My Free T4 always comes up low. I understand from this grp that this means I am over medicated. I do not feel over medicated, but am I doing myself long term damage?
I currently take 45mgs of NDT & an extra 12.5mcgs of T3. (In one dose) each day.
(& supplements)
Thanks in advance.
Hi Eleanor M-G
I think if T4, T3 were low and TSH was high, you'd be under medicated
If T4, T3 were high and TSH was low you'd be over medicated.
I think that's how it works 👍
Thsnk you. So does that mean I am over medicating now?
You are not over medicating.
The nuance of that:
* TSH where it should be, suppressed
* Your FT3 is about half way through range - could be higher by the numbers so it comes down to how you feel
* FT4 is way too low - which is (by the numbers) way too low for most of us to feel well.
But your overall panel is pretty good upon glance - and so your symptoms are most important to start with.
Then we need someone else on the board to advise if FT4 that low is bad in absense of symptoms.
But no - NOT overmedicated.
Ok, thank you, that’s interesting. Hopefully someone can get back to me about the low Free T4….
Just what fallinginreverss as said.. There going of your TSH being 0.01 and saying your over medicating but your T4 is low, T3 looks OK.TSH... Brigade.. It's a usless test to determine over medication🤦♀️
Thank you for your reply. So are you saying that taking more medication should raise my low Free T4?
Yes if under medicated you'd increase your thyroid medication, but slowly... Slowdragon as great advice on this, helvella also❤️.They may see your post and offer advice about increasing your meds in the best way. 👍
Very undermedicated, not over.
Oh really? Very interesting. Do you think I should be increasing NDT or T3 or both?
An increase in T4 would increase FT4.
BUT - we don’t know enough about you to say what you should or shouldn’t do.
I see some previous posts are fairly complex - NDT is more complex than simply titrating Levo. T3 is also as you know another thing all together when balancing it all.
The above is an accurate analysis of the numbers on this one blood test. But it’s not enough for anyone to say what you should do.
Would be helpful to know what protocol you followed before the test (last doses etc) as this would change the interpretation. What your dosing regimen is and for how long. What your symptoms are. And depending on how much you titrate, any key details about your last titration and last blood test results by comparison.
Let us know!
Hello EleanorM-G -
No - but importantly -- how are you feeling ?
On NDT you dose to the relief of symptoms and not a blood test :
The blood test and ranges were introduced to be used for people taking synthetic T3 and T4 :
Did you first try the conventional route - T4 monotherapy - and then tried various options and found this suits you best ?
Both NDT and T3 tend to suppress the TSH - so I wouldn't worry about that - and most doctors tend to treat from just TSH readings and the computer prompt which is simplistic and suggests a high TSH - may need more T4 and a low TSH suggests less T4 and possible over medication.
Your Free T3 which is the most important of all the readings - once on thyroid hormone replacement - and which one tracks on when taking NDT or T3 - and at just under 70% - well in the range.
Your inflammation marker CRP - looks a little high - but if you're well and happy where you are I wouldn't suggest changing anything.
FallingInReverse and pennyannie , thank you so much for taking the time to reply.
I went without taking anything for 24hts before my test. I did a fasted test. I’ve been on this dose for about 4mths. Before this I was taking a smaller dose of NDT (30mg) & slightly larger dose of T4. (25mg). I increased the 1st & lowered the 2nd at the suggestion of someone on here, who thought it might increase my FT4 level. It raised it by .2
I have been on very similar doses for the last 7yrs.
I ended up treating myself because for years my GP told me there was nothing wrong with my thyroid but I had lots of symptoms so didn’t believe them. I went to Dr Peatfield who confirmed I did & I started medicating myself because the GP wouldn’t help. Later, my Gp tested my thyroid as part of investigations for something else & told me I had an under active thyroid. (I was undermedicating so it showed in my results. ) They said they would medicate me but I would have to come off all my thyroid meds & start afresh with them, which I wasn’t willing to do, so I have been going it alone, doing the best I can.
My CRP is a continuing concern to me. It is always high, usually higher than this. My GP says it’s fine under 10, but I read that it is a concern at over 1. (6mths before this test, it was 4.44, 12 mths before that it was 8.63, 6mths before that it was 12.31, 6mths before that it was 9.21) Even when it’s gone higher than 10 they have shown no interest.
My current symptoms are: Always very cold, headaches, achy muscles, sometimes I stutter, constipation. I had gestational diabetes in all my pregnancies, spasms of the eyelids, My biggest issue is sleep issues & recurring yeast infections.
I am always scared to over medicate because of the fear GP’s put into you, so I am not surprised to hear it could be that…..
I will add photos of my last few blood test results….
Thank you for any help you can offer, as I am a bit lost.
This was APril ‘23 when I was on slightly more T3 & slightly less NDT as previously mentioned
This May 22. I can’t remember exact doses but I have never strayed far from where I am now…
Well - you are not over medicated in any of these blood tests and if anything ' look ' to be under medicated, and the symptoms described are those of hypothyroidism and under medication.
Though I very much doubt your doctor will sanction an increase as s/he is just looking at the TSH and does not know how to read the blood test in context to the medication being taken.
Did you ever try T4 only medication and find it did not work for you -
as that is what the NHS doctor will put you on and when and if, you may get a referral to an endo for a trial of T3 , not NDT, and there are very long O/P waiting lists and understand financial constraints rather than medical need are present in certain areas of the country.
I don't know how you have ended up with this dose - but if you tolerate well both NDT and T3 - I'd be inclined to start increasing the NDT by a 1/4 grain a week, and see how you go :
IF you get to 2 grains stay on this dose for 6-8 weeks and then run a blood test to see where your T3 and T4 then sit compared to these current bench mark readings.
There will come a week where you fell edgey and just uncomfortable in your skin - drop down that last 1/4 grain and stay on the lower dose for 6-8 weeks and then run a blood test and see where you are.
When I started self medicating NDT I tracked on the clinical symptoms of my pulse, blood pressure and body temperature am and pm - and whilst the first 2 remained constant I watched my temperature creep up from 35.4 to 36.6 where is still hovers some 6 years on.
it’s very odd that your TSH is so suppressed and yet your T4 and T3 levels are not over medicated. Also your antibodies are showing no signs of thyroid disease. Are you sure you have a thyroid condition? What are you going on to point to the thyroid. Your initial symptoms could be related to some other deficiency. Vitamin deficiency maybe? Or another factor? Have you checked your gut function for celiac disease and absorption it’s odd looking at your figures and the amount of thyroxine you’re taking Maybe get your pituitary checked to see if your have any issues with it
Thank you for answering.
I find it odd too, but I have had 2 doctors tell me I have & I have been under the care of an endo for the duration of 2 of my pregnancies. (Those 2 sets of 9mths were the only times I have been T4/levo only. I didnt keep results from this time as the NHS only tested t4 & tsh so it didn’t seem worth it to consider them….) My mum also has it….
I had my pit gland checked & they said all was ok. I have never looked into celiac but I assume I would have issues/symptoms with gluten/food, which I don’t.
As you take NDT and T3 this will probably suppress your TSH. Then you should go on how you feel. If you feel good does it matter if your FT4 is so low? Do you start feeling fatigued etc when you are due your next dose? If so, maybe you could try splitting your dose and take roughly 12 hours apart?
This is only a suggestion. I take T4 and T3. The T3 in 3 doses.
That is a good next question. My 1st question was am I over medicated? The answer seems to be no and that I am probably under medicated.
Now I should ask Does it matter if my FT4 is so low? Is it dangerous? I do still have symptoms so it makes sense for me to try increasing NDT & see what happens to my FT4 & symptoms as suggested, which I will start doing. (Slowly.)
I have never tried splitting does so that is something to look at too. 👍🏼
I will keep you posted, thank you so much for all your suggestions. 😀😀😀
There are people on here on T3 only. One might assume that their FT4 levels are pretty low too.
Good luck. Looking forward to positive future posts 😊
Agree with your reply just above, and also recco you reread pennyannie ’s two replies.
Whether low T4 causes damage is completely secondary to the fact that your symptoms are still there … we often say “most people don’t feel well with XX so low” but everyone is different. But you still have all hypo symptoms. And so the more accurate question is how to increase your T4.
I’m not sure you ever answered the question (?) as to how you ended up moving from a T4 mono and made the leap into not only T3 but also NDT.
That combination means you should take dosing guidance/input on here from people who are in NDT. For example - splitting Lio can work due to its half life, and for Levo splitting helps some people for other reasons (ie, I think it’s the initial spike , vs half life since it’s so long for t4). I don’t know if or how splitting NDT would work, so make sure that you ask someone on NDT about it before.
I’m Levo/Lio so can only say getting your free T4 up is a good objective to focus on for your next step.
Thank you.
I ended up on these doses because at the start my GP said I didn’t have an under active thyroid & so I couldn’t get T4 from them. Dr P (private doc who used to work fur NHS, then left to better help those with an under active thyroid) said I did. We studied my temps, blood pressure, pulse etc, as another person mentioned above. I started on NDT & not long after, added in T3 once I found affordable blood tests & noticed my T3 was low.
So you might benefit from adding some levothyroxine to bring Ft4 level up
Or you might be fine with low Ft4
It’s trial and error what suits each person
If on just levothyroxine most people end up with high Ft4 and low to middle Ft3
On levothyroxine plus small doses of T3 …..many people find they need both Ft4 and Ft3 at least 60% through range
But NDT works differently
On just NDT it’s common to have lowish Ft4 ….but usually within range
On NDT plus T3 then more likely to have low Ft4 …..as you have
Wether that’s best option for you …..you would have to try different mixes to see what’s best
Thanks for this. That’s what I will do, thanks to you guys. 😀
Interesting! So never Levo! Everyone is so individual and different.
The important part is that what you are taking is not yet working for you - you still feel like garbage.
So it’s agreed that your first order of business is increasing t4.
More NDT will do that - in which case I would get forum advice from NDT takers.
I suppose Levo would be an option Since you weren’t allergic/intolerant of it. But again, your fellow NDT people will be the best help.
It sure gets complicated with all these pills!
Agreed & agree! I would have happily tried Levo, but by the time the NHS agreed that I had a thyroid prob, I was already on NDT, so I just keep going. Who knows if it was the right choice….
NDT is the most natural choice and worked fine for people for a lot longer than levo. I think many people would like to try NDT, but lack of suppliers, high cost and lack of decent medical advice/backup will put most people off.
Hi EleanorM-G
Was thinking about you as this thread played out:
healthunlocked.com/thyroidu...
Very useful in understanding the nuances of what you'll hear about NDT on this forum. As we know, this is largely a UK-based forum, and so what I didn't fully understand was that because many find it's hard to get ANY treatment from the NHS, and when they do, the NHS will default to Levo, hence advice and experience with NDT on this forum has a slant to it because of that situation.
From a hormone perspective - you can read, it's a fine first choice!
From a "convenience" perspective - I think that's where some people have experience about availability and cost as Lovecake notes above.
Either way - think you'll find the above thread useful and helpful!
Thank you so much, I will defo read it. 👍🏼
Over medicated? 
Am I still over medicated on NDT?
Over or under medicated?
Over medicated symptoms
