Hair loss since switching from NDT to Eltroxin

[imfene]

I was doing okay on Thyroid-S for over a year but soon after Covid arrived, the costs became impossible and I was forced to switch back to Eltroxin. My main concern is the hair loss I have had and continue to have after five months of being on Eltroxin. Does anyone have any advice on what to do about this?

[Hidden]

If you did not have hair loss on Thyroid-S it´s likely that you are hypo on Eltroxin. Do you have recent labs to see if you have poor T4 to T3 conversion? How much Thyroid-S were you on and how much levo are you now taking?It´s a shame what happened to Thai NDT...first, two out of three brands were discontinued, and then the price of Thyroid-S went through the roof...it´s now almost as expensive as prescription NDT

I have friends in the same situation. Unfortunately, it does not seem prices will return to what they once were. The raw material has become much more expensive due to shortages caused by swine flu, plus with Thyroid-S being the only Thai brand left the manufacturer can really make a profit by raising prices.

[imfene in reply to Hidden]

Thanks Purple Cat,

I don't have any other hypo symptoms. I have struggled with hair loss for decades but it got better on Thyroid-S with two tabs a day. I am now on 75 mcg Eltroxin as this was my dose before I went on to Thyroid-S. I do need to get new lab tests to understand more. Last time, my RT3 was high and I suspect that it usually is high (this is a very expensive lab test so I have not had it since). I am wondering if I should try 50 mcg T4 with 12 mcg Cytomel. I do suspect I have problems converting T4 to T3.In February of this year while on 2 tabs of Thyroid-S, my labs were: FT3 - 4.4. and FT4 - 12.9. RT3- 0.26

[Hidden in reply to imfene]

Even though it´s difficult to say without reference ranges, your free Ts look low to me on 2 grains of Thyroid-S if the ranges are indeed what I think they are (the upper limit for FT4 being around 22 and +/- 6.8 for FT3). So it´s likely you would have needed a raise, not a decrease. 50 mcg of levo and 12 mcg of T3 will give you even less than what you find in 2 grains of Thyroid-S (76 mcg of T4, 18 mcg of T3), and you seemed undermedicated on that. Although we are all different, many people find that a full replacement dose of NDT is at least 3 grains. Were you self-treating on Thyroid-S or, if under a doctor´s care, was your doctor knowledgeable about thyroid hormone treatment? I am asking because your free Ts looked low on NDT. When on an optimal dose of NDT, FT3 should be closer to the upper normal limit. FT4 is less important (some say it should be around midrange on NDT but in some it drops below that), but that requires you to have optimal FT3 levels. I would say you did NOT have that on 2 grains of Thyroid-S. Having BOTH low FT4 AND low FT3 on NDT is a sign you´re undermedicated.

[imfene in reply to Hidden]

I was consulting a naturopath. Given my dose on 2 grains was low, would you have some advice on what dose I should take now? I don't have an endo to go to that I would trust and am no longer going through the naturopath as I was getting Thyroid-S through him and the price increased by 400 % after Covid! I am now hoping to self medicate by getting Eltroxin via my doctor and adding some T3 (Cytomel which I can get online) perhaps?

[Hidden in reply to imfene]

In my own and other patients´experience, endos are useless when it comes to thyroid disease. Most are diabetes specialists who don´t know enough about thyroid disease. They also tend to be TSH-obsessed and dose by the TSH alone. Unfortunately, there is no way to tell what YOUR optimal maintenance dose is. Before today´s lab results were invented, doctors used to go by symtom-relief and body temperature; a method which seems to have resulted in better results than today´s "ultrasensitive" lab results.

Could you go back to your naturopath, or find another one in your area? If you need T3, I honestly believe a naturopath could offer you better advice than an MD or an endo.

Even if you can no longer afford Thyroid-S, there are other options if you need additional T3. However, you would need to find a good doctor working with T3 and alternative treatments. I have no idea what that would be in South Africa, but if you used to see a naturopath you trust, why not go back to him and see if there are other options available to you? I have no idea how these things work in South Africa, but maybe you could get a prescription for synthetic T3 (Cytomel etc)? That´s much easier than ordering it yourself online, especially if you cannot verify the source. If you have found a reasonable naturopath, my advice would be to stay with him, even if you can no longer afford Thyroid-S.

[imfene in reply to Hidden]

I feel desperate. Since going on Eltroxin again, I have been slowly falling apart. Thanks, I will try go back to my naturopath. It is my experience as well that endos are useless and the ongoing attempts to get help that doesn't work really wear one down. I have half a thyroid and lost my gall bladder 25 years ago and think this is contributing to my need to add T3.

[Hidden in reply to imfene]

Most endos are obsessed with the TSH and will adjust treatment to keep it well in range. I have heard about countless people who were kept undermedicated and never had their free Ts tested because endos believe only the TSH matters. The few doctors who prescribe NDT/T3 tend not to be endos...

[SlowDragon Administrator]

75mcg levothyroxine is only one step up from starter dose

Essential to regularly retest vitamin D, folate, ferritin and B12

Low ferritin levels are frequently linked to hairloss

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

When were vitamin D, folate, ferritin and B12 last tested

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Come back with new post once you get results

[imfene in reply to SlowDragon]

Thank you Slow Dragon. I am in South Africa and going to a government hospital is particularly risky but will do so when it is safer. When I was on 75mcg Eltroxin, before going on to NDT, my FT4 levels were in the top range hence I was advised not to take a higher dose. However, I worked my way up to 3 tablets when on Thyroid-S and felt relatively good on that. It looks like I may be taking too little Eltroxin at 75mcgand am hypo now after going from 3 tabs of Thyroid-S. (The labs I posted were taken in Feb 2020). Vit D and Iron were okay last time I checked. Just not sure how much I should increase my Eltroxin dose now: as far as I understand, the correct conversion would have been to go to 300mcg after taking 3 tabs of Thyroid-S. That however is 3 + times what I was on before taking Thyroid-S. I will increase the dose slowly.

[jand123]

Hi Infeme I went from NDT when WP Throid was withdrawn back to Eltroxin and Thybon. I always had swelling in my face and hands from Eltroxin, maybe it doesn’t agree with you. My doctor has now put me on Thybon only and I feel much better. Just a suggestion!

[imfene in reply to jand123]

Thank you for your response. I am on Eltroxin and a T3 medication I found online now (I've given up on finding an endo in SA that will help me). My hair loss appeared to be because I was under medicated as it has stopped completely now. Just need to grow it back.

[jand123 in reply to imfene]

Oh that is good. Only noticed after this was a few weeks old