Hello! Firstly just want to say thank you for reaching out to help!
I had a Total Thyroidectomy due to a large goitre back in 2014.
Since then I've been on the very exhausting mission of trying to get my thyroid levels sorted and within optimum range.
For years my GP was dosing me at 150 of T4 per day, on 150 I felt very hypo, she would only test my TSH and T4 (never free T3), she was completely useless to say the least, this went on for 3 years - Yes, 3 YEARS OF HELL!
I've now found a Endo who is well know for thinking out the box has worked me up to 175 of T4 per day, My results on 175 a day are as follows
[TSH 0.04 (0.55-4.78)]
[FT3 5.6 (4.0-7.0)]
[FT4 23 (10-25)]
I Spoke with my Endo the other day and he says i have two choices,
1 - up my T4 to 187.5 and that should up my FT3 to ~[6.3 (4.0-7.0)] the upper 33% range which is what I want
or
2 - Reduce my T4 dose to 125 and introduce 12.5 T3 split in two doses (6.25) throughout the day. im happy to try this option but dont want to be hypo again!
I'm worried that if i went for option 1 and up my T4 dose i would be touching the realms of over medicating T4? Does having a high pool of T4 have negative effects? I know it can potentially turn to more Rt3 but should i be worried?
Please note, ive never had my Rt3 checked so not sure if it high or within range.
Is it ok to have suppressed TSH of 0.02 with HIGH FT4 around 25 or 26 out of(10-25) if it means my FT3 is in a good range?
Also its probably worth to mention that I was also diagnosed with SIBO, which seems to be under control now with medication.
Thanks for the help!
J
What causes hyper symptoms - raised T3 or raised T4?
On T3 and T4 has dropped and TSH rose?
Low TSH, normal T4 and T3
Confused. Why is TSH low but T4/T3 also low?
Increasing your levo so that your FT4 is at the top of the range will increase conversion to more rT3 and less T3. So it could lower your FT3 rather than increase it.
rT3 is not a problem in itself, the rT3 is converted to T2 within a couple of hours, the T2 to T1, and the iodine recycled. It does this so that you don't have a high 'pool' of T4 and neither do you have high levels of FT3. That is its purpose. But, seems to me it would be more effective to reduce the levo and add in the T3.
Your TSH will be suppressed on T3, anyway. It doesn't matter. But, if you suppress it with too much levo, it will further affect your conversion. So, if I were you, I'd definitely go for the T3.
Greygoose , Thank you for the reply, you dont know how much this means to me, its been a long road, and i finally feel like im getting close.....
You probably know what i'm going to ask next? How much should I reduce my T4 by and how much T3 should I add? I've been following some other discussions and some say T3 should be 10% to 20% of the overall dose combined and that T3 is anywhere between 3 to 4 to 5 times stronger then T4.
hypothetically speaking, if my FT3 is at a good level (upper 30%) [FT3 6.3 (4.0-7.0)] with 187.5 of T4 am i correct to say that i should probably reduce my T4 to ~ 137.5 and add 12.5 of T3 split into two doses throughout the day (assuming its 4 times stronger) that would mean 12.5 * 4 = 50 +137.5 of T4 = 187.5?? this would only mean my T4 to T3 ratio is only 8% tho and not 10% or 20%.
My Endo think that T3 is 5 times stronger and wants to reduce my dose to 125 of T4 and add 12.5 T3 split twice throughout the day which would add up to 187.5 of T4 if i did the maths going by a 5 times strength and not 4.
Some people (dr Childs) even say that for every 50 of T4 reduced you should add 25 of T3, if this is true I'm going to be hypo If i follow my endos proscription, I work a very demanding job and i need to be on the ball so im just trying to take precautions not go hypo again.
Can you also please tell me how to dose the T3? is it every 8 hours? with or without food? what would happen if i miss a dose? i know the half life is 24 hours but ive heard that it could be much less then that?
Also can you please tell me how i go about running a blood test after taking T3 to make sure my levels are in the appropriate FT3 range? my endo told me to take the t3 pill in the morning an do my test in the afternoon or evening? would this show the real level of FT3? He mentioned you dont want to take it first thing and go for the blood test straight away cause that would show FT3 as too high, so when is the best time to do it?
Looking forward to hearing from you!
For a start, forget percentages and ratios and all the maths. They are not relevant to thyroid hormone replacement.
For convenience, we usually say that when you add T3 to T4, you reduce the T4 by 25 mcg and add 6.25 mcg or 5 mcg T3 - depending on the size of your pill. If you want to add in 12.5, you could still just reduce by 25 mcg, or you could go for 50 mcg. But, personally, I would go a reduction of 25 mcg and an addition of 6.25 mcg. Slower is usually better. You can add or subtract more later on, if needed.
If you're just adding 6.25 mcg, I wouldn't split it, if I were you. Take it either at the same time as your NDT, or at a different time, as long as you take it on an empty stomach, etc. just like levo - and, presumably, the way you take your NDT.
I would be very wary of Weston Child's, if I were you. He has some strange ideas. And, what if you do go a little bit hypo? You can increase your T3 by 6.25 mcg every two weeks until you get it where you want it to be. But, also be wary of fixing goals - except the goal of feeling well. The numbers are less important than how you feel.
I take 75 mcg T3, and I take it all in one go. That does me no harm, with the hormone resistance, and because of the hormone resistance, I need the receptors to be well and truly flooded. Splitting it in any way would be less effective for me. But, we're all different, so there are no rules about how often you should take it. You need to find out what's best for you.
Forget about the half-life, too. It's always 24 hours. But, that's in the blood. What gets into the cells stays there for about three days. So, if you take your T3 regularly, it doesn't matter about the half-life.
noted, ill try not to mathematically sort it out
haha.
can you please tell me how i go about running a blood test after taking T3 to make sure my levels are in the appropriate FT3 range? my endo told me to take the t3 pill in the morning an do my test in the afternoon or evening? would this show the real level of FT3? He mentioned you dont want to take it first thing and go for the blood test straight away cause that would show FT3 as too high, so when is the best time to do it?
Also how clued up are you on PTH? my PTH is pretty low at 1 (1.6-6.9)
due to this i'm also taking 0.25 of alphacidol + 500 calcichew which is helping in levelling /controlling my Calcium levels at about 2.36 (2.2-2.6)
. do i need more alphacidol? whats the optimum calcium level? Should i be taking vitd3 tablets on top of alphacidol?
With regards to T4 / T3 combo therapy, I'm going for it. Will let you know how i get on.
Thanks again for all your help!!!!!!!!!!
Well, he's sort of right. You do need to leave an 8 to 12 hour gap between your last dose of T3 and the blood draw. But, it depends on his attitude to TSH, because the TSH would be a lot lower in the afternoon/evening, than in the early morning. And, I'm not sure that taking your T3 in the morning and testing in the afternoon would leave a long enough gap. So, you need to work out what fits in for you.
I'm afraid I know nothing about PTH. I would suggest you post a new question asking just that. Because there are plenty of people on here that do know.
Great, ill start another discussion about PTH.
Greygoose, can I ask you what vitamins you take if any? ive been taking multi vitamins daily in order to support / help me convert T4 to T3, however, my multi vitamin has iodine in it aswell, am i right to say too much iodine can have negetive effect in the body? i dont have a thyroid anymore so dont need iodine? or do i? i know T4 has iodine in it , is it best to take a multi vitamin with no ioidine in it?
You're right about the iodine, you should not be taking extra. You will already be getting 113.75 mcg from your levo, plus what you get in your food. Excess iodine is not good, and, as you say, if you don't have a thyroid, you will be using less anyway.
But, that's not the only thing that's wrong with multi-vits. They can contain other things you don't need, like copper and calcium. These should be tested before taking any. Plus, if your multi contains iron, it will block the absorption of all the vitamins, so you won't be getting anything out of it. Waste of money!
What you should do, to support your conversion, is get your vit D, vit B12, folate and ferritin tested, and only take what you need, according to the results, plus co-factors.
Myself, I take iron - with lots of vit C - vit D and magnesium, vit D, vit B12 with a B complex and vit E. I also take NAC, which helps with my breathing problems, turmeric and honey, and CBD oil. Plus lots of ginger tea!
I found this very helpful. Thank you GG
You're welcome.
Would Armour Thyroid work for him it would be less pills to take through the day? Either way Joe sounds like he has a good Endo I'm jealous.
If, as I suspect, he has some degree of thyroid hormone resistance, Armour would contain too much T4 for too little T3. He needs a very high level of FT3, apparently. Taking T4+T3 gives you more flexibility.
He sure is a good endo! im very greatful for him to say the least!
You are a lucky guy... When I go to see my Endo I hear circus music.
I had to find somone! the endo i currently see is not even in the same town as me! things got so bad with me where i was super deppressed, my GP was utter useless and arrogant! she littreally unintentially tortured me for best of almost 4 years and didnt even know what FT3 was, she was always trying to tune the amount of T4 with my TSH!! on top of my thyroid issues I had really bad digestion and bloating which I was told was for years it was IBS, turned out to be h.pylori, after h.pylori meds I was in a living hell and a few months afterI was diagnosed with SIBO, again similar story with SIBO my gp wouldnt test me for it and didnt even know what it was! I got the test done privatly and came back positive! started taking antibiotics (rifixamin again sourced privatly) and felt great for the 10 days i was on it (no migraines, bloating, fatigue) , still fighting SIBO with SCD diet and probiotics and digestive enzymes! after a lot of reaserch i found out that a lot of patenits with thyroid issues (in particular hypo paitents) have developed SIBO and dont even know about it! SIBO can cause you to not convert T4-T3 well if you have it which is what i think is going on with me! Also there is some reaserch to suggest that SIBO and h.pylori are firstly caused by low stomech acid which is common for hypo patenits!
In short! being HYPO for so many years diffenitly had a knock on effect on my digestive system an subsiquestly everything else to do with my well being!
If someones reading this and has really bad digestive issues and your GP simply says it IBS and brishes it off and puts you on random anti acid medication and so on, PLEASE TEST YOURSELF FOR SIBO, just to give you an idea, 16 million people are diagnoised with IBS in the UK, of which, 80% dont actually have IBS and have SIBO! yes 80%! the reason SIBO is ignored is all down to money much the same story with T3 medication!
Come the revolution!
Where are you located?
I don't think revolution is too strong a word. When people are left undiagnosed/undermedicated due to the apparent poor training doctors appear to get for one of the commonest authoimmune diseases it annoys me intensley.
Those people who are hypothyroid and taking thyroid hormones that make them feel worse, lose their jobs, cannot think straight why are The Professionals completely unaware -WHY - that it is connected to insufficient thyroid hormones or ones that would/could improve their lives.
The fact is that is we are dealing with life-giving hormones - and we all need different doses etc - why cannot we be prescribe options that may suit us better, i.e. NDT, add T3 to T4 or T3 only if necesssary. Those who are in a 'profession' which is supposed to be compassionate to the suffering, and all steps taken to resolve symptoms that first NDT is removed from being prescribed, then T3 and we're left with no option but levothyroxine and I do know of one who took her own life, leaving a statement of why. Utterly sad and unnecessary but some cannot carry on.