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Thyroid results/T3 dose Increase

Thyroid results/T3 dose Increase

Hi

I saw my Endo yesterday who looked at the results attached from 11th May and also took new bloods to see where I am at. Currently I take 62.5mcg T4 and 5mcg T3, Endo has suggested yesterday for me to reduce T4 to 50mcg and up T3 to 10mcg daily.

Do you agree with the reduction in T4 and does this sound about right according to these results she has gone off? I am not sure the T4 should be reduced so much but I think she has done this due to me being so sensitive to the T3?

Any advice much appreciated and how I should start to up the T3 and reduce the T4 - if this is right to do so! 😊

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It seems logical from test results. But personally I think it’s difficult to adjust both at the same time. 5mcg T3 is about equivalent to 25mcg Levothyroxine so this is a dose increase, but also a shift from T4 to T3. I would reduce Levo first for a day then introduce Increased T3 the next day

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5 mcg is about 15 mcg T4, but it depends how well you convert.

It's perfectly ok to decrease T4 and increase T3 at the same time. It's increasing both together that shouldn't be done. :)

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Yes I agree there are different conversion ratios out there but 5mcg T3=20mcg T4 does seem to be about right for me (sorry, made a mistake up there!).

It may be ok to adjust both at the same time for you, but it makes me feel very poorly!.

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OK, but that's the way it's usually done. :)

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12.5 is a tiny reduction. Given the level of your FT4, I don't suppose it'll make much difference. I'd go for it, if I were you.

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Thanks for your advice 😊

so you think go for what the Endo suggested, 50mcg T4 in morning and 5mcg also in morning and then 5mcg again of T3 around 4pm?

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If you want a more 'normal' life, I'd take the combination together as we are on a 'lifetime' of thyroid hormones. It makes things easier once daily as our stomach has to be empty and food can interfere with the uptake. It is also easier to judge how 'we feel' on one dose as the aim is relief of symptoms and also easier to judge if dose is a bit 'too much' or too little.

You may be interested in this excerpt:-

In a mythical "normal" human, around one third of the T4 is converted to T3. So you could argue that T3 is "three times as strong as T4".

When taking tablets, for example, changing from T4 only to mixed T3 and T4, it is common to estimate on the basis of T4 being one quarter the "strength" of T3.

So, 100 mcg T4 (thyroxine) could be similar to 25 mcg of T3 (liothyronine) OR 50 mcg of T4 plus 12.5 mcg of T3.

This seems a reasonable basis for estimating doses but it is no better than an informed guess.

BUT if you are NOT converting properly this falls down. Imagine if you are taking 100 mcg of thyroxine and NONE of it is converting. So you have NO T3. You then take just 10 mcg of T3 and that has an effect which the T4 NEVER had. So there really is no way you can think of one being stronger than the other. One does something; the other does not

health.stackexchange.com/qu...

Don't be nervous of T3 as my life has been utterly transformed by it. People who are doing very well on T4 will not be on this forum.

Read the following link by one of our Advisers (deceased) who only took a blood test for the initial diagnosis and thereafter small dose increases and relief of symptoms were the most important.

web.archive.org/web/2010103...

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Thank you Shaws. I am very lucky to have found this forum and have the advice of people who actually know how these hormones work and the doses the way they should be.

You are right, since even taking the 5mcg I have felt different in a better way, it's a very long process to becoming human again but slowly with T3 I think I might get there. I will see how I go but might end up needing to up the T4 back to what it currently is if it ends up being that 50mcg is too low with the 10mcg T3. I am not looking forward to the minor side affects I get when I alter doses until my body adjusts to the new doses it often makes me feel sick for a week or two 😕

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I agree with shaws. It's still not a huge dose, and might give your more benefit if you take it all together. But, see how it goes.

But, yes, reducing the levo to 50 is fine. Then, hold for six weeks and retest. :)

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Thank you Shaws & Greygoose 😊 I will give this a go then and see what happens. Hopefully it works and I feel better as right now I feel 'stable' but still exhausted often.

But I will reduce T4 and up the T3 and retest like you say in six weeks or so 😄

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You're welcome. :)

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The Free T3 is the most important (but this seems to be unknown to GPs or - most of all - by Endocrinologists.

T3 (liothyronine is the only active thyroid hormone.

T4 (levothyroxine) is a synthetic thyroid hormone and it has to convert to T3. If we don't convert it adequately into T3, we will feel unwell and symptomatic. That's why many benefit with a combination.

If you read page 80 on the following link the top left-hand para you will see what the researchers found re dosage of T4/T3.

tpauk.com/images/docs/reduc...

Not enough emphasis is put on relieving the clinical symptoms (which they are ignorant of) but rely only upon the TSH which is from the pituitary gland in the first place. Also blood tests are only guides and cannot inform the doctor how we 'feel' on a dose we have to tell them but it makes no difference as they are fixated upon the TSH and are scared stiff in case they get into trouble. Never mind that the patient needs to improve their health.

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Thank you I will give this a go and see how it works out, I hate the minor side affect symptoms when you change doses I often feel not great for a few weeks until my body adjusts but I will have to just put up with it until it settles 😊

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I don't know anything about those - they're not feelings I had. So, I can't really help you. But, if it does settle in the end then that is the main thing. You can't continue on too low a dose forever. May be it will be different with T3?

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Sounds good, try it and see 😊 👍

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I was replying to mistygrey in message above. I would do as your endo says. T3 has a short half life that is why endo has suggested splitting the dose and taking twice daily.

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Otherwise you may get symptoms of overtreatment in the morning and of undertreatment in the afternoon.

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Are your vitamin levels optimal? How long since last checked?

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Hi, my iron was just taken on Friday awaiting the results along with B12 but I supplement daily with two iron ferrous funarate capsules and 1000mg b12 methyl.

My vitamin d is 90 so it's well above the average, haven't had any othe vitamins tested but I do take Vitamin b complex and Vitamin c along with the vitamins above and a daily vitamin D spray 😊

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I would be very happy indeed if doctor reduced T4 and increased T3. T4 (levothyroxine) is inactive and has to convert to T3. T3 (liothyronine is the only Active Thyroid Hormone which is required in our millions of T3 receptor cells and you can take both T4/T3 together - usually first thing with one full glass of water. Some prefer a bedtime dose. If taking a bedtime dose miss this if having a blood test next a.m. Take dose after test and night dose as usual (if you take a p.m. dose).

I think your Endo is good to prescribe both and is seems to be interested in relieving your clinical symptoms.

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Thank you Shaws. Your right, I am glad that you all agree with these doses, it might end up that I need to up the T4 back to what it is currently after I have upped the T3 but I will stick to this initial change of decreasing the T4 to 50mcg and upping the 5mcg T3.

Yes you are very right, I am so lucky to have found my Endo, she is such a kind soul too and seems to really listen and take time with me which is a real rarity in an Endo! 😊

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I did that! Some people say it’s hard to lower t4 while upping t3 or vice versa but I went through it a few times, even some changes where I increased both at the same time (when I went from 75:5mcg to 100:10) and I preferred it. I wasn’t a roller coaster for me, i was able to get to a better dose faster. (I’m 32 years old if that makes a difference, for some older folks it might be suggested to reduce one first then increase the other)

I say go for it and see how you feel. Likely you’ll feel a lot better. 5mcg t3 is low and based on your test results you could use a little more. I’m on 10mcg t3 and 88 t4. And I can tell you t3 does a lot more for you than t4, your endo seems to know what he/she is doing.

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Thank you, that's good to know! I am a similar age, I think I can just be very sensitive to drugs.

It might be that I end up needing to up the T4 to what it is now once I've upped the T3 but I can give this a go and see what happens 😊

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For what it’s worth I’m also “classified” as sensitive to the meds (according to my endo), the most minute changes in dose have a big impact on my results and how I feel. That’s why I have some experience with such dosage switches, since I get quite bad quickly on the wrong dose.

But yea if you feel worse off then it’s easy to add the T4 back after (as long as your endo agrees I suppose). Good luck with it all, personally I think the extra t3 will totally outweigh anything you’d “lose” from the lower T4, I’m not one to make assumptions, but I’d be optimistic that you’ll feel better :)

All the best!

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