Appointment Today, Need Help w/The Maths. PLEASE...

[TappedOut]

Hi All,

Good afternoon/morning:

I'm sorry so last minute, but this issue occurred just yesterday and I need your input, please. I have a doc appointment in a few hours and will need to know what to ask.

Please Note: I am under insurance plan, in the U.S.

So I called for refill on Nature Throid, knowing I had another 120 tablet refill before I go to the doctor today. It was written for 120 tablets of 1/4g. I was instructed to take 2 in the am and 2 in the evening.

However, when I called the pharmacy for refill, as I'm an at the end of the month supply, they said I can't refill because my insurance only allows 90day prescriptions of Nature Throid, effective after the third refill. I wasn't told this when I filled this perscription. This would have been my fourth refill of Nature Throid, which triggered the clause.

I called another pharmacy (it's a chain) to make sure this was correct information, and was told that it was true: my doc will have to write it for 90days in order for me to fill this next round.

However, Im afraid and concerned because I am still on a beginner dose and will certainly be titrating up in the next 90 days; how much, I don't know.

Moreover, I noticed that Im still having a cardiac (palpitations, rushed adrenaline feeling) shortly after taking the Nature Throid. I haven't been doing the am/pm dose split well because my PM doses, I can rarely do on an empty stomach due to timing. So I was going to ask to try Tirosint (a t4 drug with the fewest fillers) along with an extended release compounded t3. My thought is perhaps the compounded t3 will minimize the rushed and adrenal feeling, and also Id only have to take it once a day, eliminating the need for a pm empty stomach.

I am currently on 1.5g a day of Nature Throid.

My question is how much Tirosint and SRT3 would I need to equal 1.5g of Nature Throid?

Or

Should I just stay on the Nature Throid for 90 days and work on my low iron? It's a precarious situation as I'm just starting treatment and this insurance clause forces me to stick to a med that may not work and may lock me out of trying an alternative.

I'm going to google this info, and work on finding the maths myself, but as my appointment is in just a few hours and I need to know concisely what to ask my doc, I hoped you could help me while I try from my end as well.

More hands on the problem, if you will. Please help me, if you have time?

Thank you so much. This is such a trip!

❤️TappedOut

[shaws]

I am sorry you are being restricted to 90 days NDT. Some people get well on 2 to 3 grains but some need up to 6, depending on 'how they feel' on particular doses.

You don't need to split doses, one daily dose is sufficient. As you say it is inconvenient when we have to have an empty stomach etc and try to take second dose at the same time daily, which can be impossible.

1/4 grain of NDT is equal to about 25mcg of levothyroxine, 1 grain = 100mcg of levo, so your dose is quite small. One of our doctors stated that 200 and 400mcg used to be the 'usual' doses and we are getting too low a dose nowadays to enable us to recover.

The usual way to increase NDT dose is to start on an equivalent dose of levo, if you were or 1/2 grain to start with 1/4 increases every week or two until relief of clinical symptoms, taking pulse/temp before you begin and several times a day until you are on an optimum, i.e. you feel well.

Some people find T4/T3 helpful so if you are restricted to a dose of NDT instead of an optimum, you may well have to add Tirosent. Palps etc can also be due to being on too low a dose (as well as high) but you aren't on a high dose. Our body needs optimum thyroid hormone replacement in order that our heart and brain (they contain the most receptor cells) work normally. Your insurance company should allow a dose for you to feel well, not to keep you restricted so that you still have symptoms.

I am not medically qualified but had undiagnosed hypothyroidism.

[TappedOut in reply to shaws]

Hi Shaws. Thank you so much. I'm doing the math now....I think I will ask him then, to write it as though I'm on 5g/daily. So that if in the 90days I need to titrate or lose tablets or whatever, I'll have back up.

I had been splitting dowse to minimize that rushed feeling. But I've read that a low ferritin/iron can also make people, even on a low NDT dose feel that way. That's why I'm so ticked with the 90day requirement bc it forces me to pick meds and I'm not yet on anything really! Not enough to make a solid choice about what med to use.

I don't know if I take Tirosint/compounded SRT3, is that inferior to a Nature Throid or Armour Thyroid? Do you know?

Thank you so much for your quick reply. I appreciate this very much....

[TappedOut in reply to shaws]

Hi Shaws and Clutter - I've been on the phone since last message, trying to figure this out before the appointment today.

I just called my prescription insurance and was told if he writes for a different strength I can do 30 day supplies; so the clause is triggered when it's three refills of the same drug, same strength.

After three refills of any drug, am I required to get a 90day supply prescription for that drug.

So I will have him write it for 90 tablets of 1g. That way in the thirty days I can titrate and will also be covered if I lose a tablet or if something happens that prevents me from getting to the pharmacy (like Hurricane Harvey did! Ugh!!)

[shaws in reply to TappedOut]

Glad you sorted that out and you will be relieved. If you want specifically to alert members to your post you put an @ before name, i.e. Clutter and a list will appear below and you click on the one you want.

[TappedOut in reply to shaws]

Thank you Shaws. Got it....

[Clutter]

TappedOut,

Presumably your GP will check TSH, FT4 and FT3 to ensure 1.5 grains is sufficient dose.

1.5 grains NatureThroid has 57mcg T4 and 13.5 mcg T3. If you decide to switch you may have to switch to the nearest commerically available dose unless you are able to get T4 and T3 compounded.

[TappedOut in reply to Clutter]

Hi Clutter...thank you so much for your quick reply! I appreciate it. I think I can get the t3 compounded - as long as he will write the scrip; and I was going to try to Tirosint. I guess I could ask for both to be compounded but if I can use my insurance for the t4 that'd be most financially helpful (compounded drugs in the states you have to pay for, no insurance allowed on compounds).

Thank you Clutter.

[Clutter in reply to TappedOut]

TappedOut,

Why do you need T3 compounded? Perrigo Liothyronine or Pfizer Cytomel should be available on insurance but they're not slow release.

[TappedOut in reply to Clutter]

Oh because I wanted to do slow release. I took Cytomel and had that same rushed adrenal feeling. So I thought perhaps I need to improve my iron, but in the meantime, try a slow release so I don't get that palpitation

/adrenaline rush feeling. My blood sugar also spikes when I have that feeling (I'm a type 1 diabetic). It's horrible. It fades but takes several hours.

I know I could split the dose to slow the release, but I haven't had any luck with PM doses (having to be on an empty stomach, and four hours away from minerals...difficult )

You think compounding t3 isn't a good idea? I've heard mixed reviews on it.

[Clutter in reply to TappedOut]

TappedOut,

I have no opinion at all about slow release or compounding. Neither is readily available in the UK.

If you get blood sugar spikes after taking regular T3 you should split the dose. Taking T3 morning and bedtime should give plenty of time to work around empty stomach & vit/mineral requirements.

[TappedOut in reply to Clutter]

i count three hours from food, so the stomach is empty. Then take the med. Then wait another hour to eat. Then three more hours from eating to be four hours away from minerals (iron, for example). For me, it's so hard to be consistent with all that, since I work odd hours and with diabetes, I never know when I'll have to eat to cover a low blood sugar...

[Clutter in reply to TappedOut]

TappedOut,

Women need to allow 2 hours and men 90 minutes for stomach to empty after food.

[G2G2]

TappedOut

I'm also a T1 in the US. Hypothyroidism plays havoc with BG control. Every time thyroid dose is increased (I'm on NatureThroid &T3), I have to up my insulin. Something about thyroid supplementation increases insulin resistance.

Relate to your problem about dosing around food. I have the same dilemma made worse by gastropareisis. I never can be certain when my stomach's empty except for the morning.

I haven't been able to get WP or NatureThroid refilled because there's a shortage.

[TappedOut in reply to G2G2]

Hi G2G2,

Thank you so much for your reply....the blood sugar game with this stuff is....phew!!!! And I have gastrparesis as well. It's takes me about 4 hours or more to empty.

If it's ok, I'm going to PM you, cause same here, since that original post, no Nature Throid available. Can't even get through to the 800 number.

[G2G2 in reply to TappedOut]

Sure, PM me. Sorry to meet another gastropareisis sufferer. No NatureThroid anywhere--waaa. CVS couldn't tell me when it'd be in stock.