Self treating with NDT, a little advice needed please.

I would appreciate some advice from those with greater knowledge and experience of NDT as I have a few questions:

•How to do I raise my FT3?

•Is it Ok for FT4 to be under range when on NDT?

•Can I realistically expect to feel 100% again? Progress is annoyingly slow.

1st GP Blood test: 06/04/2016

serum B12 203 (145-569), Folate 21 (10.4-42.4), TSH 2.89 (0.27-4.2), Free T4 13.5 (12-22)

Vit D 45.8 (75-100)

Blue Horizon 26/09/17

Total t4 81 (59-154), TSH 3.39, FreeT4 16.1 (12-22), FreeT3 3.9 (3.1-6.8), Thyroglobulin antibody 10.2 (0-115), TPA 11.7 (0-34)

BH 26/01/18

TSH 4.94 (0.27-4.2)* , FT4 13.2 (12-22), FT3 3.6 (3.1-6.8)

2nd GP Blood test 27/02/18

TSH 3.42 (0.27-4.2), FT4 15.7 (12-22), Ferritin 82 (13-150), Folate 45.4 (8.83-60.8), B12 >1476 (145-569), Vit D 140.3 (75-100)

BH 12/06/18

TSH 4.67 (0.27-4.2)*, FT4 11.4 (12-22)*, FT3 3.6 (3.1-6.8)

BH 18/07/18

TSH 1.49 (0.27-4.2), FT4 11.5 (12-22)*, FT3 3.5 (3.1-6.8)

Summary of self treatment:

From April 2016 : Daily Sub-lingual B12 5000mcg, Vit D , B complex, magnesium, multivit. Felt great for about 8months, then some symptoms started to return, so then I looked in to Thyroid issues.

Attempted self-treating with NDT (Thiroyd) Nov 2017 – mid Jan 2018. Temp all over the place, felt terrible, so stopped NDT and focused on supplementing adrenals.

After Feb 2018, stopped with vit D. Added in selenium.

March 2018, temp now stable at 36.3c. Started on NDT ¼ grain and increased slowly so now currently on 2¼ grains split between am and pm.

(Temp still around 36.3c)

Any advice gratefully received. Thank you.

[Venicefan]

Hi. How long did you leave between your last dose of NDT and the blood test?

Both FT3 and Ft4 are low and your TSH is too high (should be below 1 and is usually suppressed with NDT). This suggests that you need an increase of NDT.

It’s fine for FT4 to be low as long as FT3 is in the top half of the range.

Try increasing to 2 and a half grains.

I am on 2 and a half grains but I don’t split it. I take it in one dose during the night. You may find it works better if you don’t split it.

[Hidden in reply to Venicefan]

Hi Maggie0652,

My last dose was a bedtime (around 11pm) and blood test taken first thing the next morning around 7.30am (before taking anything). Would that make much difference with the FT3 numbers?

[Venicefan in reply to Hidden]

It’s recommended to take the last dose of NDT about 12 hours before the blood test to get an accurate reading for FT3. However, yours won’t be too bad - it peaks around 3-4 hours after last dose, so you haven’t got too much of a false high.

Try increasing by 1/4 grain and see how you go. Try to make it as near as poss to 12 hours from last dose for your next test.

[Hidden in reply to Venicefan]

Good to know. I’ll do that when I next do a test. Thank you

[SlowDragon Administrator]

You need to retest vitamin D. Most of us need ongoing maintenance dose. Not just supplement and then stop

vitamindtest.org.uk

[shaws]

You do not need to split doses of NDT. One daily dose is sufficient and increasing dose by 1/4 tablet every 2 weeks until you feel better and symptom-free.

[Hidden in reply to shaws]

Thank you Shaws. Is it best to take it am or pm?

[shaws in reply to Hidden]

Most take their NDT when they get out of bed with one full glass of water and wait an hour before eating.

Or at bedtime, in that case your stomach has to be empty so a meal should have been about 3 hours before taking NDT. Miss night dose if having a blood test for hormones next day and take after test and night dose as usual.

[greygoose]

It would really help if you noted with each test, how much NDT you were taking at the time, if any.

Your questions :

* To raise your FT3, you either increase the NDT by 1/4 grain, or add in some T3.

* That depends on the person. Some do fine with low FT4, some need it higher. It's all trial and error. But concentrate on getting your FT3 up first.

* 100% perhaps not. But, some people do. It depends on so many things, like how long you were hypo before diagnosis, etc. But, you should expect to get reasonably well. And, if you don't, you have to find out why.

One should leave between 8 and 12 hours between the last dose of T3/NDT and the blood draw. So, your result should be OK.

[Hidden in reply to greygoose]

Thank you Greygoose, here is what I was taking at the times of blood tests.

06/04/2016 - NO THYROID REPLACEMENT TAKEN. TSH 2.89 (0.27-4.2), Free T4 13.5 (12-22).

26/09/17 - NO THYROID REPLACEMENT TAKEN Total t4 81(59-154), TSH 3.39, FreeT4 16.1, FreeT3 3.9 (3.1-6.8)

26/01/18 - Had stopped NDT on 9th Jan. Until then I had increased to 1gr. TSH 4.94, FT4 13.2, FT3 3.6

27/02/18 - NO THYROID REPLACEMENT TAKEN. TSH 3.42 , FT4 15.7,

12/06/18 - 2nd March started NDT ¼ gr and slowly increased. Was on 1 ¼ gr at time of this test) TSH 4.67 , FT4 11.4 , FT3 3.6 .

BH 18/07/18 - On 2 gr of NDT. TSH 1.49, FT4 11.5, FT3 3.5

(Ranges same for all tests)

Maybe I have been too slow with raising NDT?

[greygoose in reply to Hidden]

No, I don't think raising too slowly is the problem. The problem is not enough T3 and poor conversion. 2 grains of NDT only contains 18 mcg T3. Your FT4 is also low, but that's usual with NDT. But your TSH is coming down, so you must be absorbing some of it.

How do you take your NDT. Do you take it on an empty stomach, leaving an hour before eating or drinking anything except water? Do you take any other medication or supplements at the same time?

[Hidden in reply to greygoose]

I take it with water on an empty stomach an hour before breakfast and before going to bed. No other supplements at that time. I will try taking it all together at bedtime from now on and see if that helps.

[greygoose in reply to Hidden]

OK, worth a try. But, if that doesn't help, you need to continue increasing the NDT by 1/4 grain every two weeks.