t3 & t4 combination therapy - i am so damn tired!!

[Kpoll97]

okay so my endo switched me from levothyroxine 100 mcg per day to t3 10mcg and t4 50mcg on a 4 month trial after sooo much begging from me! i have dropped 3 pounds since then however i am so damn tired! i feel like the dose isnt strong enough... anyone have any idea? im reluctant to call her yet as not sure if its unrelated and too soon to feel tiredness. and also cause i dont want her to pull me off the trial!

[Marz]

Maybe you didn't need the Levo reducing so much. Did you seek advice here before reducing and introducing T3 ?

How are your Ferritin levels ? - also B12 - Folate - VitD ?

[Kpoll97 in reply to Marz]

I didn't seek any advice which is unlike me, however my current endo is the first doctor to have taken me seriously and try to help, so I guess i have kind of been taking her word as gospel lol...

I would need to dig out the paper work for my levels, I haven't had them checked in a few months because trying to get blood tests further than TSH from my GP is like trying to get blood from a stone... My Iron levels were low once upon a time but this was treated with supplements and I was in range on all vitamins after this

[jimh111]

Your endocrinologist has reduced your levothyroxine too much. This is a common mistake as endocrinologists are not very bright. T3 is about 4x to 5x as potent as T4 when assessed IN THE BLOOD. Doctors often assume that this also applies to T3 and T4 in tablet form. However, liothyronine and levothyroxine have different absorption rates and different elimination half lives. So the proportions you put in your gob are not the proportions that end up in the blood. In tablet form liothyronine is about 3x as potent as levothyroxine. See ncbi.nlm.nih.gov/pmc/articl... . So, your endocrinologist should have reduced your levothyroxine to 70 mcg when subsituting 10 mcg liothyronine. The nearest tablet size is 75 mcg. Maybe speak to your endocrinologist and if they are uncertain refer them to the Celi study.

[DippyDame in reply to jimh111]

...and there is no way of testing how much T3 has reached the cells, particularly if they have been depleted for (possibly) decades and the T3 receptors have consequently done a Rip Van Winkle and need added T3 to waken them up again, use that T3 and begin recovery.

"How do you feel?" is the key question!

Truth or fiction....I'm sure somebody will tell me!

[Kpoll97 in reply to DippyDame]

It's just a shame that when you tell them how you feel, they look at your blood tests and say, not possible! your thyroid function is optimal! lol

[DippyDame in reply to Kpoll97]

On becoming doctors "they" made a promise "to do everything possible to help their patients and to have high moral standards in their work".

I would suggest that responding to patients, who are (clearly) unwell, by saying that they are fine because a set of numbers says so, is hardly fulfilling that promise.

That doesn't strike me as "a shame", as you suggest...instead it smacks of negligence!

You no doubt know that the original Hippocratic Oath, written 2,400 years ago, states that doctors must not harm patients!

So, we ask ourselves, why are there about 80,000 people on this forum from all over the world, who have come here looking for the help they hoped to - but didn't - receive from the medical profession. The answer is clear....this forum wouldn't exist if patients were being correctly medicated by well informed doctors.

Start to self educate, read widely about the thyroid and it's function (search old posts on here) and ask advice of the well informed folks here who know more than most medics.

Post any test results you have (or ask for them) and reliable advice will be offered. Patients are legally entitled to have these results.

If you continue to feel unwell and think your thyroid medication is the problem don't let anyone brush your concerns aside on the basis of the position of a few numbers in a lab range. Take control!

With time, patience and a lot of determination, along with the help on offer here you can feel better.

I'm not sure this rant will offer much solace but I hope it offers some encouragement.

[jgelliss in reply to jimh111]

jimh111

KODOS !!!! You Get It !!!!

[Supul in reply to jimh111]

That made me laugh! ''...common mistake.....as endo... not very bright!"

Thank you, for that, its not many days I get to laugh, whilst on a reduced dose of levothyroxine so endo can get a baseline.! Lol.

[Kpoll97 in reply to jimh111]

I thought this. I am reluctant to contact her yet if I'm honest, but I know something is definitely NOT right with my body & mind. I am going to start taking 75mcg as of tomorrow and see how I get on.. I'm desperate for T3 to help haha

[greygoose]

I agree, your endo reduced your levo by too much. But, I'm not convinced she did it because she's not very bright - although I don't suppose she is very bright! I suspect that endos do that sort of thing to set you up to fail. To prove that you didn't need T3 in the first place. When you go back saying you don't feel any better - or even feel worse - they can say, well, there you are then, T3 doesn't help.

A four month trial with no blood tests and no increases is pretty unnatural, anyway. Normally, people going onto T3+T4 would increase their T3 by 5 mcg every two weeks until they feel better. No, I honestly believe that this so-called 'trial' has just set you up to fail. Surely an endo, who has spent blah-blah number of years in med school, can't really be that 'un-bright'!

[jimh111 in reply to greygoose]

I'm afraid they are dim, although I fully agree that some are devious and do not want L-T3 to succeed. There have been a dozen or more trials comparing combined L-T3 / L-T4 therapy with L-T4 only. The majority replaced L-T4 with L-T3 in a 1:4 or 1:5 ratio. Thus, I conclude endocrinologists are dim. These studies had a number of team members and went through peer review, nobody picked up on the fact they were undertreating the combined therapy groups. A hopeless state of affairs.

[greygoose in reply to jimh111]

Oh, I don't disagree with you! I know they're dim. lol I was just pointing out that I also suspect them of being devious. I would not trust one as far as I could throw one! Totally unprofessional and unprincipled!

[jimh111 in reply to greygoose]

Yes, I know. If T3 medication is seen to be important it means the simplistic view of hypothyroidism is wrong and they will have to get off their backsides and start thinking and working. There's a lot at stake.

Coming back to the original question (sorry for drifting) you can't replace 50 mcg L-T4 with 10 mcg L-T3, it's not enough.

[greygoose in reply to jimh111]

Agreed.

[Kpoll97 in reply to greygoose]

I really hope that isn't true (setting up for failure) although I would definitely not be surprised if that was the case after the experiences of doctors I have had so far on my journey. She was pretty positive about it being successful with some of her other patients so hopefully it's more about dimness than reluctance to treat with T3 lol...

[greygoose in reply to Kpoll97]

We-ell... I really can't see that it is going to have any positive effects for you, done like that. As I said before, one normally increases T3 every two weeks until we find the right dose. So, you're going to have to play her at her own (supposed) game. Tell her you really felt a difference! What wonderful stuff T3 is! BUT, you really feel like you need an increase in dose, and things would be even better.

[Sunny101 in reply to greygoose]

Love your devious mind GG haha always one step ahead of them lol

[greygoose in reply to Sunny101]

I do my best.

[Marz]

Just wondered how you are ?

[Kpoll97 in reply to Marz]

thank you! i’m actually doing quite well now in terms of thyroid - i’ve recently been diagnosed with epilepsy which is a whole new set of hurdles, but my thyroid seems to have settled to a very therapeutic level for me! i’ve even been losing weight consistently and my energy levels are finally close to a normal 21 year olds!!😊

[Marz in reply to Kpoll97]

How are your B12 levels ?

[Kpoll97 in reply to Marz]

i haven’t had my vitamins checked in such a long time i really don’t know!

[Marz in reply to Kpoll97]

I only asked as I have read that B12 is often very low with epilepsy. With thyroid issues B12 - Folate - Ferritin - VitD are usually low. So do have them tested when you can ...

[Kpoll97 in reply to Marz]

the last time i had them tested was around the same time as the original post and my ferritin was very low so i was put on iron supplements and it got back up to normal levels and that helped a lot, everything else came back pretty normal. i am due to have a check up soon for my epilepsy meds so i will ask then if i can be checked again, although it’s not easy with my GP, she always seems to be very reluctant to check anything to be honest!

[Marz in reply to Kpoll97]

Yes they are often difficult. In that case do your research and make sure you have your facts to hand. Your Ferritin should have been re-tested anyway - so ask for the others too. Can you have private tests through Thyroid UK ...

[Marz in reply to Kpoll97]

healthunlocked.com/thyroidu...

No mention of any B12 - Folate - Ferritin or VitD results B12 is not the same as Ferritin ...