Questions about switching from NDT

[Lorilou56]

Hello, can someone please clarify something for me? If I'm on 3 gr NDT & I want to switch to T4+T3 individual therapy, would that be an even switch to start with 27 mcg T3, since that's what is in 3gr of NDT? Or can you not switch evenly like that?

[Lorilou56]

Got it ... thank you!!!!

[gimel]

I have no conclusive answer for that.  The only things I can think of that could be factors would be whether there was enough elapsed time for the levels to become stabilized, and the repeatability of the lab tests, and how much your Free hormone levels were being affected by your P-E ratio at those times.  If you had results for Total T4 and Total T3 during those times, it might shed some light on the subject.  Recall that I thought that was the likely reason your Free thyroid hormone levels were relatively low while taking a hefty dose of NDT.  The estradiol dominance causes increased TBG levels, which would reduce the Free hormone levels, even when Total thyroid hormone levels would be increased by the higher med dosage.  

[Lorilou56]

I've been reading and rereading all this... A question I've come up with is why would my labs be almost the same being on 112 T4 / 15 T3 as on 3gr NDT?? That seems really weird considering the 3gr has 12mcg T3 more than the when I was on the t4 + T3.

Any thoughts???

[Lorilou56]

Thanks again Gimel for your advice!! I'll check back in!!

[gimel]

You can alternate T4 meds because serum levels build up slowly, since the half life is about one week.  But it is so easy to just split a 50 and start with 25 each day, or add 25 to a 50 mcg tablet, to get the same daily dose.

Yes, you can take all the T4 and 1 grain of NDT at 5:00 am and then the other grain of NDT around noon.  With T3 the half life is less than a day, so it reaches peak effect in about 4 hours and then diminishes over the next 4 hours.  By splitting the dose it helps even out the effect over the whole day.  I can't imagine why your ND would think otherwise.  

[Lorilou56]

I found some stuff Gimel and an reading about the TBG. I need to get that tested.

I think I remember reading on here last week (from Barb maybe) that you can alternate your Meds to say every other day?  I've never heard of that. I thought we wanted to keep everything the sand each day even down to the timing? So in raising, would it be beneficial to add the extra 50 T4 every other day to slowly do that, or no?

Also if you don't mind... What are your thoughts as to the best way to take meds? Timing wise? So if I do the 100 T4 + 2 gr... Could I do 100 T4 + 1 gr at 5:00am then the other 1 gr at noon? Or even all together at 5:00am? Is that too big of a dose in 1 shot? I know about the thought to space the T3 out as the level falls faster. My ND feels it's best to take it all together in the early morning.

Thank you!!!!

[Lorilou56]

Gimel  I'd like to read  about the low P:E affecting things.. What did u search up??

Thank you for all your advice :)

[gimel]

I see no reason to think Tirosint plus T3 is a better option.  If you do go with the 2 grains plus T4, I would make the increase from 50 T4 very gradual.  I say that because it takes at least 4 weeks for a change in T4 dosage to be fully reflected in serum levels.  

[Lorilou56]

Thanks Gimel for all that, I appreciate it!!! Dropping the NDT and adding Tirosint Is actually what we decided to do last Tuesday... That option is in my first reply to you. Im doing 50 T4 for 1 week then going up to 100 t4 + 2gr NDT.  Everything UR saying makes sense to me... I WISH I could do the higher dose T3, I felt amazing for 6 weeks, but I sliwly gained 10+ pounds and it was making me cycle every 28 days which I hadn't done for 4 years!!!! There's DEF a correlation with E & thyroid... It just acts as a huge stimulant to my E.  

There's too much wrong to figure out all at once.  I've been trying to do that and have gotten nowhere... It's a vicious circle. So I was trying to focus on adrenals (good supplements, HB, PS, "trying" to reduce stress, eating healthy, sleeping 10-6) & that really seems to be working, and focusing on thyroid too, in the "hopes" that other things would balance out too.

Since dropping the 1 gr & adding the 50 T4, I'm DEF noticing the drop... Joint pain , exhaustion... I feel like I've taken 20 steps back. It was like a cruel joke to experience the clarity and energy that I had while on t3, & now it's all gone and I'm worse.

I seem to tolerate about 20mcg T3... I was just asking if doing straight T3 + Tirosint (100 T4 + 20 T3) would be a "better" option than 2gr + 100 T4??

[gimel]

Seems to me that the puffiness, etc. is more likely due to the very low levels of Free T4 and Free T3, which are being caused by the low P-E ratio, even though you are taking 3 grains of NDT.   I don't see how it could be related to T3 itself.  If you can't tolerate T3, then I don't see how dropping NDT and going to T4 and less T3 would possibly improve the situation.  As you know T4 has to be converted to T3 to be utilized by your cells, so either way you get T3.  .  

Rather than going through the lengthy effort to try that, if you are convinced that it is T3 related, why not just go back to 2 grains and add extra some T4?

Another option is to find a good hormone doctor and find a way to get your P-E ratio and your cortisol level straightened out for you.  Maybe I have overlooked something that you are doing, but it seems to me that just ignoring those and trying to circumvent by tweaking your thyroid med is unlikely to achieve what you want.    

[Lorilou56]

In not feeling great on the 3gr... I'm puffy and not able to lean out like I know how. I'm attributing that to the extra 9 mcg T3 in the extra gr on NDT that I'm on... I sat on 2gr for 5 years, and while I cetsinly didn't feel optimal, I wasnf puffy like this.  I continue having breakthrough bleeding, which again I feel is the extra t3. That's why I can't up the NDT... I just tried last week to add 2.5mcg T3 & TWO days later CM increased, stomach bloated , gained weight & have had breakthrough bleeding since. It turns on my E immediately.  But I know my levels need to cone up.

Cortisol is made from P, & if stressed P will be "stolen" down the cortisol pathway, raising cortisol and never raising P because of the cortisol steal. My evening and night cortisol were raised because of it, which caused my am to fall below normal now.

It always seems like it's hard to figure Out what I should do cause I'm affected weirdly by things :( this is what I mean. Thank u thoygh for taking the time to read.

[gimel]

It is a bit puzzling that you seem to be so sensitive to the small dose of T3, yet you are taking 3 grains of NDT med which contains 27 mcg of T3.  So, since your Free T4 and Free T3 levels are too low, possibly due to the low P-E ratio, then why not just increase your NDT dosage?

What do you mean when you say that you had to stop the high dose of Progesterone because it was going down the cortisol pathway?

[Lorilou56]

I do have low progesteeone levels and low Estrogen but E is higher than P causing an E dominance effect. I supplemented with high dose P for almost 2 years but had to stop because it was going down the cortisol pathway. So now now I can't take it, plus each course it started stimulating E more and more. I take a lot of supplements in general... Was taking DIM + CDG to lower E, but like I said it's actually low, but P is "lower". I was using a compounded P cream + oral.

As far as having problems with straight T3... I have no idea!! I'm on another forum and I've posted numerous times and no one knows either :(  My cycles are extrememely irregular... This is how sensitive I am now to T3... 2 times in the last 5 weeks I tried to add a small amount of T3 (2.5mcg) in the afternoon, BOTH times within 2 days my CM increased rapidly, water retention, bloating/cramping & then breakthrough bleeding with weight gain due to E being stimulated too aggressively!!! It's crazy.

Thats why I'm scared to raise NDT cause it will add more T3. I was thinking since I seem to convert ok, to supply more T4 hoping that I will concert it and therefore increase both levels. Plus, like I said, my iron will never be optimal as serum iron is/has always been low due to BTM which I cannot supplement iron.  

I'm so confused as to what to do. This consumes my life... Reading, researching... I'm so stressed and depressed & it's taking a toll on every aspect. I feel especially sad for my kids who watch me struggle every day.

My Dr is kind of at a loss, but always willing to do what "I" want to try... I just don't know what that should be.

Appreciate any advice!!!!!

[gimel]

It is not clear to me why your would have had a problem as you said with T3, when taking 3 grains of NP.  Your Free T4 and Free T3 were basically no different than when taking the 112 of T4 and 15 T3.  Your Free T4 is way too low.  It should be middle of the range minimum.  Also, your Free T3 is way too low.  It needs to be in the upper half or upper third of its range, as necessary to relieve symptoms.  

I am a bit surprised at your relatively low levels of Free T4 and Free T3, which made me wonder about the possibility of being affected by a low progesterone to estrogen (P-E) ratio.  In doing some reading I found that a low ratio, estrogen dominance, can cause increased thyroid binding globulin
(TBG) that carries hormone to the cells.  Levels of T4 and T3 can become low because they get attached to the TBG.  This often prevents the hormone from entering the cells and can result in hypothyroidism.  This might explain your relatively low Free T4 and Free T3 while taking 3 grains of NDT.  So something to discuss with your doctor and maybe do some testing.  This might be something to figure out before raising your dosage.  

If it comes to that, why not consider just raising your NDT, rather than changing so much by going to T4 and T3 individually?

[Lorilou56]

Oh something else to add... I was also thinking that an option would be to drop NDT altogether and go with straight Tirosint and Separate T3, controlling each 1 individually.  That's why I was asking if I dropped the 18 mcg T3 from my current NDT , if that's an "even" switch to adding straight T3??

I just want to go with the "best" option that I'll have the most chance of success with.

THX agin!

[Lorilou56]

Thanks Gimel for the reply! I've been on NDT for 5+ years and have never been optimal. Just recently (since September) I've been trying to raise from levels. I added T3 to my NDT and felt amazing... BUT it was waaay too aggressive with my Estrogen, causing bloating, breakthrough bleeding and weight gain, so I had to stop using it directly. my adrenals are a little off and I've been treating those making great progress. My iron will never be optimal because I have beta thalassemia minor, so I don't think that il ever be able to raise NDT to a level that I need. I've basically been on 2gr. Since using T3 and then dropping it, I've gotten up to 3 gr, but my labs are only very slightly better, and not FT4, only FT3.

So I was thinking to drop back down NDT to 2 gr ( to lower the T3 content back to what I've tolerated for years) and to add T4, which should concert and raise both of my levels. I don't seen to have conversion issues. I just don't think I've ever had enough T4 to do anything with it to affect my levels.

I do work with an ND... But I go in "armed with knowledge" and tell her what I want to do. Just this week we decided to drop from 3gr to 2gr NP and add 50mcg Tirosint for 1 week then bump it up to 100mcg, hold for 6 weeks and see what it's done. I'm on day 2 of this.

Back in November throygh January for 8 weeks we did switch me to 112 Synthroid + 15T3... Then back to NDT and higher doses T3 which didn't sit well unfortunately. I'm trying desperately to get back to that feeling of "normal" with energy, clarity, no depression, creativity... That I felt on the T3. My hope is that by supplying more T4, all my levels get up into range!!!

Here's my labs from 8 weeks on 112 Synthroid + 15 t3 (1/15/15)

TSH .030 (0.450-4.5)
FT3 2.7 (2.0-4.4)
FT4 0.8 (0.9-1.7)

Labs (5/2/15) 8+ weeks on 3gr NP

TSH 0.015 (0.450-4.5)
FT3 2.6 (2.0-4.4)
FT4 0.84 (0.82-1.77)
RT3 5.6 (9.2-24.1)

Thanks for reading this and giving any insight!!!

[gimel]

How are you feeling with the 3 grains of NDT?  Why are you interested in making the switch?

As for the equivalent dosages, 25 mcg of T3 is as close as you can get to the 27 you are currently taking.  For the T4 you are getting 118 mcg now. Switching to Synthroid, for example, you can get a dose of 112 mcg and 125 mcg.  

If you will please post your thyroid test results, perhaps we can better assess what doses would work best, based on your symptoms and lab results.