How we increase Combo and NDT medications

[FancyPants54]

Genuine question to help me understand what I'm doing.

I've seen people on NDT advised to go on symptoms and signs rather than blood tests and to increase by 1/4 grain every 2 weeks until symptoms are mostly gone and then let it stabilise for a few weeks longer.

But with combo T3/T4 treatment we are advised to make a small increase and wait 6 weeks to retest and assess.

It suddenly struck me that these 2 methods are quite different, yet the outcome of the medication is quite similar. Why can't those on combo treatment just increase by small amounts every 2 weeks and base it on symptoms?

(About to do my 7 week retest).

[SlowDragon Administrator]

Personally I think NDT patients also need to wait 6-8 weeks to test before increase too

But NDT is apparently "bound" and not immediately available to use in body, unlike T3, so that may be the reason

[shaws]

Before levothyroxine and blood tests were invented we were all diagnosed upon our clinical symptoms and given NDT. No blood tests at all. but symptoms were the No.1 and we were given a trial of NDT which was slowly increased according to relief of symptoms.

The link I will give below was by one of Thyroiduk's Advisers and his method was one initial blood test only and thereafter he took no more but concentrated on the patient's symptoms being relieved and become well again.

He would never prescribe levo because he stated that it became No.1 due to payments made to doctors/endos to prescribe levothyroxine (T4 alone). The three chapters are from one of his books which you might find helpful. He prescribed NDTs or T3 alone for thyroid hormone resistant patients.

naturalthyroidsolutions.com...

[FancyPants54 in reply to shaws]

That isn't really what I'm asking though.

I want to know why people on NDT now, in this group, are told to increase every 2 weeks on symptoms. But those of us who have introduced T3 to our existing Levo dosage are advised to adjust and test as if we were on T4 only, every 6 weeks.

Is it because we have the ability to adjust either T3 or T4 whereas on NDT you can't do that? Or is there another reason behind it?

I'm puzzled by it because it seems a bit contrary to me when I think about it.

[shaws in reply to FancyPants54]

Could it be that NDT is made from animals' thyroid glands and more conducive to the human body than the synthetic hormones?

[greygoose]

As far as I know, people on T4+T3 are advised to reduce their levo when starting T3 by 25 mcg, and start on 5/6.25 mcg T3. Then, increase the T3 by 5/6.25 mcg T3 every two weeks until they get to 20/25 mcg, then hold for six weeks and retest. And never to increase levo at the same time as T3 - one or the other. And, this would be because one usually starts taking T3 after one has become established on levo, and finds that FT4 is high by FT3 is too low. It's rare for someone to be started on T4+T3 at the same time. But, I've never heard anyone saying that you should wait six weeks after a small dose of T3. Wouldn't be much point in that. But, you should do the six week wait at one point, to allow the T4 to catch up.

[FancyPants54 in reply to greygoose]

So have I done it wrong then? I reduced my Levo from 125 to 100 and added in 6.25 of T3 just before Christmas. I waited about 10 days and then added 6.25 T3 into the afternoon. I've held that for 6 or 7 weeks and am due to test now. I've felt like I needed an increase in that time but held out because the advice I've seen on here is to do that. Or have I misinterpreted it?

[FancyPants54 in reply to FancyPants54]

Should I retest now or just add in another 6.25 to the morning dose?

[greygoose in reply to FancyPants54]

I think you might have misinterpreted it, because I've never seen anyone say that. Just 12.5 mcg isn't going to make that much difference, is it. And, whilst I'm all for going slowly so that you don't miss your sweet spot, I don't think you need to go that slowly.

But, now you've waited all that time, by all means test, see how your doing. It will give you a clear idea of your FT4, anyway. And give you an idea of how much more you're going to need to increase your T3 until you get a decent FT3.

[FancyPants54 in reply to greygoose]

Thank you. I’m a bit afraid of what I’m doing so I guess I’ve allowed myself to get confused. I’ve found it a struggle to work since Christmas. That’s perhaps why. My warehouse is so cold, that’s not helping.

I might as well test then. See what is going on now. Good to know that I might not have to wait another 6 weeks before a small increase next time.

[greygoose in reply to FancyPants54]

Well, do share the results of your test, and let's see how you're doing.

[shaws in reply to FancyPants54]

Before levothyroxine and blood tests were introduced to replace Natural Dessicated Thyroid hormones. We got slow increases until symptoms resolved.No blood tests.

[shaws in reply to FancyPants54]

On of Thyroid UK's Advisers (deceased through an accident) only took one blood test - for the diagnosis and thereafter it was all about relief of clinical symptoms. Oh! If only there were other doctors like this.

[FancyPants54 in reply to shaws]

If only! If only there was a doctor who looked at blood results and didn't say you were fine just because your results were in range, regardless of where in range.