I’ve just started taking NDT - today is day 5. I was on 100mg T4 and 12.5mg T3 before starting on 2 grains of NP Thyroid (one when I wake up, one early avo).
I’m feeling awful- extremely tired, weak and my brain fog is much worse than usual.
I know starting dose for NDT would be 1 grain but my doctor thought it would be okay to start on 2.
Also taking iron, zinc and vitamin D. My B12 and folate levels are good.
Should I keep taking 2 grains and hope my symptoms ease or drop back to 1 grain? If I swap to 1 grain, how long should I wait to increase?
2 grains would contain more T4 & T3 than what you were previously medicating.
Don't forget that although 1 grain = 60/65mcg T4, it is bioequivalent to 100mcg T4 (as stated by manufacturers). Therefore, I think your dose is too high and you would feel better on 1.5 grains.
1 grain is not necessarily a starting dose as it depends on what you were medicating before. As you were already medicating some T3, doing a direct swop is fine.
It’s 38mcg T4, it is not bio equivalent to 100mcg T4. 1 grain ndt is 38mcg T4 and 9mcg T3. It is equal to 38mcg T4 and 9mcg T3 because that’s what it is.
Yes, you are absolutely correct in stating 1 grain contains 38mcg T4 and 9mcg T3, but remember T3 is more powerful so when added together is equivalent to 60mcg T4 (or 65mcg). Some NDT tables even have the '60' stamped on them.
However, because of the T3 contained in NDT, the amount of T3 converted from the T4 is considered more than if you were just to medicate T4 alone, so the manufacturers state in the PIL (patients information leaflet) 1 grain of NDT is ‘bioequivelent’ to 100mcg T4.
This can be confusing to understand but it is important to remember, so to reduce the risk of medicating too much NDT. The reason I mentioned it was it looks like the O/P's doctor has failed to consider this when dosing her, which is common with those unfamiliar with NDT.
1 grain of NDT is equal to approx 100mcg of levothyroxine. So 2 grains would be equal to 200mcg which might be a bit too much.
I am not medically qualified but I would suggest you start on 1 grain again and then after a couple of weeks you can add a 1/4 tablet every few weeks, always taking note of 'how you feel' and if your symptoms are being relieved. That is the aim i.e. feeling well again with no symptoms.
I think you should have started low and slow as detailed in my last reply to you :
NDT is not synthetic and I do not think you can do a like for like swop.
Since you had already taken T3 I think I'd have started on 1/2 grain and increase slowly and remember that the synthetic T4 will take around 6-8 weeks to fully leave your body.
Hi PennyannieThanks so much- I’ve dropped back 1/2 grain in am and 1/2 grain in pm and feeling much better. Think you’re right- my dose was too high. Still yet for symptoms to disappear but have a while to go before that will happen I think!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Blood results advice - should I increase my NDT slightly? 
NDT feeling worse please help
Should I add T3 to my NDT?
Changing from NDT to T3 What dose of T3 should I take to equal the amount of T3 in the NDT?
