Thyroid UK
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3 grains of NDT and my T4 is only 8.2???


I've been switching over from T3 only (60mcgs) to NDT. I feel very hypo even though I'm now on 4 grains and I suspect I'm not converting. However I had some bloods done last week when I was on 3 grains of NDT and my TSH had come up from 0.01 since the last time it was tested on T3 only (as one would expect) to a respectable 0.23 - range 0.27-3.2. But my T4 is only 8.2 - range 11-25.

Can anyone give me any idea where the supposed 114mcgs of T4 has gone? Would this seem to support my instinct and symptoms that I am not converting or vice versa?

Can anyone else tell me what their T4 looks like on 3 grains of NDT?

Any advice of intepretations etc would be interesting to hear.

Also does anyone else have any experience of a fatty liver? My ALT has doubled since I first got M.E 4 years ago, from 56 to 114, and a recent scan shows I have a fatty liver. Yes I'm fat, even fatter thanks to the M.E and hypothyroid for 20 years, but my diet is really good, lots of fruit and veg, no fried foods etc. My lipids have just been tested and my LDL Cholesterol is 3.2 and my HDL is 3.8 and my triglycerides are 2.7. Does anyone know anything about the effects of Hypothyroid or low cortisol on the liver etc? Seems to me my body is laying down fat rather than making energy - which I sorely need - I know my GP will be offering me statins, but is there any research or knowledge about the relationship between hypo and the liver and heart function etc?


15 Replies

Sulamaye, Your TSH has risen because your pituitary has detected lower levels of circulating T3. You are still getting T3 direct from NDT so high levels of T4 aren't needed for conversion and the T4 you have from NDT is probably used more efficiently as the T3 also stimulates conversion.

I've frequently observed that people have higher levels of FT4 on Levothyroxine which drop when T3 is added or they switch to NDT.

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Thanks clutter, but I feel pretty shite even on four grains as if all I'm getting is the t3 from the NDT , if that, whereas I needed at least 60 mcgs t3 neat to stop having dry skin, hair falling out etc, even though I never stop having m.e unfortunately. as I obviously am hypo why isn't my body using more of the t4 to fund cellular energy production?


Sulamaye, I don't think every scrap of T4 available converts to T3 and rT3. Not sure why or what the unconverted T4 is for.

3 grains has 27mcg T3. Perhaps you need more T3 or perhaps NDT doesn't suit you as well as T3?


Yes I'm beginning to come to that conclusion but it's swings and round abouts as I lose weight and have stopped having hot and cold flushes on the NDT, but the t3 seemed to get into the cells better. I feel I must push on increasing the NDT to be certain and rule it out otherwise I will be left thinking what if ....


Sulamaye, some members have said it took them 6 months to adjust to NDT and feel well. Perhaps this dose increase will help.


Ps my tsh was totally supressed when I used to be on a t4 t3 combo with only 20 mcgs t3


Sulamaye, some people have suppressed TSH on 75mcg T4 only. That's why I don't think TSH should be used as a dosing guide (other than to warn people like me that their TSH is not suppressed when it ought to be).


Maybe switch to another NDT which might suit you better than the one you're on now. I tried about 4 NDTs altogether.

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Sulamaye, your cholesterol level and your weight have little to do with what you eat when you are hypo. And the fact that you aren't losing weight suggests to me that your T3 is still too low. And it hasn't been tested.

The TSH, FT4 and FT3 tests were not designed for someone taking NDT. They were meant for people on synthetic T4 only. And even the man who invented the TSH test admitted that it was a rubbish test. It's only useful when it's reallly high, or really low with a high FT3. On it's own it means nothing. BUT the fact that yours has come up from 0.01 to 0.23 suggests to me that you are no longer on a sufficient dose of T3. There's nothing 'respectable' about it, it means nothing in itself. It is perfectly possible that you're not converting, but unless you get the FT3 tested, we will never know.

As to fatty liver, yes, the thyroid does have an effect on the liver - it has an effect on everything - either directly or indirectly. And, low cortisol? Do you have low cortisol? That would have an effect on your conversion and needs attention.

You say you have a really good diet. What does that mean, exactly? Lots of fresh fruit - you can have too much fruit - and veg, but also lots of protein? Lots of fat? No fried foods, fine. But it dépends what sort of fat the foods are fried in. If it's olive oïl or coconut oïl, that's fine. It's trans fats that are bad, not all fats. You need fat. You need cholesterol. Hormones are made from cholesterol, so, as you are already hormonally challanged, having low cholesterol isn't going to help. Butter is a super food. As are avocados. Olive oïl on your salad. Even a slice of bread and dripping! You need that fat.

I Don't know much about fatty liver - except that it's not 'fat' that causes it (but it can be caused by mal-nutrition!) - but have a look at this video. He doesn't mention thyroid, but it might give you some ideas about how to help it.

You must make sure that all your nutrients are optimal. You can have the healthiest diet in the world but if you can't absorb the nutrients in the food, due to hypo low stomach acid, you are going to be suffering from malnutrition. Get your vit D, vit B12, folate, iron and ferritin tested, minimum, and magnesium, selenium, copper, zinc, if you can.

And take lots and lots of vit C!

Hugs, Grey

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Thanks grey goose. All my vits r optimal. What I meant is I don't eat a tradition deep fried diet. Yes I eat butter and olive oil I don't touch highly processed rubbish. Plus as much protein as I can afford. It's not that I'm using the bloods to gauge my dose, more that I am curious what on earth is happening to my t4 and should I go back to t3 only yet or push on a bit with NDT. I'm on lots of hydrocortisone and some dexamethasone too so the low cortisol is as covered as it can be with my messed up body.

It's so difficult to know what to do, push on with raising NDT or bail out and retreat to t3 where despite hot flushes and bad sleep my hair wasn't falling out. Ahhhhh


No point in continuing to raise the NDT if you can't handle the T4. It will only pool/convert to rT3 and cause problems. But, as I said, you would need to have your FT3 tested to know that. Plus rT3 would be helpful. But you won't get that on the NHS!

What you could do, if you really want to have a little T4, is to add some T3 to your NDT. That might just do the trick as you say some of your symptoms have improved on NDT that didn't improve on T3 alone. But, it's all trial and error. Nobody can tell you, in advance, what is going to suit you, I'm afraid.


Yes the lab this new GP uses just won't do ft3. It used to get done when tsh supressed but my previous blood GP even asked for ft3 and my tsh was 0.01 but the darn lab still wouldn't do it!


I know, it's a terrible situation when a lab technician can over-rule a doctor. The only alternative is to do it privately.


Sulamaye, I'm really sorry that you feel so awful and that you aren't having much luck with the various drug trials.

I've been on many combo T3/T4 trials. Won't bore you with the details. Generally speaking, my FT4 is always below range and FT3 just at top of range. Not enough free t4 to fill in the gaps when the t3 peaks and drops. Need a steady background supply of FT4.

Now thinking that we got side-tracked onto the T3 route. Going back to T4 only on a reasonable dose that won't send my FT4 crazy. As a trial it can't yield worse results than I've had so far. Think I may be missing the obvious.

I know it isn't the same for everyone and really hope you get sorted soon. When you feel like this it isn't 'living' it's just 'breathing'

Very good luck and best wishes to you.



Thanks Grace, hope you get yours sorted too.


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