Dosing Thyroid Meds

[Danoute]

What dose is each of you on to feel optimal - I'm actually thinking here more about people who are on T3 and NDT meds ... but it would just be interesting to hear peoples full stories (the horror part through to the success) about successful treatment of Thyroid symptoms?

When I once saw Dr.Skinner he felt that most people would actually feel better as long as there T4 was top of range and that in fact Levo eas often enough for most. STTM seem to think that NDT is the only way and that T4 should be slightly over mid range and T3 at the top.

I'd be interested to hear what medication, what dose, what protocol people use and how they feel/felt before and after ....

[Clutter]

Danoute, it's totally individual as to the dose or type of medication a person needs. Some, like my sister, are well on Levothyroxine only, others, like me, need T4+T3 and others can't tolerate synthetic T4 or T3 and do well on NDT. Some don't tolerate NDT and prefer T3 only.

75mcg T4 + 40mcg T3 elevated my FT3 too much but I undoubtedly felt best here although some of the 'feel good' was undoubtedly due to the Summer and warm weather. I loathe the winter. 75mcg + 30mcg bloods were almost optimal so I'm seeing what 100mcg + 30mcg turns up. I'll reduce to 75+30 if I feel overstimulated in the summer.

[Danoute in reply to Clutter]

But what are you looking for in your labs to be "optimal" Clutter? Its interesting that there are dfferent measures of this. I suspect with T3 and T4 you would be looking for a high in range FT3 level?! Have you ever had your RT3 tested?

[Clutter in reply to Danoute]

Danoute, I'm looking for FT3 to be near or in the top 75% of range circa 5.2 (3.2-6.2). I'm just short of that at 4.5. FT4 was around 14.5 (9-19) so I'll be interested to see whether increasing T4 from 75mcg to 100mcg pushes up FT4. I don't want either of them too high because FT4 34 when I was originally over-replaced made me feel like I was dying and recent high FT3 made my hair start falling out. 'Tis a very fine balance

I've never had rT3 tested. Hadn't heard of it when I was over-replaced initially and I don't understand how to interpret the results. I did think I had a build up of T4 and came off it for 3 months to clear it, which is the same protocol for clearing rT3. Been fine since then on T4+T3 with occasional tweaking and fine tuning.

[HIFL]

I feel best with a T4 + NDT combo. It turns out a human thyroid gland secretes both T4 and T3 in a certain ratio, which neither T4 or NDT alone replicates. Here's a graphic for you: tiredthyroid.com/blog/2014/...

It's interesting that each camp gives the optimal labs that reflect their own dosing. If Skinner was T4-only, then of course, T4 would be top of range. If STTM is all NDT, then of course T3 will be higher than T4, because NDT has more T3 than T4 compared to a human. But I think a normal person, not on any medication, probably has both T3 and T4 just somewhere in the top half of the reference range.

[Danoute in reply to HIFL]

Skinner wasnt T4 only incidentally. But yeah, it seems that each different medication option has a different "optimal" target.

[Heloise in reply to HIFL]

HiFl, My sources say this about the comparison of human to animal thyroid. Don't you think they are close?

(Human thyroid hormone)

Although the thyroid gland produces more T4 (80 percent) compared with T3 (20 percent), T3 is 300 percent more active than T4 and is the thyroid hormone responsible for increasing metabolism.

(Natural Desiccated from porcine)

Active ingredients are listed as 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per one grain (60 mg), though like all desiccated thyroid, has all five hormones. stopthethyroidmadness.com/a...

[HIFL in reply to Heloise]

I'll have to disagree with your source. Have you read the Tired Thyroid book? Human thyroids produce about 90% T4 to 10% T3. And while yes, T3 is more active, T4 has non-genomic effects, which means it has an effect as T4 before conversion.

Also, the thyroid gland produces T4, T3, rT3 and possibly T2. It cannot produce T1, and if there is any, it would be in minute amounts. tiredthyroid.com/blog/2012/...

[Heloise in reply to HIFL]

Armour thyroid was used for a hundred years because it was the most closely compatible to human thyroid and bovine was found far too weak which still seems to be the case. I wonder why it was so effective for so many if it was so different. But I will definitely check it out.

[HIFL in reply to Heloise]

Wasn't Armour the only prescription choice back then? I have no gland and was functional on 1.5 grain, but hair and brain function weren't great and I was cold. Likewise, on T4-only I was functional, but was still a little brain fogged. Since there are people who do fairly well on T4-only, you could make the same statement: "why is it effective for so many?" I think there will always be a subset who do well, because of their biochemistry, on certain medications. But in actuality, neither medication alone replicates normal human thyroid gland output.

[Heloise in reply to HIFL]

I think we are in agreement but this is the abstract my info came from.

hormones.gr/91/article/arti...

[helvella Administrator in reply to HIFL]

Armour was not the usual product in the UK. We here had Thyroid BP (which was less potent grain for grain that the USP-based products like Armour).

[Heloise in reply to HIFL]

Is this the explanation?

Desiccated thyroid has roughly a 4:1 ratio of thyroxine (T4) to triiodothyronine (T3). In humans, the ratio is 11:1.[11] However, after peripheral conversion of T4 to T3, the ratio is closer to 3:1.[12]

INTRODUCTION

In the euthyroid state, the thyroid gland produces the entirety of the body's thyroxine (T4) (about 80-90 µg/d), but only 20% of the body's triiodothyronine (T3). In fact, the total integrated daily production of T3 in the body is 32 mcg: 8 mcg secreted directly from the thyroid gland and the rest ( 24 mcg) originating from peripheral deiodination of the outer ring of T4 by type I 5'-deiodinase, mainly in the liver and the kidney1. However, in hyper- and hypo-thyroid states, a higher fraction of total plasma T3 is produced by the thyroid gland2.

[HIFL in reply to Heloise]

That's it! Note that your source above says human gland is about 90 mcg T4 + 8 mcg T3. Once you pass 1 grain, you are taking more than 8 mcg T3.

[helvella Administrator in reply to Heloise]

The ratio of T4 to T3 in the thyroid is of virtually no interest whatsoever - except to those desiccating them! There is somewhat more interest in the ratio released by the thyroid. As you rightly point out, what matters in terms of measurement is how much ends up circulating (i.e. we have to take account of T3 released by the thyroid plus that converted and then going back into circulation).

But what really matters is the amount ending up at the T3 receptors, which will depend on the amount circulating and the rate of transfer into cells, plus the amount locally converted. Followed by the effect of the T3 on the receptors which might vary between cell types and between pigs and humans.

[Heloise in reply to helvella]

Thanks, Rod. I am short on time but if you are trying to replicate your own thyroid hormone secretion, I assume you need to know exactly how your outside material is going to act inside your body. Would you use 10 to 1?

[helvella Administrator in reply to Heloise]

I really don't know!

At one time I would have thought that made sense, but as time goes by I feel less and less sure. The recent paper about implanted pellets in mice really sounded intelligent. The dosing regime (very largely timing and splitting) seems possibly to be fundamental. Anything that doesn't more or less continually release hormone seems less likely to be as effective. With the optimum regime, the required and tolerated ratios might be different? After all, we have mechanisms that can get rid of excess thyroid hormone - so you might expect them to kick in shortly after taking a dose. With continual dosing, that might never really happen.

[Danoute]

... and how does he feel? Does he feel considerable better than when on T4 alone?

[eeng]

I am currently happy on 100mcg of Levothyroxine, but I expect that to rise as my thyroid is progressively nibbled away at my the naughty little antibodies!

[greygoose]

I've tried T4 only, T4+T3, all the brands of NDT, and am now on T3 only. I felt like death on T4 only, and even worse on NDT - and I put on a ton on weight! T4+T3 made me lose some of the weight, but also my hair! On T3 only the weight is coming off and hair (slowly) growing, and I feel better than on any of the other regimes.

At the moment, I'm taking 75 mcg, but have been as high as 225, with absolutely no hyper feelings. I'm not saying 75 is my final dose, it could change one way or the other, depending on how I feel.

I don't do labs. Optimal for me is how I feel, and nothing to do with numbers on a sheet of paper or a screen. I'm just old-fashioned, I guess! lol

[Danoute in reply to greygoose]

Interesting - why did you go up to 225 and back down to 75 then GG?!

[greygoose in reply to Danoute]

Oh, gosh! Long story. lol

So, I was self-treating on NDT, ran out and couldn't get hold of any, so went onto T3 only to tide me over. Felt better on T3 only so decided to stay on that, but still didn't feel quite right. Increased and increased looking for the 'sweet spot'. Didn't find it! Fell ill in summer 2013 (non-thyroidal illness) and had a stay in hospital where they did the labs and were horrified by the results! lol Advised me to come off all thyroid hormones and I was too ill to argue. Once out of hospital and once more compus mentis, got some labs done and discovered I was suffering from malnutrition (stay in hospital had done nothing to help that!). Went on to address my nutritional deficiencies, found I felt better, started T3 again, increased to 75 and decided that was as good as it got! Briefly, that's it.

Still not perfect, but then when one has been undiagnosed for over 50 years, I don't know how good one can expect to get. As I said, the dose is not set in stone. We'll see how it goes. I am, actually, now trying to sum up the courage to try half a grain of NDT with my T3 to see if I can now tolerate a bit of T4, now that I'm no longer starving to death. Because so many people think that some T4 is necessary. But, haven't done it yet. lol

I know all the usual reason for not being able to tolerate T4, and at the time I started NDT, my then doctor put me on iron and HC as well. But it didn't help me tolerate T4.

It's all so complicated. And in the end, we forget how we're supposed to feel and what 'normal' is - as for 'fantastic', I've never felt that in my whole life! But, we live in hope. lol