T3 dosing

[clynnesloan]

Hi, I need some guidance with dosing of t3. I will first provide a little background.

I had a total thyroidectomy in 2011 and was taking Levothyroxine only for years. I have had hypo symptoms probably for years and just didn’t realize it because my doctor would only check my Ft4 and TSH which were always good. Finally I asked for a free t3 because I literally had almost every hypo symptom possible in November 2018 and found that it was 1.7 ( reference range 2.3-4.2). She prescribed me 5 mcg once a day and Basically told me that she wouldn’t be giving me anymore because she wasn’t going to make fT3 a treatment goal because the levels fluctuate so much during the day.

Well I took the 5 mcg and felt nothing. I had enough pills to mess with it some but not enough to do it consistently. I ended up making an appointment with a naturopath who checked labs and my fT3 had gone DOWN to 1.2. So he prescribed me a compounded t3/t34 slow release formulation. After a month I felt horrible so I had my levels checked and my TSH was > 7, my Ft4 was low and my free t3 hadn’t budged. He adjusted dose a couple of times and I have still not even been within range for free t3. 1.95 was my last level on 45 mcg of the sustained release.

Well I finally found a doctor to give me a prescription of the synthetic form and told me to play around with dosing until I felt well. My question is where should I start and how often should I increase it until I feel optimal?

Thank you in advance for the guidance.

[SlowDragon Administrator]

First step is to get FULL Thyroid and vitamin testing

If vitamin levels are low these need improving first or at least at same time

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

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

Is this how you do your tests?

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

Medichecks currently have an offer on until end of May - 20% off

thyroiduk.org.uk/index.html

Suggest you try 5mcg T3 twice a day initially - waking and mid afternoon.

Retesting bloods after 6-8 weeks

Adding third dose at bedtime if bloods look ok

[pennyannie]

Hello Clynnesloan

Ok, a fully functioning working thyroid would be supporting you daily with approximately 100 T4 + 10 T3.

I just think that if there has been a medical intervention and the thyroid ablated or surgically removed both these vital hormones should be on the patients prescription.

Some people can get by on T4 - Levothyroxine alone, some people simply stop converting the T4 to T3 at some point in time and some people simply need both these essential hormones dosed and monitored independently to bring the hormones into balance and to a level of well being acceptable to the patient.

My doctor gave me T3 once, without even me asking, it wasn't enough to make a difference so rather than adjust the dose up, it was deemed not necessary and of no value to me ? Pity I didn't know then, what I do now, however, it's never to late to get better, and you're in the right place now, and will get the support you're looking for.

I have self treated with T3 at a dose level that made a difference in my health.

It was like a light switch being turned on.

It's good you have been given enough T3 to " play around " with but then again I guess, you might be looking for more structure in your dosing, especially in the beginning.

Most people seem to feel best when their ratio of T3 to T4 in about 1 / 3.5-4.00.

T3 is approximately 4 x stronger than T4. You simply divide your T3 read into the T4 read.

Thyroid hormone conversion can also be compromised if vitamins and minerals are not optimal so think it a good idea to get these and a full thyroid panel tested as already suggested, and then repost results with the ranges and people more able than me will advise accordingly.

The thyroid is a major gland responsible for full body synchronisation, including your physical, mental, emotional, psychological and spiritual well being, and if anything is out of kilter it upsets everything like a house of cards when one card is removed.

I am with Graves Disease post RAI thyroid ablation in 2005 and am now self medicating with NDT. This is natural desiccated thyroid and is pig's thyroid dried down into tablet form. It has a fixed ratio of about 4 / 1 with one tablet giving 38 T4 + 9 T3.

You might like to read a book, Your Thyroid and How To Keep It Healthy. It is written y Dr Barry Durrant - Peatfield who is hypothyroid himself and is a sometimes funny, insightful account of all things thyroid and the implications on the rest of the body when not optimally medicated. We may not now have thyroids to keep healthy, so all the more reason to know what we've lost and how to compensate accordingly.

Just realised I've said most of this before to you - silly me, I must sound like a broken record !!

[clynnesloan in reply to pennyannie]

Thank you pennyannieand slowdragon. I guess that I should have said more in my post but it was very long so I tried to just include what I felt necessary.

I did have vitamins checked and they were low but within range so I just increased supplements.

I am type one diabetic and we have a deficiency in gene that converts T4 to t3. I have read several books, been active on this forum as far as reading not posting. I have had my thyroid labs checked monthly since the end of January.

The doctor that I saw on Friday said that looking at my labs he expects that I will need 15mcg + of T3 replacement. Coming from 45 mcg of sustained release that I know I was not absorbing well with fT3 still under range I don’t want to start at 5mcg twice a day because I know that won’t be sufficient.

In hindsight maybe I should have just asked how often should I increase until feeling optimal? I have a prescription for 5mcg tablets.

[pennyannie in reply to clynnesloan]

No worries - none of this is easy at the beginning, and in all honesty, I think I should try and change the record sometimes anyway LOL xx