3 grains of NDT not working - what's the next step?

[Mr. T]

Edit: the Title should be "1.5 grains..." which is 3 capsules (I can't edit the Title of the post).

I've been on 1.5 grains (3 capsules) of NDT for 102 days and my thyroid numbers and overall symptoms have remained the same. I was started on 1/2 grain for 10 days, then 1 grain for 10 days, then 1.5 grains until the present.


Dec/2017:


TSH 3.72 (.45 - 4.50)
Free T4 1.06 (.82 - 1.77)
Free T3 3.1 (2.0 - 4.4)


April/2018:


TSH 3.48 (.45 - 4.5)
Free T4 1.01 (.82 - 1.77)
Free T3 3.0 (2.0 - 4.4)
Reverse T3 14.6 (9.2 - 24.1)
TPOAb 18 (0 - 34)
TGAb <1 (0.0 - 0.9)


It was mentioned on another thread that some guys take up to "4 to 6 grains/day." I didn't want to hijack that thread, so my question is:

How does the Doc/patient know whether to only increase NDT, eliminate it and replace it with T3 and/or T4, or do a combination of NDT, T3, and T4?


I have a follow-up mid-June and am wondering what to try next. Also, if I should even refill my current non-working NDT prescription before then.

 

[looyvillelarry]

Need to follow this..

 

[OMI100]

FWIW I am on 202.5MG 0f NP Thyroid. Had been on 225MG but that was a bit over the top.
Have no idea what that equates to as far as grains BUT I think it is about 3 (202.5MG) to 3.5 (225MG).
Gotta do follow-up labs here shortly.
Also you need to educate yourself on the thyroid.
Go here and look around and read first:
http://www.tiredthyroid.com/
Then order her book.
BEST web site and book covering thyroid.
Book is so well written and documented it could be used as a medical School text on thyroid conditions.
After that you will find some good information here:
http://hypothyroidmom.com/
then you might want to visit this site and get the "Stop The Thyroid Madness revised edition"book. They have a new book out written by healthcare professionals that I have not read yet, but I have it (just had cataract removal in one eye so getting over that):
https://stopthethyroidmadness.com/
One additional site that has a lot of good easy to read info is:
https://www.restartmed.com/?s=ndt
Don not recall who posted this site (ratbag?) but it is a good one.
After all that you should have a much better understanding of your situations and to be able to know if your Endo has any idea what he is doing.
If it looks like he has no clue than find one that does...
Finding a GOOD thyroid Dr. is like finding a needle in a hay stack....
One last comment:
If your Endo says all your labs are within range, just get up and run out of his office as fast as you can and find a DR that treats to symptoms and NOT ranges.

 

[Vince]

Here's my thread. You may like to read it over I just started liothyronine 25mcg.
can cytomel by itself be used to treat hypothyroidism
https://www.excelmale.com/forum/sho...mel-by-itself-be-used-to-treat-hypothyroidism

 

[Mr. T]

Thank you, Vince. I have been following your thread and look forward to seeing how the T3 works for you; I think I may be in the same boat. I appreciate all your help and info.

 

[Mr. T]

Thank you, Orrin - I have been following your posts and links for awhile now. I just ordered the Kindle version of Tired Thyroid and am reading it now. I appreciate all your help and info.

 

[Vettester Chris]

Is your NDT brand, Armour? There has been a lot of scuttle going on since Activas acquired the company in 2014. Possibly switching it up with another brand or pharmacy compound can be the ticket ...

1.5 grains as noted in your edit, indeed might not be enough for your optimal wellness desire. Possibly titrate up a bit, also look at dividing your dosage up (if possible) 2x per day, going with 2/3 of dosage in the AM, 1/3 dosage in the PM. Adding selenium can also help with the T4 conversion to T3.

 

[1Draw]

I would follow our thyroid guru Chris’ advice. Here is good info on what ranges are and what is optimal

https://www.restartmed.com/normal-thyroid-levels/

 

[ratbag]

1 grain is equal to 60-65mg of NDT, which is usually 1 tablet. There are many brands of NDT that do not work! Also many of the top brands in the past were re-manufactured at some point and became no good. This is something many do not know about. As VC said Armour is considered one of those that doesn't work well. Even the best manufacturers of NDT have had their problems with the result being their NDT didn't work. This is the problem with using NDT. You end up with stuff that doesn't work and you go back to being hypothyroid yet your thinking you are ok because you are taking it.

I gave up on this game and switched to synthetics (cytomel and synthroid) At least the synthetics work all the time. On four different occasions my MD Rx'd me NDT that I purchased thru my pharmacy and everyone of those (4 different brands) of NDT failed for one reason or another and the pharmacy had no idea. For this reason you cannot trust NDT. Having said that the brand I trust the most is Thyroid-S or Thiroid. It's available from Thailand online for a great price. It has had issues too but not as often as other manufacturers.

Mr. T your labs indicate you have something that doesn't work or... you are not taking enough. I believe STTM concluded long ago that most need a minimum of 2 grains daily (120-130mg) anyone dosing less than 120mg daily simply isn't getting enough T3.

Dosing T3 or NDT cannot be done by labs or numbers. This is why all the best MD's say you should try it even if your labs look ok. Numbers are useless with thyroid except when your labs are all low then you know for sure you need T3 or NDT. Getting the correct dose of T3 or NDT is best described by Broda Barnes. He's the one who wrote books on books on how to treat thyroid successfully without the use of the TSH or other labs.

I believe the current best practise is to start at 2 grains, keep it there for 2 weeks and raise it to 3 grains. Again hold it for 2 weeks and raise to 4 grains and so forth. You keep doing this until you feel your hypothyroid symptoms disappear. Then you know when you have reached the correct dosage. But before you do this you must be sure your cortisol levels are ok and that your ferritin isn't too low. Low cortisol and low ferritin cause high RT3 which essentially shuts down your T3 receptors and causes any T3 you are taking to pool in your bloodstream.

 

[1Draw]

Awesome Ratbag.

 

[OMI100]

"I believe the current best practise is to start at 2 grains, keep it there for 2 weeks and raise it to 3 grains. Again hold it for 2 weeks and raise to 4 grains and so forth."
When I was getting dialed in my DR had me bump the dose up a 1/4 grain at a time, every 2 weeks, and eval how I felt until symptoms were gone.
I think 1 grain at a time is way too much of a med spike at one time.
My 2 cents
A bit more on the subject:
https://stopthethyroidmadness.com/natural-thyroid-101/
and
https://www.restartmed.com/armour-thyroid-weight-loss/

 

[rhino5169]

So I had posted a thread as I was having trouble also.
When I first started ndt I felt great for a shirt bit and then it dropped off. Over many months I couldn't get the right dose.
As stated earlier, I did a ton of reading and happen to realize that the way my lab numbers were reading and from what i lewrned on a site somewhere that I needed to drop the ndt and go with straight liothyronine.
I discussed with my doc and that's what we did.
Started with a few days of 1/2 grain then a couple weeks of 1 grain and then 1.5 grains which I've been on for a couple of months now.
I feel really really good.
I also take it at bedtime instead of morning because of the usual not eating for 30-60 minutes there's things like vitamin c which you can't take within 4 hours of thyroid meds....there's a couple other things too I think and I basically couldn't take a pre workout, so I switched to taking at night.

It's been a long time and a struggle but I think I'm stabilized finally. I have normal energy now from morning to night. It feels good.

 

[OMI100]

Thank you, Orrin - I have been following your posts and links for awhile now. I just ordered the Kindle version of Tired Thyroid and am reading it now. I appreciate all your help and info.

Post your views on her book when you are done reading it.
STTM has another good book.
Both books cover the subject from a different approach and both are good to have around
What I like about Barb's book is that all her points are footnoted with the reference's at the end of each chapter.

 

[OMI100]

Additional short article from Dr. Mercola on NDT dose splitting:
https://www.mercola.com/article/hypothyroid/treatment.htm

 

[Mr. T]

Thanks, Chris (I was hoping you'd weigh in - I started with 1.5 grains upon waking up, then moved to 1 grain waking up, 1/2 grain midday, then split them throughout the day. Didn't feel any changes with different protocols. The first two I take with Selenium.

It is from a compounding pharmacy - I did read about the mixed reactions regarding Armour's acquisition.

 

[Mr. T]

Thanks, Orrin, I will post the review of her book. I also read the STTM book and Dr. Kharrazian's book (recommended by a friend awhile back), Elle Russ's book, Suzy Cohen's book.

I read the other books when I was haphazardly searching for answers to the chronic fatigue, constant cold, and loss of hair - but hadn't been diagnosed with anything other than "you're getting older." I'll need to go back and read everything again now that I have more skin in the game.

 

[Mr. T]

Thanks RB (I certainly lucked out - all the thyroid gurus are here - Orrin, VC, Vince, Rhino, 1D). Good point about NDT, and one I was wondering - if you keep raising NDT, at what point do you throw in the towel and eliminate NDT and/or add cytomel/levothyroxine to the mix?

I AM chronically anemic (my iron levels got worse after starting TRT) and am being treated by a hematologist with IV iron infusions a few times/year. I thought good iron was a precursor to a healthy thyroid, but it seems that a hypothyroid can affect iron (per the Tired Thyroid book).

 

[Mr. T]

Thank you, Rhino - I did not know that about Vitamin C. This is the first I've heard of taking it at bedtime - interesting.

There seem to be mixed opinions about coffee (although at least one study I read showed reduced efficacy if taken with coffee). I was told by one person in the office to take it on an empty stomach, and another said to take it with food.

Dr. Lowe (of T3-only fame) says to take all doses at one time when one wakes up because that's the only time one can really be sure of having an empty stomach.

 

[Vettester Chris]

Excellent posts from Rat and Orrin. This forum is not only at the TOP tier of any TRT /Mens wellness forum out there, but in my opinion it has quickly become one of the TOP sites for thyroid discussion. There are some seriously smart members here with great information that is related to all the aspects of the thyroid, and what I like is the diversity and different angles that these guys and some of the other KEY minds bring to the table!! Just wanted to put that out there, thanks guys!!

IMO, I'd probably try to go 1/2 grain at a time to get it dialed in. Keep us posted, I'm sure it will come together for you soon!!

 

[Mr. T]

Hi Vince - I read Dr. Lowe's last interview (I think it was in your thread) a while ago. It made sense to me and I was set to pursue a T3-only approach, but then I was looking around that same site and came across this http://recoveringwitht3.com/blog/why-paul-needed-t3-only-medication-update which seems to point to a [FONT=&quot]defective DIO2 gene. Arrrgh!

I find the thyroid the most frustrating of all. After inhaling Excel Male and reading all the Testosterone books, I feel fairly comfortable with the mostly-consistent body of Testosterone knowledge by the leading docs and Excel Male gurus here.

Thyroid, on the other hand, baffles me no end.[/FONT]