I have not posted on here for a while but have been doing a lot of reading. I have been feeling very very bad for the last two months. My levothyroxine dose was increased to 100mcg on March 15th 2018, I felt awesome through to the end of August and I then started feeling worse in September with fatigue, brain fog, constipation, joint, tendon and muscle pain, palpitations, etc, you know the drill. I've been brain dead and in excruciating pain for the month of October. My last blood tests on October 18th were:
TSH: 1.34 (.35 - 5.0 mIU/l)
FT4: 19 (12 - 22 pmol/L)
FT3: 3.5 (3.4 - 5.9 pmol/L)
My T3 is at the bottom end of the range after an overnight fast (bloods were taken at 7:30 a.m.)
I just switched to 1 x 30 mg Erfa Thyroid tablet plus 1 x 50mcg levothyroxine tablet each morning, and my pain, brain fog and constipation are much less already. I'm assuming that my T4 to T3 conversion is abysmal due to my diabetes and menopause status (8 months period free and very insulin resistant).
Problem is, since I am diabetic, The T3 has increased my glucose a lot (it's only been 3 days) and I'm not sure if I will be able to stay on this combination.
I would really appreciate any help you can provide in determining the amount of T4 and T3 in a 30mg tablet of Erfa Thyroid. I've read conflicting information. The internet states a 30mg tablet contains 18mcg T4 and 4mcg T3. Is this true? I want to make sure of the amounts of T4 and T3 that I am getting in this mix as I want a more natural T4 to T3 ratio by combining levo + NDT and don't want to push my glucose any higher with too much T3.
It seems my T3 goes low about 6 months after each and every increase, ideas on why this is are very welcome (other than my assumptions above). Just to recap, my questions are:
1. How much T4 and T3 is in a 30mg tablet of Erfa Thyroid
2. Do you think I should stop all thyroid meds and start again from a low 50mcg levo dosage just in case I have missed my sweet spot?
Thanks in advance for any help/advice that you can provide.
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Kalicocat
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Thanks so much Hidden , that's what I was thinking too. But I've also read that too much T4 can interfere with T4 to T3 conversion. From my extensive record keeping I converted the most T4 to T3 when I was on 62.5 mcg:
May 2017
TSH 1.05
T4 16 (9-19)
T3 3.8 (3.1-6.2)
but then I crashed in December with higher T4 and below normal T3. Or do I just need more hormone in the winter? I don't do bad at all in the summer, always feel fantastic and levels are optimal.
Yes, very low energy, no hair loss yet but it takes 3 months of feeling crappy before that starts to happen, yes to brittle very weak nails - they just shred if I try to use them and they reduce to powder when I file them, yes to fatigue and brain fog, yes to weight gain (when I gain 5 lbs in a week I know my T3 is low - I'm actually up 6 lbs), joint, muscle and tendon (very bad) pain, extreme constipation, FREEZING cold, cramping muscles, and palpitations. These are my usual low T3 symptoms, although the pain this time around has been very excessive compared to previous times I was low on T3.
Welcome to our fourm and you are a young man with young children as well.
It is women who usually develop hypothyroidism but we do have male members as well.
Do you to take your diabetes meds well away from thyroid ones. So that there may be not an unpleasant reaction. I shall give you a link and hope it is helpful. Extract below:-
"Levothyroxine can change how other medicines work, so their doses may need to be altered. These medicines include:
medicines for diabetes - either insulin or tablets
the blood thinning medicine, warfarin
Some medicines shouldn't be taken at the same time of day as levothyroxine as they can reduce the amount of levothyroxine your body takes in, including:
antacids
calcium salts
iron salts
orlistat, a medicine used for weight loss
sucralfate, a medicine used to treat stomach ulcers
some cholesterol-lowering medicines such as colestyramine, colestipol or colesevelem
Read the information leaflet supplied with these medicines or speak to your pharmacist for advice on how much time to leave between taking these medicines and taking levothyroxine.
Mixing levothyroxine with herbal remedies and supplements
There's very little information about taking herbal remedies and supplements with levothyroxine.
Important
For safety, tell your doctor or pharmacist if you're taking any other medicines, including herbal remedies, vitamins or supplements.
When you get a blood test for hypothyroidism, it should always be at the very earliest and fasting (you can drink water) and allow a gap of 24 hours between your last dose of levothyroxine and the test and take afterwards..
Usually we take levothyroxine when we get up with one full glass of water and wait an hour before eating. Some prefer a bedtime dose, in that case about 3 hours gap should be allowed between food and levo which should be taken with one full glass of water.
If having a blood test next morning, miss the night dose and take after test and night dose again on the same day.
Many doctors only look at our TSH result and it is highest early a.m. and drops throughout the day, that is why an early a.m. blood test is advised and may prevent a reduction in yur dose of levothyroxine.
Levothyroxine is a synthetic thyroid hormone and it is inactive. It should convert to liothyronine (T3) and it is T3 which is required in our billions of T3 receptor cells so that our body has the hormones it needs to enable us to go about our life feeling well.
Also get checked B12, Vit D, iron, ferritin and folate. Everything has to be optimal.
Always get a print-out of your results with the ranges and post if you have a query. The aim is a TSH of 1 or lower, and Free T4 and Free T3 in the upper part of the ranges and, the most important, relief of all our awful clinical symptoms.
Thanks Shaws. I'm not on diabetes meds yet, been controlling with diet and exercise. And I'm female, you may have read someone else's bio. I'm doing all of the above, will be getting the vitamin tests and inflammation tests tomorrow.
One of our Advisers recommended increasing NDT by a 1/4 tablet every 2 weeks until symptom-free always taking pulse/temp several times a day and if either went high, reduce to previus dose.
Thanks Greygoose! Should I cut my Erfa tablet in 1/2 then? I've taken 3 days of 1/2 a grain and I'm definitely feeling better today. And what do you mean about the levo? Should I be on 75mcg of levo instead of 50mcg levo?
I don't really know why you're on levo at all. Why didn't you do a straight swop and take it from there? How much levo were you on before you started Erfa?
I was on 100mcg of levo. I'm worried that I'm taking too much levo as you mentioned above. I'm diabetic and T3 impacts my blood sugar, that's why I don't want to take too much. And I wanted to try a more natural T4 to T3 ratio. I'm actually thinking of alternating 50mcg and 25mcg of levo per day along with my 30 mg Erfa Thyroid, but I don't know if that's right. I am getting my RT3 checked but those results take 3 weeks to come in, so I won't know until then if I was on too high of a dose of levo.
Regarding NDT, I've been talking with my pharmacist and they said Erfa Thyroid medication is constantly on back order (not good), I just lucked out that they ordered a bunch in and have stock, that's the reason why I'm on it now. I actually had a prescription for Cytomel but it is back ordered until the summer. So I asked my doctor for the Erfa prescription until Cytomel is available. I don't want to be dependent on something that is that hard to get. They said Cytomel doesn't go on back order near as often as Erfa Thyroid does.
An rT3 test won't tell you if you are on too high a dose of levo. It won't tell you anything much at all. What you need is an FT4 test - plus an FT3. Erfa is not a substitute for cytomel, because Erfa is T4 plus T3. Cytomel is just T3. Not sure that pharmacist knows much about thyroid, either!
And, as I said above, ratios have little to do with replacing thyroid hormone. You need what you need, and what you need is enough of each to make you well, and that is rarely what one would call a 'natural' ratio. I think you're barking up the wrong tree. But, what you want is FT4 and FT3 tested.
FT4 is high end of range and FT3 is bottom end of range. I had a presription for 88mcg levo and 10mcg cytomel, but cytomel is on back order. so I asked for roughly the equivalent dosages with Erfa Thyroid (T4 to T3 ratio).
And as I said above, I'm worried about my blood sugar going whacky from too much T3. I'm currently having trouble controlling it, exercise and low carb are not doing the trick since I started on T3 but I'm hoping my body will adjust to the T3 instead of getting rid of it.
Well, I very much doubt you've got too much T3 there. 30 mg NDT will give you about 4.5 mcg T3. Which is quite a long way from 10.
How much levo were you taking when those labs were done? Sorry if you've already said, but I'm getting a bit confused with this. You really are a very bad converter. So, not much point in taking a lot of T4. Ratios really are not appropriate, here. You need to be experimenting with how much of each you personally need, and forget the ratios of healthy people.
Sorry, I missed your reply, didn't get a notification. Yes I agree with you on taking what my body needs. My glucose today is better, so maybe I can start creeping up with the NDT. I was taking 100mcg levothyroxine at the time of those blood tests. That's why I was thinking I might be taking too much levo. Right now I'm getting 68mcg T4 on my current prescription, so this will let some of it clear out. I'll be going back to my doctor to talk about my blood tests and will ask her for a new prescription for 2 x 30mg Erfa per day. Just so worried about the Erfa being on back order all of the time.
I just started on 30mg Erfa and 50mcg Synthroid on Monday. I was going to get my bloods done this morning, but was too lazy so I will get them done tomorrow. Then I'll have to wait at least 6 weeks.
Oh, well, it's much too soon to do labs. You won't get much information from them this close to starting. Increase the Erfa a bit - say to 1 grain, increasing by 1/4 grain every two weeks - and then hold for six weeks before testing.
No, I don't think I said rT3 was a myth. It's real enough. When FT4 gets to a certain level near the top of the range, it will convert to more rT3 than T3, so conversion gets worse as FT4 levels get higher, rather than better.
In the days when doses of T4 went up to 400 mcg, TSH certainly wasn't tested. It's since the invention of the TSH test that things have gone from bad to worse. But, I would imaging that people taking 400 mcg T4 were pretty bad converters, to need that much T4 to get their T3 to a level that made them well.
It doesn't matter what the ratio of T4 to T3 is in NDT, because most T3 comes from conversion, anyway. It will sort itself out. But, yes, healthy pigs do have a different ratio to healthy humans. But, healthy humans don't take NDT.
TheCat346 what are you on right now? Full NDT, or are you still on a mix of levo and NDT? What doses are you on today? Did NDT make you feel well? What were your symptoms and labs when you were on levo only? Sorry for the mutiple questions. And thanks for your help so far!
Hi Kalicocat I am type 1 diabetic and have an insulin pump. I realise for you with no meds and diet that it is different. However I found that when I first started T3 my glucose was raised but as I have finally found my balance this has sorted. Insulin resistance apparently can be higher when hypothyroid and now I am well on 75mcg T4 and 20 T3 in two doses things have settled well. Good luck
Sorry I didn't reply before now, I have not been getting notifications, they are really flaky.
That's awesome news!!! Thanks so much!! I have noticed that my glucose is a bit better today but I've also been very careful with my diet and have been exercising right away in the morning. I'm printing this entire thread to give to my doctor! It's a bit more difficult to get the proper ratios with NDT but hopefully the Cytomel will come in and I can switch back in the new year.
Well, each case has to be judged on its own merit. If you were taking a lot of T4 when you switched to NDT, then yes, perhaps 1/2 a grain was propriate. But if someone is starting on NDT without having been on levo beforehand, then you would start with 1/4 grain.
But, I do think that reducing your T4 by 50 mcg when adding in just 1/2 a grain is a bit unequal. 1/2 grain NDT is equal to approx. 32.5 mcg T4. Depends how well you convert, of course, but that is a bit of a reduction in dose.
Awesome, thank you so much for your thyroid history, it really helps! If I continue to do well on Erfa, then I may try to stay on it and switch over completely however, i will need to talk with my doctor and especially with my pharmacist to ensure that they can order in stock when it is available. He said that Erfa has been on back order for months now with no ETA. It just so happens they had ordered in a lot of the 30s when it was available, but they have been sold out of the 60s for quite some time.
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