Avatar universal

Labs and NDT

I have been working to get my labs in range, and am closer then I have been in awhile on the current dosage of
Levoxyl 75 mcg and 15 mcg Cytomel.

Here are the results:

TSH: 0.02  (L)
T3, Total:  83                      (76-181 ng/dL)
T3, Free:  3.3                     (2.3-4.2 pg/mL)
T4, Free:  1.0                     (0.8-1.8 ng/dL)
T3, Reverse:  6                  (8-25 ng/dL)
Vit B12:     511                   (76-181 ng/dL)
Vit D, 25-OH, Total:   37    (30-100 ng/dL)

Switching to NatureThroid he prescribed to start: 975.5

Would that be equivalent to what I am on now, which is getting closer but not yet there?  
This Dr. is compliant, but not 100% confident with his knowledge of NDT and I can't seem to figure it out either.  I started to take it, and then decided to hold off till I know for sure.
I am still tired, and still steady with gaining weight, and truly reluctant to test something out and make things worse.  SOS.
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Avatar universal
Why are you considering switching to NDT.  It is much easier to adjust either Free T4 or Free T3 levels, as needed, when taking separate meds.  Don't forget the old saying, "If it ain't broke, don't fix it."

Instead of switching, why not just continue to slowly increase your Levoxyl and Cytomel doses in order to get your Free T4 to around the middle of its range, at minimum, and your Free T3 high enough n the range to relieve remaining hypo symptoms?  Also would be good to increase your B12 to the upper end of the range, and your d to about 60.  Also, what is your ferritin level?
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Avatar universal
I agree with Gimel.

I would recommend you only change the dosage on one or the other at a time.  I would recommend since your FT4 is low in the range to only increase or ask your Dr to increase your T4 dosage.  Again slowly increase this dosage until A) you feel better and your symptoms are relieved or B) You get your FT4 to be about 50% of the range.  At which point you can then start to slowly change the Cytomel (T3) until your symptoms are relieved.

I have no issues with using NDT.  But you may be SOOO close to optimization there is no reason to throw the baby out with the bath water and completely upset the apple cart by essentially starting over!

Just my opinion.
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Avatar universal
Since last I wrote, its been a month of weight gain and being unconscious.  I decided to wait on changing to NDT, and instead, went with the Endo's suggestion to DEcrease the t4 (Levoxyl) to approx 66 mcg (75 mcg 6xweekly) and Increase the t3 (Cytomel) to 20 mcg.  I have felt worse then ever.  Yesterday, I nearly passed out driving to the Dr.  We decided to, try the NatureThroid at 65 Mg.
He said this dose is equivalent to 100 T4. He did not say what the t3 ratio was.
The reason for the shift to NDT has to do with money, the bloat from Cytomel or the T4, (not sure which) and the fact that nothing has been working.  I have gained nearly 20 lbs in the 8 months since my return from the UK. I barely get through the day without sleeping, weeping or feeling lost.  Here are the recent labs.  
And the questions are:  
Is he is heading in the right direction?  

I fear taking extra medication, due to having been 200lbs while on 175 mcg of Synthroid.  I can't carry that weight again.

T3, Free:  3.0  (2.3-4.2 pg/mL)
T3, Total: 81 (76-181 ng/dL)
T4, Free: 0.9 (0.8-1.8 ng/dL)
TSH:  0.01 (,IU/L) L
Reverse t3: 6 (8-25 ng/dL)
ParaThyroid Hormone, Intact:  49 (14-64 pg/mL)
Vit D, 25-OH, Total:  37 (30-100)
B12: 511 (200-1100 pg/mL)
Ferritin: 39 (10-232 ng/mL)
Cortisol, Free, Urine: 31.9  (4.0-50.0 mcg/24h)

I hope for that one day when I write that all is well, but I am not there yet.  Thoughts and advice are welcome.
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Avatar universal
Not clear on when your med and dosage changed and when blood was drawn for those latest tests.  At any rate, your Free T3 has gone down, when it should be increased.  Your Free T4 has also gone down.  And it was not high enough previously.  Your Vitamin D needs to be about 55-60, your B12 should be in the very upper end of the range, and ferritin should be 60 minimum for women.  So you need to supplement to reach those levels for D, B12 and ferritin.  

And your dosage of 75 T4 and 15 T3 was equivalent to about 127 of T4.  I don't understand why your doctor wanted to reduce your T4 med when your Free T4 was too low already.  Your change to 66/20 did nothing for your Free T3.  65 mg of Naturethroid is an even lower dose.  It is more like the equivalent of 75 mcg of T4, at most, not 100.  I think you most likely need 2 grains of Naturethroid, to get your levels higher than what you posted in the first set of tests above.  
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