What do you think about labs not changing with meds?

I just was reviewing older and recent lab work. A year ago my labs were without medication

tSH: 1.08 0.10-5.0 Reference range

Free T4: 9.9. 11.0-23.0 Reference range

Free T3 4.3 3.5-6.5 Reference Range

Recent labs with 90 mg of NDT ( same reference ranges) 60mg for 1 year, dose raised to 90 mg last month.

TSH .28

Free T4: 11.8

Free T3: 4.0

I am completely bone exhausted throughout the day, it went from about 20% life force ( energy) to about 40% on NDT. I am still sick/exhausted. My iron, D3, B12 etc are all balanced. I am having nightly heart palpitations.

What does it mean that my T4 is up very little with medication and my T3 is actually lower.

I have tried so many things, doctors, supplements etc, and feeling very hopeless to ever recover my energy at this point. I'm 40 yrs old.

15 Replies

  • May be your own body has realised it doesn't have to produce anymore thyroid hormonesas it's getting them from your medication but you were taking them as a supplement and so now need more to exceed what was your then too low level.

  • As thyroid, adrenal, pituitary and hypothalamus work together, it's not possible to have only one of them affected. I recommend a functional doctor who is able to help with these.

  • Daisylain,

    You need a higher dose to raise your FT3.

  • Daisylain, I don't find these results too surprising. You're on quite a low dose, and a whole year has passed, so many things could have changed, your thyroid may have got worse, or conditions might be different (like maybe you've lost or gained weight or are doing different activity levels, or eating differently, or had a virus).

    Best practice in general is to retest blood every six weeks and adjust the dose. With NDT people often increase every few weeks without blood testing, and just take note of symptoms.

    It took me several raises to get from below the range to the top of the range.

  • Thank you so much for this answer. My doctor is a functional doctor, yet, looked at the tsh and told me not to raise the dose. She then gave me a prescription for a year. Your note makes sense to me. In every aspect. Thank you.

  • Doctors are often terrible at reading these results :( The rule of thumb is that freeT3 should be in the top third of the range. FreeT4 may not raise much on NDT, but that doesn't matter. Your TSH will likely be suppressed, but that also doesn't matter. FreeT3 is the closest approximation to how much useful hormone you've got, and yours is rock bottom.

  • Thank you. Because I get heart palpitations, I often question myself and wonder if I'm taking to much NDT. As well, because the "functional" doctor that I pay to see, has told me things look good, don't change the dose, I have been unsure and confused. I will continue to slowly raise it up, and gauge the symptoms. I am feeling more hopeful today. Thank you. 😃😃😃

  • You're welcome :) I learned about thing by hanging round this forum, it's very good.

    The heart palpatations might just be due to undermedication.

  • You are very under-medicated.

    My iron, D3, B12 etc are all balanced

    I'd be interested in the results that show this.

  • Magnesium and potassium (and other minerals) often need to be good to prevent palpitations - also b-vitamins including proper methyl-folate NOT folic acid (new reports coming out of the USA about hypothyroidism being possibly linked to poor methylation of folic acid due to a relatively common gene mutation); B6 in the form P-5-P; B12 as methylcobalamin and riboflavin (B2) to perform proper energy metabolism. Something's definitely out of balance there.. and you're under medicated. Hope you soon get a review and bloods done to figure it out..

  • It means that, once you start exogenous thyroid hormone, that turns down your endogenous thyroid level because your TSH has decreased (from 1.08 to 0.28). So you are now running mostly on the hormone you take orally.

    Note that your FT3 is only 17% up in range. Most of us on this board want to see it roughly 75% up in range. Yet, although your dose is still not high enough, you are having palpitations. That makes me wonder if the palpitations are due to a higher T4 level, rather than your T3 level, which has dropped from the time you started using NDT. I know there are some people who have a bad reaction to T4 - that is, it can cause symptoms like anxiety and palpitations. (I am one of those people.) Have you considered the idea that you may be one of those patients who needs lots of T3 to feel well? If you are, you might want to reduce your NDT slightly (to lower FT4 a bit) and then add in supplemental T3. Also, there are some patients who go onto T3-only because T4 just doesn't work ... I was on T3-only for a while, and it worked pretty well, but it is a demanding regimen (I was dosing myself 5x per day).

    BTW are you getting at least 100mcg selenium (preferably chelated) daily? Selenium is required for your body to convert T4->T3. Also assuming you don't have Hashi's, since you said nothing about that.

  • If you have Hashimotos Disease, an auto immune disorder, then the lowered T3 could be your body's way of calling for more T4, converting the T3 into T4. It is highly recommended to view the series from Dr. Izabella Wentz and especially episode 3 on gut permeability and gluten sensitivities.


    If you have not excluded gluten from your diet then do learn all you can about how it can be the cause of your lack of energy. If you have Hashimotos and have not excluded gluten then there could be a war like immune system attack going on within, just like when you have a cold or the flu. The blood levels would not change, but you would still feel less than 100% energy, just like when your immune system is fighting off any other intruder. If you have not excluded gluten (Barley, Rye, Oats, Wheat in all forms - including beer) then it might be well worth your while to try at least a 3 week experiment (it takes 21 days for the antibodies produced from gluten and an immune system gone awry) in excluding gluten. If you have the diagnosis of Hashimoto's then do consider excluding gluten for sure. If you have not been diagnosed with Hashimotos, you could still do the experiment, if nothing else for the return of energy alone.

    Don't give up. We are all in this together. Watch the Dr. Wentz series - learn all you can. (and yes she does promote her products - but there is a ton of valuable information given away for free - and it is beyond my power of understanding to know how she can do all that she is doing.) What works for one, doesn't work for the other for each of us has our own puzzle to solve. Gluten was my poison, and oh how I still crave it. When you find what works for you, share it here. More and more are suffering each day, from this same ill that affects you and me.

  • Thank you. I am celiac and have been gluten free for 15 years. I have dermatitis herpetiformis which is a skin form of celiac, or should I say, there are skin symptoms more so then traditional celiac, which my brother has. I had iron iv's last year, and finally the iron stuck with me. Prior to that, even though I eat meat and took iron, I was always anemic. This tells me I still have absorption issues. I actually am a strict organic paleo eater, but I intend to go, autoimmune paleo for a few months, as well as work on bringing my thyroid labs up. I did watch Dr Wentz videos, or most of them, last month. She is brilliant. I'm waiting for her book. I also follow Dr Amy Myers and she had a new thyroid specific book coming out. I do feel like my gut is still a problem, I will re watch # 3. Thank you :)

  • Dr Wentz has written a great deal of good stuff and since she's a paleo eater she reports that she 'hit a wall' on her road to recovery and found out she was thiamine (B1) deficient.... I'm beginning to realise that this may also be true for me (due to avoidance of grains) as some of my symptoms are similar to those for B12 deficiency, and although I've increased my B12, it's not helping.


    I also agree with comments above that you may require T3 only, especially since you're celiac, so a poor converter.

  • Thank you. Im going to buy this today. Looking at my supplements, I inject b12 and take another for folate and pantothenic acid, but I don't see thiamine in my supplements. It's worth a shot!! 😊 I appreciate that you sent me this!!

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