Thyroid UK

Getting Erfa Thyroid dosage right

Hi,

I am still struggling to get my Erfa dosing right. I just can't seem to get on top of my health. I switched from Levothyroxine to Erfa a year ago. I currently take 90mg/1.5 grains in the morning and 60mg/1 grain in the afternoon.

I feel absolutely terrible. I felt really dizzy today and utterly exhausted. I'm not sleeping well and wake several times at night and wake very early and can't get back to sleep. I'm a Mum to 2 including a 2 year old who doesn't like sleeping. My Husband does most of the night waking duties, but I am still disturbed by them. This is because my Husband knows how much I suffer without sleep.

I'm feeling really low and anxious. I upped my Erfa due to sudden hair loss and not feeling great, but I've been on the extra 30mg 3 weeks now and I'm not feeling better.

My GP's are being useless and are no help with my thyroid. My Holistic Doctor told me to up my Erfa, but I don't know how to know if I've got it right or wrong. Can anyone offer any guidance please?

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This is the only method I know about using NDT. You start on a dose equivalent to what you were taking in levothyroxine.

Then after two weeks you increase by 1/4 tablet and so until you are symptom-free. One daily dose with one full glass of water and wait an hour before eating.

web.archive.org/web/2010112...

When you have blood tests for thyroid hormones it should be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours from your dose of Erfa and the test.

web.archive.org/web/2010112...

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Thanks for your reply. I couldn't see much mention of correcting dosage in this article although it is very useful for reference.

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Have you had your adrenal status checked? If your cortisol levels are low, NDT can make you feel worse. Without enough cortisol, thyroid hormone cannot make its way into the cells where it's needed, but stays in the blood and can cause the symptoms you describe...adrenal fatigue is very common in people who have been hypothyroid for years. What is the cause of your hypothyroidism; autoimmune or something else? Do you have any recent labs to post here?

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You are taking 2.5 grains of NDT, equal to around 250mcg of levo. Is this a bit too much?

How did you arrive at this dosage? i.e. was it prescribed for you?

What was your starting dose?

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Hi Shaw,

It may well be too much NDT. I really don't know which way I'm facing :-(

I'm not really getting a lot of help from my Holistic Doctor. He started me on 2 x 30mg daily a year ago and told me to completely stop the Levothyroxine, which I did. I completely bottomed out and felt awful.

It took until the Spring of this to start to feel better.

My Doctor told me to drop the dose by 1/2 a grain in June which I did. But I really don't know what dosage I should be on now. I really don't know how to tell when I'm on the right dose. It's worrying me now.

I saw my Doctor at the start of October and he told me he didn't think I was Hyper, but still Hypo so told me to up my dose again. That's why I upped it by 1/2 a grain. So I've no idea what I'm doing at all!!! Sorry.

Thanks for your advice and help.

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There may be several reasons that you are not well with an added possibility that perhaps ERFA doesn't suit you.

Your holistic doctor asked you to up the dose. Was this based on blood tests that he has looked at? Do you have any recent thyroid function blood tests? Do you have other blood tests done? Ferritin, B12, Vitamin D? Please share them and I am sure you'll receive some good advice.

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Hi ResearcherUK. Yes I've considered that Erfa may not suit me. I feel better on this than I did on Levothyroxine though. Less brain fog and I've lost 2 stone since I started taking it, but I'm still obese at just under 15 stone.

My Holistic Doctors advise to up the dose was based on me explaining my symptoms and from blood tests taken in early September.

These were from a blood spot hormone tests done via ZRT labs:

Free T4 - 0.9

Free T3 - 2.9

TSH - 0.2

TPOab - 79

Cortisol - 12.1

DHEAs - 53

SHBG - 39

Testosterone - 15

Progesterone - 5.4

Estradiol - 75

When I took the above results they were done in the first thing in the morning and I was taking 2 grains of NDT/Erfa thyroid.

I've recently had a blood test done via my GP to test my thyroid, ferritin and B12. I can't get them to give me a copy until I've seen my GP and that's not until 14th November. All they've told me I need them repeated in 2-3 months time! Aargh! Not amused. It doesn't help that my GP is leaving shortly and me and my whole family will be moved to a new GP (the story of the NHS at the moment) so I don't think there is much follow through. Our town only has one GP practice now as well so it's very overstretched.

Thanks for all your help and guidance.

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Thanks for the additional information and the confirmation that you have seen some improvement with NDT which is a good sign. What helps if you please add the lab ranges. This will give us a clue whether your FT3 levels are optimal or not and a glimpse on your adrenal functions with the DHEA and cortisol, and hormonal status.

A TPOab - 79 may point towards Hashimoto's. The standard reference range should be Less than 35 IU/mL.

Again the lab range will confirm this.

The gluten-free diet has helped in reducing the antibodies. The other co-factor is selenium which helps in the conversion of T4 into active T3 and reduces antibodies. Also, many Hashimoto's sufferers have found that dairy is a major trigger and once they have eliminated it they began to feel better.

More to follow!

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Researcheruk I'm so sorry. I completely forgotten to reply and thank you for your response. Your help was much appreciated.

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No probs! You are welcome!

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