NDT results, advice appreciated as always.

[Sally56]

So I've been on NDT since last July. I have posted my results intermittently here, last time I was advised to take it up a notch. These are my new results. I have a history of reacting badly to T3 (adrenal issues). I am currently taking it as 60mg early 6am ish and then 60mg lunch time. Total 120mg.

9.1.19

Free T4 - 9.8 (9.0-19.0)

Free T3 - 4.2 (2.6-6.0)

TSH - 0.13 (.03-4.0)

I took my Capsule 120mg, after my morning blood test.

Symptoms: weak, breathless, anxious, agitated, hot flushes, shaking inside. I am stunned by the results. I thought I was over-medicated? Can I be under? Thoughts, advice appreciated.

[SeasideSusie Remembering]

Sally56

There should be only 8-12 hours gap between last dose of NDT and blood draw, if you left longer than this then your FT3 result is a false low. How many hours did you leave?

Have you ever had thyroid antibodies tested, do you have Hashimoto's (confirmed by raised antibodies)?

[Sally56 in reply to SeasideSusie]

Hi Susie,

Have I got it wrong again? It was 24 hours. Damn it! So FT3 could be a false low? Can I ask a question, is my T4 level ok? It's very low as well?

Yes I've had antibodies done. I had. TT in 2017. I never had a diagnosis of Hasi's but strongly suspect now that I did. Thanks

[radd in reply to Sally56]

Sally56,

I believe thyroid antibodies don’t always correlate directly with thyroid function and may be still detected following thyroid removal.

If you left 24 hours between the blood draw & meds, TSH still leaves room for a dose increase. FT4 is often seen low in people medicating NDT (mine is) but yes, FT3 result could be a false low.

But I wouldn’t increase meds any further atm with your symptoms. Cortisol issues, also low iron can make it difficult to raise NDT enough to bring well being.

Are you still supplementing to support adrenal issues ? ? .. Are other nutrients and iron levels ok ?

.

stopthethyroidmadness.com/a...

[Sally56 in reply to radd]

Hi Radd,

Thanks for answering. I see. Yes I am still supporting my adrenals. I take Holy Basil. I will not increase. I was splitting the dose, but if I went too late with the second dose I didn't sleep till early hours of the morning.

My adrenals are not good and never will be I have Primary Aldosteronism hyperplasia of the Adrenal glands and while I am treated for the excess Aldosterone, they are not entirely convinced that cortisol is an issue. It is of course. But with one major disease they are not willing to consider cortisol issues. Shame because I recall the Venous sampling directly from each gland showed higher cortisol then usual. Not having a thyroid has really screwed up things! I was on T3 only and felt great but coluldn't get up to a therapeutic dose and my TSH went through the roof, my adrenals crashed and I was hospitalised. It's a balancing act all the time between adrenals and the thyroid drugs. I persevere with NDT because I've exhausted other options. I just have to get the timing and dose right?

[radd in reply to Sally56]

Sally56,

Have you tried splitting your dose three or even four times a day to reduce the rapidity of T3 onset and prolong the duration of its action.

It can be a pain trying to organise food, work, life around more splits but may be useful in helping your body accept the T3. I found doing this helped quell that awful internal shaking and inner heat.

Also cortisol raises the cellular level of glucose required for cell receptors to receive T3 from the blood to the cells. I found eating regular meals always with proteins & fats, and healthy snacking in between kept sugar levels stable.

Also, supplementing stuff like Coenzyme Q10 that aids mitochondrial function.

Your previous posts explain your experience with HC. Have you tried adrenal glandulars ?

[radd in reply to radd]

Oh regarding adrenal glandulars. I don’t know if they would be contra-indicted with aldosteronism. Do you take any meds for this ?

[Sally56 in reply to radd]

Oh yes Radd, I take 2 drugs for my Aldosteronoism. Eplerenone (which I have to be privately because it's not on the PBS (NHS equivalent in Australia) ) and Aldactone which is a similar drug but in large doses is not good. Men grow breasts! Yep that revolting, but it has no real sides in females thank goodness. These drugs stop the Aldosterone from being picked up. Sal

[Sally56 in reply to radd]

Hi Radd,

No I have not tried splitting to that degree, but I can see the rationality of it. I will get some empty capsules from the chemist and try dividing it by 4. Thank you. I am currently on the Michael Mosley diet for weight and health. I have been on it for 2 years and I eat very much how you suggest. I could up the healthy snacks though. My adrenals have responded well to V8 Vege juice daily as an adrenal tonic. I will gets some Coenzyme10. I've seen this for years but didn't know what it did. Re the glandulars, no can't go thjere because of the delicate balance in the adrenals. HC was a disaster, it made me sicker. Sal

[Hidden in reply to Sally56]

If you feel well and have no symptoms, then lowish FT4 levels can be OK provided your FT3 levels are sufficiently high. Some doctors claim that high FT4 levels along with high FT3 levels will cause excess T4 to be converted to the inactive form of T3 (rT3) which in turn blocks the action of free T3. I have often read that, when you have optimal FT3 levels on NDT, your FT4 levels should not be higher than midrange.

Of course, that does not work for everyone, but the problem with NDT is that it contains a fixed ratio of T3 and T4. If you need to raise your free T4 levels, but not your free T3 levels, you'd have to add some T4 to the mix. Some do that successfully.

If you left 24 h between taking meds and going to the lab, your FT3 levels were approximately 25% higher on the previous day so around 5.25 which places them in the upper third of range where it often recommended to be when optimally dosed on NDT.

But your symptoms mean you have not yet found your optimal dose of NDT. Symptoms of hyper- and hypothyroidism can be confusingly similar. I find this blog interesting; this person found that the ratio of T3:T4 in NDT was wrong for her and that she needed to add T4 to a decreased dose of NDT:

tiredthyroid.com

[Sally56 in reply to Hidden]

Hi ASander69,

Thanks for replying. I shall ask my Endo about testing me again for RT3. I see him in 6 weeks. My GP doesn't understand NDT, so she defers to me and my two professors. I am one of the lucky ones who is supported and in fact my Prof for my TT browses this site. He is also happy for me to take advice. I shall read the link. Thank you for sharing that with me. I have wondered if I needed to supplement T4? Sal

[Hidden in reply to Sally56]

Yes, some seem to do better on a combination of NDT and T4 (others on NDT + T3). It can take a long time to find out the right combo and dosage. It's great that you have a doctor who actually listens to you and is willing to learn!