Thyroid UK
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When using a combo, do the t3/t4 ratios need to be similar to manufactured NDT ratio?

Hi All,

New to thyroid meds, Im on a very low 1/4grain of Nature Throid. However, my FT3 is consistently low 2.0 (2.2 - 4.4), and I am considering adding a compounded slow release t3 to the Nature Throid, as I start titrating up in the next few weeks.

I've read that most NDTs, here Nature Throid, have a 4:1 ratio of T4:T3. But if I take more t3, my ratio would be closer to 2:1 (9.5 : 7.25.

Is it reasonable that one might have a higher t3 intake than t4? How do you decide which to raise or lower, when using a combo of t3 and t4, or in my case a combo of NDT and T3?

Thank you so much for your time.

❤️ TappedOut

28 Replies
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1/4 tablet is extremely low. It is a starter dose if someone hasn't been on thyroid hormones before. An increase of 1/4 about every week or two is required until you feel well. The blood tests we have are for levothyroxine alone, i.e. T4, so NDT contains a selection of hormones.

1 grain is said to be around 25mcg of liothyronine (T3) (100mcg of T4 )in its effect.

TappedOut - I made a mistake in the last line which I've corrected, ie. 25mcg liothyronine.

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Aw, Thank you....I think I will titrate up tomorrow from 1/4 grain (1 tablet) to 2 tablets (1/2 grain). Im getting there...slowly but surely. 😊

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Oh, thank you. No worries. So you meant to say 1 grain of Nature Throid is about 25mcg of t3?

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Yes.

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I remember reading awhile back 38:9 (t4:t3) for 1 grain. I wonder if the makeup is different in the US/UK? When you say 100:25, is that how it actually feels? Or is there a difference between the one I'm taking? Am I reading this incorrectly?

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One quarter grain is very low. I just go by how I feel and now take 3 NDT per day taken in two doses. I have been on NDT for just one year now and feel just about right.

My best subject at school was maths but it hasn't helped me to feel better. I have no thyroid.

Some of the others on here will help you with your figures.

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Thank you so much. Yeah, I know I'm gonna have to go up on the NDT. One of the docs I'd seen introduced me to the whole T3 only regime, so it's made me consider it. The suspended release thought was bc I noticed when I take t3 only, I do ok, and then crash by midday. But I'm hearing from a few members here, that I need to up my NDT first, before considering the additional t3.

Thank you for replying! We shall see how it goes! 😊

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So bunnyjean, you take 3 grains a day. You said you take two doses. Are they BOTH taken on an empty stomach? So is one of your doses taken before bedtime?

Also, how many tablets are you taking to get to 3grains? Are each of your tablets 1/4 grain? 1grain? I'm asking because I was thinking, if I stay on Nature Throid and get up to more than one grain, which I probably will, should I keep the 1/4grain tablets so I can better tweak the dosing. (I hope that makes sense). So if I wanted to take one grain, I'd take 4 tablets; if I want to take 1.5grains, I'd take 6 tablets, as opposed to having to cut such a small pill to change the doses.

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Hi I take three grains i.e. 3 pills per day. I started off with one half and gradually worked up to 3. I increased by one half every 10/14 days. It does take time and patience. I take two grains i.e. two pills at 6 am with just water and I take the other one around 2.30 in the afternoon. Both on an empty stomach. I read all the information on this site. I was a complete novice when I had my thryoid removed in Oct 2015 as I wasn't on any medication.

Mine are NDT thyroid s. I have found that the most improvement comes with learning on this site and a little bit of trial and error. It is not a quick fix and does take time. Good Luck.

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Thank you for that. If I may ask, how long have you been on 3 without having to dose up? Did you feel the improvement with certainty, or did you have to see the labs to be sure?

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Hi I have been on three for a few months now. I take my temperature each morning and also take my own BP and heart rate each week. I am looking to get my heart rate back down with more exercise.

I was first put on Levo after my operation after only 6/7 months I

was going downhill fast. Aches and pains tiredness. I joined this site and started treating myself with NDT. It has taking months but I now feel much better. I am not on any other medication.

I intend to have my blood tests done in October when I visit the UK these will be done privately. I forgot to mention I also use litmus test papers to find my PH and then alter my diet to suit.

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No - they do not have to be in the same ratio as desiccated thyroid. That ratio was based simply on what occurs in real pig thyroids - and was adopted as a standard.

Although there are not that many synthetic combination products, they seem to split into two camps. Those that replicated desiccated thyroid at around 4:1. And those that purport to replicate human thyroid production at around 10:1.

I wouldn't choose to use two different medicines until my dose at least approached full replacement dose. In my view, you are making life much more difficult without yet having shown that you need to.

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Thank you. That's what I was wondering, whether I should wait. The reason I was intrigued by the slow release t3 is because my FT3 is consistently low and I understand the slow release t3 is becoming more of a common approach for people that fall into my category of poor conversion with Type 1 diabetes and low FT3. I'm concerned to add too much t4 because I'm not converting it anyway, although it could use a little boost. It's just my ft4 is nowhere near as low as my FT3 most is not all of my symptoms are brain/energy related, which I was wondering are t3 Symptoms? Or is there such a thing as t4 symptoms vs. t3 symptoms?

Then there's my last doc who said she was going to put me on a slow release t3 and a small amount of t4, since I was, at that time on Cytomel only.

But like you said, in all the meds, I've only been in very low doses, so perhaps I should just keep titrating up with the NDT alone until I've reached an actual dose.

My FT4 is low but not insanely so, like my FT3. I've gotten so many different doctors explanations but the explanations here are more uniform and for that reason, I coMed here first to see what you all say lol. And I wish I could hug and bring gifts to every last member of this website. Thank you so much.

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Your FT3 is consistently low because you aren't taking a sensible dose of thyroid hormone.

1/4 tablet is a tiny amount and wouldn't be enough for the average hypothyroid flea.

Why don't you just increase your NDT?

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Haha!! I know. That makes sense, what you're saying about not being on enough. I understand. I've been timid with dosing because I'm new to this and I am not currently under a doctor's care. When I first took NDT I had breathing shortness and chest pains that subsided somewhat, when I stopped taking meds. Not entirely, which lead me to think what you're saying that I wasn't taking enough and those symptoms were from the thyroid itself and not the meds. I upped my blood pressure meds and magnesium and haven't had those symptoms since.

I was initially started on 1/4 grain of nature Throid, when I was under a "world reknowned t3 expert's" care. He started at that dose and that brand. I stopped seeing him (for several reasons), but had the prescription refill. After failing to find a subsequent doc who knew anything about thyroid or who recognized FT3 at all, I stopped all the meds for awhile and worked on supplementing my vit d and iron. At the same time, for weeks, still suffering but getting along, I read hours a day, took notes, looked for patterns in my labs, and joined this site, trying to figure out how this all works.

Another practitioner subsequent to the initial doc, told me I needed to be on T3 ONLY. She never tried NDT on me at all. When I asked her on my third appointment, about adding a low dose t4, she said she didn't use t4 at all. She said, "why add t4 when you're not converting. That doesn't make sense. Your FT3 is the lowest I've ever seen....you can cut the middle man and take t3...trust me, I will get you well..."

I know - Totally counter to everyone in the world!! She dropped me as a patient because she said it sounded like I was getting advise from another doctor and it wasn't fair to put her in the middle of it, especially since she doesn't believe I need any t4, with such low FT3 labs.

Around that time is when I joined this site. So I had then, in my possession Cytomel and Nature Throid.

I was really nervous bc I had no thyroid knowledge and was getting different advice from doctors (one who gave me samples of Synthroid 100s mcg and another who gave me Armour Thyroid); though, what was consistent was my hearing of the dangers and adverse effect of thyroid drugs in general. So out of fear of making things worse, I waited until ten days ago to retry the Nature Throid.

Someone here said to titrate slowly, about every two weeks, so that's how I've been going, unsure if I'm doing the right thing. I will titrate up, probably tomorrow.

And I only have about 60 1/4grain tablets left. So I have to find another prescribing doc at least, if not one who can truly help me make gains, at best, before I have no NDT at all. I haven't found any company that supplies TO the US without prescription.

I'm afraid. But I'm a fighter, trying to not give up.

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There are possible problems with thyroid medications if taken at too high a dose or too low a dose for many years.

Presumably you aren't familiar with the UK health system. We have an organisation called the MHRA which, amongst many other things, is the organisation that people have to send complaints to about prescribed medicines - side effects and dodgy medicines, for example. If there is ever a recall of a prescribed medication then the MHRA organises it.

Patients (mostly) and doctors (a few, possibly) send what are known as Yellow Cards to the MHRA to complain about side effects and other problems. The Yellow Card data is publicly available in the UK.

They have data on Levothyroxine (T4), Liothyronine (T3), and combined treatments like Armour and Nature Throid. Their data goes back 50 years.

In the 50 years worth of data there have been 13 reported deaths on Levothyroxine, zero deaths on Liothyronine, and zero deaths on combined treatments. I am not claiming that the data is complete - in fact it will be far from it. But its the best we've got in the UK.

The danger involved in taking thyroid meds is massively over-hyped.

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Thank you...I wondered about that too- how much of this is fear/hype. I realize it's all serious, but also wondered how much of it is my fear based misunderstanding.

Wow....I never knew about the yellow card. Interesting. I have friends from London and they have chatted over the years about your medical system, but I didn't know about the MHRA.

Thank you. Learning has been my greatest tool. Thank you.

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The Levothyroxine report is here :

info.mhra.gov.uk/drug-analy...

and the Liothyronine report is here :

info.mhra.gov.uk/drug-analy...

Both reports include the combined product data as well as the single product data.

Both reports can be displayed in a printer friendly form.

I don't know if you can see them or not, but your friends should be able to. Perhaps they can send them to you via email.

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Thank you!!! Let's see if I can click it...yup! It works. Thank you. I appreciate that you see my reservation is based on unfamiliarity with the drugs. This gives me a bit more confidence. I've been taking insulin since age 5, and when I hear newly diagnosed people's fear about something I've taken for 33years, I'm thinking "ohhh it's not that bad." But I appreciate that it's their first encounter with insulin so it takes experience to gain comfort. All that to say, thank you for your patience with my unknowing/unfamiliarity. I will def relook over these links. 😊

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You are in the US? And you paid $' 3000 to one doc for one visit? Good grief !! And some docs don't take kindly to those that they feel are 'doctor shopping'.

Anyhow, you need some current labs to see where you are at and what is going on. Especially your adrenals, iron, B 12 and D 3 .... they need to be optimal before you can stabilize your NDTdosage.

Do read this information.... tells you about NDT and dosing protocols. Low T 3 in the afternoon/evening? Some folks split their dosage and take their NDT 2 - 3 times per day with no problem.

stopthethyroidmadness.com/n...

As you increase your dosage, do keep a daily log, noting dosage, body temp and heart rate, all taken about 3 - 4 pm. Some Vet vendors and on EBay, mercury thermometers are sold (most accurate). Don't pay a fortune for one. They are a couple of dollars from the Vet Supply and less than 10.00 as a rule on Ebay (you may have to be patient and wait for one to hit the site). If you have to use a digital thermometer, do leave it in longer than required normally, in order to get close to an accurate body temp.

No need to get fancy with the log... be sure to note how you doing and how you are feeling. I am nervous about you doing a T 3 only protocol when you may not have a good grasp on thyroid conditions as yet. You will get more knowledgeable as you study and research. A lot of us do self-treat as many docs are clueless. We use them for labs and prescriptions but we seem to have to paddle our own canoe, so to speak.

Edit.... keeping a log and noting body temp/heart rate can guide you as to when to increase (low body temp/slow heart rate) and when to decrease NDT back to a lower dose if higher body temp and heart rate. Usually increase 1/4 - 1/2 grain every 10/14 days. Usually need to 'tweak' things to find your sweet spot and everyone is different.

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I'm planning to do that- just get an easy going doc who will write the scrip and order the labs I need and I will "paddle that canoe"! It's essentially what I've done all of my life with Type 1 juvenile onset diabetes. But thyroid is a bit more, in my opinion, complex, in this regard as there is not blood meter to self check the thyroid levels; and the medications are more of a challenge to get prescribed.

(I sent you a private message bc I wanted to ask you about docs in AZ.)

Thank you so much. I appreciate your knowledge and look to it with utmost regard.

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Treating one's thyroid can be a complex business for many and the easiest thing in the world for others.

Just remember... before the creation of synthetic T 4 hormone (Synthroid) and the discovery of the cursed 'TSH' test and the labs for T 3/T 4, antibodies, Frees and Reverse T 3 etc, docs could only treat with natural desiccated thyroid hormone (Armour) and go by heart rate, blood pressure and body temp. They also tracked the alleviation of symptoms.

Of course, years back when this treatment protocol was all there was, we didn't have all the chemicals and toxins to deal with. Also all the xenoestrogens (synthetic estrogens and chemicals, food additives that act on our bodies like estrogen).

My grandmother had thyroid cancer and had to have her thyroid removed. This was in the mid-fifties. She took Armour NDT all her life (lived to be 96). It was remembering her medication that encouraged me to ask for NDT when I did so horribly on Synthroid for that year after I was dx hypo. Within a few months, 90% of my hypo symptoms were resolved and my dosage was stabilized. This was in the mid-nineties and I still take the same dosage and am doing well. I was one of the easy ones... one of the lucky ones. My only problem was the inability to convert T 4 to T 3 in my liver. Taking NDT means I don't have to worry about the conversion.

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🤗 ohhh that makes me so glad to hear that!! Stranger or not, I hurt to hear other people suffer or go through the rigor of complex med issues.

im sad that we've met in this context, but sooooo grateful and glad that we've "met". Everyonehere is spectacular. Thank you; I will print out your reply and post it to my mirror to encourage me to keep moving...

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You are most welcome. If anything I say is helpful, I would encourage you to be patient. It took a while for us to get sick and it may well take a while for us to recover. It is a journey and so many wonderful folks (as you pointed out) are here to help us along the way with their encouragement and their expertise.

Getting those hormones in balance (thyroid is just one among a myriad of hormones in the human body... tho an important one) can be a time-consuming process and can take persistence, research, patience and tolerance, especially with docs and well meaning family members who just don't 'get it'.

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Hypothryroid flea!!! LOL. I knowwww. I know. I'm getting it together. I'm scary about all this new info and meds.....I hear you. And I appreciate you so much.

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Helvella-

Have you ever heard of people using a higher ratio where the t3 is greater than the t4? So if t4:t3, let's say for example 10:25 where 25mcg of t3 for every 10mcg of t4.

I'm wondering if after getting to a higher, more common NDT dose, with my conversion issue, would I just at some point start pooling the T4, and still have low FT3, making it necessary to take just a little t4, and a higher ratio of t3.

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Yes - we have had a number of people who were on T3-only and added in a little T4.

When you are on a very low dose, perhaps it is not surprising if T3 is used up as fast as it is made? Just maybe, as you increase dose of desiccated thyroid, your Free T3 will rise without taking additional liothyronine (T3)?

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Ahhhh, I see. I think, and not to point blame at all, when my doc mentioned compound SR t3 and explained with the whole "t4 is crude oil. T3 is refined useable oil. Why give unrefined crude to your car, when it runs on refined oil?" It made sense THEN, but it was when I came here that I was explained, even with conversion problems, in most patients t4 (and the other Ts) are needed for a more concerted thyroid/endocrine system.

Then I became fearful, since I don't convert too well, and was having the breathing troubles on my first NDT trial, that I'd end up pooling the t4.

But I understand what you're saying - I'm not even on enough to warrant trying t3, before trying to get use out of the other Ts provided in a more robust dose of NDT. And it seems more holistic, especially considering the array of symptoms im having.

Yes, I will chill out on the T3 only plan. 😉At least until I've gotten to a real trial of NDT.

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