My endo doc had been treating my hypothyroidism with levothyroxine (T4) only, since I had tried liothyronine (to get some T3) before but even at tiny doses (like 1/4 of a 5mcg tablet) I've had bad reactions (wicked fast heart rate, etc) to it and had to stop. I finally suggested that maybe we try NDT to see if I could tolerate that... he agreed, and I seemed to be OK on a trial 15mg (1/4 grain) of NP Thyroid.
I had been at 50mcg of levothyroxine, so we started with the 15mg of the NDT and dropped the T4 by about the amount of T4 in the NDT (9.5mcg) to 37.5mcg. Gave it about 6 weeks and drew labs... things improved a bit.
Moving forward... dropped the levo to 25 mcg (taken at bedtime, 11PM) and added a second 15mg dose of the NDT. So, the NDT was now taken at 7AM and 2PM. I found myself "crashing", becoming really tired at about 1 PM before the second dose. After another 6 weeks we did labs again... some real improvement, my formerly stubborn RT3 dropped from 26 to 18, and the other labs were also moving the the right directions.
So the plan is to further increase the NDT dosage incrementally while watching the labs, continuing the levo/T4 at 25 mcg. My question is about timing of the doses.
I had read that the timing of the T4 (if needed) was not terribly important, but some folks suggested bedtime so I just left it there. The issue is the timing of the two NDT doses (to "split" the T3 dose, to which I seem to be sensitive). It seems as though folks have suggested taking the first NDT dose upon waking (7AM), and then taking the second about two hours before the afternoon "crash" (which was occurring about 2PM... so the second NDT dose would now be at about 12PM). Breakfast, lunch and other meds would be timed at least 1 hour after the NDT doses.
Just wondering what your experience with this is, and if this seems like a reasonable plan? Does anyone split their NDT into 3 doses (to further even out the T3 during the day) with the third dose an hour before dinner? Thanks in advance for your help!
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goodoldan
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I had the problem of an "afternoon crash" I now split my ndt into 4 equal doses. I take mine 1 hour before food and drink and the last dose at bed time. It's worked well for me, the afternoon crash has gone and I feel stable throughout the day and night. We are all different so take it slowly and find what works best for you.
Greybeard: Thanks for that! That was my thinking too... to go to 3 (and maybe 4) equal NDT doses daily to even out the T3 and avoid a big T3 surge after each dose.
If been left on just 50mcg levothyroxine, likely low vitamin levels as direct result of being under medicated
When were vitamin D, folate, ferritin and B12 last tested
What vitamin supplements are you currently taking
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine or NDT or T3
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
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 and last dose levothyroxine 24 hours before test
On T3 or NDT - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last dose 8-12 hours before test
This gives highest TSH, lowest FT4 and most accurate Ft3 and consistent results. (Patient to patient tip)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
Gluten intolerance is often a hidden issue too. Request coeliac blood test BEFORE considering trial on strictly gluten free diet
Thank you for all that! Yes, full labs were being performed after each incremental change, and as described (first thing in AM, etc). Also had a SIBO test last week which was negative. Thyroid values, vitamins, iron, etc. are in range. The one parameter that was consistently high was RT3 at about 24 ng/dL (lab range 9.2-24.1). The endo doc was concerned about further raising the levothyroxine (without additional T3) because of the high RT3. I am apparently VERY sensitive to liothyronine, and even a small dose (5 mcg) had sent me to emergency with a 160 heart rate. The endo doc recognized my need for additional T3, however, and is why we decided to try NDT and see if I can tolerate the "natural" T3 it contains. So far, it seems I can. After the first 6-week interval of taking the NDT at a very low dose, the RT3 lowered from 24 to 18 (lab range 9.2-24.1). I think once I get the NDT dose timing dialed in and we increment (with labs) up to the correct dose, things look promising. The doc is agreeable to maintaining a small dose of levothyroxine (currently 25 mcg) along with the NDT as need be.
I too split my dose to stop the crash like Lynneypin . Try it and see if it works for you. A pill splitter is a good investment to stop you trying to find the split pill in the fluff under the bed.
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T4 split dosing making instant difference!
