Levothyroxine and Liothyronine levels - please help

Can you help me please? My 19 year old daughter has chronic hypothyroid symptoms. She was put on Levothyroxine (50mgm) and Liothyronine - at my insistence -(10mcg) 6 weeks ago. Her initial blood tests showed TSH 2.73, FT4 13.6 and FT3 4.82. Her endo agreed to put her on medication for a short time to rest and reset her system - we think she has adrenal fatigue. She started immediately to feel better. After the first month her blood tests showed TSH 0.06, T4 15 and T3 4.84. I was surprised and disappointed her T4 and T3 hadn't improved. Since then she has got steadily worse again, so that now she is just as exhausted as she was prior to going on the medication. Can you tell me whether it is the Levo or the Lio that I need to see whether we can increase? Does the Lio effect the T4 and T3. I can see that her TSH should be low enough now. Initially her endo had been talking about a ratio of Levo to Lio of !:5, but she is on 1:10, so I assume it is Lio we need to try and up? Many thanks for your help.

8 Replies

  • ....mighty_mouse posted yesterday I believe about rT3 caused by T4. Maybe have a read.....it was contained within the post about Blood tests v Urine testing. It could be a possible cause for your daughter not feeling good. It does take time for the body to become accustomed to T4 and T3. Sometimes you have to stop and try again at a lower dose and increase very slowly....80/20 is a common split for T4/T3.....

  • T4/T3 ratios are pointless if she's not converting. But that's difficult to say because you haven't given the ranges for the frees. Have you got them?

    I don't understand your question 'Does the Lio effect the T4 and T3.' Lio is T3 so it's not going to have any effect on the T4 level. T4 is levo.

    I would say that before deciding anything you should get those ranges so that we can understand the results. But it is perfectly normal to go down-hill a bit after about six weeks on a dose. It means she needs an increase.

    Personally, I don't think much of her endo's idea of 'resetting the her system'. I'm not sure it works like that and will probably make her worse. Levo and Lio are not like aspirins, they are not drugs, they are artificial hormones to replace the one's that her body can no-longer make enough of. And it's needed every minute of every day. I think your endo is out of his depth.

    Hugs, Grey

  • Thanks Grey the blood ranges are TSH 0.35 to 4.94, T4 9.0 to 22.0 and T3 2.63 to 5.7. Her endo wouldn't have put her on anything if I hadn't insisted (due to this and other web sites). The effect was immediate and dramatic. Her initial ranges were 'within ranges'. The point I made to my daughter's endo was that the ranges were different in the US and that some people didn't feel better until their TSH was much lower than my daughter's, and their T4 much higher. Hence he agreed (grudgingly) to put her on a trial. As I say, the effect was dramatic short term. I have today increased her Lio - her endo had talked about a ratio of 1:5 and she was on a ratio of 1:10), and again the difference has been immediate and dramatic! So something is working now (Lio I assume) which wasn't working enough yesterday! What I haven't investigated is reverse T3. I feel I am at a cross roads again. Second opinion endo? reverse T3 blood test? Anything anyone else can recommend please?

  • Looking at the results in the context of the ranges, I would be surprised if it were rT3. If you have an rT3 problem, it blocks the receptors so that even taking T3 doesn't have an immediate effect, whereas with your daughter, it does.

    It wasn't that the lio wasn't working enough yesterday, it was that she wasn't taking enough. Which is born out by the fact that she's now feeling better after taking a higher dose.

    Actually, she doesn't appear to have a convertion problem at all, more of a low dose problem - because she was on a very low, starter dose. The idea of the treatment is that the dose is increased every week until all the symptoms are gone. So, it would seem you are on the right track, just need to continue with the six-weekly increases.

    Hugs, Grey

  • Thanks Grey I can't tell you how much better that makes me feel! Think I will take her for a second opinion as I am having to fight this endo every step of the way! Best wishes Amanda

  • Hi Well I ,like a lot of people need my T4 in the top third of range and FT3 right at the top of range. However, this should be checked frequently by these tests.Most good Endo`s say to get the thyroid right and then if still not wlell you may need the Adrenals treated. Ideally an adrenal test , through a good Endo, as you need a script for the drug involved, Early in thyroid treatment and then when stable on the thyroid drugs, if you do not feel better

    I hope that helps,

    Best wishes,


    Not sure if you know ,to reply to a specific post, click on "Reply to this" under that post..

  • Thanks Jackie, for the reply and for the 'specific post' check! Still not very good at this! Please excuse my ignorance but I am so new to all of this, what tests are done for adrenals? I have done the saliva test on my daughter which showed 'extreme fatigue'. What other tests are there specifically for adrenals? Interestingly enough she has a very sore lower back which I took her to an osteopath for. It was the osteopath who, of course, made the connection between the sore back and adrenals! Best wishes Amanda

  • Hi As the adrenal glands sit on top of the kidneys, they can often feel sore etc, mostly, if lucky this improves with the correct thyroid treatment. However, she should have the best test, now and probably later, through Endo or may be GP if not. It is a 24 hour urine test with a cortisone tablet at midnight (script) and then a blood test at 9 am. apart from blood ,home test, easy. Extremely reliable. In her case she should have the test now and then if low, after thyroid treatment bloods look Ok, especially if still feel ill. That is because the treatment is with cortisone, most Endo`s, GP`s prefer to be sure it is needed first. Endo should have done all relevant tests or even GP , but unlikely, she also needs at least the hormonal autoimmune tests, vit D ( if low, corrected calcium before treatment, it can go up on treatment and must always be in range), Foliates + B12 ( needs to be high in range), Diabetes ( need not be fat) and Iron/ferritin need best)

    As you can see a lot of things to test but above all make sure the T4 and Free T3 are right, often T4 ( levo) and T3 are needed.

    Best wishes,


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