A while ago I posted on here with continuing hypo type symptoms eg fatigue, weight gain, hair loss, coldness, while taking 1 grain NDT daily. (I have Hashimoto's and had a partial thyroidectomy in the 1990s due to Graves). The issue is that every time I try to increase my NDT dose, even by as little as an eighth of a grain, I get more frequent episodes of paroxysmal atrial fibrillation (PAF). My choice has seemed to be between staying hypo and having fewer palpitations or trying to improve my thyroid function and risking more PAF.
I'd thought the problems could be due to adrenal or iron or Reverse T3 issues. Some helpful experts on here suggested that I do the Medichecks Advanced Thyroid Function test, and I've also done the 4-point saliva test to look at adrenal function.
I stopped taking all B vitamins (including biotin and B12), vitamin D and other supplements a couple of weeks before testing. I divide the NDT into twice daily doses so the last dose was over 12 hours before testing.
Results are below and I'd be really grateful if anyone could throw any light on what's going on and any possible remedies.
I noted the low D3 and am again supplementing with 25 ug (1,000 IU) daily but not seeing any difference in symptoms.
With many thanks for any help.
Katherine
Medichecks Advanced Thyroid Function Test (17 Jan 2022):
TSH = 3.01 mU/L (0.27 - 4.2 R)
Free T3 = 4.52 pmol/L (3.1 - 6.8 R)
Free Thyroxine = 11.4 pmol/L (12 - 22)
Thyroglobulin Antibodies = 65.1 IU/mL (< 115 R)
Thyroid Peroxidase Antibodies = 198 IU/mL (< 34)
CRP HS = 0.76 mg/L (0 - 5)
Ferritin = 67.6 ug/L (13 - 150)
Folate - Serum = 19.4 ug/L (3.89 - 19.45)
Vitamin B12 - Active = >150 pmol/L (37.5 - 188 R)
Vitamin D = 64.7 nmol/L (50 - 200)
Medichecks Stress Cortisol Saliva Tests (17 Jan 2022):
Cortisol - Waking = 17.6 nmol/L (6 - 21 R)
Cortisol - 12:00 = 2.98 nmol/L (1.5 - 7.6 R)
Cortisol - 16:00 = 1.69 nmol/L (0 - 5.5 R)
Cortisol - Before Bed = <1.5 nmol/L (0 - 2 R)
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I stopped taking all B vitamins (including biotin and B12), vitamin D and other supplements a couple of weeks before testing.
There really is no need to stop any supplements other than Biotin or a supplement containing biotin. You continue to take the others then your results will show your level when supplementing and will tell you if you are taking an appropriate amount or if you need to adjust the amount you're taking.
I divide the NDT into twice daily doses so the last dose was over 12 hours before testing.
It really should have been between 8-12 hours so we adjust time of the dose the day before. How much exactly was the time gap? You could have false low FT4/FT3 levels.
CRP HS = 0.76 mg/L (0 - 5)
Nice and low, as an inflammation marker the lower the result the better.
Ferritin = 67.6 ug/L (13 - 150)
Could be higher. Ferritin is recommended to be half way through range so 82 with that range. However, some experts say that the optimal ferritin level for thyroid function is 90-110ug/L
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Folate - Serum = 19.4 ug/L (3.89 - 19.45)
Vitamin B12 - Active = >150 pmol/L (37.5 - 188 R)
Are you taking both B12 and a separate B Complex? You don't actually have a result there, you just know it is high, it's higher than their machine reads. You don't need a separate B12 with that level, the amount in a B Complex will maintain it.
As your folate is top of range then if you're taking a B Complex daily I would now adjust the dose and maybe take alternate days.
Vitamin D = 64.7 nmol/L (50 - 200)
I noted the low D3 and am again supplementing with 25 ug (1,000 IU) daily but not seeing any difference in symptoms.
1,000iu is just a maintenance dose for someone with a good level already.
The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L. To reach the recommended level from your current level, you would be looking at supplementing with about 3,000iu D3 daily along with it's important cofactors - magnesium and Vit K2-MK7.
Retest after 3 months and if you've reached the recommended level then you'll need to adjust dose to a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This would be an ideal time to retest B12 and folate to see how they're doing.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form
Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Medichecks Stress Cortisol Saliva Tests (17 Jan 2022):
Cortisol - Waking = 17.6 nmol/L (6 - 21 R)
Cortisol - 12:00 = 2.98 nmol/L (1.5 - 7.6 R)
Cortisol - 16:00 = 1.69 nmol/L (0 - 5.5 R)
Cortisol - Before Bed = <1.5 nmol/L (0 - 2 R)
Unfortunately you haven't chosen the best adrenal test.
Ranges are based on the levels of healthy people.
Two of those ranges have zero as the lower limit. If anyone did have a level of zero, they would be very far from healthy.
Also when the result says <1.5 then there is no actual result. It could be anywhere between 0 and 1.4. If it was nearer the low end the level would be good, if it was nearer the high end it would be too high.
Also, Medichecks only measures cortisol. We also need DHEA testing alongside cortisol as this helps with determining stages of adrenal fatigue. In the initial stage, both cortisol and DHEA will be high, the more we struggle to produce stress hormones then DHEA will lower, and more advanced adrenal fatigue then cortisol will lower too.
• Morning at the top of the range - yours is 77% through range so pretty good.
• Noon approximately 75% of the range - yours is 24% through range so it's low
• Evening close to 50% of the range - no lower limit so I wouldn't rely on this range
• Nighttime at the bottom of the range - no lower limit so I wouldn't rely on this range and you don't have an actual result you only know it measures lower than 1.5
Thank you. The gap between last dose and test was about 12 hours and 10 mins. I'm very drawn to liver so will keep eating it weekly. Yes, B vitamin complex only every other day. I will increase vit D3 dose and add vit K2-MK7. Am taking Mg Taurate giving 200 or 300mg of elemental Mg daily. I'll look at a better adrenal test including DHEA in the future, but can't afford it at the moment.
Thank you. I'm on a strictly gluten free diet as I'm not coeliac but have a strong sensitivity to it. I had thought of adding some T3 to the NDT as I've seen that recommended - but I suspect it could easily increase susceptibility to palpitations. I've read that adding levo to NDT is likely to increase Reverse T3, so not a good idea - but I know that's controversial. Maybe it would be a sensible thing to try - thanks for the suggestion.
Have you considered that this balance of hormones may not be correct for you and that a T4/T3 combo may offer greater flexibility when titrating.
Have you tried LT4 monotheraphy?
Above labs show -
FT4 is -6% through the reference range
FT3 is 38.4% ditto
For good health both Frees need to be approaching 75% through range, though we are all different with different needs
I wouldn't be concerned about TSH, it shows what we know....you are undermedicated!
FT3 is the important number.
As the active thyroid hormone T3 needs to move from the serum to the nuclei of the thousands of cells in the body before it becomes active - via T3 receptors. The T3 must be in an adequate and constant supply
Low T3 = poor health
You need to raise your FT3 level.
You are undermedicated which you no doubt already realise....hence your symptoms.
This is an old study but provides evidence that hypothyroidism can cause Afib.
With such an abysmally low FT4 why are you not prescribed levo?
It looks as if your T4 to T3 conversion may be fine, but difficult to be certain with those labs
Might it be the T3 in the NDT that is causing the problem, and you need a T4/ T3 balance more suitable to your body's needs. Some people need only a tiny dose of T3 and any NDT increase you make may tip the balance.
In your shoes I'd try increasing T4 with 25mcg levo, give it 6/ 8 weeks to settle, test again....and most importantly see how you feel. Your will likely need more T4 and then your Afib may resolve!
You've already been given excellent nutritional advice follow that in order to support thyroid function
Some really good thoughts, thanks. I was on T4 only for a long time but always felt something missing and have been better on NDT. Adding some T4 to the NDT does sound like the way to go. The Medichecks doc said that low T4 doesn't matter, but I agree that it does and needs to be raised, as well as the T3. I'm thinking that experimenting with different combinations of T4 and NDT might find the right balance.
If you decide on adding 25 mcg of t4 you may want to split it in half and take it with your 2 doses of ndt. Hopefully it will lessen the impact. Just a suggestion
If you dont have high blood pressure, you can try adding 1/4 of a teaspoon of Himalayan salt to your water or food for each meal. For whatever reason its great for the adrenals and calming down the heart. Doing this has helped lessen my tachycardia. Regaring ferratin, my heart goes berserk anytime I get close to the midway point so I couldn't agree more with raising you levels up to 110. Liver was great at raising it for me.
Thanks - I'm actually craving salt and have some Himalayan here, so will try adding some. And I think the liver craving is a sign of needing more iron.
Himalayan sea salt is rich in several minerals, including sodium, that help to restore normal functioning of adrenal glands and satisfy salt cravings. It also supports the effective functioning of NeuroEndoMetabolic (NEM) Stress Response – thus helping to fight AFS.
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