Timing of NDT doses

[Magpie5]

I will be switching from Levothyroxine to NDT in the next few weeks. How do people manage to eat if we need to split the dose into 2 separate times, and leave 2 hours either side of taking an NDT dose, particularly avoiding magnesium, calcium and iron?

So for example

9am breakfast followed by supplements

11am NDT dose 1

1pm lunch

3pm NDT dose 2

5pm snack

7pm supper

I cannot go without food for 4 hours as I have low blood pressure and get dips in blood sugar. Most of the foods I eat seem to have calcium, iron or magnesium, and I don't want to fill up with junk like gluten free rice bread (I am on a low oxalate diet).

[Farrugia]

I wasn’t told to leave 2hrs either side, I was told between thirty to sixty minutes. I take my morning dose when I wake up - if I wake ridiculously early then I take it and go back to sleep. If I wake at 7ish, I take it then and just wait a minimum of thirty minutes before I have a cup of tea or coffee or breakfast. I have any supplements mid morning. I then take my afternoon dose an hour after lunch. This seems to work for me.

[SlowDragon Administrator]

Take your first dose NDT very early morning or in night if you regularly get up for the loo

Then you can take most supplements after breakfast

Iron at least 2 hours away from other supplements

2nd dose NDT - mid to late afternoon

Magnesium best at bedtime

[pennyannie]

Hello Magpie and welcome to the forum :

No thyroid hormone replacement works well until your core strength vitamins and minerals of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels.

Please take bench mark readings of TSH, T3 and T4 before switching to NDT so you have base line results to work from and can track your progress when you switch to NDT.

I seem to be able to get by on just 1 daily dose which I take at around 2 am when I naturally wake up for a toilet break and then easily go back to sleep until around 6 am.

Are you self medicating or working with a doctor ?

[Magpie5 in reply to pennyannie]

Thank you. I am improving my supplements to support thyroid and high cortisol first, and will be taking reading before changing. I have a private GP for the purpose of getting the ERFA prescription, but she doesn't really seem up to speed and only told me to start at 1 grain. Everything else I have learnt from TPAUK and Health Unlocked

[pennyannie in reply to Magpie5]

Ok then - well you have a foot in each camp - as did I - so no worries :

[pennyannie]

I switched from 125 mcg T4 to NDT overnight :

It takes around 6-8 weeks for the T4 medication to fully leave your body and as one treatment option reduces in your body you build up the new treatment option and hopefully this way you have a smooth transition.

Efra contains a known measure of 8 mcg T3 + 35mcg T4 in each grain and if you haven't taken T3 before you need to introduce it slowly and with NDT we need to build up the dose in 1/4 grain increments weekly or fortnightly allowing the dose to bed and settle in the body.

I haven't a thyroid ( RAI thyroid ablation for Graves 2005 ) and started on 1/2 grain NDT :

I am dyslexic and was very brain fogged when I switched and mistakenly didn't follow the instructions as listed on the TPA forum to the letter, such as splitting the dose am and pm.

I monitored myself on blood pressure, pulse and body temperature both am and pm and weekly increased my dose by a 1/4 grain - and my blood pressure and pulse remained stable but watched my temperature rise from 35.4 to 36.6 where it is today some 5 years on.

If you get to 2 grains a day you stay on this dose for 6-8 weeks to let this dose settle and bed in and then run a blood test to compare to your bench mark readings :

Your T3 should be improved and your T4 maybe lower than the bench mark reading but this does not matter if you feel improved and with relief of symptoms.

If still with some symptoms but know you are improving but not quite there yet - you start building up again from 2 grains until you reach a week where you don't feel as good as the previous week and so need to drop back down to the previous dose - and that is your best dose option on NDT at that point in time.

I only managed to get to 1 + 3/4 grans in 1 dose and felt I had gone too far - so dropped back down to 1 + 1/2 grains and have been on this dose for around 5 /6 years now and much improved.

Compared to T4 monotherapy my T3 and T4 results literally swopped places -

On NDT after around 10/12 hours of taking my dose, fasting, just taking in water - my T3 is 90/110 % through it's range with my T4 at around 25/30 % through it's range.

On T4 monotherapy my T3 was around 25% through the range with my T4 at 100% and dose reduced as my TSH is always suppressed at 0.01.

Hope that makes sense :

Do you have Hashimoto's AI thyroid Disease ?

 1lolabear

[Magpie5 in reply to pennyannie]

Thank you, this is all really useful. My current T3/T4 on 75mcg thyroxine is fT3 low to mid range, fT4 near top of range, TSH 0.01. I do have antibodies, but only low, TPO 27 to 73, TG 27 to 56. I still have most of the hypothyroid symptoms. I suspect I have pituitary issues, possibly Sheehans syndrome, so am about to test my hormone levels. Plus possibly T4 to T3 conversion issues due to high cortisol.