How to swap on ndt

[hipolion]

I received the package with thyroid-s and I would like to start it. I'm on 125 mcg levothyroxin+15t3. I thought I'd start with 2 grains in the morning and 1 grain in the afternoon. I wouldn't want to feel bad, that's why I would start directly on a consistent dose. Last time I was on ndt I took 3.5 gr.

[radd]

hipolion,

I note you have medicated NDT perviously so could do a direct switch, but 3 grains is quite a large final dose and more than what you are presently medicating.

Your previous post relates to difficulties in raising both labs and meds. This may indicate too many thyroid hormone transporters/elevated SHBG leaving not enough 'free', hormone for use, and/or deficiencies in essential cofactors such as iron, etc.

Your present meds are roughly equivalent to 170mcg T4. 2 grains contains roughly 120mcg T4 but manufacturers claim it is biologically equivalent to 200mcg T4. Most including myself feel it is actually somewhere in the middle, so about 160mcg T4.

Therefore, if this were me I would be cautious and initially aim for a final dose of 2 grains (you can always tweak later). I would only swop half at a time so half present meds and introduce one grain. Leave for a week or two to ensure all is good and then make final switch to 2 grains. Wait six weeks and test for final tweaking, as hormone amounts vary per brand.

Meanwhile look into why previous meds aren't working as those reasons may be prohibitive in allowing new meds to work as well.

[hipolion in reply to radd]

Thanks for the reply, I calculated by summing t4 from ndt not their potency. So in 3 grains it would be about 105 t4 and 26T3. I need a dose of 125 T4 regardless of whether I get them either synthetic or natural. So I calculated that my final dose would be 3.5 gr. I agree that I could start with 2 grains, 1 in the morning and one at noon. The last time I started with a 1 grain(1/2-1/2) I didn't last more than 3 days I had to raise the dose urgently. On the other hand, if I take a high dose in the morning I noticed that it is not good because my blood pressure rises. It's very interesting what you say about SHBG I should do the test ???

Meanwhile look into why previous meds aren't working as those reasons may be prohibitive in allowing new meds to work as well

.-and what could be the causes?

[radd in reply to hipolion]

hipolion,

You can’t work out your NDT T4 dose without considering the amount of T3 NDT contains, or you will end up overdosed.

Many peoples priority would be in determining the T3 content but if you are putting 125mcg T4 at a higher priority, then you might find reducing NDT dose and adding a bit of Levo will allow 125mcg T4 without T3 going too high.

Starting with 1 grain would be about half of your present dose and likely to induce some symptoms, so starting with 1 grain + half of your present meds will retain present levels.

Many prefer a higher med dose in the mornings as this better follows the natural circadian pattern & plays in tune with cortisol, and but if it’s raising BP you can easily adjust doses in amount and/or frequency as long as the daily total remains the same when taking meds containing T3.

You could look at cortisol levels regarding high BP, as this could also be an inhibitory factor in preventing you from raising thyroid meds comfortably to levels for well being.

Or it may be you have raised enough, ie found your sweet spot but poor thyroid hormone usage is preventing you from feeling this. Poor usage can be due to any number of reasons but common on this forum are iron/nutrient deficiencies, elevated oestrogen, or previous excess amounts of thyroid hormone.

[hipolion in reply to radd]

You're probably right, I'm a man and I weigh 115kg, and I thought my needs and weight required a higher dose of hormones. I've gained a lot of weight since I got in thyroid-trouble(about 25 kg) in 10 years.

I kept trying to find out the optimal level of hormones that I shouldn't get gained to, but for me, it remains a mystery. I eat balanced and take nutrients that are needed including iron and D3 but in vain, my puffy face and belly are still there. I recently had cortisol in the morning and it's a little low 300 (138-690)nmol/L

[Pepekins in reply to radd]

I would dearly love to try NDT however I cannot afford to rely entirely on natural alternative from both financial and endo situation. I have had no thyroid gland for 21 years (papilliary cancer)and have had many ups and down with Levo. Recently had to switch from M.Pharma to Accord because of muscle pain however I may be able to try liquid Levo after speaking to my endo's secretary (I see her in August) she is not particularly helpful so we will see. She probably would 'strike me off' if she knew I was considering an alternative treatment. So, would I be able to try NDT along with my Levo meds. I currently take 100mc daily for 5 days and 75 mic 2 days. Also, how reliabe would it be to get hold of regularly? I posted some blood results but in the Thyca section, but had no replies. Many thanks for the wonderful information available on this site.

[SeasideSusie Remembering in reply to Pepekins]

Pepekins

Please start your own thread with your question. Piggybacking on someone else's thread takes it off topic and not fair to the original poster.

I posted some blood results but in the Thyca section, but had no replies

That is a different forum altogether "Thyroid Cancer Support", nothing to do with this forum which is "ThyroidUK".

[Pepekins in reply to SeasideSusie]

Sorry not so au fait with the protocol.

[pennyannie]

Hey there :

Just remember that the T4 - 125 mcg Levothyroxine will take around 6-8 weeks to fully leave your body and a reason why NDT is slowly built up in the body so that as one form of thyroid hormone replacement declines in it's power the chosen next option is built up.

The T3 you are currently taking will be out of your system within a day or two and hope switching back to NDT sees you more improved.

[hipolion in reply to pennyannie]

I wonder if it is built equally with what is lost (T4) or built slower. From what I read in the synthetic tablet there is only the free form of T4 while in the natural one it is related to a protein.

I hope I'm tired of synthetics too.

[pennyannie in reply to hipolion]

Personally I don't think there is any point overthinking this as you can't compare these two - they work in totally different ways within the body.

[hipolion in reply to pennyannie]

You're right. It terrifies me that the build process is slow and I will feel bad for a while.