Can I take levothyroxine at the same time with NDT?

[Natab1]

My endochronologist told me to reduce my NDT and add 25 mg of levothyroxine. Can I take NDT and levothyroxine at the same time? Before, I usually took NDT twice a day.

I stopped NDT 12 hours before my blood test. I don't know why my TSH is a little bit higher now- before it was 0.15-0.16.My FT4 and FT3 are the same as before,but TSH is higher now. All my vitamins are in good ranges. My latest results:

TSH-0.36 (0.3-4.20)

FT4-12.6 (12-22)

FT3-5.7 (3.1-6.8)

[Hidden]

I cannot see any reason why you would need to lower NDT and add T4. Your FT4 is low in range (which is common when you take NDT or T3) and your FT3 well within range. Not everyone on NDT needs higher FT4; you are already getting T3 from the NDT so may need less T4 for conversion. I suspect your endo wants you to lower NDT because your TSH is at the bottom of range. Not a good idea. If you feel well on your current dose, don´t let your doctor mess with it!

[Natab1 in reply to Hidden]

Thank you for your reply.It's my GP who sent me to endochronologist because my GP was worried that I self medicating. I'm self medicating because I didn't feel well on 100 mg of levothyroxine which they prescribed me after my total thyroidectomy (Grave disease) . My blood tests were never normal on levothyroxine (TSH 3.2-4.45 (0.3-4.20) and FT4 20-23 (12-22)) and I was feeling awful. During my appointment with my endochronologist yesterday he told me that if I didn't feel well on 100 mg levo (I am 62kg lady) he told me that I should try 62.5 mg levo which I refused. After that he told me to try to reduce my NDT and add 25 mg of levo. I don't know why as I am feeling completely fine with my current dose of NDT.

[Hidden in reply to Natab1]

I bet it´s because your TSH is low. Which it often is when on NDT/T3. If you feel fine, there is no reason to lower your dose and risk symptoms coming back. This is YOUR body, YOU are the one supposed to feel fine, and that has nothing to do with pleasing your doctor.

If you have to, I´d recommend self-medicating rather than messing with a dose you feel good on.

Did the endo first suggest you LOWER levo from 100 to 62.5 mcg, only to then suggest you ADD 25 mcg daily...?! It doesn´t make sense.

You should only decrease by 25 mcg at a time but, in your case, I´d advise against it, for the reasons explained.

As to your question, NDT can be taken at the same time as levo. I have never split my levo dose, as it´s a long-acting hormone, but I know some people do.

[goodoldan in reply to Hidden]

I assume your comment "As to your question, NDT can be taken at the same time as NDT" actually was meant to say "levothyroxine can be taken at the same time as NDT", yes?

[Hidden in reply to goodoldan]

Thanks, yes, I´ve edited the post.

[goodoldan in reply to Hidden]

Thanks for the edit. I'm in a situation where I need to take the NDT and levo at the same time tomorrow... always wondered about that.

On the original topic... my endo had me on Levo only finally up to 50mcg/day with generally acceptable labs... EXCEPT for a high RT3. He tried to add a tiny bit of liothyronine (only 1/4 of a 5mcg tablet, 1.125 mcg/day because I had been VERY sensitive to it some years earlier and apparently I still am, I felt miserable). I suggested that maybe we could use NDT instead of the lio if he wanted to add some T3, and that we could also reduce the amount of levo/T4 I was taking by the equivalent amount if T4 in the NDT, and he agreed.

I started with 1/4 grain (15mg)/day and that went well, and moved on to (currently) 1/2 grain (30mg)/day. Now I'm getting 4.5 mcg of T3 from the NDT, and feel at least OK... I'll be having the first labs with this new arrangement drawn tomorrow. The 1/2 grain of NDT is also supplying 19 mcg of T4, so the daily levothytoxine dose was reduced from 50 mcg to 25, giving a total T4 daily dose of 19+25 mcg, for a total of 44 mcg... roughly the same as the previous 50 mcg of levo (alone) and also maintaining an (almost presumably ideal?) 9.7:1 ratio of T4/T3.

I'm still got some hypo symptoms, so I'm looking to increase the dose of NDT and levo using the same strategy until the labs are optimal and I feel good... that is, increasing the total dose of T4 above that supplied by the NDT using levothyroxine to maintain approximately that same 10:1 ratio of T4/T3. So, for example, if we increase the NDT to 1 grain (60mg), this would supply 38 mcg of T4 and 9 mcg of T3. By changing the supplemental dose of levothyroxine to 50 mcg, this would create a total T4 dose of 88 mcg with 9 mcg of T3, for a T4/T3 ratio again of 9.7:1. Not exactly 10, but pretty close.

So I suppose my question is whether the logic in this plan faulty... is T4 provided from NDT really the biological equvalent to that contained in levothyroxine, mcg for mcg? Is a 10:1 ratio of T4/T3 a reasonable "rule of thumb", assuming of course that the labs look good and I'm feeling OK?

[Hidden in reply to goodoldan]

I don´t think anyone can tell you how much T3 and T4 or which ratio you will eventually need. It´s all about trial and error. Some do fine on NDT only and don´t need additional T4. I generally think it´s a bad idea to obsess about ratios, and that it is much better to go by symptom-relief. Your body will tell you what it needs.

Is your doctor treating your high rT3? It is no longer considered to block free T3, and there are many reasons rT3 could be elevated, far from all of them are thyroid-related. It used to be believed that high rT3 had to be flushed out using T3 only for 8-12 weeks (at much high doses than 10 mcg daily) as rT3 can only be made from T4, but new research has shown rT3 is not the problem it was once believed to be.

The T4 in NDT in bioidentical as is the T4 in levothyroxine.