Started NDT and increasing blood sugars - Thyroid UK

Thyroid UK
110,094 members127,974 posts

Started NDT and increasing blood sugars


Hi all, I am a 36 year old woman. I have had type 1 diabetes (well-controlled) since I was 10 and Hashimoto's since I was 15. I have always taken t4-only drugs (first synthroid, then Eutirox, 88mcg) this past week when I switched to NDT (Thiroyd from Thailand). I am adjusting - as I don't feel that great - some dizziness and fatigue. I took 1 grain split for five days then upped to 1.5 split three ways for the past two days. Planning to hold here for two weeks. But my blood sugars are through the roof! Is it normal for an NDT to raise one's insulin requirements? I always feel sick/off when my sugars are high do it is hard to get a reading on what the NDT is actually doing. Recent lab work showed normal tsh (1.25) and ft4 (midrange) but very low ft3 (below range). Thanks in advance.

43 Replies

Just to clarify. Your recent results, were they before you started on NDT or since and could you give the actual numbers and their ranges. It may help to see what is or has been happening. Low results could indicated low medication or other issues that need addressing whatever medication you are now using.

Lobuabu in reply to silverfox7

Hi silverfox, thank you for your reply! My results were before starting the NDT one week ago. They were

TSH 1.24 (0.34-4.3)

FT3 3.39 (3.5-8.3)

FT4 16 (9-20)

Blood sugars have been very well controlled for a long time, last A1c value was 5.2. I wear an insulin pump. It seems that I am needing about 20-30% more insulin and still fighting highs. Other factors that could be influencing my blood sugar have been ruled out, except perhaps for springtime allergies, which ironically seemed to hit the very day after I started the NDT. I always get allergies the last two weeks of May though so that is not surprising. Sometimes I do need more insulin during this period so it could be a factor.

As for the NDT I don't feel any better and perhaps even a little more tired, but again, that could very well be due to the allergies. I appreciate your input!

silverfox7 in reply to Lobuabu

It's too soon to really know how you are on NDT. Your Levo results look as though you ewere undermedicated as room for improvement all round. But your FT3 was paricularly low so you may find that when you are static on NDT you may need to take some extra T3. Conversion is helped by Vit D folate and B12. It might be a good idea to have those tested and post those results for comments. We tend to be low in such things but need to be high to be optimal to aid conversion of the inactive T4 to the active T 3.

Lobuabu in reply to silverfox7

Thanks! I haven't had those three tested in a long time. I will try to talk to my doc about it so I don't have to pay for it out of pocket! I thought I was somewhat undermedicated too, but endo insisted everything was fine and that the FT3 value didn't matter at all (I actually did those tests at a private lab as he wouldn't check them unless the TSH was abnormal). He is fantastic with helping me on the diabetes front, though, and does listen well, even if he doesn't agree with me about the thyroid stuff.

How long do you think it really takes to see how I will feel on NDT? A few weeks? Thanks again for all of your input.

shawsAdministrator in reply to Lobuabu

I think you will have to allow time for your body to accept all of the thyroid hormones you are now getting on NDT.

1 gr is approx equal to around 100mcg which isn't a very high dose. 1.5 gr is around 150mcg.

You were not on a sufficient dose of levothyroxine because both FT3 was very low and your Endo is wrong. Our bodies cannot function without sufficient T3 - it is needed in all of our billions of receptor cells.

T3 is the Active Hormone, which you may be aware of (T4 is inactive and it's job is to convert to T3) and if our receptor cells don't have sufficient T3 (which you didn't on levo) it will take a little time for the NDT and the T3 in it to work.

I have never split any doses of thyroid hormones and I've gone through all of the types of hormones.

This link has good info and in particular go to the date January 30, 2002.

Were you diagnosed as diabetic before you were hypo?

I wonder if you take your NDT dose once daily on a fasting stomach with 1 glass of water and wait an hour before eating if that would benefit your diabetes (it's a guess) then the thyroid hormones can get to work throughout the 24 hours when the dose is reasonable.

It will take patience to get to an optimum dose and you cannot rush. You should take your temp and pulse daily. If pulse or temp goes too fast reduce dose slightly to the previous one.

This is an excerpt:

TSH is the blood test recommended for diagnosis. There is no mention of conducting full thyroid testing, including Free T4, Free T3, and Reverse T3. There is also no mention of the fact that the TSH reference range is so broad that ‘normal’ doesn’t make it ‘optimal’ for every patient. So many hypothyroid sufferers go undiagnosed because mainstream medicine relies solely on TSH as the “gold” standard for diagnosis and treatment.

Dana, your high cholesterol and blood sugar levels are now normal.

My primary care physician shakes his head in amazement. (I had searched for a great thyroid doctor who was open to exploring the thyroid treatment options to find what was right for me. Thanks to a combination of natural desiccated thyroid and time-release compounded T3 my life changed.)

You won’t be needing the prescriptions for statins and diabetes medication.

The Thyroid Federation International estimates there are up to 300 million people worldwide with thyroid dysfunction yet over half are unaware of their condition.5 Given that close to 150 million people worldwide are estimated to be unaware of their thyroid dysfunction, how many diabetics are there right now worldwide unaware of their thyroid condition? Hmmm…

Lobuabu in reply to shaws

Thanks for your input shaw. I need to be patient and see how this does goes. Taking it all at once is an interesting idea, most people and forums seem to recommend divying it up throughout the day?

I was diagnosed with type 1 diabetes five years before being diagnosed with Hashimoto's. The last time I had my antibodies checked (at some point last year) they were undetectable, which is of course a good sign. I am gluten-free and follow a low-carb high fat diet to control the diabetes.

Do you find you get a "rush" taking the dose all at once and then crash?

Waking temps are typically low (35.9-36.4 depending upon point in menstrual cycle - which is actually very regular), blood pressure is typically low/normal (100/70). For what that's worth!

I have tried discussing this stuff with my endo but he hasn't been all that receptive. Strange because he is very receptive with anything "alternative" to do with diabetes (perhaps because he has seen my great results).

Maybe I'm just going through an adjustment period. hopefully it will all settle down soon. I'm hoping to have more energy!

Lobuabu in reply to Lobuabu

PS. Pulse is usually around 80. No change since starting NDT.

shawsAdministrator in reply to Lobuabu

I take T3 once daily. It has had a most calming effect on my body after levothyroxine. The following doctor also took his one daily dose of T3 (150mcg). I do know some split. But Dr Lowe, being a scientist etc said that it is important that T3 'saturates our T3 receptor cells' thus enabling us to function. The effect of one dose lasts between 1 to 3 days.

Go to date January 30, 2002

I am on an even keel for months now with my dose - I have no 'ups/downs/crashes.

Also, I don't feel as if I have a hypo condition - take dose when I get up, wait an hour before eating. I have a normal active life.

Lobuabu in reply to shaws

Just read it, very interesting. I'll give it a try tomorrow and see if it makes a difference. Thanks again for your explanations.

I'll have to spend some time looking at the website as well, it looks like it has loads of info.

shawsAdministrator in reply to Lobuabu

Don't expect a miracle immediately, it has to work up slowly to an optimum dose (one that makes you feel well with no symptoms) :).

Lobuabu in reply to shaws

If nothing else this experiment should teach me patience :)

shawsAdministrator in reply to Lobuabu

Also Nature-Throid and Wpure manufacturers advise once a day dosing as I know some people recommend chewing etc NDT. Extract:

A: Both medications were formulated to be swallowed whole on an empty stomach with an 8oz glass of water. Use as directed by your doctor.

and if some say take NDT isublingually - extract:

A: No thyroid drug is FDA approved for sublingual usage. Both tablets were formulated to be swallowed whole on an empty stomach with an 8oz glass of water. Use as directed by your doctor.

lucylocks in reply to shaws

Hi shaws,

do you have the link were it states WP Thyroid should be taken in one daily dose.

I have just had look at one site but it just says take your meds at the same time of day.

I am taking mine twice a day and after reading your post I am wondering if this is why I am not feeling much better on it.

Many thanks browny

shawsAdministrator in reply to lucylocks

Maybe this will help. Look down post for my response:

Lobuabu in reply to shaws

Great info here, thanks shaws. Definitely starting with one dose tomorrow and will see how it goes.

Lobuabu in reply to shaws

shaws just wanted to report that I switched to once-a-day dosing and even though it's only been two days, it seems to be working. Thanks again for your input.

shawsAdministrator in reply to Lobuabu

That's encouraging for you and I hope it is successful.

it could be the low t3 levels are making things worse.

Lobuabu in reply to faith63

Thanks, faith63! I have had low t3 for years now and doc finally agreed to let me give NDT a go. Sugars were excellent until starting the NDT.

faith63 in reply to Lobuabu

it can be low t3 or high t3 that causes blood sugar issues, but i must add, that with type one and autoimmune, it is about the immune system and their are ways to heal that and reverse autoimmune disease. In the old days, researchers and doctors knew, that diabetes was an inflammatory condition and treated it with great success, with only high doses of Aspirin, which had horrible side effects, as you can imagine. i would be looking into functional medicine and their approach to inflammation and reversing autoimmune disease.

What Levo were you on? I am assuming you are not near an equivalent amount in NDT? You are having to slowing increase NDT so in the meantime you will be under medicated, would that negatively effect your blood glucose?

Sorry you gave amount of t4 brain not clear. Trying to work out conversion rate, if you can believe them, but ultimately all our bodies are different. If you have other signs of being hypo I would assume having reached optimal dose yet. Hope someone who has type 1 and uses NDT can comment.

Lobuabu in reply to sulamaye

Thanks Sulamaye, no worries! I figured 88 was probably around 1.5 grains as most seem to say to take the t4 part (35) and add four times the t3 part (4x8=32), which gives 67 for 1 grain. But I do think I was probably undermedicated so maybe I will end up needing more. I will stick to the 1.5 grains for another week or two I guess.

cazlooks in reply to Lobuabu

1 1/2 grains seems a lot to start on, I was recommended 1/2 at first increasing 1/2 weekly


Doesn't Thiroyd contain quite a lot of sugar? It seems it tastes rather sweet...I do not have diabetes, but was diagnosed with insulin resistance (fasting insulin and blood sugar within range but close to upper normal range) a couple of years ago, on Erfa, which is very sweet thanks to dextrose/sucrose. I don't know if there is a connection, though, but many NDT brands contain sugar, which many like as that is said to facilitate digestion. Euthyrox, which I took for years, tastes terrible if you happen to keep in your mouth for a second before swallowing it, so I would say it does not contain sugar at all...

Lobuabu in reply to Hidden

It does taste sort of sweet, I hadn't thought about that. But I'm not getting an immediate blood sugar spike when I take it (I have a continuous glucose monitor so I can see how foods etc affect me in real time), rather it's kind of an overall increased resistance. Weird and annoying LOL. Fingers crossed it all works out ...

Hidden in reply to Lobuabu

Interesting that it started when you started on Thiroyd...I wonder if anyone else has experienced the same thing? I hope you figure out what is going on.

Lobuabu in reply to Hidden

Thanks! I'd love to know if others have had this issue, too.


Welcome to our forum and sorry to hear of your health issues.

It is probably the addition of T3 in NDT that is the cause of your blood sugar imbalances. T3 increases thyroid activity, speeding up metabolism so you'd be burning your carbs faster and require increased insulin to utilise this. T3 concentration is directly related to glucose utilisation and metabolic clearance rate and as you are injecting you may need to manually adjust your insulin dose.

Your previous results indicate low T3 which would reduce glucose oxidation//synthesis. Doctors will tell you to match the amount of insulin injected only to the amount of carbs consumed but there are further carbs being metabolised in the body that will also require insulin to work.

Adding T3 will make the liver release more glucose in an effort to match the increased metabolism (similar to exercising in a non-diabetic person). If there is not enough insulin, the glucose can’t pass in to muscle cells to be used and glucose levels will rise excessively (hyperglycaemia). To compensate the body will release adrenaline and glucagon levels rise fast as even more glucose is released from the liver meaning further elevated blood sugar levels. Cortisol which is major in regulating blood sugar levels and when continually elevated can lead to insulin resistance whether injected or naturally secreted by the body.

If you have too much insulin the liver shuts down the release of glucose but as insulin continues to carry glucose to muscles (energy) this leads to a rapid fall in blood sugar levels. (hypoglycaemia).

Adding T3 you might need to eat a little extra carbs with extra insulin to utilise. Extra protein is excellent as it works well with thyroid hormones and takes longer to digest so keep you feeling full longer and blood sugar levels balanced. Eating three healthy meals with protein, low GI carbs and healthy fats will help balance blood sugar levels. Remember glucose is needed to aid conversation of T4-T3 thyroid hormone in the liver so hypoglycaemia can lead to conversion problems.

Another alternative to NDT would be to medicate T4 & T3. This way you could introduce T3 more gradual and adjust inline with thyroid hormone & insulin requirements. You may find you need more or less T3 than is available in NDT.

Ensure your Vit B12, Vit D, iron, ferritin and folate are optimum as deficiencies are common in people with hypothyroidism. Low vitamin D has also been associated with both insulin and leptin resistance and is an important anti-inflammatory.

I am not diabetic but my husband has been insulin dependant for 50 years and is well with none of the usual problems associated with long term diabetes. I don't medicate NDT but thought one grain is between 75-100mcg of levo. Therefore, I think you over medicated on 1.5 grains but others may advise you better.

I hope you manage to rebalance blood sugar levels soon & feel better.

Lobuabu in reply to radd

Thanks for the detailed post, radd! For now I am upping my insulin doses to keep things normal as I know normoglycemia is key to pretty much all processes working right in the body. Also, thanks for the info on the NDT conversion. Much appreciated.

Hidden in reply to radd

Sorry, Radd, but how can someone be overmedicated on 1.5 grains of NDT, when she obviously was under medicated on her previous dose of 88 mcg of T4? Most people require at least 3 grains of NDT daily. 1.5 grains only contain ca 57 mcg of T4 and 13 mcg of T3, and that is not enough for most hypothyroid people.

In order to decide whether someone is overmedicated, you need labs after being on the same dose for a while.

radd in reply to Hidden


As advised by O/P ...[.. normal TSH (1.25) and ft4 (midrange) but very low ft3 (below range) ..]... may not equate to under medication but meds not working.

Often when T3 is added a dose raise may not be necessary but as advised in my post ..[.. I don't medicate NDT and others may advise better ..] ...

With O/P's blood sugar issues too much T3 (which accelerates metabolism) might exacerbate the problem until blood sugars are balanced.

I agree labs are needed after being on the same dose for a while.

Hidden in reply to radd

Of course, I should have said "being/feeling hypothyroid", or "still displaying symptoms of low metabolism". which can refer to both being under medicated and meds not working.

Sugar (used in the widest sense of the word, to cover all varieties..dextrose, sucrose etc) is said to facilitate absorption of thyroid hormone, and many like their pills sweet so that they can take them sublingually. But, I have often wondered about pills that taste like candy...surely they must contain a lot of sugar? Maybe not enough to cause problems in all people, but at least in some diabetics and pre-diabetics. One brand, TR Man from Thailand, is even "sugar-coated".

Interestingly enough, although I never made the connection, I have been struggling with insulin resistance (which is basically pre-diabetes) since going on NDT (Erfa, to be more specific, and going on to Thiroyd later on). I guess that, if you take it first thing in the morning, on an empty stomach, an hour or so before eating, the sugar will cause insulin and BS levels to rise...?

shawsAdministrator in reply to Hidden

I have to disagree slightly re overmedication. Blood tests don't always reflect the true amount as it can depend upon the time someone has taken their hormones. Also this doctor's views were the same as patients used to be treated before the blood tests came into force. I've been overmedicated and it's not pleasant at all and reduced without blood tests

It's the actual 'dose' or combination which suits the person that is the best way to judge. i.e. does the person still have symptoms or are they free.

If we've been free of symptoms for a while and then some begin to appear a blood test will clarify but not always necessary.

(bearing in mind I'm not medically qualified - only have my own experience. - I had severe palps when on levo and they weren't caused by too much hormones but an adverse reaction to levo).

Granny56 in reply to radd

I find this response very interesting. Sorry Lobuabu I can't add anything that will help you. Nevertheless I am following your post and responses with great interest.

I am T2DM on Metformin 1500mg daily and have just introduced (20/5/2016) a small dose of synthetic T3 to my T4 regime. I have not noticed any changes in blood sugar but I have noticed a slight temperature increase and increased appetite. Therefore your explaination Radd makes sense in my case. Now I will keep an eye on blood sugars and what's happening with Lobuabu.

Many thanks!


NDT and other thyroid meds can raise blood sugar levels.

Lobuabu in reply to Clutter

Thanks clutter!

radd in reply to Clutter

Interesting Clutter.

Lobuabu, this article is directed more at people with metabolic syndrome or type 2, but it may help to explain something for you as well.

My own experience with adding T3 to T4 was that when fT3 results were 5.2 to 5.6 my blood glucose went crazy. For me it was as if GLP-1 was disabled by the T3. And unlike others, I gain weight from T3. Once the pancreas apprehended the high glucose levels, it overshot so I was getting bounces with high of 15, 18, 19 and then low of 3.4, 3.2. Maybe even lower when I tried 25 mcg T3 on one occasion.

You could add 5 mcg Cytomel (liothyronine) to your Synthroid 88 mcg. Or half of a 5 mcg Cytomel although they are tiny and difficult to cut. This way you will have a more nuanced titrated dose of T3. See what happens.

Thanks for sharing your experience, gabkad, I really appreciate it. I will check out the article. I actually live in Spain and can't get Cytomel here ... NDT is not even available, which is why I ended up buying the Thiroyd from Thailand (doc said he'd follow me and that I could try it, but was no help in procuring any other brands). I guess I'll give this a good go. I travel to the US at the end of June for two months so I suppose that if I can find the funds I could see a doc there and try the T3/levo combo. Thanks for the suggestion.

Clutter in reply to Lobuabu


If you decide you want to trial T3 and Levothyroxine post a question asking members to private message you online sources to buy T3.

Lobuabu in reply to Clutter

Great, thank you for the advice!

Just wanted to say thank you everyone for your input on this issue. Today I was able to once again achieve stable blood sugars all day long (increasing my dosage overall by an extra 20%) and hopefully things will stay that way. :)

You may also like...