How much should my liothyronine be bumped up?

[Mggirl]

Hi everyone, so did blood tests again and my levels are doing crazy things. My dr bumped up my t3 and t4 in 6 week intervals so my last blood test reads as this my Ft4 value is 0.76 range is (0.76-1.46) ft3 2.6 (2.2-4.0) tsh 2.74 (0.36-3.74) so she increased my Levothyroxine so my latest results on 9-14-2020 are tsh my value is 0.97 (0.36-3.74) ft4 my value 0.81 (0.76-1.46) ft3 my value 2.2 (2.2-4.0) so my t4 raised a little bit but my t3 went down again even lower. My dr will probably increase my t3 again but I am on 10 mcg of lio so I was wondering what you all thought about how much should it be raised to and why would my tsh drop so much lower when it’s obvious I need more t4 and t3.

[fuchsia-pink]

Your results are VERY low - free T4 is a feeble 7% through range and free T3 is at the very bottom of the range. I can't imagine you feel well with these being so low. So you are VERY under-medicated. Assume you left 24 hours from previous dose of levo and 8 - 12 hours from previous dose of lio? Otherwise you will have a "false low" if not a big enough gap ... You don't say what your key nutrients are - it's important to have them tested and supplement any that are too low.

So an increase in levo / lio both looks a very good plan Whether that's 25 mcg of levo (how much levo are you taking now?) or 10 mcg of lio doesn't really matter, as long as you re-test every 6 - 8 weeks and increase both (one at a time) until the results are decent and you feel well.

Why is TSH low? - because you are on lio: it's what happens. Effectively, you aren't making your own thyroid hormones now, just managing with your meds, which is why it's so important that you get the right level of medication and key nutrients.

Good luck x

[Mggirl]

I take 25mcg of Levothyroxine 7 days a week and on 4 of those days a half of the 25mcg of Levothyroxine which is 9 pills of Levothyroxine a week. I did leave 24 hrs off of Levo and 10 hrs off on lio. My vitamins are good and I am completely gluten free.

[fuchsia-pink in reply to Mggirl]

So that's a tiny amount of levo ....

I'd see which the GP wants to increase first, but you certainly need more meds x

[DippyDame]

Why was T3 introduced?

Do you know how well you convert the storage hormone T4 to the active hormone T3 which is essential to every cell in the body.

How much levo are you taking with the 10 mcg lio?

Your levels appear to be responding appropriately

Adding levo has as expected reduced the TSH and raised your FT4

TSH is a pituitary hormone not a thyroid hormone, as hormone levels rise TSH will drop.

TSH is a signal to the thyroid to produce more hormone.

However without knowing how much levo you are taking it's only a best guess

If your levo dose is low then I suspect you need an increase, if your conversion is adequate then that should raise the FT3.

Only, with poor conversion might you need to add a little T3

It's a process of both elimination and trial and error

Ah! Just checked your previous post and you appear to be on 25mcg levo. It doesn't look as if your GP has much idea about thyroid function and treatment!

I suspect she thinks that if your labs are within the lab range then all is welĺ - this is rubbish! The dose you take needs to be optimal for you...we are all different with different needs.

25mcg is far too low.

A starter dose for an adult should be 50mcg, retested after 6/8 weeks and dose adjusted as required. Repeat until you feel well.

FT4 and FT3 should then be close to 75% through their respective ref ranges

Your latest labs show FT4 is 7.14% through range and FT3 is 0% - you are undermedicated!

In order to accurately evaluate thyroid function you need to test

TSH

FT4

FT3

Folate

Ferritin

Vit D

Vit B12

The labs should all be optimal

In addition antibodies must be checked for Hashi's - TPO and Tg

"Bumping up T4 and T3"! Only one hormone dose should be changed at one time otherwise the system will become confused

Earlier you posted, "because she said my t4 level ( at only 7.14%) .was fine but with the raising of my dose of t3 meds my t4 levels dropped so she came back and said all looks good (sorry, it doesn't) but I dont feel so good (no wonder!) so that's where I am at."

I suspect you need to increase your levo, raise your FT4 and FT3...and teach your GP why!

As someone who needs a supraphysiological dose of T3-only, in your shoes I would be concentrating first on levothyroxine and nutrients.

Just a few thoughts

Best...

DD

[Mggirl]

Thanks for the info. I do have conversion problems that’s why I was started on lio and when I did a tpo test they said I have Hashimoto But they have keep me on the low end of meds because they seem to be afraid I will be over medicated but in the mean time I am suffering. That is why I was wondering how much to raise lio amount because I have a virtual app. on Friday and I need to explain to her to raise it.

[Marz in reply to Mggirl]

DippyDame will not have seen your response as you inadvertently replied to yourself ! Having tagged her she will now be alerted !

Good luck with your appointment !

[DippyDame in reply to Mggirl]

How can you possibly be overmedicated when your labs are so low!

Did your medic offer an explanation?

With labs so low how did they conclude your conversion is poor?

Have you had a Dio2 thyroid genetic test - a polymorphism indicates poor conversion particularly if inherited from both parents

I'm surprised they prescribed lio on that basis.

Also surprised they are focusing on Lio when your FT4 is so low

I would be inclined to raise levo, not lio, because to date they haven't given levo a chance to work....your FT4 is far too low.

The aim is to have the Frees about 75 % through range....not at the low end!

You can only alter thyroid meds "low and slow". I would ask for more levo - 25 mcg - test after 6 weeks and if the Frees have increased add another 25mcg and test again.

Poor conversion is indicated by high FT4 with low FT3. To optimise conversion nutrients must be optimal.

I'm not convinced this medic is up to speed on even basic thyroid treatment....sorry!

You need to push for more levo........best of luck

Please keep us posted.

[Mggirl in reply to DippyDame]

My dr. doesn’t seem to know much about my condition but she tries. I was sent to a Endo which was 6hrs away and she did the tpo test and she was the one that started me on 5mcg of lio because she said I didn’t convert t4 to t3 than she said I had Hashimoto but she has always keep me on low doses of meds so I have been under medicated for years. Now she retired and there is no Endo close enough for me to travel to so I was sent back to my primary dr and she doesn’t know anything about Hashimoto so I am on my own out here.

[DippyDame in reply to Mggirl]

You are not alone, you have forum members to turn to for help!

Without the advice and support of experienced members I may not be here now!

Might be a good idea to ask for a copy of your diagnostic test ( the one before medication was initiated) that might help explain your medics decisions. You are legally entitled to request copies

Don't focus too much on Hashi's the treatment is as for hypothyroidism with possibly a change to a gluten free diet.....that helps many members

This might help -

thyroiduk.org/hypothyroid-b...

[Mggirl in reply to DippyDame]

Thank you.

[Hashihouseman]

Try to emulate natural thyroid physiology- keep t3 replacement at only about 10% of t4 and Raise t4 to 75 a day, it may need to be as much as 125 depending Your response and it takes weeks for your body to get used to a thyroid regime change Try splitting levothyroxine and liothyronine doses into 2 or even 3 to be even more physiological..... Even if you are a poor converter you are likely to get more intra-cellular t3 from t4 than from liothyronine and splitting levothyroxine doses may help your conversion as may taking selenium!

[Hidden in reply to Hashihouseman]

"Even if you are a poor converter you are likely to get more intra-cellular t3 from t4 than from liothyronine".

I´ve been wondering about this since some articles state that the TSH is somehow involved in T4 to T3 conversion...so it makes sense that a person with a suppressed TSH has lower or even non-existent conversion?

This is more out of personal interest since the OP does not have a suppressed TSH (yet); however, I´ve found it impossible to maintain an in-range TSH on any dose of T3 that made me feel normal, and I´ve been wondering lately how that might affect my T4 to T3 conversion.

So, if a suppressed TSH decreases or even suppresses T4 to T3 conversion, will a person with a below range TSH get any benefits of T4 to T3 conversion...or will s/he have to depend solely on exogenous supply of T3?

I hope anyone can answer this as it´s really of great interest to me.

[Hashihouseman in reply to Hidden]

Based on my own trials on my self doing monthly blood tests and experimenting with different doses from zero t3 and up to suppressed tsh I’m fairly sure that t4 - t3 Conversion continues with low/no tsh and that excess t4 is more likely to reduce conversion in the cells because of the negative feedback loop but even with that I was still showing conversion at high t4 levels the only downside was that I felt terrible as if I was hypo and hyper with apparently ok blood tests other than excess free t4... it’s common that Thyroid replacement patients Have highEr ft4 and lower Ft3 than euthyroid and yet I persist trying to emulate euthyroid blood levels by balancing t3 and t4 doses and trying to hit euthyroid normal TSH of about 1.... sadly for my theory the closest I get is 19 ft4 4.3 ft3 and 0.2 TSH so far so good but raising tsh a little needs to be done super slowly and by dropping t4 and raising t3 and the amounts to fine this are way smaller than it’s really convenient to dose let alone get a good pill size!

[Hidden in reply to Hashihouseman]

Can I ask why you are trying to get your TSH around 1? I know it´s generally recommended to get it to 1 or lower when on levo only, but on T3 it´s often lower.

[Hashihouseman in reply to Hidden]

Actually I found my TSH ran higher (2 or more) when I was on more liothyronine and less levothyroxine but it didn’t feel quite right and I definitely benefited from more levothyroxine, up to a point but certainly not without any liothyronine. My TSH is definitely more affected by levothyroxine than liothyronine at the levels that I take. In other words, At these doses it seems to be the t4 rather than the t3 that pushes TSH under zero. More T3 would suppress my TSH but I never take that much of It because t4 is more efficient at getting t3 into the cells and it’s all about the physiological balance between t3/t4, even with inefficient conversion (I have done the gene test to prove that). I figure I am trying to find the levels that feel right compared to before I was hypothyroid and which I have no blood test info for! I wish I had done thyroid function tests every 5 years of my life before I became hypothyroid because that would seem to me to be the basis for determining replacement. Without that hindsight I am chasing the notion of it ! And the bottom line is I don’t feel right when my TSH is less than zero just as much as I don’t feel right when it’s more than 2, the difficulties lie in getting the replacement consistently right because daily needs can change and because pill sizes, prescriptions, and the combinations of t3/t4 and even the times and split of doses are all challenging.

[Marz]

Are you taking any other medication that could be preventing good absorption of your T4/T3 medication ? Likewise any supplements ?

Do you always obtain copies of your test results with ranges ? - especially B12 - Folate - Ferritin - VitD ...

[Mggirl in reply to Marz]

I don’t take other meds just supplements vitamin D and a multi vitamin and I can see my result online anytime.

[Marz in reply to Mggirl]

Good- so what were the results with ranges of your last tests for B12 - Folate - Ferritin and VitD ? How much VitD are you taking ?

Which Multi- vit are you taking ? If it contains iron then it will prevent the other ingredients being absorbed - same with calcium.

[Mggirl in reply to Marz]

The multi does contain iron and calcium. I did not know that about iron and calcium. Should I not be taking them.

[Marz in reply to Mggirl]

Multi-vits rarely contain enough of the nutrients you need and if you increase the dose you may be taking too much of something you do not need ! They often contain cheaper ingredients and fillers

What were your last results of B12 - Folate - Ferritin - VitD ? You said you could see results on-line. How much VitD are you taking ?

[Mggirl in reply to Marz]

6,000 is vitD and my level is 71 top of range is 91 and I don’t know my folate ferritin or b12 I will ask to be tested tomorrow on my virtual app.

[Marz in reply to Mggirl]

Nearly there with your VitD - 100+ is normally suggested here. Are you taking important co-factors ? - magnesium and VitK2-MK7

[Mggirl in reply to Marz]

Yes magnesium but not vitk2-mk7.

[Marz in reply to Mggirl]

When reading other posts you will notice VitK2-MK7 mentioned often. When taking VitD the uptake of calcium from foods is increased and VitK2 assists calcium in finding its way to bones and teeth and away from soft tissue and arteries !

[Miffie]

The ratio of T4 to T3 your doctor prescribes is weird. Why is it that? As you have not given us any info about why you are not on more levo it is hard to know. A GP testing conversion in a patient on 25mcg levo is unheard of. Unfortunately bloods are a moment in time and small differences are often due to timing of last meds, time of day etc. If you could give us your background it will help members give you better advice.

[Mggirl in reply to Miffie]

My Endo started me on lio due to conversion problems and she tested me for Hashimoto and that came back positive so she gave me 5mcg of lio and 25 mcg of Levothyroxine and I was okay for maybe 6months but know I don’t feel well so I asked for more blood test and she didn’t want to raise anything so I got her to add an extra 25mcg of Levothyroxine a week which comes to 8 pills a week that helped for a little bit but now I am back to feeling terrible. So long story short I have a virtual app. on Friday and I need to convince her to raise my lio or Levothyroxine than test in six weeks and raise again. I got sent back to my primary dr. and her Hashi experience is non existent and mine is only a little better than hers so trying to figure this medication doses out.

[Miffie]

I hope you get sorted soon. I am not eligible for an Endo as my thyroid was destroyed by radiation over sixty years ago. It seems if I had Hashi I would be eligible. I have had a lifetime of varied GP knowledge, certainly for the last seventeen they cannot see past levo, I was originally treated with ndt. It was only in the 1980s when a GP tested and found I was very low on T3 I was given a dose to make me well. For three years I enjoyed the same quantity of life every other person took for granted. I had never known that before. Then I moved and no other doc cared. I was on 500 mcg levo and still refused any testing for conversion. This is why I was surprised that you were apparently tests when on low dose levo . I do know how frustrating it can be. However I do think you are fortunate to be given access to an endo. Good luck

[Mggirl in reply to Miffie]

Thank you.

[Read58 in reply to Miffie]

I have Hashimoto and poor conversion, but have constantly been refused an appointment with an Endo. I think there are an awful lot of people on here with Hashi’s, who have also been refused endo consultations.

[Miffie in reply to Read58]

I think you are right, however I was told if I had Hashi I would be referred. Still it’s only been sixty years of under medicated so I am sure there are many others. I did ask on here if anyone was like me hypo due to being. given radiation therapy in the 1950s and no one replied. Do you know of any?

So far about twenty GPs have looked with jaw dropped at the cause of my hypothyroidism. It’s only been 37 years of knowing I am under medicated so I really am no worse than many on here.

I feel for so many who are menopausal in thier 50s and even 60s. I always say the blessing of a lifetime of heavy painful periods with embarrassing flooding and fainting is that at least by 40 the end is in sight. i could not have coped with another twenty years, although I do know that doctors are able to help women much more these days, mercifully for those still suffering.

Take care.