Seasonal Variation in Dosing

[FancyPants54]

If you need to adjust your dose for winter with an increase in meds, approximately when do you have to do the increase? Autumn? Christmas? January?

I am absolutely exhausted and sedentary and falling asleep mid word when typing. I feel really grim and have done since the end of the Christmas holidays. I did nothing but rest over Christmas either.

I have done a test this week past. But instead of doing it 14hr after last NDT dose as I normally do, I tested 4 hours after to see what my peak T3 levels might be. I actually wondered if I had gone too high and was seeing Dio2 action converting my active hormone away. How wrong I was on that one.

I have sent for another test kit to repeat the test at my usual time 14 hours post NDT dose so I will have 2 data points to review. I didn't feel like this before Christmas despite a huge amount of stress in November and December.

My "peek" hormone level test gave me a slightly lower TSH than I usually get (but blood was drawn at 12 noon not 8am so that will have impacted the TSH probably), but my FT4 and FT3 are around what I normally record at the 14 hour mark.

New test, 4 hours post dose on 20th January 2025

TSH 3.34

FT4 15.2 (12-22) - 32%

FT3 4.6 (3.1- 6.8) - 40.54%

I'm on 2 grains of Armour a day + alternating 37.5/50mcg Levo (= 3 x 50 pw)

My previous test on the same amount of Armour but just 37.5mcg Levo every day and tested 14 hours after last NDT dose gave me the following results. I felt a lot better than this at that time.

Test on 16th September 2024

TSH 4.04

FT4 15.7 (12-22) - 37%

FT3 4.5 (3.1- 6.8) - 37.84%

I'm going to repeat the 14 hour post dose test as I said above. But does this look like a seasonal issue to anyone? I have been trying to improve my FT3 level by increasing my Levo slowly as taking NDT really tanks my FT4 and I don't feel good with it too low.

[greygoose]

Looks like good old fashioned, common or garden under-replacement to me.

Of course, leaving 14 hours instead of 12 might give you very slightly false-low results, but not to that extent.

But do you have a test done in the summer on the same dose? That's the only way to know if you need a seasonal adjustment.

[FancyPants54 in reply to greygoose]

14 hours instead of 12? I didn't say that. Did I? This test was taken 4 hours post NDT dose. The September test was 14hr post NDT dose.

I have never needed to adjust before for winter. And I don't understand why my levels have dropped since Christmas.

[greygoose in reply to FancyPants54]

You said the first one was four hours, I was looking at the second one - which was actually done first. Sorry if I'm confusing you. lol The one with a TSH of 4.04. Was that one done at Christmas? You don't say. But Christmas is in winter, too, and that test shows under-replacement, and the one after only four hours - as you said - wasn't much better. If that's your peak then it looks like an absorption problem.

However, how do you know that your peak is four hours after taking your dose? It might on be at all. And it lasts such a short time that it could be so easily missed that it's really not worth trying to catch. That's my opinion, anyway.

[McPammy]

One might think that during the winter months you might need less depending on your activity levels. In the winter months I used to feel over medicated and my TSH would go lower. So I joined a gym to make sure I was being more active to burn up the T3. That worked for me. But your results post taking your meds are showing you need an increase. Are you eating more and maybe the absorption is less or changed your diet maybe. Hard to say what’s going on really but it looks like you need an increase. TSH over 2.5 usually you’ll have symptoms.

[tattybogle]

oh ....when you said on previous post that you didn't bother about TSH , i had assumed you meant because it was usually very low / supressed.. i didn't realise it was 3/4 ish

so please ignore my comment on that post about possibly being on a bit too much overall .... TSH at 3/4 ish suggests the opposite.

[tattybogle in reply to tattybogle]

interesting that peak (ish) fT3 is not much higher than your 14 hr level.

(ok, as GG correctly points out , we can never know exactly when highest point of this peak is , but for a straight T3 dose , then 3 or 4 hrs after dose is likely to be 'something like' the highest point it gets to assuming no absorption problems , NDT however , well that makes it even harder to be sure because the research info we have about when fT3 peaks in blood is from T3 use , and the T3 from NDT possibly behaves a bit differently in test timings , because ( i think ?) the T3 in NDT is mostly 'bound' (to thyroglobuwhatsits ? ) not free.. and then i get totally out of my depth. )

anyway .... i the numbers all point to you needing more (either T4 / T3 , or probably both ), not less .

[FancyPants54 in reply to tattybogle]

Yes, I definitely don't need less! I have proved this point at least.

When I say I ignore my TSH, it's because it doesn't respond as you might expect. I can take way more T3 than I am now and still have a TSH that appears I need medication. Then another time on the same dose it will be lower, and again higher next time. I've never managed to get it to go low. And I can't push my dose up too far because I have permanent AFib with a fast rate and pushing up my dose pushes up my HR.

[SlowDragon Administrator in reply to FancyPants54]

Looking at your helpful results over time on profile

Can’t see any vitamin test results since switching to Armour

Do you feel better or worse on NDT plus Levo compared to Levo plus T3

Which brand of Levo are you taking

and which brand T3 were you taking

Are you on gluten or dairy free diet

[FancyPants54 in reply to SlowDragon]

My vitamins are checked twice a year for my endo appointments. I'm always struggling to get Ferritin higher, but the rest are OK/good. I know what to aim for thanks to this site.

I use Wockhart Levo or Mercury and don't have issues with them. I like NDT. I don't get rushes and drops like I did with Levo and T3. I used Thybon Henning when I used T3 + Levo.

I have found when I tied 2+1/4 grains Armour (no Levo) that I felt more tired and had more swollen ankles. But I haven't tried that for a while.

I'm a bit shocked at how much T4 I'm taking now. My dose pre any T3 was just 125mcg. This is way higher but my blood results aren't much different.

No, not gluten and diary free. I have tried that in the past, for over a year with the gluten and about 6 months with the dairy. There were no obvious benefits other than I changed my eating habits so much that I lost a lot of weight. However, back then I wasn't diagnosed hypo so I don't know what my status there was. I don't want to do the exclusions again. I didn't feel good doing it.

[SlowDragon Administrator in reply to FancyPants54]

You currently take NDT in one dose?

Have you tried splitting

[FancyPants54 in reply to SlowDragon]

I do split. 1 grain and levo at 8am and 1 grain at 5pm.

[Jodypody in reply to FancyPants54]

I would never split a dose it’s way too faffy and doesn’t make sense according to a lot of esteemed scientists. I’m currently on armour at 2.25 grains but by accident took 2.5 this morning (in the dark 😂) and thought ah well I’ve been constipated and cold for a few days so what the heck. I’m going to take 2.25 tomorrow and then do my medichecks blood test. What I will say about this latest armour is it’s amazing for me. I’m sleeping 7-9 hours straight every night which I haven’t done for a decade or so. Why are you swaying between the two is it a cost issue as armour is expensive?

[FancyPants54 in reply to Jodypody]

I have tried taking it all at once in the morning but I just run out of everything and feel terrible later in the day.

I'm adding Levo because taking any T3 pushes my FT4 very low and I don't feel good like that. I need some T4. I have no idea what to increase next. I think I need more T3 though, so I should probably drop the 3 days of 50mcg Levo and just take 37.5mcg every day and try another 1/4 grain of Armour. It is expensive. Not sure how I'm going to fund it if I end up needing much more.