Im about to start Tiromel and Im a little uncertain about dosage and timings.
I take 125mcg of levothyroxine and my recent blood test was.
TSH 0.78. (0.27-4.2)
T4 15. (12-22)
T3 3.42. (3.1-6.8)
I know to go low and slow and probably best to divide dose in two each day. My initial thoughts were reduce levo to 112.5 and add 3.1 t3 twice a day. I have a good tablet cutter so Im hoping its possible to cut it into such small amounts.
Is this a good starting point and if so when would I increase t3 again and would I reduce my levo again at the same time.
I take my levo at 7am would this be a good time to take the first t3 but how many hours later is best for taking the second dose and do I need to take it before food like I do for levo.
Blood tests dont mean much to me, according to my doctor my results are great but Im far from it, and going on how I feel is what matters but I am curious what good levels would look like and how do you work out how far you are through the range.
Sorry for all the questions but any advice would be greatly appreciated .
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AS14
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First of all, there's no need to reduce your Levo dose. Your FT4 is already very low in range (30% through range) and I would have thought it would be best to get that higher up in range before adding T3. But if you're going to start T3 now don't reduce Levo.
Start T3 by adding 1/4 of a tablet (I don't think you'll successfully cut into 1/8ths but you can try). You can take it with your Levo in the morning. Stay on this dose for 2 weeks, if everything is OK add another 1/4 of a tablet, so 1/4 in the morning, 1/4 in the afternoon. Again, stay on this dose for 2 weeks, then add a third 1/4 of a tablet, so 1/2 in the morning and 1/4 in the afternoon. Personally I would then stay on this dose for 6-8 weeks then retest, see how you feel and what your FT4 and FT3 are (your TSH will very likely have lowered).
You may find that FT4 has lowered and it's quite likely that the low level of FT4 is too low for you, in which case rather than add more T3 I'd be inclined to increase your dose of Levo.
Some of us do fine with a low FT4 and upper range FT3, some of us need FT4 higher. Personally I need both FT4 and FT3 to be around 60-70% through range. It's very individual so you need to take your time, take it slowly, keep testing after every dose change (after the initial retest) and assess how you feel. It can be a long, frustrating process. Just to illustrate that, I originally slowly titrated up to 31.25mcg T3, after many, many months and lots of tweaks of both T3 and Levo, I finally settled on 12.5mcg T3.
This is new to me so please excuse my ignorance but I was under the impression that when adding t3 you always reduce your levo a little. If I leave the levo alone wont that make me over medicated ?.
If you are feeling unwell and under medicated with low ft3, adding a small amount of t3 could possibly correct this. Many people increase levothyroxine first to raise levels to the top or above range to try and improve ft3 levels. In that situation lowering levothyroxine would be sensible. In your case you are symptomatic, with lowish ft4 and by making 2 changes at once it will be difficult to assess the effect of the small amount of t3.
I was under the impression that when adding t3 you always reduce your levo a little. If I leave the levo alone wont that make me over medicated ?.If your FT4 was over range or at the top of the range then you would lower your dose of Levo before adding T3. Yours is only 30% through it's range, and taking T3 is going to lower your FT4 because that's just what it does.
Your FT4 level is so low that even that level could be causing you symptoms as the aim of a treated Hypo patient on Levo only is for FT4 and FT3 to be in the upper part of their ranges, so looking at your current FT4 and FT3 results I would say increase your Levo to get your FT4 a lot higher in range before even considering T3.
SlowDragon quoted part of an article by Dr Toft, past president of the British Thyroid Association and leading endocrinologist, who states in Pulse Magazine:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
So really, increasing your Levo at this point, to increase your FT4 which will also increase your FT3, is what would be expected.
So it's up to you whether or not you add the T3, but you certainly don't want to lower your dose of Levo.
Your FT4 is low and you have room to add more levo, so long as your conversion is good that should in turn raise your FT3.
Personally I would go down that route before adding T3....it's most likely all you need.
Have you had vit D , vit B12, folate and ferritin tested?
They all need to be optimal in order to support thyroid function/conversion of the storage hormone T4 to the active hormone T3 which is necessary to trillions of cells in the body
You can use this calculator to work out how far through the ref range your results are
Thank youIve been posting here for a while and its been pointed out to me on several occasions Im not converting well, and that my t3 needs to be higher.
Ive tried increasing levo but it doesnt matter what dose Im on it makes no difference to my t3 and hardly if any to my t4.
My gp says my tests are within normal range but did say I look hypo, and was pretty shocked by the state of my skin and hair but nope Im in range so all that counts. Endocrinologist said theres no proof t3 works so wont discuss it.
My symptoms are severe, Im literally bed bound by them and after a year of this Ive had enough .
My t3 is very low so it makes sense to me that trying to raise it could help.
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Blood results with 100mcg T4/25mcg T3
Reduce t4 to increase t3? 
Adding in more T3/Reducing T4
T4 / T3 Combo
T3 doses 
