Switching to NDT – How to build up dose?

[Hipp0cratix]

After many years on levothyroxine 100mg, I have now been prescribed Armour thyroid 60mg (1 grain) to be taken twice a day, but starting at ½ grain twice a day. How quickly should I build up from this to 1 ½ grains per day, and then to 2 grains per day? After one week, two weeks ..? What are the side effects I should look out for which would indicate I was building up too fast?

In moving to 1 ½ grains, should the 1 grain be taken first thing in the morning, and the ½ grain 2-3pm, or vice versa?

Thank you for any advice!

Hipp0cratix

[pennyannie]

Hello Hipp0cratix :

I self medicate NDT and switched from 125 mcg T4 to 1/2 grain NDT the following day -

having first run FTF test so I had bench readings to compare to and knew that my core strength vitamins and minerals - ferritin, folate, B12 and vitamin D were all optimal -

as no thyroid hormone replacement works well if these are not maintained at good levels in the ranges.

The T4 will take around 6-8 weeks to fully leave your body and in that time frame, for a smooth transition, as T4 lowers so NDT builds, and you go low and slow building up your dose in 1/4 grain increments - I went up weekly - some suggest fortnightly :

I monitored myself daily on blood pressure, pulse and temperature AM and PM, and whilst these first two physical symptoms remained constant I tracked my temperature rise from 35,4 to 36.6 where it generally sits now, some 6 years later.

There came a week when I didn't feel as good as the previous one - a little edgey and just uncomfortable in my skin - so I dropped down to the previous weeks dose - stayed on this lower dose 6-8 weeks and then ran a blood test just to see what was going on.

My TSH was suppressed at 0.01 - but my T3 was 110% through its range with my T4 at 25% through its range - and literally T3 and T4 results had switched places from when being on T4 monotherapy.

I felt good and have been on this dose - just + 1+ 1/2 grains taken at a toilet break in the middle of the night and now some 6 years later :

If you get to 2 grains - stay on this dose 6-8 weeks and then run a blood test just see if your T3 is moving - if it isn't and you still have symptoms - maybe NDT isn't the best option for you.

If on 2 grains the T3 is moving but you still have niggling symptoms start again, low and slow increasing the dose until you have symptom relief.

I did try splitting my dose but didn't feel any different -

General rule is to take as you would T4 - on empty stomach with a glass of water and wait around 1 hour before you eat or drink anything other than water.

I'm with Graves post RAI thyroid ablation 2005 and became much ill 2013/16 on T4 monotherapy and when refused any other treatment options by my doctor and hospital jumped ship and started looking after myself and am much improved on NDT.

[Hipp0cratix in reply to pennyannie]

Many thanks, pennyannie, for this full and clear advice - very helpful. I had a full set of blood and cortisol tests before making the switch, and my main issue - after years of T4 monotherapy - seems to be a poor conversion rate to T3. I have an appointment + blood tests booked with a private endo in 3 months time to monitor my progress.

I can manage splitting my 1 grain tablets into two, but 1/4 grain increments may be a bit of a challenge! Do you have a pill cutter you could recommend?

Thanks again.

[pennyannie in reply to Hipp0cratix]

Yes - I use a basic pill cutter I purchased from the chemist for around £1.50/2.00 - there is similar on Amazon for around £4.00 :

Some people use a sharp craft knife ?

If you care to share, we can read these bench mark blood test results for you - and we will also follow your progress through to taking NDT and further blood tests and can explain anything to you so you are better prepared and give you suggestions you may like to take forward to the next appointment.

Suggest if you want to take up the offer - start a new post with the blood test results and ranges as then all forum members have the opportunity to advise rather than just me tagged on the bottom of this post.

[Hipp0cratix in reply to pennyannie]

Thank you! I will follow up on your suggestion in a day or so - posting bench mark blood results. I like the idea of charting progress.

[pennyannie in reply to Hipp0cratix]

Ok then - so the first thing we need to see is a full thyroid blood test panel which is a TSH + Free T3 and Free T4 + inflammation, antibodies and ferritin, folate, B12 and vitamin D :

Many of us are forced to run this advanced / ultra thyroid blood test for ourselves - as it seems the NHS can't undertake this basic requirement for us.

If you go into Thyroid UK - the charity who supports this forum - thyroiduk.org - there is a page detailing a list of Private Blood Tests companies who can run this venous blood draw for you - with Medichecks and Blue Horizon offering a nurse home visit to draw your blood at home, at an additional cost, if this suits you better.

I now just arrange a yearly full thyroid blood test now as i still need to maintain the core strength vitamins and minerals of ferritin, folate, B12 and vitamin D at optimal levels for optimal T3 blood test results.

We suggest you arrange an early as possible morning appointment for the beginning of the week as the turnaround generally takes a couple of days and then you'll have your results back before the weekend.

As currently taking T4 monotherapy - on the day of the blood test - fast overnight just taking in water and take your T4 medication after the blood draw so we see what your body ' is holding ' rather than that just ingested.

Similarly if taking any supplements we are measuring leave these off for around 7 days prior to the blood and if taking anything containing biotin these can infer with blood analysis so leave this off for around a week also.

Once with the results and ranges just start a new post asking forum members to help you read and understand the blood test for you and give a bit of history, or complete your Profile page, so we have a some information as to how you became hypothyroid and where you are and what you feel about your current state of health