Simple advice needed please :)

[LuxN]

Hi

Some of you might remember talking to/advising me in the past. I have recently discovered I most likely have Hyperparathyroidism. All the blood and urine tests confirm it. Just waiting for a referral and imaging.

In the background, I am dealing with the impact I think it has on my hypothyroidism. Can somebody explain - in pretty simple terms - how much NDT I should take if I have been taking 100mcg Levo.

Am I right in thinking that 1 grain of Thyroid S has 38mcg T4/9mcg T3 but it is biologically equivalent to taking 100mcg Levo plus 9mcg T3? In simple terms, can I swap 1 x Levo for 1 x NDT (bearing in mind that I feel I need the extra T3 as I am a poor converter)?

Thanks.

[SeasideSusie Remembering]

LuxN

Am I right in thinking that 1 grain of Thyroid S has 38mcg T4/9mcg T3 but it is biologically equivalent to taking 100mcg Levo plus 9mcg T3?

No. The T4 in NDT is the same as the T4 in Levo so 38mcg T4 in NDT is the same as 38mcg T4 in Levo.

T3 is roughly the equivalent of 3-4 times Levo so 9mcg T3 is roughly equivalent to 27-36mcg T4.

So 1 grain of NDT is roughly equal to somewhere between 38 + 27 = 65mcg T4 to 38 +36 = 74mcg T4.

[LuxN in reply to SeasideSusie]

Hi - thanks for that. I had totally misunderstood. So if I was trying to take the biological equivalent of the 100mcg Levo I should take approx 1.5 grains?

[SeasideSusie Remembering in reply to LuxN]

LuxN

1.5 grains would be

T4 = 38 + 19 = 57mcg

T3 = 9 + 4.5 = 13.5 x 3 = 40.5mcg or 13.5 x 4 = 54mcg

So T4 equivalent of 97.5 - 111mcg

[LuxN in reply to SeasideSusie]

That's brill. Thank you.

[pennyannie]

Hello Lux

You may well " end up " on 1 + 1/2 grains of Thyroid S NDT but you do need to start slowly and with a maximum of 1/2 a grain :

The Levothyroxine takes around 6 weeks to fully leave your body and during that time you should start slowly, with just the NDT, and weekly increase by a just 1/4 grain and monitor your wellness, relief of symptoms, your blood pressure and temperature.

With NDT you dose up to the relief of symptoms and not to a blood test or a guideline.

When and if you reach 2 grains, wait 6-8 weeks and let this dose totally bed in and then take a blood test to compare with the blood test you took before starting this treatment option.

When you increase one week by a 1/4 NDT and feel uncomfortable in your body, nervous, anxious, a little hyper, simply drop back down to the dose you were previously on and then wait the 6-8 weeks and take a blood test, simply for your own benefit as this is your dose on NDT.

Your TSH will be low/suppressed : your T4 probably lower than when on T4 but your T3 should be higher. If your T3 hasn't changed at all, maybe NDT doesn't suit you.

No thyroid hormone works well if your vitamins and minerals, ferritin, folate, B12 and vitamin D are not maintained at optimal levels so these need to be at good levels before you start this new treatment option.

I am on Thyroid S - I have Graves and had RAI thyroid ablation back in 2005 :

I take all my 1 + 1/2 grains at around 3 in the morning - empty stomach - glass of water and go back to sleep until around 7 :

Some people split their dose : some people bite and chew the grains : I think it all depends what else is going on and what other health issues may impact the conversion of the T4 content in the NDT ;

[LuxN in reply to pennyannie]

Thanks for the detailed response. I actually took NDT for a number of years but due to brain fog, the stuff I read about the biological equivalence thing went straight over my head.

I am confident to swap the NDT for the Levo and start at 1 grain at least. I know from a previous period on this dose that my TSH went up to 18 (0.3-5.0), T3 was below range and T4 was bottom of range, so 1 grain is definitely not enough.

As I have these results from before, and T4 is a storage hormone whileT3 has a short half life, is there any reason not to go straight on to the 1.5 grain dose as I have taken a much higher dose of NDT before and know it causes no major problems (I was on 3 to 5 grains from approx 2010 to 2015)?

PS - I do agree with what you said about Vits needing to be optimum but my VitD is so low it will take months raise the levels to 'normal' (according the the parathyroid support group). My Vit levels are confusing and I fear I might wait in vain for them to be in range. My folate is 3.1 (3.0-18) but my B12 is right at the top of the range and my ferritin is ABOVE range. I am of course supplementing the Vit D and Folate now. There's a waiting list to even get an appt for the specialist and I could be waiting well over a year. I cannot afford to ignore my thyroid health for that long, which is why I want to at least being doing the best for myself in that regard.

[pennyannie in reply to LuxN]

Good morning to you :

So, I don't know the answer as to your having been on NDT some 5 years ago, and not needing to introduce the hormone replacement slowly.

You can only try and if it feels too much too soon drop back down as your body dictates.