Prescribing of Liothyronine.: Does anyone know... - Thyroid UK

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Prescribing of Liothyronine.

sobs1962 profile image
23 Replies

Does anyone know whether if it is decided at some point I actually need to be prescribed triiodothyronine whether it will actually happen or should an endocrinologist be trying to sort out my conversion problem if that is the problem. I have read about adrenal problems causing bad conversion and wondered if that is happening too as I suffer from chronic stress and have done pretty much all my life. I have sent my Medichecks blood test results to my GP practice and hoping they can help me get a telephone consultation with endocrinologist. Anyone here know and understand about adrenal insufficiency or "adrenal fatigue".

23 Replies
greygoose profile image

Whilst sorting out and rectifying poor conversion would be a wonderful thing, I very much doubt any endo has the knowledge or the skill to do so. Plus, it would need a lot of extra testing - and you know they don't like spending the money on that! And, sometimes, there doesn't seem to be any particular reason. Especially if you have Hashi's.

Certainly adrenal abnormalities could be the reason. But, then again, I had very, very low cortisol at one point, but perfect conversion. And there are very few doctors of any sort that know anything about adrenals.

Nutritional deficiencies can be another reason, and it's always good to optimise your nutrients for lots of reasons, but it won't necessarily improve conversion. Low calorie diets are another cause - so many hypos go on low calorie diets to try and lose the hypo weight, and I'm not sure if, in that case, it is reversible. So, very often it's just easier to take T3 - if one can.

in reply to greygoose

Yes, it seems counter-intuitive NOT to diet if you gain weight when hypothyroid. Many likely make that mistake. I didn't because I like food too much!

The harder you try to lose weight (usually without success) the more your body is likely to lower your already low metabolism even further, and the less weight you lose.

vocalEK profile image
vocalEK in reply to

And of course because the doctor has been taught that "calories in always equals calories out" s/he assumes that you have been cheating on your diet.

SlowDragon profile image

Until you are completely weened off propranolol, neither levothyroxine or T3 will work

jimh111 profile image
jimh111 in reply to SlowDragon

Propranolol is used in hyperthyroidism because it reduces T4 to T3 conversion. So, there’s no point in worrying about liothyronine until you have been off propranolol for a while.

SlowDragon profile image
SlowDragonAdministrator in reply to jimh111

sobs1962 is currently on 160mg propranolol

deekers1 profile image
deekers1 in reply to SlowDragon

hi this is Deekers and I would like to know more about the effects of Propopanal on the thyroid thanks everyone on here for help and support that you give I have been struggling with heart palps and weight gain since being put on it

Lora7again profile image
Lora7again in reply to deekers1

It does affect conversion and usually it is given to people who are hyperthyroid. What dose are you on?

deekers1 profile image
deekers1 in reply to Lora7again

100 mg have been hypo since I was 15 am now 74 as is with everyone on this site I struggle with proper dose have a good doc who works with me and will send bloods/ranges next week---but ever since going on propanal have felt worse went on it a few months ago after looooong caretaking of husband who eventually passed away--tried a couple other antidepressants but could hardly get out of bed--asked for something to perhaps give me more energy and was given this NOT working out I know my primary will agree with what I want to do am in the U.S--how do I slowly go off?

deekers1 profile image
deekers1 in reply to deekers1

would bupropion be better

sobs1962 profile image
sobs1962 in reply to Lora7again

I am on 160mg (prolonged release) and have been on it since January this year and desperately want to come off it quickly,have done some research and would like to potentially start taking a natural supplement called Ashwaganda. Anyone know about this,any help would be appreciated.

in reply to sobs1962

Just because something is classed as "Natural" it doesn't mean it is necessarily safe or good for you.

Especially note (Emphasis added) :

"Risks. Talk to a doctor before using ashwagandha if you have any health conditions, including cancer, diabetes, thyroid problems, bleeding disorders, ulcers, lupus, multiple sclerosis, or rheumatoid arthritis. Ashwagandha might interfere with thyroid tests. Stop taking ashwagandha two weeks before surgery.

Interactions. If you take any drugs or supplements regularly, talk to your doctor before you start using ashwagandha supplements. They could interact with sedatives, blood thinners, thyroid supplements, drugs that suppress the immune system, and drugs for anxiety, high blood pressure, and diabetes. Ashwagandha might also interact with supplements that cause sleepiness, like St. John's wort, kava, valerian, and others."

Also it isn't recommended if you are pregnant or breastfeeding.

SlowDragon profile image
SlowDragonAdministrator in reply to deekers1

Propranolol slows conversion and uptake of levothyroxine.

It’s used to control hyperthyroidism

It shouldn’t be used on anyone taking levothyroxine.

It can also lower adrenal hormones so you need to ween off very slowly.

I found I could manage 5mg drop in daily dose of propranolol every 10-14 days.

deekers1 profile image
deekers1 in reply to SlowDragon

thank you SlowDragon would Wellbutrin be better am looking for anti depressant that fits with hypothyroidism and maybe now that some angst is lower---to go off of them altogether

SlowDragon profile image

You need to be extremely careful reducing propranolol very very slowly

jimh111 profile image

If you need something to regulate your heartbeat your doctor needs to prescribe something that doesn’t affect thyroid hormones. If you don’t do so already it’s a good idea to take a magnesium supplement as it helps the heart and IBS.

silverfox7 profile image

Just as an aside I had a conversion issue and asked to have ViT D, B12, folate and Ferritin tested. Vit D was on the floor as was folate and it took a long time to get them optimal, not just in range but it completely reversed my conversion issue and I’ve not looked back since. If taking VIT D you need to take the co factors K2 and magnesium but your general health improves as well. It is easier, and more expensive, to add in T3 but that doesn’t always work if vits etc are low so also think about that as well, particularly if you have to fund your T3.

I don’t have antibodies so that may have helped me-I don’t know but to me it makes sense to do what also helps you generally first.

YSpencer profile image

After pestering my GP for years for T3 he finally agreed to give me a private prescription but told me l had to source it myself however he was prepared to monitor me. After help from an independent chemist l got my T3 and after trial and error l arrived at my perfect mix of T and T4. When l saw my endocrinologist she was very pleased and wrote to my GP saying l should have the T3 added to my regular repeat prescription. My GP however refused as he said he had to prove it had made a difference to me. He also said the cost would come out of his budget not the hospitals, which enforces the idea that refusal is down to cost not whether it works or not.

GKeith profile image
GKeith in reply to YSpencer

I am in USA & if a specialist prescribes something for a referred patient it is the law here that it WILL be filled.

helvella profile image
helvellaAdministrator in reply to GKeith

Not so in the UK, as I understand.

Each person who prescribes has to be persuaded that it is medically appropriate. Otherwise, it is argued, a GP would be signing something for which they are responsible without the option to refuse. If there were something wrong, they should shout and not silently acquiesce.

I am quite sure many GPs prescribe things they have no idea about simply because a consultant advises them to do so. But if the responsibility for prescribing effectively transfers to the GP, and with issues of budgets, they are far less likely to do so.

GKeith profile image
GKeith in reply to helvella

You mean a specialist doesn't write the prescription? Here the specialist is, let's use the word above, the GP, as far as prescriptions. Makes sense does it not? If a GP does not know anything ( and 99% of them don't) about the endocrine system why would, how could he NOT refer patients to a specialist? Personally, I believe that you, in my case myself, need to put the "fear of God" in any doctor who has anything to do with the medical system if he does not do his job, which is to cure his patient, period! God help us these doctors are too Capitalistic & our systems are becoming more & more broken everyday. May God's Peace be upon us all.

SlowDragon profile image

Vitamin D needs good magnesium levels

Vitamin K2 mk7

Eddie83 profile image

I cannot recommend endos. So many of them adhere to the (incorrect) M.D. Party Line about treating thyroid. My suggestion is this. Gradually increase your Levo dose towards your therapeutic dose, which is on the order of 1.5mcg/kg body weight. If you cannot reach a therapeutic dose without feeling nasty symptoms like anxiety/palpitation/etc., then consider taking liothyronine along with levothyroxine. You need to have an FT3 (free T3) test, and gradually increase dose of Liothyronine until you have reached the middle of the FT3 range, which is 2.77-5.27pg/ml at the lab I use.

In addition to all the other things (e.g. vitamin C) which adrenals require, they also require a decent level of T3 to function well.

Adrenal testing isn't done much by M.D.s. They don't understand the relationship between thyroid and adrenals. If you cannot afford/do not have access to saliva adrenal testing, which samples your levels over the course of a day, then you could ask your M.D. for a 24-hour urine cortisol test. The 24-hour test would at least tell you if you are putting out a normal amount of cortisol each day, although it cannot tell you if your adrenal rhythm is wrong.

If you suspect your adrenal rhythm is wrong but you cannot get testing, you could experiment. Years ago, Jeffries told us that taking hydrocortisone at doses of 20mg or less daily, is safe. If you can get hold of hydrocortisone tabs, you could try taking HC in a descending pattern (10mg am, 5mg noon, 2.5mg late afternoon) to see if you feel any better. The descending pattern of dosage is discussed by a lot of naturopaths/functional medicine types/etc. in youtube videos and various health boards. You probably won't find an M.D. to support you in doing this; after I got sick of M.D. bullsh*t, I did it on my own until I felt like I was recovered. I am not taking HC now.

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