I am on 100mcg levo.
These are my latest results as my T4 is high, do I need a dose increase? Or perhaps I should revert to NDT?
TSH
6.6 mIU/L (Range: 0.27 - 4.2)
Free T3
3.68 pmol/L (Range: 3.1 - 6.8)
Free Thyroxine
15.800 pmol/L (Range: 12 - 22)
Autoimmunity
Thyroid Peroxidase Antibodies - 308 kIU/L (Range: < 34)
You mean your tsh is high not your ft4. You need a dose increase because your ft3 is low and your ft4 is low. Most folks need both of these well over half way through the range say 70% through to feel well.
Sorry, yes TSH is high. I have never had T4 this high but my TSH has always been ok. It has suddenly increased and I am unsure why.
It would seem that changing from NDT to Levo has caused this.
NDT tends to lower, even suppress TSH. It also tends to lower FT4 (because of the T3 in NDT).
So when you go back onto Levo you're taking T4 only so no T3 to influcence the results and lower the TSH. So your TSH has risen.
You are undermedicated on 100mcg Levo. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
If you are considering trying to conceive again, TSH needs to be no more than 2.5 for conception and a safe pregnancy.
Hi Susie, thanks very much. I came off NDT at the beginning of August and went on to Levo everything seemed to level well and my TSH was consistently under 2.5 until this week when it has shot up to 6.6. As I am TTC would you reccomend staying on Levo? Or reverting to NDT?
Just out of curiosity: Can I ask why you switched from NDT to T4 only (it's usually the other way around unless you feel overmedicated or otherwise unwell on NDT)?
I switched because my antibodies were over 400 and I was told this could be the reason. I was also told by the (NHS) endo that if I am TTC I shouldn't be on NDT. What do you think?
Does TTC stand for total thyroidectomy?
I cannot see why that would prevent you from taking NDT...as far as I know, anyone can take NDT. Some don't do well on it, just like some don't do well on T4, but does not mean any category of patients is excluded from its use.
Some doctors claim that NDT can increase autoimmune attacks, but doctors working with NDT dismiss this claim. I recently read an interesting article about that and will try to find it and post it here.
Unfortunately, many doctors are ignorant when it comes to the treatment of thyroid disease, so you have to be prepared to handle a lot of misinformation. If they even know what NDT is (not all doctors do), they will tend to tell you that it's outdated, unregulated, and even downright dangerous. Over the years, I have come to believe the main reason they don't like NDT is because it tends to suppress our TSH and doctors usually freak out at the sight of a TSH below range...of course, synthetic T3 also does that and many doctors won't hear of it either.
Here is the article I mentioned:
drchristianson.com/the-top-...
More generally, you should never let any doctor talk you into going off any thyroid medication you are doing well on. All thyroid drugs available on the market (with the exception of supplements such as "thyroid glandulars" which of course are not drugs) are safe and approved by relevant authorities.
Dosing by the TSH is likely to make you symptomatic as many doctors seem happy with a TSH "anywhere in range". You need to go by your free Ts when on T4 only as well, and especially make sure you convert T4 to T3 well enough. The reason many switch to NDT or add T3 is because they don't. People with Hashimotos' often seem to be poor converters so make sure you keep an eye on your free T3 levels as well as they are much more important than your TSH.
Thanks for that link which I found reassuring.
I do remember reading something regarding NDT not being suitable if with A/I and am grateful that l can now discount these thoughts and free up some brain space.
I'm with Graves post RAI and doing so much better of NDT.
Thank you.
Great that you found a treatment that works better for you
Yes I have come to realise this about the doctors. Sorry TTC is 'Trying to Conceive' - Doctors seem to be very nervous of anything other than levothyroxine particuarly when there is pregnancy involved. More than anything I need to find an Endo I trust. Thank you for you help.
I have not tried to get pregnant while hypothyroid, but cannot see any reason why NDT would make that more difficult than any other thyroid drug....I think it's more a case of your doctor being ignorant and brainwashed by the pharmaceutical industry than anything. For decades, NDT was the only drug available to treat hypothyroidism (it's been around since the 1800s), and women continued to conceive during that time or the world would not have as many inhabitants today...!
More importantly: how did you feel on NDT?
It could be that you would do well on T4 only if on a high enough dose for you; many people do well on T4 only. But I agree with others that your current dose seems too low for you. And you'd need to make sure you convert enough of it to free T3. Many doctors don't test FT3.
I have read that people without hypothyroidism have a TSH closer to 1. Today's reference ranges are too broad for many people who don't feel well with a TSH anywhere in range.
Yes I completely agree. Ok so last question - If I feel otherwise well on NDT are my raised antibodies a problem?
No, your antibodies are caused by the autoimmune attack on your thyroid and that will continue regardless of the drug you take.
Some alternative practitioners will have you believe you can reverse Hashimoto's. As far as I know, that's not possible. Some will say going gluten free will help as gluten can be inflammatory. But that's on another level - there are no supplements that can reverse an autoimmune condition such as Hashimoto's as far as I know, nor can the thyroid gland heal itself once damaged.
I came off NDT at the beginning of August and went on to Levo everything seemed to level well and my TSH was consistently under 2.5 until this week when it has shot up to 6.6.
So it's approx 6-8 weeks since you changed from NDT to Levo. The T3 from the NDT would need a couple of weeks or so to completely leave your system and the T3 would have been keeping your TSH low.
Also, it seems as though you were on 1.75 grains Armour which is 66.5mcg T4 plus 15.75mcg T3 which is the equivalent overall to between 113.75 and 129.5mcg T4 given that T3 is said to be between 3-4 times as "potent" as T4. By taking 100mcg Levo you have reduced the total amount of T4 you take so this reduction would acount for an increase in your TSH.
The reduction in dose of T4 would take 6-8 weeks to be fully effective, so the timing is right for your TSH to show such a difference now.
As I am TTC would you reccomend staying on Levo? Or reverting to NDT?
I can't answer that question I'm afraid, I'm not qualified to, nor have I been pregnant since my diagnosis of hypothyroidism so have no personal experience of pregnancy and hypothyroidism.
Thank you, this could very well be the problem. I guess now I have to decide whether to increase my levo or try NDT again.
I have hashimotos and have been on ndt for 15 years. I couldn't get on with thyroxine and to be honest wouldn't even attempt to try it again. My antibodies go up and down but nothing that appears to cause any major problems. Baring in mind that it costs the nhs roughly £300 for a months supply for ndt it could be that the price has made your endo change you to thyroxine if you get your ndt on prescription. x
Your T4 is not high, but probably too low. TSH is high, probably because free t3 is so low in range. Your FT4 is 38.00% through range but your FT3 is only 15.68% through range, so you might well do better back on NDT. Either that or dose increase
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