Thyroid UK
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4 Grains. Stop, Lower, Raise?

Hi All! Happy New Year. I have been for six months now, titrating my way up from a 1/8grain beginner dose to a functional dose. I wonder if and how I should lower my dose, stay where I am, or considering that I still have nagging symptoms, increase it.

Admittedly, I’m far better than I was when I first found my low ft3. I had 17 symptoms, low Vit D, low iron, and many other symptoms, initially. Now, I only have hair loss, no hair growth, joint pain, random palpitations, sensitive to light (though improved), very dry and itchy skin. If anyone has experience, would you mind looking at my recent lab numbers, below? Thank you so much. This website has been my sole source for improvement and I thank you all, always.

Currently taking 4grains of NP Thyroid daily. I also take NAC and adrenal cocktail. This week, I skipped one day if NP as I am considering taking 3grains 2 days a week, and 4grains the other 5 days (average of 3.7 grains a day).

Here are my recent labs:

Ft3 4.6 (2.0 - 4.4)

FT4 1.54 (.82 - 1.77)

rT3 32.3 (9.2 - 24.1)

Vit D 79.4 (30 - 100)

Iron 182 (27-159)

TIBC 226 (250-450)

UIBC 44 (131-425)

Iron Saturation 81% (15-55%)

*When I started this journey my ft3 was 1.9. Vit D was 20.

29 Replies
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Does one grain contain 38mcg T4 and 9mcg T3, which means you’re taking 152mcg of T4 & 36mcg T3?

I think you’re over medicated

Do you have your TSH result and range? How long have you been taking 4 grains? What increment dose and how often have you gone from 1/8 to 4? When was your last blood test? And are they the ones above?

What vitamins and minerals are you taking?

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Thank you. Once on NDT, the TSH is ill advised because it’s suppressed by the NDT. So this last round of labs it wasn’t tested for the reason. So that’s why we look to the FT3 and FT4 once in NDT, to assure FT3 is within the upper quadrant and FT4 is in the upper half of the range.

I went from 1/8 to 4 over a span of 6 months. I titrated slowly. I’ve been at four grains for about two months.

Yes, those labs listed are most recent.

Regarding minerals/supplements I take:

1)Reacted Powder 2)Magnesium, NAC, 3)Ferrous Fumarate Iron, 4)adrenal cocktail (vitamin c + cream of tartar + sea salt),

5)prescribed compounded progesterone, and

6)Adren-All.

Occasionally I take Evenin Primrose Oil as well as Biotin.

I appreciate your kind reply. Thank you. I am considering, as you mentioned, lowering the dose.

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As long as your ft3 & ft4 are in range than you are not over medicated unless you have symptoms that indicate for YOU it is too high. Sweating, loose bowels, & shaking or a tremor are common signs.

Your ft3 is right at the very top of the range so I definately wouldnt go any higher.

How do you feel?

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Thank you so much for your reply. Overall I feel better than I did a year ago when I started the thyroid journey. However, I still have some tissue swelling, scalp hair loss, no scalp hair growth (in the same area where the patches of loss are), weakness, joint/muscle pain (early in the day/upon rising), and sensitivity to bright/computer light.

Oh and my heart rate spikes with exertion. I was a runner before all of this and now, if I go up one flight of steps my heart rate spikes (120-140).

But I’m trying to stay positive because, despite the remaining symptoms, I’m light years better than I was before starting thyroid medication.

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Changes in the endocrine system are slow. If you have not been on your max dose for long it could be that your body needs more time to adjust to your new hormone level. I don't take ndt so don't have direct experience.

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Thank you for your reply. Yes, I haven’t been on this much for long. Two months. But between this lab and my last, my numbers have changed. I don’t think, even if I should go up in dose, that my doc would write the scrip for it. I have read some people on as high as 6 grains. But I hope, like you mentioned, it’s just that I need more time for the endocrine system to adapt to what I’m currently taking. I sure hope it gets better all . It’s been so long.

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Iron over range, TIBC under, UIBC very very under range an iron sat very over 😮 I don't know the significance but you should find someone who does quickly ... Too much iron is very dangerous, stop supplementing and et expert advice urgently . Please.

Your Ft3 is top of but not over range so no need to reduce NDT unless you feel over medicated

Found info on iron status results, link below

labtestsonline.org/tests/ir...

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Thank you so much. When I first started thyroid medication, I was concerned with my, at the time very low ferritin. I asked my OB-GYN, Internist, and Gastoonterologist about possibly iron absorption being of issue (esp since I had knee length hair and now have big plugs of hair loss). Of course, not one helped me investigate further as the iron labs I provided in my post were not yet where they are now. I have stopped the iron supplement and have an appointment with my thyroid doc soon. I will check the link you provided as well. Thank you so much. I wondered if my current dose is too high namely bc the hair hasn’t come back and because I still get occasional palpitations....but it could be the iron issue. Hopefully I can get this sorted out.

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Hello TappedOut,

My apologies for not replying sooner. I’m in 🇬🇧 and fell asleep because of the time difference.

Iron needs investigating. Your Fts are good but your rT3 yikes. I’m ho long one of our more experienced members will see this soon and help. I’m wondering about ferritin & foliate intake. And also a good vitamin B & b compound. Sorry to be so vague but I’m not sure of what you are tested for Stateside. And what 6& 1 contain.

I love the adrenal cocktail. I raise a glass to the lady who suggested it to me. I was told pink / Himalayan is best.

All the best,

Ebony x

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Aw thank you so much Ebony! Yeah, I feel better when I drink the adrenal cocktail. Idk if it’s in my head or what, but I’m glad to take it. 🙃 yes, I’m havibg the iron situation looked at again. I have always suspected something there, but my labs never came back like this one did. So hopefully I can find some help soon.

Thanks again.

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Its a shame youy haven't had anyone come in to comment on the high rT3, as it's what I was curious about. Theoretically this is a very high result, and something to be concerned about, but it's hard to find advice on what to do about it. I self medicate with NDT, and have wondered if I may have this issue, and just about to test. What I'm considering is dropping some of my NDT, and replacing with T3, so there isn't the T4 sloshing around to turn into rT3. But this is a bit of an educated guess rather than based on any expert's advice.

I also think you've got a decision on your hands about whether you want to increase and allow your freeT3 to go over range. The traditional way to dose NDT is to carry on raising until you get hyper symptoms, and then drop back a bit, and you've found your dose. I think quite a few long term members have over range freeT3, but it's not talked about very much, and some people don't even get the tests, but just does purely on symptoms.

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The dilemma is, though, that if you could clear out that rT3 you'd probably be getting more benefit from the hormone you're taking, as it's thought to block T3 receptors and stop the active hormone get through. Although I recently heard someone very knowledgeable (I think Diogenes) say this view may not be true.

I wanted to link Diogenes name, but have forgotten how to do it!

Edit: found out how to do it, can you give any advice on this topic diogenes

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Thank you so much.❤️❤️❤️❤️❤️

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Thank you so much for your reply Silver. Yes, my rT3 has never been high. Until now. I wondered if it and the iron have any association. I have heard others say what you mentioned, about adding t3 and pulling back on their t4 dosing.

Yes, the symptoms have much improved but still some remain. So I was wondering if I should titrate up more, but when my labs came back as they did my doctor, and pharmacist said to hold off and give it several weeks for the body to catch up. I understand it’s very difficult to get a doc to write a scrip for anything over 2-3 grains. So I hope I don’t need to go over the 4 grains I’m already on. It seems like I’m getting better in some regards and worse in others, namely my iron uptake and rT3.

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Receptor blocking has clear evidence against. rT3 and T3 have different receptors and there is a paper somewhere which shows this clearly. I think Wiersinga is one name but I wrote a post on this some time ago showing the paper.

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Thank you silver fairy! I’m on it! Thank u for this❤️❤️❤️❤️

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Thank you for this. I think silver fairy found the link...I will check it out.

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Excellent. Silver fairy found the link you’re referencing. I appreciate you both. ❤️❤️I’m reading it now...

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Can I just add as someone who is on a ndt & has been for years the advice is to keep your ft3 in range. It can be at the top of the range thats fine but not over range as a general rule. Thats the advice I had from a well thought of endocrinologist experienced in ndt. Too high a ft3 can cause heart problems in the long term. So dont go higher!

6 grains is a high dose & it would be unusual to be on that high a dose. The average is around 3-4 grains but we sre all individuals & what is key is sytematically working out what you need for your body & keep reviewing.

Two months on that dose of ndt is a short period of time. I was once told that to allow as much time to recover as the time you spent being ill. There are no fast fixes in the world of hypothyroidism. Its all slow. Very frustrating but in this scenario its the tortoise that wins the race not the hare. Careful methodical slow changes in medications & supplementation are key as whatever the medics might say you have to try these things out. Make ONE change at a time & then wait to see the effects. It all takes time...

I do know that when I was trying to sort myself out that you have to be careful particularly with adrenal supplementation & repeat saliva testing is necessary. I over did my adrenal supplementation & it gave me palpitations & I felt weak. My adrenals recovered once my thyroid hormones levels were restored & had been for a while. I did not need ongoing long term support. So after a while I was able to withdraw it.

You said you had been supplementing with iron. Its good you've stopped as you are over range. Being too high in iron is not a good thing. You might find the following link helpful.

labtestsonline.org/tests/tr...

Am no medic but please be careful when supplementing. No matter how naturally done it can be overdone & some vitamins & minerals/ like vitamin D & Iron the body cannot excrete. So particular care is needed when supplementing with these.

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Waveylines thank you. I noticed my FT3 on this last lab was over (I was at 4.6 and the range is 2.0-4.4). And I was concerned, and you touched on it, whether my two months was enough time to really tell whether I should move the dose. I will heed your advice and not go up, give it some time. Yes, I was told to try the adrenal supplement, but I never really took it daily, to be honest and lately I don’t take it at all.

I’ll be interested to see what my doc says at my next appointment, regarding these labs and the iron panel as well.

I appreciate this note from you and will reread it. It really speaks to my concerns. I won’t titrate up anymore. And I think I’ll skip the adrenal supplement for now too. I had already decided this, but your most recent reply gave me a good supportive explanation.

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Glad it helped 😊😊

Hadnt clocked your Ft3 is a little over range. Did you leave a 24hr gap between last taking meds and testing -first thing fasting, taking meds afterwards? If you did I would lower your dose a tadge. Maybe try 3 3/4 grains. Or alternate 4 grains one day 3 3/4 the other day. Its important to keep the ft3 in range.

When I go too high I feel tired.... Dont panic though as its almost inevitable that you end up going over a little to find your 'sweet spot' just simply drop it a little. You will be fine. Its another reason why the tiltrating upwards is done slowly to avoid shooting miles past your sweet spot. 😊

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Yes, I took the meds after the blood draw - having taken the last dose the morning before the blood draw.

I was thinking I’d lower very mildly, as you suggested. Last week, I took four grains every day and skipped the medication 1 day (Sunday). What you mentioned about alternating 3 grains and 4 graibs, that may be my next step if in a few weeks I need to lower even more.

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I think your FT3 levels are about 20% higher on the day you take NDT, so I'd agree with those who say you are slightly overmedicated.

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Thank you for your reply Anna. 🙂

What do you mean, 20% higher on the day you take NDT? Does that apply even though I didn’t take it before that blood draw? Does that mean my results are actually lower?

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What I have read is that, given how fast T3 is metabolised, you have to assume your FT3 levels were +/- 20% higher the previous day, provided you let 24 hours pass between taking meds and going to the lab. To give you a practical example: my lab uses the following reference ranges for FT3. 1.7-3.7. So I aim at FT3 levels of 2.9 or 3.0 24 hours after taking NDT, which means my FT3 levels were approximately 3.4-3.5 the previous day...in range, but the upper part of range. I have also noticed that is where I feel best, without any hypo or hyper symptoms.

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Well good luck. Remember one change at a time and then wait to see the effects. If you do more than one change you wont know which change is causing what & the picture will be confusing. Its tedoius and painfully slow but worth it in the end.

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Today is my 39th birthday. I was feeling pretty down, until now. God bless u and thank u so very very much...I will remember this message when I’m feeling discouraged. I will try and hang in there...

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Happy Birthday!! Yay!!

Glad you feel more positive. Everyone on here are so lovely and offer such great support. I have had wonderful support over the years when I was sorting myself out or combating the system! Its hard getting better on your own......knowing theres other people out there who have knowledge, experience & understand really helps. 🙂

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