I just got blood tests back after struggling to get onto ndt and here are the results:
Ferritin 104.4 (20-150)
TSH 5.68 (0.27-4.2)
Total T4 56.5 (64.5-142)
Free T4 9.32 (12-22)
Free T3 4.03 3.1-6.8
Thyroglobulin antibodies 94 (<115)...was 96.4 in Feb
Thyroid peroxidase109.7 (<34)...was 46.6 in Feb.
Also my vit D is 54 (insufficient is 25-50 and we are just coming out of winter), B12 480(insuff is 140-250), folate 45.4 (8.83-60.8) and ferritin 104.4 (20-150)
I think I should swap to T4/T3 combo and increase my dose. Any thoughts anyone?
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shanza
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Okay, I'll take vit D as suggested. The main problem though is my antibodies that have increased. I am feeling ill with it and simply can't get up to a therapeutic dose on ndt. I have tried since Feb and now I think i should move to combination t4/t3 as I read somewhere that ndt can cause an increased autoimmune response in a minority of Hashimotos patients and I think this may be what is happening to me.
Does anyone have a suggestion as to what a good starting dose of t4/t3 would be and what dose to aim for given that my gp was content when I was on 80mcg of liquid thyroxine prior to Feb?
Your antibodies have risen because your high TSH is over stimulating your thyroid gland.
1.5 grains is equivalent to 100mcg Levothyroxine so you will need more than 80mcg liquid thyroxine. Are you intending to resume taking liquid thyroxine or will you try Levothyroxine tablets?
Are you daying that if i increase my dise of ndt my antibodies will go down? I am on 3/4 grain ndt at the moment which I thought wad the equivalent of 75mcg of levo? My thoughts were I would go back to the liquid and take t3 alongside in a dose that mimics our natural ratio but I don't know if this is the right way to take t3...?
Yes, antibodies should go down when you are optimally medicated. 1 grain NDT has 38mcg T4 + 9mcg T3 which is equivalent to 65mcg T4.
If you resume taking 80mcg liquid thyroxine try adding 12.5mcg T3 split into 2 doses 8-12 hours apart but have a thyroid test including FT3 6-8 weeks later to check levels.
Thank you. So maybe I should try bumping up to 1 grain ndt first, before trying the t4/t3 route? At the moment I take 1/2 grain around 6.30am and 1/4 at 2.30pm. When would you advise the last 1/4 grain?
I think it's easier to tweak NDT than to start over with something else. Why not add 1/4 to 2.30pm dose and another 1/4 at bedtime. You can add another 1/2 grain in two weeks.
I'm a bit nervous to do that as the last time I tried to raise the dose at 2.30 by 1/4 grain, I got bad palpitations and anxiety and couldn't sleep(those symptoms now settling), along with the thyroid area ache starting and joint pain increasing (which I still have now). Do you think that perhaps raising the dose by half a grain overall I might avoid those symptoms?
I can't see why raising 1/4 grain would cause palpitations and insomnia but 1/2 grain wouldn't. If you prefer raise in 1/4 grain increments. If you get palpitations or insomnia just cut back to the previous dose and try again in a week.
When you raise NDT your own thyroid reduces its contribution, so the symptoms you have maybe more a slight worsening of being hypo until the ndt gets to work.
With those labs , there's definitely need for more NDT , and if it were me , I would be going up a half grain immediately and looking to raise again in two weeks or less. And personally I don't think I would look at another blood test until I was up another grain.
I am in a similar position as you, although my TSH is much lower than yours.
I am also wondering if a T4/T3 combo will suit me better.
I take 1.5 grains of W.P. Thyroid and could get any higher without getting pals. and high B.P. which was maybe understandable as at the time my FT3 was 5.2. It has now dropped to 3.58.
My TPA antibodies have risen like yours but only by 4.2 and are just under top of the range.
No I haven't. Don't know how to take it yet either! I'm in contact with a private gp in London who will advise me but I would like to get patient experience advice as well. That has been very helpful so far...
if I decided to change over, could I maybe take 75mcg. levo. per day plus the 12.5 mcg. T3 as both my present levels are low and I have hypo. symptoms.
Yes it does help. Thanks for that. It's difficult to know how long to bear with symptoms before deciding to try something else unless someone has been there already and can advise. How long did it take you to get to your optimum dose?
Thank you, but I have been taking W.P. Thyroid for 15 months now. I had a hard time raising it to 1.5 grains.
I had a couple of good months towards the end of the summer last year, then symptoms crept back in. I had trouble raising it further as my T3 was at a good level at 5.2 but now my T3 is low I a may be able to raise now.
I shall try another increase and then if this does not help I think I will try T4/T3 combo.
I would say that Sticky blood mentors vit d idea is a good one. The dead giveaway was your comment that things were better for a couple of months at the end of the summer, this is exactly when your vit d would be at its naturally acquired highest before dropping off over the winter.
I have just taken loading doses to fix my deficient vit d and my insufficient folate and b12 and the reduction in fatigue levels is amazing. Granted I am around optimal levo dose already but prior I was sleeping for England 12 seemed to be minimum requirement. Two days ago I woke up after 10 hours with that muggy too much sleep feeling - for the first time in years!! We all know that we need proper nutrients but I dont think we realise what a physical effect poor levels have, I certainly didnt.
I asked the forum about vits and the consensus seemed to be that vit d is best around the 100 mark, b12 above 500 and up 7-800 if you can manage it, folate mid range and iron above 70 just for thyroid hormones (natural or synthetic) to be absorbed and converted properly. Iron and calcium can both stop your meds being absorbed and must be taken well away from meds, at least 4 hours. I know most also recommend taking 1000mg vit c with iron to aid its absorption snd combat constipation iron causes
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