Good idea to take NDT twice daily...? - Thyroid UK

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Good idea to take NDT twice daily...?

22 Replies

I have been doing extremely well on Thyroid-S but no longer seem able to take the dose that I need for complete symptom-relief in one go without getting hyper symptoms. I have always taken NDT once a day, in the morning, one hour before eating, and found that to be very convenient.

However, a few hours after taking it, I now get rapid heartbeat and increased sweating along with intense carb cravings. That invariably subsides in the late afternoon/early evening and makes me suspect it would be better to take it twice daily.

Has anyone else switched to from a single dose to taking NDT twice daily and noticed an improvement in symptom-relief?

Multi dosing (three times or more per day) would simply be too impractical for me.

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22 Replies
NatChap profile image
NatChap

Are you sure you aren't on a touch too much?

in reply to NatChap

Good question, not sure really...because when I decrease it I get some hypo symptoms like feeling more sluggish and cold.

NatChap profile image
NatChap in reply to

How are your vitamin levels?

in reply to NatChap

To be honest, I have not had them tested for a while and just take a multivitamin for women daily...I know it's often said to avoid multivitamins, but it's convenient...next doctor's appointment won't be until October.

NatChap profile image
NatChap in reply to

Might be worth getting vit d, ferritin and b12 tested. It could be that when you say that you feel hypo when you reduce your dose, it's not your thyroid but a deficiency in something else causing those symptoms?

in reply to NatChap

I know, it's important to optimise all levels, not just thyroid. Thanks for your input, really appreciate it!

in reply to NatChap

PS. I was diagnosed with low ferritin and iron a few years ago, and put on a prescription med (Losferron) but it did nothing for me. If levels are still low, I think I am going to have to find a better iron supplement.

NatChap profile image
NatChap in reply to

I've been deficient in all 3 (ferritin, b12 and d) at various times and they can all cause symptoms similar to those of hypothyroidism. It's such a difficult disease to navigate, especially when our doctors are so useless. Honestly as well as buying my own meds it costs me a fortune in supplements 🙄

Shubbaz profile image
Shubbaz

I’ve always split dosed mine as per STTM guidelines

in reply to Shubbaz

Thanks for your input!

After seven years on NDT, I can see a pattern emerge:

I seem to need my FT4 levels at least midrange, preferably a little higher, but it's very difficult to achieve that on NDT alone as it tends to raise my FT3 to supra physiological levels (but maybe that is only a problem if you take NDT once daily?)

I have been considering lately adding some T4 to NDT, but cannot find many sources that support such an approach. The STTM is against it (claiming NDT is 80% anyway), and many other practitioners working with NDT say NDT should not be taken with T4 as that increases the risk of rT3 dominance. A couple of websites I've visited recommend combining NDT and T3.

But a human thyroid produces more than 80% T4 (90-98% T4 depending on source), so maybe adding a little T4 to NDT is not such a bad idea...?

NatChap profile image
NatChap in reply to

Might be worth trying, you can always stop taking it if it doesn't help!

in reply to NatChap

Yes, it might be a good idea because the t3:t4 ratio in NDT is static and not ideal for everyone.

ramsfs10 profile image
ramsfs10

i cant take more than a grain at a time witout feeling hyper after follwed by a crash.. so i split mine 5 times a day with smooth energy all day

in reply to ramsfs10

Wow...doesn't it feel like it's taking over your whole life...?!

ramsfs10 profile image
ramsfs10 in reply to

better than riding a roller coaster all day! i get used to it just take half pill every 4 hours. its easy. just think of it as a cup of coffee.. i have quit all coffee and caffeine. i used to drink coffee all day just to function

in reply to ramsfs10

Yes, I see what you mean, it's like taking insulin or other drugs needing to be multi dosed...depending on what I need (less NDT + more T4 or just NDT but in several smaller doses) I might give your approach a try! Thanks again for your input!

ramsfs10 profile image
ramsfs10 in reply to

seriously try splitting it as least 3 times and get back to me. u might find u can actually take more when u split since ur not causeing huge peaks

Peanut31 profile image
Peanut31

Hi

I’m currently taking NDT, although some symptoms have gone, not all of them.

Ideally you split your NDT dosage either twice (I do) or three times a day, due to the T3 in it.

When you say its impractical to take it twice, what do you mean?, your job stops you?

I currently take 1 grain at 6am, 1 hour before breakfast, I sleep with a vibrating watch on and it gently wakes me up without waking my hubby up.

I take it with water then go to sleep again until I wake at 7pm then I have breakfast at 7.30pm.

I take another 1 grain at 2pm and wear a Fitbit Watch with a vibrating alarm that reminds me whilst a work.

T3 is short lived in the body and maybe your body can’t cope with that much T3 at once.

I can’t seem to increase my NDT dosage as my pulse is too high even after a few hours, I’ve been anxious and jittery as well.

Although they say blood tests are irrelevant on NDT, I did one recently and my T3 was over range hence me feeling jittery, this is why I reduced back to 2 grains.

Although STTM states NDT is the answer, I disagree as one size doesn’t fit all. Some find Levothyroxine helps, or T3 alone.

I have been on 2 & 1/4 grains & 2 & 1/2 grains, and didn’t feel great, so I’m looking at adding some T4 as well.

They also claim that people should be on 3-4 grains, again every one is different.

Check your vitamin levels, iron, especially.

You can do private blood tests without waiting for your GP or endo to do this, and, some are finger prick tests. Medi checks and blue horizon offer this service.

Best wishes

Peanut31

in reply to Peanut31

Thanks a lot for your input, that's very helpful as well!

Yes, what I meant was basically that I am afraid to forget to take the second dose in the afternoon/at night, especially since you should leave ideally an hour before eating or drinking anything other than water. I know some people take their thyroid meds at bedtime, but that would not leave 12 hours between doses as I tend to go to bed rather late (rarely before 10 pm) and take my morning dose around 6 am.

I agree with you that the "one size fits all" solution advocated by the STTM is not right for everyone. Many tend to see T4 as a storage hormone with one single function: to convert to T3, and if you take NDT or T3 there is no need for T4. But others claim that T4 has some activity on its own so I am not sure it's a good idea to dismiss it as an inactive storage hormone only...after all, it has a half-life of several days, whereas T3 only lasts for a few hours in the body, so I like the idea of having some T4 around in case I need more T3 at times. But of course, it depends on whether my body is able to convert it as needed...it's often said that the conversion process is impaired in people with Hashimoto's, but I don't know if that means there is zero conversion or some conversion, not just enough for the body's needs...?

MaisieGray profile image
MaisieGray in reply to Peanut31

"Ideally you split your NDT dosage either twice (I do) or three times a day, due to the T3 in it." Not necessarily. People are individual when it comes to what suits them or works best for them, there is no single ideal. When I was taking NDT, first Naturethroid and then ThyroidS, I dosed only once per day, at bedtime, and had no problems with that. I have a close friend who uses Naturethroid who also doses once per day perfectly happily.

pennyannie profile image
pennyannie

I am taking Thyroid S and believe that this NDT is slow release hereby not necessitating multi doses ?

Tired Thyroid, from hyper to hypo to healing by Barbara S Lougheed does expand on your idea of adding some T4 to NDT as on size doesn't necessarily fit all of the people all of the time.

I seem to being ok on only 1 + 1/2 tablets taken together at around 4.00 in the morning.

I'm now thinking should I be adding back in some T4 to bring my level up to nearer 100 than the 57 I'm currently utilising.

I know I have high reverse T3 so then think maybe not ?

Anyway, according to the book, any combination makes sense if it relieves symptoms.

Again, I guess it comes down to trial and error, and depends if your trying to get a blood test to appease a doctor ?

Peanut31 profile image
Peanut31 in reply to pennyannie

Hi pennyannie

I’ve just started reading that book as well, and I can relate to lots of things she says.

I would also recommend that book.

Best wishes

Peanut31

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