My prescriber said she is not willing to prescribe the amount of NDT I need because she thinks I'm over-medicated. She says over treatment is associated with significant cardiac and skeletal risk in the long term. Also, she said she suspects that my symptoms are not entirely to do with my thyroid.
I have fatigue, hissing in my ears, pressure on my chest, low libido, cold hands and feet, hair loss, pour concentration and memory, depression, achy body and constipation. My basal temperature this morning was 36.3 C.
How can I convince her?
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Canu
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I think for anyone to be able to reply we need to see your latest test results to see why your prescriber thinks you are overmedicated. Please post results, with reference ranges as these vary from lab to lab, for
TSH
FT4
FT3
Also, what are your nutrient levels like, some of the symptoms you mention could be associated with low levels of some of them. You need to tet
Vit D (muscle and joint aches and pains can be low Vit D)
Nutrient levels were good, not just average, but I should test everything again. I supplement B-complex and Vitamin D etc.
Since then I decreased from 1 3/4 NDT to 1 1/2 and started taking adrenal cortex. I felt better for 2 weeks and then increasingly got worse and I've been making increases since with little relief. I wrote about this just 3 days ago and you were kind enough to respond:
So what is your prescriber basing her refusal to prescribe more NDT on? And when did she refuse?
TSH 0.006 (0.270 - 4.200)
Free T3 5.60 (2.00 - 4.40)
Free T4 1.62 (0.80 - 1.70)
Those thyroid results are from 3 months ago and and we can see that from those results one could assume overmedication because of your over range FT3. But you've changed your dose since and haven't been on a steady dose for 6-8 weeks.
I supplement B-complex
Are you remembering to leave your B Complex off for 7 days before a blood test (because it contains biotin and this can give false results when biotin is used in the testing procedure, which most labs do).
Are you also remembering to take your last dose of NDT 8-12 hours before your blood tests?
Yes, I took no B-Complex for 7 days before the blood test.
I took my last dose of NDT 10 hours before the test, for the tests above.
Which reminds me, I repeated the thyroid tests at another lab 2 weeks later, on 28 August, leaving 24 hours from my NDT dose. I did this for the sake of my doctor here in Cyprus, and for the UK prescriber's sake. (I take all my Armour NDT in the morning anyway, because it's easier to keep away from food and I don't have any less energy in the afternoon, plus I sleep better at night this way). These test results were:
TSH <0.01 (0.27 - 4.20)
Free T4 17.88 (12.00 - 22.00)
Free T3 6.82 (3.10 - 6.80)
The prescriber is basing her refusal to prescribe more NDT on these blood tests, not the ones you wrote above. I have an appointment with her tomorrow and she wanted to see blood tests in advance. I sent these yesterday, writing my symptoms and the changes I've been making. She replied "Based on those bloods you are significantly over treated on 1 3/4 grains. This is associated with significant cardiac and skeletal risk in the long term. I would not be willing to prescribe 2 grains based on this. I suspect your symptoms are not entirely to do with your thyroid."
I understand that those results show overmedication, but my symptoms are undermedication symptoms, even now that I've increased to 2 grains Armour plus 1 Metavive I. I think she's basing all this on the TSH. I can't get my head around this and don't know what to do.
I think she's also looking at FT3. A suppressed TSH causing atrial fibrilation and osteoporosis has been shown in studies not to be the case, but high FT3 and suppressed TSH in hypERthyroid patients is more likely to cause these problems.
Some posts I have saved on this subject if you want to look through them to see if there's anything useful you can use:
I would find as much evidence as you can then make your own decision. There are other posts on the forum, do a search or make a new post asking about this specifically, I'm sorry I don't have any further links myself.
There are many of us here who have a suppressed TSH with no ill effects. My own has been suppressed for the 25 years I've been keeping a record of my results (been diagnosed/treated for about 45 years). My TSH usually comes back, depending on lab and how low they measure, <0.005, <0.01, <0.02 and I don't have AF or osteoporosis. I keep my FT3 within range, usually around 70%.
I wrote this as a reply to her e-mail and wanted to ask if it makes sense to you, before I send it:
"I understand where you're coming from and I know you want to do what's best for me. I've been trying to get my head round this: why I felt undermedicated while my blood tests showed otherwise. I also wanted to understand what made me feel worse again after having 2 good weeks.
During my research I have found that when the adrenals are not producing enough cortisol, the cell receptors for the thyroid hormone don't open up properly and the thyroid hormone does not reach the cells properly, so it stays in the blood, showing higher levels in blood tests while the organs are starved. When I started taking adrenal cortex supplementation I felt better at first because the accumulated 1 3/4 grain hormones now reached the cells but since I also decreased my NDT dose, I soon became hypothyroid again.
Also, during those two weeks when I was better, I became much more active and even started exercising (walking and/or swimming) daily (increased energy consumption means more need for thyroid hormone). The weather got cooler (some doctors suggest increasing your thyroid medication when the season changes and decreasing it in spring). The cooler weather and the increase in activity increased my appetite for food, especially fatty foods which are harder to digest (thus needing more thyroid hormone), and therefore I put on a bit of weight (not much, but which also increases the need for thyroid hormone)."
Does this make sense to you or should I change something?
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Is here an Endo in the Midlands that will prescribe NDT/Armour?
Why is it so difficult to convince doctors to prescribe T3?
Urgently need help with NDT
NDT should be prescribed on the NHS.
