Help please adding thyroxine to NDT!

[Sophie01]

Hi there,

I was diagnosed with Hashimotos in 2015, and started on 50 mcg Thyroxine which was an improvement, but soon realised I needed to add T3, so increased to Thyroxine 75 mcg plus 10-20 mcg T3 (I usually took about 10 T3 daily)

On 75 thyroxine plus 10-20 mcg T3 (8/8/17) my bloods were

8/8/17

TSH 2.60 (0.5-5.0)

FT4 15.0 (11.0-22.0)

FT3 3.6 (3.1-6.4)

I felt pretty good on the thyroxine / T3 combo but had strange knee pains, and decided to give NDT a go. I started .5 grain NDT in August 2017, and increased very low and slow, holding doses along the way for 4-6 weeks and raising based on hypo symptoms and hypo blood tests. I didn’t ever feel optimal since starting the NDT, mostly very tired in arvo / evenings.

after 5 months on 3.5 grains, bloods were

3/ 09/ 2018

TSH - 0.01 (0.5-5.5)

FT4 - 10.2 (9.0-19.0)

Ft3 - 3.4 (2.6-6.0)

TgAb - 24 (<115)

TPOAb - <10 (<35)

I raised to 4.5 grains, where bloods showed ‘pooling’ T3 after 6 weeks

24/11/18

TSH 0.01 (0.50-5.00)

FT4 16.7 (9.0-25.0)

FT3 7.8 (3.5-6.5)

REVERSE T3 247 (138.6-539)

TG 29 (<60)

TPO <28 (<60)

Around this time my saliva cortisol test showed very high cortisol at all 4 points, so I was advised to drop NDT back to 1 grain and add in T3, increasing dose slowly, while treating adrenals with holy basil and PS.

At 1 grain NDT plus 35 T3 bloods were

23/01/19

TSH 0.01 (0.50-5.00)

FT4 5.0 ((9.0-25.0)

FT3 5.4 (3.5-6.5)

At 1 grain NDT plus 50 T3 bloods were

7/02/19

TSH <0.01 (0.5-5.5)

FT4 <5.2 (9.0-19.0)

Ft3 4.0 (2.6-6.0)

I wasn’t feeling good, and at this point my doc said I was taking FAR too much T3, and advised me reduce to 1 grain NDT only, for 4 weeks (4 weeks of hell!!)

Bloods after 2 weeks on the one NDT showed

FT3 at 2.7 ((2.6-6.0) and

REVERSE T3 63 (140-540)

After 4 weeks on one grain, bloods were

7/03/19

TSH 9.5 (0.5-5.5)

FT4 8.5 (9.0-19.0)

FT3 2.8 (2.6-6.0)

At this point, doc said I could EITHER increase to 1.5 grains NDT for minimum one month, OR switch to 125 mcg thyroxine for min 1 month. I am concerned that my T4 is very low, I have never had a HIGH reverse T3 problem (though have twice had the LOW rev T3) and I do know that I seem to require additional T3 when on thyroxine alone. So I suggested adding some thyroxine to the 1 grain of NDT (I have also read the tired thyroid book, whose author has had much success adding thyroxine to NDT after a medication history quite similar to mine) Unfortunately my doc was not convinced…..but I have over the past few years already tried 1.5 grains of NDT and it was not successful, I was very hypo. I was also hypo on straight thyroxine. So, I chose to in any case trust my intuition and give the NDT / thyroxine combo a go. I wanted to ask for dosing advice from this forum, but have been feeling exhausted and foggy. Last Sunday I added 25mcg thyroxine to my one grain NDT, and had the first wonderful day in months! Like water in the desert! I’ve continued with this dose, but am feeling pretty hypo from around midday. I want to ask if, based on bloods and history, admins think I should stick with the small 25 mcg T4 for a month, and take bloods before a possible increase? Or have I started way too low? My ferritin is ok, and I’m studious with diet/ supps etc. My blood cortisol has recently tested mid range, not high, and DHEA is always VERY low, so doc advised stop holy basil, she thinks many of my symptoms are adrenal related, not thyroid. uuuugh!! It’s endless isn’t it, I’m exhausted just trying out this history, I’m sorry I did intend to aim for brevity!! Sincere thanks in advance, the collective wisdom on these forums is a life saver xxx

[Hidden]

I'm sorry I don't have much advice to offer as I'm in a similar situation, but I look forward to reading other members' advice and suggestions! Some say adding T4 to NDT increases the risk of rT3 dominance as NDT contains 80% T4 anyway, but I have also read the book you mention, "Tired Thyroid", and don't see why it should not be possible to add T4 to NDT. After all, the human thyroid is said to produce more T4 and less T3 than the thyroid gland of pigs (1:10 as opposed to 4:1), so adding some T4 to NDT makes sense, especially for those who only need a little T3 in addition to T4. I have been considering lately giving it a try (I am currently taking 3 grains of NDT and don't seem to need more T3, but I definitely need more T4 without the additional T3 in an increased dose of NDT).

I hope others will be able to offer you some useful advice when it comes to adding T4 to NDT!

[Sophie01 in reply to Hidden]

Hi there! Thanks for your comments, glad to know I’m not alone, feeling a bit desperate just now and not sure which way to turn! Theoretically it should work, adding T4 to NDT, especially if T4 levels showing as very low, and reverse T3 ok....but as this doesn’t seem to be done as often as other medication combo’s (thyroxine plus T3, or straight NDT, or straight T3) there’s not so much advice about correct dosing out there - so I’ve added just 25mcg thyroxine to the 1 grain NDT, but after just one day of relief, have felt rotten for a week, very hypo, and not sleeping well...maybe, after a long time taking high doses of T3, the body needs to ‘learn’ to convert T4 to T3 again? Or maybe it’s just that long slow painful process that raising thyroxine involves (the dose raises with NDT and T3 are more forgiving, shorter time frames, and don’t demand such a waiting game!!) My problem is that I have already put my life on hold over the past 6 weeks to address thyroid meds etc, kids have suffered, and I really can’t afford too much more time completely out of action. I did just read a post talking about a Dr Blanchard ‘jump starting’ thyroxine dose, where you take an increased dose (50% more) for 3-5 days, then drop back a little for maintenance, this way the effect is felt sooner than the usual 6 weeks.....ahhhhh, what a journey hey?! Let’s hope someone weighs in with some wisdom for us!