Adjusting T3/T4 dose

[Blueskyyy]

Hi all

Could anyone please review my result ?

My tsh is too low, will that cause problems ?

I would like to fine-tune my T4/ T3 dose, could anyone please suggest me how ?

Thx

[SeasideSusie Remembering]

My tsh is too low, will that cause problems ?

Your TSH is not too low. Doctors like to see results within the reference range. Very few seem to understand that taking T3 lowers, even suppresses TSH. Yours is what is to be expected as you are taking T3.

I would like to fine-tune my T4/ T3 dose, could anyone please suggest me how ?

Start with a reduction of 25mcg Levo. Retest in 6-8 weeks. Post new results then and next step can be based on new results.

[Blueskyyy in reply to SeasideSusie]

Thx

I was thinking to reduce T4 by 12.5 mcg, is there any reason behind your suggestion to start with a reduction by 25?

[SeasideSusie Remembering in reply to Blueskyyy]

Because of how far over range your FT4 is.

Normal dose changes for Levo are 25mcg, except when we need to fine tune, and as explained yesterday your FT4 level is over range at 169.6%. Reducing by just 12.5mcg will bring your FT4 down, but unlikely to bring it within range, therefore you'd need another reduction so you'd just be prolonging the process.

[Blueskyyy in reply to SeasideSusie]

Ok

That’s a good point, thx

But the question is, by reducing 25 mcg T4 , FT3 might also drop, the thing that can cause the TSH to increase.

I am not sure exactly what caused the decrease of TSH, was it the brand new dose of T3 from Thybon or was it the increase of FT4 due to better absorption or/ lower BMI after starting taking T3.

Remember that my FT4 was previously 21.1 and now it’s 25.3 even under the same thyroxin dose (125 mcg)

[SeasideSusie Remembering in reply to Blueskyyy]

Remember that my FT4 was previously 21.1 and now it’s 25.3 even under the same thyroxin dose (125 mcg)

Remember that you have Hashi's, and that does strange things to test results, they can fluctuate with Hashi's activity.

But the question is, by reducing 25 mcg T4 , FT3 might also drop, the thing that can cause the TSH to increase.

If you have good natural conversion of T4:T3 then a reduction in Levo should also mean a reduction in FT3 as well as FT4.

You are taking exogenus T3, presumably because you have poor conversion, in which case your FT3 may not drop very much, it shouldn't drop as much as if you weren't taking T3. Also, as explained, as you've only been on the increased dose of T3 for 2 weeks, your levels probably haven't settled yet and your FT3 may rise even more when the usual amount of time has passed (6-8 weeks).

I am not sure exactly what caused the decrease of TSH, was it the brand new dose of T3 from Thybon or was it the increase of FT4 due to better absorption or/ lower BMI after starting taking T3.

I don't think anyone can answer that question with any certainty, there are so many variables and everyone reacts individually to dose changes.

Do you have any gut/absorption problems which is common when Hashi's is present?

Have you tested your nutrients, are they all at optimal levels:

Vit D - 100-150nmol/L

B12 - top of range for Total B12, at least above 70 (better above 100) for Active B12

Folate - at least half way through range

Ferritin - half way through range

Are you addressing the Hashi's - gluten free diet, supplementing with selenium - which some members say helps.

[Blueskyyy in reply to SeasideSusie]

But if levels fluctuate that much with hashi, then it doesn’t make sense to fine-tune dose!

Also, my natural conversion boosted after I went gluten free and supplemented with glutamine, my FT3 reached 5.4 whixh was 59% the range even without adding T3

[Angel_of_the_North in reply to Blueskyyy]

High FT4 inhibits conversion of T4 to T3 slightly because it "encourages" the wrong sort of deiodinase. So lowering T4 by 25mcg and (possibly) increasing T3 by 5mcg should be helpful, but lower T4 first, then, if necessary, increase T3 a week later. TSH seems to do what it likes and many people do NOT have a textbook TSH reaction.

[Blueskyyy in reply to Angel_of_the_North]

I heard that taking too much t3 can cause side effects.

With my actual dose, I am starting having signs of hyperthyroidism such as sweating, etc.

So I think I should lower my dose, some people advised me to reduce T3, others said reduce T4.

[SeasideSusie Remembering in reply to Blueskyyy]

It's a balancing act. What suits one doesn't necessarily suit another. You have to experiment and find what levels you need for you to feel well. With your results the most logical place to start is by reducing Levo, wait 6-8 weeks then see where your levels are and how you feel.

Hashi's is totally unpredictable and random, you may have no Hashi's activity for months and be stable. So you adjust dose as and when necessary if you have a Hashi's "hyper" swing and then maybe adjust dose again when it's over.

Do you have any gut/absorption problems which is common when Hashi's is present?

Have you tested your nutrients, are they all at optimal levels:

Vit D - 100-150nmol/L

B12 - top of range for Total B12, at least above 70 (better above 100) for Active B12

Folate - at least half way through range

Ferritin - half way through range

Are you addressing the Hashi's - gluten free diet, supplementing with selenium - which some members say helps.

[Blueskyyy in reply to SeasideSusie]

Hi

I have followed your advise by reducing my T4 from 125 to 100 mcg.

Unfortunately my TSH went high to 7.1 following the adjustment you suggested.

FT4 went down from 25 to 20 pmol/l

FT3 at 5.2 pmol/l

[Mino40 in reply to Blueskyyy]

I have read your post with interest. When your FT4 was 25, how did you feel? Has your TSH increase produce any symptoms? Even though my readings are now within range, I felt better with suppressed TSH and higher FT4. I don’t have Hashi’s.

[Blueskyyy in reply to Mino40]

While my FT4 was 25, I felt some symptoms of hyperthyroidism.

So I wanted to adjust that dose and people here suggested that I reduce T4 from 125 to 100.

[SeasideSusie Remembering in reply to Blueskyyy]

As I said, you have Hashi's and that causes strange results at times. It's how you feel that matters. Assuming the reference ranges are the same then your FT4 is now 98.73% through range which is what was to be expected when lowering your doser of Lev o, and your FT3 at 48.28% through range. How do you feel?

As you are taking exogenous T4 plus T3, I would suggest the next step is to now increase your T3 dose by 1/4 of a tablet. That will have the effect of raising your FT3 and possibly will reduce your FT4 and should also reduce your TSH (Hashi's activity permitting).

These are only suggestions, none of us here are medically qualified and replies are always based on the member's own experience. Each of us are different, have different needs and react differently.

Normally when on combined Levo plus T3, one expects to see TSH low or suppressed, a low-ish FT4 (if that is where you feel best) and FT3 in the upper part of it's range. This is a generalisation and you have to find your own optimal levels. Gradually tweaking doses is the only way you can do that.

You didn't reply about your nutrient levels. Are these at the optimal levels I mentioned above? And are you addressing the Hashi's with a gluten free diet and supplementing with selenium?

[Blueskyyy in reply to SeasideSusie]

Today I had a meeting with fertility specialist. They are pushing me to get my TsH to normal level.

I am at the moment not ready to experiment further, i would opt again the old dosage which resulted in TSH of 0.1

That dosage consisted of 125 T4 + 30 T3

[SeasideSusie Remembering in reply to Blueskyyy]

It's up to you. None of us here are medically qualified, we can only respond with information gleaned from personal experience and what we have learnt from reading and researching. Is there a reason you haven't responded about your nutrient levels and if you've been addressing the Hashi's?