T4 T3 combo help

[dodge1979]

Hi all

I added T3 2 days ago and still feel very tired and painful joints

Taking 125mcg activis and 5mcg T3 at 6am

Then 5mcg of T3 at 2pm

Any advice

[SeasideSusie Remembering]

dodge1979

Even though T3 is a more quick acting replacement hormone than Levo, we can't expect miracles. Some people do find they feel a difference quite quickly, when I added T3 to my Levo it took many months and dose tweaks and then it suddenly dawned on me that I felt better than I used to. I had to bring a high, over range FT4 down and raise FT3, it's a fine balancing act trying to find the right doses.

You also need optimal nutrient levels.

[dodge1979 in reply to SeasideSusie]

Thanks you

Been working on vitamins since January

Getting bloods done on friday

So let’s see. Hope this T3 works

[ThyroidObsessed in reply to dodge1979]

Hi don't worry I'm still waiting to see a change, after a week, but I know everyone is so different and each case is individual , I decreased my Levo to 75 from 100 as my ft4 is always high are over range but ft3 just mid range, iv worked on my nutrients for 2 years but that didn't help, luckily my NHS endo is trialing me on t3 for 3 months, she told me to lower my Levo to 75 from 100 and add in 5mcg t3 in the morning and another 5mcg of t3 at night but I have only just got up to 5mcg t3 a day yet, as I am so sensitive to any change.. also my main hypo symptoms are depression and anxiety not physical so I reckon t3 circulating the brain is gonna take longer than the body... we just have to give it time and be patient, and if our bodies have been lacking in t3 for many years it's gonna take a while to restore I think x

[Merlio18 in reply to ThyroidObsessed]

Hi can I ask what brand of liothyronine you get prescribed by your endo and where are you based in UK ? I found it difficult to balance on combi usually feel better with lower T4 like 50t4 and 10t3

[dodge1979 in reply to Merlio18]

North east

I have no thyroid so guess I need to be on night doses

[Merlio18 in reply to dodge1979]

What's your brand of liothyronine though is it blacklisted in your area?

why are they not just giving you T3 on its own as you don't really need T4 do you if you don't have a thyroid as you won't be able to convert properly anyways will you?

[dodge1979 in reply to Merlio18]

I kicked off big time with my endo

I think got sick of me and gave me a trial

To shut me up

I am ex forces and served my time

I am not converting well. But some about 4.8 but TSH too high

He said we may look at T3 only but need to get gp to agree

Lio was issued by hospital for 2 weeks

Don’t know the brand

[SlowDragon Administrator in reply to Merlio18]

Merlio18

Having a thyroid or not, has absolutely nothing to do with how well we convert FT4 to FT3

Conversion happens in the liver, the cells throughout the body and the gut

Anyone can be prescribed Liothyronine if an NHS endocrinologist says you have clinical need

A three to six months trial via hospital initially. Once well and stable on T3, then ongoing care and prescribing is transferred to GP. With annual review back with endocrinologist

After thyroidectomy it's more likely that a patient may need addition of small dose of T3

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many especially after thyroidectomy or RAI.

rcpe.ac.uk/sites/default/fi...

BTA guidelines

british-thyroid-association...

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

[SlowDragon Administrator in reply to dodge1979]

Ideally you test bloods 6 weeks after changing dose

Personally I usually feel better initially, then often terrible about 3-5 weeks after each dose change, and then slow steady improvements

[dodge1979 in reply to SlowDragon]

Endo wants bloods after one week of combo

[SlowDragon Administrator in reply to dodge1979]

What a waste of time....hey ho ...can't imagine what they think that's going to show. Nowhere near getting settled and rest of endocrine system balanced

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, even if this means adjusting time or splitting of dose day before test

[dodge1979]

We are in the same boat me and you

Thyroid obsessed