Advice about whether to continue T4/T3

I would be very grateful for some advice. After 16 years on 100mcg Levothyroxine (I had a partial thyroidectomy) my endo let me try 75mcg Levo and 10mcg T3. I’ve been on them for one year, but to be honest didn’t really notice any change in symptoms – mainly getting abnormally cold when temp. drops and also easily overheating. I was hoping he might increase the T3 dose, but instead he pulled the plug on the T3. I am not sure whether to just go back on Levo and put up with sometimes feeling I’m on the verge of hypothermia ….or self-medicating by continuing to add T3.

These are my recent results from Blue Horizon while still on T4/T3. I’m a bit confused about the low TSH result since last year it was 1.6 when I was on 100mcg Levo only and I expected it to be higher this time round on only 75mcg Levo. Also, last year free T4 was 18 and Free T3 3.8….so not much difference there.

The Blue Horizon doctor’s comments were that the TSH was rather low and that dose adjustment might be necessary as there is a possibility that hyperthyroidism will develop if the TSH fails to rise.

Incidentally, the Vitamins have all improved greatly and the Anti- Thyroidperoxidase is down from 150 – so that’s all encouraging.

Any feedback would be much appreciated. Thanks.

(Sorry this is so long!)

TSH L 0.22 (0.27-4.20) IU/L

Free T4 17.00 (12-22) pmol/L

Free T3 4.07 (3.1 – 6.8) pmol/L

T4 Total (insufficient blood sample to test)

Anti-Thyroidperoxidase abs H 77.3 <34

Anti-Thyroglobin Abs (insufficient to test)

Vitamins:

D 114 nmol/L (50 – 175)

Serum Folate H >45.4 (10.4 – 42.4)

Vit B12 (insufficient blood sample to test but last year it was near top of the range.)

Biochemistry:

CRP 0.10 (<5)

Ferritin 95.2 (20-150 ug/L)

17 Replies

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  • The ratio Free T4 17 to Free T3 4.07 is 4.18 showing no effect of T3. Should be 3 or 3.3

    A local patient advocate told in Facebook that 15mcg T3 had for her no effect, but 20mcg did.

    Ray Peat wrote that Levo to Lio ratio 4 to 1 works best, in some rare cases 3 to 1 is better

    A good thyroid doctor (age 75!) prescribes 50mcg T4 + 40mcg T3

  • Thanks Eljii. Do you think I need concern myself about the low TSH?

  • I can only give you my own experience. Forever in and out of A&E with palps when on levo. Felt more dreadful when finally diagnosed with a TSH of 100.

    I improved when T3 to T4 was added but as I lowered T4 and increased T3 the better I became and am well now. Of course, we're all different and our needs may differ as well. This is a post I did earlier.

    jeffreydachmd.com/why-natur...

    I also think your dose of 10mcg might not have been high enough to alleviate your symptoms with 75mcg of levo.

  • Thanks Shaws. I was wondering about trying 50 mcg Levo and 20 mcg T3.....but would that make my TSH even lower?

  • People taking T3 in any form find their TSH is below range or even undetectable. That's normal. Your doctor should know that but sadly most don't.

  • I am not medically qualified but believe the lower the TSH the better we feel. There are rumours that abound about the TSH and doctors believe them. This is an extract:-

    The latter group also stated that “more than 95% of healthy, euthyroid subjects have a serum TSH between 0.4 – 2.5 mIU per liter” and that “patients with a serum TSH above 2.5 mIU per liter, when confirmed by repeat TSH measurement made after three to four weeks, may be in the early stages of thyroid failure, especially if thyroid peroxidase antibodies are detected.” In 2003, the consensus panel (Endocrine Society, American Association of Clinical Endocrinologists, and American Thyroid Association) recommended a target TSH range of 1.0 to 1.5 mIU per liter in patients already receiving thyroxine therapy. ” (12)

    jeffreydachmd.com/tsh-wars-...

  • There is absolutely no chance that hyperthyroidism will develop due to the low TSH, it doesn't work like that. TSH is totally irrelevant once you are on thyroid hormone replacement. But I'm guessing that the BH doctor didn't know you were taking T3.

    Both your Frees are just below mid-range, so you needed and increase in dose - preferably in T3.

    There is, actually, quite a bit difference in your Frees before and after T3. The before results show that you weren't converting very well, and so needed the T3 added. Unfortunately, he didn't give you enough to bring your T3 up to where you needed it.

    The FT4 has gone down slightly because you were taking T3, and that's what it does. You can also expect your TSH to be suppressed when taking T3. It doesn't matter, you don't need it.

  • Thank you so much greygoose. That makes sense and is reassuring. Do you think it would be appropriate for me to try 50mcg T4 and 20mcg T3? Also, could you possibly pm me a reputable source of T3/ thanks again.

  • I think that going straight to 20 would be too much of a jump. Go back onto 10, then15, then 20. Sorry, can't help you with sources.

  • Thanks again greyness. Yes, it took me a while to be able to take 10 all at once....will proceed with caution....but should I drop levy to 50mcg when I start increasing to 15 etc....sorry to bombard you with questions!

  • I don't think it's necessary if you are going to take T4/T3. As greygoose says, increase by 1/4 tablet - every two weeks and go by how you feel plus temp/pulse if you feel they are going (either one) too high, drop down to previous dose.

  • Ok a FT4 of 18 is about right 60% of the range, your FT3 is low your goal is 6.2 about 75-80% of the range so if everything converting properly these would be the figures to expect.

    If your levels keep crashing and needing to raise your levels, consider having an adrenal deficiency, here's why the thyroid has to work harder to compensate for the deficient adrenals, then say you raise the thyroid medication to put your levels back up, in a few weeks or months the same can/will happen again as the thyroid becomes tired from the extra workload. This may also be the reason your TSH has crashed lower (mine did) but greygoose is right about taking t3 suppressing your TSH so consider either. Hope that helps...

  • Also, can I ask how you addressed your adrenal issues? Is there anything you would recommend? Thanks

  • Thanks Roadrunnergreg. I actually do have adrenal issues....higher afternoon and evening cortisol...and have been trying to address this. So should I hold off raising T3 until I have adrenal issues resolved?

  • Ok what about morning cortisol? You might gave Zinc deficiency here's why. In people with hypothyroidism tend to be very low in zinc, (I was) in addition Zinc lowers cortisol levels, not medical advice but I took 30mg of zinc 2-3hrs before bed and it helped me. I sleep better now even though I have adrenal issues.

    Fluctuating low body temperatures IE could be from 36-36.8c indicates adrenal fatigue, if it's low but consistent ie 36.6c then this says hypothyroidism

    As for helping the adrenals I've ordered a glandular to take. Also Ashwagandha is a good herb to use in my experience, it's an adaptogenic herb IE raise or lowers the problem to help normalise function. Hope this helps...

  • Thanks. My morning cortisol is now within normal range.....it is mainly the evening one that is above range, though it has come down a bit since last year. i'm finding that a lot of things are too stimulatory for me. e.g. tried Ashwaganda (in morning) and hardly slept a wink that night, tried bioidentical progesterone....gave me complete insomnia, rhodiola rose brought me out in an allergic rash. I'm beginning to suspect that adding T3 to Levo is maybe overtaxing my under par adrenals too. At any rate, I'm scared to raise the T3 incase I make matters worse, certainly without expert guidance - and there doesn't appear to be any hope of that here in N. Ireland. Have been taking zinc so will follow your advice about timing. Many thanks for getting back. Much appreciated.

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