Which lowers Tsh more 25mcg t4 or 6.25mcg t3

[Clara9]

Anybody who knows?

[greygoose]

Depends how well you convert the T4, I would imagine. But T3 would do it quicker.

[Aurealis]

I don’t think anyone will really know the answer to this. But it would be an interesting piece of research for someone. Depends on so many things, absorbtion, conversion of T4, the response of your hypothalamic pituitary axis, and timing of test. Could be different for different people too.

[helvella Administrator Thyroid UK in reply to Aurealis]

It could depend on where you start from! For example, starting at a TSH of 100 and FT4 at 10 (12-22) the result could be very different to TSH 1.0 and FT4 21 (12-22).

[helvella Administrator Thyroid UK]

Just wondering, why you are asking that specific question?

[Clara9]

Because I'm trying to figure out what to do

My latest results on 112,5 mcg t4 and 12,5 mcg t3 is

Tsh 0.008 (0.27_4.2)

Free T3 5.9 (3.1-6.8)

Free T4 20.3 (12-22)

Total t4 88.8 (59-154)

Been in this dose for 6 weeks. I'm still tired in the afternoon and have palps. Would it make sense to decrease t4 by 25 and add 6.25 T3? Or just reduce t4 by 12,5 or leave as it is? What would you advise?

[Aurealis in reply to Clara9]

What are your previous TSH results? Are they usually below the reference range? Is TSH at all helpful to you?

As you have palpitations I think I would be tempted to reduce T4 first then add T3 after a week or so if you feel you need to.

On the other hand, I feel tired if T3 is too high, or if dose isn’t split in the right way for me. So as a first step you could just try rearranging current dose and see what happens. It may give you some clues.

[Clara9 in reply to Aurealis]

The highest after feeling better at all is tsh 0.14 but that was on levo only and didn't feel we at all but at least better than before meds.

[Aurealis]

So you’ll need to go on how you feel / T3and T4 test to find your sweet spot where you feel well. On T3 and T4 I feel best with T4 low in the range and T3 high in the range. I think some prefer both high in 5he range. Perhaps reducing T4 might work? Palpitations are a really unhelpful nonspecific symptom, though a nuisance. Wish you well whatever you decide to do. x

[Clara9 in reply to Aurealis]

Thank you for your advice, I really appreciate it.

If I reduce levo by 12.5 would that lower the free t3 to much do you think?

[silverfox7]

When taking any form of T3 then your TSH should be suppressed, FT4 can fall in the range but FT3 should be high in its range so I would look at the FT4 and FT3 results only and aim to get your FT3 higher. Having said that I'm on NDT so a known dose and I wouldn't have a clue how to advise if juggling yourself.