T3 dosage when on 200mcg daily of T4 - congenital hypothyroidism

[juliarees82]

Ordered me some 25mg tablets online - on 200mg. Looking for assistance with dosage?

Thanks

[SeasideSusie Remembering]

Do you have your thyroid test results. You need FT3 result as well before anyone can suggest what dose might be appropriate and whether Levo needs adjusting.

[juliarees82 in reply to SeasideSusie]

Serum TSH 1.53 mU/L (.27-4.20) "normal"

Serum 4 T4 24.9 pmol/L(11.0-25.0)

serum free t3 4.0 (3.1-6.8)

[Clutter in reply to juliarees82]

Juliarees82,

I would add 6.25mcg T3 to 200mcg Levothyroxine. The tablets can be quartered if you buy a pillcutter from a high street pharmacy.

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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.

[juliarees82 in reply to Clutter]

Is that per day? I have heard you spread doses throughout the day?

[Clutter in reply to juliarees82]

Juliarees82,

Yes, per day, you can take it with your Levothyroxine dose. You'll be hard pushed to split 25mcg into more than 4 doses. 6.25mcg T3 is equivalent to 18.75mcg T4. If you increase T3 dose you can split it into 2 doses.

[juliarees82 in reply to Clutter]

Brilliant thank you

[SeasideSusie Remembering in reply to juliarees82]

juliarees82 OK, a bit similar to mine although my FT4 was well over range and FT3 a bit higher up than yours.

[I am not medically trained or qualified, I can only go by my own experience and this is what I would do in your situation to minimise any unwanted side effects of T3. Go slowly and gradually. Other members may have different ideas, but as a precautionary tale just have a look at this recent thread and what happened to the member when she rushed increasing T3 healthunlocked.com/thyroidu... ]

Ideally, the ratio of FT4:FT3 should be 4:1 or less, yours is around the 6:1 mark (my ratio was very similar).

T3 is roughly the equivalent of 3 to 4 times more potent than Levo, so 25mcg T3 is roughly the equivalent of 75-100mcg Levo.

As your FT3 is at the top of range I would reduce Levo by 25mcg and add in 6.25mcg T3 once daily. Give it 2-3 weeks and see how you feel. If all OK I would then add another 6.25mcg T3 (experiment to see if once daily 12.5mcg or 2 x 6.25mcg is better for you). I would then give it at least another 2-3 weeks, maybe 4, before doing anything else. See how you feel.

Keep an eye out for palpitations, maybe check your temperature as some members recommend keeping an eye on that (I have to admit I haven't done that but my resting heart rate is nicely around 68-72).

At some point you will need to check your levels again, it is important to keep FT3 in range. TSH will probably become suppressed but that doesn't matter, it's the FT3 that's important.

I haven't repeated blood tests since adding T3, purely because I'm not successful at fingerprick tests (my blood clots in the funnel before it drops into the tube), I can't get blood drawn locally and there's no Blue Horizon blood collection facilities anywhere near me. I have done urine tests though from before and since adding T3. They clearly show my FT4 has reduced and FT3 increased. I'm just about to do another urine test to see whether another increase could benefit me. I think it could but I have other things going on that I am addressing that affect how I feel so it's not entirely possible for me to know.

Just as a comparison, I was on 175mcg Levo when I had my over range FT4 and FT3 not in balance with it as mentioned above. I dropped my Levo to 150mcg and added 6.25mcg T3. I ummed and ahh'd about adding more but eventually, probably a month or so later, I added a second dose of 6.25mcg T3. I haven't increased since then because of what else is going on and I can't attribute any improvement to any one thing, which is why I'll be doing a urine test soon to see where my levels are now. The other things I consult with a practitioner about, I do not consult her about my thyroid dosing.

Good luck, I hope you start to feel the benefit of adding T3. As I said other members may do it differently, go with what you feel comfortable with.

Just a thought, are your vits and minerals optimal (Vit D, B12, ferritin and folate) as this all helps thyroid hormone to work properly. If you haven't had them tested it would be a good idea to do so, either through your GP or with Blue Horizon.

[juliarees82 in reply to SeasideSusie]

Wow amazing advice thank you ever so much.

I will do that - what benefits have you noticed by adding the T3?

Also yes, I am taking a thyroid support vitamine which includes all the above so I am hoping when adding the T3 into the mix I will start to feel human again.

Thanks xx

[SeasideSusie Remembering in reply to juliarees82]

juliarees82 It's difficult to say what benefits I've noticed. As I say there are other things going on. I have problems with adrenals and sex hormones, all of which, together with my hypothyroidism, caused problems.

I started adding T3 about 2-3 months before addressing the other problems with supplements after consultation with a practioner in February.

At the time, although I can't recall exactly how I felt other than generally unwell for many years, fatigue was a big problem and an afternoon lie down (I can't sleep in the afternoon) not unheard of.

These are the notes I kept:

22/11/15 - Lowered Levo to 150mcg nightime, added 6.25mcg T3 on waking.

6/12/15 - Levo 150mcg. Added second dose of T3 in afternoon, 2 x 6.25mcg daily.

23/12/15 - Levo 150mcg. T3 12.5mcg on waking.

6/1/16 - Levo 150mcg. Added extra 6.25mcg T3 in afternoon, total 18.75mcg.

21/1/16 - Levo 150mcg. Reduced back to 12.5mcg T3 on waking as so tired.

19/2/16 - Levo 150mcg. Reduced to 6.25mcg as per practioner.

4/3/16 - Levo 150mcg. Increased T3 back to 12.5mcg - 2 x 6.25mcg after urine test result.

So you can see I experimented. Even then I don't think I gave any changes enough time to see if there was any difference. I decided one x 12.5mcg dose wasn't for me so have gone back to splitting the dose. I also went up to 18.75mcg for a couple of weeks but didn't find any benefit, in fact I was more tired but can't be absolutely sure it was the extra T3. I also reduced back down to 6.25mcg as the practioner I consult with said it was like 'rocket fuel'. However, after I had my urine test result it didn't show I was over replaced with T3 so I put it back up to 12.5mcg as I'm not consulting her about my thyroid anyway.

Since February I've gradually introduced supplements to help the adrenals and sex hormones. There has been a gradual improvement but as I say, so many things going on and being addressed it's hard to say which has benefitted what. I can say I no longer have the awful fatigue inasmuch as I no longer need an afternoon lie down. My brain seems to function better, not saying I don't have foggy brain days because I do, but on the whole it's better. I still can't concentrate enough to read and understand much when it comes to something like a lengthy article. I've had Dr Myhill's Sustainable Medicine book waiting for a few months, not got past page 4 yet!

Any changes in how I feel have been gradual. I think generally these things change over time rather than over night and we have to be patient. When I've done my next urine test I shall see whether there is room to increase the T3 more.

Can I just say, although you are taking a thyroid support vitamin it's not the same as knowing your levels of vitamins and minerals and addressing any deficiencies. Eg, ferritin needs to be at least 70, preferably 100-130 for thyroid hormone to work properly. If supplementation is needed it needs to be tailored to the level you have. Same with Vit D, that needs to be 100+ and depending on your level again you need to supplement the right amount, together with K2. You can overdo both of them, too much iron causes problems. Too much Vit D gets stored, the body can't excrete it, so again problems can arise. If B12 is below 500 it can cause neurological problems, very low and lots more problems. It needs to be 1000. So you see how important the individual supplements are when tailored to actual needs, rather than a general supplement and not knowing your levels.

[juliarees82 in reply to SeasideSusie]

So how do I get my levels? Bloods? I've got some I will have a look at home later x

[SeasideSusie Remembering in reply to juliarees82]

juliarees82 You can ask your GP to do Vit D, B12, ferritin and folate. If he wont then you can get a private test done with Blue Horizon, they do a fingerprick test that covers all of them bluehorizonmedicals.co.uk/T... , you need to select microtainer if you want the fingerprick test.

[LtAngua52 in reply to SeasideSusie]

Just wanted to ask where do you get your thyroid urine tests done? Sounds much easier than trying to do the finger prick test I usually do!

[SeasideSusie Remembering in reply to LtAngua52]

LtAngua52 Genova Diagnostics do the 24 hour thyroid urine test - END08. You need to go through ThyroidUK with Genova as they need a 'practioner', they don't deal 'direct' with the patient. Don't go through Genova's website or you won't get the discount, either phone or email them and use ThyroidUK's code, then fill on the test result request form and TUK will send results to you thyroiduk.org.uk/tuk/testin...

The results won't look anything like the blood test results, I find the urine results show lower in range than the blood test does. However, the blood test is a snapshot of what shows in your blood at the moment it's taken, the urine test shows what has gone through the cells over a 24 hour period so you can't compare them like for like. Not everyone thinks this test is reliable, however I've found that over two tests, one before and one after adding T3, it confirmed exactly what my change in meds was expected to achieve ie I lowered my Levo and added T3. My FT4 lowered from 39% through range to 29.2% and my FT3 increased from (minus) -6.4% to 42.9%. I wouldn't use the urine test in isolation, I think it's a useful addition to the blood test.

[LtAngua52 in reply to SeasideSusie]

Thank you. As I'm waiting to receive my first batch of t3 I'll do this test before and after too.

[SeasideSusie Remembering in reply to LtAngua52]

LtAngua52 It can be a bit confusing working out the exact 24 hours of collection so if you want me to clarify that for you when the time comes do please PM me and I'll explain exactly how to do it.

Also, you don't leave your thyroid meds off during this test but you must ensure you take only the exact amount you would normally take during a 24 hour period.

It's important that it is 24 hours and only the correct amount of meds. As the test is more expensive than a blood test I wouldn't want you to get a wrong result and waste your money so do please ask and I'll be happy to help.

[LtAngua52 in reply to SeasideSusie]

Thanks seasidesusie