T3 Dosage

[Donutlight]

Hello, I have a question about possible T3 dosage as some arrived in the post this morning. Part of taking charge of thyroid issues, Hashis, after spending so long feeling unwell. I am still under medicated and just started on 75mg of Levothyroxine 2 days ago after being on 50mg for 9 months. I'm wondering what a starter dose is on T3 or should I wait until I have been on 75mg of Levo for a while? By the way thanks for the heads up on the brands of 25mg Levo - I called the pharmacy and they switched the brand to North Star 50mg to break in half so I am not mixing diff meds. The Accord seems fine for me and I don't want extra issues.

[greygoose]

Have you had bloods done since being on 75 mcg levo? If not, I would wait until you can get those done before starting the T3. Do you usually get your FT3 tested? Because only be testing that will you know if you even need T3.

[Donutlight in reply to greygoose]

Results from last Friday, based on 50mg of Levo for 9 months.

TSH: 3.68 (0.23-5), FT4 15.2 (9-23%), FT3 4.1 (3.5-6.5).

TPO still 1300 which I believe is high and won't really change.

I probably won't test again for 8 weeks so I was wondering if a low dose, say 10mg might help now.

[greygoose in reply to Donutlight]

Those labs say you're under-medicated on levo. You should not have been left on 50 mcg - a starter dose - for nine months. It should have been increase to 75 mcg six weeks after starting it.

In order to see how well you convert, it's advised to have the TSH down to 1 or under, which will give you a higher FT4 and you can then compare it more reliably to the FT3. At the moment, both the FT4 and the FT3. The FT3 is only 20% through the range, but the FT4 is still well under mid-range at 44.29%. If you get the FT4 higher in range, that ratio might change for the better.

If I were you, I'd get an increase in levo before adding in T3, and see how it goes. It would be so much easier for you if you managed to do well on T4 only, given the present difficulties in procuring T3. And there's not point in starting T3 if you cannot guarantee your future supply.

[cheesephetamine in reply to greygoose]

out of pure curiosity, if those test results are all in range as the OP said, why do you says the OP is under medicated on levo? not being a pain just really wanting to learn

[fuchsia-pink in reply to cheesephetamine]

Because once you are on levo you want your TSH to be lower than that. Unless you are one of the very very unusual people who feels fine with a TSH that high! Most of us want a TSH no more than 2, and often under 1. And because there is plenty of "space" in the free T4 and free T3 ranges to accommodate an increase without going over-range.

[cheesephetamine in reply to fuchsia-pink]

Thanks! My TSH is 37 *facepalm*

[fuchsia-pink in reply to cheesephetamine]

Then I guess you must be feeling .... sub-optimal! Hopefully you're being medicated and monitored and start to feel better soon - but buckle up for a potentially long journey - it's baby steps in dealing with thyroid issues ... Good luck X

[greygoose in reply to cheesephetamine]

Because they are far too low in the range. It's not just about getting results into range, as most doctors think, it's about getting to a place in the range where the patient feels well. And, from experience, we know that a patient will rarely feel well with an FT3 only 20% through the range. It would need to be at least over 50%, probably between 75 and 100% - or even over the top of the range.

The mistake most doctors make is believing that they need to aim for what they believe to be euthyroid. And they believe that anywhere within the range is euthyroid. But, it most certainly isn't. A euthyroid TSH would be around 1 - certainly no higher than 2. And euthyroid FT4 and FT3 would be around mid-range - certainly not the bottom of the range. BUT, hypos usually need their FT4/3 higher than a euthyroid person - nearer the top of the range - which would cause their TSH to drop lower than 1, and often below range, or suppressed.

[cheesephetamine in reply to greygoose]

Thanks

[greygoose in reply to cheesephetamine]

You're very welcome. I hope that answers all your questions.

[SeasideSusie Remembering]

Donutlight

To know if you need T3 then you must be taking enough Levo alone to get your TSH down to about 1 or lower to see how much FT4 you are producing and how well the T4 converts to T3, so you need to have TSH, FT4 and FT3 all tested at the same time from the same blood sample.

As you've just increased your Levo to 75mcg then you should now wait 6-8 weeks (preferably 8 weeks) and test.

Also, before starting T3 our nutrient levels need to be optimal. So when doing the new thyroid test you should also include Vit D, B12, Folate and Ferritin. The cheapest way to do this, as your GP wont do all these tests, is to use one of recommended private labs:

Medichecks Thyroid Check ULTRAVIT medichecks.com/thyroid-func...

You can use code THYROIDUK for a 10% discount on any test not on special offer

or

Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk...

Post new results (with reference ranges) on the forum for members to comment and guide you if you need to add T3.

[Donutlight in reply to SeasideSusie]

Thank you, I'll put it away for a bit and try to get TSH down and T3 up on Levo for a while - as long as the gp is compliant!

[SlowDragon Administrator in reply to Donutlight]

Did you get folate and ferritin tested?

Also ....guidelines by weight might help push for dose increase

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.

gp-update.co.uk/Latest-Upda...

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Donutlight in reply to SlowDragon]

Thanks for this. I will take to the GP when he refuses to up my Levo from 75mg, which is pretty likely. I will test the F and F when I do the next tests (the last one was on the NHS).

[Bugbear123]

Hi I would wait until you get new bloods. You may not need it. The vast majority do well

on levothyroxine alone. Sadly I wish I was one of them. I take T3 only.

[archipoeta in reply to Bugbear123]

How much do you take, and how did you raise your dosage?

[SlowDragon Administrator]

Likely to need further dose increase in levothyroxine after this latest increase to 75mcg

Bloods should be retested 6-8 weeks after each dose increase

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Also note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Absolutely essential to regularly retest vitamin D, folate, ferritin and B12

When were these last tested?

What vitamin supplements are you currently taking?

Can see from other post you are already on strictly gluten free diet 😊

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

[Donutlight in reply to SlowDragon]

Hi, Magnesium citrate, D3 (4000) k2 - all taken together at night. Collagen in the morning. Active B12 test should be back by Friday.