Can anyone shed light on my blood test results? Taking NDT. Thank you!

[DaisyJones1]

Hello all,

Would someone be able to offer any insight to my blood tests results here at all? Many thanks. I take 310mg of Erfa NDT. I have hypothyroidism (hashi) and am a 46 year woman (so perimenopausal) and have two children. I exercise daily for at an hour. I have coeliac disease and am gluten free. The tests were done after 19hours of meds. I was day 15 of cycle.

I take all my Erfa at one time (11am) on an empty stomach and wait an hour before any food/drink. I was trying to reduce my morning cortisol level so have been following this routine for 3months. Prior to this I was taking it in one go when I woke up about 5/6am . (I'm not keen to split my dose x3 as very busy and couldn't manage this protocol last time. I could manage this if there wasn't restriction on empty stomach beforehand and waiting an hour.)

I have been taking NDT for 10months. Generally I feel ok although weight gain is frustrating and upsetting, which occurred after a trial with T3. I then moved to NDT. I don't think I had such weight issues on T4 only.

I take a number of supplements: iron, magnesium, selenium, probiotic, zinc, ashwagandha (for cortisol). I am having occasional night time hypoglycaemic episodes (according to a CGM that I'm trying out), so not sure if that's related.

Any thoughts here and way forward at all?

Many thanks indeed,

Daisy

RESULTS

Saliva cortisol 6-10am: 20.10 Range <20.3

Saliva cortisol 12pm: 6.73 (high) range 1.6-5.6

Saliva cortisol 4pm: 4.14 range <6.94

Saliva cortisol 10pm: 1.51 range <7.56

Thyroid function test

TSH: <0.005 range 0.270-4/2

Free T3 6.8 range 3.1-6.8

Free thyroxine (FT4) (H) 26.2 range 12-22

Thyroglobulin antibodies 57.0 range 0-115

Thyroid peroxide antibodies (H) 51.6 range 0-34

Magnesium: 0.92 range 0.7-1.0

C reactive protein (h) 3.19 <3.0

25 OH Vit D 110 range 50-250

Iron ferritin 70 range 30-150

Vit B12 591 (H) range 145-569

Luteinising hormone 5.2 (range luteal 1.0-11.4)

follicle stim. hormone 4.6 (range luteal 1.7-7.7)

17 Beta oestradiol 676 (range luteal 222-854)

sex hormone binding glob 122 (range 32.4-128)

Prolactin 307 (range 102-496)

testosterone 1.03

Free androgen index 0.8 (range 02.-71)

Free testosterone 0.007 (range 0.003-0.033)

[GlowCoach Administrator]

I'm sorry your previous post didn't get any replies. I'll lock it to avoid confusion. This is a busy board and sometimes posts can get passed by.

With NDT dose restriction around food is less important. It would be good for you to try a split dose, say 3 times a day to see how you feel.

When was your last dose of NDT before this test? This is important as both FT4 & FT3 are above range which personally wouldn't suit me. You may need to drop your dose slightly.

You have TPO antobodies so are Hashimoto's and could trial a strictly gluten free diet to see if that helps symptoms. Dairy can also be an issue for some Hashi people.

Vit D & B12 are good.

No folate result?

Ferritin could be a little higher to 90-100 in range. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc

I can't comment on cortisol or sex hormones.

[DaisyJones1 in reply to GlowCoach]

Thank you Jaydee. My last dose before the blood test was about 19hours. I am gluten free as I have ceoliac disease so I do have absorption issues.

In terms of timings with taking NDT and food/drink what space should I use? If I’m slightly over medicated (I don’t have any symptoms), maybe having ndt around food may be okay as it would reduce its effectiveness?

Would it is better to try and have a second and third dose (if split) what timing would be sensible given my cortisol?

Many thanks again.

[Noelnoel in reply to DaisyJones1]

I take glandulars (dessicated whole bovine or thyroid gland) with food as advised but my bedtime dose is on a virtually empty stomach, having had my last meal 6.30-7pm

As NDT is also dessicated thyroid gland I imagine it’s perfectly ok with food and would enable you to split your dose to suit

[DaisyJones1 in reply to Noelnoel]

Thank you. That's good to know.

[pennyannie]

Hello DaisyJones :

Having left 19 hours from full dose of Efra to blood draw I would think you are taking a little too much NDT :

NDT generally peaks in the blood at around 10/12 hours from dose and would imagine this would have put your T3 way over range.

I don't quite understand your T4 reading as generally on NDT the T4 is low in the range and thinking - do you have an absorption problem ?

I see you tried T3 previously and experience weight gain on both NDT or T3 which given enough time to settle in the body should see hormonal balance restored and the possible loss of the excess fluids.

I do believe ' working out ' when the body is already struggling not conducive to long term overall health stability.

I'm sorry I do not know enough to comment on your other results.

You might like to dip into the research and work of Dr Isabella Wentz who has Hashimoto's AI disease and well regarded by forum members - thyroidpharmacist.com

[DaisyJones1 in reply to pennyannie]

Thank you pennyannie. I do have an absorption problem as I have ceoliac disease. Why would this impact T4 if I have enough medication. Wouldn’t it be high because of the medication?

How long is long enough for hormones to settle/balance - I’ve taken NDT for about 8months. Is it worth waiting longer and trying to raise my iron further? I’m supplementing every other day and it’s risen from 20 to 70 in 6months.

I have reduced my intensity of my exercise but really enjoy my workouts but will consider this further.

Many thanks for your feedback.

Daisy

[pennyannie in reply to DaisyJones1]

T4 ' in itself ' is a storage hormone and pretty much inert and stored in the body - ready to be used and converted by the body into T3 which is the active hormone that runs all your bodily functions.

Speaking from how I see NDT expressed in blood test results your T4 looks in excess as with NDT you track on the T3 and most people have a T4 some 25/50 % in the range and not over the range which makes me think you are not able to convert and utilise the NDT well.

Optimal conversion of T4 into T3 needs optimal vitamins and minerals and I see these are in hand.

Ferritin needs to be at least over 70 - I now aim for 100 : folate around 20 : with active B12 75++ ( serum B12 500 ++ ) and vitamin D at around 100.

How did you end up 3 grains Efra which gives your 24 mcg T3 + 105 mcg T4 - was it a straight swop from that below or a slow titration up to 3 grains ?

Do you have readings and ranges from when on 40 mcg T3 + 100 mcg T4 ?

Do you have readings and ranges from when on T4 monotherapy ?

As I understand things the body needs to find around 50 T3 a day just to function - let alone exercise which is using more energy than just say, walking - while you wait for your body readjust.

I read you were on T4 monotherapy and introduced T3 - and feel everything went wrong from then and the issue is one of weight gain on introducing T3 and there being no change on NDT.

The ranges and guidelines were introduced when Big Pharma launched their own treatment options, synthetic T3 and T4 on the back of NDT in around the middle of the last century and then went about gaining market share by fair means or foul.

NDT is the original and successfully used treatment for hypothyroidism for over 100 years and you simply dose to the relief of symptoms and not guidelines, and years ago before the science of the blood tests you would have been given a little nugget of pig thyroid to chew on - and the size of the nugget adjusted when you returned to the doctor if still symptomatic.

[pennyannie]

Just another thought - you said your troubles started after starting T3 -

Since we know you have absorption issues - did you try liquid T4 ?

[DaisyJones1 in reply to pennyannie]

Thank you very much for your time here. I haven't tried liquid T4 and it was frowned upon when I asked my GP about this option.

When I was on T3/T4 Initial results were T4 total: 68.7 (66-181) Free T4 13.1 (12-22) and Free T3 4.53 (3.1-6.8). I think my T4 raised further to 16 and T3 to 6.8. I made a straight swap from 125 mcg T4 and 40mcg of T3 to 3 grains of NDT as this was advised by the endo at the time. On T4 only my T3 was about 2.3 (3.1-6.8) and T4 about 12- 14 (12-22) - if I remember correctly.

I'm at a loss given that my ranges are now all high I would have thought my body would start to resolve any excess eight gained by T3 etc. I am meeting the endo on Thursday, so if you do have any further suggestions here, please do let me know. Thank you.

[pennyannie in reply to DaisyJones1]

Ok - so once on any form of thyroid hormone replacement we should be dosed and monitored on our Free T3 and Free T4 readings and not a TSH :

So on T4 monotherapy your T4 was at the bottom of the range and your T3 under range - we generally feel at our best when the T4 is up in the top quadrant of it's range and normally you would be prescribed 25 mcg increases in T4 - every 6-8 weeks once blood tests were run - to build up your T4 reading which in turn should then convert and build up your T3 reading.

It reads as though this didn't happen or wasn't successful and guess your doctor's frown was a financial one - as a prescription for liquid T4 costs a lot more for the NHS/surgery :

Natural Desiccated Thyroid needs time to bed into the body and does not work as quickly as synthetic T3 and T4 thyroid hormones.

So you switched from 40mcg T3 + 100 mcg T4 to 24mcg T3 + 105 mcg Efra :

So this is a big dose decrease in actual dosage terms and since I think you can't utilise well the T4 in tablet form I think you are running on mostly T3 - and since we need around 50mcg T3 just to function and get out of bed - your body is stressed and not able to meet the demands you are putting yourself through.

I think your options are to first try liquid T4 and when you have slowly built up the dose for your T4 reading to be up in/around the top quadrant of it's range - we will then be able to see through a T3/T4 blood test if your ability to convert the T4 into T3 - needs the addition of T3 - Liothyronine.

Hope that makes soon sense :

[DaisyJones1 in reply to pennyannie]

Thank you again pennyannie- so you think a trial of a higher dose of liquid levo will be the better way forward here, as I have never been on a high enough dose/couldn't absorb the levo tablet form to be able to raise my T3 enough? Could I ask why is it that my current Free T4 is actually high though (FT4) (H) 26.2 range 12-22 if I am not absorbing the NDT. I would have thought that this would be low in range still? Thanks again.

[pennyannie in reply to DaisyJones1]

What dose of T4 tablets were you being prescribed when the results showed a T4 at the bottom of the range and a T3 under range ?

What was the suggestion from your doctor when with these results ?

[DaisyJones1 in reply to pennyannie]

The highest I was on was 125mcg of T4

[pennyannie in reply to DaisyJones1]

and what were your Free T3 and Free T4 on this dose ?

[DaisyJones1 in reply to pennyannie]

I've just looked back and after starting T3, my T3 was 3.3 (3.10-6.8) and T4 14.6 (12-22). This was on 30mcg of T3 and after 2/3months and 100mcg of T4. I can't find an earlier test now but the results would have been lower. I can dig one out on just T4 if needs be...but hope this helps

[pennyannie in reply to DaisyJones1]

Ok - it would be interesting to see a blood test result for when on 125 mcg T4 only :

but think there is an obvious issue with the absorption of the T4 tablets :

So, liquid T4 might do the trick :

NDT may not resolve issues and you maybe looking at trying T3 only :

[DaisyJones1 in reply to pennyannie]

Hi Pennyannie, I've found my blood test results on (feb 2021) on T4 only: Free thyroxine 18.9 (12-22) and T3 3.02 (3.1-6.8). This was on 125mcg of Levo.

[pennyannie in reply to DaisyJones1]

Ah - ok -that looks a lot better and shows a decent level of T4 when taking T4 tablets so the absorption problem not as acute as previously thought.

However it does show poor conversion:

Once the T4 is up in the top quadrant of it's range we usually expect to see a T3/T4 conversion at around a 1/4 ratio T3/T4 - so if I divide your T4 result by your T3 result I'm getting your conversion is coming in at around 6.25.

The accepted conversion is said to be1 -3.50-4.50 T3/T4 with most people feeling at their best in this ratio at 4 or under - so at 6.25 yo are very wide of this ratio and even with optimal vitamins and minerals you will likely not be able to close this gap significantly.

Ok - then - you do look to be absorbing the T4 - you could have had a dose increase in T4 - though doubt your T3 would have improved enough to make much difference.

So, it seems your new dose of Efra is around 40 % less than your previous dose on synthetic T3 and T4 :

I don't know why your endo thought 3 grains Efra the appropriate dose and we generally need to slowly increase NDT letting it bed and in and settle in the body and maybe a direct swop from synthetics to NDT has simply confused your body.

I'm sorry - I don't know what else to say :

[DaisyJones1 in reply to pennyannie]

Thank you. This is all really helpful and I can now go to the endo with better insight than before. I'll she what she suggests given my recent blood test results.

[pennyannie in reply to DaisyJones1]

OK - just to add with thyroid hormone replacement -

it takes time for the hormones to settle in the body -

adding more hormones is not necessarily the answer -

sometimes - less is better - as

Over medication and undermedication symptoms are confusing and added to that we have the AI component of Hashimoto's - so it gets complicated and likely not a straight forward easy fix -

While finding what medication and dose suits you best conserve your energy - as if not, you'll likely get ' pay back ' a couple of days later and struggle to function even more.

it is a fine balance where your T3 needs to sit that gives you back your ' you ' -

Having celiac disease and known absorption problems and living with Hashimoto's - in it's active phase - you are liable to ' swings ' in symptoms and pathology as this AI disease attacks and systematically destroys your thyroid gland.

Hope that makes sense -

[DaisyJones1 in reply to pennyannie]

Thank you again much appreciated. My current thinking is that I don't change from taking NDT and see how things develop for another 3 months. Also, changing the dosing time and splitting the dose - possible 12pm and then 3/4pm - and perhaps taking it with food as ensuring my stomach is empty and then waiting an hour to drink is annoying.

[pennyannie in reply to DaisyJones1]

NDT peaks in the blood at around 10/12 hours so maybe think of extending the time between these 2 doses - and ideally take on an empty stomach to ensure maximum absorption and try and wait an hour afterwards - just taking in water.

I take my NDT at around 2/3 in the night when nature calls :

[pennyannie]

You need to actually use the person's reply button - and see their name come up as you start your reply as then they get notified they have a message - otherwise you risk - not being found by chance - and / or with you left thinking you have been ignored.

Your T4 is high because you do not seem to be able to absorb it and / or convert it to T3 - so it is building in your body and in excess - maybe even given you unnecessary symptoms.

T4 is a storage hormone - a pro-hormone - and converted by the body into T3 the active hormone that is our energy source - you can live without T4 but you can't live without T4.

The thyroid is a major gland responsible for full body synchronisation from our physical, through to our mental, emotional, psychological and spiritual well being, our inner central heating system and our metabolism.

[FancyPants54]

Pennieannie is way more experienced than I am. But I've been on NDT now for 10 months and nowhere near balanced or feeling better. But I'm struggling to get enough hormone into my body. My levels are still low.

Before doing something drastic like giving up on NDT, I would, if I were you, reduce your dose a bit and see how you feel. 1/4 grain to start with. You took all your meds 18 hours before the test but still had over-range results for FT4 and FT3. That's not right. That would mean at the peak of the medication it might have been even higher.

You won't loose the fluid if you take too much.

[DaisyJones1 in reply to FancyPants54]

Many thanks for your response. I'm having a conversation with the endo on Thursday and I'll see what she says - these comments are really helpful as it's given me a greater understanding and so I can ask some specific questions when I have the review.