opinions needed for going on NDT

[Rabbit4949]

This will be long. Bear with me.  I'll start with me latest labs taken a last week.
tsh 4.086 (.34-5.6)
ft4 1.04  (.58-1.64)
ft3  3.5  (2.5-3.9)
rt3  25  (8-25)
tpo antibodies 13  (<9)
tg antibodies  <1  (40)  My total:HDL ratio is still good at 3.5 (0-4.4) but in the past my ratio was even better at 2.5. So my cholesterol numbers have changed, not for the better.    My hair has thinned since menopause (or at least I assumed it was from menopause) over the last 8-10 years. Could be thyroid related instead and not menopause.

I've called so many endocrinologists but the wait time is 5-9 months.  In the meantime, I would like every one's opinion about my numbers AND THE FACT THAT I FEEL GOOD, if that warrants me going on Armour or NP.   When I was first diagnosed with hashi's last June, my GP put me on 25mcg of Levo.  I had a terrible reaction to that and finally quit it after 3 months.  I felt like I was going to have a heart attack while on it.   In the 7 months I've been off levo,  my tsh has remained within the range, my ft4 has remained mid range, my ft3 has actually gone up slightly, but my rt3 has gone up some.   TPO antibodies have been either in the range or slightly high.

1) If I start on Armour or similar, and she puts me on a teeny dose, in her words, what kind of schedule should I be on? Do I take it for one week before increasing it?
2) How will I know if it's working, other than more lab work?  
3) I have a very low body temp 96-97 (adrenal issues???) so would my temp improve if I'm on the right dose of NDT?
4) Is a time released pill better or just multi dose?
5) If I do end up trying NDT and I feel like there is no improvement, can I stop it or I would have to increase the dosage instead?
6) After my horrible experience on Levo, should I even be considering NDT since I feel pretty good right now?
7) Should I just wait until I can get in to see a doctor trained in dispensing NDT even tho that might be months from now?

Please, any and all opinions will be carefully considered!    

[Rabbit4949]

Appreciate it, gimel!

[gimel]

For iron supplementation, there are some good forms such as ferrous bisglycinate, ferrous fumarate and ferrous sulfate. Whichever you choose, it is a good idea to take some Vitamin C or magnesium to avoid stomach distress.  

The best place to find out about leptin resistance etc. is to do some reading on the internet.  

[Rabbit4949]

I was just checking into some reasons for my high rt3.  I know my b12 and vit  d are OK.  I also know my iron is at the low end of the range.  I'm thinking of supplementing with some type of iron.  I need to read which is  the best absorbed kind and also it's warnings because I don't want too much in my system.   I did start on 200 mg selenium a couple of months ago.  That may have been foolish without knowing if I was deficient, but none the less, I'm still taking it daily.  Can you tell me how one becomes  leptin  resistant?  Is their a test specifically for that? Is that related to insulin and/or insulin resistance?   I'd like to add a well-rounded  vitamin and mineral supplement and  am still checking out different brands.    I supplement now with selenium, super b complex, ashwagandha,  turmeric, calcium and magnesium.   I'll keep reading and trying to figure out what's wrong.  It just seems like something is out of whack....it's a mystery. :)   Thank you for helping me!   Rabbit

[gimel]

Excess Reverse T3 is a metabolism problem rather than a thyroid deficiency.  Periods of prolonged stress can cause an increase in cortisol levels which ultimately can increase production of RT3.  Other potential causes of RT3 dominance include:  leptin resistance, inflammation, dieting, nutrient deficiencies such as low iron, selenium, zinc, chromium, Vitamin B6 and B12, Vitamin D, iodine, low testosterone, low human growth hormone, insulin dependent diabetes, pain, environmental toxins, free radical load, hemorrhagic shock, liver disease and kidney disease.  

Your Free T3 to Reverse T3 ratio is only 1.4, so that is lower than recommended levels of about 1.8 minimum.   So anything you can find that is deficient in the above list and improve it should improve your RT3 level and the FT3/RT3 ratio.

[Rabbit4949]

I have read all your comments and basically said the same thing...if I am feeling fine, why take meds?  And I can agree with that on the surface.  My concern is my rt3 has crept up over the last 10 months and so has my bad cholesterol, altho the total to HDL ratio is still good.  I read where being hypo can elevate the bad cholesterol.

As for my low body temp, I didn't make myself clear because  I don't FEEL cold.  You would think I would with the temps I'm showing.  It's crazy but I even bought a second thermometer because I was sure the first one wasn't working right.  The low temp kind of makes me wonder if my adrenals may be at the root that.  

Maybe for now, I'll do more research into rt3 and work on trying to get that lower.   I do a brisk 3 mile walk almost daily but I wouldn't consider that strenuous.   As for stress, well, nothing I'm aware of besides the norm.  But I do try to limit my calories to around 1300/day.  Once again, I'm not starving myself...just not eating the junk food and refined carbs.  

Thank you everyone who replied!   I'll print out your comments to refer to.   It's a comfort getting other opinions especially when I don't really have a trained thyroid doctor to ask.    Wishing you all good health!   rabbit

[handsinclay]

I agree with goolarra that since you feel good and your free T4 and T3 are OK you may want to wait to try NDT.  On the other hand, just saying from my experience of being cold all the time for many years on levo only, that I didn't know how much better I could feel by adding some T3 to my regimen.  I feel best when my free T3 is near the top of the range.  

Last fall I tried switching to NDT only from levo and ended up worse than ever before.  Now on both levo 112 and 2.5 grains NDT and feel almost there.  In retrospect, I wish I had just gone directly to adding synthetic T3 to the levo.  It seems much easier to titrate each of the T's that way.  Also different brands of NDT can be different!  Perhaps a little dose of T3 might work for you?  With a T3 med you will know right away if you feel better.  The T4 takes 4 weeks to reach full potential. Not sure that timed released T3 is necessary if you are splitting daily dose.

The other thing to consider is ordering your own 24 hour saliva test for cortisol from a lab online.  That way you can find out what your levels are.

Getting ferritin, B12 and D to good levels first may also boost conversion to T3 and help you feel warmer.

[flyingfool]

I agree that if you feel well then change nothing.  
But you complain of being cold. So that is not "nothing".

I see that your Reverse T3 is very high.  I wonder if that is the area that needs further investigation.

RT3 goes up if there is too much thyroid (going hyPER) and is a mechanism your body dies to limit the amount of FT3.  Thus adding Armour which has a lot of T3 in it would only worsen that situation.

Reverse T3 also increases due to stress. Both from famine for example or infection or healing or major injury or too much physical excercise etc.

There is a theory that the RT3 blocks the FT3 receptors.  Resulting in you feeling Hypo, while still having adequate supply of FT3 available. But they have no place to go because of the elevated RT3 has already "filled" the receptors.

Reverese T3 is ONLY made by the conversion of T4.  So one way to limit RT3 production is to reduce the T4 available. But since you are not on any medication, specifically T4 medication you don't have that option available.

The fact you have Hashi's would seem to be over time will result in your THyroid gland producing less T4. So over time it would seem possible that this RT3 situation would get better.

So I would really look into your stress level or what is going on to increase your RT3 levels which are at the absolute highest part of the range.

I'm not sure you are male or female, but estrogen dominance can also interfere with thyroid metabolism.  So maybe getting cortisol and sex hormone levels tested would make some sense.

Cortisol is an adrenal hormone and is itself an indication of stress and like I mentioned has an effect of proper thyroid metabolism.

Just my thoughts for you to consider!

[goolarra]

Your FT4 is at 43% of range, which is a little short of the 50% guideline, but it's nothing that would ordinarily cause any symptoms.  FT3 is at 71%, which is nicely in the upper third.  You have no symptoms.  

You have to understand that thyroid meds have no curative powers.  All we can do is treat the symptoms by replacing the hormones our bodies can no longer make.  So, if you have no symptoms and your thyroid is still producing hormones, why would you take meds?  It can take Hashi's decades to do enough damage to cause your numbers to go out of range or for symptoms to appear.  Some people never have symptoms.  

With your FT3 at 71% of range, desiccated, which has a lot of T3 in it, would probably make you feel even more like you're having a heart attack.  Thyroid meds don't lower antibodies, so even more lab work won't let you know if it's working.