Help with balancing T4 and T3 dose

Hello, can I get some advise from the treatment gurus on this site about my next dose change. I’ve been on 75 micrograms levothyroxine and 20 micrograms T3 (built up to this since Dec 2018). I felt very good first of all I am now feeling much more fatigued and have some muscle ache. However I am much better than before andmy mind is much clearer and I no longer have tinnitus. I see the endocrinologist in one week you discuss next alteration to my dose. My test results taking yesterday are:

Serum free triiodothyronine level 5.1 pmol/L [3.1 - 6.8]

Serum free T4 level 11.4 pmol/L [12.0 - 22.0]

Below low reference limit

Serum TSH level 0.14 mIU/L [0.3 - 5.0]

Below low reference limit

So that’s about 53% of the range T3 and 6% below range for T4.

I followed the nutrition and adrenal advice that I have received on this site (I am avoiding gluten and supplementing with B vitamins and selenium and D).

What do people think would be a next step? I can’t really tolerate T4 over about 125 without feeling ill. I was wondering if I might suggest increasing T4 to 100 micrograms and review in 12 weeks to see if bringing my T4 back into range helps with symptoms. At 100mcg I usually get a T4 of about 15 and T3 about 5.5 so I would need to ensure I keep my T3 scores in range by slightly reducing liothyronine dose in necessary.

It’s hard to get a balance that I think that I am on the way to feeling better at last.

Thanks Michael

[SeasideSusie Remembering]

It's all trial and error when trying to find the right balance of combination meds.

I take Levo and T3 and I'd be a zombie with your FT4. I need both FT4 and FT3 around 75% of range.

I'd be inclined to increase Levo and see what difference that makes. I'd retest in 8 weeks, no real need to leave it 12 weeks. You might find your FT3 increases as well, but you have plenty of wriggle room with your FT3 anyway.

[Hidden in reply to SeasideSusie]

Blimey, you were great Susie! Thanks for the reply. I'll take your advice and talk about a levo increase next week at the appointment. Also just to add, I was an absolute wreck of a human being 18 months ago ( I couldn't even be left unsupervised cooking without starting a fire and would get lost in out shopping). I am so much better and largely because you and some of the other administrators and regular posters have answered my sometimes stupid questions and armed me with information for medical appointments. You all deserve some kind of award. Thank you 👍

Michael

[Hidden]

PS that was meant to read you were 'fast' but 'great' is fine too.

[SeasideSusie Remembering in reply to Hidden]

Right place, right time. I'd probably just popped onto the forum and started at the top of the page and you happened to be there

I'm glad you've found answers here, awards not necessary but thanks are always lovely to hear

Good luck with your next appointment.

[SlowDragon Administrator]

I would agree with SeasideSusie to add 25mcg Levothyroxine and retest in 6-8 weeks

Make sure to stick to same brand of Levothyroxine each prescription

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last dose 8-12 hours prior to test

Is this how you do your tests?

[Hidden in reply to SlowDragon]

Yep, since learning about testing on this site from yourself and others, I always make sure it's first thing a.m. before any meds. Will be following the advice from you and SessideSusie and upping my T4. I think that will definitely take me further in the right direction.

Michael

[RockyPath]

If the above advice doesn’t produce the desired results, consider a 50 mcg reduction of the LT4.

You’ll know right away when you cut back the LT4 and feel better (within a day or two) that plasma FT4 is irrelevant to your wellness.

If you could include rT3 in the testing you’d know conclusively if you’re one who doesn’t convert T4 well enough for it to be beneficial.

[Hidden]

Thanks Rockypath, I will certainly hold that in mind. I feeling pretty tired and generally hypo so I'm guessing I'm under medicated. For now I think I'll take SeasideSusie's advice and talk to my endo about upping my levo to see if they boosts my T4 readings and T3 without going over range. Hopefully that will shift symptoms. I'd be a bit scared of dropping my levo as you suggest as if be concerned that would bring down my T4 and T3 making me more hypo?

Thanks for the reply

Michael