Best way to take NDT

[Alex_N]

Hello, today is my first day taking NDT. I was on a T4/T3 combo for the last two years. I usually chewed my meds (T4, T3) and tried to grind them as much as possible with my teeth before drinking a glass of water. What is the best way to take NDT? Can I take it in the same way to ensure good absorption? Or maybe sublingual?

[greygoose]

I'm not sure that chewing does help absorption. It is absorbed in the gut but has to go through the stomach first because stomach acid detaches the hormone from the other substances in the pill. So, chewing it wouldn't make must difference to that. But on the other hand, some might hand around in the mouth and bind to the next meal you have.

Same with sublingual. The molecules are too large to pass the mucus/blood membrane, so the pill just disolves and is eventually swallowed.

The best way to maximumise absorption is to make sure you take it on an empty stomach, well away from food/supplements/medication, and that your stomach acid is optimal.

[Alex_N in reply to greygoose]

Thanks a lot for the reply and explanation. Anyway can I assume that chewing at least does not have a negative impact on the absorption?

[greygoose in reply to Alex_N]

As I said, it could. If it isn't all swallowed, and some hangs around in the mouth, it could bind with some of the ingredients of your next meal. The pills are designed to be swallowed whole.

[Alex_N in reply to greygoose]

I see, thank you very much.

[greygoose in reply to Alex_N]

You're welcome.

[pennyannie]

Hey there again :

My experience of synthetic T3 /T4 is limited - but I know with the synthetic mix it felt much more powerful than NDT which tends to be a much slower, softer medication.

I also do not think you can do a straight swop - just on T3/T4 content - from one to the other :

I take my NDT - in 1 go - on an empty stomach with just water in the middle of the night and am aware of being woken up a little some 2 hours later - but go back to sleep until around 6 :

[Alex_N in reply to pennyannie]

Thank you for sharing your experience!

[arTistapple in reply to pennyannie]

Interesting reading. The little snippets one picks up just reading posts and replies. I keep the idea of NDT firmly in the back of my mind but your comments are interesting. Just a little thing around your sleep comment. Do you wake naturally to take your NDT? Then do you wake 2 hours after taking it then go back to sleep?

I know this sounds pedantic but it seems informative along with your consideration it’s ’slower and softer’. Sounds very attractive.

Even if I sleep ‘well’ (no such thing I have discovered) I wake up full of doom and often feeling downright ill.

[pennyannie in reply to arTistapple]

I'm afraid as you age a toilet break in the night seems a given and at 77 I seem to be able to go without one for around 4 hours.

I can't stay awake much past 10 - so am up at around 2 am and this is when I also take my daily dose of NDT - I then easily go back to sleep - and I feel a little ' stir/surge ' around 2 hours later - it doesn't wake me up - and I wake up aroud 6.00 am.

I 'm Graves post RAI thyroid ablation 2005 and presume I have no thyroid function and so on full ' Manual ' controls rather than reliant on a dodgy automatic system !!

When I first started self medicating - I tried a little less T4 ( I was at top of the range ) and added 6.25 mcg T3 and followed the above timing schedule - I woke up relaxed, clear headed and without that doom and gloom that too much T4 was presumably giving me,=, and that I had come to accept as normal for me.

On T4 monotherapy my T3 was at 25% with my T4 at 100/110% through the range -

and on my first blood test on NDT - the T3 and T4 had literally switched places - on a fasting blood test taken - 10-12 hours post my NDT single daily dose of 1 + 1/2 grains.

Now 6 years on still on same dose and my levels still hang around at the same place.

I now just arrange a yearly full thyroid function - my TSH is below the range - but I'm not in the system and haven't seen a doctor since 2017/8 and still supplement the vitamins and minerals - and take adrenal glandular support.

[arTistapple in reply to pennyannie]

If I have a ‘pattern’ of sleep, I would say mine is broadly similar.

I think I just have to realise I am not getting any better - fundamentally - on Levo. It’s actually difficult to come to this realisation. So much ‘everything’ has been invested in the last three years since diagnosis.

I have described my interlude with Levo as “keeping the wolf from the door”. A sort of holding position. I think now even that might not be accurate.

Whilst I think I did actually get some lasting improvements from my short adventure with T3, the acute symptoms brought about by its introduction were intolerable.

My cardiologist sees no connection with hypothyroidism but at least this has helped procure an NHS endocrinology appointment.

I have (due to info supplied on the forum by helvella ) an appointment with an NHS endo with an interest in heart issues in about a month. Hoping for at least a sensible discussion.

There is something truly insane about even attempting a discussion within a system of medicine which allows for only one single treatment. The whole thing is insane.

[pennyannie in reply to arTistapple]

When I tried to increase my small dose of T3 to 12.50 mg - I gave myself the most awful symptoms - couldn't go out or do anything for over a week - even the bed sheet hurt me - as I just lay there in a total mess and confusion - and I guess totally over-medicated myself and was very frightened for myself.

Stopped both T3 and T4 and once my brain became engaged again started back on T4 monotherapy.

Started looking at NDT - and thought I'll give it a ' go ' as I knew that I needed T3 - in some shape or form -

So now my NDT breakdown to 13.50mcg T3 + 57mcg T4 -

but I've never felt that T3 synthetic ' surge ' that was very real for me even on the smallest dose of synthetic T3 at 6.25 mcg - and I thought I had to just push through and it would all come out ok !!??!

So now knowing this level of T4 is much lower than I would have considered when trying synthetics - I think should I ever go back to synthetics I've a better more realistic starting point for me -

Hope that makes some sense :

Some people suggest eating with T3 so to offset ' the surge ' :

Some people refer to NDT as slow release - it's just that the hormones are attached to hemoglobin and get broken down and released into the blood stream much more slowly.

[arTistapple in reply to pennyannie]

Thank you. You have answered a question I could not articulate. I did get a surge with the T3. However it was the ones during the night that I could not cope with. I was taking it in the morning with my levo. I was already on the road to ruin when I asked for help. Perhaps I really should have tried it at night! Symptoms too strong and level of fear too high.

I have always dreaded the situation of depending on NDT supply (and cost), plus problems with GPs poking their noses in.

This cardio thing was a last gasp before I completely self medicate. I knew the chances were high of - well I am sure you know, involving more NHS protocols but I was desperate. After my private endo refused to treat me, my options were limited. I needed cardio back up.

As I suspected my cardiologist is ‘interventional’ without taking into account my hypothyroidism. It has more than added to my problems. But she knows this endo I want to see and was happy to back me up. I just think it’s odd that an eminent cardiologist sees no connection re: thyroid and most endos are seriously ignorant about hypo/heart which is under their very own purview.

Look thanks pennyannie it gives me a bit of hope there might still be a way out of this SH1T.

[arTistapple in reply to pennyannie]

Apologies to heloworl for jumping in on your post!!

pennyannie, further to our exchange re: NDT. That level of NDT is proportionally quite a bit less T4 and higher T3 combination than I have tried via synthetics. I don’t think I am on a high dose of levo (100 mcg) but it’s taken me pretty near the top of range. I am certain I need a ‘working’ level of T3 but I am, on the face of it, apparently unable to take it. My T3 dose was low, 2.5 mcg. Every time I started to put it up was when I hit problems. I think it was SlowDragon who suggested I was making myself more hypo - perhaps by not increasing my T3 at quite the right time.

I did well on T3 until I did not!

Once things went ‘pear shaped’ I was reluctant to attempt increasing it, as my heart symptoms were just too bad. I have been coming round to the idea of less levo and more T3 but entirely lacking in confidence with this view. Hence being intrigued by your dosage. Its not made real sense until realising this works for you!

I do think levo has done something for me so abandoning it (and long time user of just T3 DippyDame seems to agree that I am not in a position to attempt just T3) does not seem sensible.

I don’t see anyone else discussing retaining quite a bit of improvement after my/their enforced abandonment of T3. So far reports are magic bullet or NOT. I think T3, for all the trouble it has caused me - did actually work and left me in a better place: mentally, brain fog and overall fatigue. Undesired physicals not quite so good. I think heart issues and anxiety have a deep connection for most people. Anxiety was definitely a response to heart symptoms - not the other way round. Important.

Anyway NDT all of a sudden looks like a possibility from where I am viewing.

Are you able to comment further?

[pennyannie in reply to arTistapple]

Yes - most brands of NDT are around a 1/4.20 ratio T3/T4 :

Though I don't think you can then say the same dose of synthetic T3 and T4 will do the same job for you :

When I played with synthetic T3 + T4 - I dropped my T4 to 100mcg daily and would never have considered or trusted myself to drop T4 too much from around 100 mcg and thought I needed to try and get to a dose of T3 at around 10 mcg and would then - ' be there ' - and just like the dose details I've read of on how much T3 and T4 support you with on a daily basis.

But as we know - that didn't work - I dd have well over range reverse T3 - unconverted T4 - before I started the experiment - though optimal vitamins and minerals which had taken my 2 years to build up - maybe this was having an effect - I'll never know as I haven't had reverse T3 run again :

I read Ray Peat some years ago now and he suggested RAI thyroid ablation a medical folly as no one knows the long term consequences of these treatments - so that got a tick from me - and he went on to say with regard to thyroid hormone replacement for hypothyroidism - start of with synthetic T4 at 40 mcg and top up as you go low and slow with synthetic T3 to the relief of symptoms.

There is no magic bullet - it needs working at - which ever way round you go and in my case some maintenance long term - hopefully not drastic - but with age who knows what's round the corner.

[arTistapple in reply to pennyannie]

Ok. Well I have not had RAI but I reckon I have been undiagnosed at least since 1969. Three years ago since being told. So it’s a long time to have been dealing with this. It just seems my story has wrinkles that seem less common. I am aware of other formites reporting of very long term suffering. Could be even longer but I think youth might have allowed me to worsen slowly. And if you don’t know any different, you just to some degree accept it. It’s not that I never thought there was anything wrong, just getting someone (medical) to agree!

I think I must be careful not to clutch at straws but sometimes I wonder how long I can hold out. Don’t mean to be melodramatic but …. Now I have had to involve cardiology; who could not ‘fix’ it last time, I am not exactly full of confidence.

Interesting about the RT3, something I thought unimportant but may account for dreadful symptoms? I still suffer from time to time. I am pretty sure my thyroid must be capout but just the last few days I would have called it a Hashi flare. Now I don’t think that is a reasonable thought.

Anyway I am not ready to try something else just yet. Info gathering and yours is good info. Thanks again.

[pennyannie in reply to arTistapple]

I know now I've be hypothyroid from a child - undiagnosed dyslexic - left handedness - scolded at school and simple living with a level of stress and anxiety I saw as normal.

Never diagnosed though tried a few times and then just lived with ' it ' - exhaustion was crippling at times - taught myself to read in my 20's - in order to get promotion in retail - and had a career etc .

Aged 56 I was physically threatened and verbally abused by a man I employed as my assistant manager - went through company disciplinary procedure which was a waste of time - developed insomnia and gave in and went to the doctor after 3 months thinking I just needed sleeping tablets but diagnosed Graves and there you go :

[arTistapple in reply to pennyannie]

Crikey. I remember reading this before. Sorry I did not make the connection. Somehow I have been doubting the life I have had at the moment. However I have also had a glimpse at a better life too since starting treatment. I felt quite stable on T3 until I did not. I guess that’s what kept me going since diagnosis. However I am fed up with the instability - which I definitely will not be telling any medic. I feel I will just be written off - AGAIN.

Don’t you think it’s a bit strange so many of us have experienced ‘injustice’. For all I know it could be a general human experience but it really taps into the disgusting way we are treated as thyroid patients/people. I always come back to how clumsy, primitive (almost tribal) medicine is. No real sophistication. No ‘tailoring’. No finesse.

Unless we treat ourselves!

[pennyannie in reply to arTistapple]

Around the year 2000 - ( history lesson now ) all 3 treatment options T3. T4. and NDT were available from your doctor and if T4 the cheapest option didn't restore health and well being there was the option of trying T3 and lastly probably due to costs NDT :

I would also imagine back in these ' dark ages ' doctors were able to order the appropriate thyroid hormone blood tests - and a least a TSH +T3 + T4 blood test run - if with some interest and knowledge in thyroid health and on how these thyroid hormones need to present in a blood test.

The TSH was originally introduced as a diagnostic tool to help identify a person suffering with hypothyroidism - it was never intended to be used once the person was a patient and taking any form of thyroid hormone replacement as then the Free T3 and Free T4 were run.

NDT was the original treatment for hypothyroidism and 100 years ago a doctor would slice off a little piece of dried pig thyroid for a patient to chew on - there were no blood tests nor ranges or guidelines - if the patient felt better but not 100% - a slightly larger piece of dried pig thyroid would be given - until the right size nugget were found - and then that was the dose, the doctor got paid and likely recommended and respected as a good doctor who knew his stuff .

Big Pharma came onto the scene mid 20th century and launched synthetic T3 and T4 on the back of NDT and then went about gaining market share and in a similar time frame, I think, the science of the blood test evolved with the ranges and guidelines to give some help to doctors and as an additional tool to the checking physical symptoms,

Currently - unless you pay - the landscape is very different - with little or no choice of doctor, inadequate blood tests and prompts from a computer which may or may not know your medical history and doctors who seem interchangeable at the drop of a hat and can only ' keep up ' by reading the last line on the rolling screen.

[arTistapple in reply to pennyannie]

Let’s face it. It’s a blooming shambles. The NHS does not know what the right and left hand is doing! It really can’t do any reflecting on how appalling the mess is and therefore don’t seem to have a clue how to fix it. It’s both worshipped and castigated. Often both views held in one person. I am definitely of that view.

I am concerned it is terminally tainted by the clear corruption of its values, never mind the actual corruption due to appallingly ignorant (and self preserving) government decision making. Maybe we have been at the forefront of this battle? We, after all, are ‘fair game’. Whilst ill, we are remarkably unable to defend ourselves from any bullies, no matter where they are in society.

It’s apparent that this is not just the NHS. In fact the NHS may be the last protected bastion of what was true and fair in our society.

We have been warned of this demise in the making. However, by now, surely it escapes few people’s notice.

[Lily905]

I take NDT & T3. I found through trial & error my NDT only works properly if I take it 3 hours after & before food & drink so I take it in the middle of the night. I just swallow them.I take my full dose of T3 first thing in the morning with 2 cups of coffee - I don't eat breakfast. I just swallow them. Most people a avoid taking T3 with coffee or food because it messages up absorption.

[arTistapple in reply to Lily905]

What’s your combination dose Lily905?