Can too much T4/NDT increase constipation?

[CrimsonMacaw]

I've been taking 140mcg of T3 alongside 300mcg T4/3 capsules Thyrogold (NDT) for a number of months now. I've noticed that whenever I increase the dose of the T4/NDT medication by 100mcg/1 capsule then I get an onset of constipation symptoms.

Does anyone have any ideas as to why this would happen? Is it an issue of too much T4 pooling in the body, requiring me to increase my T3 dose? Or is it the somewhat similar Reverse T3 issue?

As odd as it sounds, I find that when my Free T4 is below mid-range and my Free T3 above mid-range I feel best. Going T4/NDT free isn't an option because I've tried that, and after a week or two all the hypo symptoms return. That's why I'm thinking that it's an issue of me needing some T4, but too much of it may be suppressing my Free T3.

I'd appreciate any and all ideas.

[shaws Administrator]

I note you state "I've noticed that whenever I increase the dose of the T4/NDT medication by 100mcg/1 capsule then I get an onset of constipation symptoms.".

Normally when increasing we only go up by gradually 1/4 tablet every six weeks

I wonder if you're taking a larger dose than you require (and I'm not medically qualified) i.e. 140mcg of T3 alongside 300mcg T4/3 capsules.

Compared (and I am aware everyone is different) to my dose of one tablet of 25mcg of T3 daily.

25mcg T3 is equal 'in its effect' to 100mcg of levo. The following may be helpful and it's by the doctor/scientist who invented Thyrogold so that a prescription wouldn't be needed.

naturalthyroidsolutions.com...

[greygoose]

I'm a little confused by what you're saying, here. That sounds like a massive dose. So, you're taking 3 capsules of Thyrogold; one capsule of thyrogold contains 100 mcg T4 and 46 mcg T3? Odd amount. Are you sure about that?

Anyway, over-medication doesn't normally cause constipation, as far as I'm aware. But, are you actually over-medicated? Can you post your latest blood test results and ranges?

Does anyone have any ideas as to why this would happen? Is it an issue of too much T4 pooling in the body,

T4 doesn't 'pool' in the body. There's no such thing as 'pooling'. The body retains a certain amount of T4, obviously, as it's a storage hormone. But, excess T4 is excreted or converted to rT3.

Or is it the somewhat similar Reverse T3 issue?

rT3 isn't an 'issue', it only stays in the body for about two hours, so doesn't have time to 'pool'. And, it's inert so not likely to cause constipation.

Free T4 is below mid-range and my Free T3 above mid-range I feel best.

I don't know why that would sound odd. Sounds perfectly normal to me. T3 is the active hormone, needed by every single cell in your body. And, when you take T3, it lowers your FT4 level, so it's bound to be lower than the FT3. But, if that's where you feel best, then why isn't that what you're aiming for? I find it difficult to believe that your FT4 is below mid-range when taking 300 mcg. If it is, then you're not absorbing the hormone correctly for some reason.

That's why I'm thinking that it's an issue of me needing some T4, but too much of it may be suppressing my Free T3.

Taking too much T4 cannot suppress your FT3. How would that even work? There's nothing surprising you you needing some T4, most people do. And, there's nothing surprising in needing high doses of T3. What is surprising is needed such high doses of both.

[CrimsonMacaw in reply to greygoose]

In relation to the FT4, most advice I've read on the internet suggests that FT4 should be in the upper third of the range. What I've found is that when I increase my T4/NDT dose to get it into the top of the range (which requires either 400mcg levo/4 capsules Thyrogold) I get worse constipation than when I keep my FT4 levels below mid-range (which requires 300mcg/3 capsules Thyrogold).

But the takeaway I'm getting from the replies from you and shaws is that high dose of T4/NDT shouldn't cause an increase in constipation symptoms. Again, it sort of clashes with my own observations and self-experimenting with different dosages of T4 whilst keep T3 at 140mcg (that's 7 tablets of Tertroxin here in Australia)...but I wanted to get some outside input anway.

For what it's worth, the recent endo specialist I saw here in Sydney mentioned that there is a strong possibility that taking T4/NDT may suppress endogenous T3 production (and FT3 levels) for some people, thus necessitating an increase in T3 dosage. Similar to what a high dose of T3 would do to FT4 levels.

Anyway, it is a bit of a head-scratcher as to why I need to be taking such massive doses of T3 and T4/NDT just to get my FT3 and FT4 levels to the top of the range. Some have mentioned that it may be a cortisol issue, but even when I was taking adrenal support herbs/supplements, I still needed to take the same dosage of T3 and T4/NDT meds. Any ideas?

I should also mention that when I started taking these meds my FT4 and FT3 were not totally abysmal or anything. My FT3 was slightly below range and my FT4 was at the bottom of the range, borderline just below. However, they had been at these levels chronically for some time which was I needed to start taking meds.

BTW, I've posted my blood test results in one of my previous posts from several months back, so if you check my post history you should be able to find it quickly, as I don't have a slew of posts to my name.

[greygoose in reply to CrimsonMacaw]

In relation to the FT4, most advice I've read on the internet suggests that FT4 should be in the upper third of the range.

That is for people on levo - T4 - only. Not people on T4+T3/NDT. If you have any T3 the FT4 is bound to be lower and trying to raise it is often very difficult and often pointless.

For what it's worth, the recent endo specialist I saw here in Sydney mentioned that there is a strong possibility that taking T4/NDT may suppress endogenous T3 production (and FT3 levels) for some people, thus necessitating an increase in T3 dosage.

Well, obviously. If your thyroid is even still capable of producing T3 by itself. Even just taking T4 by itself can stop endogenous production of thyroid hormone. But, that doesn't mean you have to increase the exogenous T3 to rediculous levels. It's rare to find someone taking as much as you. If what he said were true, we'd all be taking really high doses like that. But, some people are quite well on 1 grain of NDT, which is only 9 mcg T3. We're all different and all have different needs. But, endos like to come up with these weird and wonderful 'explanations' for something they don't really understand.

Anyway, it is a bit of a head-scratcher as to why I need to be taking such massive doses of T3 and T4/NDT just to get my FT3 and FT4 levels to the top of the range.

How do you take your hormone? Do you take it on an empty stomach etc. just like you would levo? Do you take any other medication/supplements at the same time? Do you have low stomach acid?

I should also mention that when I started taking these meds my FT4 and FT3 were not totally abysmal or anything. My FT3 was slightly below range and my FT4 was at the bottom of the range, borderline just below.

I would call that abysmal. Certainly very hypo.

BTW, I've posted my blood test results in one of my previous posts from several months back

A lot can happen in several months. Sounds like it's time you had new labs done.

[greygoose in reply to greygoose]

I've just reread your first post, with the blood test results. That was six months ago. I think you've changed your dose since then, haven't you? I'm still utterly confused about what exactly you're taking. Are you taking Thyrogold (real NDT, not a glandular) + synthetic T3 + synthetic T4?

I mentioned leaving one hour before eating in that post, rather than 1/2 hour. Are you doing that yet? Are you splitting your dose? I see you're still talking about 'pooling' although it was mentioned in that post six months ago that 'pooling' doesn't exist, it's just an invention of STTM.

So, rather than worrying about if and why increasing your dose increases your constipation, it might be a better idea to address the constipation itself. Raise stomach acid? Take pro/prebiotics? Take vit C and/or magnesium? Test your nutrients?

[CrimsonMacaw in reply to greygoose]

I take my T3 on an empty stomach 30 minutes - 1 hour before breakfast. I take 100mcg in the morning, then 20mcg mid morning (anywhere from 1 - 2 hours after breakfast) and then 20 and sometimes 40mcg around 1.5 - 2 hours after lunch.

I'm not taking any other medications with them. However now that I'm taking T4/NDT, I'm taking that alongside my T3. But even when I wasn't taking T4/NDT I still needed these huge doses to get my T3 levels up.

For instance when I started taking it last year, 80mcg T3 in the morning would raise my FT3 but it would stay in the lower part of the range.

Also I do have low stomach acid and gut dysbiosis. I'm not sure of the severity of my low stomach acid, but it is low. If I want to digest food properly I need to take acid/enzymes along with the meal.

[greygoose in reply to CrimsonMacaw]

So, are you doing anything about the gut dysbiosis?

I still don't think you are taking your thyroid hormone far enough away from food. Food should be at least one hour after hormone, or two to three hours before. That is going to affect your absorption.

[CrimsonMacaw in reply to greygoose]

I've no idea how to fix the gut dysbiosis.

I've been at it for 10 years, thrown thousands upon thousands of dollars away on specialists/naturopaths/herbalists/internet health hackers, and nothing. I've tried all types of prebiotics, probiotics, resistant starch, minerals, vitamins, food elimination and nothing led to long-term improvement.

Or I would get improvement for a week or two and then whatever I was doing would stop working and I would revert back to how I was before.

As regards the timing of my medication, I've found that there was no difference in their effect if I was taking my meds 1/2 hour, 1 hour, or 2 hours away from food. For me, the dosage seems as though it has a much greater effect.

And it was the T3 and T4/NDT meds that restored my normal bowel movements, even though the dysbiosis remained. The problem is that after a month or two the thyroid meds would stop being as effective as before and I'd need to tweak my dosage.

Yet I have no idea which way I'm supposed to tweak it - do I decrease my T3 or my T4/NDT, or do I instead increase them? And like I mentioned, although it's counterintuitive, decreasing my T4/NDT actually made my bowels function better.

I take synthetic T3 and Thyrogold NDT. I still take the beef thyroid/liver glandular because I find that to be very effective in reducing overall hypo symptoms. I tried the synthetic T4 around a month ago at 300mcg - that's how I know what its effect is.

[greygoose in reply to CrimsonMacaw]

Well, I still think you need to retest. You've obviously changed your dose in the last six months, and you should always retest six weeks after a change in dose. That's the only way you can know if you need to increase or decrease.

And, if I were you, I would get my nutrients tested: vit D, vit B12, folate, ferritin, iron and vit A, as you're taking that beef liver supplement. Do you take that well away from your thyroid hormone? Should be at least four hours away from it. It could be that nutritional deficiencies are exacerbating your gut dysbiosis.