Suppressed TSH and getting optimum on NDT

[Insomania]

I'm being treated by a private thyroid Dr for hypothyroid, I'm on NDT Armour and I've been slowly titrating for 12 months from zero treatment. I couldn't get treatment on the NHS.

My latest results show TSH at 0.01. My T4 and T3 are the highest they've ever been and I feel much better than I did last year but I don't yet feel optimum. My vitD and ferritin are the best they've been. When my dose increases by 1/4 grain I get this great 'uplift' and feel this for several weeks, then I'll start getting fatigue again and it's time to retest and increase.

At my last review, the Dr has stopped my increases of Armour and says he thinks my remaining symptoms are low cortisol (2 tests shown adrenal fatigue stage II). He suggested I retest throid in 3 months.

I'm only on 1 and 1/4 grain per day. This seems like a low dosage to me, and like I say, I don't feel optimum. (Note: I am a short adult 5' 1" and weigh 8st 3oz.)

I feel disappointed because I feel a lot better than I did last year but I want to get optimum.

I'm active during the day, I can garden and DIY again. My lingering symptoms are afternoon fatigue, night time teeth clenching, insomnia with getting to sleep (I sleep for 7-8h once I'm asleep, now I'm on Armour). I've got midnight munchies again. I've just had a bout of painful mouth ulcers affecting eating and noted the last time this happened was pre-Armour.

Is it possible my TSH could go up in three months?

I'll post my latest results. Advice appreciated.

[pennyannie]

Hello Insomnia :

I think it inevitable that your TSH will become low/suppressed as you become optimally medicated on NDT.

The TSH was originally introduced as a diagnostic tool to help identify someone dealing with hypothyroidism and was never intended to be used once the person became a patient and taking any form of thyroid hormone replacement.

Once hypothyroid and taking any form of thyroid hormone we should be dosed and monitored on our Free T3 and Free T4 readings and not a TSH.

NDT is the original treatment for hypothyroidism and used successfully for over 100 years by very many thousands of people and you dose to the relief of symptoms, and not a blood test.

When Big Pharma launched their synthetic T3 and T4 thyroid hormone treatment options on the back of NDT around 70 years ago we also then had introduced the ' science of the blood tests ' and the ranges and guidelines to work to.

When taking NDT the most important reading is the Free T3 and its best to just be consistent with times of fasting blood draws so you can compare and track what is going on.

I self medicate NDT and found it helped me to find my best dose by tracking on my physical symptoms of blood pressure, pulse and temperature AM and PM -

and as I built up my dose in 1/4 grain increments and found my blood pressure and pulse remained constant which was reassuring and my body temperature slowly moved up from 35.4 to 36.6 where it tends to always hover, now around 6 years on.

I'm with Graves Disease post RAI thyroid ablation 2005 and became very unwell some years on ( RAI consequences though no NHS acknowledgement ) and after being refused both T3 and NDT on the NHS - decided to self medicate and do it for myself and am much improved to how the NHS would have me.

I've not had a problem with cortisol and can't offer help there - but I do also take adrenal glandular and started these 2 years before I started NDT.

[greygoose]

Could the TSH rise again? If you're under-medicated, yes. But is TSH all that is tested? Because that is going to be low/suppressed when taking NDT because of the T3. That's what T3 does. And you can still be under-medicated even with a suppressed TSH. This doctor doesn't know much about treating hypo, does he!

[Insomania in reply to greygoose]

Well that’s why I was surprised because he’s been great up to this. Completely different approach to anyone else I’ve seen. He treats by symptoms and T3 and that’s now at 76%. The reports to share with my GP acknowledges TSH is suppressed due to T3 (because GPs get concerned about it). He’s tweaked my supplements through the year and they’re looking good. But I wonder if there’s now caution because it’s now at 0.01. I can’t see how I can get fully medicated…

Maybe I should look at the low cortisol?

[greygoose in reply to Insomania]

Well, it wouldn't hurt to look at cortisol, but it's still worrying that he wants to stop increasing the NDT. And, he really should have thought about cortisol before even starting you on NDT - either that, of just continue increasing the NDT and hoping the adrenals will sort themselves out - as they often do. It's like changing horses mid-stream.