Hello, I am new to this group and very happy to be here. I am taking NT 120 MG. My labs are not in optimal range. I am working with an NP who is new to thyroid disease and not sure how to help us change medication to reach optimization. The labs are listed below. Suggestion would be greatly appreciated.
Thank You
Have to say, I would be extremely wary of anyone advising in any way if they have no experience of thyroid disease. At those who respond with their experiences here are doing so out of the goodness of their hearts - and very often with long and deep experience despite not having medical qualifications.
At pretty much every step, you come across things that actually are the reverse of obvious. There are issues at every stage which confound expectations. It is absolutely not something you can learn on the job by experimenting on convenient subjects.
I do agree. However, she is the only physician willing to help reach optimal ranges vs other physicians medicating for TSH. My TPO has decrease to 150 in this last year of seeing her. She does specialize in digestion and nutrition which has greatly improved my overall health.
When you write NT - what exactly do you mean? There are at least two branded products with that abbreviation, and it is also sometimes used just to refer to natural thyroid (desiccated thyroid).
It would probably help with answers to let us know exactly what you are taking! Please. 
NP thyroid (natural thyroid usually from pig)
I will give you a link which may be helpful in that you are self-medicating indirectly. Optimum means that we feel well with no clinical symptoms as doses are different for nearly everyone, it is what suits our bodies and makes us feel good which is the criteria.
nebula.wsimg.com/e0c9c9ed95...
Thank you a bunch!
Treating thyroid is not about optimising numbers. It's about getting the patient well again. It's about increasing the dose slowly until all the symptoms are gone. The blood tests are just a guide. How you feel is the most important. It's certainly not about the TSH.
And, it's not just about hormones. It's also about feeding your body good food, and making sure your nutrients are all optimal (that is about numbers). It's about getting your vit D, vit B12, folate and ferritin tested, and treating any deficiencies. It's about optimising your digestion and absorption, testing the level of your stomach acid, and adding acid if it's low, so that you can absorb nutrients, and your hormone. And, if you neglect any of those aspects, you're not going to get well.
How long did it take you to get up to 1 grain? How long have you been on one grain? Have you had your antibodies tested? How do you take your NT? How do you do the tests? So many details we need to know in order to be able to help you.
I was put on detox diet (simlar to GAPS) then added foods for allergy or reactions. I have been taking NT for six months starting with 1.5 GR the increased to 2Gr, 3 months ago. I take them when I first wake on empty stomach and wait at least one hour before consuming anything. Labs above. TPO has decrease to 150 lowest ever. Now is my weight gain and hair loss issues. I am now taking supplements and vit D ( which is now increase in the 40's. Thanks for your help
Ok, well, it's about time for another increase in dose, then, isn't it. Your Frees are very low.
But, you haven't once said how you feel. And you don't give any details about your nutrients, so really, we're none the wiser.
As of now I feel a little groggy still. Hard time losing weight even with exercise and diet. I eat grass fed meats and bone broth, oraganic veggies and fruits as much as possible. My one horrible vise is my one cup of black coffee each morning. My hair thinning is hard to look at in the mirror. I think that's about the gist of it. Thank you. I will speak with my NP about an increase.
You probably can't lose weight BECAUSE of your exercise and diet. Low calorie diets have a negative effect on conversion, and exercising uses up you T3, so you are making yourself more hypo, which will make you put on more weight.
With your low FT3, you can't expect to lose weight, and you shouldn't be trying. You need to increase your FT3 before you do anything else, and that means getting an increase in dose.
Shall do. Thank you.
First question is: how do you feel? Are you in a state where you feel not-quite-well? Is that why you want to "optimize" your labs? Optimizing labs is a time-consuming, expensive process.
Your D3 is high enough. Although it could safely be higher.
You have to decide whether you want to go after T3 or T4 first. To get this done quickly, I would go after T3 first. FT3 is currently 54% up in its range. I would recommend you raise your NDT dose to see if you can get FT3 to 75% up in its range. I suggest this because T3 is key to how you feel. If you raise your FT3 and don't feel a difference, then you should ask yourself whether optimization is really necessary.
Once you get FT3 up a bit, then go after T4. Note that your FT4 is only 9% up in range. I would add T4 in small increments of 12mcg. Then you will have to hold each dose constant for ~6 weeks before re-testing. You need to make sure adding T4 doesn't raise your FT3 higher than range top. If you respond at all like I do, you may find that you start feeling hyperthyroid symptoms while FT4 is still fairly low in its range. But that may not be your response, in which case I would not attempt to place FT4 more than 50% up in range, while making sure FT3 never goes over range top.
I am suggesting the above because that is basically what I did. I had a long history of not responding well to T4-only therapy, probably because I had Hashi's, gluten enteropathy, and large nutritional deficits. So I was on T3-only for a while, then went back to T3+T4. My doc told me that he has some patients who do their best when FT4 is low in its range, and that has turned out to be my situation. I have used NDT in the past, but have gone to T3+T4 for a couple reasons, and find I am doing well with it. I am currently on T3+T4=10+88. T3=10 places FT3 about 70% up in range, and T3=15 places FT3 over range top. T4=88 places FT4 about 17% up in range, and if I goto 10+100, I feel hyperthyroid within a few days. The weird thing about this situation is, if I increase T3 and drive FT3 above range top, I have mildly bothersome symptoms. However, if I increase T4 too much, I get into majorly bothersome symptoms (hyperthyroid anxiety) while FT4 is still pretty low in range.
I would not pay much attention to TSH. Some docs panic about low TSH, but what really matters is how you feel. I know exactly what hyperthyroidism feels like, and that is sufficient to establish my max T4 dose.
Thank you. Are the T3 + T4 medication synthryroid and cytomel? If so the one problem I have had with these medications is canker sores in my mouth. We tried multiple things and when switched to natural they have been gone.
I use Levoxyl and Cytomel, for historical reasons. When they were manufactured by King Pharm, they were definitely GF and low allergen. But Pfizer bought King, and Pfizer has apparently been messing with the formula. I wish I had an option for T3 and T4 from a smaller company whose focus is patient health first, and whose products are paid for by insurance companies. Some (all?) US drug plans won't pay for NDT.
Also check levels of b12, folate and ferritin. As well as vitamin D. These all need to at good (not just average) levels for thyroid hormones (our own or replacement ones) to work in our cells
Are you taking selenium?
Excellent free web based document-series - re-running, starting March 1st
Masses of advice for all thyroid issues, but especially for Hashimoto's or Graves
Are you gluten free?
The most important results :
Free T4 0.91 (0.82 - 1.77) 9% of the way through the range.
Free T3 2.8 (2.0 - 4.4) 33% of the way through the range.
Both your Free T3 and Free T4 are far too low. While taking NDT you won't get up to the high levels of Free T4 that someone gets when treating themselves with Levo. The most important result with NDT is the Free T3. Most people on NDT prefer the Free T3 result to be in the upper half of the range. Some feel well in the upper third of the range, some prefer the top quarter. It can take some trial and error to find our own sweet spot on whatever thyroid hormones we take - but I'm sure that being in the lower half of the range for T3 is probably nobody's sweet spot!
One thing that is essential for good health is getting nutrient levels to optimal, which is different for different nutrients. The really essential nutrients are usually given on this forum as ferritin/iron, vitamin B12, folate, and vitamin D.
Your vitamin D looks good.
You might like this link :
grassrootshealth.net/d-calc...
which suggests a level of 40 - 60 ng/mL is ideal, and yours is already there.
Fasting for thyroid labs 
thoughts on my labs!
Thoughts on latest Labs? 
Update on Labs - What is Going On? :-)
