Endo says a trial of t3 is worth a try, but I’m not keen on UK supply prices. Politics aside, and rather than confront him about the merits of an nhs trial or taking a private prescription to a German pharmacy etc etc, I have got my paws on some Unipharma 25mcg tablets, and I have acquired a pill cutter.
I plan to reduce levo from 125 to 100 daily and start with a ¼ t3 pill per day.
My questions are:
1. Should I take this with my levo dose?
2. How many weeks should I take the ¼ before increasing to ½ a tablet (assuming no evidence of over medication?
3. When moving to ½ tablet (or eventually more) when do I take it?
4. How often should I test tsh, ft3 and ft4 whilst finding the right dose?
5. What impact should I expect to see in blood test results?
6. Other than symptom improvement being key, what might ‘ideal’ bloods look like on combo therapy?
7. What haven’t I asked that I should have?
latest blood results for ref are:
tsh 0.36 (0.27 - 4.2)
Free Thyroxine 20.8 (12 - 22)
Free t3 3.7 (3.1-6.8)
Thanks in advance!
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Laundretta
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It's all individual so you will have to experiment to find what suits you best. But a general guide is
1. Should I take this with my levo dose?
Yes, you can start taking your first 1/4 tablet with your Levo.
2. How many weeks should I take the ¼ before increasing to ½ a tablet (assuming no evidence of over medication?
I would suggest 2 weeks.
3. When moving to ½ tablet (or eventually more) when do I take it?
I would take 1/4 in the morning and 1/4 in the afternoon or bedtime (make sure you take on an empty stomach, same as Levo, water only). When you eventually settle on your optimal dose, you may find, through experimenting, that you need to split your dose into 2 or 3, or you may find you can take it all in one dose and feel no different.
4. How often should I test tsh, ft3 and ft4 whilst finding the right dose?I would test after reaching 3/4 tablet but wait until 6-8 weeks after reaching this dose. If you want to be ultra cautious test 6 weeks after being on 1/2 a tablet. I've based that suggestion on my own experimenting with T3, I got up to 31.25mcg whilst tweaking Levo and T3 doses, eventually settled on 18.75mcg so I actually wasted quite a lot of time!
5. What impact should I expect to see in blood test results?
FT4 should lower, FT3 should increase.
Just my opinion, others may think differently. But the main thing is, take it slow, increase gradually. It took me almost 2 years of experimenting to get it right.
Hopefully you have optimal nutrient levels, otherwise I wouldn't suggest starting T3 until they are.
Vit D - 100-150nmol/L (40-60ng/ml)
B12 - serum top of range, Active at least above 70
Thank you SeasideSusie. My vitamins ought to be ok given the daily cocktail, but I was planning a test to check soon. Ferratin seems to be the trickiest one for me to control and has been significantly different each time tested, but in October I also had additional iron tests. At the time ferratin was 43 ug/l (13-150) but iron was 26.3 umol/l (6.6-26) %ibc sat 42.9 (15-45) total ibc 61.3 umol/l (45-81)
Unfortunately, iron is tricky, you have high serum iron whereas the optimal level is 50-70% with the higher end for males. High Total IBC indicates need for iron supplementation, low indicates lack of capacity for additional iron. Percentage saturation should be 35-45%, higher end for males, and as always mentioned on here, ferritin is said to be best half way through range. I'm afraid I can't advise, it's beyond what I know about iron.
Everyone is very different when adding T3, so there is really no fixed answers to your questions...I even started first two days on 1/8 th of a pill, and took about full month to get to whole 25 mcg T3 pill. I’d reduced too much of my levo. dose ( removed 50 mcg down to 75 mcg) and my bloods after 4 weeks on full 25 mcg T3 dose had in fact ended up with lower FT3. It is usual for TSH and FT4 to droop when on ‘reasonable’ T3 dose ie they drop below ‘normal’ ranges, but that is ok, it is your FT3 only that is really important. You can experiment with when you take your T3: some split it up into 2 even 3 doses staggered throughout the day( but well away from food, drink, other meds, and supplements...which can be difficult with 3 doses), others just do one dose ( with levo.) on principle that ‘flooding’ receptors is good, at night ( my preference). Can be good idea to keep ‘diary’ of dosing, your bp, pulse, basal body temp and how you feel to aid future ‘medication’. Main thing you don’t mention is your ferritin, folate, vit D and B12 levels...I ‘d check them and get the them all optimal, upper half of range...supplement if necessary before starting T3 at all. Other tip...go slow, be patient...some get instant feeling from T3 ( I did on 1/8 th of pill), others not...these can be relief from symptoms , but new unpleasant ones like palpitations ( which I got until disappeared on getting to full 25 mcg T3 pill)...if you over do it at least T3 leaves system relatively quickly! Good luck.
But your ferritin is low, but note Seasidesusie has expressed concern re all your iron/ ferritin results...would seek medical advice before increasing T3.
I’m about due another multivit + test, (I’m doing them every 6 months) so will have more up to date results soon. I’m hoping the ferratin has improved some. My Endo has advised a t3 trial (he’s happy with iron and vit levels, I’d rather improve them first) but privately using Uk sources of T3, which as we know is prohibitively expensive. So I have sourced some elsewhere.
I’ve been on a combo for 7wks now. My results were pretty much the same as yours. I just dove in and took 15mcg in split doses from day 1. After 2wks I ditched the afternoon dose and took 10mcg in the morning with my Levo and then 5mcg at bed. Now after my blood tests I’m going to add another 5mcg. So 125mcg x 5 and 150mcg x 2 and 20mcg of T3 every day.
I just haven’t had the adverse reactions that some have had.
My experience was that I started taking my 20 mcg T3 as prescribed, in a single dose, and without reducing my then 125 mcg levo. I have done this twice (my NHS T3 was withdrawn in 2017 and I was without it for a while). On both occasions I was perfectly fine.
Regarding taking T3 with food and drink, there is no evidence I have found that requires them to be separated, and some evidence that says they don't. In 11 years I have mainly taken both my T3 and T4 at night to avoid my other meds but did have a spell taking the T3 during the day and around food, with no ill-effects.
Regarding using a private prescription, currently you can order German Thybon Henning online and have it posted to you - 100 x 20 mcg tablets will cost only c 31 Euros plus P&P which obviously compares vary favourably with UK prices which will generally be in excess of £200 for only 28 tablets.
I would definitely start to address vitsetc first. Ask for Vit D, B12, folate and ferritin to be tested. They need to be optimal, not just in range and these help your thyroid to work better, can help with conversion issues you have-high FT4 andcmuch lower FT3, and can also help with some symptoms. I managed to reverse my conversion issues within 5 months but I don't have antibodies so more stable but it will make it easier to add in T3 if you need to as some can't make conversion improve without getting the four optimal first. Remember if you need to supplement its often for life but once optimal you may be able to find a maintenance dose.
Thanks. I rattle with supplements. Have also recently started taking adrenal cortex. (see long list of test results and supplements on profile)
I’m due an ultravit check which I’d planned having once every 6 months to keep an eye on things. I’ll have it in the bag and address outstanding deficiencies before starting t3.
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