Endo wants to put this pt on Levo, opinions please!!!

[Gerishan]

Hi Everyone,

The Endo wants to put this person on Levo but I am trying to advocate for NDT and T3 only, I would appreciate any feedback based on the results attached. We are currently waiting for more blood test results. Based in Ireland

[SeasideSusie Remembering]

Gerishan Levo could very well work, it is the easiest option if it does so why not give it a try. It would be best to have FT3 tested at the same time as FT4 to see whether there is a conversion problem that would indicate if NDT and/or T3 is needed.

TSH is very high over range and FT4 very low in range indicating hypothyroidism so treatment with thyroid hormone replacement is needed.

With antibodies that high indicating autoimmune thyroid disease, aka Hashimoto's, then addressing them is necessary. Many members find that a strict gluten free diet helps reduce antibody attacks, as does supplementing with selenium L-selenomethionine 200mcg daily.

Some reading about Hashi's:

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

thyroiduk.org.uk/tuk/about_...

[Clutter]

Welcome to the forum, Gerishan.

85% of patients do very well on Levothyroxine once they are optimally medicated. Why do you think NDT or T3 are required? As far as I'm aware NDT isn't licensed for use in Ireland so is unlikely to be prescribed without a private prescription. In the UK it is increasing difficult to get Liothyronine (T3) prescribed due to the extortionate cost so I imagine it is similarly difficult to get T3 prescribed in Ireland.

The results show overt hypothyroidism. I'm surprised FT4 and FT3 aren't lower with such high TSH. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 1.0 or lower with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Ideally FT3 will be near, or in, the top third of range. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before or 2 hours after food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose.

The patient should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after the blood draw.

thyroiduk.org.uk/tuk/about_...

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I am not a medical professional and this information is not intended to be a substitute for medical advice from your own doctor. Please check with your personal physician before applying any of these suggestions.

[Gerishan]

Thanks very much for the replies, I appreciate them. My worries were that this pt wouldn't be able to tolerate the Levo, her Endo suggests 25mg for the first week then an increase to 50mg then an increase to 75mg, I just felt that the NDT would be easier for her to absorb.