When should I decrease- had a gap and still fee... - Thyroid UK

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When should I decrease- had a gap and still feel overmedicated .....

Katoir profile image
45 Replies

I've been and am feeling rubbish and am over medicated. I'm fed up with this feeling ! I've been on 2 grains (NDT) for about 2 months (reduced from 2.5 on doc P's advice - by a half increment when I was fairly hyper. I tried 2 25 for a few days but as soon as I dropped to 2 felt better very quickly)

In the past few weeks I increased misreading the haziness and thinking I was going hypo but blood tests showed I was over medicated . Infortunately I increased to 2.5 grains for about a week ( I had intended the raise to be 2.25 but made a mistake)

I've had 2 days skipping doses and took 2 grains again today hoping to get things back on an even keel but still feel overmedicated .

It doesn't feel right continuing to medicate with 2 when I'm feeling like this .

If I dropped to 1.75 would that be too steep a drop and would that make me feel more unwell ?

I think the correct way to do it is to stay at 2 grains for a fortnight and then reduce but I feel so crappy on it and feel I need less. ( now really)

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Katoir
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Clutter profile image
Clutter

Katoir,

If you're still feeling over medicated skip the NDT for a couple of days more and then reduce to 2 grains.

Katoir profile image
Katoir in reply toClutter

Ok - thanks Clutter.

I felt so good yesterday and had an amazing sleep yet today as soon as I popped that pill I started feeling awful again !

Just must still have too much in my system . Horrid tiredness behind my eyes and this veiled heady feeling . Yuk .

Katoir profile image
Katoir in reply toClutter

Hi Clutter

On day 2 of skipping and feeling better but still not right .

Would taking 1.75 grains be foolish ? Bit of a jump from the 2.5 I was taking for about 10 days or so when I slipped into an over medicated place but I had been on steady 2 grains before that for some weeks .

What would happen if I skipped another day ?

Still feel over medicated .

I have been asking for opinions- useful information given but nothing specific to my dilemma of how much to now take and how/when .

Thanks .

Clutter profile image
Clutter in reply toKatoir

Katoir,

You can skip as many days as it takes to stop feeling over medicated. When you resume taking NDT it would be better to resume 2 grains.

Katoir profile image
Katoir in reply toClutter

Oh I am so pleased to hear that .

Thank you ( again !)

Katoir profile image
Katoir in reply toClutter

Hi Clutter

This is my fourth day minus med while I have been waiting for the over medicated feeling to pass.

I have felt really good today - like I did before taking medication : aware, bright , energetic .

I'm (quite reluctantly actually) going to resume and am concerned that I will feel all medicated again. I haven't felt this clear headed in ages.

I guess if I feel crappy it's a clue that I'm on the wrong dose .

If I feel it's wrong and I need less am I right in thinking I have to stick with it before reducing?

The other thing worth mentioning is that I started having maca and didn't realise how powerful that can be regarding thyroid : it could be a coincidence but ?

Thanks 🙏🏿

Clutter profile image
Clutter in reply toKatoir

Katoir,

You don't have to remain on a dose for any time if you feel over medicated, just skip a few doses and reduce dose if you want to.

I don't know what maca is or what effects it has.

Katoir profile image
Katoir in reply toClutter

Ok - So I'm worrying unnecessarily . For some reason I've been thinking it would be detrimental to try 1.75 grains and skip doses ( I've somehow got it in my head it's too big a drop and that dose changes need to be gradual only by a quarter)

I want to get past this and find my level. If I can't then I will call doctor p.

Maca is a plant from the Andes used to help balance hormones .

It was in a superfood cereal I bought but unaware of its potency.

It's quite a journey all this I hope you haven't minded me calling on you so frequently during this tricky spell. It's very much appreciated .

Clutter profile image
Clutter in reply toKatoir

Katoir,

Skipping doses reduces the amount of hormone in your blood so you shouldn't feel over medicated when you resume 2 grains. You might feel under medicated if you reduce to 1.75 grains because why would you previously have increased to 2 grains? The 1/4 grain difference is so small it isn't worth stressing over. If you feel under medicated on 1.75 grains you can increase to 2 grains or vice versa.

Katoir profile image
Katoir in reply toClutter

Thanks - you're a star .

Resumed on 2 today and feeling really well . Will retest in 4 weeks.

Fingers crossed .

Clutter profile image
Clutter in reply toKatoir

Katoir,

4 weeks is too soon. Retest after 6-8 weeks.

Katoir profile image
Katoir in reply toKatoir

Ok - will do.

Thank you Clutter !

Katoir profile image
Katoir in reply toClutter

Hello Clutter . Happy New Year to you !!

I have taken 2 grains for the last 6 weeks having been over medicated and about to re test .

Was just wondering if it comes back too high ( I've started to have some headaches although has been good )

I take it the best way of reducing is to skip a few days and then reduce?

Thinking dropping to 1.5? For another 6 weeks?

Of course ideally would be great if all is ok on 2.

I'm taking some supplements and happy with these. They took thyroid into account and I had hair mineral analysis done) but I realise they may have an impact.

Hopefully the headaches are unrelated and won't have to do anything . Will know in about a week x

Clutter profile image
Clutter in reply toKatoir

Katoir,

If you are over medicated it is fine to skip a dose or two and reduce dose. You must be very close to the optimal dose. I would make any adjustments in 1/4 grain increments.

Katoir profile image
Katoir in reply toClutter

Ok thanks so much

Reduce by a quarter and retest after 6 weeks ?

I've kept having this feeling that my thyroid is improving with the right minerals supporting it. For a while .

I'm doing a home test tomo and really starting to think I might be over medicated because I feel that headiness again . I was hoping 2 G would be it and could settle . I might skip a few days if this head doesn't improve.

This year I hope to get this sorted. I go great for 6 weeks then seem to get these symptoms.

At least I know they're not under medicated signs now though .

Clutter profile image
Clutter in reply toKatoir

Katoir,

Why not wait for the results of tomorrow's blood test before adjusting dose?

Katoir profile image
Katoir in reply toClutter

Yes ... be at least a week before results though .

Think you said if needed to skip didn't matter how long .

Katoir profile image
Katoir in reply toClutter

Hello Clutter

Here are my results from Medichecks which are different ranges to the ones used by my gp. 2grains been taken for 6 weeks since last overmedicated period.

TSH 0.01

T3 5.4 ( range 3.1 - 6.8)

My GP's ranges 2.63-5.7 though.

T4 14.5( ranges 12-22)

T3 is at the top of the (gps) range and explains the heady fuzziness and suspicions about being over medicated.

So I'm happy to reduce to 1.75

I still feel foggy so will skip a few days. I did skip a couple while waiting for results.

I'm going to continuewith the supplements. Difficult to know whether they are related to the need to reduce or not.

Looking at these results would you agree ?

Thanks

Clutter profile image
Clutter in reply toKatoir

Katoir,

You aren't biochemically over medicated. FT3 is just shy of top third of range, it's not top of range which is 6.8.

If you feel over medicated then reduce to 1.75 grains and see if you feel better. You can always reinstate 2 grains if 1.75 isn't enough.

Katoir profile image
Katoir in reply toClutter

I do feel a bit heady ( early signs before) so will drop down and have skipped today.

5.7 has always been top of the range iro the test results from gp.

Last time the tests were 5.6 ( just in range for those results ) and I continued and became out of range.

I can't imagine going above 5.7 as in these ranges .

How do they work them out ?

Clutter profile image
Clutter in reply toKatoir

Katoir,

Ranges are specific to analysis machine and the lab which does the tests.

You need to use the ranges of the lab which did your test. It doesn't work to use the Medicheck results with the lab ref range of your GP's lab.

Katoir profile image
Katoir in reply toClutter

Oh !

Katoir profile image
Katoir in reply toClutter

So that actually means that my t4 is actually in the bottom of the range and t3 in upper third .

So the headiness may be the supplements and not the ndt .

Not sure what to do now - reduce the supplements instead .

Clutter profile image
Clutter in reply toKatoir

Katoir,

FT4 is usually low in range, sometimes even below range when taking NDT or T4+T3.

I can't see why supplementing vitC, selenium or magnesium will make you feel heady but why not stop supplementing to see. If it makes no difference after a couple of weeks you can resume supplementing.

Katoir profile image
Katoir in reply toClutter

Yes and stay at 2 grains afterall going by those results .

Katoir profile image
Katoir in reply toKatoir

I think as I'm taking vit c , selenium, magnesium . I would have expected to be deficient in those with the under active thyroid and I was .

I wonder if those levels are being improved then the thyroid would be improved too.

Schenks profile image
Schenks

It is interesting to read that you feel awful as soon as you took an NDT because what I have found over time is that i am very sensitive to T3, especially in NDT as opposed to synthetic T3, or liothyronine. So if you feel instantly poorly it's more unlikely to be the T4 component of the NDT because this is not as active as the T3. Some people say that T4 is inert as a prohormone and is only utilised when it is turned into the active form T3 but there are others who dispute that and say that T4 is used by the brain. Whatever the case, T3 is the more powerful of the two and has a powerful and fast effect.

For what it's worth I have found my need for T4/T3 has changed over the last few years, especially when I have introduced supplements such as vitamin D3 and it's active companion Vitamin K2 (as MK-7), vitamin B12 (which i now take as subcutaneous injections) and the accompanying folate (oral). I take other supplements but these mentioned are, for me, the lynch pins. As my body adjusts to its needs being addressed, my response to NDT has changed.

From being stable on 125mcg of Levo for yonks, I needed to change to NDT, then I needed to lower the dose of NDT and introduce Levo again and at the moment I am as stable as i can feel to be, on 75mcg of Wockhardt's Levo plus 3/4 grain of Nature-throid. both medications are taken since they have either fewer excipients or those that i do not react to as much as those in other brands. What these doses add-up to is roughly 124mcg - almost the same as the dose of T4 that I was maintained on for years. this was quite by chance but it seems to be working.

My belaboured point is, your needs for thyroxine change as your body changes, so don't feel slavishly attached to using NDT alone. It works for some but not all, as do T3 alone, Levo only and Levo plus Liothyronine. And all of the combos worked for me for some of the time before my body made its next shift in healing/usage.

Hope this not only makes sense but helps!

Katoir profile image
Katoir in reply toSchenks

That does make sense - much appreciated .

I'm just about to do a hair mineral test and refresh my supplements and look at these other components too!

I feel that succinctly - that my health and stress levels are much improved and changed since thyroid first identified ..

I'm on another break from med today . Still feeling over medicated .

Schenks profile image
Schenks in reply toKatoir

Have yo ever used Levo? It's a big bad bogey subject, I know, but it does have its place in treatment and you may find lowering the T4 to T3 ratio is helpful. Human ratio is either 20:1 or 14:1, depending on your source of information, and porcine (the usual source for NDT) is about 4:1, so you may be overloading with T3 and messing-up your conversions to T3 as well as creating rT3 unnecessarily. Listen to your body - if a break from NDT for a day or two is helping, then the culprit does appear to be T3 - you can have too much of a good thing! And a hair mineral test is useful, but won't show this potential problem with the T3.

Katoir profile image
Katoir in reply toSchenks

Yes - I have been thinking about alternative ways. My T3 is raised currently .

I think I will see if I can get stable after this break . I definitely don't feel like taking anymore .

Also feeling that 1.75 would be more suitable but guessing I can't really start taking 1.75 before gradually reducing.

I was on 2 and then 2.5 for a week ...

lucylocks profile image
lucylocks in reply toKatoir

Hi Katoir,

see my reply to Schenks,

hopefully she/he will reply and could be of help to us both.

Katoir profile image
Katoir in reply tolucylocks

Thank you

lucylocks profile image
lucylocks in reply toSchenks

Hi Schenks,

Do you mind me asking how you changed from NDT to levo. and NDT combination.

I like you was taking 125mcg. levo. and felt O.K. but felt there was room for improvement. My G.P. kept reducing my dose according to my TSH so I decided to try NDT.

I take 1.5 grains W.P. Thyroid and although feel O.K. but I only feel marginally better then when I was on levo. I have had a tottering time raising it and when I increased to 2 grains I got a bad reaction, so I think the ratio is not right for me.

On 1.5 grains NDT my TSH is 0.42 range 0.35 - 4.7

T4 7.6 range 7.8 - 21.0

T3 5.2 range 3.8 - 6.0

I took my last dose 0f NDT approx. 17 hours before blood test.

As you see my T4 is under range and T3 near to top of the range.

I think a combination of NDT and levo. maybe better for me.

Any advice would be gratefully received.

Thank you.

Juliatom profile image
Juliatom in reply tolucylocks

Do you have bad reaction due to low FT4 ?. What are your symptoms ?.Some follow only T3 medication with very low FT4 and feel well.

I have hypo symptoms when FT4 is in mid or upper range and adrenal fatigue .

Schenks profile image
Schenks in reply toJuliatom

P.p.s. She.

Schenks profile image
Schenks in reply tolucylocks

Hi, lucylocks.

I can only give an opinion rather than a medical diagnosis, of course, but in my opinion your T3 level looks ok but your T4 looks to be on the very low side. I doubt you may need more of the T3 component at this stage since a) you felt unwell on 2 grains (with the equivalent dose of 18mcg of T3 in the NDT) and b) the clearance time for T3 to be eliminated from your system is around half of the intake over an eight hour period. Given your time lapse of 17 hours before the blood test, it would appear that you don't need to increase intake of T3, as in that contained in NDT.

As far as I'm concerned, the TSH level is misleading and I only use it as a vague curiosity, especially if I'm feeling not too well. I begin to take more notice of it when I feel well, in order to get an idea of where it seems to settle when I feel a little better. And that can be temporary, as my needs adjust. That's the first part.

The next part is the dose you were on. You felt ok-ish on 125mcg of Levo, yet on 1.5 grains of WP NDT the total thyroxine dosage would be around 97.5mcg, since NDT is 65mcg of total thyroxine per grain, give or take a fraction according to manufacturer. Therefore you are somewhat below what was near to your previous optimum, wellish dose. Still, you do feel marginally better on this lower dose of NDT so you may need the T3 to be in there; evidently, though, you're going in the right direction. Personally, adding in some Levo, a little at a time every few days or so and seeing how you feel, would seem to be a sensible and reasonable thing to do, especially since your T4 is so low. At least you'll be increasing up towards the comparative dose of 125mcg - your personal bench mark.

You may find that you could titrate your NDT dose down against raising your Levo proportionally once you find yourself stable symptom-wise, in order to tweak the TSH level, if it's too wayward for your doctor's nerves, but the immediate aim is to stabilise your symptoms at optimum.

I hope this makes sense and is helpful. The key, for me, is to go slowly and feel your way through. And to get the supplementation to optimum - absolutely critical, but a whole different ball game. All I'll say at this stage, is that in my opinion vitamins D3 and K2, and B12 and folate should always be considered- and not to the exclusion of all else.

All the best.

lucylocks profile image
lucylocks in reply toSchenks

Many thanks,

that's great information.

I am going to add a small amount of levo. to the NDT but not sure whether to keep NDT at same dose for now or reduce and add the levo.

I am wondering if when adding in levo. then how much of it will convert to T3 and bring the T3 above range. I supposed if I feel worse and think the T3 is the culprit then I can then reduce the NDT and the T3 should get out of the system in a day or two.

I do take all the usual supplements you have mentioned.

Many thanks again for all your advice.

Wishing you continued good health.

Schenks profile image
Schenks in reply tolucylocks

That's a good question. Why not ask as a separate post? There are several people on here that would have an informed opinion on that and the info would be useful to many others who might not be reading this thread.

You're pretty well aware - as you say, you'll know if you need to drop the NDT. Usual stuff, especially the fast pulse rate (does it for me). But over several days the more subtle symptoms emerge, especially if too low, like feeling chilly, lethargic/weak/tired, you know the score.

When my T3 was well-up in the range, I dropped the NDT by 1/4 grain, waited for a couple of days whilst monitoring my symptoms then increased the levo by half a 25mcg tab (pill cutter essential). There was little point in checking soon after to see the levels because T4 takes a while to build up; I waited a month.

After a couple of blood tests to check where I was at on the ranges but with particular attention to my more obvious symptoms (as I've said, pulse rate) I've settled at my current dose (for the present). Not had a blood test done recently because I feel ok and am attending to other issues, such as B12, but am gearing-up to have a thyroid mini-panel on the NHS - TSH, T4 and T3, so it'll be interesting to see the results. Not too bothered by the TSH, but it's amusing to watch the GP have kittens.

Good health and luck to you too, and thanks for your good wishes.

lucylocks profile image
lucylocks in reply toSchenks

Thank you Schenks,

thanks again for all the useful information.

I will post another question as you say any replies could be helpful for other members.

I hope you get your other issues sorted out soon.

Very best wishes.

Schenks profile image
Schenks in reply tolucylocks

P.s missed the first part of your question. I have an endo who has learned to listen to me, and with whom I can work. So far!

lucylocks profile image
lucylocks

Hi

When I increased to 2 grains, after a few days I started with a severe itching pricking sensation one evening, then during the night I woke up and every part of my body felt as though it was on fire, it lasted a few minutes then subsided. I still had the itching pricking sensation the next day so reduced back to 1.5 grains and the next day the sensation had gone.

It is said T4 can be low when on NDT but mine is actually under range.

I do not think the reaction was from the low T4 more like too much T3.

Katoir profile image
Katoir

I'm following all this .

My t4 is right at the top of the range and T3 raised so a bit different . I was ok on 2 grains for a good while.

Desperate to try 1.75 and not looking forward to the compulsory sticking at 2 grains .

I definitely have too much thyroid in my system !

Schenks profile image
Schenks in reply toKatoir

Sorry, Katoir, not replied to your specifics and have only just realised your problem.

If your T3 is lowish (the aim is around the top third of the range, as a rule of thumb) and your T4 is high, you may want to drop the NDT dosage and add-in a little liothyronine - the T3. Now that's an interesting issue. I tried T4 and T3 along my journey; worked well-enough but the bloods caused too much concern for the endo I was seeing and I got cheesed-off listening to his dire warnings of stroke and heart attacks with an un-measurable TSH, especially since he would not prescribe NDT on the NHS. But I didn't feel as well on the synthetic combo as I do on the synthetic + NDT (i.e. NDT + levo).

Anyway, my point is, you may not be converting the T3 in sufficient quantities, or the ratio of T4 to T3 is not high enough for you ... whatever; you may feel better lowering the T4 content and raising the T3, and the only way I can see you doing that is to add-in a little liothyronine whilst reducing the NDT; different to my journey but parallel. But again, why not pose the question as a separate post? As in, 'could I take NDT and a little T3 as well?' - make it clearer. And it would help to include your test result ranges. There are others who have a different slant to me on these matters and their experience may more closely parallel yours than does mine.

Keep on trucking - you'll get there. It just takes lots of time and lots of patience - and lots of frustration! But you'll do it.

Katoir profile image
Katoir

Thanks Schenks

My t4 is too high and so is my T3 from over medication .

I'm skipping dose again today as still feeling the effects and still feeling 2 grains may still be too high because I'm overmedicated

I'm worried about taking the med again but feel I might make worse if I drop to 1.75 ?

Disliking feeling like this . Doesn't seem right resuming . How long can I take a break ?

Katoir profile image
Katoir

Just want to sort out the immediate issue first. hi

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