RE: TSH suppression for thyroid cancer on NDT?

[Guest guest]

Anyway, my TSH is now suppressed but my FT3 is still only 4.4 (3.5 - 6.5)and my FT4 only 15 (9-24. I'm still three stone overweight (endo had me on carbimazole for two years and I gained over 50lbs). I'm considering either doing a T4 / NDTcombo or switching to NDT. However it's imperative that I keep my TSH suppressed.Can someone explain equivalences to me? The conversion charts say that 15mg NDT = 25mcg T4. Or One Grain = 100mcg T4. But looking at the actual contents it seems that 60mg (one grain)= 38mcg T4? So would my 175mcg anti-cancer dose of T4 = 2 grains, or 4.5 grains?Also, any mileage in combining T4 and NDT (e.g. 75mcg T4 and equivalent 100mcg NDT?).

Hello ,

I am sorry to hear that you had to have a thyroidectomy due to cancer, but glad that you are doing relatively well after the ops.

I am going out on a limb by making a statement that I cannot back up with any scientific evidence - but in my personal view people who had a thyroidectomy, or even a partial thyroidectomy, do not do well on Levothyroxine alone... at least I do not know of a single person who does (and I do know of a few). If my memory serves me right, this point of view is supported by Drs. Peatfield, Skinner, Starr and a few others, although I can't find the relevant passages in their respective books. Anyway – it is my personal opinion that people without a thyroid gland do best on NDT... either Armour, Erfa or Naturethroid - rather than T4 alone, a mix of T4 and T3 or T3 alone.

If you are considering to switch to NDT, I would stop the Levo and the following morning start with ½ grain of your chosen NDT for 7 days, then double the dose (but always split it) to 1 grain for a further 3 weeks, and then go up by another ½ grain every 3 weeks until you get slight hyper symptoms, then cut back to your previous dose and stay there for a few more weeks to assess if this is indeed your level.

If it were me, I would start with ½ grain (30 mg) of NDT regardless ... although – you were hyperthyroid before, so your body should be used to T3 coursing through your veins and for that reason perhaps you could start with 1 grain, split dosage ½ grain am and ½ grain pm – play it by ear. If a full grain overwhelms you on day one, cut back to ½ grain for about a week before doubling up.

The conversion you list is correct (and 175 mcg equate to roughly 2 grains) ... but this conversion is of no use to you other than for rough guidance. The amount of NDT you might eventually tolerate and finish up with does not usually correspond too well with the dose of Levo that you can tolerate at present.... usually the body needs more of the natural thyroid than of the synthetic T4. I, for instance, went hyper on 150 mcg Levo, but now take 2 - 2 ½ grains of generic Armour, which equates to well above 200 mcg of T4.

If you switch to NDT you won't have to worry about your TSH ever slipping out of suppression ... when your dose is right, your TSH will stay suppressed. And the weight should slowly come off as well .....

Hope this helps,

With best wishes and good luck,

[Guest guest]

Hi - have you considered asking your endo. for a

combination of synthetic T4/T3 to see if this would help. The T3 would keep

your TSH suppressed and it is very likely this would do the trick. You might

even stop the T4 altogether and find you need synthetic T3 only.

Luv - Sheila

Anyway, my TSH is now suppressed but my FT3 is still only 4.4 (3.5 - 6.5)and my

FT4 only 15 (9-24. I'm still three stone overweight (endo had me on carbimazole

for two years and I gained over 50lbs). I'm considering either doing a T4 / NDT

combo or switching to NDT. However it's imperative that I keep my TSH

suppressed.

Can someone explain equivalences to me? The conversion charts say that 15mg NDT

= 25mcg T4. Or One Grain = 100mcg T4. But looking at the actual contents it

seems that 60mg (one grain)= 38mcg T4? So would my 175mcg anti-cancer dose of

T4 = 2 grains, or 4.5 grains?

Also, any mileage in combining T4 and NDT (e.g. 75mcg T4 and equivalent 100mcg

NDT?).

[Guest guest]

Hi

Thanks for such a comprehensive reply. Funnily enough I spoke to Jill the other

day who was saying how much you'd helped her switch to NDT. There's one

complicating factor - I forgot to mention my TED. My eyes are stabilising and

they are much improved post op. I can't risk my levels dropping too much as it

sends my eyes haywire (hence them wanting to use thyrogen injections pre RAI to

get my TSH up artificially to improve uptake - I've refused to come off my meds

- which is how they normally do it!) so I'd be nervous of coming off levo and

taking such a low dose?

I read on STTM that some patients can tolerate a pretty much straight swap but

I'm nervous of that too. I think your idea of one grain split and playing it by

ear, seeing what I can tolerate might be the way?.

I'm trying to find a local clinic that will do private blood tests (I'm back

with my parents in Shropshire recuperating, had to give up work) so that I can

keep track of how I'm doing.

But thanks for your message, it's really helpful.

x

> If it were me, I would start with ½ grain (30 mg) of NDT regardless

> ... although – you were hyperthyroid before, so your body should be

> used to T3 coursing through your veins and for that reason perhaps you

> could start with 1 grain, split dosage ½ grain am and ½ grain pm

> – play it by ear. If a full grain overwhelms you on day one, cut

> back to ½ grain for about a week before doubling up.

>

>

>

[Guest guest]

... There's one complicating factor - I forgot to mention my TED. My eyes are stabilising and they are much improved post op. I can't risk my levels dropping too much as it sends my eyes haywire (hence them wanting to use thyrogen injections pre RAI to get my TSH up artificially to improve uptake - I've refused to come off my meds - which is how they normally do it!) so I'd be nervous of coming off levo and taking such a low dose?

Hi ,

Oh yes, I'd forgotten about your TED.... but no need to worry ... the TSH is a slow mover.

But yes, just try it; start off with 1/2 grain twice a day (which would roughly be the equivalent of 100 mcg Levo) and see how it goes. Since you were hyperthyroid before there is a good chance that you won't have a problem with the T3 in the NDT being too much for you to cope with. But be still very cautious not to panic and to go up with the NDT too fast, as this could badly backfire. It is possible that your FT3 and FT4 might drop a little on only 1 grain, but it is unlikely that your TSH should move. It usually takes 4-6 weeks before a TSH starts creeping up again, even when there is no thyroid hormone forthcoming.... and you will be putting plenty in. All going well, after 3 weeks you should be up to 1 1/2 grains, which is the equivalent of your current dose of Levo.

If you were terribly worried, you could always take 25 mcg Levo in addition to whichever dose of NDT you'll be at, although my feeling is that it is better just to stick with NDT. I have tried supplementing with Levo in addition, and it gives me muscle aches... but perhaps that's just me. Sheila used to do it and she was fine with it, if I recall correctly. We are all different.

When you have the next blood test on NDT (no point in doing it earlier than 4-6 weeks - you need to let the hormones settle), please do not be surprised or panic if your FT4 should be lower in relation to your FT3 - i.e. mid-range FT4, but near top of range FT3.... this happens, because the T4:T3 ratio in NDT is "T3-weighted" so to speak. There is more T3 in NDT than the ratio of T4:T3 that a healthy human thyroid gland would produce. So do not worry about that. The most important figure is the FT3, which should ideally be at the top of its ref range, even if the FT4 were "only" somewhere in the middle. For as long as your FT3 is well up, your TSH will be suppressed, and for you this is important. The FT4 is only the "fuel in the tank", ready to convert more FT3 when it is needed.

Good luck and please let us all know how you get on.

Best wishes,

[Guest guest]

Hi Sheila and

Thanks for both messages. My surgeon and my cancer doc are open to T3, they are

saying I don't currently need it as my T3 is 4.4. But they've promised to

listen to me, and I believe they will, I have had absolutely excellent care

(finally!).

I've just been reading your TPA Guidebook and I've also filled in the adrenal

questionnaire in the files. I score as severe!! I also feel shaky on T4 so I'm

a bit worried about adrenals. I had a genova test about 18 months ago that came

back normal and they did all the relevant hospital blood tests recently (inc 24

hour urine) and all was normal (although in again in Tues so will get a print

out). Do you think I need to test again with Genova? I'm taking supplements

but not specific adrenal support.

Sorry, so many questions! Thanks for getting back to me, I'll keep you posted.

x

>

> Hi - have you considered asking your endo. for a combination of

> synthetic T4/T3 to see if this would help. The T3 would keep your TSH

> suppressed and it is very likely this would do the trick. You might even

> stop the T4 altogether and find you need synthetic T3 only.

>

> Luv - Sheila

>

>