Please help with the interpretation of my results. Should I move up to 3.5 grains.

[biowarrior]

I posted before, where I thought I was overdosing NDT, but it became clear I wasn't. Now I have been on a stable dose as advised of 3 grains for 6 weeks.

Firstly could I have skewed my results: I have been taking 2 grains at 5am-7am and 1 grain at 3pm per day. The day before the test I didn't take any doses, should I have taken my 2 grain dose and would this have made a difference.

My test was at 7am.

My blood results:

FT3: 4.66 pmol/l (3.95 to 6.16)

FT4 8.67 pmol/l (7.87 to 14.45)

TSH 0.010mUI/l (0,340 à 5,600)

Symptoms: I am not super cold, or have any really obvious symptoms, I am also on other hormone replacement so it is difficult to tell what is what. I still have this eye condition, which came about when my hormones crashed, which top doctors are sure is hormonally related and would benefit/go away if the thyroid levels were correct.

My thoughts are that my TSH is suppressed, but I have seen people say not to take too much note of that. My FT3 seems to be far from the optimum, near the bottom of the range. Would this have been much higher if I had taken my 2 grains am dose the day before?

I am thinking of moving up to 3.5 grains (2 grains am, 1 grain pm), as FT4 is near the bottom as well, is this a bad idea?

I also have T3 which I could take like 10mg a day but think that is overcomplicating it, and I will stick to NDT dose, as my FT3 and FT4 are mirroring each other.

Thanks

[marsaday]

I have read your first post and your history is complicated.

Have you been messing with anti balding meds? If so this is why your metabolism has tanked.

Your ft4 was high at 18 but you really needed a ft3 to confirm what is really happening.

The obvious thing to say is conversion is low if tsh is 5 and ft4 is 18.

You have made a mistake in jumping into nth usage before trying t4 only. Now you are paying the price trying to fine tune it.

You should have been aiming to try a little t4 to see how this went first of all. Or even a little t3. When you throw both in together it can make it hard to work out what amounts you need.

For some nth works and away they go but it isn’t for you.

Try raising again but if more and more doesn’t help you will need to lower back down and probably make a switch.

[biowarrior in reply to marsaday]

Anti balding med, is the reason why I am in this mess, but I took it 4 years ago for only 3 months. I was struggling for 3 years, and then my hormones really did crash, in october. I am impressed if you deduced that without me having said it.

It is complicated, and maybe that reasoning was right at that stage. And there probably was a better solution at the beginning of all this, especially treating it early on, so I didn't waste 3 years of my life. But after I crashed in October, the hormones just went haywire, I was literally freezing, so something happened to my thyroid and my testosterone and estrogen went so low.

But before I tried anything, I went on testosterone first, and then had a test and my FT4 was 10.7 (12-22), and my FT3 was low. So there wasn't a conversion problem then, it was all just low. And now they are both low. I thought NDT would be the less complicated option than T3, and felt I needed T3 as well as T4.

Since going on hormone treatment I have felt way better, not 'normal' but definitely life can be good, even great again.

What do you mean nth?

If I went on T4 only surely I would have the same problem, it wouldn't convert?

So I can't see why I would do that, I can see that maybe I need more T3 right?

Ok I agree that my treatment has added variables, but for my situation now do you think I should raise to 3.5? I do have some T3 so could take a tiny bit of that instead

[marsaday in reply to biowarrior]

It’s really complicated when you crash your own system. There are so many variables.

Increasing the thyroid hormone is a valid way to get better so try it. But when someone is upping and upping and still not getting better the answer is not the quantity of thyroid hormone.

So be aware of this issue. Go for more and see how you are in 2 months time. It will be a slow process to work it all out.

I do doubt a large amount of thyroid is your answer but I am happy to be proved wrong.

High thyroid usage will jump your shbg so watch for this. This will bind up your testosterone and make you effectively low in testosterone. It is common for this to happen on day high t3. People get weak muscles because testosterone is effectively to low.

The hormone eco system is complicated and the endos struggle fixing it as we all know.

[biowarrior in reply to marsaday]

I agree with that, thanks marsaday.

[shaws]

The blood tests were introduced along with levothyroxine (T4 only). Therefore if we take NDT which contains a number of hormones the tests cannot correlate and the main way to judge is how you 'feel' on particular doses.

When taking NDT, we raise dose slightly (1/4 tablet) every two weeks until symptoms relieved. You should take pulse/temp several times a day and if either rises too high drop to previous dose. I shall give you links which may be helpful. This doctor only prescribed NDT or T3 alone for thyroid resistant patients and didn't recommend splitting doses.

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

The following are three chapters and copy and paste the tinyurls. If you have difficulty let me know.

Chapter 2

tinyurl.com/ya5blrr2

Chapter 3

tinyurl.com/y7ejh9sh

Chapter 7

tinyurl.com/ycxpz565

[biowarrior in reply to shaws]

So you suggest raising by a 1/4 and measure my pule and temperature?— (I did buy a digital thermometer, but it did not seem to be that accuracte as it said both me and someone who isnt hypothyroid had a temp of 35.)

Ok I am going to give those a read. THanks!

[shaws in reply to biowarrior]

If hypo, usually our temp/pulse is low. Taking thyroid hormones should increase back to near normal.

[biowarrior in reply to shaws]

Ok, I don't know how to get an accurate temp reading— I bought a high end digital but it always comes back low. My pulse is about 40-60, I am quite young and run a lot.

[biowarrior]

I am on Testosterone replacement as well, which means estrogen can rise.

Meibomian gland disease, I contracted it when my hormone levels first went awry, and it has improved with replacement, but is still there.

Ha yes I guess I will know if I try raising. I am currently thinking of raising to 3.25. I did miss a whole day's dosing before the test stupidly and I don't know if the TSH being suppressed is a warning sign that I shouldn't go higher

[fibrolinda]

Should be just 8-12 hour gap between last dose and blood test when taking NDT or t3 so your results would have been higher, no idea how much higher I'm afraid 😶 Instead of not taking any the day before you'd have done better taking morning as usual then 3pm dose later at 9pm. I always go for 10hour gap🙂

Maybe try 1/4 grain increase if you feel like you need it then test again in 6 weeks? Leaving 12 hour maximum gap lol 😁

[biowarrior in reply to fibrolinda]

Ah yes, I should have done that. I don't know if it would have raised it enough. So I really missed a whole day's dosing before the test. As I should have just taken my 3pm dose as well.

Ha ok that sounds like a good plan.

[researcherUK]

Biowarrior,

Your FT3 are at 4.66 because there was a 24 hrs difference between the last dose and the test. We could assume that your FT3 are usually 20% more than what the test is showing. This means your FT3 are 5.592.

The optimal levels at 75% of the range are 5.6

So, you are very nearly there. I would certainly not add 10 mg of T3 on top of 3 grains of NDT. Any further additions will make you overshoot and you'll crash on the other side.

I would stay on this dose a bit longer and restest for comparison; then, decide whether there is a scope for an increase.

[biowarrior in reply to researcherUK]

Cheers researcherUK.

That would make sense, as i have felt ok, and I haven't felt noticeably cold or anything. Hmm so I basically just mucked up the test. This makes me think I should just stay on 3 grains.

I thought the optimal FT3 was nearer the top?

YEs i think you are right about the T3, I shouldn't over complicate it, especially when I have been relatively stable for the last 5 weeks. Hmm I still am thinking maybe thinking only a 1/4 grain raise, I don't know how much that can do!

That's good news that I am there or there abouts:).

Do you think FT4 would also be 20% higher?

Also what do you think of the TSH being suppressed, should I just forget that now.

[researcherUK in reply to biowarrior]

T4 is a storage hormone. If you have enough T3 circulating, your system won't store too much of T4.

Calculated, Optimal T3 starts at 75% of the range without going over the range.

Other factors that contribute to your well being and feeling great are optimal levels of B12, Folate, Vit D, Ferritin.

As for TSH, I am copying here a previous reply that I have made to someone with similar question/concern about suppressed TSH and its connection with osteoporosis:

"Your TSH is low because you are on NDT which combines T4 and T3 and not because your T4 levels are very high to the extent they are upsetting the rate by which bone replacement is done.

Yes, there is a connection between Thyroid hormone and bone density. Too much thyroid hormone (T4) in your body speeds the rate at which bone is lost. If this happens too fast the osteoblasts may not be able to replace the bone loss quickly enough.

For healthy bones, you need a good ratio of T4/T3 so to dissolve old bones. However, you need optimal levels of T3 to create new layers/bones. Y

People who are on T4 only and are not converters are at a much higher risk of developing osteoporosis than someone on NDT.

Furthermore, other factors/hormones contribute to the bone density such as estrogen and progesterone."

[fibrolinda in reply to researcherUK]

Actually biowarrior left 40 hours I've just realised... Slow brain day, mind they all are☹

Agree with you on stay on 3grains for a few more weeks and leave 12 hours max after last dose when testing 😊

Many find they need ft3 at top of the range or even slightly over whilst others are fine lower in range... Only time and trial will show where your 'sweet spot' is 🙂

[biowarrior in reply to fibrolinda]

Yes you are right!! I left 40 hours. I don't know how I misinterpreted the protocol so badly—I knew you wanted to miss a dose before, to avoid a false positive.

Shame as it was my last day in France, and blood tests there are a lot cheaper.

Ah that makes me definitely not want to go up to 3.5. I'm thinking maybe 3.25 for 4 weeks then a test.

So to get it right next time. As I take 2 grains in the am and 1 grain in the pm, I should just take it all as normal and miss my morning dose for a morning blood test.

[fibrolinda in reply to biowarrior]

No take your afternoon dose later than usual,. If you do blood test at 7am then take your afternoon dose a 7-11pm the evening before 🙂

[biowarrior]

Ok cheers, well I jog for about 30mins-1 hour each day. I would hate to give up exercise as I am a 23 year old male, and exercise does me good mentally etc.

I hadn't really thought of that, that because I am not naturally producing, and because my TSH is suppressed that I kind of use it up if I exercise.

Yes I am inclined to stay on NDT, I don't think it has caused too many issues, maybe I am undermedicated, but going on it definitely made a huge difference from where I was, I was wearing 5 ski jackets when I got up in the winter.

[shaws in reply to biowarrior]

As you reach an 'optimum' dose you can still exercise to tolerance. Not overdoing it. Sometimes we are tempted to do 'just a little bit more' but T4 is inactive and has to convert to T3. T3 is the active thyroid hormone needed in our millions of T3 receptor cells, its work then begins.

(I am not medically qualified but have also read that T3 lowers in excessive exercise but if you are converting your NDT dose well you may be o.k. - if too much exercise you'd feel not very well next day.)

[biowarrior]

Thanks reallyfedup123, I really appreciate the support!!. Well I thought my life was over, and didnt know why i was such a wreck, and now Ive started hormone replacement, there seems possibility again. So could be worse :), hopefully i can live normally now.

Sorry to hear you also woes, and that your husband has difficulty. 5 grains is a lot!!

So you think dry eyes is related to thyroid hormones as well?

I am not completely sure if it was the low testosterone or low thyroid, or both, but hormones definitely play a role in the eyes!! And the best opthalmologists won't tell you.

I don't use eye gels, I have to use an eye bag each morning, to warm up the glands, if I stay on the computer too long they get really dry.

Before I was on hormone replacement, if i got stressed they would be untenable, it increased in severity when my other hormone symptoms were bad. And now it is better, I am just wondering maybe if it could go away.

[greygoose]

If you'd just left the usual 8 to 12 hours, your FT3 would probably have been about 5.66, or something like that. Only just over mid-range. So, you do have room to increase.

But, I really don't think increase by half a grain is advisable at this stage. a quarter grain would be wiser.