Will a decrease of 1mcg t3 be enough to replace with 12.5mcg t4?

[owl87]

Hi all! My bloods have altered a lot recently due to me working on vitamins and improving physically after being very poorly. Physically I am much improved - my periods have come back after 2 years! - and now it seems that I have too much t3 and too little t4. From trial and error over the last year it appears I need a ft4 around mid/just above mid range and an ft3 between mid and 3/4 range. If either is too high/low I feel bad. currently my ft3 is 70% and my ft4 is 35% through range and I feel awful with a mix of overmed and hypo symptoms. I had a similar thing happen when my ft4 was too high and ft3 too low earlier this year.

My endo has advised me to increase my t4 by 12.5mcg but I also need to reduce my t3 a bit. The amount of t3 I make from t4 has improved recently so if I up t4 without reducing my t3 will likely go too high for me. At the time of the blood test I had only been on 6.5mcg t3 and so even a 2.5mcg decrease would be quite a bit of my dose! Would a 1mcg decrease be enough to replace with 12.5mcg t4? It seems like a very small amount but I’m aware it’s more powerful than Levo and that in ratio to my current dose it’s more than if someone were on say 10mcg t3. Currently I’ve been on 5.5mcg for the last couple of days with my increased Levo and I want to choose a dose to stick to so I can get accurate bloods in 6 weeks but I’m also nervous of not reducing enough as my overmed symptoms are very unpleasant!

Does anyone have any advice/experience? Thanks!

[greygoose]

Before making any comments, I would ask: how do you know that your conversion has improved?

Also, it really would help people understand the situation better if you posted your actual results:

TSH result (range)

FT4 result (range)

FT3 result (range)

It's very difficult to follow the way you've told it.

[owl87 in reply to greygoose]

Ah worry got carried away! 😂

My latest results are

TSH <0.03

Ft4 13.5 (10-20)

Ft3 5.5 (3.5-6.5)

From past experience I felt best when both were at least mid range and lower than 75%. I used to take 10mcg and my T3 was 4.8 but now it is 5.5 on only 6.5mcg likely because I’ve gotten much healthier - I was underweight and had digestive problems and pcos which are much better and get b12 injections now!

[greygoose in reply to owl87]

OK Do you have Hashi's?

[owl87 in reply to greygoose]

As far as I’m aware no - no antibodies and normal tsh at diagnosis though have family history of thyroid disease

[greygoose in reply to owl87]

If you had a 'normal' TSH, how did you get diagnosed?

In any case, you can easily have a normal TSH and still have Hashi's.

Anyway, back to your question. Why not increase the levo first and see how it goes? You might not even need to reduce your T3 as you're taking such a small dose.

[owl87 in reply to greygoose]

I was very unwell and my doctors were useless so I paid for private blood tests after googling my symptoms and coming across thyroiduks website. They showed under range ft3/4 and so I went to an endo who diagnosed me. That’s very interesting about the TSH I had no idea!

Thank you for all your help I think I will keep the lio where I am

[greygoose in reply to owl87]

OK, I see. So, your TSH was somewhere in the 'normal' range, but the Frees were under-range? And, so did your endo diagnose you with Secondary Hypo? Or Central Hypo?

[Lalatoot]

It is all guesswork and it changes as our bodies alter.

I too am reducing my lio dose and increasing my levo dose. I have been doing it gradually over the last 10 months. I was on 50mcg levo and 20mcg lio and I am now on 125mcg levo and 10mcg lio (thats 5 changes done 1 at a time).

How do you know that 12.5 mcg would replace 1mcg decrease in lio - it would depend on your body and your conversion. How are you going to accurately measure 1mcg lio?

I know that the previously a 25mcg levo increase has increased my FT4 by 2 and my FT3 by 1.2 and that a 5mcg decrease in lio has reduced my FT3 by 1.5 but this would not be applicable to you.

The only way to know is to do. Be kind to yourself while the hormones are changing and the body settling. Get bloods after 8 weeks and see the effect.

[owl87 in reply to Lalatoot]

Yes that’s what makes me nervous is that it’s complete guesswork!

I have jewellery scales and so am able to measure small doses! It’s pretty necessary as I only need such a small dose!

Thank you I will try to take it easy on myself - it feels like I might finally be understanding my body’s needs

[helvella Administrator in reply to owl87]

Pharmaceutical companies (and others) warn that the active ingredient of a medicine might not be evenly dispersed in a tablet.

All they are required to do is ensure that the complete tablet has the right amount - within the agreed margin.

For this reason (among others) tablet splitting is often discouraged.

I suspect they exaggerate this somewhat, nonetheless there is some truth to it.

A single split is probably reasonably accurate. But if you are going to try to get to one microgram of active ingredient, that is going to be somewhere between a fifth and a twenty-fifth of a tablet.

Even modestly imperfect distribution could affect the resultant dose. Even if you can weigh the amount of tablet reasonably accurately.

[owl87 in reply to helvella]

This is interesting. I only have 20mcg thybon henning tabs and have been splitting them into 4 and 2.5mcg for months - I did have two blood tests on same dose after 6 weeks each and ft3 was the same. I wonder if it would be better to get a 5mcg tab but I don’t know how likely that is and I don’t think they make a 5mcg tablet?

[helvella Administrator in reply to owl87]

Henning Thybon do not make anything less than 20 microgram tablets.

[adin]

1mcg decrease ??? and how you will do it?

[owl87 in reply to adin]

I have jewellery scales!

[LECJ in reply to owl87]

On endos advice I’m currently splitting t3 25ug into quarters and struggling to get even splits - pls can u tell me how the jewellery scales help as perhaps I need to get some x

[BB001]

The only things I can think of to suggest is either

1) work on percentages.

Work out what percentage of your levo dose you have increased by, and then decrease T3 by the same percentage?

There are a lot of assumptions about conversion rate of T4 to T3 in this, but as yo say, you've got to start somewhere.

Or 2) look back at your previous results and work out what effect on T3 raising levo by 25mcg had