Obviously with those lab results you need to increase your dosage of NDT, but I would not try to get back to your prior dosage of 4 grains all at once. From your description of prior symptoms, perhaps a good target would be to get back to 4 grains + 37.5 mcg of T3. Along with that you should make sure your Vitamin D is at least 50 ng/mL, B12 in the upper end of its range, and ferritin at least 100. Probably a good idea to also let the doctor give you a trial of hydrocortisone along with DHEA. Also after you reach target levels, be sure to allow at least a couple of months to get full effect on symptoms. I think part of the problem in the past was that large changes were being made too quickly.
Just to clarify, last July, on the 4 grains + 50 you still had those hypo symptoms, but then you started having mild hyper symptoms. If that is correct something else must have changed to cause the switch from hypo to hyper. The likelihood of figuring that out now is pretty low I expect. So I suggest that you try to get the doctor to put you on the dose at which you felt best in the last year ( 4 grains + 50 ????) and also make sure that your Vitamin D, B12 and ferritin levels are optimal, and cortisol and DHEA are optimal, and see how you feel. From there, if needed you should tweak dosages, not make large changes. And make sure you always give enough time for a good evaluation of any change, since symptom changes tend to lag changes in thyroid hormone levels.
Please list the hypo symptoms you were having that never got better. Also please list the symptoms that you had for a few weeks that you felt were hyper.
Another question I wanted to ask. Do you take iron supplements, or does your diet include a lot of sources for iron?
I am a bit confused. You said, "I never felt good on the four grains /50 t3. I had all the usual hypo symptoms on that dose. " Di you mean hyper, because that would be consistent with prior info you gave.
I thought you said you started feeling a bit hyper on the 4 grains + 50 mcg of T3 , so I am somewhat confused about your statement that you never felt good on the four grains + 50 of T3. Also, please post the reference ranges for the ferritin, sat, TIBC and Iron.
If the doctor does give you a rial of Cortef, be sure to ask about the need to take some DHEA also.
I agree that you have been swinging back and forth too much in your dosage changes. Seems to me that the one you felt best on, for the longest time, was the 4 grains + 50 mcg of T3. Then you felt a bit hyper and made a big change.by reducing to 25 mcg of T3. Since that time you have only gotten worse with all the different changes that were made. . Again, I think you are overly concerned with a RT3 of 20. I think you should ask the doctor to go back to the 4 grains and maybe 37.5 mcg of T3 and stay there for long enough to get a good evaluation. Also, you need to make sure your Vitamin D is at least 50, B12 is in the high end of its range, and ferritin at least 100 (what was your actual ferritin result?).
Although your saliva cortisol was just below mid-range in the early test, you do have a few symptoms that do not overlap hypothyroidism. Being in range does not always assure adequacy, and there is also a condition called cortisol resistance. All that might suggest at least a discussion with your doctor about a therapeutic trial of hydrocortisone to see if symptoms improve.
Before getting into more detail, please respond to the following.
What lab did the saliva cortisol tests? Why are you taking the hypothyroid tonic and milk thistle, and for how long? Have you ever been tested for ferritin? Back when you were taking 4 grains + 50 mcg of T3, you said you felt mild hyper symptoms and reduced your T3 by 25 mcg. How did you feel at that time, and why did the doctor subsequently change you to 5 grains and no T3?
So I think your current dose is 2 grains and 50 mcg of T3. , correct? What did you mean by "at half a dose I feel utterly exhausted, etc.""
I think you are overly concerned about the RT3. Have you been tested for FT4, FT3, RT3 since Oct? Your cortisol level may be a bit borderline. Even more important is whether you have any typical symptoms of low cortisol, such as the following.
Mental and psychological ailments such as depression
Faintness and dizziness
Weakness and fatigue
Heart palpitations
Emotional hypersensitivity
Inability to cope with stress
Social anxiety
Muscle weakness
Headache, scalp ache, or general body ache
Severe or dull lower back pain
Extremely sensitive skin
Nausea, diarrhea, and vomiting
Abdominal pain and hunger pain despite an empty stomach
Extreme craving for salty foods
Anxiety and jitters
Clumsiness and confusion
Motion sickness
Insomnia and dark circles under the eyes
Low bladder capacity and symptoms of IBS
Irregular or non-existent menstrual period
They also had DHEA that said not checked but the number 17.2 was listed with a range of 2-23. I’m recalling this from memory so not positive.
I have my saliva cortisol results. I stopped taking hypothyroid tonic and milk thistle for a week before the test: here are my results:
am: 6.3. Range 3.7 - 9. 5 ng/Ml
Noon 3.1. “ 1.2 - 3
6:00 pm. .9 “ .6 - 1.9
10:00 pm .4. “ .4 - 1.0
I take Benadryl to sleep at night or to wake less frequently. Some nights I wake at 12:30, 2:30 etc.
I have been taking zinc and b12 vitamin D, Selenium.
Does cortisol look good?
You don't have to get rid of RT3, just get it to mid-range, or below. As an outstanding thyroid doctor tole me once, "thyroid med dosage is irrelevant, only the physiological effects matter". Unless there is thyroid hormone resistance, which is somewhat unusual, then he wanted to see his thyroid patients with FT4 and FT3 both in the upper third of their ranges. Or if taking NDT type med, then typically he wanted to see FT4 around mid-range, and FT3 at the high end of the range, with the blood draw for the tests about 24 hours after the last thyroid med dose was taken. The reason for that is to avoid false high results.
In addition, you do need to know about your free cortisol levels, by doing the diurnal saliva cortisol panel of 4 tests at different times of the day. Also, Vitamin D should be at least 50 ng/mL, B12 in the upper end of its range, and ferritin should be at least 100.
Also, since hormones can affect the level of thyroxine binding globulin (TBG), which affects the levels of Free T4 and Free T3 also, it might be useful to test for TBG, or as an alternative, test for Total T4, along with the Free T4 and Free T3. This would give an indication as to whether your levels achieved with those med dosages are being affected by poor absorption, or high levels of TBG.
Thanks. Yes. He is open to changes and also open to receiving info from patients. He said he didn’t want my Ft3 at a low normal either so he put the T3 back in. I was on the 4 grain dose plus the 50 cytomel for a long time but I started to feel hyper so I cut 25 out. I thought that might be a good dose except my Ft4 remains super low.
We need to figure out why. If dropping two two grains doesn’t get rid of RT3, I may have to switch to T3 only.
It is good that your doctor is so cooperative about the changes.
Looking back, how were you feeling on 4 grains plus 50 mcg of T3?
My dr was open to reducing to three grains NDT but after talking we decided to drop to 2 grains of NDT plus take 50 mcgs cytomel. I have cleared Rt3 on two grains before but as far as I can recall, there was no T3 added. I feel this change is fair; it’s a good way to reduce Rt3 while still living on T3. He wants to see me in four -five weeks.
Also, I have to go off a few herbals for a week, then do a saliva cortisol test from ZRT labs. I’ve been sleeping a little better than usual.Waking frequently but sleeping later.
Yes, he probably will. When I had Rt3 a few years ago ( with another dr) we reduced to two grains for a few months. I don’t recall ever feeling better after that. My Ft4 is so low, the idea of lowering... yikes.
Thanks for replying.
My Free T3 is 3.3 pg/mL and my Reverse T3 Result is 20 ng/dL. My dr wants me to come in. What does this mean? I had reverse T3 a couple years ago and we cut NDT in half. Is that what I can expect?
I’m answering my own question. I think coffee is preventing absorption. To improve this, I’m going to wait an hour or more after a dose to have coffee and try to eliminate coffee altogether. Also, I’m starting probiotics. I have two bottles of adaptogenic tonic that I haven’t been taking because I’m taking other supplements. I’m going to fit those in too.
What should I be doing differently? Would four hours between supplements and thyroid be better?
Diet? Stomach issues? How can I figure this out?
Please help me! The last two months I have been feeling worse. My dr wants me to drop to four grains and add some T3 back in, plus take 3000 tyrosine a day. We did not have labs when he asked me to do this. I left his office with a sinking feeling and anxiety. My hair was growing for about two weeks but it’s coming out again. I have other hypo symptoms.
Now I have labs (waiting for Rt3) and I’m even more worried.
Two months ago: on 4 grains naturethroid and 50 mcg Cytomel:
Fr4. .83. Range .8-2.7 pg/dL
Ft3 4.6. “. . 2.8-4.4 pg/ml
Rt3 was not checked
Today, after two months on 5 grains NDT only:
Ft4. .75. .8-2.2
Ft3 3.3 2.8-4.4
Rt3 unknown
I take thyroid 2-3 hours after supplements. My temps are consistently low. I live on T3.
What could be causing the lack of T4? I am deficient in zinc but now taking supplements.
What should I be checking?
If the doctor argues that the conversion tables show that one grain of NDT is equal to 100 mcg of T4, just tell him that is wrong. A grain of NDT contains 39 mcg of T4 and 9 mcg of T3. The ATA/AACE Guidelines for Hypothyroidsim recognize that T3 is 3 times as potent as T4. So when you convert one grain of NDT to equivalent T4, it equals 66 mcg of T4, not 100 ( 39 plus 3 times 9 equals 66).
The 4 grains of NDT is the equivalent of 264 mcg of T4. When you add the 50 mcg of T3, which is 3 times as potent as T4, that means you were taking the equivalent of 414 mcg of T4. Now at 5 grains of NDT, that is equivalent to 330 mcg of T4, which is quite a drop from prior. So I think that the second reduction of 25 mcg was too much. So I expect that you need to be at 5 grains plus about 25 mcg of T3 or slightly less T3.