I’ve had a a successful (private) endocrinologist appointment where they agreed my T4 to T3 conversion sucks so been given a prescription for Erfa Thyroid trial. His classic Dr handwriting looks like 45mg..?
I’ll be looking to get this filled asap but I’m not clear how I should introduce it. The Endo wants to drop my Levo from 187.5mcg to 100mcg and updating my GP accordingly, but I’m not sure how I take the new combination of tablets. Can levo and Erfa be taken together? I’m probably being impatient and should just wait for the prescription to come through but I like to know what I’m doing as this feels like a big change!
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LittleSchnau
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I've no great knowledge of Erfa other than it is pricey (worth ringing around for quotes) and a bit like marmite it doesn't suit everyone, it is often combined with Levo to get the right ratio of T3&4, a cheaper and possibly more straight forward (more easily adjusted) first option would be to add some Liothyronine did the Endo discuss this option with you?
45mcg is in between sizes so cutting would be required....
ERFA® Thyroid Tablets
EFRA™ distributes ERFA® Thyroid (desiccated thyroid) in Canada in strengths of 30mg, 60mg, and 125mg.
In each ERFA® Thyroid 30mg tablet there is 18mcg of T4 and 4mcg of T3;
In eachERFA® Thyroid 60mg tablet there is 35mcg of T4 and 8mcg of T3;
In each ERFA® Thyroid 125mg tablet there is 73mcg of T4 and 17mcg of T3.
45 milligrams is a feasible dose. But awkward to achieve! They only make 30, 60 and 125 milligram tablets.
Is he aware this will require tablets to be split? Or does he think they make 15 or 45 milligram tablets?
helvella - World Desiccated Thyroid
Contains details of all known desiccated thyroid products including information about several products not considered to be Natural Desiccated Thyroid (NDT/Desiccated Thyroid Extract/DTE).
It is, in principle, fine to take levothyroxine and desiccated thyroid at the same time. But identifying the best doses of each, in combination, for you might take some time.
helvella - Desiccated Thyroid Equivalence
A short document which explains how you can approximately convert dosages of desiccated thyroid and levothyroxine.
Thank you for this information- I’ll take a moment to digest it.
I’m not too worried about splitting tablets as I have to do that currently to reach 187.5 levo! If I receive 30mg increments, I need to take 1.5 tabs a day which will all be down to how well I wield my pill cutter.
But if the prescription is written for 45 milligram tablets, you can't get that dispensed! It needs to be written for 30 milligram tablets even if instructions say take one-and-a-half a day.
And the number of tablets would need to be based on 45 tablets per 30-day month. Which might not have been factored in.
Far from the first time that some doctor appears to have prescribed the un-dispensable!
Basically there are 3 stand alone treatment options for hypothyroidism - irrespective of how this diagnosis came about.
On the NHS we all tend to get prescribed T4 - Levothyroxine - the cheapest option and that works long term, very well for around 80% of all those who take it.
T4 is a pro-hormone and needs to be converted in the body into T3 - which is the active hormone that runs the body - much like fuel runs a car - with the thyroid being like the gear box - synchronising all body parts to work well and get you through the day and back home again and to sleep, repair, replenish your body and ready to do it all again the next day.
Some people have trouble converting T4 into T3 -
So there is also T3 - Liothyronine - which is the active hormone which some have prescribed a small dose of T3 to ' kick start ' metabolism - if T4 monotherapy does not restore one's health and well being.
T3 is said to be around 4 times more powerful than T4 :
Both the above are synthetic thyroid hormone treatment options developed on the back of the original treatment for hypothyroid - Natural Desiccated Thyroid - which is derived from pig thyroids and contains all the same known hormones as the human thyroid - viz - trace elements of T1. T2 and calcitonin + a measure of T3 and a measure of T4 in each tablet - which are referred to as grains.
Erfa is a brand of NDT and a much more expensive treatment option compared to the synthetic treatment options which can be manufactured in volume by Big Pharma.
NDT contains a unique ratio of T3 and T4 in each grain - which works very well for many thousands of people - and offers a full spectrum of thyroid hormones and a complete treatment option in its own right for the vasr majority of people who ake it.
My concern is that taking T4 x 100 mcg and adding in a little NDT - you are in essence watering down/reducing the power of the unique NDT ratio of T3/T4 - negating its effect.
It may well be easier and a lot cheaper to add a little synthetic T3 to a reduced T4 dose.
No thyroid hormone replacement works well until your core strength vitamins and minerals - those of ferritin, folae, B12 and vitamin d are up and maintained at optimal levels -
Do you have any current readings of the above and bench mark readings of your TSH+T3+T4 + antibodies and inflammation ?
I don’t have super recent results as I ended up getting a cancellation so didn’t sort my planned tests in time. Planning to do a full range before I change any medication.
Yes I saw you had replies to your blood test results a few months ago and was writing more about this decision to change your dose from T4 monotherapy to a T4 + NDT combo.
You have Hashimoto's a thyroid Auto Immune Disease and liable to erratic own thyroid hormone production as this AI systematically attacks and destroys your own thyroid gland resulting in you needing a full spectrum thyroid hormone replacement - probably either a T3/T4 combo or NDT :
With Hashimoto's some people tend to have some stomach/gut issues and benefit from stopping / restricting certain food stuffs such as gluten, dairy, wheat and many follow the research and suggestions of Dr Izabella Wentz who writes as thyroidpharmacist.com
Of all the NDT brands Efra is said to have the least fillers - which tends to suit some Hashimoto's patients better.
I now aim to maintain my ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D up at around 125.
On T4 only medication we generally feel best with a TSH under 1 and towards the bottom of the range with the T4 up in the top quadrant at around 80% with the T3 tracking behind at around 70% with a conversion ratio at around a 1/4 ratio T3/T4.
Currently your T4 is coming in at 93% with your T3 at just around 35% with your conversion ratio coming in at - ( 21.30 divided by 4.40 ) 1/4.84 - T3/T4.
Your inflammation is running quite high showing your body struggling and under stress.
You will feel better on a T3/T4 combo of synthetics or Natural Desiccated Thyroid -
I do not see this dose of T4 + NDT as suggested by the specialist working well for you - and I hope I'm wrong :
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