Question about NDT

[Alli1]

I take Erfa Thyroid 90mgs daily in divided doses of 30mgs. I was on Levi for many years but eight years ago seemed to have a blip on it and went onto Erfa ( private Endo prescription) however recently have been suffering from headaches and wonder if my dose is too high. My bloods always show a below normal TSH my FT4 is 14 (12-22) and FT3 mid range. I’m wondering why FT4 is so low when on NDT even though the dose of T4 is 50mcgs in each 30 mg tab Erfa. When I was on levothyroxine I was only on 100mcgs daily and my FT4 was upper mid range. I feel that having a lowing FT4 is making me feel hypo

Any thoughts very much appreciated

Thank you

Alli

[Clutter]

Alli,

There's 52.5mcg T4 and 12mcg T3 in 90mg Erfa which is equivalent to 88.5mcg T4 so you may be a little undermedicated.

It's fairly common for FT4 to be a lot lower on NDT, sometimes below range. Most people on NDT are optimally dosed when FT3 is in the upper third of range. You might want to increase dose by 30mg.

[Alli1 in reply to Clutter]

Hi Clutter

Thank you for your reply. Now I’m confused as looking on a supplier site ( which I won’t name and advertise) it states that each 30 mg tablet contains 50 mcgs T4 and 12.5 of T3 !

[Clutter in reply to Alli1]

Alli1,

Check your Erfa bottle or go to Erfa's website. Each 30mg tablet should contain 17.5mcg T4 and 8mcg T3.

[Alli1 in reply to Clutter]

Hi

I have just checked my bottle of Erfa and it doesn’t state the amount

It’s all rather confusing I notice that on the bottle it says it contains 0.2% iodine which I thought people with a compromised thyroid were not supposed to take.

[shaws]

Blood tests were invented along with levothyroxine i.e. T4 only. T4 converts to T3.

If we take NDT or T3, or add T3 to T4, the blood tests cannot equate. The way to judge if your dose suits is by how 'we feel'.

The following link is by a doctor who was an Adviser to Thyroiduk.org.uk before his death. He only took a blood test for the initial diagnosis and then on how the patient was improving and adjusting dose.

web.archive.org/web/2010103...

[Alli1 in reply to shaws]

Thank you Shaws I have read a lot of Dr Lowes articles all very enlightening . However with a suppressed TSH the NHS jumps up and down. I have recently had to have a DEXA scan due to the advice of the Endo because of my suppressed TSH and unfortunately I have Osteopenia- all blamed on suppressed TSH

[Clutter in reply to Alli1]

Alli1,

2 years after my TSH was suppressed a DEXA showed I have osteopenia. I don't believe it was due to 2 years suppression. I think it more likely due to early menopause and severe vitD deficiency I was treated for 6 months earlier.

[Alli1 in reply to Clutter]

I agree in my case I believe it was down to the poorly treated hypothyroidism that I had for a few years .... but TSH is the go,d standard ( apparently) within NHS

[honeybear1 in reply to shaws]

If your thyroid is functioning poorly or not at all then you will struggle to convert T4 to T3!

[silverfox7]

You are undermedicated. On any form of T3 your TSH should be suppressed, your FT4 can fall but your FT3 should be high in the range and yours isn't. Increasing your medication will get your FT3 higher , I was told it must never go above the range, and may bring up your FT4 buts it's the FT3 that is important and the only accurate reading.

[Alli1 in reply to silverfox7]

Thank you Silverfox 😊

[Clairewalker751]

I take 1 cap of thyrogold which contains 12.5 of T3 and 50 of T4 apparently? But intake 75mcg of levo with it every morning my TSH is surpressed also but my T4 is 20 and my T3 is 5 I feel well despite being in the early menopause and medichecks doctor has told me to have a bone scan? My TSH was also surpressed on 150 Levo it' seems it's either suppressed TSH or hypo symptoms to have it in range?

[RandiMG in reply to Clairewalker751]

Hi. Have you had your progesterone levels checked? I find that my progesterone levels need to be in balance with my thyroid levels now that I am in menopause, as well. Balance is everything.

[Clairewalker751 in reply to RandiMG]

I haven't but I will look into it I'm only 45

[Hidden]

Your FT3 is still too low perhaps that's why

[mrmoo]

Hi Alli1, Have you been on the same dose since you started ERFA 8 years ago? There have been a lot of issues reported with ERFA in recent years an I'm wondering if you are feeling the effects of changes in the newer pills? Were you feeling good on ERFA till more recently?

[Alli1 in reply to mrmoo]

Hi

Yes I have been more or less on the same dose varying between 60 and 90 mgs I cannot go higher as I get headaches I think from the T3 all other associated bloods and minerals are ok I have had them checked frequently privately. I sometimes feel that the dose varies from one batch to the next and from tablet to tablet. Sometimes I’m fine then other times I feel undermedicated/ over medicated just not ok. I have also wondered if it’s the ERFA reformulation ( or not as they say!) which is the problem. I also notice that I can get a burning sensation on my tongue after taking the tab and even before it’s due- it’s so strange I have mentioned this to GP and Endo and I get a blank expression!

[mrmoo in reply to Alli1]

Because they just don't know... No one but ERFA knows what's actually in the pills and how they processed the thyroid tissue - which has apparently had some changes as well... Many places now radiate the animal products during the sterilization process and if they are doing this to the thyroid tissue along with everything else - we're screwed!