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Need help making sense of my Labwork and help with sourcing NDT in India

Hi,

I have been battling what are clearly hypothyroid symptoms for over a decade, though Docs have cleared me based on the inadequate TSH tests.

Here's where I am right now:
Weight gain, inability to lose it
Thinning and falling hair
Crushing fatigue
Chronic pain and stiffness
Insomnia
Depression and anxiety
Low basal body temperature

My labs from Dec 2020:
ANTI-TG: 27 (Ref <60) 15 in 2015
ANTI-TPO: 54 (Ref <60) 34 in 2015
FT3: 2.57 (Ref 2.3-4.2)
FT4: 1.29 (Ref 0.89-1.76)
TSH: 3.585 (Ref 0.550-4.780)
FERRITIN: 58.1 (Ref 10-291)

The above labs and my symptoms tend to suggest hypothyroid and antibodies to watch out for. I have been prescribed T4 medicines, but I am not sure I want to be on them. I think NDT is where I want to be headed, but need help both finding a Doctor in Delhi, who will understand the composite picture, and also prescribe/ help source NDT. Any help on reading my labs, doctors and NDT will be most appreciated. I have heard of a pharmacy in Bangalore that customises compounds, but am not sure of their review.

I look forward to hearing.

Thank you very much.
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649848 tn?1534633700
COMMUNITY LEADER
Your lab results (partcularly FT3) is indicative of hypothyroidism.  Since your TPOab is so close to the reference range, I'd guess that you do have Hashimoto's; it's just that the antibodies haven't ramped up yet.

Your Ferritin is lower than it should be, even though it's within the range.  Ferritin should be around 100.  Ferritin is the storage hormone for iron, which is necessary for adequate conversion of FT4 to the usable FT3.

Have you been tested for Vitamin B-12 and vitamin D?  Vitamin B-12 deficiency can cause horrible fatigue, brain fog, etc.  Both B-12 and D are necessary for proper metabolism of thyroid hormones.

What dose of T4 was prescribed and how long have you been on it?  Is there a particular reason you don't like being on T4 medication?

From what we've heard from others in India, T3 medications (including desiccated hormones) are not available there.  If you can find a compounding pharmacy to make them for you, you'd have to get your doctor to prescribe the proper amounts of T4 and T3 to be included in each pill.   I'm not sure about finding a doctor.  I'll check around but since most of us are in the U.S. I'm not sure how helpful we can be.
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Thank you so much for your prompt and detailed response. Your reading of the labs is very helpful - hypothyroid and Hashimoto's. It gives me a direction and a definite understanding of my intuitions.

I will bear in mind the other labs as well. When last checked, my B12 and D25 were both low - the former 214 (Ref Range 211-911) and the latter 45 (Ref Range 75-250). I have since been on supplementation, but not repeated the tests.

I have been prescribed 12.5 mcg of Eltroxin, but decades of seeing my mother not improve on it, now coupled with the sea of knowledge from patients around the world makes me very suspicious of synthetic T4 only. If I read my labs correctly, my FT4 is midrange and FT3 low, which might even suggest I dont lack T4 in the first place. Please correct me if I am wrong. Some other people I spoke with suggest it might be worth the fight sourcing NDT somehow instead of getting on T4. Would you suggest trying T4?

I am well aware of NDT and T3 not being available but want to try still. I found many threads on this forum with the same enquiry about Armour for instance and to many such queries there was a response with details of Armour in the PM. I was hoping someone would be able to help. Like all desperate patients, I am happy to explore every option that is promising.

I look forward to hearing. Thank you again.
Yes, at 214 and 45, your B-12 and D are definitely, both low.  B-12, typically needs to be kept at/near the top of the range in order to keep symptoms from appearing.  As I noted, both are necessary for proper metabolism of thyroid hormones.  

12.5 mcg of T4 is a very minute dosage.  A typical starting dose is 25-50 mcg, often depending on age, and increased as needed to alleviate symptoms.  If that's all your mother was ever prescribed, it may be no wonder she didn't see improvement.  

You did understand correctly - your Free T4 is just under mid-range at 46% or range.  Most of us feel best with FT4 around mid-range.  Everyone is different so you could possibly stand to have yours higher.  Your Free T3 is 14% of range.  Rule of thumb is for Free T3 to be maintained between half to 2/3 of range, so you definitely have a way to go.   I wouldn't go so far as to say that you don't need the T4 med, but I would say you have a conversion issue, which isn't uncommon.

As  I noted, your Ferritin is on the low side and indicates that your iron might not be optimal.  Aside from helping with conversion of FT4 to FT3, iron is necessary for making red blood cells which carry oxygen throughout the body.  Iron deficiency can cause extreme fatigue, along with other symptoms.  Selenium has also been shown to help with conversion.
Thank you again. Super helpful. In the last twelve hours, I have managed to have a consultation with my Doctor, who I am happy to report, is totally on board with me, and has withdrawn the T4 prescription, in favour of a compound or NDT, but only after a detailed set of labwork, including all the ones you have advised me on.

I can see why some of my issues might be getting worse because of my low labs. Thank you for drawing the connections. That brings me back to the question I have been obsessing about: is there any way at all you can help with a possible NDT source in India. I say this only because I have seen repeated posts on the forum that say 'details sent over PM'.

I am feeling on firm ground after all the analysis you have shared with me and also your advice on the other parameters I need to work on, which I definitely will. But unless I can find NDT or T3+T4, I will remain stuck in this situation.

Pardon my pushing this, but I hope you appreciate my desperation. It is even more discouraging to be stuck with a diagnosis when you can see what might heal you, but have no way to reach it!!
I'm happy to hear that your doctor is on board with a compounded or desiccated medication and is willing to do further blood work.  Has s/he provided a prescription for anything?  

To my knowledge there is no source of desiccated hormones "in India", unless your doctor knows of a source.   I'm not sure I understand why you're "stuck in this situation" if your doctor is on board with change in medication.  
I shared your first response and analysis with her, in addition to the research/ experiences in the book Stop the Thyroid Madness. Because she is a holistic healer and was already clued into the ineffectiveness of TSH as a marker alone, it was easy for her to consider what I shared with her and commit to learning and researching it more before treating me. When I shared your opinion on both, my numbers and why iron for instance is critical, she agreed to press the pause button and retract the T4 only prescription. She said we will together figure out what all bl00dwork I might need - from cortisol and iron to sodium and potassium. So she hasn't given me a detailed list yet.

I am sorry if I was unclear about the being stuck expression. All I meant was that while the first part of the battle seems won now that I have a Doctor who is willing to consider all this rich information on understanding and treating Thyroid,  we are both still going to be at a loss for options if we are unable to manage NDT or T3-T4 together. We know the solution here, but have no access to the meds. Hence the worry about being stuck. I appreciate you have no contacts in India or any leads and I am going to try as hard as I can to explore it. I might need more handholding from you and might come back for that, because I realise I have a whole lot to figure out about this condition, including the impact of Selenium you mentioned. I am humbled at your patient indulgence and hold much gratitude.
And that explanation of the ranges makes so much sense!
I'm happy to help and will be here if/when you have more questions.

Desiccated hormones aren't the only option.  Talk to your doctor and see if she can prescribe synthetic T3 (brand name Cytomel or generic Liothyronine) to go along with the T4.  This is often done in the U.S. if one doesn't convert adequately because many doctors are unwilling to prescribe desiccated hormones... For example, a person may require 50 mcg T4 and 10 mcg T3.   From what I've heard from other members even synthetic T3 is not available in India, but things change so talk to your doctor and see if it's possible that it's become available recently.
Ohh. That makes sense and opens up another option. I have learnt of one such pharmacy. Am going to make some calls. Will get back to you once I am done with my recce and have a rough plan in place!
So glad for this group and your advice.
Thank you.
Another option is a compounded dosage - on the order of desiccated, but whereas desiccated  hormones are manufactured in bulk with each pill containing (usually) 38 mcg T4 and 9 mcg T3/grain (one grain Armour = 60 mg), compounded medications are produced by a special pharmacy with whatever levels of T4 and T3 you might require.  Again, that one would depend on whether or not the T3 is available in India.  Personally, I'd prefer the synthetics because each can be controlled individually.
That is an interesting observation to add to the conversation. I have been hearing so much about NDT being the most superior intervention, which explains my pestering you with the question of where to find it, that I gave this one relatively less importance. The Pharmacy I mentioned to you last is said to create such compounds, but if they still exist, much will depend on how carefully my Doctor is able to calbirate and arrive at my dose. But I will be ecstatic if they are an option.

I am also being told that NDT by itself may not be enough and with that too, synthetic T3 would be a good/ necessary addition. All in all, that explains your suggestion of T3 being all so important.
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Sending you a PM with info.  To access, just click on your name and then from your personal page, click on messages.  
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