T3 problems

[fiftyone]

what are the main problems people experience when reducing levo dose but adding T3 supplement instead.

[helvella Administrator]

Two major issues. First, getting hold of an adequate and reliable supply of T3. Second, getting appropriately tested.

I realise these are probably not the issues you are asking about, but they have to be addressed before it is sensible, or even feasible, to go onto a combination medication regime.

[SlowDragon Administrator]

Making sure vitamin levels are optimal BEFORE starting on adding T3 can make transition easier

Starting extremely slowly....2.5mcg T3 (1/8th of 20mcg tablet)

What are your most recent thyroid and vitamin results and ranges?

Couldn’t see any recent results on previous posts

TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

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

Testing 6-8 weeks after each dose change

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 1/2 or 1/3rd of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

[BadHare]

I haven’t taken T4, but have switched from NDT to T3 only. First day I foolishly took no NDT & a whole 25mcg T3. I had sufficient energy for a big day out with a 4am start. At bedtime I noticed I had rapid heartbeat so reduced dose to half a tablet for the ten days then increased by a quarter until I felt ok. I’ve been cautious swapping backwards & forwards since & often nip my T3 in to (somewhat inaccurate) eighths as I dislike being hyper. I can’t afford the extra food I eat & hate that it interferes with sleep. Being slightly underdone just means I need an afternoon or evening nap so increase T3. As soon as my lips need lip balm more than twice daily I know I need more NDT.

[fuchsia-pink]

My endo had an unconventional approach [that's me being kind :)]

He put me straight onto 40 mcg of lio - one 20 mcg tablet first thing and another 12 hours later. Six weeks later - perhaps realising this was not right - he halved the lio to 1 x 20 mcg tablet ... At the same time levo decreased from 125/150 mcg to 50 mcg.

I suffered when the dose was suddenly halved with joint and lower leg pain, but this only lasted a few weeks, presumably while my body adapted.

So I would be inclined to follow the advice usually given here: low and slow - so you start T3 on a low dose - 1/4 or 1/2 a tablet - increasing gradually, while decreasing levo slowly as well to compensate.

[Lalatoot]

Do you need to reduce your levo dose? We need to reduce our dose only if our ft4 is near the top of the range. Otherwise I personally would leave levo at the same dose and introduce t3 slowly.

My levo and lio are on NHS prescription so I cannot self medicate as much as I might do. When I started on t3 my ft 4 was 60% through the range, tsh at bottom of range and Ft3 16% through range. I was on 100mcg levo. Endo prescribed 50mcg levo and 20mcg lio. I slowly reduced levo and introduced lio.

My ft4 ended up 0% through the range and although Ft3 was good, I felt terrible as I needed higher ft4.

If you have to reduce levo I'd say only by 25mcg.

[Hidden in reply to Lalatoot]

Hey Lala, I'm going a bit of research after dropping my t4 dose, feeling dreadful 4 weeks in now. When your ft4 was low, but ft3 high, what did you experience exactly symptom-wise?

[Lalatoot in reply to Hidden]

Symptoms I had seen go came back. Lack of energy. Cold. The worst was the sore throat with the stiffness at front of neck along with a very husky croaky voice.

[Hidden in reply to Lalatoot]

Sounds a bit like me, thank you for answering so fast. I'm hot/cold, tired, bloated, twitchy and I feel spaced out? So strange. My t4 only has dropped to under midrange though. I couldn't tolerate more than 15-17.5 t3 on 112 t4 for some reason. Afraid to make a move toward more t3 and less t4 to be completely honest as I feel like I'm losing my mind

[Lalatoot in reply to Hidden]

Now I have upped my levo the throat and voice are normal. I still get cold and achy if I do too much.

[Hidden in reply to Lalatoot]

I see, that's a good sign though. I can't seem to figure out the balance at all.

[Lalatoot in reply to Hidden]

It is a slow process. Sometimes we need need to wait for the body to catch up rather than constantly changing doses of one or the other after every blood test. And then if symptoms linger we need to look at where our frees are through their ranges to decide whether to alter lio or levo.

[Hidden in reply to Lalatoot]

It's really hard to know when we should change and it's enough waiting. Anytime I decrease t4 I get new symptoms, some of which t3 is struggling to resolve. And of course under and over symptoms are almost identical and labs are useless

[fiftyone]

that's interesting. levo t4 is way above range. range ends at 16 and my t4 is about 25. I feel very well and if I reduce my levo even by 25 I begin to feel rotten with a week. My t3 is normal though, highish but normal.

[SilverAvocado]

I think maybe your question is a bit broad, and has been interpreted in a few different ways by different posters.

I assumed you were asking about how some people have trouble introducing T3 in the first place? It can make people have hyper-like symptoms, feeling speedy, palpitations, hot temperature, etc, even though they know they aren't overmedicated.

For this reason it's a good idea to start very low with T3 and increase slowly. A standard size increase of T3 is about 5-10mcg. It's better to start at the low end or even half that if you've never tried T3 before. And if you have any problems, cut back and try an even smaller increase in a few weeks time.

As others have mentioned, chances of having a bad reaction are reduced if vitsmins are already good, and also if you're already fairly well and your current thyroid results suggest you are quite adequately replaced. The speedy feelings are said to be caused by weak adrenals, which suggests the adrenals are already overworked by long term illness.

Anecdotally from my own observations on the forum it tends to be people with very very undermedicated looking results who really struggle with this.

[fiftyone]

thank you for the information. I may be given T3 supplement in order to bring down my high T4 level, but I'm worried my T4 will be greatly reduced but I may not be given enough T3 to make me feel well.