Should I change my medication as per GP or do something entirely different...

[LJG84]

Hello,

Hoping to pick some of your brilliant brains for advice on medication change GP has suggested, should I follow the advice, remain on same medication or possibly increase T3?! I am currently on 150mcg T4 4 days a week and 125mcg T4 3 days a week and 10mcg T3 2 x daily (8am & 1pm). I know it’s very confusing and this dosing was set up by a UK Endo (FYI I only started T3 treatment in February 2018)

Based on bloods taken on 06.10.18 a GP I have seen in Australia whilst travelling suggests reducing dose to 125mcg T4 daily only 7 days a week (keeping T3 at 10mcg x2 daily). I think this was purely based on the suppressed TSH blood result and ignores the fact that the T4/T3 levels are not at a high or over medicated level. I do not feel overmedicated and never have. I still don’t feel optimal yet but I’m not sure if that’s due to diet/supplements which need improving (gluten free and some supplements gone out the window which travelling!). Please let me know what your thoughts are and I’ve included other bloods below for reference too:

RECENT BLOODS

06.10.18 (9.40am)

TSH 0.07 (0.40-3.80)

FT4 13.1 (10.0-22.0)

FT3 4.4 (2.5-6.5)

OLDER BLOODS

19.04.18 (approx. 9am) *medication taken 1hr prior by mistake so may have affected these results*

TSH 0.03 (0.55-4.78)

FT4 16.4 (10.0-18.7)

FT3 6.6 (3.5-6.5)

28.03.18 (approx. 12.30pm)

TSH 0.01 (0.32-4.2)

FT4 15.2 (12-22)

FT3 4.3 (2.7-5.7)

I can provide further historical bloods if required.

Also on a separate note NHS changed my vitamin D supplement almost 2yrs ago for one which I hadn’t realised wasn’t as powerful as the original and my Vit D was down to 89.7 (50-140) when tested in March this year. I switched to Better You Vit D spray which is much stronger and avoids gut absorption and my Vit D level is back up to 122 (50-150) when tested in October. Just wanted to add this as I didn’t have much faith in the spray but it has clearly worked and I will be looking into more of their sprays when I get back to the UK. Well worth using and would never have found it without the invaluable advice on here, thanks so much 😊

[LJG84]

Hi also meant to add I’m on Levothyroxine and Thybon Henning at the moment but will be switching to AUS substitutes Eltroxin (T4) and Tertroxin (T3) soon - does anyone have advice or history with switching to/from these brands?

Thanks so much

[SlowDragon Administrator]

My comment would be have you tried taking T3 in 3 split doses

10mcg at 8am, 5mcg at 3pm and 5mcg at 11pm

T3 can help you sleep

Or if T3 wakes you up, try 8am, 2pm and 8pm

It's a long time between 1pm and 8am .....

T3 every 8 hours can give smoother levels

Are you taking last dose T3 exactly 12 hours before blood test?

[LJG84 in reply to SlowDragon]

Thanks, I hadn’t thought about splitting it down further as I thought it was a fairly small dose anyway. I’ll give it a try and see how it works for a few days. I still have quite a bit of broken sleep so fingers crossed that may help. My last T3 dose before the blood test would have been the previous days 1pm dose so much more than 12 hours - do you think this might explain low blood levels?

[SlowDragon Administrator in reply to LJG84]

T3 is only in the blood stream for 12 hours

Suggest you try 8 hour dosing

Graph showing why to take T3 approx 12 hours before blood test

healthunlocked.com/api/redi...

Research Paper data comes from

ncbi.nlm.nih.gov/pmc/articl...

[LJG84 in reply to SlowDragon]

Great thanks for those links, that all makes much more sense now. I would have been 20hrs without T3 in that recent blood test! I’ll try splitting more throughout the day in 3 doses and see how it goes. I’ll probably try and get my blood work done again before increasing as clearly I’ve made a bit of a mess with dosing. Thanks for the info it’s a great help and explains my blood work well. It’s invaluable having advice like this as the Endos don’t seem to have or trust the info for some reason (sceptical of new research?).

[greygoose]

Are you taking your T3 the same way you take your levo - on an empty stomach, one hour before eating, etc.? If so, then you need an increase in T3, as you suggested. Your FT3 is not even mid-range.

As for the T4, do you think it really matters? The FT4 is going to be low when taking T3. Do you find that changing the dose has any effect on the way you feel? If not, leave it as it is, or change it to what makes you feel good. You certainly don't have to lower the dose because of the TSH. Forget the TSH.

[LJG84 in reply to greygoose]

Thanks for your reply. Yes I take T3 away from food and vit D etc (not sure if it has to be taken apart from a vit D spray but not taken the risk!). Your right T4 probably doesn’t matter now as I assume, unless sorting my gut works, that I will gradually switch to more T3 as conversion worsens with time? I’ve not felt changing T4 makes much difference unless it’s up to 200mcg daily where FT4 is well over the blood limit but T3 still not enough. Starting T3 was a noticeable difference in only 3 days as my gut began to move again (didn’t realise how bad it was until it started moving again!).

I may try changing how I take the dose as Slowdragon suggests before increasing but I think I may still need a T3 increase. I don’t like working without an Endo/GP but struggle with their advice as it’s so poor or the Endo I had took 6 months to come to the conclusion it was conversion failure. It was good that she checked everything but we could have made progress much quicker.

😊

[greygoose in reply to LJG84]

Yes, I don't think splitting your dose is going to solve all your problems, your FT3 is too low.

You won't have felt any improvement just by keeping increasing your levo, because it's low T3 that causes symptoms, not low T4. Good that you finally got the T3 you need, but unless you take enough of it, that won't help, either.

[LJG84]

Thanks, I think I’m probably under medicated like you say but think I’m going to try splitting my T3 out across the day a bit more first before increasing. When I took the T3 by mistake before my blood test in April the FT3 was just over the limit so hopefully by splitting the pills more throughout the day I can keep a consistent FT3 blood level and get a better picture. In the recent bloods taken in October I would not have had a T3 dose for 20hrs so that may be why it was so low...?

It’s one extreme to the other so if I try to level out my bloods by splitting the dose more throughout the day then I can look at increasing if bloods are still low or I don’t feel any improvement. 😊

[FancyPants54 in reply to LJG84]

I have used T3 only in the past (not currently on any T3) and found I needed at least 3 doses a day, but I needed the first 2 to be bigger. If I were you in your current situation with your current dose, I would both split and increase a tiny amount by taking 10/10/5 throughout the day. Make your last dose around 7pm. I slept like a baby on T3. I always had an evening dose.

Hope that helps.

[LJG84 in reply to FancyPants54]

Thanks for this, I think 10/10/5 will be a good plan but I’m going to stick with my original dose to settle into the new dosing regime and then adjust dosage afterwards so I know what’s having what effect (so tempting to change everything at once but I’ve done that in the past and you end up spending longer finding out what worked!). Yesterday was my first go and, although I woke up at 1am for a loo break (as usual), I slept the best I have in ages - hopefully a good sign!

[FancyPants54 in reply to LJG84]

For a time I worked with the Recovering with T3 book by Paul Robinson and I used his method of aiding cortisol production by taking 5mcg of T3 at around 4.30am. I can't quite remember the time exactly, I had to experiment a bit to find what suited me best. He calls this the circadian rhythm protocol. I would set the alarm for 4.30, wake, lean over to the bedside cupboard, empty my 5mcg tablet piece into my mouth, swig with the water that was ready and go back to sleep before my head was on the pillow. No light was needed. The sleep I got from the time I took the tablet to the time I woke up was the best sleep I've had in a couple of decades. We really do need a bit of T3 overnight I think. It makes sense, our TSH is highest at midnight, calling on our thyroid gland to produce more hormone for overnight repair and restoration.