T Nation

Adjusting NDT and/or T3 Thyroid Medication - What to Do?

A few months ago, my provider (Defy Medical) put me on an NDT (Armour Thyroid), which was gradually built up to 2 grains (76mcg t4/18mcg t3). I did not see any results with this, despite 6x/week exercise + 1600-1800 calories/day. They then prescribed Cytomel , which was built up to 20mcg of t3, and lowered the NDT to 1.5 grains (57mcg t4/13.5mcg t3) for a total of 57mcg t4/33.5 t3.

Since the new dosage, I have been seeing some results, losing roughly 1-1.5lbs a week, give or take. However, this is with taking in 1600 calories per day. Given I’m ~155 lbs and exercise 6x per week, I imagine I should be able to consume more calories and maintain this weight loss pace, while 1600 cals/day would be the very aggressive approach. I want to continue the weight loss, but don’t want my metabolism to adapt to 1600 calories a day.

I feel maybe I should adjust my thyroid dosage? Given all of the above, would it make sense to increase the t3 only medication? Or should I increase the NDT? Defy medical originally said cap it off at 20mcg pure T3+1.5g NDT, but I read of people taking far more T3 only medication. I believe Defy’s main expertise is TRT. I also am not sure if the recent weight loss is due to the adjustment of the T3 medication, or if it was just a matter of the thyroid medication taking it’s intended affect after about 8 weeks of use. I also don’t want an excess of t4 to then convert to reverse t3, which I’ve read can occur.

Thanks for any insight.

What were your pretreatment levels? Was rT3 high then?

Thyroid patients tend to do better with compounded T3/T4 combinations. Porcine thyroid can vary in strength from pig to pig.

Pre-treatment levels:
(From February 2019)
TSH 2.090 (.450 - 4.50)
Free T3 2.4 (2.0-4.4)
Reverse T3 13.8 (9.2-24.1)
Free T4 1.23 (0.82-1.77)

I have only had Free t3 checked since, in May 2019. It was 2.6. That was after being on the T4/T3 compound for 6 weeks. I am scheduled to get the whole thyroid panel checked in about 6 more weeks. I’m wondering what adjustments I should try up to that point, as I feel my current protocol is helping, but not as optimally as it could.

Right, 2.6 won’t cut it. At this point, I think you should follow the doctor’s protocol and see where you are when due for follow-up labs. I suspect there will be a change at that time.

Also - how much should I consider my body temperature? I began taking my temperature orally, every morning. WHen I first began the T4/T3 compound, I was sometimes high 96. I eventually would be 96.8.0-97.3. After adding just additional T3 with the compound, I now consistently am at 97.5-97.9, but have never seen a 98+ reading. I read that 98.6 should be your standard. Would additional T4 and.or T3 help this body temperature, and thus raise metabolism? I’m consuming 1600 calories per day because it’s the only way my weight is going down currently, but am aware this shouldn’t be something I should continue long term.

I wouldn’t. I would go with how you are feeling.

Don’t bother. That’s some nonsense from a quack named Wilson.

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Thanks for the info.

Is there more information as far as why one would be prescribed t4/t3 compound or just t3 only? Is there any indication going off the free t4 reading to have a better idea on how t4 medication will attribute to conversion to t3 and help within TSH as opposed to converting to Reverse T3?

The body can compensate for body temperatures by other means, I have read published studies indicating people who had normal body temperatures and after testing revealed labs indicating hypothyroidism.

How tall are you @tnation11? You are 155lbs and trying to lose 1 - 1.5lbs a week? Why?

You might be over training. While it feels counter productive, you do need to give your body a rest. Try taking more than one day off a week from exercising.

What does your diet look like? Quality of calorie is important too.

I’d like to pinpoint if overtraining is indeed the case. One thing I like about blood lab results is things such as free testosterone and thyroid can be measured to pinpoint where the problem is, and it can be addressed accordingly. What test might I want to have done to test if in fact overtraining is what is stalling me? I hear saliva cortisol test might be of value? Any thoughts or experiences?

My diet is measured quite thoroughly. Less than 1800 calories per day with the 6x training per week. Over my bodyweight in protein, relatively low fat, and carbs coming from whole fruit, veggies, or whole grains.

Do a 24 Hour Saliva Cortisol test. Thyroid hormones will NOT work without sufficient cortisol.
You will drive inflammation up significantly if cortisol is not normal while on thyroid meds. It will get worse, not better from here.

@TRT_Phoenix is the saliva cortisol test the gold standard to determine over training? And what else could cortisol being out of range indicate? I believe when I looked into it, the test was quite costly. Looking for experience from others here who have had the saliva cortisol test, and what they got out of it.

Thanks for insights.

Saliva testing is the gold standard testing because it is the most accurate. Blood testing for cortisol is not accurate in most cases because it measures bound cortisol. Saliva measures free cortisol. Some doctors can order the test for you. Otherwise, Amazon and Life Extension have the saliva kits (Doctors sign off on these as well, so they are the exact same test as if your provider ordered it).

Is it?

You are adding to my information, not refuting anything. Please think before posting.
ACTH stimulation would be the followup test to see if the adrenals are incapable of producing cortisol. The saliva cortisol test will 100% show flat lined levels at each of the 4-6 different times throughout the collection of the 24 hours. If cortisol shows low, but they pass the ACTH stimulation test this only means that their adrenals are capable of producing cortisol given a stressful situation (Cosyntropin stimulates the stress response). However, if their underlying problem(s) are not addressed their adrenal function WILL weaken overtime and they WILL fail the ACTH stim. test down the road. Infections (bacteria/virus/fungus), stress, etc. are often present in these people and they need to figure it out.