Do I need increase in NDT or Liothyronine? Advice much appreciated!

[Warwickian]

Hello everyone,

I was diagnosed hypo many years ago, surviving on ever increasing Levo, insomnia, weight gain and high BP before seeing a private Endo 9months ago. I already had full tests for folate, B12, ferritin etc and all were good. I am a poor converter ( homozygous fault for DiO2) and now, thankfully doing much better on NDT. I continue, however, to lose hair really badly (combover needed), have poor energy levels (no cardio poss) and struggle with losing weight. I eat a healthy, low GI Mediterranean style diet. I walk 15k steps a day. I had bloods 6 wks. ago (following no Rx 24 hours prior to test) whilst on 1.5 + 0.5 grains NDT:

TSH 0.414 ( 0.27-4.2)

T4. 10.4. (12-22 )

T3. 5.3. ( 3.1-6.8)

Antibodies results came back ok

Since substituting 10mcg Lio in the afternoon in place of 0.5 NDT, my new results are even lower:

TSH 0.185. ( 0.27-4.2)

T4. 7.88. (12-22)

T3. 4.3. (3.1-6.8)

Test also showed high antinuclear antibodies although previous test gave thyroid antibodies in range (TGA 52 ( /_115) and TPOA /_9 (/_ 34)

I realise that levels can fluctuate but the overall trend is for all levels to be dropping. Am seeing my Endo in a few days’ time but in the meanwhile, do any of you please have any suggestions on what doses I should be taking?

Thank you in advance! X

[SlowDragon Administrator]

Leaving 24 hours between last dose of NDT or T3 will give false low Ft3 result

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, or NDT make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Obviously changing pm dose of NDT for just T3 was going to lower Ft4

Some people are fine with low Ft4, providing Ft3 is high enough

Others need good Ft4 and Ft3

Ft4 nearly always on low side if on NDT

Have you ever had ultrasound scan of thyroid

20% of Hashimoto’s patients never have raised thyroid antibodies

Are you on strictly gluten free diet

[Warwickian]

Hi, thanks for getting back on this. I followed the guidelines exactly for both tests apart from I didn’t take my small (afternoon of day before) dose NDT for 1st or my afternoon Ta for the second test. So I thought that would allow comparison between the two... will see what the Endo says when I see her.

I do follow an (almost) gluten free diet and have never had an ultrasound of the thyroid, which may be a good idea as I sometimes feel a ‘tightness’ front of throat.

Thank you x

[Warwickian]

Sorry, *T3 not Ta! Should have put my reading specs on!