Low TSH and FT3/FT4 on levo. Switching to Naturethroid?

[bluezebra5]

Hey guys,

I posted a while back when I was diagnosed with Hashimoto's. I've come a long way, but my energy levels are still not anywhere close to what they were.

I'm now up to 125mcg of levothyroxine daily. At first it seemed like I was making T3 nicely, and that perhaps T4 monotherapy would be sufficient, but I'm much less optimistic now. Latest labs were as follows:

TSH: .984 (.36-3.74)
FT4: .82 (.76-1.46)
FT3: 2.4 (2.18-3.98)
Antibodies: I don't have the numbers handy, but my anti-TPO was higher than ever, and anti-thyroglobulin was slightly elevated out of range (which has never happened before).

My TSH is finally sub-1, yet FT3 and FT4 are still pretty low. I've filled a new prescription for NDT (Naturethroid), written reluctantly I should add.

1. Is this the right move?

2. How do I make the switch? I've read wildly conflicting recommendations, though most seem to recommend a low starting does to give the long-lived levo time to go away.

 

[CoastWatcher]

You actually sound as if you hope someone will talk you out of this move. What are the underlying negatives, in your mind?

 

[bluezebra5]

You actually sound as if you hope someone will talk you out of this move. What are the underlying negatives, in your mind?

I would only view it as a negative if I were to later find out that there was some correctable, underlying reason that I couldn't keep my FT3 up on levothyroxine.

Happy to make the switch, I just don't want the hassle of dosing throughout the day, being careful with food/coffee if that's not necessary. But if this is the way to get my energy back, it would be a welcomed sacrifice, and I'd appreciate any tips from those who've made the transition from T4 monotherapy to NDT.

 

[Vettester Chris]

At 125mcg, you are equal to 1-1/4 grain, which in some respects isn't a lot of medication. The other variable is Reverse T3, and if T4 is converting at a high rate of it (RT3), then that will affect your overall FT3 serum level. So, to assess properly, you would need an RT3 assay to compare (ratios).

Me personally, not a big fan of Levo or any T4 only synthetic, but that's just my preference. NDT and/or T3 cytomel is a better route IMO, but everyone to their own ...

 

[bluezebra5]

At 125mcg, you are equal to 1-1/4 grain, which in some respects isn't a lot of medication. The other variable is Reverse T3, and if T4 is converting at a high rate of it (RT3), then that will affect your overall FT3 serum level. So, to assess properly, you would need an RT3 assay to compare (ratios).

Me personally, not a big fan of Levo or any T4 only synthetic, but that's just my preference. NDT and/or T3 cytomel is a better route IMO, but everyone to their own ...

Thank you Chris. I have not, in the past, had an issue with pooling but it certainly could be a recent development.

How would you suggest I go about switching meds? I've read suggestions ranging from "just start taking an equivalent dose" to excruciatingly slow ramp ups.

Additionally, what do you think is the ideal dosing strategy? If we're talking 2-3 times daily, how should this fit around meals (particularly coffee, as I know this is a common culprit in malabsorption)

 

[Vettester Chris]

Thank you Chris. I have not, in the past, had an issue with pooling but it certainly could be a recent development.

How would you suggest I go about switching meds? I've read suggestions ranging from "just start taking an equivalent dose" to excruciatingly slow ramp ups.

Additionally, what do you think is the ideal dosing strategy? If we're talking 2-3 times daily, how should this fit around meals (particularly coffee, as I know this is a common culprit in malabsorption)

And that's the thing, I don't know if "Pooling" is a problem with you or not (?), but the RT3 lab would help clarify that with an RT3/FT3 Ratio.

IMO, if you switched to NDT, my starting point would be = at 1.25 grains, or call it approx. 75mg of NDT. Keep in mind, with Hashis, I've seen more reports than not that it takes some higher dosages to effectively combat or stabilize the autoimmune attacks, e.g., 3, 4, 5+ grains. Also, make sure you have selenium in the mix, especially if your diagnosis is TPO (?).

To conclude, if it were me, I'd start at the 75mg as mentioned above (1.25 grain), taking 60mg in the AM, 15mg at lunch (2/3, and 1/3 split). Titrate up 1/2 grain per week thereafter. Before getting too far, I would know what my iron, ferritin, cortisol, electrolytes, D3 and of course RT3 looks like before ramping up. And of course, run all of it by your physician, one who will hopefully be in-tune with how to help you manage a protocol.

 

[bluezebra5]

And that's the thing, I don't know if "Pooling" is a problem with you or not (?), but the RT3 lab would help clarify that with an RT3/FT3 Ratio.

IMO, if you switched to NDT, my starting point would be = at 1.25 grains, or call it approx. 75mg of NDT. Keep in mind, with Hashis, I've seen more reports than not that it takes some higher dosages to effectively combat or stabilize the autoimmune attacks, e.g., 3, 4, 5+ grains. Also, make sure you have selenium in the mix, especially if your diagnosis is TPO (?).

To conclude, if it were me, I'd start at the 75mg as mentioned above (1.25 grain), taking 60mg in the AM, 15mg at lunch (2/3, and 1/3 split). Titrate up 1/2 grain per week thereafter. Before getting too far, I would know what my iron, ferritin, cortisol, electrolytes, D3 and of course RT3 looks like before ramping up. And of course, run all of it by your physician, one who will hopefully be in-tune with how to help you manage a protocol.

You are correct, TPOab has been the issue, althought TGab was slightly up and out of range for the first time on my most recent labs.

The last time I had it checked, I had an RT3 of 16.1 ng/dL (9.2-24.1) to a FT3 of 3.1 pg/mL (2.0-4.4), but this was over a year ago.

Thank you very much for all of this. I will plan on getting those labs after a few weeks.

Do you take morning dose upon waking, and the second a while before lunch? Or is it acceptable to take near food?

 

[Vettester Chris]

You are correct, TPOab has been the issue, althought TGab was slightly up and out of range for the first time on my most recent labs.

The last time I had it checked, I had an RT3 of 16.1 ng/dL (9.2-24.1) to a FT3 of 3.1 pg/mL (2.0-4.4), but this was over a year ago.

Thank you very much for all of this. I will plan on getting those labs after a few weeks.

Do you take morning dose upon waking, and the second a while before lunch? Or is it acceptable to take near food?

Your RT3/FT3 ratio was close to 19 at that time. Just slightly below the ideal mark of 20, so not too shabby all and all. Get the labs updated like you said in a few weeks, we can compare notes ...

Also, yes on taking 2/3 when you wake, and during or after lunch is fine on the 2nd dose, or 1/3 of the daily dosage. It's more for the sake of getting a tad bit more T3 into the system during the later part of the day, due to the short half-life associated with T3. Splitting it evenly or going later could/might promote more access energy in the later hours of the day, which would probably be better served in the earlier hours when the physical and mental demands tend to be greater.

 

[raginghormone]

What's your diet like? You need to also look into lowering your antibodies by adapting an autoimmune paleo diet and seeing if that helps with what's causing the attack on your thyroid.

I also highly recommend you switch to NDT since T4-only therapy doesn't seem to be working for you. A RT3 like others have mentioned will really help reveal more about your conversion here.

I'm currently on WP Thyroid 2.25 grains per day which keeps my TSH suppressed (< 0.01) but puts my FT3 at 1/4 upper range (optimal). I split my dosage and take 1.25 grains on wake and another 1 grain around 3-4 PM.



Check out Stop the Thyroid Madness or read some of Izabella Wentz's books.

 

[bluezebra5]

Your RT3/FT3 ratio was close to 19 at that time. Just slightly below the ideal mark of 20, so not too shabby all and all. Get the labs updated like you said in a few weeks, we can compare notes ...

Also, yes on taking 2/3 when you wake, and during or after lunch is fine on the 2nd dose, or 1/3 of the daily dosage. It's more for the sake of getting a tad bit more T3 into the system during the later part of the day, due to the short half-life associated with T3. Splitting it evenly or going later could/might promote more access energy in the later hours of the day, which would probably be better served in the earlier hours when the physical and mental demands tend to be greater.

Will do. Thanks Chris. I will post labs once I've been at this for a few weeks.

 

[bluezebra5]

What's your diet like? You need to also look into lowering your antibodies by adapting an autoimmune paleo diet and seeing if that helps with what's causing the attack on your thyroid.

I also highly recommend you switch to NDT since T4-only therapy doesn't seem to be working for you. A RT3 like others have mentioned will really help reveal more about your conversion here.

I'm currently on WP Thyroid 2.25 grains per day which keeps my TSH suppressed (< 0.01) but puts my FT3 at 1/4 upper range (optimal). I split my dosage and take 1.25 grains on wake and another 1 grain around 3-4 PM.



Check out Stop the Thyroid Madness or read some of Izabella Wentz's books.

Funny you should ask, I started doing this the day before I posted. I've cut out all grains, dairy, sugar, and sweeteners (basically following the Whole30 guidelines).

But to answer your question: my regular diet has been "healthy" (nutrient-dense foods, lots of protein and good fats, minimal refined carbs), but also quite dairy and grain-heavy. I'm anxious to see if this can put a dent in my autoimmunity.

Thank you for the suggestion. Do you have any other tips as far as diet is concerned?

 

[bluezebra5]

Quick update, I've been titrating up for 3 weeks now. I started at 1.5 grains, 1 in the morning and .5 in the afternoon. I tried to do the 1.25 but I only have .5's and they are damn near impossible to split- so I just took a few day to let the levothyroxine wear off before starting.

I am now up to 2 grains, 1 in the morning and 1 in the afternoon. After about 10 days of this I'm still very very tired. There are times when I feel as clear and awake as ever, but it's extremely fleeting. I'm sleeping a ridiculous amount and I start to feel tired shortly after waking up.

What do you think? Does it make sense to increase again or should I wait a week or so and get labs?