Re: Desperately sticky situation and how to respond re T3 and multi-disciplinary mtg

[Guest guest]

Sorry Jacquie

I realise this is incorrect:

>I think you went up too fast and started on too much. I appreciate you were on

a big dose of T3, but I still would not have gone up so quickly and started so

much. I do not think you say " i'm on x of T3, so i'll take y of NDT " .

I realise you didn't start on too much (1/2 grain) but did go up the next day to

4 grains. That's what I meant by starting on too much.

If it were me I would order more thiroyd, given that you had a positive response

to it initially. If you feel you need T3 then it makes sense to order that, but

I really do think you need to take this slowly.

I appreciate you urgently need to get well, but some things cannot be rushed,

and you said yourself after just a few days on NDT you were feeling well but

then it went. Perhaps if you go back to that much lower dose it will work

again, and quickly. Have you considered stopping NDT if you are hyperthyroid,

to let the excess run down?

I don't know what you read about Nick and taking NDT, but at one point - before

T3 I believe - Nick was taking 12 grains. I have never heard of anyone else

take as much. So if Nick was able to increase his NDT very quickly, then I

think it might have been because he had been on a hefty dose before. I have not

heard of anyone else with a similar experience.

thyroid treatment/message/72388

I hope you feel better soon

chris

>

> Okay! This is freaking me out as I don't know which way to turn! I

> have gone through most of Nick Foot's back posts to see how he went from

[Guest guest]

One thing you should remember Jacquie is that NDT has T4 in it which has a much longer half life than does T3.   So whereas T3 can be raised within a few days, T4 or anything containing T4 should be raised much more slowly.

It takes something like 4 - 6 weeks for T4 to kick in.    Also as NDT  also contains T3 you  do not need as much T4 as you would if you were taking T4 alone.So  if you keep raising the NDT too quickly by the time six - eight weeks have passed you might be seriously overdosed, and you would be feeling pretty awful.

Lilian

[Guest guest]

Hi NadiaThank you for responding. I took many months to build up my dose. I have a thyroid resistant problem and am also unable to convert synthetic T4 to T3 so I cannot take ANY synthetic T4. I am not sure if this problem is also happening with natural desiccated thyroid, for if it is, then I am really in trouble. I have been working with and have also his book. He helped me so much by suggesting I take my first dose of T3 in the early hours. This gave me energy and I started to see the light at the end of the tunnel. To anwser your question, I started self medicating and took control of my health as my first endo was out of his depth and almost killed me with his protocol. He also didn't know how to interpret TFTs. My current endo has read 's book and understands what is going on but was instructed by his colleagues at a multi-disciplinary endocrinologist meeting he has to attend every week or so as he is a Fellow, that I was to decrease my T3 radically in order to bring my TSH into the reference range. Here is an article from Pulse magazine which I have pasted as some member cannot see it without registering:Can you remove a patient from your list without complaint?By Dr Peddie | 01 Mar 2012A patient has been behaving in a troublesome manner and you want to remove him from the surgery list, how should you proceed?A patient has been behaving in a troublesome manner, being persistently rude and abusive to staff and critical of the practice, and you want to remove him from your list. However, your partner has raised concerns and is worried you might get referred to the Parliamentary and Health Service Ombudsman. How should you proceed? Recent NHS figures show that out of the 15,000 investigated complaints made against GPs in England in 2010, a fifth were about patient removal from surgery lists.If you are considering removing a patient you must think carefully before doing so and follow guidance set by the GMC, RCGP and the BMA, as well as considering the requirements of your GMS contract.Deviating from these guidelines – which apply to all doctors across the UK – could lead to the patient complaining and even attract the attention of the GMC.In November 2011, for example, a GP in the West Midlands was ordered to pay £500 in damages and reported to the GMC by the Parliamentary and Health Service Ombudsman after a patient removal row.You should be aware that your contract requires you to give a warning and a reason before removing a patient, except in exceptional circumstances where this could increase the likelihood of unacceptable behaviour, such as violence or harassment towards a doctor or other member of staff.If a relationship breaks down between you and a patient, your practice would be encouraged to consider continuing treatment for that patient via another doctor within the practice. However, you retain the right to remove a patient from the practice list if their continued registration with the practice might be detrimental to your primary healthcare team as a whole.Patient removal should be dealt with sensitively and sympathetically. Situations that may justify removal of a patient include unacceptable behaviour such as physical violence, verbal or physical abuse, sexual and racial harassment, stalking and inappropriate emotional attachment to a doctor.Another reason is crime and deception such as cases of patients fraudulently obtaining drugs, deliberately lying to a doctor or other member of the healthcare team or stealing from your practice premises or staff. A patient can also be removed legitimately if they move out of the designated practice area.Except in extreme cases (such as those involving violence), removal should only be considered where the patient has persistently displayed unacceptable behaviour. It is important that you avoid a knee-jerk response to a single incident. Patients should not be removed from a practice list simply because they have made a complaint against your practice, for failing to comply with your health advice or because they have a highly dependent condition or disability.If you feel your relationship with a patient has irretrievably broken down, you must discuss it carefully with your colleagues, inform the patient of the problem and consider meeting the patient to discuss the situation further.If all steps fail, you need to inform the patient and your PCT/health board in writing of the decision and reason for removal and explain to the patient how to register with another practice. You shouldn't automatically remove the patient's family, nor should any patient be removed due to the actions of their relatives.It is important that you thoroughly document the incident or incidents that have led to a removal as well as any discussions with your colleagues and communication with the patient. This will provide valuable evidence if the patients complains. The documentation should be kept in a separate file as it does not form part of the clinical records, and should not be passed to the new practice.Dr Peddie is a medical adviser with the UK-wide medical and dental defence organisation MDDUS.Print | EmailShareREADERS' COMMENTSMark Preston, GP Partner, 02 Mar 2012I don't understand the last sentence. Why should such letters and meeting not be sent to the new practice? It may be very helpful for the new practice to understand the reasons for removal. I don't see that it matters whether it is abuse of a practice member or fraud, the next practice still needs to be aware. For medication abuse it is essential and for staff it may be a matter of safety.ReportYour RatingRate this 1 stars out of 5.Rate this 2 stars out of 5.Rate this 3 stars out of 5.Rate this 4 stars out of 5.Rate this 5 stars out of 5.Average (4 Votes)The average rating is 4 stars out of 5.TopAnonymous, Practice Manager, 02 Mar 2012I would like clarity on removing patients who persist in missing appointments.ReportYour RatingRate this 1 stars out of 5.Rate this 2 stars out of 5.Rate this 3 stars out of 5.Rate this 4 stars out of 5.Rate this 5 stars out of 5.Average (0 Votes)The average rating is 0 stars out of 5.TopDoctors can strike you off if self medicate and I need him to work with me to carry out further tests which is why I cooperated. Unfortunately, I have now messed up my system and don't know how to proceed.I hope your endo increases your T3 soon and that you start to feel better. Isn't just awful what we are forced to put up with and what they put us through!LoveJacquieI did not deliberately change my dose from 150mcg Mexican T3>> I'm not saying this is the answer to your problems, just wanted to share my story of personal recovery on T3 only - which was prompted by and wouldn't have been possible without 's book "Recovering with T3". I think the best bit of advice in the book for me was to go slowly, don't get impatient to get rid of all hypo symptoms, rather get a clear of T4 (6-8 weeks) and minimize worst of symptoms only during that time and then work slowly but consistently to finding your own personal dosing regime that works best for you as everyone is different. >

[Guest guest]

Thanks for that, Lilian. So appreciate it. I increased it quickly because I

became incredibly hypo, I felt I was dying. I decreased it when i started

feeling well because I didn't want to go hypER but didn't expect to go hypo.

My concern is if I cannot convert synthetic T4, I'm wondering if this is the

case with NDT. This was my immediate thought when I started getting

symptomatic. How would I know?

I don't know what is a reasonable dose to start on from 150mcg T3. I know that

half a grain was much too low as I my hypo symptoms returned but went away when

increasing the Thiroyd. I have been on 2 grains but felt worse so increased it

in order to function.

Love

Jacquie

>

> One thing you should remember Jacquie is that NDT has T4 in it which has a

much longer half life than does T3. So whereas T3 can be raised within a few

days, T4 or anything containing T4 should be raised much more slowly.

>

[Guest guest]

Thanks for your advice Chris. I worry because if I cut back too much (say 2 grains) I feel REALLY bad. I read that Nick had been on 12 grains but he took years to get to that dose. Nick and I seem very similar because this is what happened with me on T3... I could never get enough and even on 150mcg T3, I felt I could take more. I even tried taking it in one dose at night for a week, like Dr Lowe did, with no adverse affects. I stopped doing that because I found that taking my first dose at 4.15am (as per 's protocol) really gave me so much more energy and stamina. I also felt more positive even though I still had some symptoms.I may order more Thyroid, and should I need to take T3, I shall take the NHS T3 as I really need to get my meds on the NHS as I am unable maintain myself on these high doses for the rest of my life. If I was on 60mcg T3 only then I wouldn't worry with doctors but such high doses are expensive and I can't afford it. Perhaps Nick will pick up this message and, if not, I may have to email him to find out how he did it. I just didn't want to worry him with this and was hoping I would be fine on my own. LoveJacquie> Sorry Jacquie> > I realise this is incorrect:> > >I think you went up too fast and started on too much. I appreciate you were on> a big ose of T3, but I still would not have gone up so quickly and started so> much. I do not think you say "i'm on x of T3, so i'll take y of NDT".

[Guest guest]

Jacquie,

I am not sure how you can tell whether your problem is that you are not converting without a blood test. I did a private blood test and as the result came back with under range T3 they said it looked like I was not converting. So I went to a private doctor until we got the dose right and then I carried on treating myself. He started me on synthetic T4 and T3 which I tolerated quite well and it did improve, but I thought if I was going to buy the T3 anyway I might as well go the whole hog and buy NDT.

I think I must be converting a little because I am at my best with a T4/T3 combination. Either 100mcg thyroxine and 40mcg of T3 or, which I prefer, 4 grains of NDT. Occasionally I add the odd 10mcg of T3 which I start to get the afternoon zombie effect.

A lot is trial and error, but I find that one has to do things slowly so that the body gets used to it. We talk a lot about adrenals and I think if the body is suddenly hit with a high dose of anything it is a shock to the system and will more than likely affect the adrenals, and then one is going to feel worse anyway, and possibly undo any good that has been done.

This is purely my own opinion of course.

Lilian

My concern is if I cannot convert synthetic T4, I'm wondering if this is the case with NDT. This was my immediate thought when I started getting symptomatic. How would I know?

[Guest guest]

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done this before clicking SEND leaving just a few lines of what you are

responding to. Luv - Sheila

_______________________________________________

hi jacqui,

i have a simlar problem i have been up to 12 grains armour and still felt hypo

so changed to 10 grains erfa plus 120 mcg t3 and felt a lot better but still

suffering stiff muscles and some fibro pain but the sweats stopped.

I improved with the mexican t3 but have recently started taking goldsheild t3

and my symptoms are returning i think i,ll go back to the cynomel.

My thyroid hormone resistance began after i developed pneumonia whilst only

taking thyroxine, i wasn,t converting,

when did you see dr hertzoghe,did you have to travel to brussels,could you give

me some information regarding his treatment plan.

>

> HI Jacqui,

>

> I don't know all your history (I have read as much as I can) but can I ask -

when your endo prescribed 100mcg T3 were you already on some T3? How did you

start on T3 or increase your dose and how many doses were you taking? And have

you considered trying T3 only?

>

[Guest guest]

Jacquie,

whatever thyroid hormone you take, whether synthetic or natural, it is very

important that you are consistent in your dose. You don't appear yet to have

found any real lasting benefit from whatever thyroid hormone you have taken,

whether synthetic T4, T4/T3 combination, T3 alone or natural thyroid extract.

You need to find the cause for this and you have to do this through a process

of elimination. You need to be tested to find whether you are suffering with

thyroid hormone resistance. Check out

1. Refetoff S. Syndromes of reduced sensitivity to thyroid hormone:

genetic defects in hormone receptors, cell transporters, and deiodination.

Best Pract Res Clin Endocrinol Metab. 2007;21:277-305.

2.

Beck-Peccoz P, Persani L.

TSH-producing adenomas. In: DeGroot LJ, on JL, eds. Endocrinology.

5th ed. Philadelphia, PA: Elsevier-Saunders; 2006:475-484.

and then check out the

attached. Go through every single one of these associated conditions that go

hand in hand with hypothyroidism to ensure 100% that one of these is not the

cause of your thyroid hormone not being fully utilised at the cellular level.

Ask your GP to also test

your levels of iron, ferritin, B12, D3, magnesium, folate, copper and zinc. Get

your adrenals checked out to see where your cortisol and DHEA lie at four

specific times during the day if this has not been done. Also, check that you

are not suffering with systemic candida.

It is no good carrying

on as you are believing your problem is just titrating your dose of thyroid

hormone to find out exactly what your body needs.

Luv - Sheila

I am unable

to function on 100mcg NHS T3 only (bearing that my endo wants to decrease

it to bring my TSH into the bottom of the reference range), so I HAVE

to take something else, like NDT... or what?

Do I place

an order for some more Cynomel whilst there is still a 15% discount (it ends

today, I think) whilst I am in this situation, or do I order some more Thiroyd

as I only have a little over two weeks left (bearing in mind, that my finances

are stretched so I really need to place the right order), or do I try something

else? The thing is, I don't seem to be getting on with either!

Love

Jacquie

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