Help with latest Thyroid blood test results

[Flatdanny]

Would appreciate some feedback/advice about my most recent thyroid bloods.

* Im self medicating my thyroid meds and am also on TRT.... Though I now have an endo in the US who I’m working with.

11th of Feb I switched from 31.55 of T3 to NDT (Thyroid-S) as my new endo thought it would be a better option. From 11th Feb - 28th April slowly increased dose up to where I am now which is 3 grains. I’ve been monitoring my blood pressure and pulse and BP is good and pulse slightly higher than pre thyroid meds. 120 over 72 and pulse of 76. (Pre thyroid meds pulse was 60-70)

Symptoms - Not been feeling too bad. Apart from worsening join pain and slightly shaking fingers.

Last two set of bloods...

5th March (after being on T3 for about 7 weeks)

TSH: 1.59 (0.27-4.2) FT4: 12.4 (12-22) FT3: 4.77 (3.1-6.8)

2nd May (after being on NDT for 11 weeks)

TSH: 0.005 (0.27-4.2) FT4: 20.05 (12-22) FT3: 12.7 (3.1-6.8)

————-

So looks like I’m over medicated! Will be speaking to my endo about these results but would really appreciate some feedback here too 🙂

Was wondering how much to lower my dose?

Thanks,

Dan.

[SlowDragon Administrator]

How long before blood test was your last dose of NDT ?

Last dose should be 8-12 hours prior to blood test and test done as early as possible in morning and fasting

You also need vitamin D, folate, ferritin and B12 tested

These vitamins are often too low and frequently need supplementing to help thyroid hormones work better

Joint pain can be low vitamin D

Shaky fingers might suggest over medication....reducing dose slowly by 1/4 grain at a time - retesting 6-8 weeks later

[Flatdanny in reply to SlowDragon]

Thanks for the reply SlowDragon.

I take my NDT at about 6am and blood test was done at about 16.00 so 10 hours between...

Not done ferritin and d3 tests for a while.

B12 tested with Dutch Plus Test on 8th March - 3.2 ug/mg (0-3)

Ferritin tested 29th August 2018 - 118 ug/L (30-400)

Vitamin D tested 29th August 2018 - 89.2 nmol/L (50-175) * I now supplement with 10k iu D3 a day.

[SlowDragon Administrator in reply to Flatdanny]

Next time test early morning and fasting

[Flatdanny]

Thanks for your reply 🙂

Okay I’m gonna slowly reduce my dose and then redo bloods in about 6-8 weeks.

[greygoose]

Sorry to appear dumb, but how do you work out that 3 grains of NDT is equal to approx 60 mcg T3? I've tried the maths every which way, and I can't get that result.

[Cariad123 in reply to greygoose]

I understood that Thyroid -s each grain has 37mg of t4

and 9 mg of t3

[greygoose in reply to Cariad123]

37/38 mcg - not mg. And 9 mcg T3. So 3 grains contains 27 mcg T3.

[Cariad123 in reply to greygoose]

Total brain fog at the moment l knew after l had written mg it was wrong and wasn’t sure how to edit Thankyou grey goose

[greygoose in reply to Cariad123]

To edit, just click on the down-ward facing arrow next to the word 'More' at the bottom of your comment. You will get a drop-down menu with 'edit' at the top of the list.

[greygoose]

No, it certainly isn't. Because it's not just a case of dividing T4 by T3, it depends how well the person converts. Considering the OP was on a high dose of T3, that would suggest to me that she converts very poorly. So, it's pointless to try and convert NDT to a T3 equivalent. I'm actually shocked that this endo considers it suitable to change some one who was on 31.55 (how on earth do you get to that number, anyway?) to just 3 grains of NDT. It may not sound like a big difference, but it can make a hell of a lot of difference to the body.

[greygoose]

lol Perhaps Flatdanny will explain?

[greygoose]

Sounds awful! Poor you.

[greygoose]

I thought it had been decreased. I didn't understand if he was taking T3 only or taking some levo with it. If it was T3 only, then there's no guarantee he'll be able to convert all that T4 to make up the difference in the T3. And, it would all be easier to understand if he'd put in some lab results and ranges. I'm hoping he'll get back to us and fill in the details.

Sorry to talk about you as if you weren't there, Flatdanny, but we have your interests at heart.

[NWA6]

I used to have to fit my FIL’s surgical stockings for him last year! Nurse showed me a fab way but still a faff! Good luck with the new knee 🤗

[NWA6]

That’s right! The plastic bag! It’s great technique but still a faff! 😂

[greygoose]

Oh yes! you're so right. And I meant to comment on those results. Completely forgot!

Flatdanny, those results:

TSH: 0.005 (0.27-4.2) FT4: 20.05 (12-22) FT3: 12.7 (3.1-6.8)

Do not suggest over-medication to me. They suggest that you have Hashi's. Have you had your antibodies tested?

[Flatdanny in reply to greygoose]

Good morning guys and thanks very much for all your input. There seems to be a little confusion which may well be because of me not being clear in my original post. Apologies for that.

I originally wrote I was taking 31.55 mcg of T3 (* T3 only) before I moved to NDT. That was a typo! I was on 31.25 actually. Each tab was 25 mcg and I cut into four. So I was taking 1 & 1/4 tabs.... I then moved to the NDT and started on a low dose and increased the dose over time. Maybe I should have started on a slightly higher dose of NDT at the start.

I had antibodies done on the 4th July 2018 -

THYROGLOBULIN: <10 KU/L (<115)

THYROID PEROXIDASE <9 KIU/L (<34)

[greygoose in reply to Flatdanny]

I did wonder about a typo. lol

OK, so now you're taking 3 grains of NDT. But, I'm still not convinced about those results on 3 grains. Your antibodies are low, there, but that doesn't actually prove anything. You can have Hashi's without ever having high antibodies.

Have you ever been on T4 only? If so, do you have labs from that time?

And, how do you feel on that dose, compared to how you felt on the T3 only? Why did your endo think you'd do better on NDT?

[Flatdanny in reply to greygoose]

I didn’t know that about hashi’s. So how would you diagnose hashi’s if one does not have high antibodies? Curious...

I did trial Levo back in September for only a short time. About four weeks but felt really awful so stopped. In hindsight I should have probably given it more time to see how I felt on a higher dose. I was on 50mcg a day... unfortunately I don’t have labs for that time.

- Did not feel good on Levo.

- Felt much better on T3 than I did on Levo.

- Feel much the same as I did on T3 on NDT.

At the moment I’m not noticing many negative side effects of being over medicated. Only thing is slight shakes in my fingers and increased joint pain. No issues sleeping, no increase in BP, only slight increase in pulse. Just taken my temperature and was 97.6f

US Endo basically just said he would prefer me start with a combo thyroid med (NDT). He did not give me much of an explanation as to why that was, just that he was not a fan of Levo and that ‘it’s a marathon, not a sprint’. So he’d rather I did not start with T3 alone... Not very helpful I know.

[greygoose in reply to Flatdanny]

Hashi's people with low antibodies are often diagnosed by an ultrasound, where the damage done to the thyroid will show up clearly. But, if your levels tend to swing about, that's a pretty good indication.

Well, you could try reducing your NDT by 1/4 grain, but no more than that in one go. See how it feels, see what your next labs are.

I agree with your endo that it's a marathon, not a sprint, but I fail to see what that's got to do with taking T3 only. Whatever type of thyroid hormone replacement you take, the rules are to start low and increase slowly, so that doesn't sound like sprinting to me. I take T3 only because I didn't do well on levo, and was very ill on NDT. But the last thing I'm capable of is sprinting! lol

[Flatdanny in reply to greygoose]

Okay thanks. Will reduce dose as you recommend. How low do you recommend I reduce it to before running more bloods? I know you say reduce 1/4 grain but should I just reduce by 1/4 then retest? Also how long till bloods? 6 weeks okay?

[greygoose in reply to Flatdanny]

Just reduce by 1/4 and retest in six weeks. You're not on a very high dose, you don't want to reduce too far. And, as you don't really have any symptoms of over-medication, you should take it very slowly. I like to err on the side of caution.

[Flatdanny in reply to greygoose]

Okay make sense... Thank you very much for your help and advice. Very much appreciated 🙂

[greygoose in reply to Flatdanny]

You're very welcome.