NDT Advice

[starbuck10]

My consultant has given me a private prescription for NDT Armour one and a half grains at 7.30 am then one grain at 12.00pm i currently take levo 125 and t3 10 every morning. Is this a high dose of NDT compared to the synthetic i am taking i wonder also why he splits the dose am very nervous about switching. My previous blood results are higher but have had more energy . free triodothyronine 6.9 pmol/l serum t4 17.1 pmol/ TSH 0.01mu/L. taken last month .

[Jaydee1507 Administrator]

A total of two and a half grains is probably an average sort of dose for NDT.

Most people taking anything containing T3 will split their dose into 2 or even 3 as the T3 component is immediate acting and has a short half life.

Can you add raanges for each test - numbers in brackets after your result? Ranges vary between labs.

When did you take your last dose of Levo & T3 before this test? Recommended timing is 24hrs for Levo & 8-12hrs for T3.

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

What are you supplementing with?

[greygoose]

You don't have to split it if you don't want to, but endos don't know much about dosing thyroid hormones and just because some people need to split it, they think we all do.

The half-life of T3 is about 24 hours so you don't need to split it for that reason, but some people don't like the spike after taking it all in one go and find they have a smoother 'ride' if they split the dose. Other's need to take it all in one go to flood the receptors and get enough into the cells. You fave to find out by trial and error which is the best way for you to do it.

[radd]

starbuck10

Yes, I would consider 2.5 grains too high a dose considering your present of 125mcg Levo + 10mcg T3.

1 grain of Armour contains 60mg T4 but manufacturers claim it to be biochemically equivalent to 100mcg T4. However, many members (including myself) would put 1 grain at around 85mcg T4. Therefore, a more realistic dose for you would be 2 grains.

However, members often claim NDT to work better for them and can take a reduced equivalent dose so I would actually introduce NDT at 1.75 grains, and then test and see how you feel after a few weeks, allowing provision to titivate dose as required. I find Armour quite T3 potent and as you don’t want to overshoot your sweetspot it’s better to add than have to take meds away later.

(Note - As you’ve previously medicated some form of T3 you can do a straight switch over (I did). Also note NDT grains are measured in mg, as opposed to synthetic thyroid hormone replacement meds measured in mcg).

Regarding split dosing, the forums then resident professor/researcher diogenes provided several papers evidencing the NDT thyroglobulin hangs on to the thyroid hormone content until stomach enzymes release them in a kind of natural slow-release mechanism allowing us to avoid the ‘T3-bump’ and take all in one daily dose . I do this and have not noticed any difference. Given you are already taking your T4/T3 combo dose as one daily dose I would suggest you can do the same with Armour.

How the T4 and T3 bound on to thyroglobulin are released as free hormones … healthunlocked.com/thyroidu...

T4 and T3 in NDT are largely strongly bound on to thyroglobulin protein - .. healthunlocked.com/thyroidu...

Pharmacokinetics of NDT - .. healthunlocked.com/thyroidu...

[Incoguto in reply to radd]

Hey radd, I was wondering if you tested the peak after 3 hours of NDT? I took 2.375 Armour and 5 t3 in the morning and tested 3 hours after, my ft3 was 295% of range 8.45 (1.48-3.91). The question is, is this bad? 😐 for reference, my baseline ft3 in the morning before meds is 79% of range.

[radd in reply to Incoguto]

Incoguto,

That is a controversial question, and many on the forum would say not. However, I would say that is quite a peak and would be worried if I was experiencing that every single day as we can not know what negativities are being induced.

The peak of 2-3 hours post dose is associated with synthetic fast release T3 meds. A healthy working thyroid gland and endocrine system will control thyroid hormone levels through many mechanisms to ensure the closest amount that is required and maintained at all times. When we medicate T3 we lose that luxury and our aim is to keep levels as close to an average that keeps us well to reduce any risk of negativities caused by elevated or deficiency fluctuations. Hence many members multi-dose.

When we medicate NDT (as you are) that elevation should be reduced as both T4 and T3 are tightly bound to thyroglobulin, only degraded by gut digestion, and Tania Smith quotes thyroid scientist J. Hersham as stating the T3 peak as between 4 - 8 hours post dose. Different tissues will transport and convert T4 and T3 at different rates, but generally after we have reached our optimal dose a larger dose equates to a larger peak. Note 'optimal' dose is not the most we can take but the least with the most optimised relief of symptoms.

We know excess T3 risks negatively altering hormone conversion, bone architecture, blood glucose levels, and intefers with sex hormone levels, etc, and I suspect your 'peak' could be higher if you tested a little later after dosing. Therefore, I would worry a huge daily elevation is not only causing daily negativities but could be worsening through a cumulative effect.

You will also be making your body work harder as every time T3 levels fluctuate too far from the average many changes take place to try restoring average levels: in transporters, deiodinase conversion enzymes, extra cortisol release to level blood glucose, your temp might increase, you might experience noticed or unnoticed mild tachycardia/jitters (T3 sensitises beta-adrenergic receptors to noradrenalaine/adrenaline), puffiness from enhanced T3-vasodilation, etc, and then your body has to recover again as T3 levels drop, only for the whole process to be repeated again tomorrow.

If you read my bio you will see I used to regularly test 2-3 hours post synthetic T4/T3 combo for endo to ensure I wasn’t over-peaking as suffered pyschosis from thyroid hormones in 2015.

[Incoguto in reply to radd]

Radd, thank you so much, this is really, really helpful.Strangely, on NDT only my peak was almost 200% after the one morning dose 3 hours later. I must be metabolising it real fast.

Would it be correct to suspect that this peak is responsible for my glucose elevation? I am indeed jittery, anxious and brain foggy, my hands shake.

Also, is it right to say that enzymes try to deactivate hormones at such a peak? And I definitely feel puffiness!

I'm going to read about it now thank you 😊

[radd in reply to Incoguto]

Incoguto,

‘Strangely, on NDT only my peak was almost 200% after the one morning dose 3 hours later. I must be metabolising it real fast.’

No, even without seeing your labs it sounds more like you are over medicating.

‘Would it be correct to suspect that this peak is responsible for my glucose elevation?’

Yes, there is much research evidencing a continuous supply of excess/elevated T3 increases elevated blood glucose levels.

‘Also, is it right to say that enzymes try to deactivate hormones at such a peak?’

Yes, the body will deactivate excess thyroid hormone to protect itself from hyper effects. When a large proportion of thyroid hormone is continually deactivated, it can affect future conversion/usage of all thyroid hormone (whether excess or not).

If you would like further discussion, it might be better to start your own post 😬😊

[Britpol]

Hi. I was on 125 mcg Levo and switched to Armour thyroid. Took just one grain for 10 days then went up to 1.5 grains for another 3 weeks before settling down on 1 and 3/4 s week later. It was a brilliant advice from Pennyanne that told me to keep adjusting the dose up or down depending on how I feel. My final destination is likely to be 2 grains , as my daughter and husband are on that dose. My daughter went up to 2 grains within 2 weeks but felt as if she was going to die during the process , with palpitations etc, but this was on the advice on [doctor name edited] to push through the unwell mess. She then settled on 2 grains very quickly. My advice from [prescriber name edited] was 1 grain for a few days, then 2. I found the jump too great, my BP and pulse shot up and couldn’t sleep. So I went down to 1.5 grains and stated on it for 3 weeks but felt tired and sleepy . Then increased to 1 and 3/4 grains and seem to have stabilised on that but noticed on the days when I exercise more, I need a higher dose so I started cutting my 1/4 grain in half and adding it to my 1 and 3/4 grains, ending up on just under 2 grains on those days. My current regime : 1 grain in the morning and then 3/4 grain around 13.30 , then lunch at 14.30 . To get the dose I need, I purchased 1 grains and 1/4 grains and split them to suit. [prescriber name edited] who prescribed for me agreed to that. Best way to split Armour 1 grain is using your thumbs - it won’t crumble then. 1/4 grain is more tricky , I use a blade knife . I hope this helps. We are all different - just listen to your body and adjust accordingly ; I found I could go up to 1.5 grains fairly quickly and then change by 1/4 grains according to how I felt.

My husband is also on Armour, 2 grains. He stayed on 1 grain for 1 month, then went up to 2, He also adds 25 mcg Levo at night but is thinking of giving that up and getting an extra Armour if need be. All three of us feel better on Armour but the process of getting there can be difficult, and I think some people give up too quickly. From mine, my daughter’s , and my husband’s experiences we noticed improvements after about a month, and started to feel quite well after 2. All the best!

[Litatamon in reply to Britpol]

'I think some people give up too quickly.'

I also believe this to be true, and it's unfortunate.

I am not on NDT right now due to financial constraints & border issues (Canada). I felt great on it. But if I had judged the starting out on it, I would have sworn it was not for me & would never be. I felt like a drug addict must feel - my body was pumping feeling like it was searching for more. So pushing through is paramount. Too many feel symptoms & just assume it is not for them.

Which brings me to another issue on here about NDT. Yes for the majority of people starting low & increasing slowly is the best advice. Sound & smart. However, there are some where for whatever reason that is not the best choice with NDT. So for those reading always take in the great advice but if there are issues with it all consider that that simply might not be for you, with increases. Both times increasing in what would be seen here as an aggressive manner alleviated all my symptoms, almost immediately. And I am not alone. So there is not a one size fits all on finding the best ending point with dosage.

(Talking NDT only on the last paragraph, I do not feel the same with levothyroxine increases.)

All the best to you.

[Brightness14]

It sounds too high a dose compared to your Levo + T3 dose. You results look good on what you are taking now, why are you changing how are you feeling.

The Levo in you body will take some time to leave so starting on a small dose anyway, I have been taking NDTs for years without a thyroid but started with just one half a grain am and half pm. After 10 days raising up to 1 am and half pm and so on.

Two grains sound more like the dose that you should be taking.

[JackieHeath]

Hi, just out of interest where does everyone on here UK based get their supplies for NDT.

I was taking NDT Armour over 20 years ago for a period over 5 years - I responded amazingly

My consultant was[name edited by admin] - then managed to get my Gp to prescribe.

I then had to revert back to Levo as no longer able to source NDT through my GP and struggled to find another private consultant.

[RedShells]

Actually, your readings are very similar to mine. Go by how you feel. And remember TSH will be suppressed on NDT and T3. I feel sooo much better on NDT... FT3 should be close to top reading which it is.