just wondering if most members would say it is best to always start with T4 at the beginning of hypo journey over say NDT or T4/T3 combo.
I have done a short trial of NDT (at too high dose) which caused quite extreme pulsatile tinnitus. I am ready to try again, at much lower, slower dose or I could put that on hold and ask to try T4 instead and see how I fair.
I need to do something as I am feeling really low and symptoms are getting progressively worse. Response to NDT has scared me a bit.
thanks for any advice.
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PaleoGirl
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Personally I think it’s ALWAYS best to start on just levothyroxine
A) it’s mainstream, widely available, free on NHS and easy
It’s a storage hormone…..so is smooth and gentle and well tolerated by the majority
There’s approximately 2 million people in U.K. on levothyroxine
It does still need to be started at lowish dose and increased slowly upwards over several months testing regularly
B) taking anything that contains T3 will significantly reduce TSH rapidly and this reduces your own thyroid output of hormones very quickly
Also most medics freak out at low/suppressed TSH
Adding T3 too soon makes it difficult to get Levo dose increased high enough, because TSH will drop rapidly
C) majority of people do absolutely fine on just levothyroxine provided
Dose is fine tuned
Pay attention to brand of levothyroxine. May need to be on one particular brand
Test correctly, early morning and last dose 24 hours before test
Vitamin levels need to be tested and maintained at good levels
if autoimmune…...may benefit from/need to be on gluten free/dairy free diet
D) if after doing all listed at C…..if Ft4 is high….but Ft3 remains low and ongoing symptoms……then trial adding SMALL dose T3 alongside levothyroxine. This is increasingly possible on NHS.
E) many thyroid patients do fine on just levothyroxine for years or decades ….but may eventually need T3 added…..
NDT is very expensive and impossible to get on NHS
To metabolise B12 the body needs folate. If current levels of folate are low then make sure that you only take methylfolate. Avoid folic acid completely.
That’s interesting, thank you. My most recent vits/mins are in my profile. B12 is slightly over the range and folate looks okay, so maybe not in my case? The pulsatile tinnitus has still not settled, although less intense now.
Yes, and for many reasons such as its cheap, easily assessable, easy to adjust doses, it works well for most hypos, but primarily you can’t know if you actually need any T3 meds until you’ve medicated T4 alone for some time.
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Is it always necessary to reduce levothyroxine dose when adding T3?
NDT plus T3 top-up anyone? 
Has anyone felt better on just T4 rather than T4/T3?
is it time to try NDT ?? 
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