Advice needed on changing from Levo T4 to Armou... - Thyroid UK

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Advice needed on changing from Levo T4 to Armour NDT

Blanche1960 profile image

Hi guys wondered if you kind people could give me some advice on upping NDT please!

Really struggling with Levothyroxine... had 2 ops to remove all thyroid 4 years ago due to cancer but struggled with medication ever since! Long long story which I won’t bother you with but topside is I feel unwell every day and have no quality of life with ongoing other complex conditions which have been made worse since thyroid removed!

Three weeks ago I was on 150 oral levo thyroxine but asked Endo to try NDT as a last resort... which he agreed and gave me Armour 1 grain (60mg) 38 T4 9 T3... one tablet daily with view to increasing at next appointment hopefully next week! Stopped T4 straight away as instructed started Armour next day!

I realised straightaway this was a lot lower dose than the 150 T4 but thought I’d seen it on here whereby it’s a storage hormone so still be in my body for few weeks... anyway had bad palpations, chest tightening, bit diarrhoea, headaches worse etc for couple wks but more or less wore off so think was over medicated then but now bad fatigue/sleepiness headaches worse pains in hands/ arms, constipation etc...noticed that about 6/7 hours after taking the 1 grain I get a bad slump just need to sleep can’t keep eyes open so I’m sure I’m under medicated till NDT gets upped next week which is where I’d like some info from you knowledgeable people...

1: Shall I ask Endo to increase it very slowly as very sensitive to any kind of medication got a feeling he might do it it quickly with being on low dose?

2/ how long does it take for the NDT to get into your system is it like Levo taking 5/6 wks or is quicker?

3/ Do people find splitting doses helps instead of taking in one dose like I do?

Thank you for reading, sure someone will be able to answer my questions!

9 Replies

Hello Blanche :

I stopped 125 mcg T4 one day and started off on 1/2 grain of NDT the following day.

The T4 takes around 6-8 weeks to fully leave the body and in that time as the T4 decreases you build up the NDT dose with most NDT 1 grain tablets containing 9mcg T3 + 38mcg T4 :

I read NDT should be increased low and slow and by 1/4 grain increments weekly, or fortnightly.

I too do not have a thyroid and I built up in 1/4 grain increments weekly :

I take my NDT at around 3.00am to dovetail in with the circadian rhythm of the body and take it all at once - some people split the dose into 2 - am and pm.

I first ensured my ferritin, folate, B12 and vitamin D were optimal:

I took bench mark readings of where my T3 and T4 sat on T4 :

I monitored myself on blood pressure, pulse and temperature twice daily while I built up my dose.

My blood pressure and pulse remained constant and my temperature slowly rose from 35.4 to 36.6 where it hovers now, some 4 years later.

With NDT you dose to the relief of symptoms and not a blood test :

I reached 1+3/4 tablets but felt a little anxious and uncomfortable in my body so I dropped back down to 1 + 1/2 grains and stayed on this dose for 6-8 weeks, letting it bed in, and then ran a blood test to see where I was :

My T3 and T4 had literally swopped places to where they sat on T4 - and now my T3 is at around 90-110% through the range with my T4 sitting at around 25-30% through the range.

If you reach 2 grains you should hold this dose for 6-8 weeks and then run a blood test to compare to your bench mark readings. If there is movement of T3 and you still have symptoms, start off again, slowly building up until the symptoms are relieved or that you feel you have gone to far and then just drop back that last dose and give it time to bed in and then reassess what you want to do next.

Your bloods on NDT will look different - your TSH will likely be lo suppressed :

Your T4 likely lower than bench mark BUT your T3 should be higher than bench mark readings and if it isn't maybe NDT is not the best thyroid hormone replacement for you.

P.S. I'm with Graves Disease and post RA thyroid ablation in 2005 and now manage lingering Graves, thyroid eye disease and hypothyroidism and self medicating with NDT for 4 years.

Hi pennyannie, so sorry just realised my replies to couple messages from you and radd on my last post didn’t get through to you… well not that I can see lol thank you for your valuable input… I’m starting new post as struggling soo bad with Armour NDT so unwell not sure where to turn! Thanks for your knowledgeable info as ever in last post!

Kind regards

Blanche1960

No worries - my laptop crashed last Thursday and I'm still in catch up mode replying to people who I left up in the air over the last 5 days !!

Ah don’t worry… it’s me, thought I had replied to you but couldn’t see it so apologise in advance if you did receive it… still learning how this site works and not good with technology lol take care

Ditto - It's not just you - I'm just a couple of years on here ahead of you - no worries - we all get there in the end - hopefully :

Blanche1960,

Your endo should know better than to switch you straight from 
Levothyroxine to NDT if T3 meds have never been taken before. T3 should only ever be introduced in small increments starting with 5 mcg a day and raised slowly. Some people even struggle with that much and have to reduce to 2.5mcg daily before raising.

It would have been much easier for you to have asked for T3 to be added to your Levo as you have more control over the T4/T3 ratios. However, it can be done with NDT but involves retaining a Levo dose alongside NDT dose (that can only be raised slowly) until optimal levels can be achieved. As it stands you are now over medicated with T3 with insufficient T4 levels.

Did you have TFTs drawn before starting NDT? Can you post previous FT4 & FT3 levels?

Assuming your FT3 was low, if this were me and using any another NDT except Armour, I would have reduced 150mcg levo to 100mcg and introduced 1/2 grain NDT.

However, I found Armour T3 potent so would suggest reducing Levo to 125mcg and introducing 1/4 grain Armour. These doses would be held for at least a week (maybe two) to ensure tolerance before making further adjustments of 25mcg Levo reductions and 1/4 or 1/2 grain increases. I also split my dose as have weak adrenals and considering your reaction to T3 it might be prudent to split-dose whilst gaining tolerance, and then evaluate once hormones are optimised/stabilised.

You would expect to end up on about 1 & 1/2 or 1 & 3/4 grains of Armour, or might find like myself that the ratio is too T3 strong so need to retain a little Levo anyway.

Being over T3 medicated is really horrible but it has a short half life so will leave your body quickly. If this were me I would resume a week of Levo full dose to allow better hormonal adjustment and then start the whole new protocol.

NDT is more demanding of adequate iron levels than Levothyroxine so I am assuming you have optimised iron and nutrients before med change considerations. You might also benefit from adrenals supplements (Vit C, adaptogens and/or glandulars) as adrenals will have taken a battering after thyroid cancer, thyroid removal, thyroid meds that didn't bring well-being and now T3 over medication, as thyroid meds also need good levels of cortisol to work effectively.

Blanche1960 profile image
Blanche1960 in reply to radd

Hi Radd I’m so sorry just come to do another post and noticed my reply to your last message is not there…. Spent a while typing replies to all three messages but only one showing up… so sorry if you thought I was being rude… not sure where they went must be somewhere in the cloud 🤷🏼‍♀️Sorry really struggling with Armour NDT …so unwell so starting a new post about symptom advice hopefully you and all great helpful people on here can help! Ps re your reply from before yes I’ve had T3 before for 3 months with Levo took 100 T4 10 T3 and was so ill… Realise now this is not long enough but Endo said to come off and go on just liquid t4 15mls equivalent to 150mcg which took for a year but still symptomatic do requested NDT last resort!

Sorry if don’t explain very well and moaning at my wits end n brain fog horrendous!

Thanks radd

I have never been able to do a straight switch from levo to an ndt. I either need to add a tiny amount ndt to my levo and reduce the levo or come off it altogether for a while - a few weeks - before starting the ndt (I don't recommend this if you have a job, children and responsibilities).

Either way, it should be noted that you can initially feel worse (or uncomfortable) on ndt before getting better.

Some people don't experience that, but some are surprised when they do. Working Armour is very potent, I had to cut a half grain in quarters in order to tolerate it, and I was already used to taking ndt beforehand so I would suggest a quarter twice a day max at first.

Hi Alanna012 Thanks for your helpful info will take it on board... it’s a minefield but slowly learning from you very kind people in here!

Thanks again

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