How to add levo to ndt?

[hipolion]

I've been on the 3,5 gr.Thiroyd ndt for about a month now and my ft4 is below of the range. I feel that ft4 should be higher because on the current dose I feel weird and some hipo symptoms. I thought of reducing the dose to 3 gr. and to add 12,5 mcg levothyroxine. I tried to add to my dose but went into hyper.

[Lora7again]

Have you got any blood results to share with us?

[hipolion in reply to Lora7again]

So, on 3,5 ndt my ft4 is 11,90(11,97-21,88) and ft3 5,64(3,1-6,8) no tsh.

[Lora7again in reply to hipolion]

When you take NDT you will find that your TSH is low or suppressed as well as your T4. Your T3 doesn't look too bad. If you feel a bit jittery you could always reduce it by a 1/4 grain and see how you feel. When I took Thyroid S I only took 1 and 1/2 grains so your are taking a good dose. You go by how you feel with NDT and adjust the dose accordingly.

[hipolion in reply to Lora7again]

Thank you, I don't have thyroid(due RAI) that's why I take such a good dose. I spilt ndt in 2 doses and yes the second dose causes me some anxiety and fast pulse. The problem is that I gain weight and my hair is dry and I feel weird like I need some levo or maybe it's too early.

[silverfox7 in reply to hipolion]

Do you split it down the middle? If so I’m wondering if a higher dose first thing and a top up dose later may help.

[hipolion in reply to silverfox7]

No, I take 2 gr in the morning and the rest(1,5gr) at noon, I tried to take the whole dose at once but it's too much for me, also 2.5 gr in the morning is it's too much. I feel like I'm missing a bit of t4, no matter how I divide them.

[Peanut31 in reply to hipolion]

Hi

I’m on NDT and Levothyroxine, like you my T4 was either below range or just in range and still had symptoms.

If I added more NDT it sent my T3 over range with nasty symptoms, so I now take 2 grains of NDT, 1 grain at 7am then the other 2pm and I have 25mcg of levo two days of the week and the remaining 5 days 12.5mcg of Levothyroxine.

I take my levo in the morning with my NDT morning dosage.

I tried increasing my levo to 3 days at 25mcg but it sends my T3 over range.

Best wishes

Peanut31

[hipolion in reply to Peanut31]

Thank you for response, my max dose it's 3,5 grain, so I can not add any more ndt nor levo. In this case it only remains to cut some ndt and add some levo but I don't know how. From what I read 1/2 grain would be equivalent to 25mcg levo, I don't know exactly. But I don't know exactly how to match them, it would be better to reduce ndt and wait a few days to eliminate the excess or make the direct switch ?

[Hidden in reply to hipolion]

Hey there, you could go slower and reduce NDT by 1/4 and add 12.5 levo. You can switch straightaway.

[hipolion in reply to Hidden]

Hi, yes I cut half a gr. because a quarter is difficult to manage but it's ok. On the first day I had hyper symptoms but things calmed down in the meantime. I take 12,5 mcg of levo when I go to bed.I think I will reach 25mcg levo but it's too early.

[pennyannie]

Hey there Hipolion

When dosing with NDT your TSH will go low suppressed and your T4 will be low in range -

I don't think this matters as I think this shows that you are using and converting it, and that's just what is meant to happen.

I guess a blood test will give a guide to where your T3 is and that's the only number you need to keep an eye, if you want to, with a blood test.

NDT was used successfully for over 100 years prior to blood tests, ranges and guidelines and you treat the symptoms :

I think it's too early for a blood test, as you need to wait out the 6-8 weeks on this dose, letting it bed in, and then see where you are and how you feel, but if you are feeling weird maybe you need to drop back down 1/4 grain/tablet.

Your hair is the result of the past couple of years, as maybe your weight is also, so whilst it's not as you might like, think it's early days, for both of these issues, just stay with it, and see where and how you feel in another month's time.

[Peanut31]

Hi

It’s a balancing act I’m afraid. I convert very well with T3, in fact too well.

I would perhaps reduce your NDT to 3 grains and then cut your Levothyroxine to 12.5mcg a day, see how you feel then maybe increase your levo if you don’t feel right.

Good luck.

Peanut31

[hipolion]

I tried to take the whole dose at once but it's too much for me, also 2.5 gr in the morning is it's too much bbut 2 gr in the morning it's ok. I feel like I'm missing a bit of t4, no matter how I divide them in any settings .

[hipolion]

NDT contains too little t4 and too much t3 (rap; 4:1) and that's why some patients feel the need to add a little levo

[pennyannie in reply to hipolion]

Hey there again,

I think we all have our very own T3/T4 ratio - and generally the accepted ratio is between 1 / 3.50 - 4.50 - T3 to T4 with most people preferring to be around the 1/4 or lower end :

When I saw an endocrinologist, the first specialist in 10 years after RAI thyroid ablation for Graves she thought my then ratio when on T4 of 1 / 5.5 acceptable :

I seem to be ok on the ratio in the NDT I take, which I understand is the only one that is slow release - there are small differences in the strength of the T3 and T4 in different brands of NDT and also some differences in the fillers used, all of which may contribute to small differences in body utilisation.

Ultimately it's down to the individual and know of some people who add a small amount of either T3 or T4 to their NDT to enable them to find their exact ratio between the two hormones.

The combo medications of T3/T4 seem to mostly favour a 1/4 ratio but as we see on here all the time, those people taking T3 and T4 independently don't necessarily end up with " text book " ratios either.

It's all trial and error but at least we have these options when self medicating :

[hipolion in reply to pennyannie]

I think it suits me better ;1:5 than 1:4(as in ndt). I've also been irradiated (RAI) 10 ago years for Graves and I was left with vision problems and I can't find any solution(spaced, tunnel vision, photophobia, sensation like my glasses lenses are not properly aligned., etc) and anxiety in the morning.

[pennyannie in reply to hipolion]

Yes, that's fine also, we are all different.

I too had my thyroid ablated with RAI deeply regret this action but back in 2003 knew no different and offered no alternative though I was well on the anti thyroid medication.

Hey Ho : I now manage lingering Graves, thyroid eye disease - caused by the RAI, and hypothyroid becoming very unwell some 8 years after this treatment when my whole body seemed to dry out.

[hipolion in reply to pennyannie]

I also regret it but I had nothing to do, antibody values -aTrab were high and ft4 &3 sky high and the anti thyroid medication they gave me allergies.

[hipolion]

You are lucky

[pennyannie]

Hey there Scrumbler

No what I am saying is that we all have our own set point ratio - but the trouble is finding it :

I read that most people feel well when their ratio on Levothyroxine is around 1 / 3.5-4.5 - T3 to T4 - with most people preferring around 4 or under : it is a ball park estimation and as we see on here - no one size fits all :

My endocrinologist was a diabetes specialist so discount that red herring just thought I'd throw it in for a laugh !!

Presumably modern T3/T4 combo medications initially looked at NDT to copy and found mostly a ratio of 1/4 : though there are some T3/T4 combo meds at 1 / 5 :

What I was trying to say is that we are all different and should celebrate our uniqueness and as self medicating we have the power to adjust and try the fine tuning - which dosing T3 and T4 independently would give us :

NDT gives us the basic cake mix of both T3 and T4 plus T1, T2 and calcitonin but if this doesn't do it for you, there is the option of adding a little bit extra T3 or T4 which ever you feel is lacking, and you'll only know by trying to identify what you lack.

Personally I'd like a little more va va voom in the afternoon.

I tried a little extra NDT in the afternoon but became stuck to my fridge at 10 pm wanting to eat everything in sight :

I then tried a little Levothyroxine and it had no effect but I developed pseudo gout :??

So I'm resigned, I think, to where I am, it's a vast improvement, and maybe at 73, I'm allowed a nap some afternoons, but actually they are getting more spaced apart.

[pennyannie]

Hey there Scrumbler, it's me again :

The conversion I'm referring to is one's own natural ability to convert Levothyroxine T4 into T3, and obviously optimal vitamins and minerals will assist in this process.

When on T3 or a T3/T4 combo, or NDT, the conversion I'm talking about does not apply.

When on NDT your TSH will be low suppressed and your T4 nearer the bottom of the range and your T3 high or maybe slightly over the top of the range, and again optimal vitamins and minerals will assist in the conversion.

The ranges were introduced alongside the guidelines and the new thyroid hormone treatment Levothyroxine launched by Big Pharma in the 1960s. to replace NDT as the pharmaceutical industry weren't allowed to patent NDT and make " it " a lucrative business opportunity for themselves.

NDT is not to be dosed to be in the ranges, though understand if your having to stay in the medical system you probably need to " box clever " and try not to draw too much attention to your thyroid blood test results and feel obliged to " fit in " when necessary.

Hope that helps a bit - your T4 is quite high for someone on NDT which suggests you are not converting the T4 element very well - obviously optimal vitamins and minerals will assist here again, but do wonder if you might find it easier forgetting the conversion of T4 completely and going T3 only ?

[pennyannie]

Well it seems to me you are not converting the T4 well and apart from the obvious suspects - vitamins and minerals - there can be other reasons, physiological stress - (emotional or physical) , inflammation, depression, dieting, to name but a few.

You've been through a lot, and trying to " bounce back " again, like we all do :

On a T3/T4 the bloods will have been about the same, as it's the T4 element in both, that maybe isn't working as well as did once, if it ever did.

The average person uses about 50 T3 daily just to function and you're not getting that from 2 grains of NDT - you're guaranteed 18 T3 and then you're trying to make up the shortfall with T4 conversion, but for some reason it's not happening as well as it might.

[pennyannie]

Yes, I know, and can " Ditto " - recognise the over compensating and trying too hard.

We're all guilty of that because none of us feel 100 % and just want things better and yes, it's depressing, upsetting and dammed frustrating, and seeing as most of us can't find any mainstream medical help it is all the more annoying and we take it out on ourselves, and sometimes through this medium.

Cut yourself some slack, I need to close down by 6 pm - otherwise I don't sleep, yes I know it's nearer 10, but you're earlier question was playing on my mind, and I wouldn't have slept if I hadn't come back on, and checked this out again.

So, I'm now looking for some rubbish TV to wind me down and we can pick this up another day.

Night night :

[jrbarnes]

It's a tough one. I only have half my thyroid so I'm stuck on meds. After about 3-4 years on T4 only meds my Free T3 levels started going down.

I'm on day one trying to add 25mcg of T4 to 90mg of NDT because 120mg was too much but 90mg is too low. I wish they would make different ratios of NDT with lower T3. I knew after two weeks 120 mg of NDT was too much for me. I guess time will tell but today I feel terrible.