Converting NDT and T3 to combo

[carolinegodlonton]

I am currently on 20 mcg T3 and 150 mcg Thyroid—S daily. I have always bought my own medication as I didn't think I would manage to get T3 on NHS. I have just received a message to say they will give it to me so I'm over the moon. They also want me to ditch the Thyroid-S and replace with 100mcg Levo. Does this seem reasonable? In my mind it may be a bit much Levo and not enough T3. I'm so reluctant to mess with my dosage at the moment. My adrenals are not great at the moment and I'm worried the change will make me worse.

[SeasideSusie Remembering]

Carolinegodlonton

Thyroid-S comes in grains and 1 grain = 60mg (not mcg) and is said to contain 38mcg T4 and 9mcg T3 so 150mg or 2.5 grains = 95mcg T4 and 22.5mcg T3. If you add in your 20mcg T3 then your total hormones come to 95mcg T4 and 42.5mcg T3.

If they want to replace your Thyroid-S with 100mcg Levo then that's almost the same amount of T4 you're currently getting from your Thyroid-S but how much T3 are they going to give you?

[carolinegodlonton in reply to SeasideSusie]

20 mcg which is what I was taking excluding the NDT.

[SeasideSusie Remembering in reply to carolinegodlonton]

So you will be getting more or less the same amount of T4 but only half the amount of T3, you could well end up feeling undermedicated with hypo symptoms unless they increase your T3.

[carolinegodlonton in reply to SeasideSusie]

This is what worries me. I think I will monitor my symptoms closely. I think the endo thinks I'm slightly over medicated and wants to reduce my T3 a bit. My last test a week ago my T3 was 6.8 (3.1_6.8)TSH 0.005 (0.57_3.60)

[SeasideSusie Remembering in reply to carolinegodlonton]

When did you take your last dose of NDT and T3 before that test and what was your FT4 result?

[carolinegodlonton in reply to SeasideSusie]

I took my 0.5 grainThyroid-S at bedtime as usual and the test was 10.15am. T4 was 9. 2 (7.9-14)

[SeasideSusie Remembering in reply to carolinegodlonton]

So you didn't take any T3 with the bedtime dose of Thyroid-S?

T4 was 9. 2 (7.9-14)

T3 was 6.8 (3.1_6.8)

Your top of range FT3 suggests you might be getting a bit too much T3 overall and your FT4 is 21.31% through range. That might be the right balance of T4 and T3 for you but there are many of us on combo thyroid hormone replacement that need FT4 more in balance with FT3, it's a very individual thing.

[carolinegodlonton in reply to SeasideSusie]

I take all my T3 in the morning then split the NDT into 3 doses. The only T3 at bedtime is what's in the Thyroid-S.

[SeasideSusie Remembering in reply to carolinegodlonton]

OK, so we say to split T3 the day before into 2 or 3 doses and take last dose 8-12 hours before test, so as you took all your T3 about 24 hours before the test then chances are that your FT3 is showing a false low even at 6.8 and does suggest perhaps you're taking too much T3 in total.

[carolinegodlonton in reply to SeasideSusie]

Yes this does seem to be right. I'm going to drop my Thyroid-S to 120mg for a week and see how I feel before changing anything else. Thank you for the advice.

[SeasideSusie Remembering in reply to carolinegodlonton]

If your reduce your Thyroid-S then that will have the effect of lowering your FT4 level (it does contain more T4 than T3) which is already low in range at 21.31%, it will also probably lower your FT3 but to a lesser extent. My suggestion would be to reduce your T3 dose, wait 6-8 weeks and retest with the advised time gaps for T3 to get a true reading. You know your FT3 is aready at the top of the range and if our advised time gap for T3 had been used it would be even higher, suggesting that you are taking too much T3.

Also, you would need to be on a steady unchanging dose for 6-8 weeks to allow time for your levels to settle, seeing how you feel after one week on a reduced dose isn't anywhere near enough.

[carolinegodlonton in reply to SeasideSusie]

Thank you. I will try this.

[Brightness14]

According to my workings you take a lot of T3 in your NDT and extra in T3 only. The Levo replacement would be too low for you to feel well. Why if you are self medicating are you now changing. Your could be up to 25% less

[carolinegodlonton in reply to Brightness14]

I have managed to get my T3 on NHS and this is what he recommended. I buy NDT as well so it has become very costly. I could just stay in the NDT with added T3 instead of taking levo.

[Brightness14 in reply to carolinegodlonton]

I think that your idea of staying on your NDT and then adding your NHS provided T3 is a good idea, and only you will know. I pick up Levo and T3 every month here in France my treatment and meds are all free here because I have no thyroid. I have been taking NDT Thyroid s for nearly eight years now but I never tell my GP. If you are feeling well why change. Just obtain the T3 on the NHS.

[serenfach]

You will be saving a bit by not having to buy the T3, so I would be inclined to carry on the NDT if it is suiting you at the moment.

[carolinegodlonton in reply to serenfach]

This is what I was thinking although I've heard others say the Thyroid-S is not stable in every batch and so thought taking Levo would be better. I'm quite symptomatic at the moment and my cortisol has crashed due to overdoing things so I'm scared to mess with my needs tbh.