I'm new here and would really appreciate some help.
I was diagnosed with Hashi's in 2008 and I have been taking T4 since then. A new GP prescribed compounded T3 about 5 years ago.
Wow, what a difference that made.
I'm not in a situation where I need to switch from compounded to pharmaceutical T3 (my compounding pharmacy has closed down and i'm not willing to try my luck elsewhere due to compounding inconsistencies).
My question
Does anyone have experience or knowledge about switching from compounded T3 to a pharmaceutical brand such as Liothronine (Tetroxin)?
I take 6.5mcg of compounded T3 daily at present and the Tetroxin only comes in 20mcg tabs...which to my way of thinking seems like I could take a quarter of a Tetroxin tab 5 days a week.
However, I've discovered over the years that 1) I'm super sensitive to medication changes and 2) things are rarely straightforward when it comes to Hashi's.
I'm seeing my GP today and will discuss it with him but nothing compares to first hand experience and knowledge so I'd love to hear from you.
Thanks in advance
Narelle
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SydneySider123
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You can start your new dose by quartering the 20mcg of tablets. A pill cutter can quarter them. I quarter my 25mcg quite easily - it needed be strictly accurate but as near as.
I wish you well for your new regime.
I use this one and it does a good job. If you use this link for Amazon, Thyroiduk get a tiny sum to help defray expenses.
Yep, my 6.5mcg is 7 days a week which is 45.5mcg weekly.
The best way I can think to replicate that weekly dosage is by taking 2 1/4 tabs of Tetroxin (in Australia Tetroxin only comes in 20mcg tabs). Does that sound right? It doesn't does it. Now i'm confusing myself
I'm also super curious about the difference in potency between the compound and the pharma options...
No, it doesn't sound right. You can't do that with T3. You need to take a regular daily dose, same dose every day, not just five days a week.
Was the compounded T3 slow-release? If so, you might find that the pharma options are a bit stronger, so taking 5 mcg a day instead of 6.25 mcg might be ok, because with SR, you can never guarantee how much is going to get absorbed. But, it's all trial and error. You just have to try it and see.
Be as greedy as you like. There's no limit on how many questions you can ask.
Well, me personally, I would do a straight swap. But, then, I'm a pretty insensitive soul and can swap and change with no ill effect. You know your body, and how you're likely to react - we're all different. You could try a straight swap for a while, and if that doesn't go well, try a more drawn out process.
I have to say I'm excited about having a more stable T3. Travelling to Kenya over Christmas with such an unstable medication was tricky at best. Heck, when I'm free of the compounded T3, I could even go camping
I'm guessing you're in Sydney. I'm in Brisbane. I am currently on the slow release compounded T3. I'm on a low dose 5mcgs. In fact I halve the prescribed 10mcgs dose by opening the capsule. I am tolerating this very well and this is the first time I have been able to tolerate T3 without adrenaline rushes. I was previously on NDT and also T3 only (this was the pharmaceutical) with terrible results. I have an issue with high and low cortisol because of an adrenal disease, so I have to be very careful, as T3 requires cortisol (from my understanding from here on the forum). I used to use a pill cutter (yes they are tiny pills!). There is a difference between the slow release compounded and the pharmaceutical. So be aware that you will get a hit very soon after taking it. Absolutely take it every day, and if it's too much of a hit, you can crumble it and take it spread out over the morning. Good luck.
Hi can I ask what is the slow release compounded T3 you are taking what brand and can you only get it prescribed by a doctor I don't think we have this in the UK but I sound like I am similar to you with being sensitive and having cortisol issues so it could be something to research into.
The compounded T3 is made up at a compounding pharmacy - similar to a regular pharmacy but they are licensed to compound on the premises as well as administer mass produced meds. The compounding pharmacist makes up the capsules right there on the premises. I wouldn't recommend it personally - despite having been on it for 5 years. I recommend T3 but i have found the compounded version to be very unstable, it has to be refrigerated all the time (as opposed to my Thyroxine which can last up to two weeks out of the fridge...not that i do that often). Also it's very hard to travel with the T3 because of the refrigeration issue. Finally, not all compounding is the same...so there are inconsistencies between pharmacies which has led me to my current conundrum. So yeah, it's ok if it's the only option but I've only recently found out that I could buy a pharma version.
I have started the Liothyronine (orederd from US) a few weeks back ; incerased to 7.5mcg but realised my dose is 5mcg as the higher dose made me a bit anxious....so am now just atking the 5mcg in the morning and am OK; I also have cortisol issues (low all day) so am taking Adrenavive II also first thing in the monring shortly after T3....I used to take the T3 in 2 goes but can't be bothered anymore....so far am OK but the blood results in 8 weeks will tell.....am trying to lower my rT3 from 16 to 12 hopefully.....I do all this privately soit's very expensive....I also take NP 30mg around 2.30pm...Good LUck
Wow, thanks Sally. Firstly it's great to chat to another Aussie. Thanks for sharing the information about T3. Do you find the compound T3 a hassle in terms of how unstable it is...eg: can't have it out of the fridge at all. I got used to that but I won't miss it if i can transition off it.
I have a couple of questions if that's ok?
* Can you tell me more about the differences you've experienced between compound and pharma T3? Sounds like the pharma T3 starts working immediately, is that right? If so, do you find it leaves your system quickly too?
* Is one stronger than other? Eg: would you say that 5mcg of compound is similar to 5mcg of pharma?
* When you've swapped between compound and pharma, have you transitioned slowly or done it all at once?
Thanks very much - hope that's not too many questions to ask.
No I've found the T3 in the compound chemist to be consistent. It is slow release, I don't understand how this occurs? I don't keep mine in the fridge, I'd better check if it says to refrigerate! I didn't keep my compounded T4/T3 (NDT) in the fridge either. I keep levo in the fridge.
The differences in compounded to pharma T3 are purely the slow release. I find it convenient to not have to take T3 in divided doses all day. Also Pharma T3 hit me like a truck! Adrenaline rushes, high BP and pulse. I think this is because of my cortisol issues. But I know that T3 is essential. I have no brain fog when I take T3, as it does permeate the brain barrier. It's taken me a long time of trial and error to get to this combo of Levo T4 and compounded slow release T3. It's about finding what suits you. When you start to feel well it's all worth it! I agree with the advice given, start with 5 mcgs daily (4am) and see how you feel. Remember though, that getting used to T3 takes time and you may be yuk till your body acclimatizes. You'll know by how you feel.
SydneySider123, you will be a little bit limited by the sizes of tablets unfortunately. I agree with others that your best bet is to replace your 6.5mcg with 5mcg, simply because that is a quarter of a tablet. And definitely agree you should take the same dose of T3 every day. Unlike T4, that is slow acting and averages out over several days, T3 is very quick acting and gets used up on the day you take it.
If you're concerned 5mcg daily will give you a small dose reduction, another option is to settle yourself on the 5mcg, and then attempt a raise to 10mcg soon after. To keep your dose even, reduce your T4 by a little as you increase the T3. T3 is about 3-4x as potent as T4, so if you increase T3 by 5mcg, reduce T4 by 20mcg to match. In this case going up to 10mcg would be a 3.5mcg raise on your old daily dose, so decrease your T4 by as close to 14mcg as you can get with your tablet size.
Its possible you will feel a little different on the new dose, and may want to adjust your dise again. I find that a decrease can make me feel yucky, even if it doesn't change symptoms much. You may be lucky and feel completely fine or even better, or unlucky and have a few months of feeling less well, trying to get your dose adjusted to work better.
In terms of keeping things in the fridge, I'm not so knowledgeable about this, some people in here are very knowledgeable, but the compounded tablets are almost certainly made from the same active powders as the commercial tablets. For T4 I'm pretty sure almost all the manufacturers use the same supplier for their active ingredient powders, then all separately turn them into their own tablets. Which suggests to me that refridgeration issues should be the same across both. In the UK we keep our tablets at room temperature, but it may be necessary to keep them cool in a hotter country. If you make a new post asking this question you should get replies from some of the experts on the forum who know all about the chemistry of these tablets!
Wow SilverAvocado, thanks so much for the wonderful information. So helpful!
I'm still a little stuck on how to transition from the compounded to the pharma T3 given one is a slow release and the other is fast acting.
Would you replace the compounded with the pharma T3 each day this week? So, in 7 days, I'd be fully on the pharmaceutical T3? Or would you phase it somehow....
The question of how to change over.... I think you don't have much option. The dose you're going over to is probably the smallest dose you can reliably get out of the tablets you've got. If you were on a higher dose you could do it in phases, and if you can successfully split your 20mcg tabs into 8 pieces you could swap over half at a time. I wouldn't try to mix it up by taking different tablets on different days, because if you react differently you'll just be yanking your body up and down repeatedly rather than just ripping the plaster off in one go.
I think overall you'll be in a similar position to any patient who is adjusting their dose. You may feel a little worse, and if so you'll have to just deal with it by adjusting your dose again to try and get back to where you were. In the unlikely event you feel a lot worse, you'll have to reverse the change, and then figure out how to do things more gently. But until you've tried it and had a bad experience, you probably don't need to worry too much.
Most people taking T3 will feel better splitting the dose into 2 to keep it stable across the day. You're taking quite a small dose, in my experience with smaller doses it doesn't make as much difference. I believe slow release T3 is a bit experimental, and even though they say it's slow release, it might actually be no different than plain T3. Or even if it's different, you may not personally feel any different.
Depending on how you feel, raising up to 10mcg per day is an option you've got available to you. There are a couple of things that could happen and make you want to raise. The obvious ones being if you feel undermedicated on 5mcg, or if you feel worse in the afternoon/evening so feel you need a split dose.
Thanks...by way of an update, I had a very bad day on Sunday so have decided to wait until I level out before introducing another change. Timing is everything. Thanks again for your support. I can't believe is spent the first 11 years dealing with this condition without this type of support.
Sounds like a good idea! Its best to wait till you have a few nice gentle days in a row to make the change! Be as kind to yourself as you would if you had the flu or something similar, get plenty of rest. Even if it goes smoothly, your body is having to adjust how its used to handle everything when a slightly different form of hormone comes in.
I took compounded long acting T3 for about 5 years. I stopped when the T3 became too inconsistent. Compounding T3 is apparently an art. I was taking 15mcg of T3 at the time. I made a direct switch. I am in the US and we have 5 mcg tablets. I take 5mcg at 6:30am, 5mcg at 10:00am, and 5mcg at 1:00pm. Some people do better on divided doses. I am very sensitive to medication changes and could not take the T3 in two daily doses. To divide your 20mcg tablet you could pulverize it in a mortar and pestle, put the powder in a powder paper, roll the powder into a uniform line, and with a ruler measure and divide the powder into as many doses and amounts as you wish. Yes, it does sound like a lot of trouble and I would only do that if the single dose didn’t agree with me. My husband is a retired pharmacist and this is his suggestion.
Sydneysider123, pharmaceutical T3 still needs to be taken away from food. Unfortunately there is not really accurate research about this. All we really have is data that T4 will not be absorbed well close to certain specific foods. But the most reasonable interpretation seems to be that all thyroid hormone should be taken away from food. Leave a 2 hour fasting gap before the tablets, and a 1 hour fasting after the tablets.
This does become a huge pain in the neck with multi-dosing. I also take 3 doses, and as I'm still quite ill am only really up and about around 12 hours. It means I only have an hour or so timeslot for most of my meals. Can be hard at social occasions!
I feel better than I ever have. I had to try taking the T3 at different times to get the correct time for me. I tried spacing it out and taking the last dose at bedtime with my T4. I tried taking my first dose at 8:00am ( as my Endo suggested). Both of those were a disaster. I tried two doses of 7.5mcg and the peaks and valleys were too much. By trial and error I discovered what works for me. This does NOT mean that it will work for anyone else. The transition was not bad because the compounded T3 had become so unreliable from one capsule to the next. The beauty of T3 is that the half life is so short that even if the strategy doesn’t work for you the unpleasantness is over quickly. You can try something for a few days and see how you feel and if it isn’t great you can change the timing and dosage. I am very sensitive to small changes in my meds, too. I find that T3 has to be taken at the same time everyday. Even a change of 30 minutes will make a difference in how I feel that day. Try the 5mcg all at once and see how you feel. If you experience an uncomfortable peak in T3 just remember it will subside in about 30 minutes. If this happens then do what my husband recommended. Good luck and feel free to ask more questions.
Yes, you can take T4 and T3 together. Barrett582's advice about experimenting and trying things out is very good. I always advise people so start with one large dose and see how they feel, because it makes life so much easier to take just one dose. After maybe 3 weeks when things have settled, you can try other things if you like.
I think it's quite unusual to be able to really feel taking the T3. It will still probably take a few days or weeks for you to feel any difference at all. Some people can feel the more subtle impact that their energy levels are best a few hours after the tablet. Some people feel a slight sense of urgency when they are about to take their next dose, etc. I've felt this way a bit when my dose was much lower. And each time I've split my dose it's becaause I've noticed I sometimes feel very bad in the evenings - but with thyroid everything is a bit confusing and different each time!
Doctors tend to think of T3 like rocket fuel, that will get you buzzing. But I don't think patients ever see it that way!
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