Adding T3 to T4 - how much: Been on T4 for a few... - Thyroid UK

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Adding T3 to T4 - how much

Sunny3
Sunny3

Been on T4 for a few years for Hashi's and it worked ok. But after this last year of struggling (feeling really, really bad but labs showed "withing range") I found found a doctor who found my Reverse T3 ratio was 12 (should be > 20).

So added 20mcg of T3 (Cytomel) to the 75mgc of T4 (Synthroid). And the Cytomel has helped - I am having more better days than horrible days, but not optimal. I think I may need more T3 - wondering if anyone has been through adding T3 - how much did you add? Did you reduce T4?

My basal body temp (morning w shake down thermometer) is still low (ranges anywhere from 36.c (97) to 36.5c (97.8) every morning.

All nutrients (Ferritin, D, B12, iron etc) are good and did the saliva test and cortisol is just a bit low. I went gluten free when I started T3 - 4 months ago. Any other tests I should consider like the Dio2 gene test?

Recent blood tests:

April 2018 (prior to starting 20mcg T3 daily)

TSH 1.59 (.5 - 4.5)

FT4 1.6 (.8 - 2.8)

FT3 2.8 (2.3 - 4.2)

Reverse T3 23 (9 - 24)

Reverse T3 Ratio: 12.2

August 2018 (4 months after starting T3)

TSH .014 (.5 - 4.5)

FT4 1.25 (.8 - 2.8)

FT3 3.7 (2.3 - 4.2)

Reverse T3 19 (9 - 24)

Reverse T3 Ratio: 19.5

37 Replies
oldestnewest

20 mcg was a massive dose to start on. People usually start on 5 mcg and increase by 5 mcg every two weeks. Whether they decrease their levo depends on the level of the FT4 when they start the T3.

Your rT3 was high in range, but still in-range. And your FT4 wasn't high enough to be the cause of it being high. So, there's something else going on, like a virus, or low ferritin or something.

The rT3 ratio is psuedo-scientific mumbo-jumbo. It doesn't mean anything, it doesn't show anything, it doesn't prove anything. It was low because your FT3 was low and rT3 top of the range. It certainly wasn't responsible for making you feel bad. And, the reason you felt better when you started taking T3 is because it raised your FT3 - it's low T3 that causes symptoms. Your rT3 then dropped because your FT4 dropped - it usually does when you start taking T3. And your rT3 ratio then rose because your FT3 had risen and your rT3 had dropped. It's just a numbers game. Doesn't mean anything.

And the reason you still have low temperatures is because your FT3 is still on the low side. You obviously need it higher.

But, your FT3 hasn't risen much considering the dose you're taking. How do you take your T3? Do you always take it on an empty stomach, leaving at least one hour before eating and drinking anything but water? Do you take any other supplements or medication at the same time?

Why did you go gluten-free? Do you feel any better for doing so?

Sunny3
Sunny3 in reply to greygoose

Greygoose - thanks for the response.

I take 75mcg Synthroid and 10mcg Cytomel at 7am an hour before I eat anything. I take another 10mcg around 1pm.

I take selenium and fish oil and get B12 shot at doc's office.

I went gluten free because I've always heard gluten is hard on thyroid. My TPO antibodies went from 129 to 17 in the last few months not sure if gluten free helped or not.

Just tired of having bad days. Working with new integrative doc and she is testing for everything from inflammation to heavy metals. Trying to figure out and fix why I have bad days on and off. I go back next week and expect her to tweak T4/T3 some perhaps. Thanks you.

greygoose
greygoose in reply to Sunny3

So, what about the 1 pm dose? Is that an hour before eating?

When do you take the selenium and fish oil?

Gluten isn't hard on the thyroid itself - what is hard on the thyroid is the Hashi's! It's not necessarily the gluten-free diet that has lowered the antibodies. Antibodies fluctuate so could go high again. However, a lot of Hashi's people are gluten-intolerant and feel better when they cut it out. That's why I asked if you felt better with no gluten. :)

Sunny3
Sunny3 in reply to greygoose

The 1pm dose is usually at lunch - I thought Cytomel was ok w food! Is that not the case?

Yes from my extensive testing I learned I am non celiac gluten intolerant and I do think gluten makes me feel worse.

I have created a chart of all my blood work since I started going downhill last fall. And, I keep a daily log of everything - temp, if it was a good, fair or bad day, etc. It's interesting that I have had two 30-day stretches this last year when I felt great. Here's when:

May of 2017 went from Synthroid 75mcg to Armour 60mc

6 months later by Nov 2017 I was having on and off severe hypo

March of 2018 went back to Synthroid 75mcg

30 GREAT DAYS IN A ROW and then fatigue, bad days on and off

May of 2018 added Cytomel 20mcg to Synthroid 75mcg

33 GREAT DAYS IN A ROW then on and off fatigue/bad days again.

So, changing meds have been successful at making me feel really good for a while. Do you think I could just need a little more T4 and/or T3? Going to talk over with doc next week.

I do think there are things that set of a stretch of a few bad days and they are:

1. A hard workout (last workout last month and I was horrible for 3 days didn't want to go to work - but I did).

2. Gluten - I recently had a cheat day and didn't feel well for about 3 days.

3. Run down - if I don't get enough sleep and run myself down I will feel unwell as well.

Thanks again for your input.

greygoose
greygoose in reply to Sunny3

I thought Cytomel was ok w food! Is that not the case?

One hears that all the time, but look at your results. The FT3 should be higher on your dose. You have the FT3 of someone on 10 mcg. It happens so often on here that people say 'oh, you can take T3 with food', but their blood test results don't bear that out. Try taking it an hour before lunch - or two hours after - and see if there's any improvement.

March of 2018 went back to Synthroid 75mcg

30 GREAT DAYS IN A ROW and then fatigue, bad days on and off

May of 2018 added Cytomel 20mcg to Synthroid 75mcg

33 GREAT DAYS IN A ROW then on and off fatigue/bad days again.

This happens frequently. And it usually just means you need an increase in dose. But, in the case of My 2018, it probably just means you need to start taking your afternoon T3 without food. That would act like an increase in dose.

1. A hard workout (last workout last month and I was horrible for 3 days didn't want to go to work - but I did).

That is saying that you're not yet optimal and ready for a had workout. And by trying to do it you are making yourself worse. Ease up a bit. :)

Hidden
Hidden in reply to greygoose

Will start today to take T3 2 hours after lunch.

So FT3 at 3.8 is lower than might be expected on 20mcg of T3?? I was wondering if I was getting too much T3 since I had such a good month after switching back to T4 only.

Thank you so much for your comments and explanations.

greygoose
greygoose in reply to Hidden

I would think it is, yes. But, see how it goes when you've been taking your second dose without food for six weeks. :)

Hidden
Hidden in reply to greygoose

I will do that. Thank you thank you.

greygoose
greygoose in reply to Hidden

You're welcome. :)

Sg14
Sg14 in reply to Sunny3

Hi Sunny3,

I know this is unrelated to your post but I was wondering whether you could send me the name of the doctor via private message as well as your assessment of her. I would really appreciate this. Thank you!

Hidden
Hidden in reply to Sg14

Hi Sg14 I would be glad to send info! but I don't know how to private message from this site! Can you tell me?

Tile
Tile in reply to greygoose

Greygoose Disagree with you that RT3 is worthless!!!!! Please it can be the only test the shows cellular levels. YOU CANT REVERSE AGING and MANY OTHER THINGS THAT CAUSES HIGH RT3. It tells more than FT3s and FT4s. Please for those who cant get younger or suffer migraines, diabetes, etc the RT3 can be the only test besides SHBG (if you are nonmenopausal) that can give a truer picture of your thyroid state when tests say you are fine. PLEASE STOP DOWNPLAYING THIS CRUCIAL TEST.

greygoose
greygoose in reply to Tile

First time I've ever heard that aging raises rT3. And, if it does, that makes the test even more worthless.

As far as I know, it doesn't show cellular levels. How would it do that? I'd be extremely grateful if you could explain that - in your own words, of course. I don't have time to google. :)

Tile
Tile in reply to greygoose

You didnt argue with the person who said her RT3 was low. So don't say this test is mumbo jumbo. Yes aging and othet ailments prevent FT3 going to cells isnt that why people want T3 added or NDT. SHBG and RT3 are the only more revealing tests as of now. Until we can test tissues/cells for hormone levels that is as good as it gets.besides genetic testing.

greygoose
greygoose in reply to Tile

I didn't say the rT3 test was mumbo-jumbo, I said the rT3 ratio was mumbo-jumbo, and I still say that.

Well, we only have your word for it that aging increases rT3 levels. We do know that viruses and things can increase it. But, that's got nothing to do with T3 going into cells. High rT3 doesn't stop T3 going into cells. Therefore the test doesn't show whether it's going into cells or not.

Tile
Tile in reply to greygoose

The FREE T3 / REVERSE T3 Ratio presently is the most ACCURATE test for CELLULAR LEVELS. In medicated hypothyroidism when serum T4 and T3 are not being transported into cells they build up in serum so testing serum can show false levels Aging, chronic debilitaing diseases, obesity, unrelenting stress, malfunctioning transporters, etc. lower mitrochondria function (less energy) and the fact that T4 requires a LOT of ENERGY. to get transported into cells even more so than T3. So T3 meds added would help in these people.

greygoose
greygoose in reply to Tile

Will you please stop shouting at me. All those capital letters are not necessary, I'm capable of understanding what you're saying without them.

No-one is denying the benefits of taking T3. I take quite a lot of it myself. But, you still haven't explain exactly how the rT3 test tells you how much T3 is getting into the cells. If you're thinking that rT3 blocks T3 receptors, which used to be universally thought, then you are a bit behind the times. We now know that rT3 doesn't block T3 receptors because it has its own receptors. That's not to say that hormone resistance at a cellular level doesn't exist, of course it does. But it's not the rT3 causing it.

Tile
Tile in reply to greygoose

Sorry the reverseT3 ratio is not mumbo jumbo. Just bc you can't understand it doesn't make it mumbo jumbo.

greygoose
greygoose in reply to Tile

I'm not the only one that thinks that. But, if you understand it, why don't you explain it to me?

Missydoo82
Missydoo82 in reply to Tile

if you can't explain it to others then you dont understand it either 😉

Tile
Tile in reply to greygoose

Emphasizing is not shouting.

greygoose
greygoose in reply to Tile

The emphasising is still totally unnecessary, and all those capital letters hurt the eyes. I would rather you didn't do it, please.

Tile
Tile in reply to greygoose

Sorry didnt know caps can actually hurt one's eyes...that's a new one...are there research studies on it? What studies can we believe. What explanations can we believe. Why do two people witb the same FT3 FT4 (sorry for caps) not feel the same? I know someone who isn't hypo but their FT3s and FT4s are. just like mine but do we feel the same energy wise etc NO (sorry for caps). Maybe some of the advice given here.can really harm someone unintenionally just because it makes us feel better doesnt mean it does no harm. Some people for genetic reasons shouldn't take methylB12 so we have to be careful here too. Read one study on RT3 and then a different study on it and both will come to completely opposite(very hard not to cap "opposite"...but did it for you). T3 is instant gratification unlike T4 meds but we don't know our tipping point. Some might accept the jitteriness of T3 more than that from T4. Some NDTs have been recalled bc they actually added synthetic T4 to it. There's no guarantee on any thyroid meds we take of the amount on the label is actually what is contained in the pill we take.

.Maybe taking enough of T3 to get rid of symptoms allover may be too much for our brains to handle. Maybe a lower FT3 means more FT3 is being absorbed. Maybe the FT3 RT3 ratio is mumbo jumbo and not easy to understand but at least we have some idea of what is going on. Medicine is not perfect science it changes from day to day.from one study to the next. A lot of research has been biased and tainted to get a certain result that may bring in financial compensation not claimed.

helvella
helvellaAdministrator in reply to Tile

There is no need to be facetious about not using excessive capitalisation. You have been requested not to excessively capitalise, more than once, please just do as requested.

Please identify any desiccated thyroid products that "have been recalled bc they actually added synthetic T4". Or at least add one reference to such a recall.

Please do not use 'Text Speak' when posting or replying (as in, "bc" just quoted).

greygoose
greygoose in reply to Tile

I agree with most of what you say, there. But, you still haven't explained how the rT3 ratio shows how much T3 is getting into the cells. Nor do I see how it possibly can. A ratio just shows how much of one thing there is compared to another thing. It doesn't tell you what either of those things is doing. That's what ratios are for. They are just a statistical device, that's all.

I think your made problem is taking food with your second dose so I wouldn't look at anything else until you get that sorted and then stable for 6 weeks. Try taking it later in the afternoon. 3-3.30. I take NDT and as I kept forgetting the second dose I started taking it all at once once I was used to the T3. It works for some so may be consider giving that a go.

Hidden
Hidden in reply to silverfox7

Silverfox thank you and I will start today taking the T3 a little later and no food for a couple hours! I am desperate to get this right it's been a year fighting this on and off extreme hypothyroid fatigue! Thank you for your input!

Forget about it. About what? About everything & ask yourself one question: How do I feel? Well, I guess you already said it, right? I started taking T3 with T4. 75 mcg, Synthroid and 5 mcg of Liothronine, for the first time on T3, two months ago, at the end of June. Didn't work for 30 days, I suffered the usual headaches, heart palpitations & brain fog in the mornings. I stopped, cold, taking T4. Why? Because, it's the only "doctor" pill I had taken for the past 26 years. And guess what? I quit and felt much better. I am not "down" on doctors: I'm down on their version of the "truth" and the reality of the truth. And the truth is this: It's MY body not the doctor(s), they are only using it for their "studies" & then saying, to quote, literally, a VA doctor I saw: "I have thousands of patients and they're all just fine taking T4, so why are you not fine? and taking it? (he then writes on a prescription: "patient is self-medicating himself.") O.K. fine & I'm still self-medicating myself against, my endo, this VA doctor, my GP, my wife, and, it seems to me, sometimes, the rest of the world. Well, be that as it may, I'm still on T3-only and am up to 25 mcg, twice a day. I always take it very late at night, anywhere from midnight-4 or 5 am (sometimes I fall asleep for 4 or 5 hours) and then, the next day 12-hours later, (I use it for my workout period, usually 2-3 hours before and after taking the pill) It's sometime hard because I'm really hungry but life has always been hard on me anyway. Funny, as we get older, we all seem to regress back to our childhood. Well, when, at 17, I volunteered for the Marine Corps, as I was a juvenile delinquent who got in "trouble" daily, I began boxing, previously having boxed in the various neighborhoods I had lived in up until that time, but began taking it seriously and turned pro when I was discharged 3 years later. One thing about boxing, and any ex-boxer will tell you this also: the managers, trainers and even other fighters always asked this one question of every fighter who was training for an "important" fight: "How do you feel?" Well, Sunny3, how do you feel? because, in the end, that's the only thing that counts. BTW, I feel great! I have no idea what my blood tests are or what they would "tell me how I should feel." Peace be with you.

rjb112
rjb112 in reply to GKeith

Very interesting post GKeith. Thanks.

GKeith
GKeith in reply to rjb112

No problem, thanks for your interest.

rjb112
rjb112 in reply to GKeith

I also get all my medical care at the VA. I was put on T4 only. My latest blood test showed TSH 1.66, free T4 right in the middle of the range, and free T3 at the bottom of the normal range. But of course, your question is the most important, "how do I feel." I have a problem with being tired a lot.....and not sleeping very well, which could be a big factor in the tiredness, but it's hard to know which is the bigger factor in my tiredness.

I asked my primary care physician at the VA to please prescribe me both T4 and liothyronine (or Cytomel)......so both T4 and T3......but she said she can't do that, and sent me to endocrinology. The endocrinology resident that I saw said no, I have to take T4 only, that T4 gets converted to T3....you know, the same "party line" that physicians repeat.

What would you do GKeith?

GKeith
GKeith in reply to rjb112

The first thing you gotta do is see a civilian doctor, The VA guys figure you gotta use them and that you won't go anywhere else because the VA pays for (almost, depending on your discharge) all your expenses. Get an endo who will, at the very minimum, prescribe T3. Do you have a CBC (complete blood count) from the VA? It's usually one of the first things they do. The VA moves very slowly and they don't respond to much, if anything, esp. from enlisted men, now inactive, so you won't get much from them. Your free T3 shows how much T3 is in your bloodstream and your free T4 shows how much is converting, so explain that to doctors, then ask them why your FT3 is so low and the FT4 is where it is. BTW, how do you feel? You really need a complete blood count and check your cortisol, ferriten, B12, Vit D & iron and calcium are all equally important. And peace be upon you, brother.

rjb112
rjb112 in reply to GKeith

"BTW, how do you feel?"

I feel OK if I've slept a lot, and tired if I haven't slept a lot.

And getting a lot of sleep is very difficult for me, as I'm not a good sleeper.

"You really need a complete blood count and check your cortisol, ferriten, B12, Vit D & iron and calcium are all equally important."

I've had all those tests except cortisol. I've never had a cortisol test in my life.

My CBC, ferritin, B12, Vit D and iron/ferritin/hemoglobin are all normal.

The only reason my Vit D is normal is because I supplement 5,000 IU daily; and I supplement B12 3,000 mcg weekly, and my homocysteine and methylmalonic acid tests and serum B12 were all normal, as well as folate.

rjb112
rjb112 in reply to GKeith

My TSH, free T4 and free T3:

TSH: 1.66 uIntUnt/mL (Reference range: 0.55-4.78)

FREE T-4: 1.1 ng/dl (Reference range: .67-1.52)

FREE

TRIIODOTHYRONINE: 2.4 pg/mL (Reference range: 2.3-4.2)

GKeith
GKeith in reply to rjb112

Looks about right, maybe low T3? Cortisol levels are critical because your adrenaline glands could be your problem with getting little or not enough sleep. If you have too much anxiety or worry, it will effect your ability to think; much less get enough sleep. Peace be with you.

Lost my comment so here it goes again your FT3 is USA measurements and ranges 3.7 in USA is NOT LOW (sorry goose).

Sorry my phone screen is blocked by my keyboard for some reason and can barely see what I'm typing (sabotage) and I replied to myself in error. Your FT3 of 3.7 isnt LOW at all it's USA measurements and ranges not UK. 3.7 ng/dL?

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