Advice on increase of T3

[Essexmum]

I was on 125mcg levothyroxin and after all the great advice I am now on 100mcg levothyroxin and 10mcg T3.

My thyroid results before i introduced T3 were:

Free T4 - 21 (range 12 - 22)

TSH - <0.05 (range 0.27 - 4.20)

T3 - 4.2 (range 3.1 - 6.8)

After 8 weeks on 100mcg levo & 10mcg T3 my blood results are:

Free T4 - 19.1 (range 12 - 22)

TSH - <0.05 range (0.27 - 4.20)

T3 - 5.6 (range 3.1 - 6.8)

I have b12 injections, taking vitamin d, b complex, magnesium citrate, zinc & selenium and vitamin k2 mk7.

I'm no longer having muscle spasms and my hair is not falling out. I take the levo & t3 in the morning around 6am and by early afternoon I start to feel unwell & by the end of the day I can't function as so tired and feel ill.

I was thinking of taking another dose of 10 mcg T3 in the afternoon but wondered if this would be too much. I don't feel it would be but wanted someone else's thoughts.

I am going to call nhs endo to request increase as trying to do this officially but if endo does not agree I will look at taking another dose anyway as I know how I feel.

I would be grateful on your thoughts as I wouldn't have come this far without the support.

Thank you

[SeasideSusie Remembering]

Essexmum

It's good to hear of your improvement

Your current results aren't bad, and there may be room for an increase in T3. But as you are slumping from afternoon onwards, have you tried splitting your T3 into 2 doses - morning and afternoon? That may help.

If you do increase, it should be just 5mcg, not 10. Increasing slowly means that you don't miss your sweet spot.

[Essexmum in reply to SeasideSusie]

Thank you SeasideSusie, I'll try splitting the dose first to see if that helps. Then consider taking 5mcg of t3 if I still feel unwell. There's a great help.

[marsaday]

I think before you do an increase you try 5 t3 am and then the other 5 around 2pm. Sometimes spacing t3 out gives better results.

Also try taking the t4 at bedtime and the t3 in the day as you are currently doing. T4 at bedtime can often make a big difference to people. It does for me.

The reason is to do with our own production cycle. We make most of out t4 when we sleep. We can end up sleeping better and make a better balance with cortisol as this is related to t4 production.

A raise of t3 is something to try but try experimenting with the different dose times.

[Essexmum in reply to marsaday]

Thank you Marsaday, that's really helpful, I think I'm always cautious about taking at different times as then I have to remember! I will definitely try this though as may make a real difference to how our feel. Always helps to know what others do & what works for them.

[jgelliss in reply to marsaday]

Great Advice . Tried and True .

[Greybeard]

Hi, when you had your last blood test. How many hours before the blood test did you take your t3?

[Essexmum in reply to Greybeard]

Hi Greybeard, I take the T3 & levo around 6am but didn't take these until after my blood test which was at 8.30. Therefore, T3 & levo would have been taken around 24 hrs before blood test.

[SeasideSusie Remembering in reply to Essexmum]

Essexmum

Therefore, T3 & levo would have been taken around 24 hrs before blood test.

In that case you have a false low FT3. Last dose of T3 should be 8-12 hours before blood draw (it's 24 hours for Levo only). If you had taken T3 at the appropriate time then your FT 3 would be higher, and it's likely you don't need an increase in dose.

[Joesmum in reply to SeasideSusie]

Hi SeasideSusie,

I totally understand what you’re saying about taking T3 too early for the blood draw leading to the FT3 result being falsely low and therefore possibly not needing an increase.

However...

Some people do need their FT3 levels much higher and if Essexmum said she felt tired and ill in the evening I would suspect she needs an increase. The clue for me is that she feels not just tired but ILL.

Those with pituitary/hypothalamus issues often need much higher FT3 levels to feel well. ( my endo has explained this to me.) I’m one of the lucky ones who has a brilliant NHS endo after years of being kept desperately poorly by appalling doctors.

I am hypopituitary and see him every 8 weeks.

I would suggest that Essexmum May have a ‘central’ issue as her TSH is so low on just Levothyroxine with an FT4 in range.

Personally, if I don’t keep my FT3 around 6.4. (12-22) I start to feel desperately poorly in the evenings. Shaky, nauseas, achy, cold, slurred slow speech, dizzy, low mood. Really poorly.

I take 125 mcgs T4 and 20mcgs T3 divided into two doses.

Hypopituitary patients just can’t convert properly at all but the T4 is necessary in the mix( I know others would disagree). My endo says I won’t be able to manage without the T3 in the mix. Having tried it......he’s right!

[Essexmum in reply to Joesmum]

Thank you, that's really interesting as I can't function in the evenings, I can't concentrate, I get muddled, repeat what im saying, feel sick, dizzy, low mood, and Im desperate to do what has to be done so i can get to bed. i get a sense of urgency to lay down before I fall down. I do what has to be done & I'm in bed so early but it's not just tiredness. My endo said where I had been over medicated by the gp for several years that may be the reason for requiring high levels. I'll look into this more.

[SeasideSusie Remembering in reply to Joesmum]

Joesmum

I would suggest that Essexmum May have a ‘central’ issue as her TSH is so low on just Levothyroxine with an FT4 in range.

My TSH has been suppressed or below range for the 20+ years I've been keeping a record of my results (diagnosed hypo 43 years ago). It doesn't mean that I have a "central" issue, it just means that my pituitary is detecting that there is enough T4 so doesn't need to send the signal TSH.

To know if Essexmum does have a central issue we'd need to see her results for TSH and FT4 before she was diagnosed and ever prescribed any thyroid meds. And these are in a previous post of hers:

January 2010:

TSH level: 4.76 (range 0.4 - 4mu/L)

Free T4 level: 14.8 (range 10 - 22pmol/L)

March 2010:

TSH level: 5.97 (range 0.4 - 4mu/L)

Free T4 level: 12.2 (range 10-22pmo/L)

Thyroid peroxidase antibody level: 91 (>75 positive)

Secondary/central hypothyroidism is diagnosed with a low (below range) FT4 and low, normal or minimally elevated TSH.

Those two sets of tests suggest hypthyroidism - Hashimoto's.

Some people do need their FT3 levels much higher and if Essexmum said she felt tired and ill in the evening I would suspect she needs an increase.

But she may just need to split her dose of T3, it suits some people better and is what is generally advised by endos. One step at a time. If she doesn't feel any better after splitting the dose for a while then it's time to think again.

[Joesmum in reply to SeasideSusie]

You appear to be medically trained?

[SeasideSusie Remembering in reply to Joesmum]

No, just an experienced patient. I've had to learn due to ignorant doctors who are happy to just look at numbers and ignore patients' symptoms.

[Joesmum in reply to SeasideSusie]

Ditto. I too am entitled to my opinion.

[marsaday in reply to Joesmum]

You are saying she has hypoPit hypothyroidism, but she doesn't based on those results.

Many people have low TSH with a good Ft4 level. This indicates the body is not processing the T4 that well and is often related to the unbalance between the thyroid hormone and the cortisol/DHEA balance.

[Joesmum in reply to marsaday]

No I’m absolutely not saying that she has hypopituitary hypothyroidism which would involve more than one deficient hormone and is an entirely different issue with its own set of complications and not one for this forum. I merely mentioned that I am hypopituitary. The ‘Central’ hypothyroidism aspect does have a very valid home here.

I suggested that Essexmum might have a pituitary/central issue.

Ie. Secondary or tertiary hypothyroidism.

[Essexmum]

Oh I see, thank you for letting me know & I'll try splitting the dose & try changing the time I take the levo to see if that helps.

Thank you so much.

[FancyPants54 in reply to Essexmum]

One change at a time. So either switch to bedtime Levo for a few weeks and keep the T3 to the morning. OR keep the Levo where it is and split the dose. Don't do them both at once. If you do you won't know what it was that made a difference (good or bad).

[Essexmum in reply to FancyPants54]

Thank you, that's really good advice. I'll only make one change at a time.

[marsaday in reply to FancyPants54]

Yes good advise. I always try make one change at a time. Sorry i should have mentioned doing only one thing first for a few weeks and see how it goes.