New here. Started taking t3 with t4 first blood test, advice

[muci]

Hi all, new here. I changed my medication from .88 synthroid to .75 plus 2.5 time released t3. Prior to that I was on 1.0 synthroid but my TSH went very low, ft4 very high and ft3 still in low end with high rvt3. I did bloodwork now at the 3 week mark. I know earlier than 6 weeks, but wondering if it's worth contacting doctor now to adjust anything at this time. Would the doctor prefer to wait the longer time? Next apt is end of March. He had changed to include t3 as my results of free T3 were always at the below to low end range despite free t4 being high end and TSH being low end. Symptoms of hypo persisted, tired, cold hands feet, brain fog, hair fall, etc.

Previous results were TSH 1.34 (.32-4.00), ft4 16 (9-19), ft3 2.5 (3.1-6.2)

Current TSH 2.21, ft4 15, ft3 3.7.

I do think these results are a good sign though, however, believe even if this stays consistent it could be better. Would your thoughts be to adding back in more t4 to lower tsh or adding ft3?

[greygoose]

2.5 mcg time-released T3? That's a very small dose, not likely to do much to make you feel well. And, with time-released T3 there's no guarantee that the absorption is regular. It could leave the gut too rapidly, before it's all absorbed, or stay in the gut so long that it binds to nutrients in the gut. It's not the best way of taking T3.

Your FT3 is still very low. And the aim of thyroid hormone replacement is not so much to lower the TSH - which does not cause symptoms - but to raise the FT3 - it's low T3 that causes hypo symptoms. So, I would think you really need to increase your dose of T3. The FT4 is fine where it is, at least for the time being. But, you do need to get that FT3 up - which, of course, will reduce the TSH.

[muci in reply to greygoose]

Thank you!! I guess I’m relieved that even with this small dose it’s raised FT3 by 1 unit. I did do the bloodwork 24 hours after taking the t3 dose would it be right to assume it is absorbing well then?

I think my dr starts very gradually. It’s only been three weeks. And from my understanding ft3 should raise quickly because of its short half life and I’m also guessing the FT4 (and then maybe ft3) could still lower because of the long half life of the reduced synthroid?

Would you guess my doctor would be willing to look at the blood numbers now and adjust?

[greygoose in reply to muci]

24 hours is too long for T3. You should leave a gap of 8 to 12 hours. But even so, it would probably only be about 4.4, so still too low to make you feel well. But, I imagine you are absorbing it, yes, but I don't know how well. It might not be consistant.

The half-life of T3 isn't that short. It stays in the blood for 24 hours, and I don't see why that would make it raise quickly. The half life of T4 is about 7 days, so you should be feeling the reduction by now. But, it could go lower, certainly. However, that might not affect the FT3 very much because you weren't converting that T4 very well, anyway.

It's good to start all hormones low and increase slowly, but I think your endo is exaggerating a bit. Normally, one starts on 5 mcg and increases by 5 every two weeks. I think you're long over-due for an increase.

[RockyPath]

You refer to high rT3 but don't give the result for either test instance. The FT3 value divided by the rT3 will give a number to indicate whether you're still taking too much LT4. My endocrinologists tests my rT3 each time now, after going eight months without testing it and letting it get so high I thought I was going to die.

You also haven't said how you are feeling. Dr. John C. Lowe observed that once treatment begins, the labs don't really tell what you need to know. What you need to know is if you are feeling well in all respects.

For a rule of thumb in swapping out some LT4 and replacing it with LT3, I found a study where they reduced by 50 mcg and added 10 mcg LT3. What is the unit of measure you're giving for the LT3? Is it 25 mcg LT3?

[muci in reply to RockyPath]

Thanks for replying. My new doctor has me retesting everything 6 weeks after starting. At 3 weeks I just checked the three values. I wanted to make sure that my FT3 didn’t lower any more than it had been.

My symptoms haven’t changed much. A few days into adding the t3 I felt way more clear, less brain fog and awake for the whole day. That’s kind of decreased at this time. Generally many hypo symptoms still. But I will give this doctor time to adjust how he sees fit as I’m glad I’ve found someone willing to try to find me a way of feeling better not just ok.

[RockyPath in reply to muci]

The T3 would be expected to make you feel better and, if the better feeling wears off, it could be the T4 conversion is still overwhelming you with rT3. You would need more T3 and less T4.

When getting T3 treatment, tests should be every 2 weeks and by all means check rT3. It is one clear indication, and can be the only one when you feel poorly and have brain fog.

The doctor is waiting six weeks out of habit, not out of necessity.

[muci in reply to RockyPath]

Thanks again. I’ve just sent him my results will see what he suggests.

[muci in reply to RockyPath]

Thank you greygoose and rocky path for the advice. My doctor called back, doubled my T3 dose to 5 mcg and wants me to redo my bloodwork and see my in two weeks (just like you said rocky path) instead of the original 8 weeks. Glad I reached out here!