Hello all....
I am Hashi's and hypothyroid. Was taking Levo (175mcg) for almost 20 years, increasing dosage as years went by. But always had cold hand and feet and fatigue. Switched to NDT in August 2022, increasing the dosage to 4 grains now (Feb 2023). Not feeling any different. Blood work show mid-range T3, below mid-range T4, and very low TSH. Wondering if I should add some T4 to my regimen to get the T4 in range? Thanks in advance for any suggestions....
-a
Allen-P,
Welcome to our forum, many of don't get on with Levothyroxine mono-therapy.
You are taking quite a large NDT dose to only achieve mid-range and below mid-range results. Do these results relate to the 'free' or 'total' hormone?
When you made the switch did you increase slowly? If you can also advise of test results and which NDT you are taking, members will be able to offer a more informed response.
Thanks radd... sorry I forgot to be clear - those are Free T3 & T4 readings. I started at 1 grain and increased by 1/2 grain every two weeks till I reached 2 grains and stopped and had a blood test. Then I went up to 3 grains and stopped and had a blood test. Now I'm up to 4 grains but maybe I went too far. I will do another blood test in a few days to check. I was thinking I might have too much T3 and was wondering if I backed off my dosage and added in a little Levo maybe my T4 would come up?
Allen-P
Yes, four grains of NDT contains a lot of hormone not to be visible in bloods or to feel any different.
If we raise T3 too quickly (aside of hyper/hypo side effects) if can increase SHBG that binds T3 leaving too little ‘free’ for cell activity. Then labs would show high ‘totals’ + low ‘frees’.
If we take levels too high the un-utilised excess can turn into inactive metabolites such as RT3, that impair future conversion. Most seem to function best with FT4 middle of range or slightly over and FT3 slightly higher.
Some split their dose into twice daily to prevent highs and troughs, and prolong T3’s action. Some (including myself) have had to reduce NDT dose and introduce a little bit of Levo to normalise the T4:T3 ratios best suited for themselves.
Remember any thyroid hormone meds only work best primarily with optimised nutrients and iron, but also balanced glucose levels and sex hormones, etc.
Hello Allen-P and welcome to the forum :
The ranges and guidelines were intended for Big Pharma's T3 and T4 treatment option and there are no ranges for NDT as you simply treat to the relief of symptoms.
There is a unique ratio of T3 and T4 in each grain of NDT so by adding in some T4 you are effectively watering down th effectiveness of the NDT - for what ?
On NDT you will likely have a low suppressed TSH and a T4 lower than when you took T4 - Levothyroxine but your T3 should be proportionately higher than when you were on T4 monotherapy.
No thyroid hormone works well until your core strength vitamins and minerals are up and maintained at optimal levels - so might make sense to get ferritin, folate, B12 and vitamin D run.
With Hashimoto's you are looking at a thyroid auto immune disease and may well need to factor in food intolerances etc - many forum members find the following website very useful :
Thanks Pennyannie... On Stop the Thyroid Madness it recommends to have FT3 in the top area of the range and FT4 in the mid-range so I have been increasing my grains by 1/2 every two weeks. Actually I think I have gone too far as my pulse has gone from low 70's to mid 80's. So I will have to lower my dosage. I had my B12 and Vit D checked in the normal range. But, thank you, I will have to add in folate and iron. Also, thanks for the link, I will def check it out.
Ok - yes, I believe 1/4 grain increments are a better, safer option :
Monitor on pulse, blood pressure and temperature twice daily - and track on your T3.
Where your T3 needs to be for you to feel well is unique to you -
Obviously Hashimoto's throws a spanner in the works as your own gland will become further disabled by this AI disease and your own natural thyroid hormone supply erratic
Guessing you are splitting these 4 grains - am / pm ?
On STTM they recommend 2/3 in the morning and 1/3 in the early afternoon (so I'm doing 3 in the morning and 1 in the afternoon). I'm a little worried if I go too late that I won't sleep. Thanks for the tip on the temp - I didn't think of that!
Well you can stay following that routine if you like but I wouldn't recommend that :
An even split should be considered -
And you work up very slowly with NDT as it takes time for your body to adjust and the hormones to settle and bed themselves in.
First off you take bench readings when on T4 monotherapy.
You then stop the T4 and switch to NDT and build up in 1/4 grain increments, I went weekly.
If and when you get to 2 grains NDT - you hold that dose for 6-8 weeks and then run a blood test to compare to your bench readings when on T4 monotherapy.
If your T3 hasn't moved much and you still have symptoms maybe NDT isn't the best treatment option for you.
I your T3 has moved but you still with some symptoms, but improved, just slowly start increasing again in 1/4 grain increments monitoring on blood pressure, pulse and temperature.
The 175mcg T4 you were taking takes around 6-8 weeks to fully leave your body and as this declines within your body you slowly introduce your NDT slowly soo as one treatment option fades away a replacement option builds.
Thank you pennyannie - I will try to adjust my morning/afternoon split. I do have my prior T4 only blood tests. My FT3 is a little better with NDT but I will have to drop my dosage for a little while till my pulse gets back to normal. I will def go 1/4 increments from now on...
Ok then - sounds like you have over shot your dose of NDT or not waited long enough for your body to settle with all these changes -
So on 4 grains you are currently taking 4 x ( 9mcg T3 + 38mcg T4 ) which comes out at around 36 mcg T3 + 152 mcg T4 :
If you don't feel much better and your vitamins and minerals are optimal you may find T3 only a more suitable option - but T3 is said to the last resort - so I suggest we wait and see and let your body recover from this ordeal.
It seems generally accepted that we need around 50 T3 a day just to function :
Adding T3 to T4 - how much
T3 DOSING - adding in some T4
Added T3 making T4 redundant?
T4 and TSH numbers not adding up?
