Switching from cytomel and synthroid to naturethroid/Westhroid

[Justin Chile Farrar]

Hey guys,

currently I'm on 100mcgs of synthroid and 20mcgs of cytomel. I'm still not feeling that great. Still fatigued and wake up with a swollen tongue ect.

i want to switch to naturethroid or Westhroid. I was looking at the conversion charts though and it doesn't make any sense. It says 1grain is equivalent to 100mcg of synthroid but if I'm on the dose of cytomel/synthroid above, how many grains should I start with?

Thanks

 

[Tom Larabee]

Justin - Saw your other post and thanks for asking the question in this forum. I am sure once Chris see's this he will reply as he is our Thyroid goto guy.

 

[HarryCat]

If you go to the Naturthroid website:http://www.nature-throid.com/available_strengths.php

You'll see that 1 grain contains 38mcg T4 and 9mcg T3. So for the 100mcg T4 in your current protocol you would need to take between 2.5 and 3 grains, which would also give you 22.5 to 27.5 mcg of T3.

 

[Vettester Chris]

Justin, good post. Yes, your current dosages of Synthroid and Cytomel are about equal to one (1) grain of NDT. If you start out with one grain you should be able to cut out the Synthroid right away, but I would suggest cutting your Cytomel dosage down to 10mcg/day.

With the Synthroid you are getting T4 only, which then converts downstream to T3 & Reverse T3. With the NDT's you will get approx. 80/20 of T4 to T3,T2,T1, so you will be getting some T3 right out of the shoot with your NDT treatment. If staying on just one grain of NDT, you 'might' look at staying on a small amount of Cytomel, like 10mcg or 12.5mcg. Or, you might be able to start bumping your NDT dosage up to 1-1/2 to 2 grains (or more) and possibly eliminate the Cytomel all together.

There's a few variables involved with this transition; basically reviewing your labs and finding a dosage that makes you feel optimal. I think it's crucial to make sure your cortisol, iron & ferritin, D3 & some of the electrolytes are in order before trying to get the NDT's dialed in, otherwise the adverse effects of pooling and elevated RT3 is going to be a factor. Being that you're on the other thyroid meds, you probably have a handle on this already (?). I'd be curious to see how your labs look with your current protocol.

Hope some of this helps. There's quite a bit of information at STTM.com as well, so definitely check their site out. Keep us posted please.

 

[Justin Chile Farrar]

Thanks Chris,

yeah, I haven't been feeling too great on the Synthroid/Cytomel combination, so I was thinking I'd go to 1-1/2 grains of naturethroid and keep 10mcg of Cytomel on board with it and see how that works out, since that means I'd be getting about 5mcg more of T3 and a little more T4, right? Because maybe I need a little more thyroid. The conversion part is what is confusing because one grain of Naturethroid only contains 38mcg of T4, like what HarryCat said, so I'm confused as to how that equates to 100mcg of synthroid.

My doctor also has me on about 25mg of hydrocortisone per day and I'm concerned about T3 pooling... Does high cortisol or low cortisol cause that? And how can I tell if that's happening to me, being on Hydrocortisone?

Here are my labs results as of late:


TSH:
1.13 (0.40-4.50)mIU/L

T4, FREE:
1.2 (0.8-1.8)ng/dl

T3, FREE:
3.3 (2.3-4.2)pg/ml

REVERSE T3:
9 (8-25)ng/dl

 

[Vettester Chris]

Justin, regarding the dosage comparisons of T4 only & NDT's, I have seen some varied opinions on some other health and thyroid forums, and STTM.com. When you sift through all the chemistry in the Synthroid you will probably find that 1 grain of NDT will equal around 70-to-80 mcg of Synthroid and some of the other T4 only meds when it all metabolizes. Again, that's been tossed around in other discussions with folks that have transitioned to Armour.

On your labs, your T4 storage is sitting 40% of the reference range and FT3 is at 53%. Your FT3/RT3 ratio is GREAT, I don't see anything that would indicate pooling. I would suggest aiming to get BOTH your FT4 & FT3 labs in the 50% to 80% range of their respective labs, 50% being the bare minimal and titrate your dosage up to a range where you feel good and can sustain. Me think you will probably start seeing the results you're looking for when both sets of labs get around the 65% range; say 1.4 to 1.5ng/dl on the FT4 and maybe around the 3.6'sh area for FT3. That's just all speculation on my end, so please work close with your physician and take it REAL SLOW as you try to achieve that optimal zone.

Got to run, but yes, cortisol will play a BIG role in how the thyroid functions. Usually low cortisol is the culprit and pooling will be evident, but this doesn't appear to an issue on your end. However, these stats could change as things progress, so it could take several rounds of labs to see if things are proportional as you increase thyroid hormone dosages, and as you get other components (e.g., HC therapy) dialed in. I'd also suggest making sure your Vitamin D level is good (IMO >60).

 

[Justin Chile Farrar]

awesome Chris! thank you so much for the info. You're a gentleman and a scholar, but seriously that helps a lot. One other question...

when I go in for labs should I take my NDT dose the morning of? Or just take my pm dose the night before?

 

[HarryCat]

Justin, regarding the dosage comparisons of T4 only & NDT's

But Justin is not on T4 only he is taking 83% T4 and 17% T3, so I don't think the old rule of thumb applies. As you know the reason they say 70-80mcg of T4 only is about 1 grain is because you are adding in T3 in addition to the T4. A lot of people have problems converting T4 to T3 and therefore can get away with a smaller dose of NDT.
Justin is already taking a large-ish dose of T3 and at 1 grain of NDT he is going to be taking a lot less.

Justin, do what your Doctor says, but you may be in for a rough ride until you get you dosage adjusted.

 

[Vettester Chris]

Harry, yes I'm aware of Justin's situation with the T4 & T3 ratio. The T3 supplementation was based on pound for pound going with one (1) grain of NDT against the previous protocol that he was on with 100mcg (not 70mcg or 80mcg) of T4 and 20mcg of T3. If he started with one grain, it might not hurt to cut the cytomel in half to 10mcg, since one grain probably won't provide an equal amount of storage T4 as the 100mcg of Synthroid (but it will have 9'sh mcg or so of T3). Once he starts titrating up on the NDT to get his T4 & T3 up and more consistent with each other he probably would be able to drop the cytomel all together. That's why I mention it's all speculation, to work CLOSE with his physician, take it slow, and base the assessments from labs and how he feels.

 

[Vettester Chris]

awesome Chris! thank you so much for the info. You're a gentleman and a scholar, but seriously that helps a lot. One other question...

when I go in for labs should I take my NDT dose the morning of? Or just take my pm dose the night before?

Justin, don't take any NDT's the day of your lab work. I think it was Dr. Rind (don't quote me on that) that said to hold off taking any after lunchtime the day before your labs.

 

[HarryCat]

Harry, yes I'm aware of Justin's situation with the T4 & T3 ratio. The T3 supplementation was based on pound for pound going with one (1) grain of NDT against the previous protocol that he was on with 100mcg (not 70mcg or 80mcg) of T4 and 20mcg of T3. If he started with one grain, it might not hurt to cut the cytomel in half to 10mcg, since one grain probably won't provide an equal amount of storage T4 as the 100mcg of Synthroid (but it will have 9'sh mcg or so of T3). Once he starts titrating up on the NDT to get his T4 & T3 up and more consistent with each other he probably would be able to drop the cytomel all together. That's why I mention it's all speculation, to work CLOSE with his physician, take it slow, and base the assessments from labs and how he feels.

OK, fair enough. Thanks for the explanation.