Endo advises increase in ERFA and Levo - if this is right how do I raise them?

[SmPea]

My current medication is:

7.00am ERFA 45mg, Levo 25mcg

2.00pm ERFA 30mg

Still having some symptoms, constipation, poor sleep, aching joints.

I sent Endo most recent blood test and he had advised I increase to:

7.00am ERFA 45mg, Levo 50mcg (increased by 25mcg)

2.00pm ERFA 45mg (increased by 15mg)

It would be helpful to know what people on here think about this and how I should make the increase - in stages or just do the full increase straight away?

Many thanks for your thoughts in advance.

[Lalatoot]

Only increase one thing at a time so you know what is causing any benefits or effects. Because your ft4 is low in range I would increase the levo first by 25mcg. Then wait 8 weeks and do bloods. The increase in levo will also slightly increase your ft3 as well depending on how you convert.

[SmPea in reply to Lalatoot]

My problem is I’m not a great converter - my FT3 had always been low in range and that is why I have been trialling ERFA privately.I am a year in to trying to find the right level and so far haven’t found my optimal level.

I think you are right one increase at a time - do you think 6 weeks on higher Levo is ok to know if it suits me? It’s just that I have an appointment with Endo at that time and need to do a blood test just before.

[pennyannie]

Hello SmPea :

Personally I'd drop the T4 altogether and slowly replace with additional NDT increments of 1/4 grains over a period of weeks. :

I find mixing up 2 different treatment options confusing and especially if you are tracking on blood test results that were not designed for NDT medication.

On NDT your TSH will likely go low suppressed : and this does not matter as TSH is the least important of these ranges once on any form of thyroid hormone replacement.

Your T4 may go lower than when on monotherapy with T4 BUT your T3 should be proportionately higher and you just track on the T3 - and / or monitor on your body temperature, pulse and blood pressure.

These blood tests and ranges were introduced to be used with Big Pharma's T3 ad T4 which was launched on the back of NDT which had been used successfully fused to treat hypothyroidism for over 50 years and prior to the " science " of a blood test and you simply dosed up to the relief of symptoms.

When you go a little over, your body tells you, then drop down to the previous dose and stay on that dose for 6-8 weeks, letting tht dose bed i and then run a blood test to see where you are.

[SmPea in reply to pennyannie]

Thanks pennyannie for your thoughts. I’m struggling to know what to do next! I decided to work with a private Endo as I didn’t feel confident enough to go it alone. So reading approaches on here and trying to work with the Endo is somewhat confusing 😵‍💫!!Was going to go with just an increase in Levo now I’m thinking just raise ERFA from your post!

Welcome others thoughts in the hope I can settle with the next move 🙂

[greygoose in reply to SmPea]

I agree with pennyannie , T3 is the active hormone, so important to raise that first. And, if you're a poor converter, you probably don't need all that T4. At least try a higher dose of NDT and drop the levo. You can always add it back in if that doesn't work.

[SmPea in reply to greygoose]

Thanks that’s really helpful

[greygoose in reply to SmPea]

You're welcome.

[pennyannie in reply to SmPea]

Well NDT has it's own unique ratio of T3/T4 which works very well for many thousands of people and I think as you are building up your dose you need to try to use the NDT as it was intended.

By adding more T4 you are " watering down " the effectiveness of the NDT :

I do read of some people who when very close to finding their sweet spot adding in a little T3 or T4 but personally found no benefit in doing this and think this sweet spot an illusion.

All you can do is try and find a treatment option that suits you best and as life gets in the way you need to be prepared to reassess your dose when your goal posts move.

[SmPea in reply to pennyannie]

Thank you based on all your posts I’m able to make a decision - increase NDT only!

[pennyannie in reply to SmPea]

Track on your temperature, blood pressure and pulse daily as you slowly increase the NDT - my blood pressure and pulse were constant and my temperature rose from 35.4 to 36.6 where it still hovers some 4 years later.

[pennyannie in reply to SmPea]

Obviously having Hashimoto's throws a spanner in your works - as you are liable to erratic levels of thyroid hormones from time to time.

Again it's more a question of learning to ' read your body ' and dropping down your dose a little when an attack is present, and readjusting your dose afterwards as your thyroid becomes further disabled.