NDT - rushing heartbeat?

[malohant]

Hi all

I've been on NDT since last summer, taking 1 grain in the morning when I wake up and 1/2 grain in the evening before going to sleep. I was taking Armour until January, when I switched to Erfa because of costs. My recent blood test results are in the attached image.

I have had a reduction in fatigue on Armour, but it is still there. I asked if I could increase to try and reduce symptoms further and was told yes, try 1 grain in morning and 1 grain at bedtime. I tried this but got a very excited pulse while trying to sleep, and woke up in the night with my heart racing, so I went back down (my NHS endocrinologist is having kittens that I'm giving myself future heart problems even before that).

However at the most recent review, the specialist I'm seeing said 1) that he thought I'd still been taking 2 grains (my mistake for misreporting, brain fog and telehealth) and 2) that I still need an increase.

As mentioned I switched to Erfa for cost, but I am finding Erfa less effective and will probably switch back. I have been trying taking 1 grain in the morning, 1/2 grain early afternoon and 1/2 grain at bedtime for about a week - this has been better for sleep but I am still feeling my blood is pumping too strongly.

Any advice please? Is the racing pulse/strong heartbeat something I am rightly worrying about? Why might it be that I still have symptoms?

Thanks for your help in advance

M x

[GlowCoach Administrator]

Firstly have you tested key vitamin levels recently, if so what were the results?

What are you supplementing with?

How much NDT are you taking before blood testing and what timing do you allow?

FT4 is pretty low which doesnt suit everyone. If vitamin levels are good you could consider adding a small amount of Levo to raise FT4.

[malohant in reply to GlowCoach]

From November - folate 3.8 ug/L, ferritin 114 ug/L, B12 766 Ng/LDon't have a recent vit D, has always been low but I supplement 2000iu daily.

Supplementing vit D, vit K2, magnesium, b complex, B12.

For testing - I take 1/2 grain 12 hours before (true for last test but not the one before).

It surprises me to see you suggest adding in levo - not that I have enough knowledge to question it, but I was on levo only for 4+ years and always felt awful. NDT (well Armour at least) has been a noticeable improvement.

[GlowCoach Administrator in reply to malohant]

Were you also supplementing with A B complex before the November Test? Folate was very low then and you may need an additional separate 400mcgs methylfolate.

2,000iu vit D is often not quite enough. members seem to need a minimum of 3,000iu, some a little more. Suggest you test vit D to be sure you're taking enough.

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

On levo alone you would have been missing T3 which is contained in NDT. Likely the T3 content is improving how you feel but many people need an almost equal amount of T4 to T3 in blood results.

We need what we need, and that is the correct combination of each hormone as suited to us as an individual.

Armour is ideally suited to pigs but not necessarily humans without some adaptation.

[malohant in reply to GlowCoach]

Yes I've been on b complex for a few years now. I'll try a methylfolate supplement, thanks.

Really appreciate your advice, thanks

[Jazzw]

How fast is your pulse?

Something you might want to experiment with is raising by a quarter grain at a time, rather than half a grain. And maybe avoid taking it at bedtime. It does take a week or three to get used to dose changes, I find.

[malohant in reply to Jazzw]

I haven't measured my pulse, sorry.

Thanks for your suggestions, I will try that.

[Farrugia in reply to Jazzw]

Yes I agree - I find a quarter of a grain change can make quite a big difference.

[pennyannie]

Hello Malohant :

Efra and Armour have slightly different T3/T4 content - though I doubt it would make much difference in the overall scheme of things :

Efra 1 grain tablets contain 8 mcg T3 + 35 mcg T4 -

whilst Armour 1 grain tablets are 9mcg T3 + 38 mcg T4 :

The ratio only applies when taking T4 monotherapy and the challenge is just to find a dose of NDT that works for you -

and as for antibodies - if with Hashimoto's it is said that Efra contains the least fillers of all the NDT brands and so less likely to ' upset ' your immune system and cause further AI issues -

and I am just wondering since you have o/range TPO is this a signal that your body does not ' like ' NDT - or that you are coming down from or building up to another AI attack as some people with Hashimoto's simply can't tolerate any NDT and need to take synthetic T3/T4.

Your last result looks as one would expect - but this was only from 1/2 your normal dose so I imagine had you taken your main dose of 1 grain you may well have found your readings much higher - and too high as they were in December.

More subtle symptoms of over medication would be raised pulse and blood pressure -

but your own description of a racing pulse / strong heartbeat is enough to know that you are now over medicated - so stop taking the Efra for a few days and allow this excess T3 to pass and leave your body -

I would then think about these underlying TPO antibodies and if there is a cause - as in May last year there were no TPO readings - were AB tested then ? - and guessing this blood test as on T4 monotherapy ?

Moving forward - if staying on NDT - slowly start to rebuild your dose and go up by 1/4 grains slowly - weekly/fortnightly - and monitor on blood pressure, pulse and body temperature AM & PM -

you may find you need less rather than more NDT as your fatigue can also be caused by too much medication and over stimulation.

Did you try a synthetic T3/T4 combo before switching to NDT ?

[malohant in reply to pennyannie]

Hiya - both TPO and TG ab have been out of range since I developed Hashi's, TG has come back in range but TPO still needs to come down more, I don't think it's a reaction to the NDT. December blood tests were not taken under proper conditions so probably shouldn't really be counted.

Blood tests last Mayb did not include antibodies which is why there were no results. Yes I was previously on T4 mono.

I have previously tried T3/T4 (a couple of years back) but didn't feel it made much difference, up to the point that my then Endo was happy to prescribe.

Thanks

[malohant in reply to pennyannie]

Also - sorry, I thought T3 left the body in less than a day? Am I mistaken?

[pennyannie in reply to malohant]

I think you need to wait at least 3 days - we are all different as to how we utilise and absorb thyroid hormones -

No thyroid hormone replacement works well until you have optimal levels of the core strength vitamins and minerals -

What are your current readings for ferritin, folate, B12 and vitamin D :

[malohant in reply to pennyannie]

From November - folate 3.8 ug/L, ferritin 114 ug/L, B12 766 Ng/L. Don't have a recent vit D, has always been low (sub 100)

[pennyannie in reply to malohant]

Ok - as a woman I now aim to maintain ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin d at around 125.

However first off you seem to be clearly over medicated - so let's see how you feel after a few days -

Ferritin is not too bad - I make my own chicken liver pate and that keeps my levels topped up :

[waveylines]

Typos? 😊😊 All the dessicated thyroid extracts or NDT 1grain contain 38mcg of T4 and all contain 9mcg of T3 EXCEPT for Erfa that contains 8 mcg of T3 (but 38 mcg of T4).

thyroidresearchjournal.biom...

[pennyannie in reply to waveylines]

I think you'll find 1 grain Efra contains 35mcg T4

[waveylines in reply to pennyannie]

My sincere apologies penny annie!! Shouldve gone to specsavers! Ure completely right! Thankyou for correcting me and I'm sorry I erroneously corrected u! No wonder its a bit cheaper then!! 🤣😂

[pennyannie in reply to waveylines]

You didn't as I did a typo anyway !!

[waveylines]

I've been on NDT for 17yrs. And been on Armour for several years now. It is very expensive.....lol. I've been on most of the ndts over the years. These days only 2 brands of ndt on script here is Erfa or Armour Thyroid. Link to ratios of T4 to T3 of different brands;-

thyroidresearchjournal.biom...

So Erfa has a slightly lower T3 content which you have noticed but thr same t4 content. As on Armour of 1 1/2 grains the T3 content would be 13.5mcg and on Erfa 12mcg.

I don't know why your Endo (?) told you to take 50% of your Erfa dose at night! Keep anyone awake!! My Endo told me not to take any ndt after 5 in the afternoon as it eill keep you awake.

When I needed to split I took the bulk of my ndt first thing with a little top up up around 2ish in thr afternoon as I used to get an energy drop.

So in your shoes my first step would be to take your one grain as usual first thing is but move your half grain to early afternoon.

Next step when that's settled (dont need to wait 6 weeks as its not a dose change but just a change in timings) I'd increase your morning dose by 1/4grain bringing you to 1 3/4 grains. Usually increase are 1/4grain at a time.

Alongside this definately take methylfolate 400mcg. And you need to address your ferritin too.

The cofactors are very important and need to be optimally for best usage if your thyroid neds.

NDT has a much slower rise and fall of T3 cibtent so often can feel even. Many can take one dose per day because of this. But some do need to split it. But once you get your cofactors more optimal you may find you no.longer need to do this.

Hope this helps.

[malohant in reply to waveylines]

Thanks - yes I will try moving my dose earlier and add methylfolate.

I struggle to address my ferritin as the only way I can really stomach organ meats is as pate, but I don't tolerate black pepper so have to make it myself and rarely have the time/energy.

Thanks

[waveylines in reply to malohant]

Awww that's tough. I'm not an expert on raising iron as I was only mildly anemic which corrected with thyroid hormones and b12 complex with methlyfolate.

[malohant]

Thanks all for your replies - I will certainly try the things you suggest.

Can I check, am I right in thinking that feeling of strong/fast heartbeat is a sign of over medication, so I should adjust medication down until I no longer feel it? Is it a symptom I should be concerned about?

Thanks again x

[Freedom2025 in reply to malohant]

Yes that can be hyperthyroid

[Pearlteapot in reply to malohant]

It can also be a sign of under-medication. Under medication can lead to high blood pressure and high blood pressure leads to fast heart rate and (for me) a rushing sensation in the head. When I am undermedicated my BP goes to Grade 1 Hypertension and when I am well medicated my BP is optimal. I use BP as a significant indicator of whether I am under medicated. So far, high BP has correlated with blood tests that show I am under medicated and not over-medicated.

I suggest that you test your BP at the GP surgery or if you can, buy your own BP monitor and test regularly at home.

Edit: Your January results suggest that you are undermedicated.

[terebol]

I have been on thyroid meds for 30+yrs using levo @times when the ndt I used was pulled by FDA. With Nature-throid gone I switched to NP thyroid - much, much less expensive than Armour. The excipients are the bare minimum. Maybe it is sold in the UK?

[malohant in reply to terebol]

It's not available from my current provider, but worth looking into - thanks

[Freedom2025 in reply to terebol]

How do you find NP

[Freedom2025]

May I ask overall how have you found armour was to take did it take away your low thyroid symptoms.

[malohant in reply to Freedom2025]

Not completely but more so than Erfa

[Freedom2025 in reply to malohant]

And you are taking presently.are you in the u.s. I am in canada. Erfa has stopped working! I'm terrified because I'm fading away here.

[malohant in reply to Freedom2025]

Oh gosh I'm so sorry! I did hear Erfa was less reliable than armour, which was why I went for armour first but am struggling to afford it. Yes now taking Erfa. I'm in the UK.

[Freedom2025 in reply to malohant]

No worries is it working for you