Results advice please

[Sewingbee24]

I have just had my 3 monthly blood test. I take 1.5 grains of armour thyroid and 15 mcg of Liothyronine daily. I feel great BUT my results don’t reflect that. I’m not sure how to go about obtaining optimal levels. Advice please. I am very nutrition conscious and take supplements as follows. Multi guard ADR, magnesium 375,Saccharomyces Cerevisiae Boulardii Methyl B complex and Vit D

[pennyannie]

Hello Sewingbee:

Optimal levels for me are where I feel well :

I take NDT which does not present in blood tests the same way as synthetic T3/T4 so the blood test in relation to the ranges means nothing at all.

The blood tests and ranges were introduced to be used alongside Big Pharma launching their synthetic thyroid hormones of T3 and T4 treatment options.

With NDT you will likely have a suppressed low TSH - which happens when taking any form of thyroid hormone replacement containing T3 and results in a low suppressed TSH -

We track on the Free T3 and from a fasting blood draw around 10-12 hours after last dose.

The T4 can be low in the range compared to when taking synthetic T4 and this doesn't matter if you feel well.

So 1 + 1/2 grain NDT is T3 x 13.50 mcg + 57mcg T4 - + T3 x 15mcg :

totalling - T3 x 28.50 + T4 x 57mcg 57 mcg

Just wondering if you might do as well on a T3/T4 synthetic combo as it might well be significantly cheaper for you ?

No thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -

I now aim for a ferritin at around 100 - folate 20 - active B12 125 ( serum B12 around 500++) and vitamin D at around 125.

[elaar in reply to pennyannie]

"The blood tests and ranges were introduced to be used alongside Big Pharma launching their synthetic thyroid hormones of T3 and T4 treatment options."

I'm not sure exactly what you mean by this? The ranges represent a large sample size of people, where FT3/FT4 ranges are shown at the 5-95% percentiles. They're normal medical measurements, and nothing to do with Big Pharma.

I don't know very much about NDT, as I don't use it myself, but I've seen that NDT T3/T4 ratios are different to what Humans normally produce. I believe they're a bit top-heavy T3 wise, which presumably could result in FT4 being lower if FT3 is "normal", and TSH would obviously be suppressed due to the higher T3.

[pennyannie in reply to elaar]

Yes - the ranges represent a random proportion of the population -

with the presumption being this cross section be the accepted range - and its accepted that we, as hypothyroid patients, once optimally medicated sit within this cross section of the population range.

Prior to Big Pharma launching their synthetic T3/T4 thyroid hormones and adopting these population ranges to dose and monitor to -

Hypothyroidism was successfully treated with NDT for over 100 years and you simply dosed to the relief of symptoms as back then the ' science of blood tests ' wasn't even there to know or even start questioning anything even the differential in human / pig ratios -

the fact was, and is, that Natural Desiccated Thyroid works very well for many thousands of people dealing with hypothyroidism -

though we now know now the T3/T4 ratio between these 2 species is different.

NDT is a prescription medication, medically graded with a 1/4.22 ratio - T3/T4 and within a known tolerance level as are all medications.

I think the question is more one of - what is a ' normal T3 ' - in the range, somewhere, anywhere, or where it feels right for the patient -

we all have our unique set point, likely within the ranges, but I don't think you'll find your health and well being in the bottom quadrant of the ranges, nor maybe at the top of the ranges -

as it does seem that it is towards the bottom half of the ranges is where those with hypothyroidism continue to be dealing with disabling symptoms of hypothyroidism.

[elaar in reply to pennyannie]

Whilst there are plenty of flaws comparing our ranges with those found in normal people without Thyroid issues, there is no better alternative, it's the best we have.

We must assume that our thyroid values were within those normal ranges before the trouble began, and that ideally our bodies would want those same levels now, so it's not wildly incorrect to compare to the public normal range. The difficulty is, we have now lost the dynamic nature of the thyroid feedback loops, and so it makes sense that our ranges now need to be a bit higher, the question is to what degree.

The long half life of T4 means, in my personal opinion, that it does not necessarily need to be high in the range "to feel good", simply that ideally it should be around what it was before, and someone could have been absolutely anywhere in that range. There's no evidence that Hypothyroid people are better higher in the range, unless they're not converting well, in which case they should not be on mono-therapy, and risking long term issues with high FT4. My own research (and a few others on here have also come to the same conclusion) that it should be under 50%, preferably a bit lower (My opinion, not fact of course).

Much more importantly, like you say is the T3, what their body expects, and how you ensure that when you're dosing, and no longer have the dynamic drip-feeding from the Thyroid.

NDT is successfully used by many people as you say, we're all different, and it's great that we have options. But you have to wonder how successful it has really been over 100 years, when there were no forums such as this to historically detail people's complaints, and research papers are nothing like what they are today. What were the long term outcomes? (I'm not suggesting there were, and that it's a worse treatment, just that I can't tell either way).

One of the reasons that Levothyroxine was able to takeover the market in the 80s wasn't just that Big Pharma was throwing money around, but also because NDT was found to have massive inconsistencies in potency, some were found to have zero hormone activity, whilst some had up to double the stated dose. So I'd be surprised if it was completely successful for those 100 years.

[pennyannie in reply to elaar]

Natural Desiccated Thyroid is a medically graded prescription only thyroid hormone replacement and the original treatment for hypothyroidism and on the back of which Big Pharma launched their synthetic T3 and T4 thyroid hormone treatment options.

Both Stateside Armour and Canadian Efra are on prescription through the NHS on a Named Patient Only Prescription - though as a new patient it seems this treatment option is now Black Listed.

The manufacturing and production of synthetic thyroid hormones has also had issues of non compliance - and all we can hope for is that all companies comply and follow the regulations.

I have nothing more to add that is of any relevance to the O/P.

[Brightness14 in reply to pennyannie]

Yes you are right, here in France a few years ago a legal action was brought on behalf of patients who took Levo made in Germany i.e. Mannitol was added and made many people ill. It was not added to the list of ingredients. The outcome was in favour of the patients who won over 7 million in Euros.

[pennyannie in reply to Brightness14]

Yes. thank you, I have read about that particular incident amongst others -

and I think your reply should have been to the forum member who I was replying to :

[Brightness14 in reply to pennyannie]

Yes probably my mistake.

[pennyannie in reply to Brightness14]

No worries - xx

[Sewingbee24 in reply to pennyannie]

Thanks for your reply and the explanation about low TSH. I wasn’t aware of that suppression. I have optimal levels for B12 etc but these weren’t taken with this test. I will n mention the T4/T3 synthetic combo to my functional dr as you can imagine it does cost a small fortune at the moment. Thank you for taking the time to answer.

[pennyannie in reply to Sewingbee24]

Well your functional doctor should not be ' hung up ' on the TSH reading anyway - and should have knowledge of how NDT presents in blood test results.

[greygoose]

Optimal is not a number. It doesn't matter where your numbers are, if you feel good then that's all that matters. Why would you want to change anything?

[Sewingbee24 in reply to greygoose]

Thank you for your comment. That’s reassuring to know.

[greygoose in reply to Sewingbee24]

You're welcome.

[jgelliss in reply to greygoose]

DITTO!!!! O learned it the hard way too. Falling into a Range does not mean You feely well. I personally stopped going by Ranges. I dose according to the way I feel. I think that is where Dr's go wrong. On my lab results it showed I was in range but I felt very unwell. I later went for TT. Dr's need to respect what the patients are saying. The lab results are not be all.

[tattybogle]

couple of thoughts .

if it ain't broke ( you feel well ), why fix it ? .

can you give details of time of your last dose NDT / and T3 before that test was taken, and time of test ..... difficult to give sensble answers about T4/T3 levels without knowing that .

a bit more info on why you've ended up on NDT + T3 might be useful for replies . ( last post 3 yrs ago you were on small dose of levo and needing an increase)

but (assuming last dose was not too long a gap before test), there is nothing that would worry me unduly about those TSH / fT3 / FT4 levels ..... so i don't see any need to change anything if you feel well .

[Sewingbee24 in reply to tattybogle]

Thanks for your reply. My last medication was the previous day at lunchtime the test was done at 7.45 am. I am now under a functional dr who prescribed NDT and Liothyronine as levo was not working at all and I had a conversion issue.

[tattybogle in reply to Sewingbee24]

so your mid range ft3 result is the lowest level of fT3 you have in your blood on any day, but it will obviously be somewhat higher than that for several hours each day after you your take dose[s]

it's a good idea to test no more than 8-12 hrs from last dose T3 , to give you a more realistic idea of your average levels of fT3 over the day .(move time of last t3 dose on pre test days if necessary , so gap isn't too long )

and occasionally it's interesting to test around 3 or 4 hrs from last dose T3, to give you a rough idea of how high fT3 is getting at it's peak shortly after after each dose ~ but not a good idea to show results that are taken around 'peak' level to medics ,unless they are well versed in using T3 , as it tends to freak them out unnecessarily if it's over range.

but still , given your mid results and doses , it seems unlikely that even your 'highest' daily fT3 levels would be any cause for concern.( many people using t3 will have fT3 go slightly over range for a few hrs shortly after each dose, then coming back down into range , without it seeming to cause them any issues . no one really knows if this is actually a problem / risk long term or not, and remember, the level in the blood is not the same as the level in your cells, so even if blood levels do go over temporarily, that doesn't necessarily mean your cells are getting too much.