Help me to get the right dose please. - Thyroid UK

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Help me to get the right dose please.

SohanFrankyy profile image
17 Replies

Here is the range of FT3: 2.80 - 7.10 pmol/L & FT4: 12.0 - 22.0 pmol/L.

My results are: FT3: 13.11pmol/L & FT4: 28.48 pmol/L. My TSH has decreased from 4.21 to .021, which is slightly below the normal range, after t3+t4 comdbination.

I am planning to go back to t4 only. Would that be a right decision?

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SohanFrankyy
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SeasideSusie profile image
SeasideSusieRemembering

SohanFrankyy I have just replied to your previous post. So that members get the full story I have copied that reply below:

From what you have written I understand your results to be -

Previously (was this when you were on 75mcg T4?):

TSH: 4.2 (no range given)

Total T4: 107.1 (no range given)

On 50mcg T4/6mcg T3:

TSH: .021 (no range given)

FT4: 28.8 (12-22)

FT3: 13.11 (2.8-7.10)

The latest figures indicate over replacement with thyroid medication. Your FT4 is approx 165% of range and FT3 is approx 239% of range. Generally, both should be on their upper quarters of their ranges with FT3 higher in it's range than FT4 is in it's range. It's important for FT3 to be in range.

My understanding is that you need to reduce both T4 and T3 but I am not medically trained. However, there are members who are more knowledgeable than me so it may be an idea to start a new post, possibly mentioning Clutter to alert her to your post by putting @ in front of her name as she gave you suggestions in your previous post.

SohanFrankyy profile image
SohanFrankyy in reply to SeasideSusie

Thanks for the reply.

Yes, I was on 75mcg of levo prior to the t4+t3 combo.

And you have understood my all points except the result 107.1 is of only T4 not FT4.

SeasideSusie profile image
SeasideSusieRemembering in reply to SohanFrankyy

OK SohanFrankyy I have edited my above post now that you have clarified that.

SohanFrankyy profile image
SohanFrankyy in reply to SeasideSusie

Ok. I got that. Thanks.

So, should I reduce my T4 from 50mcg now? What about T3?

SeasideSusie profile image
SeasideSusieRemembering in reply to SohanFrankyy

SohanFrankyy This is what I would do personally, bear in mind I am not medically qualified and you might want to see what Clutter suggests.

You are on a very small amount of both L-T4 and T3 meds. Your FT4 is over range and FT3 very high over range. I think you may be converting T4 to T3 well enough but you don't really know that yet. So -

1) I would stop T3 for now, the effect of that will be reasonably quick as it has a short half life.

2) I would reduce L-T4 a bit. It's difficult with such a small dose but you're going to need to experiment. I would start by alternating 50mcg one day, 25mcg the next, so you average 37.5mcg. As L-T4 has a half life of about 6 days, you will have more than the 37.5mcg in your system for a few weeks and to see the full effect of the new, lower dose.

3) Stick with it.

4) Retest FT4 and FT3 after 6-8 weeks.

5) The retest in 6-8 weeks should indicate whether you are converting T4 to T3 well enough. If you are then L-T4 is probably all you need. If not you need to look at how much T3 needs to be added. It will also tell you whether you need to adjust the dose of L-T4 up or down.

As I say, this is my opinion only and how I would do it if it was me. Other members might have other ideas.

The only other thing that jumps into my mind is whether you have any other conditions and are on any other medication which may be contributing to how you feel or reacting with the thyroid meds.

SohanFrankyy profile image
SohanFrankyy in reply to SeasideSusie

Thanks a lot for your concerns mam. I am sorry if I don't make much sense in my writing, because while I am writing I am feeling terrible headache and depression!

For your answer, I only took calcium and vitamin D combo med, but stopped taking for a week. Now, I only take Ginton a herbal med to enhance energy. And I also take my T4 and T3 after starving for 4 hours and don't eat anything after the consumption of the meds for 1 hour.

Anyway, that is what I was also thinking exactly--stopping T3 for now and reducing T4 a bit. Thanks for your clarification on how would I reduce my T4.

But one think I still am unable to fathom is that how would I understand if my conversion is ok after the testing of FT3 & FT4 after 6-7 weeks?

SeasideSusie profile image
SeasideSusieRemembering in reply to SohanFrankyy

SohanFrankyy Conversion will show in the test results. If your FT4 is in a good place (preferably upper third of range) and FT3 is in upper quarter of range then conversion is good. If FT3 is low in range then conversion is compromised. Sometimes poor conversion can be helped by having optimal vitamins and minerals (Vit D, B12, folate and particularly ferritin) and taking selenium. Sometimes there is a need for the addition of T3.

The ideal ratio of T4:T3 is 4:1 or less. Mine was nearer 7:1 on blood tests so I lowered L-T4 and added some T3.

SohanFrankyy profile image
SohanFrankyy

Clutter Any kind of advice would be more than beneficial for me.

Thanks.

Clutter profile image
Clutter in reply to SohanFrankyy

SohanFrankyy,

If you left 24 hours between last dose and blood draw you are over medicated and should reduce dose as SeasideSusie recommends.

If you took T4+T3 before your blood draw this may be why FT3 and FT4 are elevated and you may not be over medicated.

SeasideSusie profile image
SeasideSusieRemembering in reply to Clutter

Ah yes Clutter I had assumed that criteria had been met. SohanFrankyy perhaps you can advise, it would make a difference.

SohanFrankyy profile image
SohanFrankyy in reply to Clutter

Thanks for the reply.

It was not 24 hours at all. I had given my blood after 5-6 hours of t4+t3 consumption.

So what should be my dose then if I am not over-medicated?

Clutter profile image
Clutter in reply to SohanFrankyy

SohanFrankyy,

T4+T3 can still be peaking in your system up to six hours after last dose but I think you must be overmedicated to have FT3 >13.0.

What dose T4+T3 are you taking?

SohanFrankyy profile image
SohanFrankyy in reply to Clutter

50mcg T4 and ~6mcg T3. Now, should I reduce my 50 mcg Levo to 25 mcg and keep the T3 as it is?

Clutter profile image
Clutter in reply to SohanFrankyy

SohanFrankyy,

Yes, I think so. Retest in 8 weeks and remember to take thyroid meds after your blood draw.

SohanFrankyy profile image
SohanFrankyy in reply to Clutter

THanks again. Another thing- would there be any adverse effect if I stop T3 suddenly?

Clutter profile image
Clutter in reply to SohanFrankyy

SohanFrankyy,

No, but you might want to take 37.5mcg T4 instead of 25mcg if you intend stopping T3.

SohanFrankyy profile image
SohanFrankyy

Here is no natural thyroid and I am struggling with T4+T3 combo also. I think my career is over! :(

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