STARTING NDT ADVICE PLEASE

[CaroS]

Our Endocrinologist has reduced my daughters T4 to 50mcg and added ERFA NDT 30mg/half grain, [stopping her T3] about 1 week ago. [ She was previously on T4 75mcg/T3 18.75mcg for 6wks then 62.5mcg and T3 18.75mcg for 6 weeks but did not improve ]. After the first day or two on the T4/NDT regime she started to have an afternoon slump so we added back T3 6.25mcg before lunch which has helped. I know the total equivalent dose is low, but I understand NDT is more bioavailable. She is certainly not worse on the above regime but not much better either. I’m not sure what to do, perhaps I am being impatient? Our telephone review is in 6 weeks, I could ask for an earlier one although probably not before 4 weeks. I enclose the most recent bloods taken just before starting the new regime. She tends to high cortisol [ saw Dr P and is on adrenavive 2 daily ], her iron, b12, folate and vit D levels are all good. We tried gluten free for 12 weeks when she was on T4/T3 but it has not made any difference.

Options I am considering;

Do nothing but with the T4 level dropping I’m not sure if things will improve and we will waste precious time.

Keep the T4 at 50mcg and increase ERFA to 60mg/1 grain, leaving out T3.

Reduce the T4 to 25mcg and increase ERFA to 60mg/1 grain, leaving out T3 if necessary - still a low dose but gets Levo levels lower.

I would really appreciate any advice. I did order some Thiroyd S as a buffer but it won’t arrive for another 4 weeks.

hs-CRP 0.31 <5.0 mg/L

Ferritin 83.7 13 - 150 ug/L New range

Thyroid Function

TSH L 0.01 0.27 - 4.20 mIU/L

T4 Total 76.5 66 - 181 nmol/L New range

Free T4 13.60 12.0 - 22.0 pmol/L

Free T3 5.58 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs H 74.4 <34 kIU/L

Anti-Thyroglobulin Abs 16 <115 kU/L

Vitamins

Vitamin D (25 OH) 90 Deficient <25 nmol/L

Insufficient 25 - 50

Consider reducing dose >175

Vitamin B12 H >1476 Deficient <145 pmol/L New range

Insufficient 145 - 250

Consider reducing dose >569

Serum Folate 37.30 8.83 - 60.8 nmol/L

[Heloise]

Caros, It's difficult to figure although as you say her total dose is barely equal to one grain and below the normal dosage. One week is not long enough to tell the full effect of the dose. I notice the antibodies are still there. Selenium and zinc are useful for that. We just had a docuseries about heavy metals and learned if you are deficient in the good ones, your body will use bad ones like mercury. Does she have a lot of amalgams or vaccines? If you feel that gluten isn't the main problem, it should definitely be limited in any event, sometimes dairy will make the difference. There are so many alternative to dairy it may be worth trying.

youtube.com/watch?v=3_uaUXi...(Not working as expected?)

[CaroS in reply to Heloise]

Thanks Heloise, she supplements with selenium and zinc and has stayed on a very gluten light diet. She has very little dairy but that might be worth trying. Perhaps I just need to wait a little longer? Am also going to try Holy Basil for the high cortisol.