Question about raising NDT

My daughter has been taking 60mg of compounded NDT for 4 weeks (raised from 45), in addition to amino acids and vitamins to help with mood symptoms. Hair is breaking and dry, very cold, and tired. Mood much worse. Got her labs back yesterday (compared to 45 mgs) - our Dr requires that labs be drawn 3-5 hours after morning dose:

11/20/14 - 45mg compounded suspended release NDT taken 4 hrs earlier so it is "in her system"

TSH 2.01 (.45-4.5)

T3 164 (71-180)

Free T3 3.9 (2.3-5)

Total T4 7.5 (4.5-12)

Free T4 1.17 (.93-1.6)

Reverse T3 14.5 (9.2-24.1)

Antibodies - negative

New labs on 60 mgs drawn 1/3/14 (3.5 hrs after taking meds) - (same reference ranges)

TSH 4.89

T3 138

Free T3 4.3

Free T4 1.15

Dr asked about symptoms and compliance. She does not always wait before drinking a morning smoothie and has been taking Pepto-Bismol for stomach problems almost daily. Could this account for poor absorbtion and the raise in TSH despite a higher dose? Dr said to go by symptoms and said we could do any of these: double her dose and see if it helps; make sure she stops using Pepto and waits to eat and keep same dose; or open up capsules and give her 1.5 dose (90mgs). She is very sensitive to meds, so I don't want to double it! We gave her 60 today and made her wait an hour before eating.

Thanks as always for your help!

Wendy

4 Replies

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  • Wendaeh, leaving less than an hour between taking thyroid meds and eating/drinking will reduce absorption and so can can low stomach acid. Antacids will reduce stomach acid which is usually low in hypothyroid patients. Your daughter may benefit from raising stomach acid by taking Betaine Pepsin before meals or a couple of tsp raw apple cider vinegar in fruit juice or honey sweetened water before meals.

    You could see whether her symptoms improve following the above regime for 3/4 weeks and increase meds if not.

  • she needs betaine oe pepsin for her stomach NOT peptobismal

    however

    what are her ;levels of

    Ferritin

    Folate

    B12

    they must be over halfway in their range otherwise levothyroxine simply cannot be utilised by the body and will produce reverse t3

  • Hi - all of those levels (ferritin, folate and B12) are in the high end (from previous tests) and don't need supplementing. He ordered a reverse T3, but it didn't come with the test results; she hd RT3 in Nov and it was 14.5 (range 9.2-24.1). She is supposed to be taking adrenal glandulars, but I haven't started that supplement just yet as she had several others to start and she has such high anxiety I am afraid the whole glandulars might increase it.

  • If she takes supplements and other medications, a gap of about 4 hours is usual. I am surprised the doctor said to have a blood test 3 hours after meds as we normally say to leave 24 hours between medication and blood tests which should be as early as possible.

    To double a dose of thyroid hormones sounds too much to me. Normally we raise gradually each time until we feel much better. I hope your daughter feels better soon as she sounds quite hypo.

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