Self Medication help. There are so many options where to start please?

[redhotchestnut]

So I am thinking of self medicating but so many options to choose from - what should I try and in which order, how long to trial for to expect good results, slightly confused with it all?

I currently take 75mcg a day Levothyroxine, have gradually been reduced from 175mcg over the last 12 months and feel awful most of the time. All the doctors say is my TSH is too low as it's 0.05 .

I am due for more blood results next week. Last bloods taken 6 weeks ago.

I really want to medicate to feel better rather than base my results on what my bloods say. Why do people take their temperature and pulse rate during the day, is this indicative of something if over or under medicating?

So my options are - T4 only (which isn't working atm but felt a bit better on higher dose I think?)

- T4 and T3

- T3 only

- T4 and NDT

- T3 and NDT

- NDT only

Gosh I didn't realise there were so many, please can anyone reduce the list as to what might not work, or put them in an order of trying, and tell me how long you would try for before moving onto the next option? I have heard from other people they sometimes get really good results with how they feel quite quickly?

Many many thanks for reading and I look forward to hearing back from you all with thoughts of the way forward for me?

Bloods Mid December:

T3 4.5

T4 12

TSH 0.02

All my vitamins, B12, iron are around the middle of normal and I can't seem to get them any higher with taking extra supplements, so these will have to stay this way.

[Jazzw]

How did you feel on 175mcg of Levo?

It might be that's all you need - would certainly be the cheapest self medicating option.

[shaws Administrator]

My TSH is low and I'm feeling very well. The TSH is really only a guide and shouldn't be judged as having a perfect dose of levo. It's how the patient feels. not to have the dose adjusted up/down according to the TSH. The result will not be to the patient's benefit.

I would not add T4 with NDT as NDT contains all of the hormones our healthy thyroid gland would have. I am not medically qualified and it's just my own experience.

If I was taking T4 only and feeling unwell I would add T3 to T4 and would start with a 1/4 to 1/2 tablet to start with and increase by the same amount every 2 weeks

When starting with T3, because it is the active hormone required in all of our receptor cells it is stronger than T4. Sometimes if a bit too much is taken we can get a fast pulse or feel very hot, so that's why its good to have a starting point before you begin adding T3 and make a record a few times a day. So, when you add T3 you have a guide of what your temps/pulse was. Sometimes we can feel quite hot but are surprised to see the temp is much the same.

If you take T3 only 20mcg is around 60mcg of levo and 25mcg of T3 is between 75mcg and 100mcg of T4. It is the 'effect' of T3 which is stronger than T4 because it is the Active hormone and is into your receptor cells in about 3 or 4 hours, its work then begins and lasts between one to three days. T4 is inactive and has to convert to T3 and it has a long half life.

I wish you success in your new regime.

[redhotchestnut]

I remember feeling a little bit better on 175mcg but still thinking I would have liked to have increased it further as still had a bit of tiredness. So NOT entirely symptom free, but better than I feel now.

If I decided to go down the T4/T3 route - should I start on 75mcg and 1/4 or 1/2 T3 tablet, or a higher dose of T4 similar to what I was on before?

[Clutter in reply to redhotchestnut]

Redhotchestnut, I would add 1/4 tablet (6.25mcg) for a week or two to see how you tolerate it. If you need to you increase to 12.5mcg but I would stick with that for 6-8 weeks and have a blood test to check FT3 before increasing further. Increasing dose, T4 or T3, will further suppress your TSH but it is more important to have good FT4 and FT3.

B12 is optimal around 1,000 and ferritin is optimal >100 to halfway through range. If your results are lower you can increase the doses you are taking.

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I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

[redhotchestnut]

Thanks Clutter - we spoke before I went to see the Endo I was referred to, as I wanted to self medicate with T3 added to my then current dose of T4 that I was taking which was 125mcg. I definitely felt better on this 125mcg T4 and 12.5mcg T3 as you had suggested would be a good starting point.

But then the Endo reduced me down to 100mcg T4 and 12.5mcg T3 because my TSH was supressed.

6 weeks later more bloods and then my GP reduced my T4 down to 75mcg. I carried on taking the 12.5mcg of T3 but by this point I started not to feel any benefit and then ran out of them - doctors wouldn't prescribe them even though Endo said yes I should have them for 6 months to trial. So I've just been on 75mcg of T4 and look and feel like death warmed up most of the time!

So I'd either like to go in at a higher dose, or increase up to a higher dose fairly quickly as I feel so rough, and have been and tolerated higher doses of meds before. I have never been high in T3 or T4 in blood tests so not much chance of going over on them!