When to increase T3 and reduce Levo??

[ThyroidObsessed]

So I started on T3 on Wednesday given to me by the NHS luckily!

Iv started very slow because I'm so sensitive and I haven't reduced my Levo yet neither as Iv started on a really tiny amount of t3..

I started by taking 2.5mcg (half a 5mcg tablet) of T3 split into 2 pieces and took one piece in a morning and one at night, then same again on day 2.. then day 3 I went up to 3 pieces of a 5mcg tablet so that's 3 tiny pieces took 3 times a day, then today Iv took the same... I'm also on 100mcg of Levo which i haven't reduced due to me only taking a tiny amount of T3 .. I don't feel really any different and still having my mental symptoms, moods anxiety... what now...

Just to say my endo told me to reduce to 75 of Levo and take 10mcg of t3 split into 2 times a day ...

[SlowDragon Administrator]

Recent results here, do show you could perhaps do with slight dose reduction in Levothyroxine.....

Perhaps 75mcg and 100mcg alternate days .....or perhaps just twice week initially and retesting bloods in 6 weeks

healthunlocked.com/thyroidu...

Are your vitamin D, folate, ferritin and B12 levels optimal?

What vitamin supplements do you currently take

[ThyroidObsessed in reply to SlowDragon]

Yes I supplement vitamin D spray 10,000 with k and magnesium, also take the b12 spray and take iron tablets with vitamin C..

Vitamin d was at 100 when last tested before supplementing and b12 is at 1000 on the spray, folate top if range and ferritin at 70...

Thank you I was actually thinking the same of reducing Levo 75- 100 alternate days... after tomorrow I'm thinking about taking a full 5mcg of t3 half in the morning and the other half in the evening is this too fast or Ok?.. how long should I stay on the 5mcg t3 before increasing?

[SlowDragon Administrator in reply to ThyroidObsessed]

Suggest you stick on 2 x 5mcg T3 for 6 weeks then retest

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

You may need to add another 5mcg after testing

I find three doses per day - eight hours gap between each dose works best

Obviously we are all different

You need to test vitamin D

10,000iu is a very large dose

You don't want too much vitamin D, its toxic in excess

Wvitamindtest.org.uk

[NWA6]

Hi Thyroidobsessed. In what way do you feel ‘sensitive’ ? Can’t be sensitive to T3 as you haven’t taken it before so are you sensitive to t4 increases?

[ThyroidObsessed in reply to NWA6]

Yes I'm very very sensitive to the t4 especially increases, I go through he'll even increasing it by a tiny crumb, but I think that's more because the ft4 keeps going high and over range and my body doesn't need it, as it needs t3 added as my ft3 is only cutting mid range ....

[Aurealis]

You could do worse than follow the endo advice. Too much thyroid hormone is very unpleasant and Levo won’t reduce quickly. 10mcg T3 is equivalent to 50mcg Levo so endo is already giving you a dose increase, you’ve increased it further. It won’t affect you straight away...

[ThyroidObsessed in reply to Aurealis]

Ok, So I was thinking reduce Levo to 75-100 on alternate days whilst I'm slowly working up to the 10mcg of t3 then go down to 75 Levo when up to 10mcg of t3??

[Aurealis in reply to ThyroidObsessed]

Yes, the best thing is to follow your instinct - there’s only you in there with all the knowledge about how it effects you. Some of the signs and symptoms are so subtle and difficult to express to others in words. I would think if you are able to increase T3 first then reduce Levo that you’re going to need a higher dose than that.

[ThyroidObsessed in reply to Aurealis]

Yes I am definitely going on how i feel and my own 12 year experience rather than the endo who doesn't live in my mind and body!!

[Hashihouseman]

All these changes can cause perturbations and take a while to settle as you body finds a way to balance it all as well as it can. If you are sensitive to levothyroxine you may also be sensitive to liothyronine and I find that even changes of as little as 25mcg levothyroxine and 2.5mcg liothyronine are profound. It’s easy to go over-medicated with t4 when taking 5mcg of t3 or whatever your optimum maybe because exogenous t3 reduces the metabolic clearance rate of t4 and the t4 dose can then start to accumulate without us noticing at first and even on a static or reducing dose of t4 you may be building up excess fT4. So yes cut the levothyroxine to a regular and consistent dose for 4-6 weeks and use little adjustments of t3 to fine tune, the t3 effects subside over 12-24 hrs if you go over and need to back off, levothyroxine takes much longer to dampen. Personally I find it helpful to split levothyroxine into 2 or even 3 doses and keep liothyronine to 2.5 mcg doses 2-3 times over 24 hours with an emphasis on am rather than pm! And as we all know, everyone is different so good luck and well done for the nhs support you are getting, did they prescribe 5mcg liothyronine by the way, or 20 mcg?

[ThyroidObsessed in reply to Hashihouseman]

Hi thanks for your reply.. can u put it in simple terms I don't understand what u mean 😞...

I have been given 10mcg of t3 a day by my endo she told me to take it in to doses 5mcg in a morning and 5mcg in an evening...

I'm currently taking around 4mcg a day split into 3 doses but this is awkward for me being busy I also take 100mcg of Levo I was told to reduce to 75 but I haven't yet although I did take just 75 today and going to maybe alternate 75/100 each day??

I get anxiety and depression moods up and down all day everyday, nothing has changed yet but it is only 4 days..

I'm thinking of taking 5mcg of t3 tomorrow split into twice a day, so 2.5 mcg in a morning and 2.5 in the evening, but I know my ft4 won't have dropped yet and was over range but ft3 not even mid range, I thought u could only be overmedicated by the ft3 levels??... it's all so confusing

I'm getting Palps but I get them when hypo too!!??

[Aurealis in reply to ThyroidObsessed]

The smallest dose I’ve ever taken is 5mcg. I have always been sensitive to dose change with Levo and T3 but I was ok starting on 40mcg T3. That was under the direction of an endo. I think the dose you’re on isn’t doing anything yet. Paul Robinson argues that a higher doses can be necessary to get into the cells. T3 has a very short half life, only about four hours to start with. As you get closer to your set point it lasts longer.

[Hashihouseman in reply to ThyroidObsessed]

Sorry if I added to the confusion, it’s bad enough without my attempted explanations

Simply put I think you’re right to start t3 slowly in divided doses even if that is inconvenient and yes you can definitely take too much t4, it’s not an inert compound with effects only from its conversion to t3.

FT4 levels directly affect several feedback loops in your thyroid system as well as the absolute levels stored and metabolised in your body. Too much could be as troublesome as not enough! Having said that the immediate metabolic effects of excess t4 do not seem to be as of much concern as t3 to the medical profession.

Excess t3 can be rapidly unpleasant (and potentially risky, which is why it’s better to have an endocrinologist prescription) whereas the adverse effects of excess t4 can build up into a lack of balance which can be confusing and slow to re-adjust and settle. I have definitely experienced hypothyroid symptoms from excess t4 and hyperthyroid symptoms from excess t3!

Balance is everything

[SilverAvocado]

Although the tablets are tiny, T3 is deceptively strong. That 7.5 mcg you're now taking is the equivalent of about 30mcg of T4, so you've added an additional 30% to your dose.

As you've increased quite fast, if you haven't felt any negative effects from the T3 you are probably not going to struggle with it, you're through the worst part.

Usually you'd decrease the T4 at the same time or slightly before adding T3. T4 is very slow acting, whereas T3 is very fast acting. There isn't any waiting process for the T3 to kick in, and the quantity you've been given will be a dose increase for you overall. There's no reason not to add in the T3 and reduce the T4 at exactly the same time. If you mess about with it and reduce the T4 later it will give your body something a bit more confusing to deal with.

You've only been on the T3 for a few days, so I wouldn't be surprised not to feel it. If you are lucky you will feel the difference in the next week or so.

[SilverAvocado in reply to SilverAvocado]

Sorry, I may have misunderstood this: "I started by taking 2.5mcg (half a 5mcg tablet) of T3 split into 2 pieces and took one piece in a morning and one at night, then same again on day 2.. then day 3 I went up to 3 pieces of a 5mcg tablet so that's 3 tiny pieces took 3 times a day"

You took a 2.5mcg piece of tablet, and then split that into 2 pieces, so the total amount you took in the day was 2.5mcg?

Then on day 3 you took 5mcg in total?

This sounds a perfectly fine way to raise. Carry on as you are and the only reason to drop back is if you feel unpleasant new symptoms. If you want to be cautious you can stick on each dose for a week or two, but if you haven't had any issues at all there's no reason to go slower. Most people are able to start on T3 with no problems at all. It's just a small percentage of people who are more sensitive who can feel overstimulated. You may find you are one of the lucky ones and can increase without problems.

Doing it this way, if you continue to increase every few days, you can make the full drop in Levothyroxine straight away, as it will take several weeks to wash out of your system. If you decide to increase slower over several weeks, you could reduce your Levo in proportion to the added T3 (again, this is a very cautious way to do it). Because T4 is very slow acting, it's the average of how much you take over a few days that counts.

[BadHare]

I don’t take T4, but adjust my NDT & T3 dose according to season. I know I’m taking too much T3 if I’m still wide awake & ravenous at 1am.

10mg of T3 is approximately 30mg of T4, so perhaps reduce appropriately once you start to feel your T3 is working.