Shocked by my blood tests - what should I do next?

So I just got the recent bloods in from LetsGetChecked, that I took on Tuesday, after 6 weeks on 2 1/4 grains of NP Thyroid.

I split my dose the day before and took 1 grain of NDT at 10pm. I did the blood test the following morning at 8am, before taking NDT, leaving a gap of 10 hours.

Before starting NDT I took a blood test as a benchmark.

March 8, 2021

FT3: 5.3 (3.1-6.8)

FT4: 17.7 (12-22)

Since then I started on 1 grain of NDT and increased up to 2 1/4 grains and held there for 6 weeks. These are now the latest results:

June 17, 2021

FT3: 20.5 (3.1-6.8)

FT4: 37.4 (12-22)

I'm obviously way overmedicated. (I've triple checked - there are no typos!) I just hadn't correlated my symptoms with overmedication as I still am feeling very much hypo (aching joints, brain fog etc). I have been feeling a little nauseous and my resting heart rate has increased to 82bpm, but I've been so unwell for so long I'm just not sure what symptoms to attribute to what.

I looked back at the notes I was taking as I increased NDT and I think my symptoms were most reduced on 1 1/2 grains but I certainly didn't feel better then. I still had a very foggy head. Would it be worth stopping NDT to let those high results settle a bit and then try the 1 1/2 grains? Or should I just try 1 1/2 grains tomorrow? Or if you have any other advice I would be so grateful. I assume whatever I try I retest in 6 weeks again?

Thank you all.

[greygoose]

According to your post 17 days ago, it looks like you have Hashi's. So, it's very likely that these high levels are due to a Hashi's 'hyper' swing, rather than over-dosing.

Don't automatically jump to the conclusion that you are over-medicated, because, frankly, your dose isn't that high. I very much doubt that it's high enough to make such a difference in just six weeks. It's not logical. Stop your NDT for a few days and see how you feel. If you start to feel hypo, go back to your dose of 2.25 grain, and take it from there. I take it you're self-treating, so don't need to get your doctor involved?

[Hidden in reply to greygoose]

Thanks for your reply greygoose . What you say there definitely makes sense. I was a bit shocked that my T3 and T4 had gone up so much so the Hashis swing makes sense.

I had my antibodies tested too and they came back as:

TGAB - 27.1 (0-115)

TPO - 32.5 (0-34)

TPO was 15 in March so has increased. Is that a sign of a Hashis swing?

My doctor prescribes NDT but isn’t very proactive in managing my symptoms so I prefer to self manage.

[greygoose in reply to Hidden]

Could be indicating a Hashi's swing. But, not necessarily. But, I think it does confirm Hahi's, it's so near the top of the range.

OK, so just stay off the NDT untill you feel the need again. The levels will come down by themselves eventually.

[Hidden in reply to greygoose]

Thank you greygoose - I really appreciate your advice 😊

[greygoose in reply to Hidden]

You're very welcome.

[pennyannie]

Hey there again :

Well - suffice to say - NDT is working for you :

I too would be over range if I just left 10 hours - and had an empty stomach throughout that period - though not as high as your result as I'm only on 1 + 1/2 grains.

I need to leave 24 hours - ( just the same protcol as when taking T4 only ) and read of some people needing to leave 48 hours to get their numbers into range for a " doctors appointment " :

Don't worry just drop back down and maybe return to 1 + 1/2 grains where you thought your symptoms were almost resolved - let that dose bed in for the 6-8 weeks and then see where you are.

This could have been a Hashimoto's spanner as mentioned in my previous post :

Can I just ask on your original bench marks numbers - were these on just T4 as everything looks very good and there is room in the range to increase your T4 medication ?

P.S. Just to say I don't think I've ever found this " sweet spot " people refer to :

But this is a vast improvement than when on monotherpy with T4 when my T3 was at just 25% with my T4 at 110% though the ranges :

I'm 74, so I guess I'm in a very different position to you : I can, and generally do dip a bit in the afternoon and obviously not holding down a job or being accountable to anyone else except myself.

Let the lower dose bed in as I found continued improvements in myself months after I was settled on my dose of NDT :

I'm with Graves and had RAI treatment in 2005 and becoming very unwell some 8 years later with, I believe, the consequences of drinking this toxic substance and being dosed and monitored in primary care on just a yearly TSH reading.

[Hidden in reply to pennyannie]

Hi pennyannie

Thanks for your reply - you're so kind and helpful. As you say, yes at least NDT is working for me and I don't appear to have a conversion issue!

Interesting to see that you leave 24 hours before a blood test. I'm sure if I did that then those results would have looked a lot more normal.

I'm going to take a few days off NDT and see how I feel, and then as you mention drop back to 1 1/2 dose, stay there for 6 weeks and test.

It could well be a Hashimoto's spanner. If it was it would be my first experience of it. It was also the first time my antibodies are close to being out of the "normal" range.

My original bloods were on 12.5mg T3 and 50mg T4. My doctor refused to increase my dose (said I would have to take more and more thyroid medication the older I get so best to start on a low dose even if symptoms aren't resolved 🙈).

I switched doctors and he was keen for me to try NDT, rather than increase my T3/T4 dose. This was before I joined the forum and had only heard NDT was the holy grail of thyroid treatment (can thank STTM for that!).

Interesting to hear you don't think you've found your sweet spot, but glad to hear you were still making improvements months after starting NDT.

While I do have a full time job, I'm glad to be working from home while figuring out all of this "thyroid stuff"! I spend my lunchtimes in bed sleeping which helps me through the day. I'm looking forward to a week when I don't have to do that anymore. (Hopefully it's before we all go back into the office!)

Thanks again for your reply - you and others on the forum are so supportive and really keeping me going through all the highs and lows!

[pennyannie in reply to Hidden]

OK then :

So those original bench mark numbers were on a T3/T4 combo - so forget the rest of my sentence on your conversion ratio etc.

I don't understand why your doctor wouldn't increase the T3/T4 combo but there you go:

So, ok then, drop bacl to 1 + 1/2 which is where you thought you had less hypothyroid symptoms and see what that looks like in 6-8 weeks time .

Your T3/T4 synthetic combo was - 50 T4 + 12.50 T3 :

1 + 1/2 grains of NDT contains : - 57 T4 + 13.50 T3 :

I don't know if one can compare synthetic T3/T4 to NDT but it will be interesting to see how you go with this.

Take good care and try and duck those spanners !!!

I'm guessing you are not in the UK as to find a doctor here even suggesting / recommending NDT would be a miracle !!!

[Hidden in reply to pennyannie]

Thank you pennyannie ! It will be interesting. I will pick up at 1+1/2 grains and see how I go.

You’re right- I’m in Ireland. I am lucky to get NDT prescribed but it isn’t cheap, that’s for sure!

Have a lovely weekend and thank you again for all of your advice.

[shaws Administrator in reply to Hidden]

Blood tests for thyroid hormones were introduced a lot later than NDTs.

From 1892 when NDT was first introduced, the dose was based upon how the patient 'felt' when on this with very small gradual increases. No blood tests were available and the doctors were skillful.

hormonerestoration.com/

[Hidden in reply to shaws]

Thanks for the reply shaws . I’ll have a look at that link.

Listening to my body isn’t something I’m very good at. Hopefully the longer I’m on NDT the easier it will be to figure out whether my dose is right.

Have a good weekend and thanks again.

[Carys21]

I too had a high T3/T4 result due to only leaving 12 hours between the last dose and the blood test, and I was only taking 125mg of Thyrovanz which is around 2 grains although they don't publish the hormone content of it - 24 hour gap is needed. I certainly don't feel overmedicated either.

[Hidden in reply to Carys21]

Thanks Carys21 that's really interesting to hear. How do you find the Thyrovanz? I suspect if I had left a bigger gap that those blood tests wouldn't have been so high. I might consider that next time.

[Carys21 in reply to Hidden]

I have found Thyrovanz brilliant, sadly they are running out of stock so I will be switching to Metavive IV soon as that is the nearest equivalent I can find that is easy to source in the UK until Thyrovanz stocks improve/or I find Metavive works as well.

[Hidden in reply to Carys21]

That’s a shame. Hopefully you find Metavive as good. Just from what I’ve been reading on the forum it sounds like supply is a bit more reliable so hope that all works out for you.

[Carys21 in reply to Hidden]

I have hashi's but my hypothyroidism is still quite mild so I'm ok with OTC glandulars. Self treating as the NHS gave me the usual fob off. Metavive would be my preferred as it is so easy to get.

[MichelleHarris]

Hi TiredPanda, I agree with previous posters but also want to add that I have not found private blood testing completely reliable sadly.

More than once my results have been vastly different to NHS and the NHS were much more believable. Just bare that in mind too x

[Hidden in reply to MichelleHarris]

Thanks MichelleHarris . I’ll certainly keep that in mind and take the results with a pinch of salt. It’s a shame that we have to resort to private home blood testing rather than our doctors doing the tests we need. Thanks again & take care xx