Dosage of Liothyronine and Levothyroxine

[Mugs19]

Post RAI have been on 75mcg Levo. Had DIO 2 test and am heterozygous. Have been on T3 for a week. Levo was reduced to 50mcg and told to take T3 10mcg twice daily and increase to 3x daily in a couple of weeks depending on how I feel. Vit D and iron were within normal range. Taking selenium.First dose took 5mcg and felt improvement. After 2 days changed to 10mcg x 2 daily. Since then feel weird. Hypo symptoms of tiredness at least as bad if not worse. can anyone help or reassure me I am on right dosage?

[helvella Administrator Thyroid UK]

Seems unlikely to be sufficient!

We need to better understand what you are saying.

When did you have RAI? And why?

Do you know if you have any functioning thyroid tissue?

Were you tested whilst on 75 micrograms - and what were the results?

[SlowDragon Administrator]

We need to start T3 slowly

5mcg twice daily for at least a few weeks

Sounds like you may have increased too quickly

What were blood results BEFORE starting on T3

Can you add actual results and ranges on

Vitamin D

Folate

B12

Ferritin

Say exactly what vitamin supplements you are taking

[Mugs19 in reply to SlowDragon]

Thankyou for your quick response and apologies for my delay in replying to you all. I have a lot of family commitments and my time is limited at the moment. I have limited results and haven't had time to look for them,. I don't know many of them anyway as I don't have access . For this reason I had my notes copied for the last few years last May but have only had them partially verbally since then, The last ones I had in September T4 was 21.5 (range 10-20) T3 =4,2 (3.5-6.5) while I was still on 75mcg daily. I had always had breakfast and meds prior to tests, so in January I did as suggested by the forum and fasted and delayed my meds. the effect was remarkable. T4 down to 15.1 T3 down to 3.9 , can't remember TSH, Endo asked me to take more levo but I reminded him that I have tried it and it made me worse. Also I have lost hearing recently and as an amateur musician this is bad news. This helped get the prescription of T3 though my impression is that he doesn't think it will work.

I take Selenium 200 mg daily. Don't know any results for Ferritin, Vit D and don't know whether B12 has ever been tested. I did chart my blood test results from my notes and found that my results were always in the bottom half of the range for T4 unless I was going hyper which happened twice. Even then my T3 was always in the bottom third of the range even when T4 started rising.I think I had symptoms of under active thyroid all the time I was on carbimazole,though my blood tests appeared normal.

[SlowDragon Administrator in reply to Mugs19]

Suggest you try splitting your T3 into 3 smaller doses

10mcg in morning, 5mcg mid afternoon and 5mcg around 10pm

Many of us find taking small dose T3 in evening helps improve sleep

If you find the last dose keeps you awake you can do three doses as 6am, noon and 6pm

Would strongly recommend getting vitamin D, folate, B12 and ferritin tested when you get thyroid testing after 6-8 weeks on T3.

Obviously you will need TSH, Ft4 and Ft3 tested

On levothyroxine or T3 we ALWAYS need good vitamin levels

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last 5mcg dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

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

For thyroid including antibodies and vitamins

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

Your Levothyroxine dose after RAI was extremely small at 75mcg ....so probably didn’t need reducing .....

[Mugs19 in reply to SlowDragon]

Thank you very much. I will try these suggestions. Should I go back to 75 much Levo? Also would appreciate a site which explains what the importance of antibodies is for me as I’m not clear about that.

[SlowDragon Administrator in reply to Mugs19]

Usually when someone has RAI its because they have had Graves’ disease (autoimmune hyperthyroid)

But it’s possible to have hashimoto’s (autoimmune hypothyroid) and Graves’ disease at same time.

Do you know if you ever had thyroid antibodies tested for either/both?

Link about antibodies

thyroiduk.org.uk/tuk/about_...

About hashimoto’s

thyroiduk.org.uk/tuk/about_...

Obviously after RAI you become hypothyroid as thyroid is knocked out

But after autoimmune disease we frequently have low vitamin levels and very often leaky gut

There’s some research suggests autoimmune disease starts with leaky gut

Leaky gut and gluten intolerance frequently go together

Low vitamin levels frequently need improving by supplementing regularly

Always test first and retest regularly when supplementing

[Mugs19 in reply to SlowDragon]

Thankyou again. I will look at these sites. When I was diagnosed I was told it could have gone either way because I have antibodies. I have had hyper relatives on both sides of my family. I have had problems with IBS and suspected leaky gut. Also when I had angioplasty Nov 11, they put in a stent with antibodies instead of chemicals because I am very sensitive to medicines and have adverse reactions to medications . My daughter has antibodies to which we discovered 2 years ago when she had surgery for an adenoma on her parathyroid gland and it was discovered then that she has Hashimotos. She suffers from PMS which she has inherited from me.

[SlowDragon Administrator in reply to Mugs19]

Sounds like you probably had hashimoto’s

Graves is only confirmed by positive TSI or Trab antibodies...unbelievably often never tested

Strictly gluten free diet helps thousands.

Have you tried it?

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Other gut issues due to being hypothyroid

healthunlocked.com/thyroidu...

Personally I couldn’t tolerate T3 until vitamins were optimal and on absolutely strictly gluten free diet

[Mugs19 in reply to SlowDragon]

Thank you. Yo you have given me a lot to think about. Yes I have tried the gluten free diet som years ago. It calmed down my ins. I took acidophilus for years. I still eat hardly any bread and omit apples and other items from my diet. I did reach a point when I was anaemia and haematology were saying that I had an auto immune disease but didn’t know what. They thought it was lupus but it turned out not to be . I tested negative for coeliac. I decided I might be suffering from malnutrition and started to include more foods in my diet. Blood tests and anaemia righted on their own. However ibs is starting to be noticeable again. I don’t tolerate iron supplement well either. Have been taking adors twice a week for 4 months and was told iron levels are within range. Any more than that and I get pains in my joints and feet. Really bad when I was pregnant. I will do all the reading you sent me. Many thanks for taking the trouble to do this.

[SlowDragon Administrator in reply to Mugs19]

You might find my profile info helpful

Early on in hashimoto’s I had classic rash on face like lupus. Hashimoto’s often mistaken as lupus

I always had zero gut symptoms

Only suspected gluten after joining here and seeing just how common it is .......plus despite good diet had poor vitamin levels

2 negative coeliac Blood tests 20 years apart

Private Endoscopy confirmed severe gluten intolerance. Gastroenterologist astonished I wasn’t coeliac...even did coeliac DNA test on NHS ....result was “probably not coeliac “

Getting vitamin levels optimal was key plus absolutely strictly gluten free diet (no cheating allowed)

Heterozygous DIo2 gene variation confirmed by private test

[Mugs19 in reply to SlowDragon]

It’s very kind of you to share this information. Thank you.

[Lalatoot]

T3 needs to be introduced low and slow. I read up on here and followed various pieces of advice. I think you are increasing too quickly.

Starting dose 5mcg lio for one week. Then add another 5mcg dose. Leave for 2 weeks. Then add another 5 mcg dose with as a third dose or added to existing dose. Continue adding every 2 weeks until 20mcg reached. Leave for 6 weeks and do bloods.

What you might also find is that the benefits of the T3 wear off once the reduction of levo kicks in. Again it is a case of looking at blood results at the 6 week point on full dosage T3.

Unless your FT4 level was near the top of the range at 75mcg there would be no need to reduce to 50mcg. My endo was being very careful and she cut my levo from 100mcg to 50mcg when T3 was added. I cut this slowly down but after 6 weeks at 50mcg and 20mcg lio my FT4 was at the bottom of the range and I knew that I needed it higher.

[Mugs19 in reply to Lalatoot]

Thankyou for sending this info. I had suspected that I had got too much too soon and that reducing my levo was not a good idea

[Mugs19 in reply to Lalatoot]

Thankyou for taking the trouble to send me this info. I am getting the strong message that I have been taking too much too soon.