NDT-is it working? Take t3 supplement? Recent increase in Naturethroid the right thing?

[Furbabymommy]

Please help me identify the reason I am not making progress.

Is it too low a dose of Naturethroid? Is it the actual Naturethroid or maybe I need Levo? Do I need a T3 supplement?

Hypothyroid, USA resident. Recent labs when taking Naturethroid 130mg/day:

fsh 25.4 mlU/ml normal no range given

trilodothyronine free serum 2.6 pg/mL normal (2.0-4.4)

reverse t3 serum 9.9ng/dL normal (9.2-24.1)

tsh+free t4 :

tsh 0.151 uiU/mL low (0.450-4.500)

t4 free direct 0.74 ng/dL low (0.82-1.77)

Cortisol am 15.6 ug/dL normal (6.2-19.4)

Ferritin in 60's (middle upper range)

Vitamin D and B supplements have me in upper optimal ranges

For symptom relief on NDT I understand (please correct me if wrong or these rules apply to Levo):

FT3 needs to be in upper third range which would be 3.8-4.4. Its now 2.6.

FT4 needs to be upper third range. It is now 0.74 with a range 0.82-1.77. Upper third would be 1.44.

TSH should be supressed. It is now 0.515 low.

Last week I increased to Naturethroid 195mg/day-that's 2 increases upward. No jittery response.

(One increment upward would have been 162mg/day miscommunication with my doctor and resulted in a two dose increase)

How long after this recent increase in Naturethroid dose should i wait to do labs?

What lab measurements/symptoms would tell me the recent dose increase is not working and a t3 supplement is needed?

If t3 is needed, how much is Naturethroid decreased and what is usual t3 start dose?

Thank you for your consideration.

Furbabymommy (FBM for short)

[shaws]

Unfortunately for us, it does take time to find a dose which makes us feel well. Blood tests don't tell us that, but the action of the hormone on our body.

web.archive.org/web/2010103...

[Furbabymommy in reply to shaws]

Thank you, Shaws. I am actively reading through the link you shared and learning about the 'bell curve' described by Dr. Lowe.

[TSH110]

Have a look at this guide to determine a correct dose for you

tpauk.com/main/article/trea...

Hope it helps ☘️🍀☘️

[Howard39 in reply to TSH110]

Hi

How do you feel now. From a results point of view I'd say your about right but it's how you feel that matters,

Why was your dhea not measured and only one cortisol i.e. In the morning?

You need both measured throughout the day and one in the night- to be sure no issues are there. It's a saliva test.

Also have you had your thyroid antibodies tested? Really important.

Best wishes

[Furbabymommy in reply to Howard39]

Hello Howard39,

After feeling well the last 2 months, I now feel like I am revisiting some hypothyroid symptoms including: dry skin, low appetite, afternoon fatigue, eyebrows falling out again, weight all around my mid section.

Not sure why DHEA not checked. I take 20mg DHEA nightly. On 5/22/17 it was 402 ug/dL high (no range given. I believe it should be above 150).

Time for a recheck of DHEA and the saliva test you mentioned.

Yes, has thyroid antibodies tested in January 2017. Likely they are due for a redo. I feel much better now than in January 2017, though a backslide in the last 2 months:

Anti Dna Ds Ab Qn 1 IU normal (0-9)

Rnp antibodies <0.2 IU normal (0.0-0.9)

Smith Antibodies <0.2 IU normal (0.0-0.9)

Antiscleroderma -70 antibodies <0.2 IU normal (0.0-0.9)

Sjodgren's Anti-Ss-A <0.2 IU normal (0.0-0.9)

Sjodgren's Anti-Ss-B <0.2 IU normal (0.0-0.9)

Antichromatin Antibodies <0.2 IU normal (0.0-0.9)

Anti Jo 1 <0.2 normal IU (0.0-0.9)

Anti Centromere B Antibodies <0.2 IU normal (0.0-0.9)

Should i get antibodies retested now? Any other tests you suggest?

Thank you!

[Furbabymommy in reply to TSH110]

Hi TSH110-and thank you for the link. What a wealth of information about what to do when. Answers a lot of my questions.

[TSH110 in reply to Furbabymommy]

Furbabymommy

So pleased it has been of assistance to you. I found it very useful when I switched from levo to NDT. Hope you get optimal dose soon 😉

[SilverAvocado]

In thyroid terms, the biggest issue is that you're undermedicated. Your summary of the goals is quite accurate. The only thing I'd add is that freeT3 is the most important of the set, as it's the active hormone. FreeT4 is not actually important in itself, but this more just a guide when people take T4-only medication. The hope is that with a high FT4 the FT3 will also be high. TSH is also not really a guide - many people need it suppressed well below the range to do well.

So I think you're on the right track. The blood test showed an increase needed, you've had an increase, and now it's just wait and see if you've got it high enough. For me the gap between freeT3 at the bottom like yours is, and top of the range was about 3 grains.

You can retest again in 6 weeks. Feeling better could happen in almost any way or any timescale. You could even feel worse or feel strange. Personally I tend to feel a bit better 10 days or so after a dose increase. But last time I felt worse for about 4 weeks. I found I had to increase my activity slightly and after that I felt better.

There isn't evidence in this blood that you need to change to a different form of thyroid replacement. But there rarely is. Because NDT contains T3 you won't see on the blood test that you're not converting. It can only really be found out by experimentation. But it's important to get your blood results optimal (freeT3 in top third) and give it a good try at that level before trying other things.

[Furbabymommy in reply to SilverAvocado]

Hi Silver Avocado,

I really appreciate the thorough response, possible steps forward, and timeline of how long to wait before retest.

I just increased by 1 grain. So knowing you took 3 grains to close the gap between FT3 bottom and top 1/3 range is informative.

Looks like a retest of FT3, FT4, TSH on 8/14 will allow 6 weeks to pass since increase.

I see my doc next week and will carry this information with me. Fortunate that my doc is very open to the suggestions from this forum.

Thank you!

[Eddie83]

Keep in mind that the result is how you feel. Some of us are weird and need FT3 or FT4 that are different from standard recommendations. My FT3 is about 2/3 up, which is OK; but I do much better with FT4 low in range. FT4 higher in range makes me jittery, apparently cuz I can't convert it very fast.

Seeing as how you need higher FT3 and need to raise FT4 into range, sounds like you should just increase NDT again.

[Furbabymommy in reply to Eddie83]

Hi Eddie83,

Agreed-studying how I feel and the FT3 and FT4 for whole picture.

Since increasing 1 1/2 weeks ago from 130mg (2 grains) to 190mg (3 grains), I have no jitters and no adverse effects, which is good since it was a big increase in dose. However, afternoon fatigue continues from before recent dose increase. Was hoping that would stop.

Another increase is likely though in a smaller increment- 32mg (1/2 grain).

I know to wait for 6 weeks past an increase to retest labs.

Should I wait for 6 weeks from last dose increase until next increase or can the amount of time between increases be shorter?

Thank you!

[Eddie83 in reply to Furbabymommy]

My doc always tells me that 5 weeks is sufficient.

[Furbabymommy in reply to Eddie83]

Thank you for this helpful information, Eddie83.

Now a prior symptom has returned in the last few days-hair falling out again-UGH!

Just last week I thought though other symptoms had crept back in at least the mspyotom of my hair falling out has not returned. Oh well.

Looks as if symptoms have crept back in given I am so Undermedicated at 190mg NT (split dose 85mg 2x/day at FT3 at 2.6)

I meet with my doctor this week and will plan out a schedule for increasing meds every 5-6 weeks at 1/2 grain/32mg and lab work every 6 weeks post a dose increase.

[Eddie83 in reply to Furbabymommy]

Hairloss is one of the (300+) classic symptoms of hypothyroid. I permanently lost hair at the crown and front of my head because of it. My doctor said nothing about hairloss, he didn't have a clue.

[Furbabymommy]

.... should have added I split my dose of Naturethroid. I take first dose early am (5AM) the next dose around 4pm.