My Doc is advising I come off NDT and switch to Levo T4 only. My blood results are
serum T3 1.7
Serum free T4 8.9
Serum TSH 0.014
He’s suggesting to go on 75mcg Levo T4 rather than 2 grains of NDT.
I’m really unsure. He’s saying I don’t need the T3 and my T4 is too high. I don’t feel great (always tired) so I need to change something but worried to cut T3 out.
Any advise greatly appreciated.
Hendie
We really can't comment usefully unless you put the reference ranges that come with your results, ranges vary from lab to lab so we can't interpret results without them.
Also, can you please confirm whether the T3 result is Free T3 or Total T3.
Sorry. The results are
Serum T3 1.7 (1.30-3.10)
Serum free T4 8.9 (10.00-24.00)
Serum TSH 0.014 (0.20-5.00)
It doesn’t say if free or total. It was done at the docs not privately if that helps clarity.
In what world do these results show that your freeT4 is too high? The bottom of the 'normal' range is 10 and yours is 8.9!
Did you take your NDT before your test or not? What time of day was the test done at?
I didn’t have any NDT for 24 hours before as I take first thing in morning. The test was 9.20am.
He was saying about the TSH being abnormal too though. I told him when I lived in the UAE a endocrinologist had suggested I take T3 alongside T4 but because you cannot source it there suggested NDT instead but my doc was very dismissive of that saying as I’m in the UK all I need is T4 and my body will make the T3 itself. I said well that’s debatable with lots of mixed options/results but he said just go with the T4 and it’s free in the nhs so what more can I need 🙈
He's an idiot. It's been shown in studies time and time again that T4 monotherapy produces low T3 levels in many people. Your T3 is already low and he's offering you a 50% dose reduction. Run away - but you'll have to buy your meds yourself. I'd increase to 2.25 grains of NDT unless I felt well, in which case I'd maintain on 2 (or even add 5-6.25mcg T3 to my NDT). Thyroid function doesn't change according to the country you live in.
No I don’t feel well. I always feel like I’m going to fall asleep. I can have 12 hours sleep and still feel tired. If I increase will it further lower my TSH or does TSH not really matter? I’ve also got some T3 so I might try upping that like you mentioned.
I agree he's an idiot! He hasn't even done the right T3 test, so how can he even know if you need it or not.
But, you did leave too long between your last dose and the blood draw. For NDT it should be 8-12 hours. So, you have false lows, there… In fact, the whole test is useless:
* Too low between last dose of NDT and blood draw
* wrong time of day to take blood
* wrong T3 test
You cannot conclude anything from those results.
But, going from 2 grains of NDT to 75 mcg levo would make you very ill in any country - as if geographical location has anything to do with it! Tell your GP to take a hike and source your own NDT. 
I’m trying to figure out do I stay the same on 2 grains NDT, swap to T4 only, reduce NDT to 1 grain and add some T4 or ??? My head is mashed. I’m defo not hyper as I’m still a fat b*****d! 😂 So that can’t be surely?!?
Why? 75mcg levo is about half the amount of NDT you are taking (one grain of NDT is about 65mcg of levo equivalent). If he is not prescribing the NDT, I would tell him to sit and spin. You need a free t3 result to be clearer what's about going on.
I checked on my NDT bottle and it said 1 grain had 35mcg Levo and 8.31mcg - or did I misread that and I’ve misinformed him. He was aiming to replace the T4 like for like but eliminate my T3. Sorry if I’m being dumb. The bottle does also say 1 tablet is 60mcg but I thought I just looked at the Levo and T3 doses. I’m taking Thiroyd.
Yes. let's round up the T3 to 9 for easier arithmetic, so 1 grain is 35 mcg levo + 9 mcg T3. T3 is between 3 and 4 times as "potent" as levo, so 9*3 = 27 or 9*4 = 36 mcg levo-equivalent, making 1 grain of levo 35+27 = 62 or 35+36 = 71 mcg levo-equilavent. So 2 grains is between 124 and 142 mcg of levo. So 75mcg of levo is "equal" to just over 1 grain of NDT. Doctor is offering an almost 50% reduction in dose. To be on the "same" dose you'd need at least 125mcg levo. QED
Why didn’t he know that? 🙈
Well the I guess he’s wanting me to go on 125mcg Levo then. I think I’m better sticking with NDT and T3.
Well, given that he comes out with a cracker such as "as I’m in the UK all I need is T4", you can't expect him to know or think cogently about anything to do with the thyroid. And as for Serum free T4 8.9 (10.00-24.00) being too high, even allowing for the time gap with dosing, the man is certifiable. Can you change Drs?
I know! Yep I will be changing Doc. Shocking as he’s senior partner 😳
I moved from Cumbria to Sussex.My new GP is also the senior partner(I suspect newbies end up on his list 'cos he's useless)I had NHS bloods done & had my own private Medichecks bloods done(didn't tell him about them)having been on TUK for ages,I could see my levels were good on 2 grains NDT.The mistake I made was to tell him I was on NDT.He then announced that my results were unreadable by him(as if they had suddenly turned into martian numerals)because he had no knowledge or experience of NDT.He told me he wanted me off NDT & back on thyroxine.He did not ask me how I felt & couldn't suggest my numbers indicated a problem,obviously.
My practice will be amalgamating shortly & I think he is about to retire.I plan to get put back on thyroxine to comply,but bin it & continue with NDT.
This in order to stay in a practice that has potential. Its the best GP surgery in my catchment & the practice they are joining has very good reviews too.He virtually told me he washed his hands of me unless I went on thyroxine.That was nearly a year ago.
Yep, you've got it, do not change from 2 grains NDT for 75 mcg Levo you will be a lot sicker than you are now. As others have said, your doc is an idiot and is out of his depth. Do not change your medication, if you really want to change things, increase your NDT a little (1/4 grain). Your TSH will go even lower,but that doesn't matter very much.
Just to clarify, the single grain of NDT will be 60 mg not 60 mcg.
Didn't you know that thyroids respond to geography (they come equipped with a miniature sat-nav) and bodies generally act differently once you cross a border from one country to another?
my doc was very dismissive of that saying as I’m in the UK all I need is T4 and my body will make the T3 itself
Since your doc will never or rarely know what your Free T3 level is because it is hardly ever measured in the UK in people who are hypothyroid he can't say with any certainty at all that your body will make enough T3 for you.
And since T3 is the hormone that makes the difference between feeling hypo/healthy/hyper it is a rather important oversight!
Absolutely. Thank you, it’s much appreciated.
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