Help With Results Please, Before Endo Appt

[TrishG67]

Hi I increased NDT from 1 grain to 1.5 grains on 7th Sept, switched from Armour to ERFA brand on 3rd October. Due at Endo next Monday, just had recent bloods back. Been feeling awful last month. Don't seem to be making much progress since taking NDT from July this year. My recent bloods are :-

Folate= 45.2 ( 8.83 - 60.8)

Active B12=112 (37.5 -188)

Vitamin D= 142 (75-175)

Ferritin = 115 (13-150)

Free T4 =13.4 (12-22)

Free T3 = 4.9 (3.1 - 6.8)

Total T4 = 96 (59-154)

TSH - 0.10 (0.270-4.2) LOW! In Early Sep 2020 TSH = 5.85

I am 53 & post menopausal, I have so many symptoms which could be thyroid or menopause related. Up the wall with it all and making very little progress:- Insomnia, aching joints all over, intestine issues/GERD, constipation, palpitations,

Any advice really appreciated/welcomed with regard to what I need to know before my Endo appointment next week. Been so poorly now for over 2 years constant, so worn out with it and really need to start to see progress, things I am trying seem to be a game changer for many but not for me. I am gluten and dairy free btw. spending a fortune on private bloods, Endo appointments and NDT on private prescription but still no results. Is there something obvious I am missing?

[Lalatoot]

For me your ft4 and Ft3 are too low. Some folks need both well over half way through their ranges. With your ranges I would need ft4 17 or 18 and ft 3 around 5.8. This would mean that my tsh would be suppressed but as the thyroid feedback loop has been damaged I am OK with that.I think you need to consider how you can increase your hormone levels.

[jrbarnes]

Your T4 and T3 are still low. The dosage guidelines for NDT says to increase by 1/4 grain, which would be a half of a 30mg tablet. Chances are after you add that extra 15mg and wait 2-4 weeks it will slightly bring up your T4/T3 levels and you may still be underdosed. Your next increase would bring you up to 120mg. For some people the increase of both T4 and T3 together can be too much. You may reach that point on a higher dose and have to back down to the previous dose and add extra Levo to your NDT or T3. If it's a pain getting T3 then adding a little extra Levo, like half a 25mcg pill, to the NDT is perfectly okay. I see a nurse practitioner that says she has many patients on a Levo/NDT combo.

[pennyannie]

Hello Trish :

In my experience on NDT your TSH will be low suppressed and your T3 higher and your T4 lower in the conventional ranges that were designed to be for people taking Levothyroxine.

With NDT you dose to the relief of symptoms not guidelines and blood tests that were introduced to treat people taking Levothyroxine.

I believe I'm pretty much optimal on NDT and in fact you could say my T3 and T4 have swopped % through ranges from when being on Levothyroxine in that my T3 comes in high or slightly over range and my T4 comes in at the bottom of the T4 range at around 20 %.

I need to keep my vitamins and minerals optimal and aim for a ferritin and vitamin D at around 100 with a folate at 20 and an active B12 at 70+ / serum B12 at 500+ : as no thyroid hormone works well otherwise and supplement the above myself.

You look to be undermedicated and I would slowly keep adding 1/4 grains on a weekly basis as with NDT to treat up to the relief of symptoms.

When you reach 2 grains, hold this dose for 6-8 weeks and then take a blood test :

If your T3 hasn't moved much, NDT may not be the best option for you.

P.S. Just a thought ;

If there are any other underlying health issues and medications these may have some bearing on the effectiveness of the NDT so would just think you may end up taking more NDT than you may have thought : I read people on up to 5/7 grains - I'm on 1+ 1/2 grains but then I've had RAI thyroid ablation so with no working thyroid gland to consider with all the complexities that may bring.

Most people need about 50 T3 daily just to function and with NDT containing set amounts of T3 at around a value of 8/9mcg per grain the more you need to take presumably means the less able you are to convert the T4 component of NDT - so if needing high doses it's probably more cost effective to take T3 only.

[TrishG67]

Hi it is 12 weeks approx since last blood tests . Just not sure how TSH has swung do low so soon. Report from Thriva says abnormal TSH speak to GP ? Still feel crap 😦