NDT dosing

[Fox78]

If I’m on 175 levo and wanted to look at alternatives what dosage should I be looking at for both -

T3 and T4 combination, what should I look to decrease the levo too if I was to add in t3

NDT alone what would be the equivalent to 175?

Thanks

[SlowDragon Administrator]

Previous post shows low B12 and folate and no vitamin D test

healthunlocked.com/thyroidu...

Important to get these all optimal first before considering adding T3

Did you get vitamin D result yet?

vitamindtest.org.uk

Presumably you have been working on improving low vitamin B12 and folate

Recommend getting FULL Thyroid and vitamin testing 6-8 weeks after adding vitamin B complex (and Vitamin D if needed)

Are you now on absolutely strictly gluten free diet

[SlowDragon Administrator]

Earlier post shows you were on propranolol

healthunlocked.com/thyroidu...

Have you managed to very very slowly reduce and stop this?

Or been prescribed an alternative?

Propranolol lowers conversion and uptake of thyroid hormones. But it’s incredibly important to only reduce dose EXTREMELY slowly

I was stuck on propranolol for 19 years....not one endocrinologist understood it was badly affecting thyroid hormones

Propranolol also lowers parathyroid levels...and as result magnesium levels too

Low magnesium linked to low vitamin D

[Fox78 in reply to SlowDragon]

So my vitamin d was 89 which I was told was normal

I have been supplementing jarrow b12 and folate but not had these retested again

And yes following strict gluten free diet for the past 4 weeks

My propranolol has been reduced to 40 I have asked about an alternative

Whilst I feel better from my last post I still feel there’s room for improvement and either adding of t3 or was looking at NDT as so many people seem to feel better on that

[SlowDragon Administrator in reply to Fox78]

Well you need to get off the propranolol first

Maximum reduction of 5mg propranolol per day and wait at least fortnight before reducing next 5mg again etc

Last 5mcg can be very difficult to stop. Stop Once a week...then twice a week (not on consecutive days) etc

So will take approx 4 months to ween off completely

[Fox78 in reply to SlowDragon]

Ok.. does that apply with NDT too?

Endo has requested a d102 test as he seems to think I have issues converting and said he was happy to try me on t3 but that will depend on these results

I don’t disagree with the fact that propranolol causes conversion issues but I don’t feel that’s completely the problem I have only been on propranolol for over a year and the previous two years I wasn’t well and I was on 150 then so not much smaller than the dose I’m on now with similar results so t4 high tsh suppressed and low t3

[SlowDragon Administrator]

Just wondering about dose by weight ...or possibly lactose intolerant?

Even if we frequently don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

If dose of levothyroxine is substantially higher than guidelines on dose by weight this can suggest lactose intolerance

Lactose intolerance is very common with Hashimoto's

ncbi.nlm.nih.gov/pubmed/240...

Lactose intolerance was diagnosed in 75.9 % of the patients with HT

read.qxmd.com/read/24796930...

These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.

[Fox78]

To be honest I’ve tried all sorts of combinations of vitamins.. different diets..cutting things out and I’ve gained 4 stone in 3 years I ache more now than I ever did and have less energy

nothing seems to help... I definitely feel I have an issue converting or something just isn’t right with how I process thyroxine so I’m willing to try alternatives I’m happy to pay (appreciate I need to pay for NDT) anything to get my life back!

[Hidden]

Probably best to get off antidepressants first but I know nothing about how to do it, follow instructions of those who do know.

An alternative opinion regarding change to NDT is that it may not be necessary to rectify results of blood tests first. The very act of simply changing the medication could very well rectify those inconsistencies without you even having to identify them at all.

[Fox78]

Thanks x not on anti depressants though!

I take propranolol and thyroxine

Propranolol is a beta blocker

[SlowDragon Administrator]

You might find my profile info helpful...

Dio2 gene test definitely worth doing

[Fox78]

Thank you I will take a look