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1. Stress can cause the thyroid hormone to not be absorbed properly - this applies to both NDT and synthetic thyroxine. Instead of being converted to T3 the T4 is concerted to 'Reverse T3'. This is why in the patient information leaflet it says don't take if you have an adrenal gland problem (look up Cushing's disease and Adidisons disease).
Look up the symptoms of Addison's and Cushing's disease and go back to your doctor if you have the symptoms. Look up Reverse T3 so you can validate this for yourself.
2. Start on a low dose and build the dose up. It takes time for your body's cells to adapt so they can absorb the T4 (again this applies to both NDT and synthetic thyroxine).
This also applies when increasing or decreasing a dose. I used to increase/decrease by a quarter of a 25mcg thyroxine tablet at a time every 2-3 days until I got up to the specified dose.
It's OK to chop the tablets up.
3. If your thyroid has been destroyed by RAI you MUST be on replacement hormone or you will die.
4. Take thyroxine on an empty stomach an hour before food. Food impairs the absorption of thyroid hormones.
5. Don't to take medications containing iron or calcium until 4 hours after taking thyroxine or NDT.
6. Thyroxine has a half life of 7+ days, so stopping the dose for a few days until your overstimulation symptoms subside (7 days maximum) won't kill you, it would then give you a base that you could start increasing it from.
7. Blood tests take 12 weeks to reflect one's tissue thyroid hormones levels. Tests before this are inaccurate and may lead to the wrong action being taken.
8. Taking your Basal Pulse and Basal temperature are a good way to test tissue thyroid hormone levels. Doing both is best.
(Note I'm not a doctor, just someone who had had hypothyroidism for 28 years)
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