Received these results today and wondering if there is room for an increase. I take 60mg Efra thyroid, 50 mcg Synthroid. Labs taken while fasting. Took 30 Efra + 50 Levo 8am, then 30 Efra @ 8pm. Bloods drawn 8am the following morning, no B vit. For 7 day. Tsh: 0.91 (0.32-4.00), FT4 : 14 (9-19), Ft3 : 4.0 (2.6-5.8) Ferritin :257 (5-272) folate hemolized so no results, B vitamins has 400 folate, so should be good. B12 : 952 (138-652). So, my energy level is fair - good, continues to loose large amount of hair from my head, skin very dry, heels like a grater, sleep disturbances, very forgetful, poor concentration, severe postnatal drip, recently experiencing some palpations at nights, no desire to do anything, muscle pain and hip pain.
Do I need an increase? Would like to drop the levo and take NDT only, not sure how much NDT to add. I have an Endo but he’s as useless as a 3rd tit. He told me that elderly patients should avoid NDT because it’s not good for the heart, is he correct? I’m turning 67 in 3 months. I tried levo+ cytomel and had bad headaches and head pressure from the cytomel, NDT makes me feel more normal although I still fee under medicated
Thanks in advance to all those who take the time to read and give their valuable advice, I really appreciate this forum, tsh 0.01,
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Rosebud1955
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There's plenty of room for an increase of 1/4 grain. Which isn't much, but we have to go slowly.
So, if you want to cut out the levo, and just take NDT, increase by 1/4 grain now, retest in six weeks, and then reduce your levo by 25 mcg and see how you go. You can't just drop 50 mcg levo in one go, but you can slowly increase the NDT and drop the levo slowly.
If your endo were right about T3, there wouldn't be any elderly people, because their bodies make it naturally. At what age does he think they all drop dead from heart attacks brought on by natural production of T3? lol Obviously, too much is bad for the heart, but how much is too much? They have no idea!
I've seen posts on here recently suggesting that hair loss can be a side effect of Erfa. I've not been on Erfa long and my hairdresser agrees that my hair is thinner.
You can just switch from levothyroxine to ndt. You dont have to do it soowly though you may prefer to take it in stages. Under a known recognised medical specialist in hypothyroidism I switched across from levo to ndt. I chose however to take a lower dose of ndt and increase intially over a few weeks but after that did the same 6-8week review of thyroid hormones with blood tests, TSH, ft4 & ft3 AND signs & symptoms. This meant I switch across much more quickly. Some people switch straight across I didnt have the confidence to do that though was advised I could do so if I wished.
If you look on stopthethyroidmadness they describe this switch & give the conversion equivalent.
You are half way over with your switch, You dont say which ndt you are on? 60mcg with Armour is 38mcg of T4 and 8mcg of T3. Erfa if I remember correctly has a slightly higher T3content of 9mcg. T3 is roughly 3-4 times equivalent of Tfour. (Sorry iPad keyboard playing up). So you could consider taking half a grain more ( thats 30mg ) and stopping your Levothyroxine. Or doing it in two stages as Greygoose described.
Hi Wavey, yes I did mention that I take Efra, might be an oversight. I just did some reading on the Efra site, it states that 60mg is equivalent to 35 T4 + 8 T3. Will follow all the good suggestions give by everyone. You all do a good job helping others. I regained most of my thyroid healthy since I joined. I wish I knew about this site prior to surgery when I was in dire need, at the mercy of a useless GP. Thanks again!
Apologies.....missed that info....lol. Glad you have your plan. But check in with your signs symptoms. Blood work is a guide but not the whole picture. Everyone has different optimal levels and those fine tweaks at the end are largely governed by how we feel.
As previously detailed I switched from 125 mcg T4 to NDT the following day :
The T4 takes around 6-8 weeks to fully leave the body and within that time frame slowly increase your NDT by 1/4 grain increments, I did this weekly, some people increase fortnightly.
If you get to 2 grains NDT then hold that dose for 6-8 weeks and then run a blood test to see where your T3 and T4 then sit.
Compared to your bench mark readings your T3 should have moved, and some symptoms reduced and feel improved - if your T3 hasn't moved that much from when of T4 monotherapy maybe NDT isn't the best option for you.
If your T3 has moved, and you feel ok, but still with some symptoms start again, building up from 2 grains in 1/4 increments monitoring blood pressure, pulse and temperature as you go.
I'm with Graves Disease and post RAI thyroid ablation.
Thanks for weighing in! I’m hoping to get to 90mg eventually, thinking that might be enough but will check blood work. I’m also thinking that I will do the 1/4 increase and decrease levo from 50 to 37.5. Is this a reasonable plan?
Thanks Penny, yes I have access to NDT, my Endo prescribes it along with the Levo. He gives me the option to tweak, so I do just that and then tell him what I’ve done. This morning I added the 1/4, but silly me, I took 37.5 of the Levo instead of the 50. Probably not a good idea. I’m afraid that I will return to the dark days when I was very ill from being hypo. What you suggested sounds good, I will drop the Levo and see what happens, or should I leave a small amount of Levo for now: like25 or 12.5. I’m a coward when it comes to adjusting doses. What do you think? Sorry to be a bother. I appreciate you taking the time in trying to help.
Please do not worry about taking a lower dose of T4 this morning.
Since you added the 1/4 grain NDT :
It's said that 1/4 grain NDT is around the same as 25 mcg T4 : though i don't know if one can actually compare apples to pears.
T4 takes around 6-8 weeks to finally leave the body and in this time you'll likely be adding further 1/4 grains of NDT :
Are you monitoring yourself with blood pressure, pulse and or temperature twice daily ? Has anything changed yet ?
You are not a coward just someone hesitant to get it wrong and go backwards - I totally get as I've been there too - you'll be fine it's all a question of confidence and that will come as you start to trust yourself.
No thyroid hormone works optimally until ferritin, folate, B12 and vitamin D are up and maintained at optimal.
Hi again Penny, I really appreciate your response. So, just to get it straight: I will drop the Levo totally and just take the 1+ 1/4 NDT for now. After 1-2 weeks if I feel really hypo, should I add another 1/4 NDT? Or should I wait for 6 weeks blood test? I’m thinking I will eventually need 1+1/2 based on my weight, and the absence of a thyroid. Will monitor symptoms as well. Thanks a million!!!
Correct - drop the T4 totally - that little dose takes around 6-8 weeks to fully leave your body.
In around a weeks time if you feel a few symptoms coming back increase again the NDT by 1/4 grain :
In another couple of weeks if you still feel hypo add another 1/4 grain :
Continue this routine until, or if, you get to 2 grains - then stay on 2 grains for 6-8 weeks letting this dose settle and then run the blood test.
I only managed to get to 1 + 3/4 grains and found this new dose gave me some anxiety, and I just felt not as good as the week before and uncomfortable in my skin, so I dropped drop back down to the previous dose, 1 + 1/2 grains and stayed there for the 6-8 weeks and then ran a blood test.
My blood pressure and pulse throughout remained constant and my temperature rose from 35.4 to 36.6 where it is today.
My TSH was at 0.01 - my T3 was at just over range at 110% and my T4 was at just 25% and I felt fine and in fact a totally reversal of where my T3 and T4 sat when on T4 monotherapy.
Had I waited a little longer between last dose and blood draw I would have been " in the range " - but seeing as I'm looking after myself, I'm not too bothered about these shoe boxes for so called ' normal ' people, as I also don't think it's normal to have had RAI thyroid ablation and live without a thyroid anyway
If your happy with your progress but still with some symptoms start building up again from 2 grains with 1/4 grain increments.
I'm not sure you can use weight - I only need about 1 + 1/2 grains daily and have been on this dose 4 years and now around 2 dress sizes smaller but it hasn't meant I have dropped my dose at all and that was just an added bonus to feeling in much better overall health.
Hi Penny, thanks so much for all the valuable advice. It sure helps and give confidence when I hear other people’s story. I will do just what you suggested, GG also gave me good advice, similar to yours. I took the plunge this morning and dropped the Levo. I feel safe now after the good advices I received. Awesome! I will continue to monitor symptoms and blood tests. Have a good evening!!
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