T3 Exhaustion?

[KIRM]

My 16 year old daughter has just introduced T3 with her T4 meds. Two weeks ago she reduced her T4 from 100mcg to 75 and added 5mcg of T3. She did this for 2 weeks then 3 days ago we upped to 10mcg of T3, suggested dose by Endo. She takes all her tablets at once first thing in the morning. Since taking this 75/10 combo by the afternoon she is exhausted and has to sleep.

Is she wrong to take all the T3/T4 at the same time? Should she take it all in the evening instead? Or is this normal until her system adapts?

Thank you for any advice

[SeasideSusie Remembering]

KIRM Do you have the test results that triggered the reduction in Levo and addition of T3?

It could very well be that the dose of Levo didn't need reducing, just the addition of T3 at this stage.

I've been taking a combination of Levo and T3 (self medicating the T3) and have been tweaking doses. Even when I was up to a good amount of T3, when I reduced my Levo from 100 to 75 mcg it totally floored me, I felt dreadful and experienced awful fatigue that I didn't have on 100mcg Levo.

She could try taking the T3 in two doses, that may help with the afternoon exhaustion.

[KIRM in reply to SeasideSusie]

TSH 0.12

(0.4-4.0)

T3 4.3

(3.3 - 6.1)

T4 12.3

(9.8 -18.8)

TPO AB 41 <35

Antithyroglobulin 361 <116

Vit D 118 (50-200)

Folate 17.5

(3.1 - 17.5)

Ferritin 35

(13 -150)

B12 482

(200 - 940)

Her T3 has remained around the 4 mark since she was diagnosed in 2014.

Thank you for your advice it is much appreciated. Will try splitting her dose

[SeasideSusie Remembering in reply to KIRM]

KIRM, I'm surprised that the endo introduced T3. Those results warranted an increase in Levo. Her conversion is really good at 2.86 : 1 (good conversion takes place when FT4: FT3 ratio is 4:1 or less). The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their respective reference ranges, when on Levo only, so it would have made more sense to increase Levo to raise her free Ts.

**

TPO AB 41 <35

Antithyroglobulin 361 <116

Have you been told that your daughter has autoimmune thyroid disease aka Hashimoto's, which is where antibodies attack the thyroid and gradually destroy it?

Adopting a strict gluten free diet can help reduce the antibodies, as can supplementing with selenium L-selenomethionine 200mcg daily and keeping TSH suppressed. Gluten contains gliadin which is a protein thought to trigger antibody attacks.

chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

**

Vit D 118 (50-200) - excellent!

Folate 17.5 (3.1 - 17.5)

B12 482 (200 - 940)

B12 could be considered a bit low. The recommended level for us Hypos is very top of it's range. Folate is fine at top of range if B12 is good. You might want to consider a sublingual methylcobalamin supplement, 1000mcg, to raise her level.

**

Ferritin 35 (13 -150)

This is poor. I don't think a 16 year old comes under 'child' for ferritin level, so as an adult it needs to be half way through it's range for thyroid hormone to work.

If she's willing to eat liver then that can raise ferritin, maximum 200g a week, either as a meal or hidden in casseroles, cottage pie, curry, bolognese, etc. Also, eat lots of iron rich foods

apjcn.nhri.org.tw/server/in...

And consider iron tablets but as each one needs to be taken four hours away from thyroid meds and two hours away from any other medication and supplements as it affects their absorption, it can be difficult to fit them in, which is why liver is better. If you do use iron tablets, each one should be taken with 1000mg Vit C to aid absorption and help prevent constipation.

"She took nothing today and was fit and active all day."

That makes me wonder whether she really does need the T3 and not just the right dose of Levo.

[KIRM in reply to SeasideSusie]

Wow! Thank you for your amazing reply. Think I will take her dose back to 100mcg and probably up it to 125mg and hold off the T3 for a while.

She is supplementing with B12 sublingual. Has been for 2 years and has been a slow climb to get it where it is now.

Started on Ferrous Fumerate about 4 months ago and take with Vit c away from thyroid meds. She is also on Selenium and magnesium.

She was told straight away she had Hashimotos. She has a goitre. Had an FNA all ok but a couple of nodules we are watching.

Thank you so much for taking time to reply in such depth. It has been immensely haelpful.

[SeasideSusie Remembering in reply to KIRM]

You could try increasing the amount of B12 she takes daily to boost her level. Give it a few weeks of 2000-3000mcg daily, say, then drop back to 1000mcg. You can't really overdose on B12 as any excess is excreted.

Forgot to say, when taking B12, we need to keep all the B vitamins in balance by taking a B Complex too.

Keep us informed of how she is doing

[KIRM in reply to SeasideSusie]

Thank you, I will

[jimh111]

Better to split the L-T3 dose, half at breakfast, half at bedtime. The nighttime dose seems to improve sleep quality.

[KIRM in reply to jimh111]

Thank you. She took nothing today and was fit and active all day. So will change her meds to either all at night or 75/5 in morning and the other 5mcg of T3 at bedtime.

Thanks again for helping me with my daughter. I read in an archived post that T3 actually helped one lady with her overactive bladder, so here's hoping!