Slow release T3

[Nessynu]

Hi all. I've been reading about the Paul Robinson circadian rhythm method and was wondering if anyone has a list of T3 brands that are slow /quick release? I'm currently on Thybon Henning T3 only meds but I've no idea if it's fast or slow release as the entire leaflet is in German!

[SlowDragon Administrator]

It’s not slow release .....hence many people take as split dose 2 or 3 times a day

[Nessynu in reply to SlowDragon]

I taught as much. Thank you Slow Dragon. I get heart palpitations on it regardless of whether I reduce or up my dose. I can't access the full thyroid blood tests from Blue Horizon in Ireland at the moment due to Covid so I've no idea what's causing my palpitations.

[Suzi_ in reply to Nessynu]

Sometimes changing a brand helps.

[Nessynu in reply to Suzi_]

Thank you Suzi. It was very difficult to even get the brand I'm on so it's probably not an option for me.

[Suzi_ in reply to Nessynu]

Did u mention the reaction u r having to your doctor?

Here in USA, I send a message to my dr on the app and he replies pretty quick.

[Nessynu in reply to Suzi_]

I did. He said I could be going overmedicated so I've been reducing it for the last 10 days but still have palpitations. My doc only tests the usual Tsh and T4 so no point in getting those tested and unfortunately the private bloods I was getting have been suspended due to covid.

[HMBradley53 in reply to Nessynu]

Are you splitting the dose?

[Nessynu in reply to HMBradley53]

I am. I was splitting the dose 3 times a day and increasing slowly as per docs instructions but I started loosing too much weight and getting loose stools so I've started reducing over the last 10 days. I feel my dose is too low currently and this may be causing my palpitations so I'm slowly increasing again. I really need bloodwork done as I'm playing a guessing game at the moment.

[SlowDragon Administrator in reply to Nessynu]

Bloods should be retested 6-8 weeks after constant unchanging dose and unchanging brand of levothyroxine and T3

[Nessynu in reply to SlowDragon]

Unfortunately slow Dragon getting the correct full bloodtests is not an option at the moment. I've search everywhere and no-one is providing this service as a stand alone option during covid. I'd have to get an appointment with a functional nutritionist first, €180 and bloods another €210 and then back for the results €150. I will have to wait until Blue Horizon restart the blood tests.

[SlowDragon Administrator in reply to Nessynu]

Can you not order DIY fingerpick test via Blue horizon in Ireland?

[Hidden]

I think all slow release T3 pills have to be compounded by a pharmacy as per doctor´s specific instructions, so not commercially available. I know some functional doctors in the US prescribe SR T3, but I have not heard of doctors in Europe that do...may exist though.

[Nessynu in reply to Hidden]

It's definitely more difficult to get compounded thyroud meds in Ireland. The US have some of the best thyroid doctors. Chris Kresser, Isabel Weintz etc. I think I need to move to the USA to feel better lol !

[Hidden in reply to Nessynu]

Yes, it´s true, every time I read an enlightened article about the treatment of thyroid disease, adrenal fatigue, menopause etc it´s always by a US doctor. It´s no coincidence that all good supplements are made there...!

[Batty1 in reply to Hidden]

Im in the US and just because your reading these excellent articles about treatment from excellent US Endos doesn’t mean the vast majority of us ever receive anything remotely close to excellent treatment .... Im thyroid-less and 7 endos have allowed my health to deteriorate, I can’t even get the FT3 test because its deemed useless.

[Hidden in reply to Batty1]

Yes, I am sure those great docs are few and far between, and most of them are not even endos as far as I know, but functional/alternative/natural/osteopathic doctors. And I am convinced that, in a country the size of the US, there are not enough of them...! And I am equally convinced the few practitioners you have charge a lot for their services, so I can imagine not affordable for everyone.

It´s just that, when you read articles by Amy Myers, Alan Christianson, Isabella Wentz, Chris Kresser, Westin Childs, Christiane Northrup, David Brownstein, the late Dr. Lowe...you wish you had more doctors like that in Europe. I really liked the book "Your thyroid and how to keep it healthy" by UK doctor B. Peatfield, but I understand he gave up his licence to be order to continue to advise patients without being bullied by the NHS...?

[Nessynu in reply to Batty1]

Wow. Im sorry.i just ment that at least you have the option (finance permitting) to at least try to get an appointment with the likes of Chris Kressor. For me it would mean flying to the US for a prolonged time to await blood test results etc.

[Batty1 in reply to Nessynu]

Its fine and yeah not many if any of us In the US would have the option to see any of these doctors and I would shudder to think of the after care cost with these people.

[Nessynu in reply to Batty1]

It must be so frustrating to know the there are these doctors are in you country but the cost of seeing them is too much for most of us afford. All we can do is keep researching and saving to find our own root causes.

[Hidden in reply to Nessynu]

I recently played with the idea of making an appointment with Thierry Hertoghe´s clinic in Brussels. I contacted the clinic and was told they have no waiting list which sounded good, but they do require new patients to fill in lots of questionnaires before the first appointment, plus have bloodwork and a 24 h urine analysis in advance and then bring the results to the first consult.

I had a shock when I saw the price list...300€ per consult, and the first time you will have two consults in one day so 600€ in one go. I could only find one lab where I live doing all the tests required, incl a 24 h urine analysis, and the cost of that would amount to +/- 1000€. Add travel cost and accomodation, and we are easily talking about 1500-2000€ for just one consult...I would then be requested to come back for follow-up consults every 6-12 months.

The reason I considered seeing a doctor there was because I wondered if NDT would be something for me, but it turns out that would cost me another 1500-2000€ a year (depending on dose), and it´s not covered by health insurance as considered "organ therapy" . Several of the tests they order are not covered by health insurance (DHEA, pregnenolone, growth hormone, testosterone in women), neither are the corresponding drugs. So, this could easily end up costing a fortune.

I understand these doctors have to make a living, but I cannot help but feel that it is not right to take advantage of desperate people. If all doctors ordered comprehensive hormone panels, and were willing to treat adrenal fatigue and prescribe whichever thyroid hormone replacement the patients feel best on, those alternative doctors would not be able to continue to charge fantasy amounts...they are only able to do so as long as they have no competition. It doesn´t feel right. Are all the patients in such clinics millionaires...???

Also, but this is a detail: I read that a 24 h urine analysis is not the best way to determine for instance adrenal status, since it will only show the average cortisol levels over 24 h. So, if you have low cortisol in the morning and highish at night (common in stage 2 of adrenal fatigue), that won´t show up. It seems a DUTCH test or 24 h saliva test will give a much clearer picture of your adrenal status. When you spend this much money on tests, why not order them instead of a 24 h urine analysis...?

[Nessynu in reply to Hidden]

So true PurpleCat. Seeing the best doctors or functional docs seems out of reach for most people. If I were a woman with wealth I feel that I my Hashimotos would be well managed by now! Frustrating!

[Nessynu in reply to Hidden]

I hear ya PurpleCat!

[Lalatoot]

Please note what Paul Robinson says about his method:

'Thyroid patients should not attempt to use the CT3M unless they know with confidence that they have low cortisol. '

[Nessynu in reply to Lalatoot]

Thanks for this information. I will be getting my cortisol tested soon.

[SlowDragon Administrator]

How much T3 are you currently taking

Are you taking levothyroxine as well

When were vitamin levels last tested

These need to be optimal BEFORE adding T3

If you have Hashimoto’s or Graves’ disease are you on strictly gluten free diet

[Nessynu in reply to SlowDragon]

I'm currently taking 10mg in the morning, 5 afternoon and 5 in the evening. I don't take any levo. Irs been a while since my vitamins were tested and as I've Hashimotos I'm totally gluten and dairy free over 1 year.

[SlowDragon Administrator in reply to Nessynu]

What dose of levothyroxine were you taking BEFORE T3 was added?

That’s a tiny dose of T3 for someone ONLY on T3

It’s the sort of dose to take alongside levothyroxine...in fact that’s EXACTLY the dose I take and how I split it ....but alongside 100mcg levothyroxine

Essential to maintain optimal vitamin levels too ...likely to drop fast if very under medicated

What vitamin supplements are you currently taking?

[Nessynu in reply to SlowDragon]

I was taking 75 m of eltroxin for 2 years with symptoms getting slowly worse but because my bloods were spot On! my doc would not increase. I slowly reduced t4 and added t3 until I ended up on t3 only. I also feel that I should be on both t3 and t4. It's doable as my regular Doc will still prescribe t4 and I'm getting my t3 from a different doc. Needs must! I only take B12 and vit d daily as my diet is very good( lots of fruits and veggies and no processed foods at all but as I'm not working due to feeling so bad I've struggled to afford vitamin tests. I'm thinking of starting back on levo at 25 ml and t3. How do I safely reintroduce t4?

[SlowDragon Administrator in reply to Nessynu]

Depends on where Ft4 in range before you added T3 ....if levothyroxine needed reducing at all.

For example if Ft4 was 24 (12-22) then generally dose levothyroxine would be reduced by 25mcg and 5mcg T3 added. After 1-3 weeks second 5mcg T3 added mid afternoon....bloods retested 6-8 weeks later ...before making any further changes

If Ft4 was 16 (12-22) levothyroxine probably wouldn’t need reducing at all....would just add T3 as above

Suggest you just back start on 25mcg Levothyroxine,

assuming after 2-3 weeks that’s going ok, increase to 50mcg and hold at that for 6-8 weeks then get FULL thyroid and vitamin testing

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

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 half or third of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

75mcg levothyroxine was low dose, unless you are extremely petite

Please add results from when just on levothyroxine

[SlowDragon Administrator in reply to Nessynu]

When hypothyroid nutrient absorption is very poor, hence low vitamin levels extremely common....however good your diet is

Essential to regularly retest vitamin D, folate, ferritin and B12

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[Nessynu in reply to SlowDragon]

As always slow Dragon your a wealth of very safe and practical information! I will be starting back on 25 levo tomorrow morning. I am petite (7st 10lbs and 5ft 2inch) . I will post my last results in the afternoon. Thank you.

[SlowDragon Administrator in reply to Nessynu]

So you may not need much levothyroxine

45.3 kg = 72mcg levothyroxine (on just levothyroxine)

With taking T3 as well, you may not even need 50mcg levothyroxine....

Perhaps start at 25mcg Levothyroxine daily see how that is. Perhaps test after 6-8 weeks before any further increase

Depending on results and how you feel

possibly increase to 25mcg/50mcg alternate days ...then test again after further 6-8 weeks

[Susieg1]

Just FYI, if you have a smart 'phone, or access to one, you can go to Google translate and use the camera option to translate the instructions.

[Nessynu in reply to Susieg1]

Thank you Susie. This is a good option.

[Kimkat]

Would the book be any use to someone that has had RAI?

[Nessynu in reply to Kimkat]

I'm not sure but doing an AIP elimination diet would be a great start.

[Kimkat in reply to Nessynu]

Sorry what is AIP?

[Nessynu in reply to Kimkat]

Autoimmune protocol diet. Google Dr Isabel Weintz( thyroid pharmacist) and check out her advice on the aip diet. I think it would be great for someone with RA.

[Kimkat in reply to Nessynu]

Thank you 😊

[asidist]

Other folks on here can probably speak to this better as my memory tends to be able retain just the main take-aways and not much else, but I too was having persistent palpitations that I was interpreting as a sign of over-medication but read on on this board and then elsewhere that palpitations can actually be caused by low (or maybe more accurately, not enough) ferritin/iron. It sounded odd but I began supplementing regularly again and it helped tremendously. I’ve since then been able to raise my dose several times without issue.

[Nessynu in reply to asidist]

Thank you Asidist. I got my ferritin tested a few months ago and my doc said it's good but he also thinks my iron us a bit too high. I've requested a copy of my results as their interpretation of good or too high is questionable as we all know!

[asidist]

Ha, exactly! My understanding is the target for ferritin is at least 70 but preferably closer to 90 ng/ml (US range, not sure how that translates in terms of the UK range), which is far above the start of the range and far above what I’ve been told is “good” in the past.

If insufficient ferritin isn’t the easy answer to your palpitations I hope you find what is!

[Nessynu in reply to asidist]

Thank you Asidist. I'm one determined Irish girl that won't give up searching for the cause!