Advice needed please

[Benjamin1]

Hi Everyone ive put a post up before when i last had my results. My previous results were (free T4 3.2) free T3 3.5) Tsh 0.01

I was taking 125mg of levothyroxine a day but was feeling awful, my endo advised me to start taking liothyronine aswell but after starting both i felt worse so stopped. I decided to go back to 150mg thyroxine as this is when i felt better but after a couple of months i am still feeling awful. Headaches everyday, constantly shattered, and my eyes go glazed and red. I was just wondering how do i know if i am overtreating myself or whether i need more medication ? My other symptoms are i seem to be able to cry at the drop of a hat and also feel like im on another planet at the moment. Im due to go back to see my endo but am feeling really low at the moment, any advise would be so much appreciated.

[Clutter]

Benjamin, your endo prescribed T3 because your FT3 is low as you weren't converting well. Low T3 causes hypothyroid symptoms and is probably why you are feeling so rough.

20mcg T3 may have been too much at first, some people need to acclimate and it would probably have been better to start you on 10mcg for a couple of weeks before increasing it to 20mcg. Try dropping your Levothyroxine to 125mcg and adding in 10mcg T3 split into 2 doses 6-12 hours apart. The first dose can be taken with your Levothyroxine.

[Benjamin1 in reply to Clutter]

Thank you for your reply Clutter, it gives me hope to hear there may be a solution to why im feeling so rough at the moment. I will have to wait to see my endo as shes only given me the t3 in 20mg tablets, im really tempted to try and drop my levo to 125mg and 20mg of the t3 to see if i can hold out and bear the initial symptoms. Should i take them both together in the morning ?

[Clutter in reply to Benjamin1]

Benjamin, Liothyronine is only available in 20mcg. Buy a pillcutter from your local pharmacy for around £2.99. The pills are quite easy to halve if you line up the tablet score line with the line on the pillcutter.

You can take T3 with your Levothyroxine dose.

[Benjamin1 in reply to Clutter]

Thank you you've been very helpful indeed, i will give it a go and see if it helps me feel normal 😊

[Benjamin1 in reply to Clutter]

Hi Clutter, ive now started taking the t4 and t3 can you tell me am i going to see any noticable changes ie weight gain or loss and how long will it be roughly before i should start to feel a difference, any advise is much appreciated, thank you

[Clutter in reply to Benjamin1]

Benjamin, you may *feel* the dose by slightly increased heart/pulse rate an hour or so after ingestion but it should settle within another hour.

It takes a couple of days to be absorbed into the cells and then up to 4-6 weeks to metabolise and work on symptoms. I found brain fog and mental clarity improved within a week but physical symptoms took a lot longer.

I don't think 10/20mcg will affect weight gain/loss but when you feel better and increase activity you may be able to exercise as part of a weight loss regime.

[Benjamin1 in reply to Clutter]

Thank you for your reply.

I noticed last time i tried the t3 my heart felt like it was racing so I stopped taking them as i didnt like the effect but now i know its to be expected i will continue to take them. As for my weight ive managed to maintain my weight over the years and my only concern was if the new medication may upset that. With my previous blood results would you recommend i take 125 or 150mg levothyroxine with 20mg of t3 ? As previously i felt better taking 150mg t4. I remember someone saying on here that 20mg of t3 works out to be a higher dose of t4 unless im getting confused with my brain fog !

[Clutter in reply to Benjamin1]

Benjamin T3 is 3 x stronger than T4 so 10mcg is equivalent to 30mcg T4. 125mcg T4 + 10mcg T3 is equivalent to 155mcg T4.

You didn't feel well on 20mcg so start with 10mcg and give it 2 weeks to see how you tolerate it before increasing to 20mcg.

[Benjamin1 in reply to Clutter]

Wow thats a lot but needs to be done. Ok il give it a go and see if i feel better. Thank you very much for your help and support.

[Benjamin1 in reply to Clutter]

Hi Clutter, hope your well. I have just had my recent blood results i wanted to see your thoughts please. My free T4 is 17.3, T3 4.2 and TSH 0.01 these blood results were based on me taking 150mg levothyroxine only. As you know ive now started taking 125mg T4 and 20mg T3.

[Clutter in reply to Benjamin1]

Benjamin, hard to say without the lab ref ranges (figures in brackets after your results). TSH is suppressed as expected on 150mcg T4 but I would have expected to see FT4 and FT3 higher.

Now you're taking T3 FT3 should rise but FT4 may drop slightly.

[Benjamin1 in reply to Clutter]

Thank you for your reply, im due to go drs tmw so i will see if i can have a print out of my blood results. What is the ideal range for someone with an underactive thyroid to feel at their best ? Thank you

[Clutter in reply to Benjamin1]

Benjamin, it doesn't quite work like that. What suits one person isn't right for another but as a guide people on Levothyroxine are usually comfortable with TSH just above or below 1.0 with FT4 near the top 75% of range and FT3 near/in the top third of range. FT4 will often be lower when taking T3+T4.

[Benjamin1 in reply to Clutter]

So the higher the dose of levothyroxine the lower the tsh becomes ? Is there a reason why someones tsh suddenlybecomes supressed ? Like mine has. Im trying to understand the world of t4, t3 and tsh, youve been most helpful, thank you.

[Clutter in reply to Benjamin1]

Benjamin, When the pituitary gland detects low circulating thyroid hormone it increases TSH to stimulate the thyroid gland to produce more hormone. When sufficient hormone is detected TSH is shut off and becomes low or suppressed.

>145mcg is considered to be a suppressive dose but some people have suppressed TSH on 75mcg. Increasing dose from 125mcg to 150mcg would be enough to drop your TSH from low to suppressed.

[Benjamin1 in reply to Clutter]

Thank you. I believe my Tsh has been supressed for sometime now as i used to be on 175mg thyroxine then it got reduced to 150 now 125. So really it doesnt matter if your tsh is supressed its more about what the t4 and t3 are doing is that right ? So the reason ive been put on t3 is because i have a low t3 ?

[Clutter in reply to Benjamin1]

Benjamin, low or suppressed TSH is a contentious thing. My TSH has to be kept suppressed so I'm never treated to the alarmist warnings some GPs and endos delight in scaring their patients about.

TSH is a pituitary hormone so I think FT4 and FT3 which are thyroid hormones have to be a better indication of thyroid status.

FT3 3.5 is generally low in range and that is the most likely reason you were prescribed T3.

[Benjamin1 in reply to Clutter]

Thank you for your reply. My endo has prescribed me t3 because of my supressed tsh, so she said. I appreciate all your help and support. Il post my blood results tmw once ive been the drs.

[Benjamin1 in reply to Benjamin1]

Hi Clutter, ive been to the Drs and she has said my thyroid results are all normal with my serum free T4 17.3 my serum free T3 level 4.2 and my tsh suppressed at 0.01 these results are based on me only taking 150mg of levothyroxine. Ive now changed my dosage as i said before to 125mg levo and 20mg t3, do you still think i should keep taking the T3 and T4 ? Also my ferretin is 19 which previously it was just 7 but i now take ferrous fumerate daily to increase this to the optimum range between 40/60.