hi I have hashimotos and had a partial thyroidectomy 6 years ago. I have had my recent blood test results back I have been on 50mg of levothyroxine and 10mg t3 (5mg in the morning and 5mg at midday) I posted earlier this week but did not have ranges so this is a new post.
Any advice on switching to NDT would be appreciated as the levothyroxine and t3 doesn’t seem to have done much in fact my fatigue is off the scale!
TSH 1.10 0.270 - 4.2 mIU/L
Free T3 4.4. 3.1-6.8 pmol/L
FT4. 14.0. 12-22 pmol/L
Previous results: TSH 0.37 /free t3 4.1 /ft4 18.8 same ranges as above.
hope this makes sense to someone!
Thanks in advance
Written by
HHaz
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NDT may not be the answer. It has a fixed ratio of T4:T3 and with Levo plus T3 you have the flexibility of tailoring the dose of each to suit your needs.
Your current results show undermedication, pure and simple, that is why you feel as you do.
When on T3 then TSH becomes low, usually suppressed, so for a start your TSH is far too high.
When on T3 it can lower the level of FT4. Those of us on combination thyroid hormone replacement have individual needs as to where our FT4 and FT3 levels need to be for us to feel well. Some of us are fine with a low FT4 as long as FT3 is in the upper part of it's range, some of us need both FT4 and FT3 over half way through range.
At the moment your FT3 is only 35.14% through range which is far too low for someone who is taking T3. Your FT4 is 20% through range which might be OK when your FT3 is higher but it might not be.
I think what you need to do at this stage is persevere with the Levo and T3 and get the dose of each at the right level to give you the FT4 and FT3 levels that you need. It might be difficult to get your doctor to adjust your doses as you will possibly be told they are fine because they are within range, but you will need to emphasise that they are very low in range, that you are symptomatic, that you have spoken to Thyroid UK which is the charity recommended by the NHS for information about thyroid disease and that they suggest you increase your doses (don't mention internet or forum, just say you've spoken to them).
NDT isn't easy to get hold of, it's expensive and some people seem to be having trouble finding a supplier of the genuine article. Sourcing Levo and T3 (if you need to do this yourself) is likely to be cheaper and easier, but try for increases with your doctor first.
Also, what are your key nutrients like, these all need to be at optimal levels for any thyroid hormone to work. You need to test
Vit D
B12
Folate
Ferritin
If you have these results please post them, along with their ranges plus units of measuremet for Vit D and B12, and we can comment further. If you don't have them then you might be able to get them done with your GP or endo, or you can do them yourself with one of our recommended labs.
thank you that’s helpful. I am seeing a private thyroid specialist who is great and has been the only person who has taken my long list of symptoms seriously. My GP refuses to medicate me and on insisting I be referred the endocrinologist basically told me I was a time waster. I find it interesting that I might be under-medicated…I was originally on 15mg of t3 but my sweating and body heat/palpitations and shakiness was unbearable. Perhaps I should have persisted with it? I should add that I have been prescribed 2 grains of NDT per day starting asap.
I was originally on 15mg of t3 but my sweating and body heat/palpitations and shakiness was unbearable.
If that was the dose you started on then that is completely wrong. You start on 5mcg (or 1/4 of a 20mcg or 25mcg tablet). T3 is a powerful hormone so you start low and build up gradually by 5mcg at a time, and if you can split the tablet down to 2.5mcg then that might be the increments that some people need if they can only tolerate small increases.
Perhaps I should have persisted with it?
That would be my first suggestion before considering NDT. You might be fine with NDT but I would have pursued the other avenue first and got those levels up higher. There's no suggestion of you might be undermedicated, you are undermedicated and I don't understand why your private thyroid specialist can't see that with your FT3 result.
I should add that I have been prescribed 2 grains of NDT per day starting asap.
Even that is a high starting dose. There is a protocol with NDT, as with all thyroid meds, to start low and build up gradually.
thank you again for your reply, sorry I should clarify that I started on 2.5mg x3 a day and worked up to 15mg over a few weeks but only lasted about a week at 15 mg due to the reaction and symptoms of heat/profuse sweating/anxiousness and palpitations Are you able to suggest what sort of levothyroxine and t3 dose I should try? I have received my NDT today which is very expensive and as I have bought all of my medication privately the cost is mounting up! I have plenty of t3 and levothyroxine left so thought I could try a higher dose and see if this helps improve things before switching to NDT (if need be)
Are you able to suggest what sort of levothyroxine and t3 dose I should try?
You just have to gradually tweak doses, one hormone at a time, and try to find what combination is right for you.
With your results, if it was me, I'd start with adding 25mcg Levo to raise my FT4 level, wait 8 weeks and retest to see what difference it makes. Then I would make the decision as to what to do next.
What are your nutrient levels like? If you haven't tested recently then it's important to do so now.
You probably have low vitamin levels which is why you can't tolerate the higher dose. Best get vit levels checked and get them up higher in their ranges, then add more T3.
You look under medicated. NDT takes a long time to adjust to the ratios are different in humans than pigs. I take NDT but you may look to increase your medication first.
Yes it's difficult. After my thyroid was removed in 2015 the only way I have become well
again was joining this site, asking questions and then working out the answers. Try and listen to the administrators they always seem to know best.
By the way each tablet or grain of NDT is 60mcg. that is 39mcg of T4, 9mcg of T3 and the rest other small amount that a natural thyroid has. But you I think are just under medicated. if I were you I would try to slowly increase what you are taking.
Two grains of NDT is said to be, in effect, around 200 mcg T4 - it's a silly observation really, as if your body utilise the T4 well and convert it to T3 - no amount of T4 is going to work well.
I'm talking NDT and it's a slow build and as you stop T3/T4 one day you start on a 1/4 grain NDT the following day and slowly, build up your dose in 1/4 grain increments -I went weekly, but read some people increase fortnightly.
I think at this point in time I'd try and increase your T4.
Do you have any results there for antibodies, inflammation and / or ferritin, folate, B12 and vitamin D as these vitamins and minerals need to be optimal whatever thyroid hormone replacement option you trial ?
you’re clearly under medicated. If I were you I’d go for a good increase in Levo and consider not even bothering with the t3 or ndt route until you’ve exhausted whether you can get well on Levo (most can).
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