Hope you are well as can be. Can anybody help with my recent thyroid panel, bloods taken fasted and Medication 24 hrs away from blood draw:
TSH: 0.22 (range 0.2-4.5)
FT3: 4.4 (range 2.5-4.5)
FT4: 15 (range 9-21)
Seen my Endo on Friday, she said I should try and up my T3 to 10mcg, currently I take 88mcg T4 and 5mcg T3 around 3pm. Endo suggested 75mcg T4 and 5mcg T3 morning and 5mcg T3 around 4pm. So lowering T4 slightly to increase the T3.
Would my results suggest this is a good idea? I am still feeling very sluggish particularly in mornings hence the Endo thinking this dose change may help, also just been diagnosed with sjogrens disease.
Thanks ☺️
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mistygrey
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🤔 it’s a very slight increase in what you’re on now. I’d be inclined to keep the T4 as is and introduce the extra 5mcg per day.
If T3 is roughly 4 times the strength of T4 then currently your T3 equals 20mcg if T4 so 88 Levo plus 20 T3 equals 108mcg of thyroid replacement.
Then 75 Levo plus 40 T3 will equal 115 total thyroid replacement. So yes per day it’s a slow increase and T3 acts much faster but I’m becoming increasingly worried that everyone is being too cautious. Your T4 is already only 15, that’s low enough. I’d add the extra t3 without reducing and see how you feel. I see your T3 is almost out of range but maybe the range doesn’t suit you? A range is just an estimate and when replacing I don’t think we need to be bound by numbers, symptoms should take precedent.
Thanks for your reply. Yes your very right and the fact I’ve been feeling very very fatigued especially in the mornings would suggest my medication is not optimal yet.
I think my Endo maybe wanted to reduce as I had palps on T3 when starting and didn’t want to over medicate me however my T3 is at the end of the range would this matter when upping the T3 if I decided to keep the T4 where it is? It is very small doses of t3 I only take 5mcg around 3 pm daily presently but I don’t think it’s enough!
Timing of last dose of thyroid meds before blood test are:
Levo - 24 hours
T3 - 8-12 hours
So by taking your Levo 12 hours before the test your result will be showing higher than otherwise.
I cannot understand why your endo wants to reduce your Levo. Even if 15 was an accurate result, it's 50% through range. Chances are it's actually a bit lower than that due to only leaving 12 hours between last dose and blood draw.
Taking T3 tends to lower FT4 so increasing your T3 may lower your FT4 anyway.
We are all different as to where we need both FT3 and FT4 when on combination hormone replacement. Personally I need both mine around 75% of range (I also take Levo plus T3).
If those were my results I'd be agreeable to the increase in T3 but I would not want to reduce my Levo. We should not change both at the same time anyway, if we do we don't know which change has caused what difference. We should only change one at a time.
There's a lot of tweaking and "wait and see" needed when on combination therapy.
My reply is based on my own experience of finding the optimal dose of Levo and T3 for me, I'm not medically trained.
Thanks susie, sorry that should have said 24 hrs before blood draw I had T4 dose 7 am the day before the day of bloods and T3 dose was 3pm the day before the blood draw. I agree I was sceptical at the Endo wanting to reduce my T4 as I already feel severely fatigued at times, especially in mornings so I think maybe she did this as I previously suffered palpitations on T3 when initially staring, however this was as my T4 at the time was far too low at 50mcg so I don’t think it was a result if the T3!
I am thinking maybe to try the added T3 but just don’t want to have palps again? So do you think staying on 88 mcg T4 and upping T3 to 10mcg would perhaps not be a bad thing to try?
OR - looking at it again now that I realise your FT3 is at the top of the range (thanks NWA6 I had missed that!)
Why would your endo want to increase your T3 when you're at the top of the range? You may feel better with a higher FT4 so an increase in your Levo might be better.
Just a thought, as I said lots and lots of tweaking is necessary to find the right combination of doses. When my FT4 went too low I couldn't function and then discovered that 75% through range was right for me for both FT4 and FT3.
Looking back at your previous posts, you said your endo want to change the doses to what you've mentioned here 3 months ago and you had lots of replies
With regards to more than 12hrs before blood draw you might get a false low in FT3 so you might actually be over range. Are you certain you need T3? Sorry I haven’t read your previous posts. Are you a poor converter?
My Endo decided to try me on t3 as previously I was on 100mcg t4 alone then 75mcg T4 alone and always felt completely rubbish and exhausted it was never enough, but since starting t3 I do feel more alive once I’ve taken it. I think my RT3 at the time before starting T3 showed I may benefit from it and my stomach has various issues.
1/ increase Levo, 100mcg per day plus 5mcg T3 per day
2/ stay at 88mcg Levo, incrase T3 to 10mcg per day.
Increasing T4 might be more gentle and alleviate your concern of heart palps but will take at least 3-6wks to feel relief. Increasing T3 might jolt your body and you’d feel those heart plaps but may settle quickly.
Thanks Paula. Yes I think I need to try one of these options, the T4 increase may be a better option but then I will still have the afternoon slump of tiredness I think the Endo added the extra T3 to wake me up in the mornings and early afternoon, it’s hard to know what’s best!
Yes I was told to hold off any changes by my Rheumatologist and Endocrinologist in order to up iron levels which I’ve been working on and also had to start medication for Sjogrens disease which comes with side affects so needed to keep things to a minimum, had my review with Endo last week who said I can now try the thyroid dose alterations hence the delay and similarity in previous post, I’m just not sure to up T4 or T3 like you mentioned and keep T4 the same
Have you had many blood tests? 5mcg is just such a small amount. But you say that if you up Levo you get palps too? Maybe you’re just such a sensitive person that you need to up slowly. Adding 25mcg Levo per week rather than per day. Hold for 7-10days and then up another 25pwr week so that it will take you a couple of months to get up to the right dose but maybe less fraught or I sometimes wonder what a flood would do? It’s so personal. There isn’t a right or wrong answer here one just has to choose a plan and stuck to it for an appropriate amount of time so that you can truly say you gave it a go.
I think I am just overly sensitive to the thyroid meds in general my Endo said I was. I think going with 88mcg T4 and upping T3 to 10mcg may be the best shot as you say it’s tiny doses? What’s the worst that can happen? I can always lower it back if it doesn’t suit ☺️
If my results were yours would you just stick with 88mcg T4 and up the T3 to 5mcg in morning and 5mcg in afternoon? When texting next how far away from blood should t4 and T3 be from blood draw? Thanks
Me? Personally? I’d up my dose of Levo first to 100mcg per day and then I’d split the T3 dose into a morning and evening dose. So 100mcg plus 2.4mcg T3 in the morning and then 2.5mcg T3 in evening. I know it’s tricky when you’ve already quartered your tablet but I’d want to give it a try if I still felt rubbish.
On your next blood draw, take your 2.5mcg T3 in the evening as usual, allowing for it to be between 8-10hrs till the blood drawn. ie blood drawn at 8am then take your tablet between 10pm and midnight. Or if you decide to stick to 5mcg in one go then take that at night on the eve of the blood draw. Take your Levo after the blood draw.
It’s really hard to decide if you feel rubbish because your FT3 could potential be too over range (because it’s a false low) or because you’re not on enough medication (either Levo or T3) and ofcourse theres the worry of you being sensitive (something I can’t relate to as I didn’t build up to my T3 intake. Just took it all in 3 split doses from day 1, my endo looked at me in shock but to be fair he never gave me much guidance so I thought f*ck it and yeah yeah I know some forum members might think I’m wreckless even suggesting that that’s the right thing to do but you know what I’m not a medical professional, this is not that sort of forum and I’m just sharing my experience! Lol for what it’s worth I flooded my system and felt flipping fantastic 😬😂)
Thanks for your message sorry I never got to reply I’ve had a lot going on with my work and trying to get back to work!!
I was just looking at what you wrote and it does make really sense I am still often exhausted my exhaustion is worse in the mornings so not sure a dose increase would help this.
I am sensitive to higher levels of thyroid meds but I do wonder if upping to 100 like you say and keeping my 5mcg t3 but split like you’ve said may help me function better.
I had palps on 100mg thyroid meds previously - but this was a long time ago and I was also lower in weight than I am now, I’ve put on a few stone since then.
With my ft4 being on the lower side I wonder if the actual t4 increase may be more beneficial and keep my T3 as it is.
Hey Mistygrey. I’ve just upped my Levo and feel great. I know it’s expected that FT4 will be lower because of the added T3 but I felt that my my FT3 was perfect at 6 (3.5-6.5) but my Leno was only 14(12-22) so I added so extra Levo 6 days a week. Actually added it to my nighttime T3 just to jazz things up 😂 2wks later and my afternoon funk and slight constipation have lifted. I’ve no idea what my levels are now. No1 it’s too soon to test but 2 if it’s working why pay put to test 🤷♀️
I know the general assumption is that T4 is inactive but there’s something about it that’s working for me where taking more T3 would have put me into ‘hyper’ mode. I think it’s always best to do as much conversion as possible before adding t3, it’s better for us to keep things as natural as we possibly can.
I have exactly the same afternoon funk that you are describing 😂 also I have a morning funk and can hardly move for an hour or so each morning.
I definitely after reading all the posts here on the thread now I’ve come back to it, had a think and think that upping the T4 to 100mcg would not do much harm.
I am not sure to keep the T3 at 5 or just split it like you said to half morning half afternoon - only thing with this is my 5mcg sigma pharm pills at the worst to cut!!! So may be slightly tricky.
Well if that works for you then why not! You know your body and what works. My Endo is so lovely but by advising me to up t3 I am not sure has given me the best advice, I think she was just concerned as I’ve had palsy on 100mcg t4 previously however this was a long while ago and I’ve put extra weight on since then! Which won’t be helping.
When are you retesting your meds? How much T3 did you say you are on?
Do you think it will make me feel overmedicated upping T4 and keeping my t3 the same? Or have no bearing at all? I am a few years down the line and still trying to figure out what doses suit me! Such a long slog x
Well, that's hard to say because palpitations can be a symptom of hypothyroidism, hyperthyroidism and overmedication, but taking this particular case as an example, as the OP's results show a low FT4 and a top of range FT3, it's likely that T3 could possibly cause palps.
🤷♀️ on the occasions when I could raise my FT4 I’d have heart palps but no raise in FT3. When I introduced T3 no heart palps ever even though I gobbled it all up in one day 😂🤗
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