Thyroid UK
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If I Don't Have a Conversion Problem, Could NDT or Adding T3 Still Work for Me?

All,

So far I do not think I have a conversion problem as my FT3 is rising while my TSH is going down while taking 75 mcgs Tirosint daily. However I still have hypo symptoms (I also have Hashi's).

With that said, can someone comment as to if one does NOT have a conversion issue, would NDT or adding T3 to a T4 only regimen potentially be better?

Latest Results:

TSH 1.3 (range 0.45 - 4.5)

Free T4 1.48 (range 0.82-1.77)

Free T3 3.1 (range 2.0 - 4.4)

Do you really have to have a conversion issue for NDT or additional T3 to be of benefit to you?

Thanks!

Rose

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Thyroidrose,

How long have you been taking thyroid replacement?

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Hi Clutter,

I started very low with 13 mcgs of Tirosint in April of this year. I had to work up slowly, and have now been on 75 mcgs for 5 weeks.

Rose

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TSH 1.3 (range 0.45 - 4.5)

Free T4 1.48 (range 0.82-1.77) Result is 69% of the way through the range

Free T3 3.1 (range 2.0 - 4.4) Result is 55% of the way through the range

People vary in their response to T3 and NDT. Even if their results before starting either of them are quite good they may still feel better adding one or the other, or switching to one or the other.

Your results above show that you have room for an increase in your Levo. Many people feel best with a TSH of 1 or below, and some people even need their TSH to be a bit below range to feel good, but some doctors get twitchy with very low TSH which could be a problem.

If you increase your Levo then your Free T4 should rise a bit (and it does have room to do so), and it should increase your Free T3, which is rather lower than ideal. Some people need their Free T3 to be 70% or 80% or even 90% of the way through the range.

I would suggest that you have a couple of choices. You could switch over completely to NDT, or you could add some T3 to your current dose of Levo. There are some people who do well with NDT + small dose of Levo, and others who do well with NDT + a small dose of T3.

People disagree on how much NDT and T3 are "worth" when comparing to Levo.

Personally, I believe that 60mg or 65mg (depends on brand which size is sold) of NDT is "worth" about 60mcg or 65mcg of Levo.

And T3 is "worth" about 3 times as much as Levo. So, 25mcg T3 is "worth" about the same as 75mcg of Levo.

There are others who would say that both NDT and T3 are more potent than I've suggested, and use a conversion of roughly 1 grain of NDT = 75mcg - 100mcg Levo, and 25mcg T3 = 100mcg Levo.

I think NDT is a bit easier to get hold of than T3.

So - a suggested course of action :

1) Increase your Levo by, say, 12.5mcg, and see how you get on. Get new tests done after 6 weeks,

2) Next experiment - switch to NDT alone. It's impossible to know in advance how well you will cope with a treatment which contains T3.

Info on how to switch - note that these links have different suggestions on how to switch :

stopthethyroidmadness.com/n...

tpauk.com/main/article/how-...

thyrophoenix.com/adjusting_...

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Humanbean this is excellent information, thank you.

I have an appointment this Tuesdsay with my regular endo (who isn't into prescribing NDT) and then an appointment with a holistic MD the following Tuesday, and she does prescribe NDT. I wasn't sure if I should even ask to be switched to NDT if I didn't have a conversion issue, or if i should simply give the Tirosint more time (have been on my latest dose of 75 mcgs for 5 weeks).

It's so hard to wait and to know what course of action to take!

Thanks again,

Rose

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You don't need to have a conversion problem as NDT has been in use since 1892 and was the first only life-saving thyroid hormone. Before that we died of fatal myxoedema coma and were prescribed up until the 60's when Big Pharma wanted a share and in UK doctors/endocrinologists were paid to do so (maybe all didn't succumb but a lot did).

stopthethyroidmadness.com/m...

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Excellent thank you!

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Considering it was the only hormone replacement from 1892 up until it's prescribing was withdrawn in the UK although you can still get some private doctor to prescribe (just like T3 is at present) without just cause.

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Thanks Shaws, I am fortunate to be able to have found a doctor here in the US near me in Tampa who will prescribe NDT. I just wasn't sure if I should increase the Tirosint a tiny bit first before completely giving up on it.

I do feel a bit better, I am no longer experiencing the amazing fatigue crash at 3 pm every day. But my head is still woozy and filled with fog, plus I wake up feeling like I have been run over by a truck. I know this is not right and I have room for improvement.

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You can switch straight over to NDT in an equivalent dose of Tirosint you are taking. i.e. 1 gr is approx 100mcg of T3. Always take pulse/temp before beginning so you have a starting point. Sometimes we can feel quite hot but temp remains the same as we might reduce unnecessarily thinking we're on too much.

You increase dose by 1/4 tablet every 2 weeks until you feel much better and have relief of symptoms.

You can try an increase in Tirosint but it will take about six weeks for you to feel a benefit (I believe) as it takes that time to be absorbed.

This may be helpful if you decide to switch.

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

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Thyroid medication is only part of the picture. Do make sure that your vitamins and minerals are checked. Thyroid medication and conversion are best if nutrients are good.

Have you had antibodies checked? If these are above range you have Hashimoto's which is a very common form of hypothyroidism. Going gluten free helps those of us with high antibodies.

Be patient - as I expect you are discovering improvements take time and it's not worth rushing them.

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Thank you Anthea for your reply. My B12 is near 700 and folate is over 20. Vitamin D is 60 which I hear is good. And yes I do have Hashimoto's.

I was gluten free for a month and a half but it didn't improve my symptoms. I am now eating gluten-containing foods again as I am going to have food sensitivity testing soon and from what I understand you have to be ingesting any offending foods in order for it to show up positive on the test.

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Have you had vitamin D, folate, ferritin and B12 tested. Essential they are optimal not just in range

Are you on strictly gluten free diet? Or tried it?

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Hi slowdragon, my B12 is near 700 and folate is over 20. Vitamin D is 60 which I hear is good. Ferritin was scary low last year but with Mirena and ferrous fumerate it's now up over 77.

I was strictly gluten free for a month and a half but it didn't improve my symptoms. I am now eating gluten-containing foods again as I am going to have food sensitivity testing soon and from what I understand you have to be ingesting any offending foods in order for it to show up positive on the test.

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Very unlikely to be coeliac - only thing that show's in test

Most are gluten intolerant - no test

Or just leaky gut allows gluten to cross into blood from gut leading to raised antibodies

Read about Molecular Mimicry

amymyersmd.com/2015/07/the-...

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Gotcha, I didn't know sensitivities to gluten wouldn't be picked up on food allergy testing! Ugh!

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