Just over 2 weeks ago I started adding 1/4 tab of T3 (Tiromel) - along with my usual dose of 100mcg Levothyroxin - as reviewing previous blood test results it was apparent I have a conversion problem. Throughout the 2 weeks I felt tired but assumed it was because of a very busy period in my life. (Exhaustion, because of being hypo, has thankfully not been a symptom for me.) I upped the dose to 1/2 tablet this morning whilst reducing the Levothyroxin to 75mcg - and feel even more tired. (As the day has progressed, the tiredness has lessened.)
I can't find any reference to tiredness as a known side effect on medical websites. Have others had this problem, and Is this something that is expected to lessen over time?
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MCDW
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I was on 100mcg before I started. Only reduced to 75mcg when I upped from 1/4 tablet to 1/2 tablet this morning.
The reason for this was that my GP told me to reduce my Levo because TSH below range - yet T4 in upper part of range, and T3 in lower part of range (see previous post of mine).
My hope is to get my T3 into upper half of range, to lower my T4 slightly - and hopefully see the TSH come nearer to normal range so my GP gets off my back (and achieve euthyroid state).
Well, that's not going to happen! If your TSH was below range on just T4, it's going to be even lower on T3! That's the way it works, and your doctor should know that, and not be dosing by the TSH. Just lowering your T4 is not going to raise your TSH. You'd have to lower your T4 AND stop your T3.
Doctors just don't understand that the TSH has little to do with being euthyroid. And the TSH of someone who is euthyroid naturally, and someone who is euthyroid on thyroid hormone replacement cannot - and must not - be compared. The hypo's TSH is always going to be lower if the person wishes to be well.
Thanks Greygoose. The addition of T3 - my GP knows nothing about. I would have been happy to stay on 100mcg per day as main symptom had improved though not resolved entirely. Because TSH has now dropped below range she has said to reduce my Levo (because of risk of heart problems and osteoporosis). (She knows I'm reluctant to do that.)
Its apparent my conversion isn't optimal - even though I'm taking Vit D, Zinc and Selenium supplements. (FT3 33% into range with FT4 80% into range).
I was hoping that by adding in a small amount of T3 (and then slightly reducing Levo), I could raise my FT3 (and further reduce my symptoms), bring my FT4 slightly lower - and was hoping that would allow my TSH to rise marginally.
Seems my logic is not correct - so thank you for pointing that out.
In which case, is there a way to raise my TSH slightly whilst maintaining or improving my FT3. My doctor seems wedded to prescribing based on TSH alone.
No, there is not way. Your TSH is low because you don't need it anymore. Thyroid Stimulating Hormone, secreted by the pituitary when it senses there's not enough thyroid hormone in the blood. If there is enough hormone, it's not going to secrete TSH, is it? So, the only way to raise your TSH is to not have enough thyroid hormone, and remain sick for the rest of your life. What's the point of that?
Your GP is totally wrong about low TSH causing heart and bone problems. TSH has nothing to do with bones and hearts. It just does what it says on the packet. But, doctors have been wrongly taught in med school - and that's just about all they seem to retain! - and are not up to date on the latest research.
So many things can cause poor conversion. It's not just about nutrients. It's great if your nutrients are optimal, because they're needed for so many other things, but no guarantee that they will improve your conversion, I'm afraid.
I will be having an interesting conversation when I next visit my GP. Will request a return to Endo as I doubt she will agree me remaining on same dose of Levo (or increasing as symptoms not fully controlled).
So having parked my initial (illogical) views about attempting to increase TSH by juggling meds - if T3 additions wipe me out - and I can’t improve my conversion - what are my options - remembering FT4 is already high in range? (Are there associated problems if FT4 goes over range whilst FT3 ok.)
You don't have any proof that the T3 is wiping you out. It could be any number of things, and just a coincidence that it happened at the same time as you increased your T3. I've certainly never heard of anyone being wiped out T3. It's just not logical.
So, what are your other options? There are none. As you say, your FT4 is already high, and you are a poor converter. Increasing your levo any further and your conversion will get worse, because the T4 will convert more to rT3 than T3. And you'd end up taking a very large dose of levo, and your FT4 would be well over-range, until your FT3 from conversion got high enough to make you well. So, you either continue with the T3 and hope you get over it, or you struggle on without it. I don't see any other solution, personally.
What you could do, though, is try juggling with the times you take your doses. That might help.
Keep an eye on your pulse rate. You can get worn out if your heart is beating too fast. A bit like a car's engine running too fast, you will burn out the engine. If your heart is working faster than normal it will eventually exhaust you. T3 can speed up the heart rate and/or possibly raise your blood pressure (BP). Take your pulse (should be around 60) and go round to the chemist and get your BP measured. This might mean that you reduce your intake of T3. Another tack could be to work on all of the factors which will improved your conversion (of T4 to T3). There are a few things you must maximize for the latter, Feritin (sp), Folate, VitB12 and Selenium (Selenium is the catalyst for the conversion reaction).
When I was on T4 only (Levo) I found that my T3 was very low and I was tired until I started to increase my Levo. I finally got to a level, 135mcg that would generate a suitable level of T3 and then I felt well. For a long time my Endo wouldn't increase my Levo because my TSH was very low (<.05) and so I remained ill. Finally I ignored her and increased my dose anyway, got good results for my T3 and everything was back on track, I felt well.
Well, we are looking for an increase - or not. Know your USUAL heart rate (basal and when going about your usual daily routine). Then measure your new rate after increasing your dose of T3. If there is no difference then you have tolerated the increased dose and you are OK to proceed to a higher dose if necessary. If your heart rate has increased then drop back to your previous dose. Do not be too scared if your pulse has increased, take it easy and it will drop to your normal after about 7 hours - but then drop that increased dose. The name of the game is start low and go slow - referring to the increases in doses.
60 is good, 70 is OK. Don't forget we have a basal rate first thing in the morning before you do anything including getting up to go to the bathroom. And then there is your regular "middle of the day" rate and that fluctuates according to what you are doing - sitting on the sofa, dashing around the shops, sitting in a traffic jam etc. For me it's 60 basal and 70 walking around and I am no spring chicken.
I'm glad you asked! I take Selenium via 2 Brazil nuts per day. 2 nuts gives you at least 100% of the daily requirement. I believe, when possible, get your heavy metals from food, you are less likely to overdose. Metals can accumulate in the body if you are taking too much - particularly in the brain. If you are eating a food for a particular mineral and you are approaching overload then you will tend to not want to eat that food for a while. At least, that's how I seem to operate. Oh, and it doesn't seem to matter when you eat the nuts, I usually eat them with a cup of tea mid morning (which is about 4.5 hours after my Armour). You also get magnesium with Brazil nuts - another mineral you won't have to think about. While we are on this subject you can eat a handful of cashews per day for zinc.
The Brazil nut myth has been debunked long time ago. Unless grown on selenium rich soil (which you have no chance of knowing) it will do nothing. 200mg tablet is the way to go.
That opinion has been thrashed out ad nauseam. Please refer to dozens of previous discussions on this subject - especially if you are about to take pills for Selenium.
I added t3 without reducing Levo (150mcg) and was feeling very tired at first. I have been increasing slowly but noticed that when I added another tiny dose later in the day that made me even more tired. Taking the entire dose in the middle of the night works best for me. Maybe try taking your pills at different time than you do currently?
When you introduced T3 your TSH likely dropped. When TSH drops, conversion swings more toward rT3 than T3, and your own thyroid tissue produces less T4 and T3. Ironically, adding a small amount of T3 can reduce your overall fT3.
And it takes levo at least a few weeks for a dose decrease to approach target levels. Increasing T3 and reducing levo is the right direction to go. You will likely never get your TSH normalized while taking T3. If you do, you will probably feel terrible.
When I tried cytomel/T3 I became very lethargic and my pulse was over 100 so I had to stop it. I really want to get on dessicated thyroid so I don’t have to worry about the T4 conversion . I’m so fatigued and I suffer depression. I’ll have to pay a lot of money to see a naturopath MD. $60 per visit but it will be worth it. I’m sick to death of feeling tired and low all the time
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