So I have started NDT (Idealabs' Tyromax) again. I have been increasing the dose by half grain every two weeks while monitoring temperatures and pulse.
I have noticed some subjective improvements in health (fat loss, somewhat improved cognition, better digestion), and there was also some lasting improvement in temperatures: my fasted temperature is now always at least 96.8 F and my later/fed temperature usually reaches 98.0 F, both of which weren't the case before starting. Still, these readings seem quite low for such a large dose of thyroid. My pulse consistently remains in the low 70s.
An exception from the above are days that are nearly stress-free: if on a given day I had relatively undisturbed sleep and did not have to leave my house I will sometimes hit the Peaty 98.0/98.6/85 optimum. But even then I don't feel really energetic but rather lethargic and my extremities are reliably cold regardless of the underarm reading.
Another curiosity is that my temperatures will generally be higher in the first week on a new dose, and then fall again in the second week.
I eat a lot and I supplement fat-soluble vitamins. I eat little PUFA and have relatively low body fat. One more thing to mention might be I'm currently processing a large loss in life that makes me rather despondent and pessimistic about my future.
What could be an explanation for all this? Some ideas of my own:
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I just need a lot more thyroid than usual and need to continue increasing my dose until I'm euthyroid;
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wrong combination of T3/T4? I probably would to test for reverse T3 to check for that?
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some yet unidentified dietary deficiency (previously I got anxiety attacks on much lower dose that resolved with D supplementation);
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elevated FFA suppressing thyroid hormone. I've already started taking 500 mg aspirin daily and intend to try niacinamide again (I had a bad reaction previously, but wasn't taking thyroid back then);
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maybe taking exogenous hormones disproportionately suppresses my natural production?
Has anyone else been through this? I would greatly appreciate any suggestion.