High TSH on NDT - what to do

[wysewoman]

Hello there,

I'm hoping this will be an easy answer for someone more in the know, than I.

I have no thyroid (Papilliary Thyroid Cancer 5 years ago).

A year ago, I switched from 150mcg levo to 3 grains of NDT.

My latest blood tests shows ft3 over range at 9.3 (understandable given the test was done a few hours after taking my dose). FT4 in range at 11 and my TSH over range at 7.07.

My prior trst done in January of this year showed TSH of 0.5, FT4 10 and FT3 4.5 (done about 8 hours after taking the dose)

As I had cancer, I am supposed to keep my TSH fairly suppressed.

So my question is - should I be looking to change my current dosage of NDT, or possibly reintroduce some levo? Any insight and clarification as to what may be happening, much appreciated.

Many thanks,

Melissa

[shaws Administrator]

Due to the fact that levothyroxine (T4 alone) was introduced along with blood tests and before that we were prescribed NDT due to clinical symptoms alone and no blood tests, blood results will not correlate. NDT contains T4, T3, T2, T1 and calcitonin whereas levo is T4 alone. When we take NDT it is gradual relief of symptoms by small increases. Read 'Safely Getting Well etc' on the following link which might be helpful:-

naturalthyroidsolutions.com...

This doctor only took one blood test for diagnosis and thereafter it was all about how the 'patient felt' on a dose which was priority.

[wysewoman in reply to shaws]

Hi Shaws,

Thanks for your reply. I'm not sure what your situation was, but my results concern me a little as TSH suppression, resulting in very low TSH figures. is one of the things that they strive for post Thyroid Cancer. I *think* it indicates that there is very low or little stimulation of any growth of any remaining thryroid tissue and hence, a lower chance of encouraging potentially cancerous cells to grow again.

As for symptoms, I think I feel largely OK, though recently, I've been feeling a bit more tired than usual but been putting that down to the hot weather.

Anyway thanks again,

Melissa

[fibrolinda in reply to wysewoman]

I would think another blood test would be a good idea to check this wasn't a lab error imho

[shaws Administrator in reply to wysewoman]

Blood tests should always be at the earliest possible, fasting (you can drink water) and allow a gap of 24 hours between last dose and test and take it afterwards.

The following is from an expert in Thyroid Hormones which may be helpful:-

"Dear Thyroid Patients: If you have thyroid gland failure--primary hypothyroidism--your doctor is giving you a dose of levothyroxine that normalizes your thyroid stimulating hormone (TSH) level. Abundant research shows that this practice usually

does not restore euthyroidism--sufficient T3 effect in all tissues of the body. It fails particularly badly in persons who have had their thyroid gland removed. TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy.

The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of inactive levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. IF you continue to suffer from the symptoms of hypothyroidism, you have the right to demand that your physician give you more effective T4/T3 (inactive/active) thyroid replacement therapy. Your physician can either add sufficient T3 (10 to 20mcgs) to your T4 dose, or lower your T4 dose while adding the T3. The most convenient form of T4/T3 therapy, with a 4:1 ratio, is natural desiccated thyroid (NDT-- Armour, NP Thyroid, Nature-Throid). If you have persistent symptoms, ask your physician change you to NDT and adjust the dose to keep the TSH at the bottom of its range-- when you have the blood drawn in the morning prior to your daily dose. This may be sufficient treatment, but IF you continue to have persisting hypothyroid symptoms, and no hyperthyroid symptoms, ask your physician to increase the dose to see if your symptoms will improve, even if the TSH becomes low or suppressed. You can prove to your physician that you're not hyperthyroid by the facts that you have no symptoms of hyperthyroidism and your free T4 and free T3 levels are normal in the morning, prior to your daily dose. They may even be below the middle of their ranges. Your free T3 will be high for several hours after your morning T4/T3 dose, but this is normal with this therapy and produces no problems. You should insist that testing be done prior to your daily dose, as recommended by professional guidelines. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy. In all cases, your physician must treat you according to your signs and symptoms first, and the free T4 and free T3 levels second.

hormonerestoration.com/

[SlowDragon Administrator]

I was going to say exactly same as fibrolinda

Getting bloods rechecked by different lab ....incase it's an error

[MaisieGray]

I agree, retest, ensuring you leave the recommended 8 - 12 hrs between your last dose, and the blood draw. But also, were you taking biotin or any supplement containing biotin, that might have skewed the assay?

[wysewoman in reply to MaisieGray]

Thanks for all the replies.

In response to you, MaisieGray - no I do not take any of those supplements.

I will ask for a retest and see what it says the second time.

Cheers all,

Melissa