NDT to T3 & T4 - brands, and how to transition?

[FoggyThinker]

I'm wondering how to make the transition from NDT to T3 & T4, specifically how slowly is it best to go and which brands of T3 & T4 are most widely accepted/least likely to cause reactions?

I'm assuming I would translate my current dose of 1.75 grain NDT into the equivalent T3 & T4 and start on that?

I (perhaps unwisely) started on NDT as I was given the option of any treatment by a private GP and from my reading thought that was the best chance I had to get well. But I'm struggling to raise my dose enough to resolve symptoms fully and am suffering with some joint pains and stiffness, wondering if these would resolve on synthetics. I have a call tomorrow with the pharmacy for a represcription.

I'd be really grateful for any thoughts or advice, please - hope everyone's doing well

[helvella Administrator]

For T4, I suggest considering Aristo Vencamil. It has no lactose, no mannitol and no acacia - the three most often suspected ingredients for causing tolerance issues.

Not everyone finds Vencamil good. But I think quite a number of us find it good.

Unfortunately, currently only in 100 microgram tablets but further dosages expected within months. And they are very easy to split in two.

helvella's medicines documents (UK and Rest of the World) can be found here:

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world. There is now a specific world desiccated thyroid document.

I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.

helvella - World Desiccated Thyroid

Contains details of all known desiccated thyroid products.

helvella - Thyroid Hormone Medicines - RotW

Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.

The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.

helvella.blogspot.com/p/hel...

[wellness1 in reply to helvella]

Would you consider them easy to split into eighths to achieve 112.5 mcg dose daily?

[helvella Administrator in reply to wellness1]

No.

I chose to take Vencamil 100 plus Wockhardt 25 - splitting the Wockhardt if needed.

Having the majority of my dose as Vencamil has been good and will change to their 25 when they become available. But, for now, Wockhardt are acceptable.

[FoggyThinker in reply to helvella]

Thank you I don't get on well with some sweeteners so the mannitol in particular is useful to know about. Don't have the laptop tonight but I'll review the document when I do, it must be a labour of love to document and keep that up to date -thanks for sharing it with us all.

[Jaydee1507 Administrator]

Is there a reason you're going for Levo and T3? Just you have never tried Levo alone, its where most people start, and once on the correct dose suits most people.

Looking at your profile and the results there, I'm trying to work out which are the latest results but it looks like your B12 hs fallen back to in the 300's? If thats correct then you need to up your B12 supplement.

[FoggyThinker in reply to Jaydee1507]

Quick reply as I should get back to work - yes I've had the same thought but wanted to make changes slowly; also unsure of the effect on my adrenals, they may do better on just T4? but if not I can't do CT3M on levo... Definitely open to suggestions on this!And thanks for the replies

[Jaydee1507 Administrator in reply to FoggyThinker]

I understand the need and quest to feel well ASAP, I really do, however with thyroid its the tortoise that wins the race.

Those that try and push the limits of treatment tend to miss their sweet spot and the treatment that will work for them.

CT3M is really something to try for those that have tried everything else. Also while I'm here, Paul Robinson's methods really only suit a few and others he has made very ill. If you haven't yet tried Levo then you really should do that before any extreme method.

No thyroid hormone will work well if your vitamin levels are less than optimal.

[FoggyThinker in reply to Jaydee1507]

Yes, if i had my time again, I'd start by trying T4 only! We live and learn I suppose...

If I do transition from NDT to T4 only, I assume I need to do so slowly? Is there any guidance on how to do so?I know it's a rather unusual situation!

Edit: ref. B12, I've added latest results to my profile and tried to make it clearer. The range is different but it looks like it's near the top of the range, one of those annoying "greater than" results: Vitamin B12 - Active >150 pmol/L (Range: 37.5 - 188)

D3 was still a bit low, though, I'm supplementing that but maybe not enough.

[Jaydee1507 Administrator in reply to FoggyThinker]

Its not really possible to do an accurate conversion between the two types of hormone treatment.

You could work out a very rough Levo dose and switch half NDT to half Levo for a month then do the same again.

To work out Levo dose by weight the calculation is weight in kilos x1.6 = very approx final Levo dose. This is not accurate but a guide.

[FoggyThinker in reply to Jaydee1507]

Thanks again this is really helpful, I've calculated what I think based on that and will discuss that plan with the pharmacist, then be prepared to tweak slowly!