Should I increase or decrease my dose? - Thyroid UK

Thyroid UK

111,209 members129,263 posts

Should I increase or decrease my dose?

Arios
Arios

Hi,

These are my latest Thyroid labs results, my question is: is mt TS H too low?

I take 50mcg of Tirosint and 10mcg Liothyronine (T3)

TSH. 0.12 ( 0.45 - 4.50)

T4 Free 0.9 (0.8 - 1.7)

T3Free 3.0 (2.0 -4.

T3 Reverse 12 (8-25)

My Endo told me to lower my Tirosint, my GP told me to keep my current doses and my Naturopath told me to raise the Tirosint dosage and lower the T3, I am so confused!!

Any suggestions? thank you!

12 Replies
oldestnewest
shaws
shawsAdministrator

The most important question Arios, is 'how do you feel'? on this dose.

If you feel quite well you don't need to adjust anything. I will give you a couple of links and you can make your decision. Of all three I think your doctor has given the best advice. This is an excerpt from the following link:-

Dear Thyroid Patients: If you have thyroid gland failure--primary hypothyroidism--your doctor is giving you a dose of levothyroxine that normalizes your thyroid stimulating hormone (TSH) level. Abundant research shows that this practice usually does not restore euthyroidism--sufficient T3 effect in all tissues of the body. It fails particularly badly in persons who have had their thyroid gland removed. IF you continue to suffer from the symptoms of hypothyroidism, you have the right to demand that your physician instead give you T4/T3 (inactive/active) thyroid replacement therapy. Your physician can either add sufficient T3 (10 to 20mcg) to your T4 dose, or lower your T4 dose while adding the T3. The most convenient form of T4/T3 therapy, with a 4:1ratio, is natural desiccated thyroid (NDT-- Armour, NP Thyroid, Nature-Throid). and you should insist that testing be done prior to your daily dose, as recommended by professional guidelines. It's simple common sense. TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy. The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy; your physician must treat you according to symptoms and the free T4/free T3 levels.

hormonerestoration.com/

hormonerestoration.com/Thyr...

Arios
Arios in reply to shaws

I feel okay, but my heart races sometimes. I can't seem to lose weight, though!

I was going to ask exact same question and start the same way as Shaw.

Research finds that the majority of people are well at a TSH of around 1. Mine was optimized at 0. something, like you. I found this by self medicating and using myself as a guinea pig, in a way. I feel optimized, I don't have palpitations and I've lost all the weight. But I don't like to assume things, so I don't know what you eat, how much, if you do any exercise and so many other factors that may help to lose weight. You would have to tell me a lot of info to find out why you don't lose weight. We don't even know your weight and height.

The only thing that I can tell you is to realize what your symptoms are and be adjusting meds throughout your life to minimize your symptoms. I think if those results were mine I would reduce 5mcg the t3 and see what happens.

Good luck

Thank you!

SeasideSusie
SeasideSusieAdministrator

Arios

Goodness me, how confusing, 3 different suggestions from your medical advisors!

As Shaws says, how do you feel?

I can't for the life of me understand why it's been suggested you lower your Tirosint, your FT4 is at the bottom of the range as it is, you may need to raise that. What is your endo's reason for this? I take a combination of Levo plus T3 and I can't function when my FT4 is low, I need mine nearer 75% through the range, but of course we are all different.

You haven't given the full range for FT3 but I imagine your level is quite near the bottom so that may need raising.

I have found that it takes a lot of experimenting and tweaking of doses of both Levo and T3 to find the right balance to suit, and depending on how you feel I think you're still at that stage.

Arios
Arios in reply to SeasideSusie

The reason behind my endo's reason to lower the Levo is because my TSH is low. She says that too much T3 can cause heart problems. My Naturopath suggested raising Levo because the T4 is in the lower range. I think I'll just listen to my GP and stay on my current dosage and see what happens.

Thanks for your advise!

shaws
shawsAdministrator in reply to Arios

If you read one of the above links links this expert on Hormones tells us not to take the TSH into account - that's where the biggest mistake is by doctors/endos who know nothing at all about keeping metabolism optimal. :-

An extract:

If you have persistent symptoms, you can demand that your physician change you to NDT and adjust the dose to keep the TSH at the bottom of its range-- when you have the blood drawn in the morning prior to your daily dose. This may be sufficient treatment, but IF you continue to have hypothyroid symptoms, and no hyperthyroid symptoms, demand that your physician to increase the dose to see if your symptoms will improve,

even if the TSH becomes low or suppressed. You can prove to your physician that you're not hyperthyroid by the facts that you have no symptoms of hyperthyroidism and your free T4 and free T3 levels are normal in the morning, prior to your daily dose.

They may even be below the middle of their ranges. Your free T3 will be high for several hours after your morning T4/T3 dose, but this is normal with this therapy and produces no problems. You should insist that testing be done prior to your daily dose, as recommended by professional guidelines. It's simple common sense. TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy. The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy; your physician must treat you according to symptoms and the free T4/free T3 levels.

hormonerestoration.com/

We have to be our own 'professionals' (with a small p :)

I'd increase t3 if still feeling unwell. Free t3 is only 50% through range If range is 2-4 as you typed), but should be around 75% when on T3.

Thank you!

The only figure that really matters when already taking T3 is the FT3 reading which should be high in the range. Once on T3 then FT4 can fall and TSH will be suppressed.

Do you feel warm? Do you sweat, randomly? How many consecutive hours can/do you sleep?

Arios
Arios in reply to roxanaleah

I don't feel warm or sweat randomly, but I don't sleep well, I have insomnia.

My cortisol levels were checked and it is high.

You may also like...