Opinion needed: My turn to come back for advice after the new tests results

[Caesard]

Hello, I'm a post TT Graves (2013) 38 YO male, coming from T4 only to a T4/T3 combo 2 years ago.

Due to regularly crashing during the winter season, last year I have used a 10% increase of both T3 and T4 dosage for the winter, to come back to regular

So, in March, while on 150 T4/30 T3 my results were the ones on the left, while in July, after 2 months on a reduced 137.5 T4/ 27.5 T3 the results are on the right

TSH [mU/L] (0.27-4.2)0.01 / 0.009

FT4 [pmol/L] (12-22) 16.5 / 15.5

FT3 [pmol/L] (3.2-6.8) 5.48 / 4.35

In both cases, there were 24h between last dose of 100T4 / 20 T3 and morning drawn blood and since decreasing I've felt a bit lower on energy and mood.

I do supplement with D3 on a permanent basis, K2 in 2 months on and off courses, Mg+B6 and B12 and Selenium every 3 months, Vit C+ Zn every 2 months.

Now, I need to calibrate this with a 3rd party view of things; this community opinion has great value for me. While I am not particularly worried about the suppressed TSH, I wonder how the FT3 and FT4 levels would look under a regular day, without refraining the intermediary dose before blood and, of course, what actions should be taken.

My first preference would be to keep on the reduced summer dosage but to introduce a supplementary 6.25 mcg T3 in the middle of these two doses that I take.

Your thoughts?

[Judithdalston]

I understand what you believe re winter and summer dosing, I tend to feel more hypo in winter/cold, but from your blood tests I would think that your winter dosing gives the better FT3 results: the 5.48 being nicely above the halfway thru range(5). In only two months it's gone down to 4.35....at that rate of reduction by late summer it might go down to 3. something, then you'd spend all winter topping it up again. Of course if you were on the winter dose permanently would you gradually raise these results? I am relatively new to the T4/T3 combo, and am not comfortable with the idea of 'tampering' with T3 doses seasonally, but ok with it with slower acting T4. But interesting to see what others think.

[Caesard in reply to Judithdalston]

Actually continuous "winter dose" tends to get me on the hyper side, symptom wise.

Values related, I also think it's a bit on the low side; however, it is worth mentioned that I have managed to loose about 10% of my total weight during the last 18 months.

I also hate to mess with the dosage but I felt the need of doing so in these situations, the winter season and after intensive exercising.

[Caesard]

Other opinions? Please do not refrain, I have learned to manage my treatment but I really need your input in order to calibrate myself Thanks!

[HughH]

Your total daily amount of T3 and T4 is a supra-physiological dose - it is more than most people would need if they had no thyroid gland.

T4 is not an active hormone but needs to get converted to T3 to become active. This conversion is controlled by the body to avoid making too much T3. It is possible on your combination of T3 and T4 than much of your T4 does not get converted to T3.

It may be worth trying to increasing your T3 and decreasing your T4.

[Caesard in reply to HughH]

Thank you! I am considering the same approach. Will try a RT3 test previously, to check if that confirms a build-up from the T4.

Issue is that my combo pills do come configured in a 5:1 ratio; but I do have some T3 only laying around, more than enough to do a test run.