Levothyroxine / Liothyronine combination advice

[ali7967]

I have just had my thyroid function results back today and my GP is concerned because my TSH is outside of the reference range, although my FT4 has not really changed since starting on Levothyroxine in March. My private endocrinologist thinks it is fine, and has asked if I wanted a trial of combining Levothyroxine with Liothyronine. I wonder if anyone has any experience of this, and was it helpful?

Thyroid Function Tests

17/3/16 TSH 4.01 FT4 13.3 - before medication

8/7/16 TSH 0.90 FT4 13.6 - on 50mcg Levo

4/10/16 TSH 0.86 FT4 14.1 - on 75 mcg Levo

20/1/17 TSH 0.09 FT4 14.4 - on 100mcg Levo

The Reference ranges are TSH (0.27-4.2) FT4 (10-21)

If anything I was thinking I might need another increase in Levothyroxine as I still have many original symptoms.

Thank you

[helvella]

Half the time we see GPs claiming or admitting they are generalists who need to defer to others (e.g. toe the line of guidelines). The other half they seem to have some amazing qualification that allows them to ignore, overturn, disregard, or in any way they see fit, know better than specialists.

Has your GP done anything more than a Pulse magazine Continuing Professional Development quickie? If that much.

[ali7967 in reply to helvella]

Thanks for your reply. Do you think I need the combination of T3/T4?

[helvella in reply to ali7967]

To be honest, I don't know. I'd rather have liked to see an FT3 test or four in there! Quite possibly.

Also, how are you doing regarding B12?

Are you leaving a long gap between taking levothyroxine and your blood draws?

[ali7967 in reply to helvella]

I know, I don't know why I haven't had the FT3 tested? I always follow the advice on here about fasting before a blood draw and get an early appointment. I then take the Levo afterwards.

My B12 could be higher, it's around 550, it was only 300.

[helvella in reply to ali7967]

Pretty much what everyone finds - it isn't done even if a GP requests it. But it would have been a good additional test.

[Davidc555 in reply to ali7967]

Hi Ali

I was on T4 for 4 years and it did nothing for me I moved over to Armour which brought about improvements. My Endo then asked if I wished to try T3. Boy that made a big difference. I would try the combination of T4 and T3 as you say you still have youby r original symthoms and it might be that you are not getting proper conversion as you must go by how you feel and not rely on blood tests.

[Jazzw]

Endo is right, GP is wrong. A suppressed TSH is not something to worry about if the FT4 level is in range. Your FT4 level has some way to go before the top of the range. You may benefit from an increase in levo. Or, as your Endo has suggested, the addition of T3.

Don't let your GP overrule the Endo!

[shaws]

The blood tests were invented for the use of levothyroxine (T4) alone. Therefore if we add T3 or use natural dessicated thyroid hormones the TSH is useless as an indicator. It is how the patient feels which is the best judge.

thyroiduk.org.uk/tuk/about_...

thyroid-info.com/articles/d...

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/resear...

[whispers60]

Some people benefit with the combined mix of t4 and adding in t3 but without knowing where your ft3 in oarticular ( and all the other things mentioned above) I wonder what the endo is basing his question on?

I wouldnask if he/she could order a ft3 and full vit iron etc draw, they occassionally have more clout than the gp's with requesting the tests. Or pay for your own doing if thats affordable. Then you can make an informed decision as to whether you need t3 adding

[ElRR]

How are you feeling on just the T4 medication?