Frequency of testing

[lutepavan]

Hello all,I'm sure this has been answered 100 times, but I'm having difficulty finding the information.

My question is how quickly do TSH, T3, and T4 numbers react to a change of medication dose. 8 weeks? 12 weeks? Does TSH react more quickly than T3 and T4?

I ask specifically because 6 weeks ago I increased my NDT from 1 grain to 1.5 grains, due to TSH being at 12.3 (0.27-4.2), T4 being 7.4 (12-22), and T3 being 3.1 (3.1-6.8). That was a Medichecks test. Now, exactly 6 weeks later, after taking 1.5 grains for that period, an NHS test shows that those three numbers have improved a bit, to TSH 4.92 (0.27-4.2), T4 9.3 (10-21), T3 3.8 (3.5-6.5).

I'm tempted to increase my dose to 2 grains as a result of this test, but I'm wondering whether it's better to wait a month, take another Medichecks test, and see if those numbers have improved further. Hence my question: how long should one wait before making further dose adjustments? (I'd rather not take more medication than necessary.)

Many thanks in advance for your thoughts on this!

[Jaydee1507 Administrator]

6-8 weeks should be allowed for all results to settle between dose increases, so your most recent results after 6 weeks will be fine.

When you are closer to being optimally replaced it might be better to leave slightly longer, up to 12 weeks for final settling of the dose as small changes can happen after 6-8 weeks even.

1.5grains for a male is a relatively small dose anyway and a TSH of 4.92 quite high especially on T3 containing NDT where one would expect your TSH to be low if not suppressed.

Some people might recommend 1/4 grain dose changes so as not to shock the system.

What you are taking is a hormone replacement and not a medication as such. It directly replaces what your own body is no longer producing and you need what you need to make you feel well.

What supplements are you taking?

What are your most recent results for ferritin, folate, B12 & D3?

[lutepavan in reply to Jaydee1507]

Many thanks, Jaydee1507 !

Latest Ferritin 91.1 ug/L (30-400),

folate 25.9 nmol/L (Range: 8.83 - 60.8),

B12 >150 pmol/L (Range: 37.5 - 188),

D3 60.1 nmol/L (50-200)

Supplements: magnesium, selenium, D3, and big dietary changes to include organic grass-fed beef, including desiccated beef liver capsules. Borderline anaemia (Haemoglobin 128). Feeling surprisingly well since switching to NDT. When I get the dose right there'll be no stopping me!!

[lutepavan in reply to lutepavan]

Update: took 2 grains for the first time last night (with a view to daily alternation between 1.5 and 2 grains). Result: migraine. I had been having migraines multiple times a week when I was under-dosing at 1 grain, and they stopped more or less completely when I increased the dose to 1.5 grains 6 weeks ago. But now I find that a sudden increase of dose to 2 grains has brought them back. I hope it's only a temporary effect, because surely 2 grains (or perhaps 1.75) is closer to optimal.

[Jaydee1507 Administrator in reply to lutepavan]

Its not possible to alternate doses of NDT as it contains T3 which is immediate release as opposed to Levo/T4 which is delayed release, a storage hormone. You should plan for a constant daily dose of NDT to avoid issues.

It might be better to take 1 3/4 grains for the time being.

What are you taking for folate & D3?

Your D3 could be higher. Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150. wildatlantichealth.com/vita...

Folate should be 50%+ of its range. If you are already taking a good B complex then you can buy a separate 400mcg methylfolate to add to it.

[lutepavan in reply to Jaydee1507]

Sorry to be late replying. Struck down by Covid....

It's very useful to know that alternating doses of NDT isn't going to work. Annoyingly, the pills I currently have are two-grain pills, so I'm having to cut some of them into eighths to get 1.75 grains, a real pain! (But it's so expensive to buy the smaller denominations.) Last night I took roughly 1.75 grains, and there was no migraine, so I'm hoping that dose will work for me. We'll see how the numbers look at the next blood test.

Thanks for the suggestions about D3 and folate. I used to take D3 with K2. Must go back to that.

Thanks again.