I have been taking NDT for 8 weeks and had my blood test yesterday. Results are attached. I initially felt much better but in the last couple of weeks I have felt the fatigue creep back in a little so was thinking I may need to increase my dose a little following my blood test.
I normally take 2 grains in the morning and 1 grain in the afternoon but the day before the test I split the afternoon one and had my final 1/2 grain 10 hours before the test was done and I was also fasted.
my endo said when he gave me the ndt that he expected my t4 to come down to around 15 but it’s actually gone up from 18.6 (same range).
I was just looking for some insight into these results please. I am still symptomatic but it presents as if I’m over medicated? What would you suggest I do next please? All my vitamin levels are optimal so I’m not sure how to proceed.
thank you in advance
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Knackeredandcross
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I have discovered that too much NDT for me also causes me great fatigue and general malaise. I feel horrible. My temp drops too. I used to think I needed more. Now I'm trying to always try less first.
You have Hashi's, don't you? That could very well be the cause of your elevated levels. If so, they will go down by themselves eventually. So, if you're going to try reducing your NDT, do it without involving the doctor, because you're going to need the full dose again when the levels go down.
thank you, yes I do. I’ve got an appointment with the endo next Monday and I need to send him my results prior. Do you think I should try and hold off reducing a bit longer if that’s the case? I didn’t know hashis made a difference
Hashi's can make a huge difference. It's an autoimmune disease where your immune system wrongly identifies the thyroid as the enemy and tries to destroy it.
The immune system repeatedly launches attacks on the thyroid - some small attacks, others large - during which the dying cells release their store of hormone into the blood. This causes levels of FT4 and FT3 to rise, and the TSH therefore drops.
But, it is only temporary. The excess hormone will be used up/excreted, and FT4/3 levels will drop back down to the way they were before.
All this action is random and unpredicatable, and makes finding the right dose of thyroid hormone replacement difficult. But, eventually, the thyroid will be entirely destroyed, and levels will settle down to 100% hypo and you will be totally dependant on thyroid hormone replacement.
Doctors seem to have absolutely no understand of all that, and will often accuse patients of 'abusing' their THR, when it actually has nothing to do with their dose. They will then slash the dose and when the patient goes back to being hypo, they often have great difficulty in getting the dose raised again, which is why I suggest not involving the doctor in your dose reduction, but do it yourself. However, when your endo sees those results, he will doubtless want to reduce your dose, anyway! Perhaps you can expalian to him in a way he will understand? (Like talking to a child! lol)
So, it doesn't really matter if you reduce/stop your levo before seeing the endo but it might make you feel more comfortable for a while. Just be careful not accept a reduction in your prescription, that's all.
The dose of... levo? Levo is a hormone, th ethyroid hormone T4. With all hormones you need to start low and increase slowly. With T4 that measn starting on 50 mcg - 25 is over 65 or with a known heart problem - and increasing by 25 mcg every six to eight weeks. Increases may need to be smaller as you approach your sweet-spot.
These days, there's a tendancy to start that patient on a dose according to weight, but that's all wrong, in my opinion. That approach was started for people who have had their thyroids removed, not for people who are hypo, and the dose was then titrated up or down according to the patient's needs. If you start someone who has been hypo for a long time, on that kind of dose (can't remember the exact numbers) it's tends to be too much for a lot of people and makes them feel worse. But, it's easier for the doctor, I suppose.
I'm sorry, I haven't got time to plough through the first one - the beginning doesn't seem very relevant, anyway. And the second one, I've no idea what they're talking about - what perfusion? Can you make your question a little more precise, please?
Well, it depends. If they dose by weight, then there is a formula - but I can't remember what it is.
But, if they do it the old-fashioned way, they start low and increase slowly - as should be done with all hormones. With levo you start at 50 mcg and increase by 25 mcg every six to 8 weeks until symptoms gone.
In my sarcastic moments, I might say: Using a formula for calculating doses is such a good idea, let's have several of them all with different results.
helvella's calculation document and spreadsheet can be can be found by following this link:
helvella - Estimation of Levothyroxine Dosing in Adults
A discussion about the use of formulas to estimate levothyroxine dosing. Includes link to a downloadable spreadsheet which calculates several of these.
yes, I increased gradually although I was switching from t4/t3 combo so I don’t k ow if that makes a difference? My blood pressure and temperature are as low as they always are. Nothings really changed other than feeling a bit more tired the last week although I did have a medical procedure that involved sedatives so it could even be a knock on from that?
3 grains of NDT ( Thyroid S or Armour ) breaks down to 27 mcg T3 + 114 mcg T4 :
Efra would be slightly less 24mcg T3 + 105mcg T4 :
I think you have built up your dose too fast and the first blood test should be after 6-8 weeks of taking 2 grains - just to check that you are going in the right direction and then you slowly increase in 1/4 grains and when you think you may have gone too far - drop down the previous dose and let that bed in for 6-8 weeks and then run a blood test.
I find NDT is a much slower and more subtle treatment option and my symptoms continued to improve for a good 9 months once I'd settle on my daily dose.
I'm with Graves and post RAI thyroid ablatio 2005 and self medicate and much improved on NDT.
Just read that you have Hashimoto's which throws a spanner in the works as your own daily thyroid hormone production is not a constant and liable to erratic swings from your immune system -
I would still suggest that you reduce your dose as your body is likely in a heightened state and why you feel somewhat fatigued compared to where you were a few weeks ago.
I had been on NDT for years and just a quarter will push your levels to high. Perhaps reduce by that amount for a few week and see how it goes. My FT4 level was always around 19 or 20
but yours is too high and your FT3 is over. I always felt OK going slightly over but I self sourced my NDT so never had to answer to a GP or Endo.
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