Help with moving from NDT to T4/T3

[dannyhashimotos]

Been with a private Doctor for a few years but had to move back to the old system. Had the usual meeting with an Endo today. Not going to prescribe NDT, T3 or anything apart from T4 for the foreseeable future. I've run out of my usual supply of NDT and I have not felt this bad for a long time (how did I live like this before?!)

Decided it's time to take my medication into my own hands. I was previously on the best dosage after years of trial and error with my private doc.

75mcg T4 + 45mcg Nature-Throid

Labs:

TSH: 4.9 - FT4: 17.5 - FT3: 6.1

Now I notice that my TSH is slightly too high but it was slowly decreasing over time using the same dose as above.

My question is:

Can anyone advise me what an equivalent dose would be if I was to switch to taking T4 synthetic and T3 synthetic?

Many thanks

[Clutter]

Dannymclauchlan,

You were undermedicated on 75mcg T4 and 45mg NatureThroid to have TSH 4.9. FT3 6.1 is high in range though. How long did you leave between last dose and blood draw?

In 45mg NatureThroid there is 28.5mcg T4 and 6.75mcg T3 so the nearest equivalent dose would be 100mcg T4 and 6.25mcg T3.

I would recommend increasing T4 dose to 125mcg + 6.25mcg T3 (a quarter tablet) and retest thyroid levels in 6-8 weeks to see whether further adjustment is required.

[dannyhashimotos in reply to Clutter]

Thank you for your reply Clutter!

I had been on the 75mcg T4 and 45mg NatureThroid dose for 2 months previous to the blood test. Previous to this I was on a dose of either 90mg or 105mg of Armour for a couple years. Here are two tests from then that are 2 months apart.

90mg Armour: TSH 15.48 - FT4 10.5 - FT3 4.8

105mg Armour: TSH 3.35 - FT4 14.9 - FT3 9.6

As you can see both doses didn't work as it resulted in either a high T3 or low T4.

This is when my Doctor decided it could work supplementing the NDT with T4.

I have a previous result from way back in 2013 when I was taking T4 and T3 for reference as well:

100mcg T4, 20mcg T3: TSH 5.8 - FT4 13.1 - FT3 6

The 125mcg of T4 you mention sounds like the correct dose to me but do you not think a higher dose of T3 is necessary when comparing to my test from 2013?

Many thanks for your help!

[Clutter in reply to dannyhashimotos]

Danny,

Not necessarily. I need to know what time you left between last dose and blood draw to have FT3 6.1.

If you left 12 hours between last NatureThroid 45mg dose and blood draw then 6.25mcg T3 should be sufficient. If you took NatureThroid before your blood test then T3 will peak in your blood and you will get a high FT3 result.

[dannyhashimotos in reply to Clutter]

Ah i see, sorry.

T3 was taken on the day of the test. Roughly 3-4 hours before the blood was taken.

[Clutter in reply to dannyhashimotos]

Danny,

That means your FT3 is almost certainly quite a bit lower than 6.1. I would start by switching to 125mcg Levothyroxine + 6.25mcg T3 which is a dose increase of 25mcg. If you don't feel overmedicated after a couple of weeks you could increase T3 to a 2nd dose of 6.25mcg at bedtime. Hold at 125mcg T4 + 12.5mcg T3 for 6-8 weeks and have a thyroid test including FT3 before increasing further. Leave 12 hours between last dose and blood draw in future.

[dannyhashimotos in reply to Clutter]

Amazing, sounds like the right idea. Thank you so much Clutter. You've been a great help!

[shaws Administrator]

You've stated you take 45mcg Nature-Throid but it is only available in mg.

Nature-Throid is available in 13 strengths ranging from ¼ grain (16.25 mg) to 5 grain (325 mg).

[dannyhashimotos in reply to shaws]

Apologies, I meant mg!

[dannyhashimotos]

Hello Again,

Just started taking my dose of 125mg Levothyroxine and 12.5mcg of Tiromel in the morning. Stupidly thought I was taking 6.25mcg by cutting the pill in half but failed to notice the pill was 25mcg.

Started my dose on Friday - felt great within a couple of hours of taking it!

Saturday dose - felt pretty good and had more energy but then felt a bit rough towards the end of the night, couldn't sleep at all at night time and was up until 3am.

Sunday (today) dose - woke up feeling pretty good surprisingly even though the lack of sleep and earlier than the past few weeks after being on my T4 only dose of 125mg. As the day went on felt exhausted and not able to concentrate and now I have ringing tinnitus in my ears and feel tired but wired all at the same time. This sounds like too much T3 no?

On top of all this I'm suffering from a cold which doesn't really help with monitoring my symptoms. Any thoughts on what to do with my dosage?

Thanks for your help!