Increase in medication? Advice please!

[OllieT]

Hello everyone

I had RAI treatment approx 20 years ago to treat thyroid nodules and address the overactivity of my thyroid. I haven’t really been well since despite seeing many different ‘Professionals’. I was prescribed T4 only for many years then tried NDT. I have good days and bad days with no obvious reason as to why some days are better than others. I have had periods of extreme hair shedding, exhaustion and have no enthusiasm for anything.

A new private Doctor has adjusted my medication regime to include both T4 and NDT. I currently take 1 grain Erfa and 75mcg Thyroxine. He is happy now my free T4 and T3 are in range and says if I still feel unwell it must be something else. I know from research that different people need to be at different levels within the range and feel I am still under medicated. Blood results below:

TSH 0.867 (0.27-4.2)

Free T3 4.14 (3.1-6.8)

Free T4 16.2 (12-22)

In your opinions, which medication should I try increasing? The thyroxine or the NDT or maybe both?

Any advice gratefully received.

[SeasideSusie Remembering]

OllieT

T3 is the active hormone which every cell in our bodies need, it's low T3 that causes symptoms.

Many of us are on combination hormone replacement: some on Levo plus T3 as this gives greater flexibility with the doses of T4 and T3; some on NDT alone if the ratio of T4:T3 at 4:1 suits them; some on NDT plus T3 and some on NDT plus Levo. Trial and error will tell us where we each need our FT4 and FT3 levels to suit us as an individual.

Looking at your results, I'd say you could do with an increased FT3 level.

Currently your FT4 is 42% through range and your FT3 is only 28.11% through range

[Calculator here: chorobytarczycy.eu/kalkulator]

If you increase your Levo that will raise your FT4 level and depending on how much natural conversion you have then it may raise your FT3 level as well but probably not enough.

If you increase your NDT, because it contains both T4 and T3 it may raise both FT4 and FT3 levels.

Whether you are on the right combination or not is debatable.

When you were on NDT alone, what were your levels like then?

Maybe it's worth trying Levo plus T3.

[OllieT in reply to SeasideSusie]

Many thanks for your reply. My history with my current private Doctor is as follows:

1 1/2 grains Erfa

TSH 4.86

FT4 7.46

FT3 5.5

2 grains Erfa

TSH 3.42

FT4 9.73

FT3 3.74

Changed to 1 1/2 Erfa plus 25mcg thyroxine

TSH 0.466

FT4 11.8

FT3 4.59

1 1/2 Erfa plus 50mcg thyroxine

TSH 0.58

FT4 13.20

FT3 7.28

1grain Erfa plus 75mcg thyroxine

TSH 0.867

FT4 16.2

FT3 4.14

All ranges are the same as in my previous post.

Any opinions most welcome

Thanks

[SeasideSusie Remembering in reply to OllieT]

Have you always done your tests under exactly the same conditions, i.e.

* No later than 9am

* Fast overnight from evening meal/supper the night before

* Drink water only before the test on the day

* Last dose of Levo 24 hours before test

* Last dose of NDT 8-12 hours before test

Have you ever had thyroid antibodies tested?

[OllieT in reply to SeasideSusie]

Antibodies are negative

I haven’t stringently met all of those conditions 🤔

If I was to try a thyroxine plus T3 regime, what would be a good starting dose?

Thanks

[SeasideSusie Remembering in reply to OllieT]

To compare results accurately then it's necessary to test under the same conditions every time.

If you take your Levo too close to your blood draw you get a false high FT4, if you take if longer than 24 hours away you get a false low FT4.

If you take NDT too close to blood draw you get a false high FT3, longer than 12 hours and you get a false low FT3.

TSH can be lowered by eating before the test, coffee affects TSH so possibly other caffeine containing drinks may as well.

I wouldn't suggest anything at the moment until you've done a test following the above advice to get accurate results.

[OllieT in reply to SeasideSusie]

Thanks. I’ll repost after my next blood tests for which I’ll ensure I follow this advice 🙂