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

[goolarra]

Your FT4 is 41% of range, and the rule of thumb for FT4 is 50%.  

FT3 is 39%, and the rule here is upper half (sometimes upper third when on desiccated).

So, both are still a little on the low side.

Do you have other symptoms?

[clairetom]

thank you for the answer , i am so confused about syntoms...
sleep disorder/confused mind/memory loss/digestion problems/costipation/ thinning hair/weak muscles  are syntoms to which i got used to...
Graves is an autoimmune disease and i still have some high antIbodies...i think this can give syntoms too
i also have some liver damage due to hepatitis C (now healed) and gastritis ...so it's difficult to understand the coming and going of the syntoms
Beside that, i have low B12 , low D vitamin (which i am treating) and low iron (which i cannot treat because of the liver)
Anyway since i switched to Natur Throyd and T3 rised I seem to sleep better and to have a clearer mind but I feel this  shortness of breath ..I worry about that also because in the past I was diagnosed with some leaky heart valve (not too serious though) ... I  read that  T3 drug  can damage the heart , and Natur Throyd contains T3 as you know. ..this is the reason why i was thinking to combine Levothiroxine with just some Natur Throyd (but no doctor is willing to help me in the experiment so i have to help mysef)
The funny thing is that since i am on T4 (and maybe even worst now on dessicated thyroid) i loose weight, no matter how much i eat.
Please excuse me, it's a long post, but i hope that with the help of this forum and your experiences i will be able to find the best drug for me.
(meanwhile i started to read all the posts on this matter)
thanks !

[goolarra]

Despite the T3 that you are taking, your FT3 remains on the low side.  However, not everyone can tolerate levels in the upper half of range.

What is your sleep disorder?  Digestive problems?

What's your B-12 level?  Are you treating that as well as D?

Weight loss, as you know, is a hyper symptom typically.  

[clairetom]

Hi and thank you for your answer!
During the last week i experienced one episode of tachycardia (in the past this happened to me just once , when i was super-hyper because of not yet diagnosed Grave's) and this made me think that i am taking too much T3 ,anyway i decided to continue with the same dose (195 mg NaturThroyd) and to to split it in two doses ( 130 morning+ 65 afternoon)  It seem to be better now .
About my sleep, digestive problems and the skinniness: it is very difficult to understand the syntoms; they started 30 years ago during a  stressing period . In that time i used to vomit green liquid even if i had en empty stomach...Iit was horrible... doctor would inject me some surrenal extract and soon i was feeling much better  . My sympatetic nervous sistem seem to be overreactive and this is probably the cause of many problems.   My Grave's also started 11 years ago during a stressing period.  Anyway, after the Grave's outbreak and the radioiodine treatment,  skinniness is more evident and apparently irreversible even in non stressful times.Liver damage and gastritis  of course are also involved and this make the understanding of the syntoms even more complicate.
My main concern at the moment is the heart  ...why do i get so easily breathless when i exercise? I must say that when i was on Eutirox 125 (Levothiroxine only) i didn't experience breathlessness like i am doing now with NaturThroyd.
On the other hand my mind seem to be less confused now.
Maybe i am one of those that don't tolerate high level of T3, in this case it would make sense to take more T4 and less T3 then the Dessicated Thiroyd provide, correct? I wonder if for me it would be interesting to check the reverse T3...
in Italy doctors  routinely check FT3 - FT4 and TSH , sometime the antibodies, but they never test REVT3, in my experience.

Natur Throyd contains: 2 grains (130 mg) Thyroid USP (Rx only)
each coated tablet contains
Thyroid U.S.P. 2 gr  (130 mg) (Liothyroxine  18 mcg - Levothyroxine 76 mcg)
Calcium                       38 mg
Magnesium, sodium      1 mg (less then)

About th B12 and vitamin D : yes i am treating both , I will post the level as soon as i go back to my place an i can have a look at them.

Any other  insight on my situation?

Thanks in advance!


              


      

[clairetom]

I forgot to write that last week ,when i had tachycardia, it happened in bed ,almost 16 hours after the tablette intake...strange ....

[goolarra]

Have you had a cardiac workup?  Can you describe in more detail your episode of tachycardia?  Sixteen hours after your last dose, your FT3 shouldn't be very high.  

It would be interesting to see what your RT3 is doing.  It's not easy to get doctors to test that here, either.  

Do you have labs from when you were on Eutirox so we can compare your FT3 levels then and now?

[clairetom]

thank you goolarra for your support,
what i call tachycardia is BUM BUM BUM BUM BUM fast and loud that i can
" hear" it (in bed)
i had a cardiac workup some years ago, it was ok just some valve prolapse that is very common and considered not really dangerous
by the way ...do you think it could be useful to monitor the pulse rate?
i will write you the labs as soon as i have them in my hands.
ciao!

[goolarra]

It could be useful to see what your heart rate (HR) is.  Elevated HR can indicate overmedication, and T3 has a strong influence on the heart.  How long did your episode of tachycardia last?  Did your HR gradually get faster and then gradually slow down?

[clairetom]

About the HR: I cannot say if it  get faster and then slow down gradually...I didn't pay attention to it when I had tachycardia episode. In general in the last weeks I had strange feelings about heart pulse so 2 days ago i went back to the previous dosage, this mean back to 165 mg instead of 195 mg. that i had for the last 2 weeks.
By the way ...do you know about people who use the HR in order to find the best dosage ?

Some labs: untill July 2014 I was on Levothiroxine only 125 mg

          2010/11   2013/14  sept2014 (165mg NaturThroyd) NORM.RANGE

FT3       2,8          2,4          3,3                                    2,4 - 4,7
FT4       15           14         11,50                                    7 - 18
TSH      0,836      0,993      0,005                                0,270-4,200

IRON                                     65   (range 50-150)
FERRITIN                              35   (range 10-120)

25 OH VITAMIN D3                   7    (range 20-100)

CORTISOL                              21    (range 5-20)

THYROGLOBULIN antibodies   23,8 (range < 4,1)
Anti-thyroid peroxidase ab         2,8  (range < 5,6)

B12                                        309  (range 160-970)

Thank you in advance, any insight is welcome.

Meanwhile I am reading Medhelp 3d about Tsh suppression...I have to study a lot in order to make sensible decisions...this is why is so important that people like you share their understanding from a patient point of view..

[goolarra]

I don't know of anyone who uses HR to determine dosage.  I think HR is just one symptom and can only be used in the context of the others.

So, you can see that your FT3 is considerably higher on desiccated, and your FT4 is considerably lower.  Have you thought about adding a little synthetic T4 into your meds to see if that helps?

Ferritin is too low for proper metabolism of thyroid hormones.  It should be in the 90-110 range.

Vitamin D is also very low.  This should be in the 50-70 range for optimum use of thyroid hormones.

Cortisol is on the high side.  You might want to try to get a 24-hour saliva test, which is more useful than a one time test.  With the 24-hour test, you get four distinct readings over the day and can see what it's doing at different times.  High cortisol could be affecting your HR.

B-12 is also low.  In some countries, "normal" range starts at 500, and many people find that they have to be well up in the range to feel well.

You have quite a lot going on there in terms of vitamin/mineral deficiencies.  Remind me if you're supplementing.

[clairetom]

Thank you goolarra, and excuse me  for the delay...
actually I started this post with the idea to add a little bit of T4 and i am glad you think this could be a good idea...i will add maybe 25 mcg and see how I feel.  I want to add that the blood test were made 24 hours after the last Natur Throyd dose, this was not important when taking only levothiroxine only but with dessicated thyroid i guess it matters.

Anyway i didn't had tachycardia episode anymore and also the breath  is better now ... I split the Natur Throyd in 2 equal doses : 97.50 in the morning and 97.50 in the afternoon: probably this helped .
i must say i am glad i shifted to dessicated Thyroid: at least my memory is getting better and my mind fog is improved, i.e. i have a clearer mind...that's great! (this was the main problem for me)

When i increased the Dessicated dose to 225 mg i had also a better digestion and less constipation but it was too much for the heart
(and maybe for the bones? i am 50 and already have ostheoporosis ...)

Maybe in the future i will give a try to synthetic T4+T3 ...in Italy Dessicated Thiroid is unauthorized and buying it in Switzerland is very expensive.

About the supplementing:
I just started with D  and and B12: i will try to be consistent and see if the labs will be better in 6 months...

the iron...this is the problem...i cannot supplement because of the liver...doctor don't allow me...and i eat just a bit of read meat (already too much from the point of view of the vegetarian i used to be)..I don't know what to do...

Since you are VERY patient with me .-) and gave me knowledgeable advices, I would like to ask you what you think of this article:

http://www.healio.com/endocrinology/blogs/michael-kleerekoper-md-mace/thyroid-hormone-therapy-and-the-skeleton

I wonder what they mean with "just slightly overmedicated"

And again ...i thank you so much...it's a great help to be able to share and have feedback from an insider :-)

[goolarra]

"It is essential to monitor the thyroid-stimulating hormone on a regular basis (at least once a year) and maintain levels within the normal range, preferably in the upper half of the reference interval."

That advice is going to leave many people feeling VERY hypo.  The upper half of the TSH range is seldom recommended by anyone as the place to be to feel well.  Also, he ignores FT3 and FT4.  It's high levels of FT3 and/or FT4 that can cause bone problems.  TSH can be influenced by many other factors, especially when taking desiccated, which often suppresses TSH, so I find his arguments somewhat lame.  Once on meds, TSH is not a reliable indicator of over or under medication.  Your FT3 and FT4 do not indicate over medication.  To me, it's absurd for him to say that he lowers his patients' meds from where they feel good to where they don't.  

I'm glad to hear splitting the dose helped.  

[clairetom]

thank you very much goolarra...i do agree with you about the importance of syntoms ...
my cognitive funcions are better now with dessicated Thyroid then with T4 only therapy (it was a real issue for me) but i noticed that i am  more nervous now and i get angry more easily ...did you happen to hear somebody else report nervousness with T4+T3 or dessicated thyroid?
I am a bit confused about what T4:T3 ratio should be.
Nature Throyd is 4:1 (...i am not so good in math : in 130 mg there are 18 mcg T3 and 76 mcg T4) ...i would like to combine T4 with NatureThroyd in a way to reach 13:1 T4/T3 ratio and maybe you can help me calculate the dose i should take, considering that I used to take 125 mg Levothiroxine (alone) and now i take 195 mcg of Natur Throyd...this task is far beyond my possibility :-)
i hope somebody can help me...
I also copy  the link to the European Thyroid Association guidelines about the use of L-T4+L-T3 in the treatment of hypothyroidism they suggest  a 13:1 ratio T4/T3 ...(link below)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3821467/
As always thank you thank you very much for your valuable support!

[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.  

[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]

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

[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

[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]

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

[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!

[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]

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]

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]

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 !!!