Natur Throyd vs Levothiroxine+Natur Throyd

[clairetom]

Hallo, first of all please excuse me for my english.
My history: I had Graves desease treated with radioiiodine therapy in 2003 . For 11 years i have been  taking 125 mg levothyroxine . Anyway i still had some syntoms ; beside that, free T4 were on the high range but free T3 were on the low range.
I switched to Dessicated Thyroid (Nathur Throyd 165 mg) 3 months ago. With Natur Throyd both FT4 and FT3 are in the middle range, here are the blood test ,made a couple of weeks ago:
FT3      3,3          (2.4 -4.7)
FT4   11,50         (7-18)
TSH    0,005       (0,27-4.20)
i feel well enough (it's difficult to compare with the past though )  but i am still short of breath when climbing stairs or doing even soft exercise . Doctor suggested to increase 30mg NTH which I am  doing since one week but  i seem to feel even shorter of breath (when i climb stairs or when i exercise) For me it is difficult to understand if short breath is a hypo or hyper syntom.
i am wondering if i am having too much T3 with Nathur Throyd high dosage.
I am thinking to try 100 mg levothyroxine + 30 (or 60) mg Natur Throyd ...Or maybe 75 mg levothyroxine and 60 (or more) NTH . Anybody have experience about Levothyroxine/NTH combo proportion?
thank you in advance for your answers!
Chiara

[clairetom]

Thank you! You have been really helpful and caring...
Just a little surge : when you are sick nobody really understand your trouble, thoughts, plans and so on except who have been through the same....even if they love you they just want you to fallow the doctor and be well but when this don't happen it's a great gift to have a knowlegeable, patient and understanding friend....i wish al the best to you....

[goolarra]

You figure the percentage from the bottom of the range to the top of the range, not from zero to the top.

#1 - upper limit of range - lower limit of range  (18 - 7 = 11)
#2 - your result - lower limit of range (13.5 - 7 = 6.5)
#3 - result #2 / result #1 x 100  (6.5 / 11 x 100 = 59%)

Right, if you're FT4 is at 59% of range, and you're not converting well, then further increasing FT4 is probably not going to help how you feel.  Also, if FT4 gets too high, it can trigger an RT3 reaction and actually lower FT3 further.  

[clairetom]

I re-read the all post, very instructive ....
You wrote  'Looking at the labs you just posted when you were taking 125 mcg T4 only, you can see that your FT4 was a little on the high side if anything.  It was 59% of range'
You were referring to the fallowing result
Ft4.  13.50. Range.   7. - 18
so i realize that, since i m going back to T4 only,  it's really useless to increase the dose from 125 to 150 ....better late then never i got it :-)
may i ask you how you get the percentage? i put my values into a percentage calculator  that tells me the percentage ratio between 11,50 and the maximum of the range (18) but i got 75% as a result so i guess i am wrong but i don't  understand how should i calculate... :-) thanks :-)

[goolarra]

Yes, they can test selenium.  It's a good idea to have it tested before you take it.  If you're not deficient, taking more probably won't help you much.  

I'm glad you feel a little better this morning.  

[clairetom]

thank you for this valuable information....tonight again insommia and the decision to give up T3 came to me very strong...at least for this period, I am sick i need to recover...i will try 150  T4 and test after a month including RT3 . this morning i didn't took T3 and some peace and happyness are back ..!  and guess what ? even low back pain/disconfort is fading slowly....so  maybe i will tHink again about taking T3 in the future now i have to concentrate on ways to help conversion end to help adrenals...is there  a way to test selenium?
thanks thanks thanks

[goolarra]

In theory, if your FT4 is higher, you should convert more, but in reality that doesn't always happen.  In fact, if your FT4 gets too high, you can trigger an RT3 reaction where your body converts more T4 to RT3 than to FT3, actually lowering FT3.  Also, even with low FT3, you can have hyper symptoms from a high level of FT4.  

The enzyme that catalyzes the conversion of T4 to T3 is a selenium based enzyme.  So, if your selenium levels are low, it could impact conversion.  If you take selenium, follow label directions.  Too much selenium is worse than not enough.

Three to four hours after taking T3 is exactly when it peaks in your bloodstream.  Are you good about taking meds?  Could you split the T3 into more than two doses?  Another alternative would be slow release T3.

[clairetom]

PS Please ignore last question about supplementation to help convert : we already spoke about it in the past...
i will do as you suggested : write a new post about adrenal / thyroid issue

[clairetom]

Then i will try 138 T4 and 9 T3  or one day 163 and the other day 138....these are the option avaliable if i don't want more t3
...i was hoping that a lot of t4 would in some way raise t3 even if the FT4:FT3 rate would not be optimal
No i did no more labs since february....too many changes to be meaningful...meanwhile i am learning to understand the syntoms ...
I want to ask you if too much T4 can harm or the problem is 'only' not enough T3
Other question : do you know of any supplement helping convert T4 ? Naive question...i guess....
And last thing: i think the pick of agressessivity is 3-4 hours after taking T3

[goolarra]

Until February, you were on 138 T4 and 18 T3.  At that time, your FT4 was pretty high.  So, I do question whether you really should increase your T4 to 163 mcg.  If you only take 9 mcg of T3, that will change things some.  

Have you had any labs at all since February?

[clairetom]

it's really difficul to say ....i just notice it when something or someone make me angry.... but i will try to pay attention to it ....
By the way i noticed that i have some shortness of breath again but at this point i don't know if it's due to hypo or hyper
considering that i was doing fine until february (except for the agressivity, the energy / alertness and the breath were ok) and that labs were ok also i will try to go back to a similar dose ....but decreasing t3 (maximum 10 mcg) and increasing T4 instead....
so would you please check the below dose , do you think that could be  on the whole similar to the above mentioned 'until february dose'?
125 mcg T4 and a grain of NDT  that means
Total T4 mcg. 163  and T3  mcg 9 (in two doses)  ...If 163 mcg T4 is too much i will have to decrease of 25 mcg...

[goolarra]

Yes, T3 is very fast acting, and your body will neutralize it if it's not used promptly.  That's why you have to take it more than once a day.  

Do you have this reaction to T3 over the whole time period of the dose?  In other words, if you take your first dose at 11:00, for example, will it keep having that same effect on you until you take your second dose at 6:00, or do you notice a "peak" time when it makes you aggressive?

[clairetom]

Interesting, i didn't know that T3 ajust quickly....
i wake up around 11 and go to bed around 2 so i was taking the second dose at 6 pm....today i took it around 5 pm....since i am not working today i wanted to check how does it feel without stress....it feels ok until everything is going smoothly but when the slightest problem manifest i become agressive...i don't want this....my godness i have to choos between beeing alert and agressive  or  dull and calm :-(

[goolarra]

Yes, you do have to give each dose change a chance to settle before you move on.  The T3 component adjusts rather quickly, but the T4 component doesn't reach it's full effect until 4-6 weeks into it.

Did you say you've stopped taking the second half dose?  What time were you taking it?

[clairetom]

I have been until end od february on natur throyd 2 grains + 62 T4
(total t4 138 mcg + t3  18 mcg)
and the labs end of february were
Ft3     3.3.           Range.      2.4 -   4.7
Ft4.     13.30.      Range.       7   -   18
Tsh.   0,0004.     Range.     0,270. - 4,2

Then i tried different doses (always adjusting slowly)
Since the beginning of May  137 mcg of T4   and 10,50.   mcg  T3
after  one week i tried            160 mcg  of T4  and. 10,50   mcg   T3
since a couple of days           145 mcg  of T4  and    5,25. mcg   T3 in one dose
in the morning ( in the evening even if i was adrenalinic and i could not sleep because  of too much stress ,i still have some hypo syntoms like running nose and  cold....
Today i took  165 mcg T4  and  5 mcg. T3
so i guess these are too many adjustments in a short time, and some don't seem rational , but it's difficult sometime  to split the solid compound and i realize now  i adjusted the dose too often trying to optimize it...i really need to stick to on dose for a while ...
also i read someone saying that it takes time to get used to each different drugs brand...
Thank you !!!

[goolarra]

I'm not sure I know anyone (who isn't a quack!  LOL) who has direct experience with combined adrenal/thyroid issues.  You could try posting a new question and see if someone has.  

How much NT and how much T4 were you taking together?

[clairetom]

yes i went to an endo and needless to say he was concerned only about the supressed tsh that he called ‘subclinical hyper thyroidism'  he put me on
100 T4 (liquid) and 6 drop a day ( split in 3 doses)  of T3 ( each drop 0,71 mcg)  liquid t3 give me bowel problems even in small doses ,
100. T4 was not enough even in a liquid form that is supposed to be more effective
and i shifted to a syntetic solid compound t4+t3  + T4  
I have to admit that if i compare Nathur Throid with syntetic compound and varoius syntetic mix, Natur Throyd is much better : i had regular bowel movement first time in my life...but still I was very reactive even if i was mentally alert...so now i don't know. May be T1 T2 really play a  role...
But i think  the real point is the adrenal issue (i have back low disconfort today and i realized how manytimes in the past this happened and it has nothing to do with back pain ....is a disconfort inside...i am convinced it's adrenals related ) you have a lot of experience, can you adress to somebody that is experienced on Thyroid/adrenal issues ? I don't want to go into too complicate things/reading risking falling in quackery hands! Thank you again and again!

[goolarra]

T3 isn't for everyone, but it can also be harder to control since it is so fast acting and more powerful than T4.

Looking at the labs you just posted when you were taking 125 mcg T4 only, you can see that your FT4 was a little on the high side if anything.  It was 59% of range.  However, your FT3 was on the floor of the range.  This indicates that you do not convert well.  So, I don't think adding 25 mcg more T4 is going to help the situation much.  

Do you have lab results on your current dose of 160 T4 and 10 T3?

Have you tried a smaller dose of T3?

[clairetom]

Hi , here am i again,
since the last post i added levotiroxine rand reduced nathur throyd. The mix worked in the sense that i was energetic and my cognitive funcion were back to acceptable level. the breath was ok and the labs also but T3 make me so nervous, reactive, impatient. Then i went to an endo and experimented with syntetic t4 +t3 making some adjustment in doses , at the moment 160 T4 and 10  T3 .....since two days i am skipping the pm half dose of T3 (5 mcg) because i am VERY STRESSED because of job...i didn't sleep at night and was extremely reactive

Last year when i was on 125  T4 only I had some syntoms of hypo and my labs where:

FT3   2.4.   Range.      2.4. - 4.7
Ft4.  13.50. Range.   7. - 18
TSH 0,993. Range. 0.270 - 4.200

i am thinking to go back to only T4 therapy increasing the dose to 150 instead of 125 .

I don't like to renounce to T3 therapy because it was effective in one way but i thingk it's damaging my adrenals on the other side.
I remember in my twenties been extremely stressed because of work and sometime i had strong nausea and vomiting crisis then the doc would inject some adrenal extract and i was feeling immediate relieve. So i guess i am prone to adrenal fatigue ..actually i am sure of it.. do you or anybody here have some insight , some advice... i feel terrible, i will go to the doctor asking for one week rest from my job ....thank you in advance!

[clairetom]

yes thank you very much goolarra, i'll do that , i will make small adjustmentsuntill i'll understand better syntoms and effects.
You have been VERY KIND AND SUPPORTIVE i am really greatfull!
Chiara

[goolarra]

You can try splitting into three doses.  You do want to avoid taking it too late in the afternoon, however, since that can impact sleep (insomnia) for many people.  Some people, though, can take it just before bed time and sleep fine.

Upper half to upper third of FT3 range is a guideline.  Some of us don't feel well at such high FT3 levels; we all have to find where we feel best.  

NT has a lot of T3 in it.  So, typically, people on NT have relatively high FT3 levels.  Yours is still quite low.  But, rather than go immediately to a 13:1 or 20:1 ratio, why not add in just a little T4 and see what that does?

Make the changes slowly, keep retesting and re-evaluating symptoms and make another adjustment if necessary.

[clairetom]

Thank you Goolarra, thank you Gimel, it was very interesting your post.
Yes Goolarra ,  explained me that FT3 should be in the upper half or upper third if NDT but i have shortness of breath and nervousness...and this is the reason why i don't like very much T3 (but I have to thank T3 for my improved cognitive performance).
Yes i am still splitting the dose: i take 97,50 in the morning and 97,50 in the afternoon....I read that FT3 should be splitted in many doses....maybe i can try 3 doses.
About shortness of breath it's difficult for me to say if i am back to my normal breath ...for sure it's much better now then in the beginning when i was taking just one dose of NDT a day.
Other syntoms...i would say more nervous and anxious then normal...i lost one or two kilos weight (no good for me, i am already thin)
For the rest i am fine also because i am doing yoga almost every day and this helps a lot.
I do appreciate very much any insight on the ratio t4/t3 ...I guess it's an individual matter...but it could be that 4:1 is too much for me...
Thank you again

[gimel]

Thanks.  I thought I posted again that I had noticed those were current results.  My post didn't make it through cyberspace.  LOL

[goolarra]

Hey, gim, those results are in the original post above.

Nervousness can be a result of taking T3.  T3 is very fast acting and more potent than T4.  Do you split your dose of NT into two half doses?

Please list any other current symptoms as well.  How is your shortness of breath?

[gimel]

I am sure goolarra will reply to your post.  I just wanted to give you my opinion.  Your current issues may be related to your current levels of serum Free T3 and Free T4, which you did not list.  When taking NDT many members find that symptom relief required Free T3 in the upper part of its range,and Free T4 around the middle of its range.  

If you feel you have a reaction to your med/dosage, then you need to review the Free T3 and Free T4 levels and determine if one or both need to be adjusted.  That does not mean making an arbitrary decision about what ratio of T4 to T3 med you should take.  There is no guarantee that will work.  In fact, when I read through the link you provided, I have a number of issues with that recommendations.  

My first concern is that everything they do is based on the assumption that getting TSH within the so-called "normal" reference range is adequate.  Even though they do say, "Because of tissue heterogeneity, pituitary TSH secretion may not reflect what happens in other target tissues, and therefore serum TSH alone may not be a good marker for the adequacy of thyroid hormone replacement [67,68,70]. "  The article also states that, "There is insufficient evidence that L-T4 + L-T3 combination therapy is better than L-T4 monotherapy, and it is recommended that L-T4 monotherapy remains the standard treatment of hypothyroidism."  When I have analyzed in detail studies that support that conclusion, I have found them to be poorly designed and thereby having invalid conclusions.   I say that because in general the study did not include adequate levels of Free T3 and Free T4, usually because of targeting TSH as a decision criterion.  

Further, in the link it is stated, "L-T4 + L-T3 combination therapy should be considered solely as an experimental treatment modality."  Then they go on to recommend that if T3 has to be used, then the ratio should be between 13:1 and 20:1 by weight.  If it is necessary to add T3 to meds, it is likely due to inadequate conversion of T4 to T3.  So, in view of that, how is adding T3 in a ratio that is even lower than human thyroid going to make the patient better?  Rather than use some ratio, I think it would be far better to adjust thyroid med based on clinical symptoms first and Free T3 and Free T4 second.  

So, if you will post your thyroid related test results and reference ranges we can have a look and see where that takes us.