Switching from T4-T3 combination to NDT

[Alex_p]

I’m currently on T4 (150 mcg)+T3 (30mcg) combination (taking 1.5 Novothyral; 1 Novothyral has 100mcg T4 and 20mcg T3, I hope my math is correct), but decided to try Thyroid S NDT. Any suggestions which dose to use? And should I split it during the day, the way I do with the combination therapy? What should I look for when doing the switch?

[SeasideSusie Remembering]

Alex-P

Thyroid S: 1 grain = 38mcg T4 and 9mcg T3

so doing the maths you're not going to get an exact equivalent.

For 150mcg T4 you would need approx 4 grains Thyroid S.

For 30mcg T3 you'd need approx 3 grains Thyroid S.

So if you do swap you'd have to decide which way to go.

And should I split it during the day, the way I do with the combination therapy?

I wouldn't change the way you currently take your combo meds, see how it goes.

[Alex_p in reply to SeasideSusie]

So the safest option is to start with 3 grains and see how it goes, right?

[SeasideSusie Remembering in reply to Alex_p]

Your choice but it's probably what I'd do, see how it feels and what your test results are like in comparison to your combo meds. The hormone content of Thyroid S does vary from batch to batch according to the manufacturer.

Here is one post about the difference in batches

healthunlocked.com/thyroidu...

and helvella has an article on his blog about this:

helvella.blogspot.com/p/thy...

[greygoose]

So, you're taking 250 mcg T4 and 50 mcg T3, is that correct?

So, given that there is approx. 38 mcg T4 and 9 mcg T3 in one grain of NDT, you would need to take 5 1/2 grains of NDT to get the same amount of T3, which would only give you 209 mcg T4 - which might or might not be a good thing.

BUT, I think that before anyone could give you any sold suggestions, we would need to see your latest blood test results. If you haven't had a test recently, it would be a good idea to get one, but it does need to include both FT4 and FT3.

[Alex_p in reply to greygoose]

I’m taking around 150 mcg T4 and 30 mcg T3. I take 1.5 Novothyral, but not sure if T4 and T3 are distributed evenly on the pills so the safest thing to say is that I take 3 Novoothyral every 2 days.

[greygoose in reply to Alex_p]

So, that's 300 mcg T4 and 60 mcg T3 - approximately. Whilst I hate saying it, I have to say, that is a lot. And, you would probably need 6 grains of NDT to get close to it. But, I really think you should do labs before changing anything.

[pennyannie]

Hey there again ;

The Novothyral is at a 1/5 ratio - T3/T4 and presume this is not working well for you -

so let us hope the unique ratio in NDT of 1/4.22 - T3/T4 - suits you better.

Best to get bench mark readings of Free T3 and Free T4 before switching so we can see how effective this combo dose of Novothyral is working for you

Please also ensure first that your vitamins and minerals are optimal as no thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D at up and maintained at optimal levels.

I switched straight from T4 monotherapy - stopping T4 and starting on 1/2 grain NDT the following day - and as the T4 slowly left my body I increased weekly by 1/4 grains until I sensed my body becoming a bit uncomfortable and not as ' ok ' as the week before.

I then dropped back down the last 1/4 grain increment and stayed on the lower dose for 6-8 weeks and then ran a blood test, to find my T3 was then 110% and my T4 25% through the ranges and had totally ' switched positions " .

I had no symptoms of over medication - I tracked my blood pressure, pulse and body temperature twice daily throughout this experiment and both pulse and blood pressure had remained stable and my temperature rose from 35.4to 36.6 where it still hovers today some 5 + years later.

Since you are already taking some form of T3 I think you need to replace that more quickly than starting off as I did from just T4 monotherapy.

I think I'd go with 1 grain AM and 1 grain PM - so that's 9 mcg T3 + 38 mcg T4 twice daily and see how you go :

Week 2 - increase both doses by 1/4 grain :

Week 3 - increase both doses by a further 1/4 grain :

that takes you up to a total of 3 grains which you may not need - 27mcg T3 + 117 mcg T4 :

I would then like to think/ hope you would be comfortable and just need to be ' fine tuning ' possibly dropping back down quarters.

I know it reads less than you are currently taking but we need some adjustment for the Novothyral reducing in your system whilst we build up the NDT -

I found NDT works very differently in the body, is softer and I experienced subtle improvements in my symptoms for up to around 9 months past finding my best dose.

I'm with Graves post RAI thyroid ablation and only take around 1+ 1/2 grains daily.

[Alex_p in reply to pennyannie]

Thank you for sharing the plan. The only issue I have with it is that taking NDT in the evening doesn’t seem like the best option for me as I also have to take calcium twice daily (as my parathyroids were affected while taking out my thyroid) and would need to leave a 4h gap between calcium and NDT. What I currently do is I take one dose of Novothyral at 5AM, calcium at 9AM, second dose Novothyral at 1PM on an empty stomach and second dose calcium at 8 PM, and Magnesium at 10PM. I was thinking of following the same plan with the NDT, what do you think? Another option would be to take the second dose of NDT around 4PM, but it’s more difficult to have it away from food and coffee.

[pennyannie in reply to Alex_p]

Yes, I wrote to you planning that you kept the same routine as now - 5 AM and 1 PM :

Looking back I saw your ferritin at around 47 and your B12 at around 70 ??

Ferritin has to be at least over 70 for any thyroid hormone replacement to even work and my active B12 is well up and over 75 ++ at around 120 :

These are both much too low and could be responsible for some of your symptoms as on paper your T3 is at the top of the range :

I see you also tried a T3 and a T4 in separate doses - what dose did you find suited you best or didn't you get that far with this treatment option ?

[Alex_p in reply to pennyannie]

I’m supplementing with vitamin B complex, a separate folate, iron and D3 (but I also take alfacalcidol with my calcium), so I’m hoping to get my values up in the future.

The last time I took T4 separate from T3 was when I was taking Accord levothyroxine 125 mcg and 20 mcg Thybon Henning. But I suppose they work differently from Novothyral as I wasn’t able to get the same results even with an increased dose of Novothyral.

[pennyannie in reply to Alex_p]

That's interesting so with a higher dose of Novothyral - 150 mcg T4 + 30 mcg

you felt better on the lower dose of 125mcg T4 and 20 mcg T3 :

Reads as though the Novothyral didn't suit you irrespective of dose :

Were your vitamins and minerals better placed back when on T3 +T4 ?

[Alex_p in reply to pennyannie]

I would have to dig through the results. But they were defintely lower because they only started to increase once I started supplementing and I was not supplementing while taking Thybon Henning T3.

[pennyannie]

P.S.

Looking back I see you had good results on paper but still with symptoms -

I'd look to getting your ferritin to at least over 70 - I now aim for around 100 :

active B12 75 ++ ( serum B12 500++ ) folate around 20 and vitamin D up at around 100:

[Alex_p]

Hello again! I started taking Thyroid S, I’m at 2.5 grains now (started with 2). My final dose should be around 3 by my calculations. However I’m not feeling well at all, I’m very tired, my muscles hurt and putting on weight. Any advice on what to do? Should have I started introducing Thyroid S alongside Novothyral and work my way up in order to replace Novothyral completely? Am I taking too much or too little Thyroid S? Is this just my body adjusting to Thyroid S? If so, how should I proceed? I can’t go on feeling like this.

[RedApple Administrator in reply to Alex_p]

Alex_p 'I’m at 2.5 grains now (started with 2). My final dose should be around 3 by my calculations'

3 grains would be far too high a dose of desiccated thyroid for many people. I wonder how you arrived at that calculation.

'Am I taking too much or too little Thyroid S? '

I would say you most probably are already taking too much. At the very least, you have started on too high a dose and may well have already passed your 'sweet spot'.

If you can do a thyroid blood test to see what your current levels are, that might throw somelight on the issue.

[pennyannie in reply to Alex_p]

No thyroid hormone works well until your ferritin, folate, B12 and vitamin D are up and maintained at optimal levels as previously detailed.

Your last result on ferritin was 47 - this needs to be at lest 70 - for any thyroid hormone replacement to work well :

I don't think taking more NDT is the answer -

Maybe go back on what you know and trusted until such time as your core strength vitamins and minerals are optimal and you may well find the Novothyral will work better for you anyway and if not then consider switching to another option.

[Alex_p]

pennyannie Here is my initial post.

[pennyannie in reply to Alex_p]

Thanks - I just found it another way :