T3 to T4 change - feeling awful

[monkey65]

In August I had a TT and was put on 60mcg liothyronine. I had no problems, and in fact felt really great. Both endo and GP were happy to continue, but having chosen not to undertake RAI, I was abruptly told on Monday by the surgery follow up team to change to levothyroxine 150 straight away so that blood tests in six weeks would be 'clean'. Having done as I was told, on Thursday night I slept badly and woke up Friday feeling terrible; aches and pains, really tired, racing heart. Same again today. could this just be the 'lag' between the way the two medicines work? If so wouldn't it be better to do the change gradually?

My most recent bloods (on the T3) are TSH 0.02 (0.35-5.0), free T4 <3.0 (11.0-23.0), free T3 10.4 (3.9-6.8).

Also, I'm struggling with keeping the timing of the tablets away from food in the mornings. I do need my breakfast as soon as I wake up! Is it ok to take in the evenings?

[shaws]

I don't know why they made such a swift change. If you were well on T3 why not keep you on it. I don't know where their thought processes are really. What do they mean 'switch to levo so you results are clean'. I think they just want your blood tests to 'fit' into the normal range which is for the use of levo. Although your most recent blood results show a very high T3 (they just don't understand) that's what is usual when we take T3 alone, i.e. a high T3, low T4 (taking none and with a TT you don't produce any at all) and suppressed or very low TSH.

You can take levo at bedtime, not having eaten 2 hours before so that your stomach is empty. To switch you from T3 alone (the active hormone our receptor cells need) to T4 which means you have to convert it to sufficient T3 and that doesn't always happen.

I hope you feel better soon. My own personal opinion is that someone without a thyroid gland needs better thyroid hormones than T4 alone.

[monkey65 in reply to shaws]

Thanks Shaws. I think you are exactly right about wanting the bloods to 'fit'

[humanbean]

I'm sure the main reason for switching you the way they did was financial. Sadly, I doubt that concern for you health had anything to do with it at all.

Be aware that self-treatment with levothyroxine , or T3, or a combination of T4 and T3, or Natural Dessicated Thyroid is possible if you are prepared to buy over the internet without a prescription. But don't buy blindly - ask for reliable sites to buy from.

[Clutter]

Monkey, your last dose of T3 will be out of your blood within 6/12 hours and out of your system in around 24/36 hours whereas it will take 7/10 days for the thyroxine to start working in your system.

You were overmedicated on 60mcg with FT3 >10 but you may feel better if you take 10mcg T3 2 or 3 times a day for a week until the Levothyroxine kicks in.

Levothyroxine can be taken at any time of day as long as you take it with a full glass of water on an empty stomach one hour before, or two hours after, food and drink, two hours away from other medication and supplements and four hours away from vitamin D3, calcium, iron and oestrogen.

[gabkad in reply to Clutter]

Good god, she'll be zeroing out on both fT4 and fT3 until the T4 kicks in.... like at least 2 weeks.

Good advice Clutter and I hope she's got extra T3 pills at home.

Negligence at the least. Malpractice at worst.

[Clutter in reply to gabkad]

Gabkad, it's sheer blerdy ignorance of how T4 and T3 work and the effects on the patient. If Monkey had been having RAI she'd have been off T3 for 2 weeks prior to get TSH >30, 4/5 days of RAI then start Levothyroxine which takes 7/10 days minimum. Makes me want to rip out the thyroid of whoever decides the prescribing protocol and see how they feel without thyroid hormone until T4 kicks in.

[gabkad in reply to Clutter]

I'll join you... on the ripping part. We'll need tight fitting gloves but I'm sure we could manage before the blood would result in slippage.......... Would you mind too much if I ended up ripping out their trachea by accident? You know, collateral damage.

[Clutter in reply to gabkad]

Gabkad, how very vengeful, but no, I don't mind at all Don't damage the parathyroids though.

[gabkad in reply to Clutter]

Sorry Clutter: it's scorched earth policy or nothing. Take no prisoners.

[Stourie in reply to Clutter]

Hi Clutter, please correct me if I am wrong. If Monkeys last blood test showed a t3 reading of 10 I don't think that she was overmedicated because as you said within 6/12 hours it would be out of her system. Surely her t3 would then go under before her next dose. When I had my t3 tested the reading was 15. something and the endo didn't bother about it. I take my 80 t3 at bedtime so 24 hours later when I take my next dose it would be back in range and possibly low in range. ????

[Clutter in reply to Stourie]

Stourie, The last dose would be out of her blood in 6/12 hours but not out of her system. It then takes 48/72 to get into the cells and roughly another 24/36 to be out of her system.

Monkey was overmedicated because FT3 was over the top of range 3.8-6.8. If she didn't take more T3 it would take several weeks for FT3 to drop into range, not overnight.

My endo was very concerned about my FT3 being over range so I'm surprised yours wasn't. If you stopped T3 24 hours before your blood draw the 'true' level of your circulating T3 is probably approximately 20% higher ie 18.

[Stourie in reply to Clutter]

But they are only checking the t3 in her blood I thought. Not arguing but just want to understand. I take 80 at bedtime but the night before my blood test I took 40 t3 and the result was 15 something. Should I not have taken any the night before. The endo didn't know what I was doing with my t3 before the test but he knows that I take 80 mcg t3 a day. I don't feel overmedicated so not really understanding.

[Clutter in reply to Stourie]

Stourie, they can only measure the T3 circulating in the blood not in the cells.

Stourie I think your FT3 would still be high if you stopped taking T3 for a week before your blood test because 15 is more than double the top of most ranges. Most endos want FT3 kept within range.

I had a little heat intolerance during the summer and slight tremors in my hands but didn't otherwise feel overmedicated but FT3 was 8.4 (3.2-6.2) 12/14 hours after my last 20mcg dose. I cut T4 to 20mcg for 2 weeks to allow levels to drop and then reduced dose from 40mcg T3 to 30mcg + 75mcg T4. I'm hoping that will get me in range because 75+20 didn't suppress my TSH and I don't want FT3 over range as I'm recently diagnosed with mild osteopenia and don't want to exacerbate that.

[Stourie in reply to Clutter]

I feel that I have to keep my t3 at that amount because when I try to drop it which I have done a few times I get restless legs and that just drives me up the wall so I up my dose again and after 3 or 4 days it goes away. I certainly don't feel over medicated. But I suppose everybody is different.

[Clutter in reply to Stourie]

Stourie, we are different and sometimes have to take doses which result in levels which would be intolerable to someone else but are what we need to function. There are a couple of members who don't feel well unless their FT3 is over range.

[monkey65]

Thanks folks. I have plenty of T3 in fact. I think I'll take Clutters advice and take a tablet or two for the next week. I'll make sure the team at the hospital know how I felt and what I've done. They are after all meant to be the experts in post TT follow up.