T3 and T4 dosage

[Nellups]

Hi everyone, Doctor is trying me on T3 with T4, but he has not lowered my T4 dose of 125, and given me a dose of 20 of T3 a day with instructions to not split the tablet but to add to water and use a syringe to measure the correct dose of 10 for morning and evening ? Is this correct on doses ? Seems very high on the T3 thought it was supposed to be a gradual amount? And normally lower the T4 ? I get the impression I’m being set up to fail ? Also why Can’t I just split the T3 in two?

[greygoose]

Oh, I get the impression you're being set up to fail, too! Either that or your doctor is very ignorant.

It's best to start on a low dose - 1/4 tablet a day for 1 or 2 weeks, then increase by 1/4 every two weeks until you get to 20. Starting on 20 would more than likely be too much for you.

As for reducing the levo, that depends on your FT4 level before you start the T3. If it wasn't too high, then no need to reduce it.

This dissolving in water business is something the drug companies came up with a while ago - lord knows why! Unless it was to sell more tablets, at an exorbitant price, because it's very wasteful. That, presumably, would come out of your prescription and reduce the number of days of your trial! It has been discussed on here quite a lot, and no-one could come up with a good reason for doing it, that I remember. Perhaps helvella remembers more than me? Personally, I can't think of any reason why you shouldn't split your pill.

How long is your trial for?

[helvella Administrator in reply to greygoose]

The claim is that the combination of imperfect splitting and (potential) loss of some crumbs, means that it is inaccurate. And the claim that the active ingredient might not be evenly dispersed so even if the physical spolit were perfect, the dose might not be even.

I did try to get more information but MHRA could not provide anything for liothyronine (specifically).

I think most people who take liothyronine end up having to split, at least at some point, and the issue of slightly more in one dose, slightly less the next is not too awful.

[helvella Administrator in reply to helvella]

Furthermore, the PIL expressly tells patients NOT to keep any solution.

I don't believe there is any published research about what happens to T3 in that sort of solution, left for several hours.

And, just how can you get the full second 10ml into the syringe?

[Hidden in reply to helvella]

"The claim is that the combination of impefect splitting and (potential) loss of some crumbs, means that it is inaccurate."

Dissolving seems even more inaccurate, especially on the second dose!

[helvella Administrator in reply to Hidden]

Especially as some of the ingredients simply do not dissolve! They might disperse.

[Nellups in reply to greygoose]

Hi Greygoose

I could not understand why my Levo was not being lowered? I did mention it to the Endo, he said wasn’t necessary ? My T4 is high last results below around 4/5 months ago

TSH 0.43 mU/L (0.27 - 4.20)

Serum free T4. 27 pmol/L (12 - 22)

Serum free T3. 4.5 pmol/L (3.1 - 6.8)

Vit D 59 nmol/L

Serum B12. 926 ng/L (197 - 771)

Serum folate. 5 ug/l. (3.9 - 26.8)

They have forced me to go back to normal Levo with lactose as it is or they won’t give me T3 . I feel very bullied at the moment and it’s getting me down. And now this

When do you recommend regarding times of day to take it as well ?

[SlowDragon Administrator in reply to Nellups]

Important to have GOOD vitamin levels too, ideally before starting on T3

What vitamin supplements are you currently taking?

Vitamin D is too low

GP will only prescribe to bring levels to 50nmol. But improving to around 80nmol or 100nmol may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Folate is low. Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Igennus Super B complex are nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

No ferritin test results?

[Batty1 in reply to SlowDragon]

Won’t he get palpitations taking 125 Levo and 20 mcg T3 even with it divided because of his high FT4 level?

[SlowDragon Administrator in reply to Batty1]

Possibly..

I would lower Levo by 12.5mcg and add 5mcg T3

Then in week lower Levo another 12.5mcg and add 2nd 5mcg dose 8-10 hours later

Retest in 6 weeks and review progress

[Nellups in reply to SlowDragon]

Hi SlowDragon

Thank you for all your help, but just trying to get my head around it all, you said to take a vitamin B complex for folate ? But what about the fact my B12 is high? Surly taking more would only make it higher or am I missing something ?

The other problem do I swap straight away to the new T4 tablets? Or just carry on for now with my French ones for which I still have 4 months worth and just sort getting my T3 correct first then look at changing to the new tablets? Just feel changing everything at once will caused more harm then good. I have always had different levels on different makes of Levo.

Also I am being told I cannot specifiy a make and just have to have what the chemist has in that month is that correct?

Thank you for all your help

[SlowDragon Administrator in reply to Nellups]

Is your B12 high because you supplement or because of B12 injections

Some pharmacies are more helpful than others. Usually small independent ones...

Get your paper prescription from GP and physically go around different pharmacies (or ring) until you find brand you need

Personally I would suggest you only make one change at a time

So adding T3 or change brand of levothyroxine

Only add one supplement at a time. Wait at least 14 days to assess before adding another

[Nellups in reply to SlowDragon]

Hi thanks for getting back I only take vit D better u spray I don’t supplement any other vitamins

I thought the same to change only one thing at a time so will start with the T3

[SlowDragon Administrator in reply to Nellups]

Just read you aren’t on any B12 supplements

I use to have high B12 too, no supplements

If other B vitamins are very low this can stop B12 being utilised

You may/ should see B12 levels drop if you add vitamin B complex.

Perhaps start with just half a tablet (Igennus Super B) for few days. If no adverse reaction, increase to one tablet per day (in morning after breakfast)

Remember to stop taking vitamin B complex a week before any blood tests

[Nellups in reply to SlowDragon]

Ok I understand I will try a complex B see if that helps, have you heard of these?

Lambert Methyl B Complex, 60 Tablets

Only ask as they always seem to be good products

I am struggling with breathing problems at the moment or though when at the gym I don’t have a problem maybe stress related ?

I will only start on changing one thing, I’ll start on taking the T3 this week and see how it goes

Thank you

[SlowDragon Administrator in reply to Nellups]

What’s your iron and ferritin levels?

Low iron can be linked to breathlessness

Lamberts methyl B look good

[SlowDragon Administrator in reply to Nellups]

How much levothyroxine are you currently on with this result?

Is your B12 high because of B12 injections or supplements?

[Nellups in reply to SlowDragon]

I’m on 125 Levothyroxine, and I don’t take any B12 supplements, I use better you Vitamin D

[cazlooks in reply to greygoose]

we always split the tablet, it's a bit messy and we clean out the pill cutter straight down our throat afterwards so's not to waste any lol. Seriously though, the theory is that because it's small and crumbly it won't split into equal halves, so you will get more in one dose than the next. We always take the larger half when we want to do something physical like go for a walk/have sex/make dinner, and the smaller half when we are sitting around doing nothing.

[helvella Administrator]

The Patient Information Leaflet for T4 (UK) says that final dose might be 100 to 200 micrograms a day.

That for T3 says that a dose might be 60 micrograms a day.

If we took both as being true, we would see a ratio of 3.33:1 potency of T3:T4 by weight.

(This "how much stronger is T3 than T4?" issue is really an ultimate non-issue. You need what you need. All it can sensibly do is suggest that you need to be careful.)

[warriorscot]

With levo if you are hypo and if you already need a fairly large dose it takes a lot to push you over so I wouldn't worry about the T4. My endo decided to get my tsh sub clinical and I've been fine with tsh basically zero and free t4 at above the clinical range with not a single sign of a negative reaction.

Honestly I've never had an issue with big changes, I went from 150 to 300 of levo and didn't notice much difference. I think generally there seems to be a move away from being overcautious with people that are already on pretty hefty doses, but still have symptoms and tsh showing hypo. Worst case it makes you a little hyper and it's not likely to cause harm short term and then at least there is an upper bound.

[SlowDragon Administrator in reply to warriorscot]

You are obviously lucky ...

Many of us have significant issues even reducing Levo by 12.5mcg..let alone 25mcg ....

[Angel_of_the_North]

That water thing is what the manufacturers say to sell more tablets (as you are supposed to throw the unused portion away) and is unnecessary. Just split the tablet with a craft knife, scalpel or pill cutter and start with just 1/4t tablet a day for at least a week, then 1/4 tablet twice a day and so on.

[Batty1]

Yeah this sounds like a setup to make you think T3 is bad... your doctor sounds like a real peach!

[Hidden]

Hey Nellups, I would be also lowering my t4 being that high and would introduce t3 very slowly. For me I had to go as slow as 2.5 for a week or two or more, then increase more. I'm taking 20 mcg of thybon after 6-7 months of increasing, but I had to go backwards a few times. I was not able to tolerate t3 over 10 mcg with t4 of 125 mcg so you will need to find that spot. When my t4 was over range like yours, I was able to add only 2.5 t3. Everyone has a different balance of t3 and t4.

[greygoose]

So, there you have it. No-one agrees that dissolving the tablet in water is a good idea, and the consensus is that you should start on 5 mcg T3, not 20 mcg.

As to reducing your levo, it does seem rather wasteful to keep taking 125 mcg when adding in T3. Your FT4 is rather high, and you don't need all that levo because you obviously can't convert it. So, I would lower it by 25 mcg, if I were you. The FT4 will go down anyway when you start taking T3. Quite how much T4 is needed varies from person to person, it's all trial and error, so the initial reduction of 25 mcg might be enough, or you might need to reduce it further in future, just see how it goes.

The first dose of 5 mcg is best taken at the same time as your levo. When you add in the next 5 mcg, you can take it whenever you like. That, too, is a very personal thing. Some people like to take it at bedtime, some at midday. But, whenever you take it, for maximum absorption, it's best to take it just as you would levo: on an empty stomach, an hour before eating or drinking anything other than water.

[Nellups in reply to greygoose]

Thank you greygoose, I will start slowly and lower my T4 I just need to get a pill cutter now.

[greygoose in reply to Nellups]

You're welcome.

[Sallyplum]

If you can split tablet do so. I normally crush my tablet completely and then divide the crushed T3 into half and take as directed.

I would increase by 10mcgs daily then increase to 20 rather than jump straight in.

I would certainly reduce you T4 because if you present with any hyper symptoms they’ll blame T3.

You can always increase T4 again if necessary once your body has adjusted to T3. I would reduce T4 quite considerably.

Other thing is support adrenal glands with supplements;

Magnesium

B5

B Complex

C

E

Since thyroid and adrenals work in sync. If adrenals not functioning very well then you’ll find difficulty tolerating increases T3.

Best of luck.

[HashiFedUp]

You might tolerate the doses - everyone’s different. Given my own experience however I would say that starting on a very low dose of T3 is wise and increase slowly and gradually. I started on just 10 a day of T3 and the side effects were awful. So went down to 5 and built up to 10 over a three week period. I did try splitting as well but found it was a bit of a faff lol.

I’d probably knock the T4 down to 100 to begin with too so you’re not over medicated.