Advice on raising NDT

[SarrahMay]

Following on from my post on 26/02/24, my symptoms got worse (increased number of anxiety attacks and unable to cope with pain in head/neck and upper back) and the GP didn't have any ideas, so I saw a thyroid specialist recommended by thyroid UK in April. The doctor had my blood tests done and these are some of the results, taken when I was on levothyroxine 75/50mcg daily and before I started new treatment.

These were taken in late March 2024 and processed by a different lab to the previous results that I posted:

Thyroid Stim. Hormone 2.050 mIU/L 0.270 - 4.2

Free T3 3.7 pmol/L 3.1 - 6.8

Total Vit B12 777 pmol/L 145 - 569

Folate (serum) ** 19.8 nmol/L >7

Free Thyroxine (FT4) 26.2 pmol/L 12 - 22

25 OH Vitamin D 52.7 nmol/L 50 - 250

Ferritin 264.00 ug/L 30 - 150

Saliva Cortisol - 06:00 - 10:00 * 16.50 <20.3 nmol/L

Saliva Cortisol 12:00 * 2.76 1.6 - 5.6 nmol/L

Please note change of midday ref range inline with Pilger et al 2018.

Saliva Cortisol - 16:00 - 20:00 * 3.60 <6.94 nmol/L

Saliva Cortisol - Midnight * 2.07 <7.56 nmol/L

The Doctor advised that I supplement with Vitamin D and stop any B complex supplements as B12 was very high (I was taking B complex no more than one tablet per week,and sometimes not at all) . Five weeks ago I stopped levothyroxine and started on one grain (split into two doses per day) of Armour NDT which I was to raise to one and a half grains daily.

For two weeks after starting NDT my anxiety increased. After the initial two weeks my anxiety started to settle and after four weeks, my anxiety was much better than it had been for a long time but my energy levels started to plummet and my mood became more gloomy, I also developed slightly swollen hands and face and have dizzy spells. The pain in my head, neck and shoulders increased when I started NDT and never reduced. I had to increase the use of pain killers.

I recently increased my NDT dose to one and a quarter grains for three days, and then reduced it again back to one grain, as the pain in my head increased to the point where it was waking me in the night.

Strangely, in the past two days, my anxiety and jitteriness has returned with no change in my dose.

Does anyone know why increasing the NDT dose increases my pain and whether this would be expected to settle (the pain increase I had when I first started NDT hasn't subsided and that was 5 weeks ago).

I am menopausal and I started NDT 5 weeks ago. I had a cortisol saliva test done which showed that I have low cortisol.

I am scared to raise the NDT above one grain at the moment because of the head pain and it stopping me sleeping. Does anyone have any advice?

I'd be grateful for anyone's thoughts.

[radd]

SarrahMay,

You are over-medicating. If you were previously medicating 75mcg and 50mcg Levothyroxine on alternate days, then a more appropriate dose would be 1/2 to 3/4 of a grain Armour.

1 grain Armour contains 38mcg T4 + 9mcg T3. However, manufacturers claim 1 grain to be bio-equivalent to 100mcg T4, although many members (including myself) would put it at about 85mcg. Going further, some members (including myself) have found Armour to be T3 potent, which prevented raising FT4 labs without FT3 going too high. Therefore, we reduced Armour and added a bit of Levo back in.

I really think your endo should have just added a little T3 meds to your Levo which allows better titivation and more control. NDT can be fussy to medicate and he plainly doesn't understand the dosing regime.

Apart from over-medicating, anxiety can also be caused by cortisol issues when taking thyroid meds. When we have a healthy thyroid gland our hormones work in synergy with other hormones, but when we are medicating thyroid hormone we are forcing a set amount each day of what we should have but because of other issues perhaps cannot tolerate at this moment.

Many members have found their thyroid hormones to perform better when sex hormones have been replaced after menopause.

Sorry you feeling so bad 🤗, but it appears you have several issues that need sorting.

[SarrahMay in reply to radd]

Thank you Radd! That's really helpful.

My oestrogen levels are virtually non existent but I was told that HRT could be added later; I presume once thyroid hormones are more stable. Is that always the case?

When I was on 75/50 of levo daily, my T4 was four points above the normal range. I assumed that meant I had too much levo and not enough T3 but I'm not sure.

I'm wondering whether it would be a good idea to get my cortisol checked again to see whether there has been any improvement or is it too soon after 5 weeks on Armour?

With thyroid, oestrogen and cortisol all out of balance, I wonder what the best starting place is or is it trial and error as everyone is different!??