T3 Liothyronine

[RhodeHaw]

Having taken Levothyroxine for 10 years I now find that it is not working for me. Is it correct that an endocrinology doctor could prescribe T3(liothyronine) for me?

[helvella Administrator]

You don't say where you are? Liothyronine is not readily available in some countries.

Assuming the UK, an NHS endocrinologist could prescribe Liothyronine if they were persuaded that it is appropriate. However, far from all endocrinologists would do so. Even if prescribed by an endocrinologist, getting ongoing prescriptions through your GP can be a problem.

However, there are many other things to check before getting an appointment with an endocrinologist.

Have you had any blood tests to check other issues? Such as iron deficiency? Or low vitamin B12?

Let us know and you will get replies.

[RhodeHaw in reply to helvella]

Thank you. Yes I am in the UK, England. I recently had a blood test which showed that my TSH level was slightly depressed. In the past I have had blood tests which say that my iron levels were good. I don’t know about my B12 level but I do eat a healthy mixed diet.

[helvella Administrator in reply to RhodeHaw]

A depressed TSH level would ordinarily indicate high thyroid hormone levels (FT4 and FT3).

However, there are other possibilities such as central hypothyroidism (also called secondary and tertiary hypothyroidism).

A decent diet is a pre-requisite for adequate B12. But not sufficient - you also need to be able to absorb the B12.

If you have test results, feel free to post them. If you do not, you should consider asking your surgery for a copy of your results. (You also need the reference intervals/"normal" ranges.) You are entitled to these.

[RhodeHaw in reply to helvella]

Thank you for that I shall request the results. My hypothyroidism is due to the fact that my hypothalamus is not working properly probably as a result of extreme stress, so I am not sure how this affects my treatment.

[helvella Administrator in reply to RhodeHaw]

Ah! Central or tertiary hypothyroidism. Yes - that makes sense of low TSH.

[RhodeHaw in reply to helvella]

Thank you. Can I take that to my doctor and/or endocrinologist? Do you think that T3 might help?

[RhodeHaw in reply to RhodeHaw]

I am still working on getting your article up. I think I am signed up to Dropbox but your link has now disappeared off of this site!

[helvella Administrator in reply to RhodeHaw]

You can certainly take it - but whether or not they take notice is another matter. Sadly.

We probably would like to see what your current state is before expressing any opinion on your need and whether T3 would be appropriate. It is certainly possible that T3 would help.

[RhodeHaw in reply to helvella]

I have now got my Dropbox sorted out and I have read your article. It is a good read, thank you for all your help.

[shaws Administrator in reply to RhodeHaw]

When you get a blood test for your thyroid hormones do you follow the recommendation of 'how to get the best result' from a blood test for thyroid hormones:-

1. The earliest possible appointment.

2. A fasting test and allow a gap of 24 hours between the last dose and test and take it afterwards. This helps keep the TSH at its highest and it drops throughout the day. It seems the majority of doctors only look at a TSH result (this is from the pituitary gland) and a Free T4 and Free T3 test gives us a better information but rarely tested.

[RhodeHaw in reply to shaws]

Thank you for that helpful advice, I did not know that.

[SeasideSusie Remembering in reply to RhodeHaw]

RhodeHaw

My hypothyroidism is due to the fact that my hypothalamus is not working properly probably as a result of extreme stress, so I am not sure how this affects my treatment.

In that case the TSH signal is not getting through to your thyroid so your dose of Levo should not be determined by your TSH level. You need FT4 and FT3 results and that is what should be used to determine your dose.

How much Levo are you currently taking?

Have you ever had FT4/FT3 tested?

[RhodeHaw in reply to SeasideSusie]

My dosage goes up and down but it is currently 150mg - is this high or low or average for female?

[SeasideSusie Remembering in reply to RhodeHaw]

RhodeHaw

Everyone needs what they need so there is no average for a female. It's unusual for anyone to be optimally medicated on a dose lower than 100mcg, it's not too often that we see doses over 200mcg, but of course there are always exceptions.

What is the change of dose being based on?

Do you get a print out of your test results every time (very important)?

Do you always do your thyroid tests under exactly the same condition every time so that your results are comparable?

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* Last dose of Levo 24 hours before the test, take that day's dose after the blood draw. This is because if you take your Levo before the blood draw the test will measure the dose just taken and show a false high. If you leave longer than 24 hours the result will show a false low.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[RhodeHaw in reply to SeasideSusie]

Thank you. I have received so much helpful advice here today that I have never come across before. I generally have found that the GPs and Endocrinologists that I have seen over the years have not had a lot of time or sympathy for this medical condition.

[SeasideSusie Remembering in reply to RhodeHaw]

RhodeHaw

I generally have found that the GPs and Endocrinologists that I have seen over the years have not had a lot of time or sympathy for this medical condition.

Aint that the truth! They think one little white pill per day will make everything fine and dandy - so far from the reality

[SlowDragon Administrator]

Email Dionne at Thyroid uK for list of recommend thyroid specialist endocrinologists who will prescribe T3

[e-mail]

But BEFORE considering booking an appointment

We ALWAYS Recommend getting FULL Thyroid and vitamin testing done

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you always get same brand of levothyroxine

What vitamin supplements are you currently taking?

When were vitamin levels last tested?

Please add any recent results

Or come back with new post once you get results

[RhodeHaw in reply to SlowDragon]

Hi there, thank you for this information. I always get the same brand of Levothyroxine. I have never had my vitamin levels tested. Last month I had my usual GP check up which was T4 T3 and TSH. I do have a telephone appointment with my Endocrinologist in November. I have asked him for T3 before and I get the standard reply, as with my GP, that T3 is not necessary because the body converts T4 to T3 and then there is the cost! It is so annoying that the medical profession have not stood up to the manufacturers and demanded that the price goes back to what it was before. I am at my wits end because my Levothyroxine no longer works for me. I am totally exhausted all the time. I cannot walk more than 100 yards without stopping to rest. I have to walk out of the supermarket with exhaustion. I do not know whether I am hungry all not. My face keeps swelling up and my weight goes up and up. I have put on three and a half stones since January and when I fast in order to lose weight, as dieting does not work, days of not eating makes my weight go up even more so. My GP just laughs when I tell him this, he does not believe me! I am feeling so ill all the time I just feel like ending it all, this is why I have joined this site, and I am so grateful for all the replies that I have been getting.

[SlowDragon Administrator in reply to RhodeHaw]

First step is to get all four vitamins tested....frequently they are EXTREMELY low

It’s chicken and egg. Poor conversion causes low Ft3. Low Ft3 causes low vitamins

Low vitamins causes poor conversion

Before considering adding T3 you will need all four vitamins at OPTIMAL levels

T3 is not a walk in the park to manage.....important to have ducks in a row first

Come back with new post once you get Vitamin results

What vitamin supplements are you currently taking

Are you on strictly gluten free diet?

Often essential too

[RhodeHaw in reply to SlowDragon]

I have never been given any advice about diet. I have never heard about this vitamin test before. Is it routine or do just some Doctors do it? I do not take any vitamin supplements. I also do not have a gluten free diet, this has never been suggested to me before.

[SlowDragon Administrator in reply to RhodeHaw]

Suggest you read posts everyday,learn all about the interconnection between hypothyroidism and poor gut function and low vitamin levels

Eg Posts mentioning

Low folate

healthunlocked.com/search/p...

Low ferritin

healthunlocked.com/search/p...

Low vitamin D

healthunlocked.com/search/p...

Low B12

healthunlocked.com/search/p...

[RhodeHaw in reply to SlowDragon]

Thank you, I will do!

[SlowDragon Administrator in reply to RhodeHaw]

Links

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

endocrine-abstracts.org/ea/...

Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.

ncbi.nlm.nih.gov/pmc/articl...

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Same applies to low B12 - extremely common in hypothyroid patients

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

Folate supplements can help lower homocysteine

ncbi.nlm.nih.gov/pmc/articl...

Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.

Low ferritin frequent in hypothyroidism

endocrineweb.com/profession...

[RhodeHaw in reply to SlowDragon]

Wow, so many possibilities. I was on vitamin D supplements and when I changed GP surgeries my new GP told me I didn’t need them without doing a blood test, that was six years ago! He also told me that I could not see an Endocrinologist so I spent the best part of a year getting my old notes and applying personally to see an Endocrinologist!

[SlowDragon Administrator in reply to RhodeHaw]

Thousands of posts on here about gluten intolerance

Here’s just a few

healthunlocked.com/search/p...

[RhodeHaw in reply to SlowDragon]

Thank you, plenty of reading here. I can’t believe that there is all this information which I failed to pick up from Dr Google!

[SlowDragon Administrator in reply to RhodeHaw]

First step is to get vitamin D, folate, ferritin and B12 tested, usually have to test privately

Come back with new post once you get results

Many people need to supplement vitamin D continuously at maintenance dose, once improved to required levels at higher dose

Same with gluten intolerance. Get a coeliac blood test BEFORE considering trial of gluten free diet

[RhodeHaw in reply to SlowDragon]

Thank you, I will do.