NDT equivalent to t3?

Hi I'm on 80mcgs of t3 and thinking of swapping in some NDT as I had an episode of atrial fibrillation. Can anyone give me a rough idea how much NDT I should add if taking out 20 mcgs of t3 as an example? I know that may be self defeating because knowing my body I'll turn it all into rt3 but I'm feeling nervous after my recent experience and suspect my body couldn't down regulate my t3 levels during a high adrenalin/cortisol episode involving a wasp (which I am very phobic of) which may have triggered the A fib. If I had some t4 in the system it seems to me my body could have shunted some of it into rt3 as needed and perhaps avoided causing a short, temporary over medicated episode. It's only a theory but the best one I can come up with.

36 Replies

  • If you take T3 to have three times the efficacy of T4, then the 20 mcg T3 is equivalent to 60 mcg of T4. Thiroyd NDT has 35 mcg T4 and 8.31 mcg T3 per grain (tablet) which works out to be just short of 60 mcg T4 equivalent, and conveniently equal to the 20 mcg T3 you suggested.

    Only use any suggested equivalent as a possible starting point. In my case, I currently take about the same amount of T4 from NDT as the Levo that gives me a "good" TSH i.e. about 150 mcg, which I get from 4.5 grains of Thiroyd. I feel I could use a higher proportion of T3.

  • Hi sulamaye.

    My feelings on NDT and I'm careful here in what I say because others will not agree.

    Thyroxin will fix your TSH and keep you alive.

    Thryoxin and T3 will fix TSH, keep you alive and make you feel a little better.

    NDT will pretty much give you your life back. google "before after NDT"

    but - and here's the got you

    Thyroxin - is simple to drive

    Thryoxin and T3 TSH, - a little more fiddly

    NDT - really interesting some days - and can be hard work.

    So it really comes down to how much work you are prepared to do versus how much you want to look and feel normal.

    So here's my 2 cents worth. If you going to do NDT - just do it and don't bother with the others - they will just complicit your NDT dosing.

    With NDT you tune the dose daily. Take 60mg at 11pm - so your adrenals have a good quantity when they kick in at 4am. Then take your temp at 10am, if it is near 36.0C take another 30mg. Then if you are doing anything that requires lots of energy (jogging, swimming, sailing, football) take another 30mg. If you start to go hyper - you're taking too much.

    For me my base dose is 60mg summer and 90mg in winter.

    This will not make your doctors and his/her TSH obsession happy - but it will give you your life back. Your TSH will probably get suppresses and go TSH = 0.

    Any way best of luck


  • I should have said that i can't do NDT totally, maybe if I ever recover from my m.e and my body is less stressed and inflamed, but I got to 5 grains and still felt incredibly ill, iller than I do feel every day anyway. I make too much rt3 or so my blood test said.

    Taking t3 is tricky in its own right. Having m.e makes everything harder and obviously I don't exercise etc I spend 50% of my day in bed.

    It isn't true that m,e is just badly treated hypothyroid or hashis. I wish.... Two and half years ago I believed that maybe true having been hypo since 1994 and on a t3/t4 combo when I got m.e. So I have systematically worked my way through the options and t3 only has given me the best quality of life before the a fib episode.

  • 5 grains would kill me and I'm a 90kg male. Try 1 to 2 grains . The RT3 is your body freaking out and trying to dump T4. The RT3 has a similar molecular shape to T3 and then blocks your ability to absorb T3. Hypothyroidism.

    But I'm telling you what you already know - sorry. But question why 5 grains.

  • Well obviously I didn't jump in at 5 grains! I'm not stupid. I started on half a grain and built up every few weeks. My point is that there was no point when I felt better than i do on t3 only. My logical conclusion being that my body was not able to cope with a significant amount of t4 and NDT is not the holy grail for everyone.

  • you are completely right NDT isn't the holy grail. It gives me a head ache for 2-3 hours after taking the 60 at 11pm.

  • sulamaye,

    Some people just can't medicate enough T3 to be able to constantly maintain that well being so adding some T4 would be the answer.

    However, I agree with jamesal0 to switch totally over to NDT because it could start becoming confusing adding a little NDT to a larger proportion of T3, remembering that NDT already contains some. I believe thyroid meds work better with the correct ratio of T4/T3 (which can vary from person to person) and help to balance other hormones and protein carriers..

    You could always add a little extra T3 to the NDT at a later date if your T3 levels plummeted, remembering it is easier to add T3 than take it away.

    Do you have any recent test results which might indicate if you are overmedicated or simply can't tolerate that amount of T3 with possible cortisol issues going on ? ? ..

    I have recently read on the forum of a possible difficulty on introducing T4 back after medicating T3 alone. Also NDT can be unsympathetic to high thyroid antibodies, cortisol issues and low iron so these issues need to be addressed..

    Changing meds should certainly not be viewed as "self defeating". Taking our meds should make us feel well and if there are difficulties, it could be dangerous to make yourself persevere.

  • As I said to james, radd, NDT only doesn't work for me. Adding some to some t3 probably won't either but it's worth a try.

  • sulamaye,

    There will be a thyroid hormone replacement med or combination that will help you to get better.

    However, it is not only a case of finding which one(s) but also identifying the cause(s) that hinder them from working properly.

    Low iron and cortisol issues are classic but even inflammation, gut problems and certain nutrient deficiencies can impact hugely on how our thyroid hormone synthesis.

    It has usually taken may years to become this ill and can take many months to see any recovery.

    NDT can be unsympathetic to other health issues. Have you thought of adding synthetic T4, which would be less complicated ? ? ...

  • Yes I've been there got the t shirt! I find it exasperating that some people here just don't get m.e. You don't spend nearly six years without a life, lose your daughters childhood etc without looking into all the possibilities and trying them. I no doubt know far more about all this than you because I actually have m.e, methylation pathways, nutrition, supplements, cowden protocol etc etc. I'm an intelligent human being. I appreciate that your intention is to be helpful, but contrary to popular thyroid opinion m.e in all its mysterious hell is not under treated hypothyroidism. If you get better having treated your thyroid appropriately then you don't have m.e and lucky you!

  • sulamaye,

    I wish you well and hope you find your answer..

  • Thank you radd and sorry for the rant. I just get frustrated sometimes. This site is brilliant for sharing info etc, but sometimes it can be a bit tunnel visioned and when you say u have m,e you get to hear a lot of that hence my impatience.

  • 1NDT approx equivalent to 20-25 mg t3


  • Hi

    Radd is spot on with the advice.

    Having cfs/me is a nightmare. Having been ill for so long and given you are in bed 50% of the time there will be so many issues that need addressing even if it's to cross them off the list of things that may be keeping you unwell.

    The top cfs specialist in the U.K. ( as I know her) would test the following

    If you have ever had glandular fever and shingles( it is thought to be a main cause now following research in Germany last year)

    Adrenals high low cortisol/ dhea


    Vitamin deficiencies especially vit b12 magnesium vit d etc( thro b h)

    Stool analysis test for stomach acid bacteria and probiotics- see if any are low.( high in bacteria)

    Parasites in the gut

    Look at your diet gluten free dairy free sugar free low g I load food.

    Adaptagens to raise immune system and support a stressed body. I.e. High cortisol is helped with holy basil, sleep with motherwort colds with cats claw and elderberry (anti viral) there are so many that help.

    Sleep how is this

    D ribose for energy and can you tolerate high vit c powder.

    Address meds that interfere with the thyroid i.e. ( just making these up so apologies beta blockers anti depressants steroids mess up adrenals so care is needed not suggesting people give up steroids)

    Yes the thyroid is so important but so is everything.

    Good luck with everything. X

    The ratio of t3 in ndt is 1 in 4 not 1 in three.

  • Yep done all that and more!

  • As I always say, start on a low dose (say 1/4grain) and build up over a few weeks.

  • yep I did - I was moving from T3only to NDT and I had oved from T4/t3 combo to T3 so I wasn't starting from scratch, but even so I started on half a grain.

  • Many people will try to give you ready reckoner type answers to your questions, but I have grave doubts about the validity of such a comparison.

    You are trying to compare a synthetic chemical with a natural product and assuming that the "T3" (Triiodothyronine) within the natural product will act in exactly the same way that the "T3" chemical version of it (Liothyronine) is known to do.

    It is way beyond my abilities to be able to prove whether the chemical will actually do this but I have severe doubts due to the fact that each product is known to be presented to and available to the body in totally different ways. Those who say this are probably repeating what they are told by medical institutions, but the fact that so many medical "professionals" seem incapable of even using the correct medical terminology to describe these products does not exactly encourage me to believe anything they say.

    In a recent letter to me a fully qualified consultant endocrinologist has said:

    “The active constituents of Armour are levothyroxine and liothyronine”

    The website of Armour (presumably owned by Forest Pharmaceuticals) says:

    “Armour Thyroid Tablets, USP, contain the labeled amounts of levothyroxine (T4)and liothyronine (T3)”

    How on earth synthetic chemicals can be contained within a natural product is baffling, so I have to ask the question as to whether these people say these profound LIES in order to confuse and baffle us all. I need to check whether the Hyppocratic oath includes penalties for lying. In other words, if any doctor said to me that the UK was in the Northern Hemisphere I would immediately check my atlas to make sure it actually was.

  • Good point. But to have a rough idea is a good starting point from which to tweak things. If I could I'd be happier to be on NDT, even though it's t4/t3 proportion is not the same ratio as us humans. I was so hopeful a few years back that I would make a full recovery on NDT, but what is wrong with me is far more complex and requires something more akin to a miracle. My endo has said I can try NDT again if I want, which in itself is a minor miracle I suppose, a supportive endo, even if I do know more than him when it comes to thyroid and cortisol. I'm going to drop 10mcgs t3 and put in half a grain and see how my strange body reacts, but I will very much bear what u said in mind panda321.

  • I really did believe that I was going to be fully fit again on NDT when I started taking it 2½ years ago. But that is proving to not be so in reality. I am about to start on a different brand tomorrow and will see if that makes a difference but I doubt it.

    My problem is probably the most simple situation imaginable, which is to have had a total thyroidectomy and RAI for a benign goitre and multinodular goitre (I had no desire for my thyroid to be given a 3rd attempt at killing me as I was aware that what was left of it would regenerate into a monster).

    IF NDT only works 90% for me, it is unlikely to work fully for you if you have a more complicated situation.

    All the best to you and hope you find a real solution.

  • Thanks panda.

  • How do you know you are not just on too much T3? When I was on T3-only, I ended up on 62.5mcg daily, which worked out to about 0.82mcg/kg body weight. You said nothing about testing. Have you tested FT3 to see where you are? Normal ranges (varies by lab) are either 2.3-4.2 pg/ml, or 2.77-5.27 pg/ml.

  • Because I didn't just jump in on 80mcg. I started on 20mcg and took signs and symptoms and raised every week until I was on 60mcgs. I had been on 150mcgs t4 and 20mcgs of t3 for about ten years before I became ill. Then I raised symptomatically over the next 18 months.

  • Are you dosing throughout the day, or taking one John Lowe-style 80mcg dose?

    A T4-equivalent of 150+3*20 is a very high dose. I'm not surprised you ran into trouble. I have noticed that doctors who don't know what they are doing, will often raise T4 way beyond the full-replacement dose. After I had been on T3-only for more than a year, I came off onto T3+T4 at a low T4 dose which puts my FT4 only 14% up in its range, which is where I still am now. Fortunately before I went on T3-only, I had very clear symptoms (esp. anxiety) that alerted me my body would not tolerate a high T4 dose. Having just dropped my T3 dose from 15 to 10 (FT3 was over-range), I am about to raise T4 a little to see if my body has recovered enough to tolerate it.

  • I tried all one dose once and it made me very ill. No I do 3 doses. my meds went up historically in response to tsh rises. I really don't think it's that dose that caused me to get ill, far more likely the septaecimia and 3 bouts of abdominal surgery the last of which I never recovered from properly and then suddenly hit the wall. If it was that I was over medicated I'd have seen improvements when I've switched meds which normally involves going hypo for some time. When my last GP cut my meds to just 100mcgs within 8 weeks I was back in the floor, totally bed bound. In fact even when I was on my t4 t3 combo before I got ill my ft4 was never in the top quarter of the range and when they did test t3 that was never over and often low.

  • Have you come across Dr Sarah Myhill - she specialises in CFS and has loads of interesting, and maybe useful, information on her website.

  • Yes thanks. I consulted her not long after I got ill.

  • Did you have the Mitochondrial Function profile test she offers? The thyroid needs, in particular, Selenium, Copper and Iodine. Iodine is often overlooked because it gets such a bad press but it might be worth having a urine test to see if you are deficient - if you have not already done so. My personal experience of thyroid replacement hormones is that nothing will work if there are any deficiencies in the body.

  • I had my mitochondria tested by Myhill in 2011, but retested when I started working with a nutritionist from the Optimum Health Clinic who specislie in m.e/cfs. . She actually gave me a far more detailed intepretation of the test, that my ATP was not releasing and was clumping. as you can imagine being a lecturer in nutrition all defienciencies have been looked into by her and addressed. I am on a grain free paleo diet and more targeted high quality supplements.

    My thyroid meds had been working for 17 years before I hit the m.e wall, any deficiencies in their function now is caused by the huge stress my body is under from being ill, from whatever is dragging my body down. What that is is the nebulous mystery, but it certainly operates like a pathogen on a cyclical basis, dragging me down just as I feel I am inching forward a step.

    Iodine is only needed if you are making your own thyroid compounds, (the 3 and 4 in T3 and T4 respectively) being on T3 with a totally supressed TSH I am not, but I do take some seaweed in my vegetable smoothie, but there is controversy about the good or ill of iodine for hashimotos patients too, so I don't over do the seaweed seeing its general benefit as te reason for taking some.

    There is no reason why after 17 years of t4/t3 combo my thyroid woud suddenly become the cause of so much unresolvable trouble. It just doesn't make scientific sense. Im so happy for anyone who does resolve a diagnosis of m.e through thyroid meds but unfortunately there are thousands and thousands of us who do not. M.e is a condtion in its own right even if people dont understand it or is has various operating factors.

  • You sound as if you have just written my life story and believe me I know exactly where you are coming from. After 8 years on T4 monotherapy I fell into the same hole with what was most certainly something that might be classified as m.e. or CFS, bedridden for the best part of the day. I never sought or was diagnosed with either, didn't have the energy to seek help. Been on T4/T3, T3 only and now NDT but nothing worked, and like you it didn't make any scientific sense. However, when I did sum up the energy I kept on looking and still nothing worked. I will PM you with another source, if that's okay.

  • I had septeacemia and three major abdominal operations. I suspect some bacteria is hiding in biofilms in my body and it is that which took opportnistic hold of me following my last operation.

  • I'm glad I found this discussion. Sulamaye's situation has many similarities with my own. I've tried virtually everything (haven't tested for Lyme, yet), but I'm still very unwell.

  • Lymes is a nightmare testing wise once it's become chronic NHS bloods don't pick it up becuase it hides in biofilms, which are amazing and you have to admire them if u didn't suspect they were making your life hell! Then to get the sort of tests that do pick up lymes u have to pay so much money and get it sent abroad becuase they've got to look for the associated pathogens and try to find the stuff hidden in the biofilms etc. So my OHC nutritionist has started using other indicators and treating as if lymes using symptoms as the guide to other pathogens. It's complicated and difficult and I was doing very well in takuna but have done the usual back flip that makes you want to scream and cry and give up. But I am preserving with samento and then serrapeptase which actually eats scar tissue, of which I have a lot, and is supposed to break down the biofilms and give the tinctures access to the hidden pathogens. One can but hope.

  • That's very interesting info about samento and serrapeptase - I'll look into it. :-)

    But yes, diagnosing Lyme is an expensive nightmare. I think Dr SM says that even with the improved Elispot test, few positive results come up. Yet, in rural areas of Britain it seems sensible to suppose that infection may be quite common.

    Dental plaque is an example of a damaging and persistent biofilm, but at least you can use an electric brush on it!

  • Bacteria particularly likes catheter and other similar sites to gather and with my last op my drain had to be wrenched out of me as stuck with much scar tissue. I'm convinced some bacteria is still using the site even nearly seven years later it goes through periods of being very tender.

    I got die off reactions when I started the takuna and had to stop start but so far the samento hasn't done that.

  • Goodness, you really have been through the mill!

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