Very rarely can anyone work at ellipsoidal heights. In local coordinate systems, it only makes sense for upper geodetic calculations. Only for GPS measurements we get an ellipsoidal altitude, even there the devices can immediately calculate the altitude of the EGM96 model with an altitude above sea level (with a few meters error which is not significant compared to the 15m altitude error of handheld GPS).
Proj4 calculates the horizontal coordinates well, but there is a serious error in the height coordinates (for special national projections (
http://www.agt.bme.hu/gis/workshop4/eloadasok/proj_poszter_3d.pdf)), so it would be better if not we would count on it but leave the altitude unchanged.
Could it be an option not to change the height with Therion?