Endocrinologist changed my NDT Brand -Help !

[Avidreader]

After 5 years paying for NDT ( Nature Throid 4 grains - then when that changed - moved to Armour only needed 3 & 1/2 grains) became prohibitively expensive- Crazy prices via private Endo & pharmacy - Now been prescribed ERFA NHS. - 7 x 30 mg

felt awful after a few weeks shaking legs - falling asleep driving - back to how I was on Levothyroxine for 25 years !

Not seeing Endo til February- He doesn’t return my call to his P.a despite me saying how very ill it’s made me ?

called pharmacy who dispensed my private Armour - He said “ You’re under medicated “ But wouldn’t help me with dose - says I must speak to Endo ! I’ve left 4 messages !

I’ve had to buy more Armour incase it gets too bad - over £400 !

atm just surviving by having the odd 1/2 grain - as I want to try Erfa for reasons of cost !

pharmacist have me figures which mean nothing to me ? I ve started taking an extra 30 mg - not much difference so far -

The figures Pharmacy said over phone

Erfa 7 = 122

T428 of T3

Armour - 172 T4

32 T3

He said : eg 8 pills ERFA 8x 17 & 1/2

8 x 4

I’ll add a photo of my fast writing as he was speaking ! He wouldn’t help me further - Said hang on in there with the ERFA if you can - & left me to work out the maths ! I can’t do maths ! Hopeless !

anyone help please ? Endo not until February 11th -

2 photos

Oh I think only lets me add 1 photo ?

“

[RedApple Administrator]

Avidreader You can add the other photo as a reply to your post.

[RedApple Administrator]

I think the pharmacist was trying to explain that Erfa and Armour have different amounts of T4 and T3 in them.

Erfa = 35 mcg levothyroxine (T4) and 8 mcg liothyronine (T3) per 1grain tablet

Armour = 38 mcg levothyroxine (T4) and 9 mcg liothyronine (T3) per 1grain tablet

Your endo has simply prescribed the equivalent in grains (3.5grains) which is not equivalent in active hormone content.

Erfa x 3.5 grains = 122.5mcg T4 and 28mcg T3

Armour x 3.5 grains = 133mcg T4 and 31.5mcg T3

So yes, you are under medicated on the Erfa dose.

[Avidreader in reply to RedApple]

isn’t it sooo frustrating: Why would he under medicate me ? Then Not bother to return my calls - NHS are supposed to care for us ?

Can you suggest please how many ERFa I should be on ?

30mg pills V Armour 3 & 1/2 grains ?

I’ve gone up to 8 but still wobbly legs & tired etc

(5 in morning- 3 in evening ) ERFa is much more sugary too ! But free ! I can’t keep paying £500 plus every 3 months - it’s bankrupted me

[Hidden in reply to Avidreader]

TBH I’m utterly in awe that you managed to get NDT on the NHS in the first place, let alone get them to reply to your calls that you’re so unwell (it’s appalling I know and you deserve better!) But it’s what I have completely come to expect of the NHS and have zero surprise that they’re treating you this way… hopefully you can up your dose soon x

[RedApple Administrator in reply to Avidreader]

As suggested below by tattybogle 8 tablets Erfa 30mcg is a closer match in hormone content to your previous dose. In your situation, this is what I would be trialling. Of course, this might mean you run out of pills quicker though.

[pennyannie]

Hello Avidreader :

1 grain Canadian Efra would be 60 mg - and contains 8 mcg T3 + 35 mcg T4 :

So I guess the 7 tablets are 30mg - so 1/2 grains containing 4mcg T3 + 17.50 mcg T4 :

So then 3 + 1/2 grains would be a total of 28 mcg T3 + 122.50 mcg T4 :

with 8 tablets being 4 grains and having 32 mcg T3 + 140 mcg T4 :

1 grain Armour is 60 mg and contains 9mcg T3 + 38mcg T4 -

so 3 + 1/2 grains Armour would be 31.50 mcg T3 + 133 mcg T4 ;

I don't know the breakdown of T3 /T4 in Nature Thyroid and it is currently unavailable and believe there were said to be issues with consistency of content and why it was withdrawn but would imagine 4 grains would have been more powerful than 3 + 1/2 grains of any other NDT.

Guessing your vitamins and minerals are up and maintained at optimal levels ?

Hope that helps you see where you are with this brand change :

[tattybogle]

(Assuming he is correct in saying I grain ERFA (60mcg) contains 35mcg T4 and 8mcg T3 .

i'm not sure if it does though .. as i thought ALL NDT's contained 38mcg T4 and 9mcg T3, but i could be wrong )

anyway if he's right about that bit then :

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

each Erfa 30mcg (half a grain) contains :

17.5mcg T4 ................................................and ................. 4mcg T3

7 tablets of 30mcg Erfa contains :

7 x 17.5mcg T4 =122.5mcg T4 ...............................7 x 4mcg T3 =28mcg T3

8 tablets of 30mcg Erfa contains;

8 x 17.5mcg T4 = 140mcg T4 ...............and .....................8 x 4mcg T3 = 32mcg T3

each Armour 60mcg (one grain) contains :

38mcg T4......................................................and ....................9mcg T3

3 and a half grains Armour contains :

3 x 38mcg + (1 x 19mcg ) =133mcg T4.....and ........3 x 9mcg +(1 x 4.5mcg ) =31.5mcg T3

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

T3 is 4 times as effective as T4 so we can (theoretically! )convert it 'all' to 'T4' like this :

7 tablets Erfa is 28mcg T3 (x4) = 112mcg T4 + 122.5mcg T4 = 234.5mcg T4

8 tablets Erfa is 32mcg T3 (x4) = 128mcg T4 + 140mcg T4 = 268mcg T4

3.5 grains Armour is 31.5mcg T3 (x4) =126mcg T4 + 133mcg T4 =259mcg T4

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

7 tablets Erfa is less than 3.5 grains armour by a total of 24.5mcg T4

8 tablets Erfa is more than 3.5grains armour by a total of 9mcg T4

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

So 8 tablets Erfa 30mcg is (theoretically!) a closer match to 3 and a half grains Armour .

hope that helps .

[tattybogle in reply to tattybogle]

somebody else !! please check my maths and my logic thankyou

[RedApple Administrator in reply to tattybogle]

' i thought ALL NDT's contained 38mcg T4 and 9mcg T3, but i could be wrong '

No, Erfa has always been different: thyroiduk.org/if-you-are-hy...

[tattybogle in reply to RedApple]

Thankyou RedApple

that's 'not funny' .... making hypo's do complicated maths by having different T4/T3 content ... that's just cruel .

[RedApple Administrator in reply to tattybogle]

Totally agree. Bad enough that even with the same theoretical hormone content, they have different effects on individuals.

[helvella Administrator Thyroid UK in reply to tattybogle]

helvella - Vade Mecum for Thyroid

Desiccated Thyroid Ratios

helvella.blogspot.com/p/hel...

Desiccated Thyroid Ratios - T4 and T3 content

[tattybogle in reply to helvella]

ah ha.... thanks x

[Delgor]

Hi Avidreader

Well there's obviously no need to for me to do the maths after all the wizards that have replied and I truly hope an increase in Erfa suits you. However, as you probably already know there have been lots of changes in the fillers with NDT and it could be this that isn't to your liking. I started out on Armour years ago but changed to Erfa when there were supply issues and it was definitely weaker. I then changed over to Nature Thyroid because of expense and it was great until they withdrew it for being sub-potent and now back with Armour again which appears to be stronger and as you rightly said ridiculously expensive but for me it's needs must.

[Avidreader in reply to Delgor]

totally agree Armour is what Hilary Clinton takes & it’s the best I’ve had - - But it’s such A crazy price & I’m retirement age now - AstraZeneca damaged too & not able to work like b4 due to the damage & huge expenses of trying to get the spike protein sorted - So if I can get the Erfa dose right it would be good - seems like it’s the drop in T3 - I need to address - so maybe I could combine with just 1/4 grain of Armour ? Who knows ? But that would be sustainable money wise -

[tattybogle in reply to Avidreader]

(now edited to correct typo)

8 tabs gives you the same T3 dose as 3.5 grains of armour does

( well a teensy bit more actually 32 mcg T3 from 8 tabs Efra as opposed to the 31.5mcg T3 you were getting from 3.5 grains armour)

and you are also getting an extra 7mcg T4 .

maybe give 8 grains awhile longer to settle in ? ..it might just take a while for how you feel to catch up if you've been on less for a bit.

Then when you've had chance to talk to endo (and point out to him that he can't add up properly!) . get him to increase your prescription to 8 tablets

[Mitch27]

Holy moly folks 😲 reading all this maths at 7.30am is doing my head in ...🤣 We've got some right smart cookies on here ... 😁🙌🙌 My tests are always up and down, levo for donkeys years, useless, eventually learned about NDT...tried 3 different brands until one worked, which was TR Man. That worked for a year then didn't 🤷🏼‍♀️ anyhow won't go into my story on this thread but my question after reading all this to you Fundies out there .... I saw the chart that was posted with all the NDT and their numbers, which are mostly identical or similar , so why is there such a difference in them using different brands ? I tried armour before and definitely felt an improvement but with prices as they were I needed to up the dose and couldn't because of price so I went onto Thyroid S but don't feel any better 🤷🏼‍♀️ so seeing how changing brands with Avidreader and having to work out different doses has me wondering why when realistically they should really be the same or close enough ?

[tattybogle in reply to Mitch27]

The most likely explanation is the same as we think it is for "why different brands of Levo feel different"

ie: it is most probably to do with the 'other' components the tablets are made from rather than the actual T4 or T3 content .

The difference in effect is likely because different formulations of tablet using different 'other' ingredients in brand A and brand B will mean they behave slightly differently in the gut , and are therefore absorbed at different speeds , AND with different efficiency from each other .

80% of Brand A may be absorbed, but only 73% of brand B may only be absorbed.

The actual content of T4 and T3 is standardised and checked , so if brand A and brand B both say they contain 38(T4) +9(T3), then they both will do ,, but i don't think i've ever heard of the absorbability being checked and standardised ? so 80% of brand A may be absorbed via the gut of 'most people' , but brand B may only be absorbed at 73% in 'most people' .

(nothing is absorbed 100% ..eg if we take 100mcg T4 in Levo we are only expected to absorb around 80% of it anyway, so the actual dose we get from a 100mcg tablet is only approx 80 mcg )

AND since each person's differing microbiome/ acidity / damage (etc etc) mean the conditions in everyone's gut are different , and therefore each person absorbs the same brand in a different way to the next person , giving them a different % .... so even if the T4 and T3 content are exactly the same , you'll get difference in effect between people taking the same brands AND differences when taking different brands.

And on top of that lot ....some people have actual problems with intolerence to one or more of the 'other' ingredients' .

[Mitch27 in reply to tattybogle]

The mind boggles at how good you are with your information... ☺️ Hence we're lucky on these support groups that some people actually really know what's going as clearly doctors do not ,😁👍 thanks for that info ..I'm hoping one day that something will work/agree with me ... I've just gone back to T4/t3 combo ... 🤷🏼‍♀️🤷🏼‍♀️

[Brightness14]

Your 3.5 Efra T4 122 and T3 28 = in each pill 34.86 T4 and 8 T3

Armour 3.5 T4 172 and T3 32 = in each pill 49 T4 and 9.14 T3

7 Pills of Efra x 30mcg are the same as 3.5 x 60mcg.

As you can see the Efra has a lot less in each pill of both T4 and T3.

T4 has 14.14 less in each pill and T3 has 1.14 less in each pill x 60 mcg

[tattybogle in reply to Brightness14]

?sunday morning maths check .. your numbers are not right Brightness.

Armour has 38mcg T4 and 9mcg T3 in each "60mcg tablet"

Erfa has 35mcg T4 and 8mcg T3 in each 60mcg tablet:

(17.5mcg T4 and 4 mcg T3 in each "30mcg tablet")

So i don't know how you got to 49 mcg T4 in armour ? it's 38.

or 177mcg T4 in '3 and a half' armour 60mcg ? it's 133.

think you took a wrong turn somewhere ?

[Brightness14 in reply to tattybogle]

You can't believe I was top for Maths, you are right I had that Sunday Morning lull, anyway, that's my excuse.

[tattybogle in reply to Brightness14]

Good excuse .. i can't do maths on sunday afternoon ,so we will balance each others mistakes out lol

[humanbean]

Just a thought... Now that you are taking NDT from the NHS could you afford to buy some non-prescription thyroid products to go with it e.g. Thyro-Gold? Or other thyroid glandulars? I have no idea of prices, I've never taken these products.

Since you have changed your Armour to Erfa it would be a good idea to get new testing done for TSH, Free T4, and Free T3 every 6 - 8 weeks, and hope it proves you are being wrongly dosed.

[Ruthi]

My private doctor has given up on Erfa because it’s so unreliable. I buy Thyroid S online from Thailand. It’s a copy of the original Armour of 30 years ago. It works for me but some have trouble with the fillers.