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Thyroid UK
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Starting combination treatment

Hi all,

I'm still having a lot of hypo symptoms and last dose increase didn't seem to change anything in my opinion, currently on 125mcg of levo. I did notice some improvement after the introduction of vitamins/minerals. Levels will be checked in about a month by my GP. In about 2 weeks I'll be doing thyroid tests and depending on results I'd like to start combination treatment then.

Since my endo is not willing to prescribe T3 I managed to obtain my own supply of Novothyral. Obviously, the dose will have to be adjusted depending on my next blood work. For the time being, I'm trying to figure it out what is the equivalence of T3 to T4 as I've seen different people stating different things that T3 is 3x stronger than T4 others say 4 or even 5 times.

Can you please clarify?

17 Replies
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Before starting T3/T4 combo have you retested your vitamins to see how improved they are

Ferritin needs to be half way in range

B12 towards top

Vitamin D at least around 100nmol

Presumably you have high thyroid antibodies which is Hashimoto's also called Autoimmune Thyroid disease

If so are you strictly gluten free? If not likely to be necessary to help T3 work

Hashimoto's affects the gut and leads to low vitamin levels

Low vitamin levels stop Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

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As I've mentioned in my post I'll be doing all relevant tests in the coming weeks, some by GP, endo, hematologist or privately. So no I haven't retested them yet. Unfortunately, I can't afford to pay for everything privately and have it in one go. I'll be also checking my antibodies to check if they went down since going gluten-free 2,5 months ago.

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Gr8Nica

I have seen 3x and 4x.

Some previous threads asking the same

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

You just need to experiment and find the dose that suits you, regardless of equivalence I think. What is actually in the Novothyral that you have got, I see from Googling that there are different strengths ie 75/15 and 100/20 so those are obviously a fixed 5:1

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Ok, I get it now. Thanks.

The Novothyral I got at the moment is in 75/15 strength. I can always get a stronger dose in the future. I was thinking to start low and slow by mixing 1/4 or 1/2 of Novothyral with Levo and build it up depending on symptoms.

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Gr8Nica

Is there any reason you're not adding T3 to your Levo? You may not need the extra T4 in Novothyral.

Why not post your new test results when you do them in a couple of weeks and we can suggest if just adding T3 is a better idea.

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It was easier and cheaper for me to obtain Novothyral as it's the only product containing T3 in my home country. I realize it's not ideal but that was my 1st alternative. If that won't suit me I might move to the next one.

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Oh, I see. In that case, it might be possible to balance T4 and T3 doses by reducing your Levo. Experimenting and tweaking hopefully will find the right levels for you :)

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That's exactly what I was thinking to do :)

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Assuming your Novothyral is 100 + 20.

If you're feeling hypo on 125 Levo:

Drop Levo completely and replace with full tab of Novo either at once in the morning or split 4-6 hours between.

See how you're doing and if your happy with the replacement.

Don't be afraid of overdosing on t3 on 10 mcg. You won't.

I take big doses. From 50 mcg at once in the morning to 125 total a day. Splitting much, like some people do to get to 5mcg or even 2.5 mcg, never worked for me. Too much faff and no real working improvement.

I believe 10mcg is such a small dose anyway. Even my Endo when prescribed 1st time, though was quick to install undeserved fear of t3 in me, told me to take 10mcg as the lowest dose.

If you feel too much heart pounding, after taking half a tab of Novo, you'll need to reduce to 1/4. Though I doubt you will. Been there on 10 mcg, done that never felt it.

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I have Novothyral 75. As much as I would like to take the whole tablet I'm not sure if that's a good idea at the very beginning. I tend to react differently to meds. Some have a stronger effect on me (need to take half a tablet or less), some work slower than they should and some make me sick.

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Gr8Nica,

T3 is 3 x more potent than Levothyroxine.

ncbi.nlm.nih.gov/pubmed/204...

What is the Novothyral dose?

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It's 75/15. 15mcg of T3.

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Gr8Nica,

Half a tablet of Novothyral 37.5mcg T4 + 7.5mcg T3 is equivalent to 60mcg T4. You could reduce Levothyroxine to 50mcg/75mcg alternate days to average 62.5mcg and start with half Novothyral to see how you tolerate the T3.

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Once I get my results I'll post it and ask again for appropriate dosage advise. Just to be sure.

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What kind of Novothyral are we talking about? 100 or 75?

Starting from 125 T4 and CONFIRMED hypo (I completely agree with the above advice to wait for a full set of hormones, antibody, minerals test) would make perfect sense to start with one tablet of 100, which is 100 T4 and 20 T3 (aprox 160 T4 equivalent)

If unconfirmed hypo from tests, you could try 1/2 tablet Novo 100 (approx 80 T4) and 50 T4

From my experience (Novothyral user), but again, corroborated with test results, I would choose 1 tablet, but split into 2 doses, even 3 if not too complicated (and observing the optimum absorption protocol in respect to food and beverage intake)

Start small with the T3, it can be an overwhelmingly good experience the first pill but be careful, not everybody it seems to take very well on it.

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Novothyral 75. I was thinking to mix a small amount with my Levo. I'll see what is the whole picture once all tests are done.

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Ok, so 1 tablet of N75 would be a rough equivalent of your current dose of T4.

Would make sense to start with 1/2 N75 and 75mg T4, in two daily splits, just to see how it works.

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