Started Liothyronine T3 2 weeks ago with my T4- Advice please

[Bubbap]

Dear all.

I have tried to attach a table of all of my thyroid results below in a table so hopefully you can view the attachment - all results since my thyroid journey began. Otherwise I have summaried the last few recent ones below.

In july last year I was on 75mg Levo and my results were TSH 1.6Free T4 15.3 and Free T33.7NO INSOMNIA SLEEPING WELL - but chronic Constipation so I tried to increase my dose to 100mg thinking it would help with the constipation and then results were:-

Oct-15with a tsh of 2. The NHS wouldn't take the other free t3 and t4 myInsomnia came back and I was still constipated. I then decided to pay privately and had the below results:-

Jan-16Tsh of3.43 and Free T4 23.7and Free T3 4.6

As I was having such problems sleeping and my Free T4 was just over the range privately I made the decision to lower my dose back to 75mg which aside from the constipation I was well on as atleast I was sleeping and energy was ok in the day.

My results going back onto 75mg Levo was

Feb-16TSH1.9and I was sleeping better although when I say better I mean getting 4-5hrs a night and atleast not being awake the whole night, the other results were not taken.

BUT I have put on half a stone since dropping my dose and I hope this does not continue. It is not like me to put on weight like this.

I have taken seriphos on and off after a cortisol test taken a while ago showed my cortisol levels were three times over the range at night which I was told by a nutritionalist was causing my complete lack of sleep and I believe that has helped correct the sleep issue to some degree. Im off the seriphos now.

Anyway I decided after some great advice on this forum to introduce some T3. My feeling all along has been that my Free t3 levels no matter the dose of T4 always seem to be at the bottom of the range. I felt this was the reason for my constipation (I take magnesium (night only), Vit C and Vitmain D through out the day).

So I paid for the 5 microgram tablets (I know very expensive and a low dose). I just wanted to start very slowly and after reading a book by Dr Kenneth Blanchard on how the success with very small doses of T3 and how this matches the human physiology i.e 98%t4 2% t3 I wanted to try it first. He wrote about the success he had with small doses like 1.2 micrograms and under in slow release capsules.

Mine were not slow release capsule but basic liothyronine. Anyway with a pill cutter I actually managed to quarter the pill and took 1.2 micrograms for 10 days an hour after taking my levo in the morning (5.30am Levo) and then 6.30ish T3. I realise after the first couple of days if I took T3 with my levo I couldn't get back to sleep.

Anyway first week great, bowels actually improved and energy was good, I even noticed my mood was very upbeat. I work three days a week and have two children under 4 and I am a busy mum.

Anyway yesterday that good feeling worse off, by 1.3pm all I wanted to do was lie down which was hard with a toddler demanding my attention and felt rubbish. Also noticed that since the weekend my bowels have stopped working again, just when I thought things were improving.

My sleep is still an issue and I don't manage to nod off til about 1.30 sometimes 2 and wake up when I take my levo. I am just grateful that I sleep a bit now. The t3 hasn't helped the sleep much yet.

Anyway today woke up feeling tired again after a rubbish night sleep, decided to increase T3 to half a pill now 2.5mg.

Where do I go from here? I am confused as I never had the tiredness in the day until I started playing around with the T3. Do I go back to just my levo and try and increase to 88micrograms using the pill cutter? Although I really don't think I convert that well and that's why my bowels are bad? Or do I give it another couple of weeks at 2.5mg? Test my thyroid privately? I know I am on a small dose but going too higher frightens me a bit as I am doing this on my own?

Thanks for your help and for taking the time to read this

[marsaday]

I think your issues are the adrenal and thyroid. The two go together. Just taking thyroid meds can help, but it can take a long time to balance out the adrenal side with the thyroid side.

These are the things i do to help this area:

I take the T4 at bedtime before sleep. TSH is highest when we sleep and so the body naturally produces the thyroid hormones when we sleep. This happens in the first part of the night. Later on the body then looks at what thyroid has been made and starts to make a matching amount of cortisol. The two will then work together the next day. NB, we will also make more hormones in the day, but the nighttime production is important.

So your poor sleep will be interfering with this natural production. So try taking the T4 at bedtime and see if this works out. It may well energise you because your cortisol rhythm is out, but worth a try.

I also take a small dose of T3 (5mcg) in the morning. Small doses work best because the body is making 1-2mcg per hour. Some people prefer larger doses, but i have seen how small doses work and they are better. You are taking even smaller doses and this is interesting. so now you feel tired by the afternoon and you think it is down to the T3?

You may be using up lots of cortisol by the afternoon and so when this time comes along your body is low in cortisol and so you have a slump. On the 24h adrenal profile it is very common to have an afternoon slump in cortisol. It is a normal human rhythm. In hypoT people the slump is exaggerated.

This is where timings of the thyroid meds can be useful. I have mentioned about T4 dosing and i take most of mine at bedtime (100), but because of the afternoon slump i take 25 T4 around 3pm. This dose seems to really boost me for the evenings and because i play a lot of sport this is useful.

Your T3 dose could also be shifted about. I take mine when i wake up, but i used to find an afternoon dose of T3 was great. but i have swapped that now with the T4.

So for you i would try 50 T4 at bedtime (might be small enough not to disturb sleep) and then 25 T4 around 2/3pm. Then take the T3 in the morning as usual and see how it all gets on. I would also try seeing what a full 5mcg T3 in the morning is like.

You are looking to try and recreate a better balance of thyroid hormones because your body is not doing it for itself. As time goes on you will also influence cortisol and so things will change. What you are trying to do is elevate metabolic rate and it is not just as straight forward as pouring in thyroid meds. You need time for adaption.

It is always best to start low on any meds and increase slowly. I would try and stick with a definite plan for at least 3 months and then see what a small increase of T4 feels like (say 12.5mcg). You could choose where you add this in (bedtime or afternoon).

To help guide you it is important to monitor your temps, HR and blood pressure. These signals will help you work out if things are going well or not. Sometimes how we feel is not enough.

[marsaday in reply to marsaday]

On 100 T4 your FT4 goes much higher to the top of the range. FT3 does go up as well, but is still low. This indicates you are not converting as well as could be, so some T3 is going to be useful.

An ft4 in the high teens is good. Your Ft4 jumps from 15 to 23 on a 25mcg T4 increase. This is quite a big jump and it indicates you are not using the T4 effectively.

The problem is probably going to be the higher cortisol blocking the T3 absorption. So you need to nurture this area as well as the thyroid. Hopefully messing around with the thyroid meds and times will help this a little.

Do you know if you are low in iron ? This can be a problem as well.

[Bubbap in reply to marsaday]

Wow thank you so much, everything you have said seems v logical to me and makes sense.

My adrenal saliva test was taken well over a year ago. I paid for it privately when my insomnia was so bad I think I went through several nights with 0 sleep. It was a horrendous time especially with two young kids now atleast I feel i get some sleep but i took seriphos for a few months which really helped. Looking at my test results it seemed at every point in the day and night I was well over the range sometimes three times over especially at night in the morning. The only time it was normal but still top of the range was in the afternoon. I would imagine it is different now and I probably could do with another test but money is an issue.

I have also read about taking t4 at night for sleep problems. Did you find it helped your sleep or did it take a while to adjust?

It is my first day on the 2.5 dose of t3 after being on 1.2 for approx. 10 days and I will stick to that for a couple of weeks and then see if I can adjust to the full 5. I will also see how I feel this afternoon after taking a bit more t3 this morning if I slump again then I like your idea of the split dosing. Or taking some T4.

I must admit I am nervous of trying T4 at night as I don't want to make the sleep issue worse but I think its a good idea so will give it a ago. I have been toying with the idea for some time. I also feel I need a bit more t4 now im on t3 which is weird as you think less but I reckon 88mg might help as my TSH is probably dropping and hence T4 dropping?

I really appreciate you taking the time to read my results and to offer some sensible suggestions. Sometimes you can feel quite on your own when self dosing. xx

[marsaday in reply to Bubbap]

Taking T4 at bed never caused any issues. I may have been a little more alert at first, but it never stopped me sleeping. Now it is part of my routine and i think if i switched back to morning dosing things would be worse.

If you up the T4 by 12.5mcg then make sure that is the only change you make for a few weeks. Try and keep changes to meds simple. This way you can identify what is doing what.

So if you decide to dose at bedtime don't also up the T4 because you won't know if the increase or the change in timing has made any change (positive or negative).

So make changes one at a time. Try allow some time between them. As you get better at working out what is doing what you should be able to make changes quicker.

Don't feel bad about things if you get some negative reactions. This is all positive info which can help guide you to the best solution for you. So if you feel bad on a higher T3 dose, don't push it up, just back off again. It means your metabolism cannot cope with more T3. This doesn't mean it won't in the future, but you will need to nurture that adrenal/thyroid relationship.

Also this may be effective for someone like yourself. Rather than upping the T4 every day by x amount you could use more on one day of the week. e.g., take 100 T4 on sat and sunday and 75 for the rest of the week. Sometimes T4 dosed like this can be more effective as it has different effects on the TSH.

[Bubbap in reply to marsaday]

Oh and im now sure if I am low on iron? I don't think the GP will even be interested in testing me. They don't seem to like to pay out for anything.

[Clutter]

Bubbap, as you are having trouble getting off to sleep why not take your Levothyroxine later, when you are ready to get up rather than break your sleep at 5.30am?

2.5mcg is a tiny dose equivalent to 7.5mcg T4. Try taking a second 2.5mcg dose 2 hours before the afternoon slump hits you.

_______________________________________________________________________________

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.

[Bubbap]

Thanks Clutter. I take it at 5.30am as it gives me a couple of hours before breakfast but think I might have to review this. I am going to try and take another dose of t3 at lunch is this tiredness persists. I didn't have daily fatigue on T4 just constipation and the insomnia. The fatigue is worrying me a bit. Will it get better on t3? thanks