Side effects on combination therapy : thyroxine and T3

[TheaW]

I have been on combination therapy for about 7 weeks. I have noticed I am quite breathless and this looks like it can be related but unusual. Does this sound familiar to anyone?

[Jaydee1507 Administrator]

How much have you started on?

Have you dropped Levo and by how much?

Do you have OPTIMAL levels of vitamins?

[TheaW in reply to Jaydee1507]

I was on armour thyroid before 1 1/2 grains. Now I’m on 125 mg thyroxine and 15 of t3. I am slightly low of vitamin d and recently low on folic acid but others are ok.

[Jaydee1507 Administrator in reply to TheaW]

So it could just be the switch of hormones that is affecting you so should settle in time. Its a huge increase in T4 from 1.5 grains Armour to 125mcgs Levo alone.

It could also be less than optimal vitamin levels affecting you which will make the switch harder and your body won't be able to use the hormone well if you are low on vitamins.

OPTIMAL vitamin levels are essential when we are hypo.

Whats happening about the low vit D & folate? What are you taking and how much of it?

What exactly were your ferritin & B12 levels?

[Karen-Eleanor]

Who worked out the conversion figures from At to T3/4 - on my calculations: 1.5 grains AT is equal to 60mcg T4 and 14 T3. You’ve doubled your T4 and increased T3 at the same time. If you need an increase it’s better to do it slowly!!

[TheaW]

thank you. It’s under an endrinologist that was recommended through this site by a few people. My b12 is fine as I have injections every 8-10 weeks. I’ve literally just started 1000 vit d and prescribed folic acid

[Jaydee1507 Administrator in reply to TheaW]

Most people need a minimum of 3,000iu of vit D. Take it iwth vit K2 to help it go towards your bones.

Once the prescribed folic acid has finished start on a B complex.

B complex suggestions: Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

helvella.blogspot.com/p/hel...

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[TheaW in reply to Jaydee1507]

thank you. Really helpful. I find a lot of supplements upset my stomach so will start gradually and build up. Should these help the breathlessness do you think?

[Jaydee1507 Administrator in reply to TheaW]

They will contribute along with the other vitamins.

You need to find out your ferritin level as well.

Retest thyroid levels in 6-8 weeks from bein on a stable dose.

[TheaW in reply to Jaydee1507]

Thanks. I’ll find out ferritin. I know it was tested and periodically I do have issues with it. I have had the thyroid retests after 6 weeks of this dose and tsh was down to 1.4 from 7 before but I didn’t see t3 and t4 levels

[helvella Administrator Thyroid UK in reply to TheaW]

Having issues with ferritin periodically sounds like an example of poor treatment.

No-one should repeatedly end up iron-deficient.

See the section headed:

How long to treat?

in this document/blog:

helvella - Iron Document

This is a summary of what I have read up and found out about iron supplements over the past few years. I am not in any way medically trained. You are strongly encouraged to check every detail before making any decisions for yourself.

Last updated 02/04/2024

helvella.blogspot.com/p/hel...

[TheaW in reply to helvella]

I have iron infusions but to qualify you have to be fairly bad. They do monitor me. I can’t tolerate the tablets at all

[TheaW]

will try and get the actual levels

[radd]

TheaW,

1 1/2 grains. Now I’m on 125 mg thyroxine and 15 of t3

Your endo has overdosed you. Armour manufacturers claim 1 + 1/2 grains to be bio-equivalent to about 150mcg, although realistically many (including myself) would put it at about 132mcgT4. You are now medicating 125mcg T4 + 15mcg T3 combo equating to roughly 170mcg T4.

Therefore, you just need to drop your dose. Many of us have felt breathless with either under or over medication and as symptoms can lag behind good biochemistry, you need to be guided by labs for a few weeks/months.

As you have transitioned from Armour you can’t know your true conversion abilities so it would be prudent to reduce T3 dose right back to say 5mcg and hold for six weeks, then test. When titivating final dose it is better to add T3 than have to take it away again. You might need further titivation by reducing Levo and increasing T3 but you won’t know until you have medicated a particular dose for several weeks.

Why have you switched from Armour to combo?

[TheaW in reply to radd]

Thanks. Really helpful. I had been in armour for years and on nhs. Nhs withdrew it. I know I am not good just on thyroxine and tbh I wasn’t doing so well in armour by the end. So I went back to an endocrinologist to see what my options were x