Advice on how to reduce levothyroxine whilst increasing liothyronine please

[cazzaleo]

Hi!

I previously asked about go to go about switching from T3/T4 combination therapy to NDT but have now decided I’d like to give T3 only a try first.

Could someone please advise how best to start reducing my levo and adding in additional liothyronine? I’m currently on 75mcg levothyroxine and 20mcg liothyronine - I’d appreciate it if someone could let me know the various steps I should take in reducing one and adding more of the other.

Many thanks!

[SlowDragon Administrator]

What were your results after 6-8 weeks on 75mcg Levothyroxine plus 15mcg T3?

You may simply have needed dose increase in Levothyroxine

Your Levothyroxine dose was low

Many of us need GOOD levels of FT4 and FT3

Personally I need FT3 and FT4 near top of range (regardless of TSH)

SeasideSusie needs her FT4 and FT3 in top half of range

Your results on 50mcg Levothyroxine plus 15mcg showed you were very under treated

Absolutely essential to regularly test vitamin D, folate, ferritin and B12

as you have Hashimoto's are you on strictly gluten free diet?

[cazzaleo in reply to SlowDragon]

Thanks for replying SlowDragon. I’m having my blood taken on Monday. But going by symptoms the increase in Levo made no difference. I’ve been feeling dire still so increased the liothyronine by 5mcg myself so I could at least function a little - that was 2 weeks ago, after 5 weeks of 75mcg levo and 15mcg liothyronine.

My endo said in my last appointment that if I wasn’t improved after the increase to 75mcg he wanted me to try NDT - he doesn’t want to increase the levo any further 🤷🏼‍♀️ I’m happy to try NDT at some point but as I still have a bunch of T3 tablets left and have previously responded at least short term to increases in T3, I want to ask him to let me try T3 only before we move onto NDT.

My last vitamin tests were only a couple of months back and were all pretty optimal, the results are in one of my previous posts.

I’ve been gluten free for about 3 years, and have been on AIP since the beginning of April

[SlowDragon Administrator in reply to cazzaleo]

Do you take T3 as split dose?

I find taking 3 doses per day at 8 hour intervals works by far best

When were vitamin levels last tested

[cazzaleo in reply to SlowDragon]

No, I tried a little while back and felt worse for it.

Last time vitamins were tested was early March, results are in the picture attached to my post 3 months ago. Do you think it’s worth testing them again?

[SlowDragon Administrator in reply to cazzaleo]

Vitamin D was rather low. Did you increase supplements?

healthunlocked.com/thyroidu...

Have you considered DIO2 gene test?

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

[cazzaleo in reply to SlowDragon]

I have been using the BetterYou spray again since.

I’ve just had some genetic testing from Blue Horizon - for DIO1 it shows CA in green and TC in amber, DIO2 it shows TC in amber and TC in green. The explanation for the TC in green says:

The 'T' result is associated with increased DIO2 activity. This has been shown to present as lower T4 and rT3, and higher T3 levels. Adequate levels of iodine and selenium are required for optimal functioning of this pathway.

I don’t find the report easy to follow/understand! I’m seeing my nutritional therapist the week after next so was waiting for her to explain it all. I had the thyroid genetic panel, genetic trait report and well woman genetic report

[SlowDragon Administrator in reply to cazzaleo]

I agree the Blue Horizon DNA test is not easy to understand

I did just DIO2 via Regenerus

[cazzaleo in reply to SlowDragon]

This is some of the DIO1 report explanation:

Likely to have lower DIO1 activity and therefore probably decreased clearance of rT3 from circulation, and lower conversion of T4 to T3. Ensure adequate intake of iodine and selenium to support this pathway.

[cazzaleo in reply to SlowDragon]

And the rest of the DIO1 explanation:

The 'C' result is associated with increased DIO1 gene function resulting in rapid conversion of FT4 to T3 and reduced circulating rT3 levels. Ensure adequate iodine and selenium intake to support this pathway optimally.

[cazzaleo in reply to SlowDragon]

This is the other part of the DIO2 explanation:

The 'C' result is associated with anxiety and depression in many cases in those taking thyroxine (T4) hormone replacement therapy for hypothyroidism. This can be overcome with combined T4/T3 therapy.

[SlowDragon Administrator in reply to cazzaleo]

I think this means you have Heterozygous DIO2 and need addition of small dose of T3

[cazzaleo in reply to SlowDragon]

Thanks SlowDragon - I was wondering if it showed I was heterozygous after reading it again, thanks for clarifying!

[radd in reply to cazzaleo]

cazzaleo

@Slowdragon asked “What were your results after 6-8 weeks on 75mcg Levo + 15mcg T3? “

I agree with her that you may just need T4 dose titivation, and to be patient as remember symptoms can lag months behind good biochemistry. I haven’t medicated T3-only, and would never choose my thyroid hormone replacement meds based on pills that needed using up.

Anyway, if you wish to switch, using a ratio of 1:3 (some use 1:4)

Your currant dose of 75mcg T4 + 20mcg T3 = 135mcg T4

Reduce to 50mcg T4 & add 5 mcg T3.

(50mcg T4 + 25mcg T3 = 125mcg T4)

Hold for a week.

If no ill side effects are felt, reduce T4 to 25mcg & add another 5mcg T3.

(25mcg T4 + 30mcg T3 = 115mcg T4)

Hold for a week.

If no ill side effects are felt, completely stop T4 and add another 5mcg T3.

(No T4 + 35mcg T3 = 105mcg T4)

T4 has a much longer half life than T3, so although this final dose is less than your original it should be held for a further six weeks to accommodate all T4 leaving your body before testing true levels of thyroid hormone and assessing how you feel.

Because T3 has a short life doses may be easily titivated and many members dose on symptoms alone. However, going over-range can bring dire consequences so it is important to initially test to monitor T3 levels. Post results for members to comment.

I find splitting my meds into two daily doses reduces the rapidity of onset & prolongs the duration of its action, so avoiding peaks and troughs.

You may find reading Paul Robinsons's books insightful.

Good luck and I hope you feel better soon.

[cazzaleo in reply to radd]

Thanks rads!

You’ll see in my response to SlowDragon that I’m going to have a blood test the week after next, but had increased my T3 by 5mcg anyway as I’ve been feeling so bad (more details in the post). Post also explains that my endo doesn’t want to increase my levo any further and wanted me to try NDT next.

Using up tablets isn’t my only reason for wanting to try T3 only, just part of the picture.

That ratio/switching info is really helpful, thank you!

I’ve read some of Paul Robinson’s theories - I do take my T3/T4 early before rising as suggested by him (I forget what he called that, perhaps CT3M referencing a circadian method??). Perhaps I should read some more. Plenty on my reading list at the moment but I tire too easily currently to read very much.

Thank you - I’m determined to feel much better very soon!!

[cazzaleo in reply to SlowDragon]

As my endo won’t increase my T4, I think my next best step is to try T3 only (and then NDT if that doesn’t work out). Are you please able to let me know by how much and how frequently I should reduce levothyroxine and how much I can increase liothyronine at the same time SlowDragon?

[SlowDragon Administrator in reply to cazzaleo]

Sorry I don't know

Can only suggest you do it slowly

[cazzaleo in reply to SlowDragon]

Thanks anyway!

[NWA6 in reply to cazzaleo]

Is it 4-1 ratio?

100mcg T4 = 25mcg T3?

25mcg T4 = 6.25mcg T3?

75mcg t4 = 18.75mcg t3?

50mcg T4 +one 25mcg T3 + one quarter of a 25mcg tablet per day. Do this for X amount of days/weeks

25mcg T4 per day +one 25mcg T3 +half a 25mcg tablet per day. For X amount of days/weeks

Zero T4

25mcg + half a 25mcg + quarter a 25mcg = 43.75mcg T3 (which is equal to 175mcg T4

Increase if you need to but doing it over a 6-8wk period or more slowly might help you find your sweet spot?

I am not sensitive to T3 at all, i just took 15mcg the day it was delivered and lowered my T4 by 25mcg at the same time. So 🤷‍♀️ I don’t know you or how you might react.

I also have very very little experience and so I could be talking absolutely out my backside and am very happy to be schooled but if I had to go it alone then ^ the above is how I’d do it.

HTH, if not if it’s gobbledegook then please disregard and I hope someone can give you some good info 🤗

[cazzaleo in reply to NWA6]

Thanks you Paula6, any guidance is helpful!!

[Greekchick]

Hi there,

I can’t say who is right, but my pharmacist told me that 25 mcg of T4 is equal to 5 mcg of T3. So for example, if you are currently on 100 mcg of T4 and you are adding T3, you will take 75 mcg of T4 and 5 mcg of T3. These are the proportions I am using to calculate how much I need. You need to add the T3 slowly. It hits very hard if you rush adding it too fast. I myself will need more T3 because I do not convert and so I may not have that ratio in the end - but it’s a starting point.

Hope this helps. Different people have reported different combinations of the two because one size does not fit all with thyroid. I only provide these figures to give you some perspective. Wishing you all the best.

[cazzaleo in reply to Greekchick]

Thanks Greekchick, that is helpful!