Dessicated thyroid doesn't seem to be working (up to 3gr, no change)

[pf]

First, thanks for such a great resource! I've been around for about a year but have never had to post because there's already so many answers on here, it's almost impossible to find something that requires a new post! Well, I finally found something ;-).

Hoping that one of you hormone gurus has an idea of what's going on with me. I've been on TRT for almost a year now. The TRT has helped, but I'm still tired all the time. So we've begun looking at the thyroid. I'm up to 3gr NDT (2 in the morning and 1 in the afternoon) and haven't noticed any real change yet. Energy is still in the dumps and I wake up feeling like I got hit by a truck every single day. Doctor told me I could increase up to 4gr on my own before my next visit at the beginning of January. I'm posting my meds, supplements, and tests below in hopes that someone on here can offer some advice in getting the best results. The doc said my next step would be sermorelin therapy, but that's apparently expensive and he prefers not to go that route until everything else has been attempted.


Here are my baseline supplements/meds -
25mg DHEA 2x/day
Fish Oil (Nordic Naturals Ult Omega 1280mg 2x/day)
.35ml 200mg/ml Test Cyp 3x/wk (210mg/wk)
400iu HCG 3x/wk
Anastrozole .25mg 3x/wk
NAC 600mg (Now brand) 2x/day
I was also on RLC a-Drenal for the first couple of months, but it didn't seem to make a difference so I dropped it.


8/14
TSH 1.150 0.450-4.500 uIU/mL
T4,Free(Direct) 1.01 0.82-1.77 ng/dL
Vitamin D, 25-Hydroxy 38.2 30.0-100.0 ng/mL
Vitamin B12 1310 HIGH 211-946 pg/mL
Triiodothyronine,Free,Serum 2.8 2.0-4.4 pg/mL


8/16
Nurse reviewed my labs and added the following to my protocol.
Add Selenium 200mcg daily
Add D3 5000iu daily
Add 1/2gr NDT (actually started 8/25)


8/24
Had saliva cortisol test. Looks a little high in the morning, but overall I believe these numbers are relatively good.
DHEAS 6.7 2-23 ng/mL (Age Dependent)
Cortisol 10.7 H 3.7-9.5 ng/mL (morning)
Cortisol 2.5 1.2-3.0 ng/mL (noon)
Cortisol 1.1 0.6-1.9 ng/mL (evening)
Cortisol 0.7 0.4-1.0 ng/mL (night)




9/25
Still on 1/2gr NDT. No change in symptoms. Test seems to indicate minor increase in T3, drop in TSH. Doctor told me to increase NDT by 1/2gr every week or two up to 4gr as needed. The iron/ferritin numbers hadn't come back by my appointment time, so the doctor has not reviewed them.
T4,Free(Direct) 0.92 ng/dL 0.82-1.77
DHEA-Sulfate 506.1 H ug/dL 102.6-416.3
TSH 0.648 uIU/mL 0.450-4.500
Reverse T3, Serum 12.0 ng/dL 9.2-24.1
Triiodothyronine,Free,Serum 3.0 pg/mL 2.0-4.4


Iron Bind.Cap.(TIBC) 284 250-450 ug/dL
UIBC 183 111-343 ug/dL
Iron, Serum 101 38-169 ug/dL
Iron Saturation 36 15-55 %
Renin Activity, Plasma 0.442 0.167-5.380 ng/mL/hr
Aldosterone 11.5 0.0-30.0 ng/dL
Ferritin, Serum 133 30-400 ng/mL


So there you have it. Anyone have any bright ideas?

 

[CoastWatcher]

Welcome to Excelmale. Hashimoto's has been ruled out?

 

[HarryCat]

Looks like you're just not absorbing the NDT. Are you taking the first does on an empty stomach and avoiding food and coffee/tea for an hour? Do you eat dairy? that can also affect absorption. Your afternoon dose should also be on an empty stomach. You could also try taking the NDT sublingually.

What brand of NDT are you using? WP Thyroid is supposed to be the easiest to absorb, but has been difficult to get lately due to production problems.

 

[TheDude]

Have you been checked for sleep apnea?

 

[pf]

Welcome to Excelmale. Hashimoto's has been ruled out?

Thanks! Hasn't been ruled out or even discussed at this point. I have no goiter, though.

Looks like you're just not absorbing the NDT. Are you taking the first does on an empty stomach and avoiding food and coffee/tea for an hour? Do you eat dairy? that can also affect absorption. Your afternoon dose should also be on an empty stomach. You could also try taking the NDT sublingually.

What brand of NDT are you using? WP Thyroid is supposed to be the easiest to absorb, but has been difficult to get lately due to production problems.

Hrm, I take it on an empty stomach both times, avoid food and all my other pills for 1 hour. I do drink coffee soon after the morning one, though. I wasn't aware that could be an issue. I don't eat dairy often and never within hours of taking the NDT. If anything, it's some cheese or eggs later in the day.

I go to Defy, so my only option is compounded. Originally, I had 1/2gr tablets from Hallandale. Now I'm using 1gr and 1/2gr capsules from Empower. I haven't had bloodwork since I was on 1/2gr, but it seemed that 1/2gr did increase my numbers ever so slightly.

Have you been checked for sleep apnea?

Not officially. But my wife says that I do not snore. And I never wake up out of breath.

 

[HarryCat]

Not officially. But my wife says that I do not snore. And I never wake up out of breath.

This doesn't mean much. You could still have mild obstructive sleep apnea or central sleep apnea.

Do this test and see how you score: https://www.slhn.org/docs/pdf/neuro-epworthsleepscale.pdf

 

[pf]

This doesn't mean much. You could still have mild obstructive sleep apnea or central sleep apnea.

Do this test and see how you score:

Interesting. I don't have a regular doctor. Sounds like I might have to go find one and talk about having a sleep study done.

I scored a 12 on the test. Interesting questions, for sure.

 

[captain]

I would look into getting a prescription for thyroid meds from a regular pharmacy. It seems like a lot to be taking and have them results. You will probably save money in the end and that should make you feel a little better.

 

[ratbag]

If your having trouble with natural desiccated thyroid (NDT) try the synthetics instead. NDT has a reputation of bad batches and it's a common problem. For me it happened so often I switched to synthetics (cytomel + synthroid) and it solved the problem. You probably will have to try it in order to eliminate why your FT3 is so low on the NDT dose you are taking.

 

[pf]

I would look into getting a prescription for thyroid meds from a regular pharmacy. It seems like a lot to be taking and have them results. You will probably save money in the end and that should make you feel a little better.

I would try non-compounded but Defy charges $25 to write scripts that are filled at a regular pharmacy. So that kind of kills the price difference. Might still be worth a shot I guess, if I get my next blood work and the NDT clearly isn't raising my T3. Right now, I don't know if it is or not. I only know I feel no difference.