful diagnosis and treatment of thyroid disorders. For the majority of patients with hypothyroidism, L-Thyroxine remains the therapy of choice. Guidelines recommend it as first-line therapy, and millions of people worldwide are successfully treated with it.
Nevertheless, there is a relevant group of patients who can benefit from NDT: people with proven conversion disorder, patients with persistent symptoms despite optimal TSH adjustment under L-Thyroxine, and those who cannot tolerate synthetic preparations. For these patients, switching to natural thyroid hormones with T3 and T4 can make a difference in quality of life.
Scientific evidence supports this differentiated view. Studies show that many patients prefer NDT over pure L-Thyroxine. At the same time, large, long-term randomized controlled studies that clearly demonstrate NDT as superior are lacking. The decision for or against NDT should therefore be made individually, based on symptoms, laboratory values, pre-existing conditions, and personal response.
Medical supervision throughout the entire therapy is important. NDT requires more attention and closer monitoring than L-Thyroxine, especially in the initial phase. Finding an understanding and experienced doctor is often the biggest hurdle for patients. Self-help groups, patient forums, and practitioners with a naturopathic orientation can provide valuable support here.
At Aposchwan, we understand these challenges and want to accompany you on your path to better health. Whether you're just starting to think about NDT, already have a prescription, or have questions about dosage and intake – we're here for you.
Legal Notice: This article does not replace individual diagnosis and treatment by a physician. Never change your medication on your own. All mentioned therapy options should only be used after medical prescription and under medical supervision.
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