Switching back to Levothyroxine/Liothyronine from NP Thyroid - is it okay? (I miss my old self)

[Hunny_BEE]

Apologies for the long post. I tried to put together all the info that I have so it might help shed some light on what I should do next - but I lack the confidence to jump into the change without some input. I have put the date along with the dosages and the blood work results below. (The reason some of the labs have only THS or only T3/T4 is that the Doctor did not order them.)

I am thinking that I might go back to 125 mcg Levothyroxine/5 mcg Liothyronine because my T3 & T4 numbers were good but I had a low TSH - which is why my doctor talked me into lowering my dosages and switching to NP Thyroid. It's been a terrible choice. (I felt much better, slept better and weighed about 15-20 lbs less on the 125/5 regime.)

I have been on 90 mg of NP Thyroid for 4 weeks and I am still feeling very little (if any) improvement. Can I simply switch back to my old regime? Or should I try to ease into it in some way? I have about 2 months worth of the 125 / 5 prescriptions remaining. I was thinking that I could just switch back but started to get "cold feet" until I posed the question here. I do not trust my Endo or my GP because they only focus on the THS value.

I hope this all makes sense. And many thanks for any advice or input you care to share.

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RANGES: T4: 0.82-1.77 ng/dL | T3: 2-4.4 pg/mL | TSH: 0.45-4.5 ulU/ml

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January 21, 2021 (125 mcg Levothyroxine/5 mcg Liothyronine)

T4: 1.65 | T3: 3.0

March 04,2022 (125 mcg Levothyroxine/5mcg Liothyronine)

T4: 1.43 | T3: 2.3 | TSH: 0.035

May 06, 2022 (100 mcg Levothyroxine)

TSH: 0.064

June 06, 2022 (75 mcg Levothyroxine)

T4: 0.98 | T3: 1.7 | TSH: 0.321

July 08, 2022 (60 mg NP Thyroid)

T4: 0.63 | T3: 1.9 | TSH: 2.610

September 20, 2022 (60 mg NP Thyroid)

T4: 0.84 | T3: 2.8 | TSH: 8.610

[radd]

Hunny_BEE

Yes, you can do a straight switch back. We are only really cautious when introducing thyroid meds we haven’t taken before or for some time. 

You look very under medicated on NDT and  stipulate only 1 grain (60mg), where as you said numbers felt best when you were medicating 125mcg Levo + 5mcg T3, so this would be more likely equivalent to 1.5 grains NDT.

You could try increasing your NDT dose (in quarters every two weeks) and see how you feel. However, NDT doesn’t suit everyone and always appears less tolerant of under-medication/iron nutrient deficiencies/elevated thyroid antibodies. And you appear to have lost confidence in it so switch back to something you felt better on but ensure cofactors are optimal or any thyroid meds might not work for you.

[Hunny_BEE in reply to radd]

Thank you for your reply! I am so torn between "gutting it out" for 4 more weeks on the 90 NP Thyroid. It just doesn't feel like I have enough improvement after 4 weeks.

Thyroid issues are bad enough - and then the waiting soooo long to feel improvement is just terrible.

[jamesal0 in reply to Hunny_BEE]

You were under-medicated Optimise your NDT and you will feel a whole lot better . On NDT you use how you feel to guide dosage and not blood tests - well at least not as your primary guild. GP's have no idea. and do a great disservice when they start people on a low NDT dosage and then don't provide a racheme to optimise dosage in the first 2 weeks

[Hunny_BEE in reply to jamesal0]

Thanks for your reply. Finding a doctor that will agree with your method of how to determine what dosage I should be on is the most difficult part.

The endocrinologist clearly has no idea how terrible a person feels when not dosed properly. I am currently doctor shopping yet again.

I switched back to my old regime (125/5) in the meantime.

[jamesal0 in reply to Hunny_BEE]

It's not my method - it's the age old method that was used long before Levo was invented - maybe read some of Janies stuff from Stop Thyroid Madness site and FB page

[pennyannie]

Hello Hunny_BEE :

When optimally medicated your TSH will likely be low suppressed, irrespective of which ever thyroid hormone replacement you choose to take.

The TSH was introduced as a diagnostic tool to help identify a patient suffering with hypothyroidism and was never intended to be used once the patient was taking any form of thyroid hormone replacement as then you should dose and monitor on Free T3 and Free T4 blood test results.

Your TSH is currently showing you very undermedicated - is that a typo ? - and does ' run ' behind symptoms.

Your T3 has slowly risen back up again and just think you need to have to kept building up from 1 grain throughout July/ August until, if, you reached 2 grains and then stay on that dose for 6-8 weeks letting it bed in and then run a blood test to track that your T3 had moved and hopefully symptoms alleviated.

It is said that 1 grain NDT equates to around 100 mcg T4 :

This experiment hasn't worked and understand you just want the life back you knew you had when on the T3/T4 combo and it's just a shame that you have been ill advised.

[Hunny_BEE in reply to pennyannie]

Thank you for your reply!

The last TSH: 8.610 taken on September 20 is correct. I had followed the advice on here and broke my last dose before the test into thirds and took the last third 8 hours before my early AM blood draw.

I was taking the 60 NP Thyroid (1 grain). I was horrified when I saw my numbers and my doctor said, "Well your TSH is slightly over, so you have a little room to increase your dosage." So she increased the NP to 90 (1-1/2 grains?) I thought I would stick with that but i feel no better at all after 4 weeks.

I am currently looking for a new doctor and as someone suggested in a previous exchange with me - a functional medicine doctor that will look beyond the single TSH number.

[waveylines in reply to pennyannie]

Hello

Pennyannie - the equivalent of a ndt to levothyroxine is a bit debatable, not exact....and may vary

One grain of NP Thyroid contains 38mcg of T4 and 8mcg of T3 or is it 9mcg?. T3 is roughly 4xs the strength of T4. 4x8 (9)=32mcg (36) plus 38mcg = 70mcg. (74mcg) This can only be used as guidance.

Also people respond very differently to different NDTs. Some people prefer Armour. NP Thyroid was removed from the NHS pharmaceutical lists allowed due to its variability of levels of active ingredients. NHS Pharmacist told me this well over a year ago when I had to switch to Armour. I think he was right as I felt far more even, balance on Armour than I did on the NP. My blood levels stopped being erractic too. My blood levels are usually very stable. Unless this has changed now and NP have sorted themselves out!.

[pennyannie in reply to waveylines]

I think you meant this for the o/poster didn't you ?

[Hunny_BEE in reply to waveylines]

So when first switched because of my low TSH at my doctor's recommendation, I went from 125 T4/5 T3. to approximately 38 T4/ 8 T3!! That's a huge change!! No wonder I am miserable!!

Plus, it is not Armour brand but a generic NP Thyroid manufacturer is Acella.

Thank you for your reply. Any info is helpful.

[jade_s]

Obviously everyone is different, so this is just my experience. I tried to make NDT work for several years, and finally gave up. I did much better on even similar amounts of T4/T3 as in the NDT but taken as levo & T3. It's also been much easier to adjust each independently while working on improving iron, b12, folate, etc. I can't remember exactly what i did when I switched back.

Looking at your labs, your January 21, 2021 results look like they're on the right track. If it was me and I still had lingering symptoms, I would've just added another 5 mcg T3.

Hope you feel better soon. It makes me angry that we're at the mercy of these docs. Well, it took me many years, but I finally trained my GP to let me be. She prescribes levo & I self source T3, and we don't really discuss it much anymore. I think she's just happy i'm no longer showing up every other week complaining of lingering issues.

[Hunny_BEE in reply to jade_s]

Thank you for your reply.

I have switched back to that same dosage that I was taking back in January 2021. (125/5) I am also on the hunt for a new doctor. I guess I can talk to my regular GP about “leaving me alone”, as you have done.

Do you live in the UK or the US? I would like to have that option to self source T3 if needed.

Thanks again.

[jade_s in reply to Hunny_BEE]

You're welcome You might start 2 new threads so people will be more likely to respond.

One to ask for T3 sources. Mention you are in the US (i missed it until you mentioned it). Sources can only be sent by PMs so the admin will lock your post, to avoid people accidentally posting them publicly.

Another to ask about how people convinced their GPs to 'leave them alone' but continue prescribing levo. It's a balancing act. Quite a few have, and there are various approaches. My case probably won't apply to others. I had so many other health issues. But after I started improving, while TSH continued to be suppressed, I guess she kind of just left it it at that. Actually I was open & honest from the start that I was sourcing T3 overseas. She eventually stopped nagging about the low TSH after I started doing better. All those other issues were all due to B12 deficiency by the way.

I'm in Belgium now but from the US. I will PM you my current source but they were out of stock for a while, not sure if it's available again. Prices have gone up too, unfortunately. I know there are a few other sources so hopefully people will reply. It's good to have options.

Hope this helps

[Hunny_BEE in reply to jade_s]

It helps a great deal! Thanks so much for all the tips and info … I was totally unsure about starting new threads but it makes sense.

Perhaps if I provide my GP with research info, I think she may be open to helping. It’s certainly worth a try anyway. She is very conveniently located for me and has been helpful with other issues that I have had in the past.

All the best 🌸

[jade_s in reply to Hunny_BEE]

That's a great idea! Some doctors are open! There are quite a few good papers. Look through Diogenes's posts, he posts good papers on research showing why some people benefit from T3. Or.. start a new post Admins don't mind & it can make it easier to keep track of separate topics.