I have decided to increase my T3 from 10mcg to 15mcg and decrease my Levothyroxine from 75mcg to 50mcg. What is the safe way to lower the Levothyroxine? Is it ok to just drop it by 25mcg straight away?
These are my latest blood results whilst on T4 75mcg and T3 10mcg.
TSH 0.022 (0.27-4.2)
FT3 4.65 (3.1-6.8)
FT4 17.200 (12-22)
Redporti
Why do you want to reduce your Levo?
Because I’m not converting well. My reverse T3 before starting Liothyronine was 48 (10-24). I understood that when you raise T3 you should lower T4. I could be of misunderstood that though.
Redporti
I explained in reply to your other post about reverse T3 being a red herring and with your FT4 that low then your high reverse T3 can't be due to unconverted T4, if it was your FT4 would be high (over range). Looking at all your results posted previously your FT4 has never been high enough to cause high reverse T3 so the cause is likely to be from one of the other reasons I listed previously.
From your original post on the forum when you were on just Levo, when you asked if you needed T3, your results were
TSH 2.11 mU/L ref range (0.465-4.68).
Free Thyroxine 15.0 pmol/L ref range (10.0-28.2).
Free T3 3.1 pmol/L ref range (4.3-8.1).
Your next post said your endo was starting you on T3 medication. Your original results showed that you needed an increase in Levo which would have lowered your TSH and increased your Levo, also increased your T3. It's difficult to understand why your endo started you on T3 with those results.
Reading through your other posts, there is nothing to show you need T3, and all replies to earlier posts suggested you need an increase in Levo.
Because I’m not converting well.
You can't really know that until you are on a sufficient dose of Levo to bring your TSH down to 1 or below which will give you your highest FT4 and then you can see how well you convert by comparing FT4 to FT3.
I understood that when you raise T3 you should lower T4.
Not necessarily. If your FT4 was high or over range you would reduce Levo a bit before adding T3. The addition of T3 is going to reduce your FT4 to some extent anyway, so if your FT4 is already low in range you wouldn't want to reduce Levo.
Thank you that makes sense. I was started on T3 because I still had lots of hypo symptoms on 75mcg of levo. My T3 was also in the bottom half of the range. My temperature is so much better since taking T3 which feels nice.
As Seasidesusie explained ....75mcg was low dose levothyroxine .....TSH was too high and Ft4 too low showing that at that stage all you probably needed was 25mcg increase in levothyroxine
Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
BMJ also clear on dose required
So by that calculation if I’m 50.3 kilo then I should be on 80.48 of Levo. So do I take it up to the nearest 25 or down?
Well as you are now on T3 ...it’s largely irrelevant...unless you want to try just levothyroxine
The point was ,....endocrinologist was jumping the gun ....as your results showed under medicated rather than poor conversion
You wouldn’t know if you were poor converter until on full replacement dose of levothyroxine
Certainly wouldn’t reduce levothyroxine
Keep an eye on Ft4 level at subsequent tests. If levels start dropping it suggests you might need dose increase in levothyroxine
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