Hi All, thanks so much to everyone on this forum who helps provide so much information and support to others.. Being able to read through such informative threads has really helped me since being diagnosed as hypothyroid (not Hashimotos) about 2 years ago.
I was taking Levothroxine until mid March but was still feeling so fatigued, had cold peripheries, hair loss etc so after my T3 showed up as low in range (3.8 on range of 3-7/8 I think..) a new Doctor I began seeing started me on NP Thyroid 60mg x 2 tablets daily. I think it's helping somewhat but I'm still feeling fatigued. I'm due to get bloods rechecked soon. My Doctor also recommended I try switching to night time dosing or splitting the dose.
I'm wondering should I wait until after I get my bloods checked to try experimenting with changing timings in case it interferes with the results?
I've tried 2 days of taking the NP Thyroid at nighttime but I've been waking very early mornings then. It might settle down after a while-hard to know until I try it for a while I suppose. But maybe I should stick to very early morning for now until after I get my bloods tested before I change timings for any substantial period of time?
I think NP Thyroid is a mix of T4 and T3. When should my last dose (120mg total) be if I get blood tests done around 8.30am please?
I think my ferritin levels are quite low also so I'm trying to take an iron supplement the last month or so. I'll try to ask for an Iron Panel at my next blood test also as well as TSH, T4, T3, and Folate. I tested Vit D and B12 in Feb and they were good. I take them daily as supplements. Are their any other blood tests you recommend testing please?
Many thanks for any advice.
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CMDK2020
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Yes, NP Thyroid is a T4/T3 combo and dose timing is very individual but if you are new to taking T3 containing meds split-dosing can be helpful to avoid the 'bumps’. Sometimes our adrenals have become compromised through years of inadequate thyroid hormone levels and super-sensitive to changes so stabilising thyroid hormone levels is better tolerated as avoids jittery feelings or palps.
I personally take my meds upon waking, and around 3pm to avoid that mid-afternoon slump but some find taking the second dose at bedtime enables better sleep. Others need further splits and some take their dose all in one go.
However you take it, the final result (eg, the best it can work) can take many months so its best not to keep changing protocols quickly. Also all thyroid meds require good levels of iron and nutrients to ensure good workings. Testing timings again are individual but if it is the average levels wanted then testing 8-12 hours after last NDT dose will accomplish that best.
An iron panel would be useful if ferritin is low as will show truer levels of iron and indicate how well it can work.
radd thanks very much for your reply and advice. That sounds logical. A GP I've been consulting since February (and who prescribed the NP Thyroid) is knowledgeable on Thyroid conditions and he told me to try varying when I take the doses. He recommended I wait 2 to 3 months before testing and I'm now at about 10 weeks and keen to know if the dose I take (2x 60mg daily) is sufficient according to the blood tests. I feel it has helped me somewhat but I still feel my energy levels are not what they used to be prior to becoming hypothyroid 2 years ago.
In my eagerness to make progress since I wrote my post last week I actually continued trialling taking the 2 tablets at nighttime around 10.30/11.30 pm approx before going to sleep. I know it's early days but I think I find it gives me more energy in the morning which used to be the time I felt lowest in energy yet needing it most to get up and go for work etc. However, sometimes I think it makes me wake a bit too early around 5/6am...before I need to get up. Although I think I usually fall back to sleep but perhaps not that deep a sleep..
So I'm now wondering if I should continue to take the 2 tablets at nighttime or perhaps try to split the dose 1 before sleeping and 1 first thing in the morning.
Bearing in mind your and Slow Dragon's advice which I have just read today I'm guessing you may say don't change again before I get my bloods tested?
I'm hoping to get it done in about 2 weeks. I'm in the West of Ireland. The Galway Clinic hospital will do T3 etc if I get a referral and pay for it. It can be expensive to get several different things tested though.. 100€ + euro.. My other choice is to travel to Dublin & get them done early morning in a public hospital there on referral from my GP as my GP. The tests would be free via the public health system on a referral but I'd need to stay overnight & that accommodation costs about 200€ for accommodation nearby for 1 night at the moment.
Would you suggest waiting until after my blood tests to try splitting my dose? Or trying to split it now for the next 2 weeks or so and then testing? Many thanks
You can change the frequency of your med doses before testing but not the actual dose amount, ie when we raise/lower dose we wait six weeks before testing.
Whether you take whole or split dose becomes irrelevant when we leave the 8-12 hour wait before blood draw to find average levels.
Ah right I think I understand now thanks radd. In that case I might try split doses (not changing the quantity though) over the next 2 weeks as I'm feeling very tired now already today after waking too early. Think the 2 at night could be throwing off my energy balance more so the split might work out in better balanced energy levels I would imagine. Thanks again
If I was going out or planning on having a drink of alcohol do I need to leave a certain amount of hours gap before and after taking a drink before taking any Np Thyroid?
It's impaired med absorption that we need to be mindful of so if it were a beer or something carby, probably so but when on holiday & med timings change I haven’t always left much gap between meds and say a Gin & Soda.
Thanks radd.. If I was to have a drink it would probably be a glass or two of wine or gin and soda/tonic so I'm guessing that leaving as much time as possible between med and alcohol would be best to minimise the risk of the alcohol/carbs interfering with absorption.
Sometimes in the past I tried setting an alarm to wake up during night to take the med so that it would have enough time to take affect before I was due to get up in the morning. I could try that as an option too after having a drink maybe.
I'm wondering should I wait until after I get my bloods checked to try experimenting with changing timings in case it interferes with the results?
Yes
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine or changing to NDT or T3 or changing how you take your dose
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Recommended on here that all thyroid blood tests early morning, ideally before 9am last dose levothyroxine 24 hours before test
On T3 or NDT - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last 1/3rd of daily dose 8-12 hours before test
U.K. testing info
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options and money off codes
SlowDragon thanks so much for your reply. I'm not in the UK, I'm in Ireland so I doubt I can do those tests kits you mentioned above unfortunately unless you know different on this?
As outlined above in eagerness to make progress before I got your reply and after my GPs advice I changed to nighttime dosing just a week ago. You'll see from my message above to Radd how things are going.. What are your thoughts on staying at nighttime or returning to morning or even trying trying split dosing please?
Day before test…regardless of how you normally take your NDT you must split it into 2 or 3 (ideally 3) smaller doses and last dose approx 8-12 hours before test
Important to test vitamin D twice year when supplementing
Test folate, ferritin and B12 at least once a year
Great thanks for that information SlowDragon. I'll check outhealthunlocked.com
Do you think those postal tests are as accurate as getting them done in a hospital/Doctors setting yes?
I take 2 small 60 mg tablets NO Thyroid daily and I don't have a pill cutter so I'll probably have to just do 2 doses the day before getting the blood tests. Will make sure to take the last dose about 8-12 hours before the blood test. Thanks again for all your help.
Hello All,Many thanks again for your help a few weeks ago. I got the postal kit from Lets Get Checked and got the results on Friday. Prior to doing the blood tests I had tried splitting my 2x 60mg NP Thyroid dose into 2 doses - 1 tablet early morning a couple of hours before I am due to get up and the other at night before bed. On the night before the test I took 1/2 my dose (1 tablet) around 9-10pm and did the blood test around 7.30am the following morning before taking my second dose.
I switched to 120mg NP Thryoid from 50mcg of Levothyroxine mid March under prescription from a new GP. While I feel the NP Thryoid has helped me somewhat giving me a bit more energy and I think it has improved hair loss and speeded up metabolism, unfortunately I have been feeling a bit more fatigued again in the last month or so which is debilitating. To be honest I am very surprised at the results.
In tests on 25th February 2022 in a hospital outpatients dept. at circa 8.30am when on 50mcg Levothyroxine my results were:
Free T3 3.8 (range 3-7)
TSH 3.4 1 (range 0.27-4.20)
Free T4 16 .8 (range 12-22)
Thyroglobulin 10.3 ng/ml (range 3.5- 77)
Anti-thyroglobulin < 20 IU/ml (range 0-115)
Anti-Thyroid Peroxidase < 11 kIU/L (range 0-34)
Vit 12 1530 mg/L (range 197-771) ** I take high strength Methy B12 - 5000 IU daily on prescription and find it beneficial for energy)
Folate 19.4 ug/L (no range) * started taking iron and folate supplement approx 2 months ago to see if it would help boost energy levels
Ferritin 75 ug/L (range 13-150)
Haemoglobin 12.9 g/dl (range 11.5-15)
Cortisol 543 nmol/L (no range)
Vit D 119 nmol/L ( range 30-125) * I take Vit D daily approx 3000 IU on advice from my GP
My results from Lets Get Checked postal blood tests taken circa 7.30am June 14th 2022 tests:
ENDOCRINOLOGY
TOTAL THYROXINE(T4) 105 nmol/range L 59 - 154
THYROID STIMULATING HORMONE * <0.01 mIU/ range L 0.27 - 4.2
FREE THYROXINE 18.8 pmol/ range 12.0 - 22.0
FREE T3 * 7.6 pmol/ range 3.1 - 6.8
Thyroid peroxidase ab's <9.0 IU/m range l 0 - 34
Method used for Anti-TPO: Roche Modular
Thyroglobulin Antibody 16.1 IU/mL range 0 - 115
Method used for Anti-Tg: Roche Modular
Basically my main concern right now is trying to improve low energy levels and minimise other Hypothyroid symptoms such as hair loss, constipation, cold peripheries etc. I am strongly considering getting my main Thyroid bloods rechecked at a hospital next week- Free T3, Total T4, Free T4 and TSH in the event that there could be any discrepancy with the postal kit testing I did last week. I had been taking a Biotin supplement but stopped it around 6 days prior to the test. How long prior to blood testing is it recommended to stop Biotin please?
I would rather be very sure that my results are accurate and therefore am more likely to be able to find the right balance of Thyroid hormone replacement. I have returned to single dosing early morning about 2-3 hours before I am due to to get up (I set an extra alarm) as I didn't find the nighttime suited me and didn't think the split dosing was doing anything for me either but is I find it trickier to manage lifestyle wise.
Based on the previous advice I was given here, I presume I should to split dosing prior to doing an early morning blood test again taking my last 1/2 dose of NP Thryoid 8-12 hours prior to testing- or am I mis-interpreting anything ?
I eat healthily lots of fresh vegetables, fruit, protein etc. generally, avoiding gluten and dairy. I take Omega 3, Vit D, B12, Co-Q10 200 mg daily, taking iron and folate combined for the past 2 months . I have recently started a Magnesium B Vitamin complex with NAC and Ashwaganda called Mega Mag Energen Plus from Nutri Advanced which I find helps a bit with energy although it has small amount of iodine -75 ug but my GP said that should be okay.
Sincere thanks for any and all advice on how to improve my energy levels- it is deeply appreciated!!!
Yes as far as I can recall I've had both antibodies tested a number of times snf they've always been very low and not indicative of autoimmune thyroid conditions.
I do however have an autoimmune profile for Sjogrens Syndrome and have been to Rheumatologists for this. My current Rheumatologist did an ultrasound of my salivary glands and also checked my thyroid at that time last November and he said it looked normal whereas my salivary glands did not.
I'm guessing my underactive thyroid /Hypothyroidism is probably hereditary as quite a number of the females on my mothers side of the family developed at some stage in life.
I generally try to live and eat healthily and up to 2020 when I got what seemed to be Covid in January I was managing without any meds although my GP at the time suspected sub clinical hypothyroidism.
I became very unwell with hypothyroid symptoms about 3 months after getting Covid and being very unwell from it. I managed to recover about 2 months later and then made the mistake of returning to a very stressful job. After about 2-3 weeks at work I started to feel a decline but I thought I would be okay to finish the 3 other weeks left on my contract.. In hindsight I deeply regret this now as it seemed the trigger being unwell since and it has taken so long to try to get back on track with life.
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