Dr. Izabella Wentz, PharmD

Thyroid Pharmacist

The Listecki-Snyder Protocol for Hashimoto's

The Listecki-Snyder Thyroid Protocol

Medically reviewed and written by Izabella Wentz, PharmD, FASCP

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The Listecki-Snyder Protocol for Compounded Thyroid Medications

Pharmacist Bob Listecki was someone that I met at the beginning of my health journey. I was working in pharmaceutical sales, visiting pharmacists to tell them about the benefits of various new medications.

I walked into Glen Ellyn Pharmacy and started telling Bob about asthma products the company I worked for made. Bob listened, and then interrupted, “You know, there are ways to treat asthma naturally.” I was intrigued.

At the time, I had just started with lifestyle changes for Hashimoto’s. It was April 2011. I had been gluten and dairy free for a little over 2 months and had started to see some real changes in my health. After such a positive response to my first venture with natural healing, I was all ears.

Bob told me about the role of the bacteria in our gut and their connection to chronic diseases and introduced me to the world or probiotics. We talked about the challenges of thyroid conditions, natural health and I walked out of his pharmacy a few hours later with a bag of probiotics, another piece of my puzzle.

I have always thought of Bob as an innovator with a wealth of knowledge, so I wasn’t surprised when I came across the Listecki-Snyder Protocol in the International Journal of Pharmaceutical Compounding (IJPC) in late 2012.

This is a specialized protocol for compounded thyroid medications that delivers a physiologic or bio-identical ratio of T4:T3 for improved patient outcomes.

I had the pleasure of interviewing Pharmacist Bob last year about his innovative protocol.

Background Information

For those of you new to the thyroid, the thyroid gland has two main physiologically active hormones: T3 and T4.

Synthroid, the most popular thyroid medication on the market, contains only T4, which is a precursor to the more physiologically active T3 hormone.

In theory, T4 is a pro-drug and people should convert it to the more active T3-it’s a simple chemical process of removing one iodine molecule of the hormonal structure, but there are a lot of reasons that some individuals may not be able to properly convert T4 into the more active T3. (More in my article Which Thyroid Medication is Best?)

This can be a problem because T3 is our “go” hormone. It helps us to create beautiful, healthy hair, maintains our metabolism and helps us have energy.

While some people feel great and look great taking just T4 containing medications, (think the beautiful actress Sophia Vergara, a spokesperson for Synthroid), many of us continue to have thyroid symptoms, despite taking thyroid medications like Synthroid and Levothyroxine. Some people feel significantly better on natural desiccated thyroid (NDT) medications like Armour thyroid, WP Thyroid, and Nature-Throid (think of former Baywatch star Gena Lee Nolin, spokesperson for Nature-Throid). NDT medications contain roughly four parts of T4 to one part of T3. (Get more tips by downloading my Optimizing Thyroid Medications eBook for free!)

However, according to Goodman and Gilman’s: The Pharmacological Basis of Therapeutics, (one of the “bibles” of modern pharmacotherapy); the human thyroid secretes 11 parts of T4 to 1 part of T3.

Pharmacist Bob Listecki decided to apply the principles of bio-identical hormone therapy that are used for estrogen/progesterone to thyroid medication.

What is the Listecki-Snyder Protocol?

According to pharmacist Bob Listecki; “The Listecki-Snyder Protocol is an ability for a compounding pharmacist to recreate the ratio of T4 to T3 that is present in the human thyroid gland.”

As a thyroid patient himself, Bob felt like he was not feeling as great as he could on his thyroid regimen. “We increased my dose of thyroid medication, which took care of some of the symptoms, but then I started to have tendon inflammation, which I attributed to too much T4. So we reduced my Synthroid dose from 125mcg to 112mcg, but I still didn’t feel optimized. I then tried Armour, and was really bouncing around not feeling my best.”

After coming across an article on thyroid medications in the US Pharmacist magazine, Bob learned that the human thyroid gland actually contains a ratio of 11 parts T4 to 1 part of T3. This is much different than the ratio in Armour, Nature-Throid and other desiccated thyroid products.

Bob was fascinated by this information and had his pharmacy intern Dr. Scott Snyder, PharmD, research the bioavailability of the oral forms of T4 and T3. Based on the amount of hormone that is actually absorbed from the oral doses, they calculated an adjusted ratio, of 13.06 parts of T4 to 1 part of T3 that would accurately deliver a ratio of 11 to 1 in the blood stream.

The Listecki-Snyder protocol gives us less active T3, and rather than taking the entire dose in the morning; the Listecki-Snyder protocol splits the daily dose of T3 into two sustained release capsules, which are given every 12 hours, while the entire dose of T4 is taken in the morning.

Who May Benefit from This Dosing?

According to Pharmacist Bob, people who are not optimized on T4 but are not able to tolerate Armour, due to the high T3 content, may benefit from this type of new dosing.

Armour has been a long time patient favorite, but due to it’s once per day dosing and 4.2-1 ratio that converts to 4-1 in the body, some may get too much T3 from it, and as T3 has a half-life between 6-16 hours in the body, this may result in highs and lows, putting the body on a roller coaster. Some may feel this as palpitations, mood swings or hot flashes.

Anecdotally, some thyroid patients have found that T3 containing medications worsen their adrenals, and theoretically a slow and steady release of a lower, physiological dose of T3 should counter that issue.

So a person who was perhaps not feeling optimal on Armour or Synthroid would take one dose of T4 in the morning along with one dose of the suspended release T3. Then the person would take a second dose of T3 12 hours later.

Pharmacist Bob cautions that if you are on T4, you need to drop the dose by 30%, then calculate the ratio. If you don’t reduce the T4, and just add T3, people may not be able to sleep at night and have too much energy.

Patient Response

Pharmacist Bob pays careful attention to all of the patients on this protocol at his pharmacy. “Overall, patients come and say that they feel a lot better and that they have more energy. Their levels of TSH, T4, T3 come out balanced as well”. According to Mr. Listecki however, it may take about 90 days to stabilize on this dose vs. the usual 4-6 weeks it takes to stabilize on other regimens.

My Recommendation

If you think that this type of dosing would help you, I highly recommend that you speak with your local compounding pharmacist. As a caution, not all compounding pharmacists are equipped to handle this type of compound or any compounded thyroid medication for that matter.

This is because compounded thyroid medications are dosed in 1/1000 of a milligram. There is a lot of room for error, and I always recommend working with pharmacies that use Professional Compounding Centers of America (PCCA) thyroid starters. PCCA pre-dilutes the thyroid hormones 1000 times, allowing for more precise dosing.

Compounding pharmacists who subscribe to the International Journal of Pharmaceutical Compounding are your best bet, this way you know that they are keeping up with the latest innovation in the world of pharmaceutical compounding.

Additionally, in my experience, some people with Hashimoto’s and severe gut issues may not be able to properly absorb methocel, a suspending agent used to make a suspended release version of thyroid medications, so if you and your doctor are considering this option, you want to be sure to do follow-up thyroid testing within 2 weeks or so. You want to make sure your TSH, Free T3, and Free T4 are staying within an appropriate range- if your TSH is increasing and the Free T3 and Free T4 begin plunging, you may not be absorbing this form properly.

We’ve done some of the legwork for you and have a list of compounding pharmacies. Some have consultant pharmacists on staff that can further guide you in your healing journey as well (like Pharmacist Bob helped me in mine!), and in addition to advising you about compounded thyroid medications, the pharmacists can advise you on other innovative options for people with autoimmune disease including low dose naltrexone, which is a unique compounded medication that can help put Hashimoto’s into remission.

Questions to Ask Your Compounding Pharmacist:

  1. What types of fillers are used?
  2. What is the source of the materials? (We recommend PCCA sourced materials)
  3. Is the compound slow release or immediate release?

Resources

About Bob Listecki, RPh of Glen Ellyn Pharmacy

Glen Ellyn Pharmacy has been a family owned business for 52 years. Bob Listecki, RPh, “Ask Dr. Bob” compounds medicine for people with special needs. Bob Listecki, teaches pharmacy students at local colleges and is an authority on all types of medicines and specializes in Symbiotic Therapy.

Glen Ellyn Pharmacy is located at 486 Roosevelt Rd, Glen Ellyn, IL (630) 469-5200) and Pharmacist Bob is available for paid consults.

Publication

The Listecki-Snyder Protocol has been published in the International Journal of Pharmaceutical Compounding (IJPC). To meet the publication deadline, dedicated pharmacy Scott Snyder continued to work on the article while he was on his honeymoon in Thailand! Click here to view the abstract of the Listecki-Snyder Protocol.

PS. You can also download a free Thyroid Diet Guide, 10 Thyroid friendly recipes, and the Nutrient Depletions and Digestion chapter for free by signing up for my weekly newsletter. You will also receive occasional updates about new research, resources, giveaways and helpful information.

For future updates, make sure to follow us on Facebook!

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Disclaimer: The information contained herein is for informational purposes only and should not be construed as medical advice. Please consult your physician for any health problems and before making any medical or lifestyle changes.

Lifestyle changes can result in improved thyroid function and/or an increased absorption of thyroid hormone medications, leading to a lower required dose and possible symptoms of hyperthyroidism at a dose that was previously stable. Please discuss lifestyle changes with your physician and ensure that your thyroid function is monitored every 6-8 weeks while making lifestyle changes. Symptoms of overmedication include, but are not limited to: rapid or irregular heartbeat, nervousness, irritability or mood swings, muscle weakness or tremors, diarrhea, menstrual irregularities, hair loss, weight loss, insomnia, chest pain, and excessive sweating. Do not start, change, increase, decrease or discontinue your medications without consulting with your physician.

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Comments

  1. Izabella, enjoyed the Listecki-Snyder Protocol blog, once again proving the second thyroid patient rule; there is no one size fits all. I have run across patients taking everything from T4, T4 with various amount of T3, NDT, NDT with various amounts of additional T4 or T3, to straight T3. Dr. Blanchard has used 98.5% T4 with 1.5% timed release NDT, + or – 0.5% for many years successfully. Dr. Holtorf uses times release T3 quite often with his patients. Other than some good researchers, endocrinology is headed down the path of irrelevance with its treatment standards. Also the question of output capacity for the thyroid and the extrathyroidal production in various situations is still unanswered. PR
    Reply

  2. There are times when a healthy thyroid secretes EXTRA T3 (not the converted kind), and there are times when a healthy thyroid secretes ONLY T3 (when T4 gets converted to RT3). Unless a patient has extra T3, immediate release, doses on hand, IF they are thyroidLESS, there is no way to “replicate” what a healthy thyroid does from the outside in.
    Since meds are not as well absorbed or as well-used by cells as secreted hormones are, we thyroidLESS humans need to ingest MORE than a healthy thyroid secretes to get the same effect
    Reply

  3. My Thyroid levels have dropped to 0 and for the past 9 months they have stayed below levels and i have develoved Vertigo real bad. My dr. Has Consistantly changed my Synthroid meds and Im still losing hair and I continue to feel bad everyday, Nothing seems to help. I have had my Thyroid removed due to cancer and one of second worse case Goiders In my area at the Local hospital that theyhave seen in years. I agreed to have it sent off to be studied. I need to know what more can I do. Its like my Dr isnt paying any attention to what, I need. Please Help what I need to further ask. Maybe not aking right questions. I need to be more active and alive.
    Reply

  4. Christy, I too am post thyroid cancer & have found a wealth of information on the http://www.stopthethyroidmadness.com website. Also on facebook you will find supporting groups that are knowledgeable and helpful. Search for FTPO theres groups in America and Australia etc. Plus some tailored for those without a thyroid (ir. Cancer). I’m sure you’ll find all your answers there as a posed to your doctor. Good luck.
    Reply

  5. I have Hashimoto’s and have tried the Listecki- Snyder protocol and after a week I gained two and one half pounds.I tried LDN and gained two pounds.I don’t know where to go next
    Reply

    • Tom- When it comes to weight gain these are a couple of things to think about.

      1) What was your recent TSH, Free T3 and Free T4? Sometimes when those numbers are on the outskirts of normal, your metabolic rate may still be impaired making it more difficult for you to burn calories. Most people report feeling well with a TSH between 0.5-2.

      2) What type of medication are you on? Some report more weight loss with T4/T3 combinations (Armour, Nature-Throid, compounded medications) versus T4 medications (Synthroid, Levoxyl, Tirosint) alone. T4 is a precursor to T3, but some individuals do not convert T4 to T3 properly, and the T3 component is the metabolically active one.

      3) What type of diet are you eating? Some report more weight loss with T4/T3 combination vs T4 alone. Some do not convert T4 properly.The Standard American Diet (S.A.D.) full of sugar and simple carbohydrates is perfectly designed to cause us to gain weight year after year. Even yogurts that are marketed as “healthy” contain the equivalent of 16 teaspoons of sugar. Divorcing the S.A.D. is often a step that many of us must take to not just lose weight, but to also feel better. Some diets that have been helpful include the Body Ecology Diet, the Paleo Diet, the Virgin Diet, Autoimmune Paleo Diet, GAPS diet, SCD diet, Weston A. Price Diet, or the Mediterranean Diet. You may need to modify these diets to your own individuality.

      BEST DIET FOR HASHIMOTO’S AND HYPOTHYROIDISM
      https://thyroidpharmacist.com/articles/best-diet-for-hashimotos-hypothyroidism

      HOW TO LOSE WEIGHT WITH HASHIMOTO’S AND HYPOTHYROIDISM
      https://thyroidpharmacist.com/articles/how-to-lose-weight-with-hashimotos

      Reply

  7. I need help. Not only do I have Hashimotos but I have low protein s thrombofelia. I need to eat the autoimmune paleo way but the low protein shake makes is to icant break down animal proteins properly. I’m doing pea protein shakes. Is there something else I can do?
    Reply

    • Marla- Many people will be amazed how much more energy they have after
      they start taking digestive enzymes with their meals. I know I felt like
      a brand new person after starting Betaine with Pepsin. The digestive enzymes should stimulate your body’s own production of acid, and help you extract nutrients from your food. After some time, you should be able to get off the enzymes as your own body begins to produce enough digestive acid. You may find this article interesting! 🙂

      HASHIMOTO’S AND LOW STOMACH ACID
      https://thyroidpharmacist.com/articles/hashimotos-and-low-stomach-acid

      Reply

  8. Thanks for information when I’m on T4 meds alone my T4 is sky high and T3 drops way down, Then I try NDT my T4 drops way down ans T3 goes sky high.I can hold my TSH normal.on both. I don’t feel good on either medication its some what like a roller coaster ride for me.. I did feel good for about 8 weeks when I started the Paleo diet then crashed again. I was and still taking NDT when started the diet.

    Reply

  9. Some thyroid patients’ bodies are unable to convert T4 to T3. People like me become sicker on any amount of T4. However, my hypothyroidism symptoms subside when I take a pure T3 med like Cytomel. I’m not really sure why I’m unable to make that T4 to T3 conversion.

    Reply

  10. I appreciate your insight into thyroid issues. My thyroid was zapped with radioactive iodine due to Graves disease. Since that time I struggle with typical low thyroid issues (weight gain and now gastrointestinal issues are getting worse). I would like to find a compounding pharmacy in the Covington, Louisiana area. I am now taking NP Thyroid, which my Dr. reluctantly prescribed. Can you help?

    Reply

    • Cecelia – thank you for following this page. Graves and Hashimoto’s are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto’s, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people) – Hashimoto’s results in hypothyroidism and is usually treated with Synthroid and replacement hormone.

      The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually people with Graves have hyperthyroidism and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own and these people end up on Synthroid as well.

      Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine, the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to rebalance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The information I present is based on my own research, in my journey for overcoming my autoimmune thyroid condition.

      Hashimoto’s Protocol
      thyroidpharmacist.com/protocol

      Hashimoto’s Root Cause
      http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20

      Reply

  11. I had heard of Listecki before but I’d never had anyone walk me through it like you did! You are always so helpful in giving people all of the information they need to take things into their own hands. My doctor has kept me on ineffective meds for years, but I’ve started following this protocol and have seen amazing results! Bless you Dr. Wentz!!

    Reply

  12. You’ve done it again Dr. Wentz! Everytime you post something it gives me so much hope that I can get better. The ratio of normal T3 and T4 levels has always been an issue for me, but I’ve started to see results after following all of your posts. It’s so important that people know about all of the options there are out there. What a wonderful community you’ve created! I know of all us with thyroid problems are so grateful for the work you do.

    Reply

    • Jo-Anne – thank you for following this page. Epstein-Barr is a virus that causes mononucleosis (commonly called “Mono”), a debilitating viral infection that is common among college students, and is also known as the “kissing disease,” because individuals are exposed to the virus through saliva of those who are infected.

      Specific immune cells known as CD8+ T cells are needed to fight off the Epstein-Barr virus, however, some individuals may have a low baseline level of these types of immune cells. (CD8+ T cells decrease with age, are lower in women, and in the presence of low vitamin D intake). When these fighter cells are low, the Epstein-Barr virus may take up residence in our organs (such as the thyroid) and essentially hijack the organ to help the virus hide and multiply.

      The timing of infection may also matter as well, for example, children in developing countries usually contract the Epstein-Barr Virus when they are under the age of 10. This usually results in an asymptomatic infection—one that does not cause them symptoms. In contrast, in developed countries, where individuals are not usually exposed to the virus until they are in high school or college, the infection is symptomatic in 50% of the older kids affected. This is because by the time we reach college age, CD8+ T cells, the ones that fight EBV, have declined by threefold compared with the number of cells we had in childhood.

      Animal fats, broths, soups and stews support the body’s ability to suppress the viruses. Monolaurin or lauric acid, one of the components of coconut oil, has been found to be active against the Epstein-Barr virus. Replication of many viruses including Epstein Barr is inhibited by glycyrrhizic acid, an active component of licorice root. Quercetin, Co-Enzyme Q10, N-Acetylcysteine, and glutathione were also reported to be helpful in chronic fatigue syndrome because of their anti-viral properties.

      You also need to be sure to ask for the Epstein Barr Virus Early Antigen test, as this is a test that will let us know if the virus is actively replicating. Here is a link which might help:

      EPSTEIN-BARR VIRUS AND HASHIMOTO’S
      https://thyroidpharmacist.com/articles/epstein-barr-virus-and-hashimotos

      Reply

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