Combo tirosint and NDT (and which one to take)?

[catis]

Hello, first I like to apologise for my English, but I will give it a try.

End 2018 I have been very ill with a TSH of 94, T4 near to 1. Long story short, I barely survived but I am kinda back again. Since then I have serious neck problems, probably cci/AAI. I also have ME for 10 years. I have to be very cautious with medication.

Last year I survived on tirosint 100 ug, with TSH<1, T4 in the upper percentile, but T3 in the lowest quarter. I also started LDN which gave me some more mental clarity and energy, but I am still mostly housebound.

I have a feeling that my metabolism is slow and I am overweight. Since I am quite stable over the last year I am ready now to try something different. But I don't want to do it too rigorously. I would like to know if it possible to complement the tirosint with NDT, eg 80 ug tirosint and a quarter of a grain NDT (I think there is approximately 60 ug T4 in the NDT?). So I don't have to change too much at once. Are there arguments against it? And if I would give it a try, is there any advice which NDT to take?

Thanks in advance.

[Celestialbeing]

Why not use straight NDT? It contains both T4 and T3. Most endos that prescribe it will start out with a dose that is listed on the dispensing instructions. Manufacturers issue an equivalence chart that the doctors follow but most people need and use more than that amount. That is because there is less T4 and more T3 in the NDT. T4 is used up in the body in approximately 7-8 days while T3 is the active, usable hormone that lasts approximately 4 hours.

[catis in reply to Celestialbeing]

I cannot do that, I'm too fragile. When I started the meds it almost killed me (levo), my breathing stopped for 3 months. I can handle the tirosint but want to add some NDT.

[Celestialbeing in reply to catis]

People that i know that use synthetic T4 and T3 usually lower the T4 dose a few days before adding the T3. If your FT4 is too high in range and FT3 is too low in range, it can be a conversion and/or absorption issue.

What do you mean that your breathing stopped for 3 months? Do you mean it was difficult to breathe? For your body to react as you did, your levo dose was probably too high (even if in range). This happened to me.

A week after my TT surgery and starting thyroid hormone replacement, my BP was 190/100 and heart rate was 120. Over that year I had to lower the synthroid dose from 125 mcg all the way to 88 mcg. Even then, my FT4 was at the very top of the range. Still, my FT3 was at the bottom of the range.

Even when i switched to Tirosint, then added Cytomel, the FT3 did not increase. I had reactions to the Cytomel (headache, stomachache, constant hunger, constipation).

Be sure to discuss with your endo. And maybe find another medical opinion from another endo.

[Poniesrfun in reply to Celestialbeing]

I might also add - why not just add synthetic T3 (liothyronine) starting in small amounts. This can help you find how you respond to the T3 without changing your Tirosint.