NDT, Stress, Heart Palps - Now What?

[Juliet_22]

Hi All,

I switched to NDT from levo around a month ago.

I started to feel better on NDT right away and my TSH dropped from 3.1 to 0.7 within just 2 weeks. My Ts were still balancing - T4 was right at the bottom and T3 was only 24% through the range.

I supplement with all the key nutrients and keep them in ideal ranges.

Also tested 9am cortisol recently, it was 420, so not bad. Sodium-potassium was fine as well.

I got to 1.5 tablets of Erfa and stayed on that dose for about 2 weeks, was doing pretty ok, with some side effects (more awake at night), but I would prefer those to my issues with levo because more energy and feeling happy with more joyous mood is just too good!

Then, I went through a very stressful event and as a response to it, my blood pressure jumped to 150/90. I am not able to handle stress well at this stage. Thankfully, deep breathing and rest helps me lower it.

I had a similar issue when I tried to increase levo from 75mcg to 100, and even to consistent 88 mcg and could only get to alternating 88-88-75 max.

With NDT and that stress issue, my BP would be ok-ish during the day, but in the evening it would rise and that started to scare me.

Had my heart checked a few months ago, all was good. I am m out of UK to do the adrenal saliva test right now, so not an option.

Stress triggered that reaction in the body and I was wondering what to do. Anyway, I started to think that perhaps I was also reacting to 1.5 grains of NDT, as I read that could happen. So I reduced it to 1 tablet, but started to feel under-medicated.

Since I didn't want to trigger blood pressure issues, I added 25 mcg of levo to the mix. I know it probably wasn't the right thing to do, but my endo was not available for weeks to consult and get guidance.

My BP has been stable now, it's actually on a lower side atm. I am taking some good natural calming pills and they have been working. But I feel awful with the addition of levo to the mix, depressed, very little energy, not present, angst.

Shall I go back to 1,5 tablets of NDT and see how I do with that now that my stress is more under control?

And if my BP and heart palps return, what should I do with the meds?

Really not sure what to do.

Thank you so much for your help!

[greygoose]

High blood pressure and palps can be symptoms of under-medication. Did you do any labs when you were on 1.5 grains?

Reducing by half a grain in one go might have been to big a jump. It's usually recommended to change doses by 1/4 grain at a time.

[Juliet_22 in reply to greygoose]

That is true. No, as I was only on 1.5 grains for about 2 weeks at a time. Shall I return to the same 1.5 grain dose now, wait for 6 weeks and retest? But if I feel low, should I increase by 1/4 grain a bit later and see how that goes before waiting again for 6 weeks and retesting?

[greygoose in reply to Juliet_22]

So, you've been doing quite a bit of changing doses in a short time. Which is counterproductive. And, now you don't really know where you are.

If you want to try 1.5 grains of NDT again, I would start by increasing the NDT to 1.25 grains, and keeping the levo for a couple of weeks. Then stopping the levo. Then, two weeks later, increasing by another 1/4 grain to get back to 1.5 grains. See how you go with that for a couple of weeks. If, after two more weeks, you feel under, increase by 1/4 grain. If not, hold for six weeks and retest. Best to do things gradually.

[pennyannie]

Hello Juliet :

It's generally suggested to slowly build up the NDT in 1/4 grain increments either weekly or fortnightly :

The T4 you were previously taking would take around 6 - 8 weeks to fully leave your body and in that time frame you would then be up at around 1+ 1/2 grains.

It's generally suggested that if you reach a dose of 2 gains stay on that dose for 6-8 weeks letting it settle and bed into the body and then run a blood test to compare to your bench readings of T3 and T4 before you started this new treatment option.

If you come to a week where you feel you are not ' as good as the week before, drop down that last dose to the previous dose - stay on that dose 6-8 weeks and then run your blood test.

It could be non optimal levels of core strength vitamins and minerals sice you experienced the same symptoms when taking T4 - Levothyroxine.

Were you splitting the NDT - equal amounts am and pm as this could be the maximum amount you can take at any on time ?

[Juliet_22 in reply to pennyannie]

Thank you so much for your input. I actually got to 1 grain within a week and got to 1.5 grains within 2 weeks. I did it because I felt terribly unmedicated on a lower dose and started to gain myself back as I increased. I thought of staying on 1,5 grains for 6 weeks to retest, I had no issues with it until that stressful event that triggered things. I guess I was still under-medicated. But the funny thing is that when I reduce the dose (it was the same with levo), my BP stabilizes, but I also go more hypo.

I will get back on 1,5 grains again and might try to increase after 2 weeks by 1/4 grain to see if that changes things. Thank you so much for your input!!!

[pennyannie in reply to Juliet_22]

There is a unique ratio of T3 and T4 in the NDT - which suits many thousands of patients and I would initially drop the T4 - build back to 1 + 1/2 grains stay on that dose for a fortnight and try and see if you can nudge up by 1/4 grain increments weekly to 2 grains and then stay on this dose for 6-8 weeks and then run a blood test, to compare with your bench mark readings and consider building on up if you still have symptoms and no negative side effects.

You might find splitting the dose evenly am and pm suits you better:

[Imaaan]

How and when do you take your ndt and levo dose? Do you take it together? Is it divided doses? Im asking because I was on 75mcg of levo ( synthroid) before switching over to ndt. The weaning process took me 11 months.

[Juliet_22 in reply to Imaaan]

I take my NDT in one go. I don't have issues with it and read that Dr Christianson recommends doing it that way. I have only added T4 to the mix a few days ago, but will go back to NDT as per amazing advice I got here.

Can I ask - do you take ERFA and how much? I was more or less on the same dose as you before. I wonder why it took your body so long. And after 11 months you felt good?!

[Imaaan in reply to Juliet_22]

Some ppl find it better to divide the doses to help with the peaks and valleys. If I were in your shoes I would have split it in half and taken a little of levo at night.

Yes I take Erfa. I'm currently on 135mg. My dosea is divided in 5 doses but I didnt start out that way. In the beginning, I took my dose in the morning and took the Levo at night. As I decreased my levo and increased my Erfa, I began 2, 3, 4 and eventually 5 doses of Erfa a day. It was smoother on my system . It took me longer partly due to being afraid of getting completely off levo since I was on it 20+ yrs and also my adrenals .

After 11months i finally got my free t3 at a place i had never seen before and i slowly began feeling better, thanks to God. My free t3 was below range when I started.

I'm doing much better now but I'm still tweaking around.

[Lalatoot]

Chopping and changing up and down of doses and adding different things in a panic is unfortunately the wrong thing to do. We've all been there and done it .The body does not like change. You need to make gradual, methodical changes one thing at a time otherwise you have no idea what is going on, what is beneficial, what is detrimental or what to do next . And you just make things worse.

Your symptoms were caused by stress. There may have been nothing wrong with your NDT dose - you hadn't been on it long enough to find out.

Changes in NDT are usually better done gradually by a quarter grain and then given time to settle.

My symptoms of overmedication and undermedication are exactly the same. I could never tell by symptoms alone if I needed an increase or a decrease so I also needed blood tests to guide me .

You need to decide what you should do and stick with it for 6 to 8 weeks. I think I'd go up by a quarter grain if it was me.

Hope things settle for you.

[Brightness14]

You probably need an increase my BP and HR go up when I am under medicated. Try adding another quarter. Do you take it in two doses that's the best way maybe. First thing and then early afternoon. I never wait six weeks before raising my dose that's for Levo only. NDT can be raised more quickly say every 2 weeks by one quarter. After you are on 2 grains then wait for six weeks and have a blood test. You can then adjust if needed.