Start Over or Decrease Dose

[HeartWoman]

The labs below are for 2 grains of NP Thyroid tested about 10 hours after my dose. I see an Integrative doctor and we are not agreeing on the next step . I definitely felt overmedicated. I was emotional, looked and felt horrible, and felt like I was starving all the time, so I believe I need to lower my dose a little. (I am also estrogen dominant due to being put on oral estradiol with no progesterone for many years after a hysterectomy, so trying to sort that out as well. I am on compounded estrogen and progesterone now for close to 3 weeks.) Anyway, my doctor wanted me to completely stop my NP Thyroid for 7 days and then start back at .5 grains and increase from there. I only last 3 1/2 days without the NP. The first day after stopping, I still felt overmedicated, but a tad bit better. On the 2nd day off of it, I was energetic and in a decent mood. Yesterday, the 3rd day off of it, I was energetic, but my mood was starting to go down. Today I feel like I am continuing to decline. I can't focus. I am weepy, anxious, etc. I finally gave in and took .75 grains this afternoon. I think I need to decrease from 2 grains to 1.5 grains. My doctor wants me to start all over at .5 grains. Would you start all over or just decrease by .5 grains and hold for several weeks?

FT4 1.25 (.82-1.77)

FT3 5.1 (2.0-4.4) High

TSH .102 (.450-4.5) Low

rFT3 15.5 (9.2-24.1)

I have had all the other recommended bloodwork done. I needed to get my Vitamin D up and it has definitely been coming up, but everything else is up in the range. I am also gluten free.

Thanks for any insight.

[greygoose]

How long a gap did you leave between the last dose of NP Thyroid and the blood test?

[HeartWoman in reply to greygoose]

10 hours

[greygoose in reply to HeartWoman]

OK, so that should be a good reading. You just need to reduce your dose by 1/4 grain.

[Luna1390]

Did you start at 2 grains or gradually work your way up to that point?

Also, were those labs 24 hours after your last dose?

[HeartWoman in reply to Luna1390]

No, I have been slowly increasing since mid December.

[Luna1390 in reply to HeartWoman]

So when this issue happened to me, I just reduced 1/4 grain. And then waited a few days. And if i still felt overdosed, I would bump it down a little again. You can even reduce or raise by 1/8. Just use a sharp knife to cut it.

[HeartWoman]

It was 10 hours, which is about the time recommended for T3 meds.

[janeroar]

You could be feeling horrible because of drop in oestrogen. If I miss one day of oestrogen HRT I feel dreadful- emotional and tired. I’ve weaned myself off Oral oestrogen and on gel but it took a while to even out.

[TSH110]

I’d slowly tírate down a 1/4 of a grain and see how you feel. I presume you were ok on 1.75 grains? I’ll post a dosing protocol you should find helpful and it includes what to do if you overshoot the mark

Here it is, it’s very good, and I hope it helps:

tpauk.com/main/article/trea...

[Luna1390 in reply to TSH110]

Wow! That guide is fantastic. I wish I had known about it a few years ago!

[TSH110 in reply to Luna1390]

Better late than never 😉 it certainly helped me

[Imaaan in reply to TSH110]

Thank you

[pennyannie in reply to TSH110]

PixieElv

[PixieElv in reply to pennyannie]

Thank you! This is really useful. X

[pennyannie in reply to TSH110]

PixieElv

[HeartWoman in reply to TSH110]

Thanks for sharing the guide. I stopped the NP on Friday. I had the best day I have had in a long time on Saturday. Sunday wasn't too bad, but it has been downhill since. Today (6 days without NP) I have been an anxious, crying mess!!! I told my doctor there is no way I can wait until Friday. He said to go back on .5 grains and start slowly increasing from there. I doubt .5 grains is going to do much. I set up an appointment with him tomorrow, because I want to start with 1.5 grains. I like him a lot, but for some reason he is concerned about the TSH. When I was overdosed, I don't get anxious, I get severe fatigue. I interrupted that as needing more. I am anxious when I am hypo, not over medicated.

Does is seem reasonable that I would be symptomat start around day 2 1/2-3 after stopping NDT. I think I must not convert from 4T to 3T very well.

[TSH110 in reply to HeartWoman]

The T3 has a short half life so that would cause symptoms. If you don’t get any, reserves would be depleated in days. This is why small adjustments are best as it is quick to clear just stopping altogether is not a good idea. If you doctor is dosing NDT by TSH they don’t really know what they are doing, it is freeT3 they should be using as their guide. TSH is often suppressed because you have enough hormones so there’s no need for the pituitary to signal for more to be made. If you don’t have a thyroid/working thyroid you can’t make any anyway but the feedback loop still chugs on despite serving no useful purpose.

[surviver1]

What are grains,I take levothyroxine I'm confused

[Gingernut44 in reply to surviver1]

Grain/s is used as a measurement of NDT (natural desiccated thyroid). One grain equals 60 mg. Levothyroxine is measured in mcg.

[helvella in reply to surviver1]

My Vade Mecum has a section on units - which includes grains. And another section which lists the claimed T4 and T3 content of most desiccated thyroid products which identify their potency.

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Not everything is in this one document - my major medicines document is still separate!

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1ZW...

[Lunario in reply to helvella]

What a comprehensive summary you have gathered! Thank you very much, this is very helpful. I can’t stop reading…🙏

[helvella in reply to Lunario]

It's not as gripping as Stieg Larsson.

Hope it helps. I've never imagined anyone working their way through it.

[Lunario in reply to helvella]

In this case, I am glad that it is not a novel. Stories are told by some doctors often enough.😉

[helvella in reply to Lunario]

If you notice mistakes or things that don't make sense, please let me know.

I am so close to it, I stop seeing errors.

[Lunario in reply to helvella]

OK, I know what you mean. A German proverb says that sometimes you can't see the forest for the trees. If I notice anything of this kind, I will let you know.

[TSH110 in reply to helvella]

Oh dear…..I feel like that judge who asked “Who’s Gaza?”

Who’s Steig Larsson?

I wonder if I’m warm with the togger ie football (not sure where that expression for it comes from or if anyone else even knows it!)

Just checked Togger - it’s a northern expression for playing football and is even in the dictionary 🥅 ⚽️ 🏃🏼‍♀️

Oops miles off. Rather a sad demise one wonders whether all the arsenic his father was poisoned with might have played a roll in his heart attack. Something else to look into…,

It’s possible:

ncbi.nlm.nih.gov/pmc/articl...

[helvella in reply to TSH110]

A Swedish journalist/author of a series of books made into films - both Swedish and English versions.

stieglarsson.com/

[TSH110 in reply to surviver1]

It was the old measure of medicine, I think it comes originally from a grain of rice. helvella will have all the lowdown on it in his Vade Mecum !

[helvella in reply to TSH110]

It's all in my Vade Mecum!

Grains

A traditional measurement of medicine was the grain which was based on one grain of barley. The grain continues to be used for desiccated thyroid. Some brands use the traditional grain which is very close to 65 milligrams. Some people use an approximation of 60 milligrams which makes the numbers simpler.

The abbreviation for grain is gr but it is usually better to write grain in full to help avoid mistakes (it is often confused with g for gram).

The grain is a part of both the British and US Apothecaries measurement systems. Other units occasionally mentioned include gill, ounce, drachm/dram, scruple, grain, minim. (These units may not be identical in both systems.)

helvella - Vade Mecum for Thyroid

The term vade mecum means:

1. A referential book such as a handbook or manual.

2. A useful object, constantly carried on one’s person.

Please don't get put off by the number of pages!

Not everything is in this one document - my major medicines document is still separate!

From Dropbox:

dropbox.com/s/vp5ct1cwc03bl...

From Google Drive:

drive.google.com/file/d/1ZW...

[TSH110 in reply to helvella]

Wow what a fount of knowledge you are & I got the origin grain wrong so thanks for putting me right there. I wonder how far back it goes. I like to think it could be Egyptian in origin. I like the sound of a scruple it would be fun to ask an endocrinologist for a scruple of T3 and see the expression on their face. I wonder if it’s a lot or a minuscule amount.

[helvella in reply to TSH110]

The grain of barley is also used for shoe sizes (which make little sense in themselves). Wiki says:

The barleycorn is an old English unit that equates to 1⁄3 inch (8.47 mm). This is the basis for current UK and North American shoe sizes, with the largest shoe size taken as twelve inches (a size 12) i.e. 30.5 cm, and then counting backwards in barleycorn units, so a size 11 is 11.67 inches or 29.6 cm.

Also, we see many medicines, like aspirin, in doses of 300 or 325 milligrams. These are both based on five grains. One with the grain converted as 60 mg, the other as 65 mg.

[TSH110 in reply to helvella]

How weird re shoe sizes, do you think it’s also related to corns on the feet?

[TSH110 in reply to TSH110]

They are from different roots:

etymonline.com/word/corn

[helvella in reply to TSH110]

I have often visited that site - very useful and interesting.

[helvella in reply to TSH110]

Twenty grains would be a huge dose - for that is what a scruple is.

[TSH110 in reply to helvella]

That would be a goodly stash!

[jamesal0]

I'd have a couple of days off and then start on 1.5 grains. Interesting you started on estrogen and progesterone recently. I feel I require less NDT when I'm supplementing my full testosterone (TRT) dose. With NDT you listen your body to to judge the daily dose.

[serenfach]

It is so easy to miss the "sweet spot", isnt it? You carry on feeling OK, but not quite right, so you up it a bit and feel better, and you think, OK this is the right dose for me. But if the dose is just a wee bit high, it is cumulative, so at some point it tips over into too high a dose. Because there is the delay between upping the dose and the effects you feel, it is really easy to not find the "sweet spot". And because of life, work and stress get in the way, you can easily blame this too. .

I would drop 1/4 grain as others have said and give it a couple of weeks. The great thing about taking control of your dosage is that you dont have an ignorant GP telling you what to do and getting it wrong.

Hope you feel better soon. Hug.

[Imaaan]

No advice to add but I hope your health improves.

[HeartWoman]

I went from 2 grains to 1 1/2 grains and within 3 days I felt overmedicated again. I have been off for a few days and will try 1 grain tomorrow. I am thinking that since my estrogen was lowered and I started progesterone, maybe my thyroid is functioning better. I know I am miserable when I don't take any right now.

[Incoguto in reply to HeartWoman]

When you overdosed, did you skip any days? How long were you on 2 grains? And when exactly did you start prog and ended estrogen?