What next ??

[Steni]

Several months ago back in January whilst travelling I lost my medications and had to do without for a while. On my return I used the opportunity of having a 'cleared out ' system to have a blood test to see where I was up to level wise after taking nothing for so long. My doctor on seeing the results was alarmed and phoned me several timesto find out wha was going on. With his help I stared again, this time very slowly and carefully increasing only every 6 weeks my T3 and T4 meds. I am feeling good - not quite there there is still room for improvement but I can see progress is being made. I have attached my latest results and I wonder which of the T3 or T4 (if either)I should increase to achieve the perfect sweet spot?

[Angel_of_the_North]

How you feel is the most important thing. Some people might need a higher FT3, but if you feel good don't change what is working.

[SilverAvocado]

It's clear you need an increase. FreeT3 is well under halfway, and that is the number that most closely reflects symptoms. Most people will feel best with it high in range.

You don't give any information about what dose you're currently taking, so I'm not able to comment on that.

Whether to increase T3 or T4 is really a judgement call /preference thing. There's no objective choice.

Often people will prefer to increase T3, because it's the simplest route to getting more T3 in the body, but others like a nice cushion of T4 and to keep the freeT4 a bit higher.

Looking at these results, if you're like me you'll need quite a few increases to get where you need to be, so you can consider that when you make your choice. But everyone's different and I've seen people jumping up the freeT3 range quickly.

When you adjust, if you choose T3 make an increase of 5mcg if you can, with T4 it would be 25mcg. With T3 it will often mean splitting tablets.

[Steni in reply to SilverAvocado]

Thank you so so much for your comments. I am currently taking

100mg levo

20mg T3 (Thybon )

Aiming for the sort of results you mention ( high in range T3) I think I am going to increase the T3 by 5mg for two weeks and if no problems then either add a further 5 mg OR add 25mg of levothyroxine

What do you think?

[SilverAvocado in reply to Steni]

Two weeks is quite a short time to wait. At this point I'd probably hold on the new dose for 6 weeks. Then if possible have another blood test and then make another adjustment.

To add extra information, take pulse and temperature measures, and make good symptom notes on each dose.

[Steni in reply to SilverAvocado]

Ok - the reason I thought 2 weeks was because T3 was so instant - have I got that wrong ?

[SilverAvocado in reply to Steni]

It still takes the body a long time to get settled on the dose. It's not just a matter of how quickly it gets into the bloodstream.

I tend to find the first 3 or 4 weeks of a dose increase can be quite strange, so I can definitely feel that it takes a while for the body to get used to it. Developments actually continue for several months. 6 weeks is just a compromise so we aren't waiting forever to get better!

[Quilliam]

I self-medicate with NDT and T3 combo (my body doesn’t convert T4 well) and I feel optimal when my fT3 is slightly over the recommended range. My fT4 is usually mid-range. My TSH is always way suppressed and that freaks my GP out every time. I just ignore him.