Trialling NDT-advice please on blood test results and next steps

[WendySh12345]

Apologies for the long post but I would really value some advice.

Feb 2019 I paid to see a private endocrinologist who prescribed Armour NDT, week 1 30mg bi-daily, week 2 raised to 30 mg a.m. and 45 mg pm, weeks 3-12 45 mg bi-daily.

Blood test results after 6 weeks: TSH 0.04 (0.27-4.2), FT4 13.2 (12-22), FT3 6.0 (3.1-6.8)

Blood test results at 12 week point: TSH 0.04, FT4 11.6, FT3 5.4

2nd appointment with private endo May 2019 - based on above results he did not want to increase NDT from the 1.5 grains daily, saying FT3 was fine and instead added 25mcg levothyroxine. I am trialling this combination for a further 12 weeks and if no change in symptoms by August he says I should return to levothyroxine monotherapy.

However, as I still feel symptomatic (fatigue, no weight loss, slowed brain function, low mood) I would have liked to dose NDT by symptoms and slowly increase, but feel hostage to blood test results. I would really welcome advice on next steps - should I self-medicate on Thai NDT perhaps? Other thoughts? I am desperate to get some semblance of my former life back!

[SeasideSusie Remembering]

WendySh12345

The way I read your post you were started on 30mg twice daily for 1 week (total 1 grain, 60mg), then week 2 your dose was raised to 1 and 1/4 grains, then week 3 it was raised to 1 ands 1/2 grains. That is a high starter dose , it's usual to start on 1/4 grain to see how you cope with the T3 then increase gradually.

Blood test results after 6 weeks: TSH 0.04 (0.27-4.2), FT4 13.2 (12-22), FT3 6.0 (3.1-6.8)

Blood test results at 12 week point: TSH 0.04, FT4 11.6, FT3 5.4

I see from your profile that you have Hashi's and this may have some bearing on why your FT3 is lower in the second test, but can't be sure.

Did you have vitamins tested immediately prior to starting NDT? What are your current results?

I am trialling this combination for a further 12 weeks and if no change in symptoms by August he says I should return to levothyroxine monotherapy.

Are you sure this endo is a thyroid specialist? Was he recommended on the list from ThyroidUK? If you have decreased ability to convert T4 to T3 confirmed by the DIO2 test, then Levo only isn't right for you. Maybe trial Levo plus T3, you may find the balance of T4:T3 in NDT isn't right for you and you can get a better balance by taking synthetic Levo plus T3 and tweak the doses until you find what's right.

It's still fairly early days, and your FT3 at the second test had reduced. Did you feel better when it was at 6? You might need it higher in range for symptoms to improve and lose weight.

[WendySh12345 in reply to SeasideSusie]

Dear SeasideSusie

Thanks so much for your advice. In answer to your questions:

I didn't have a blood test prior to starting NDT unfortunately, my most recent results are from August 2018 as follows: Ferritin 136 (30-470), VitD 85 (50-200), VitB12 780 (180-900), Folate 11.1 (2.5-19.5). I supplement with Spatone and BetterYou DLux Vitamin D+K2 oral spray, and Magnesium Malate. I am having a further blood test end July for thyroid function, but will ring the surgery to ask if my vits/minerals can also be checked.

The private endo I am seeing isn't on the Thyroid UK list, but I knew that he had prescribed T3 to someone on this forum, and that he could also prescribe NDT, so hoped that he would be a thyroid specialist. I must admit that when I went to the first consultation I expected him to prescribe some T3 to add to my T4, so was rather surprised that he went down the NDT route, but I've been happy to trial NDT, nothing ventured, nothing gained! As you say it is early days, and looking back I may have felt a little better with FT3 at 6, but I find any changes are always so subtle and hard to discern. I suppose I was hoping for a magic bullet!