Reducing levothyroxine before liothyronine ?

[AS14]

Hi

Apologies for another post so quickly but I forgot to ask something earlier.

Endo said to reduce levothyroxine by 25mcg from 150 to 125, but he didnt say if it was when starting t3 or for some time before.

Im still trying to find t3 at cheapest price but when I do and know its on its way I could be reducing while I wait if necessary.

Latest blood test

Tsh 0.2 (0.27-4.2)

T4 20.2 (12-22)

T3 4.68 (3.1-6.8)

Thanks

[greygoose]

You could do either. But, don't lower the levo for more than a week before adding in the T3.

[AS14 in reply to greygoose]

Thank you

[greygoose in reply to AS14]

You're welcome.

[SlowDragon Administrator]

How much T3 is endo recommending?

Recommend reducing levothyroxine 3-5 days before starting on T3

T3 best to start low and slow.

5mcg in morning (or even cut in half and take 2.5mcg morning and 2.5mcg mid/later afternoon - yes a speck of dust)

If that’s going ok

Add 2nd 5mcg dose in mid/late afternoon after few days

[AS14 in reply to SlowDragon]

Thank you

The endo has prescribed 10mcg twice per day. I know thats far too much, and I did tell him my concerns but he was pretty adamant.

I will be following the advice here so thank you very much.

Ive had to see this endo privately and he is one of the recommended ones but to be honest I cant say he was an awful lot better than previous doctors Ive seen.

First appointment 2 months ago he said straight away he can see I have low t3 and thats causing symptoms so he increased levo hoping that would help. Its increased the t3 but I cant say I feel much different, blood pressure has gone down and heart rate has improved so it has done something just very little.

He seemed quite different yesterday, not the very understanding doctor from 2 months ago and tried to tell me I have fibromyalgia and asked if I was feeling down.

Ive no idea how I kept my cool, I was calm and collected but so angry but I thought hell no so I stood my ground and told him I am hypo and I want treating . He told me how theres no proof liothyronine works and ndt is just the same and he couldnt prescribe that even if he wanted too.

I was hoping for ndt but not a chance of that so he reluctantly prescribed the t3.

I had such high hopes for this doctor especially as first appointment seemed to go well but feel so let down and angry by his comments yesterday.

Thanks very much

[SlowDragon Administrator in reply to AS14]

Well many of us do need 20mcg

But adding it in slowly

After adding 2 x 5mcg

Assuming all ok, add 3rd 5mcg dose ....many of us find 3 doses 8 hours gap works well ...taking last 5mcg dose before bed can improve sleep. But others find T3 keeps them awake ....it’s all trial and error

Some people can even add 20mcg in pretty much straight away....or even as single dose

But often it’s necessary to add cautiously and as split dose

I have ended up on 20mcg as approx 10mcg at 7am, 5mcg at 3pm and 5mcg at 11pm....plus 100mcg levothyroxine at bedtime....it took roughly 2 years trial and error working out doses and timings to suit me ...more on my profile

[AS14 in reply to SlowDragon]

Thanks very much

[SlowDragon Administrator]

Retest thyroid levels after 6-8 weeks on new scheme

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)

If/when also on T3, make sure to take last 5mcg of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Do you always get same brand of levothyroxine?

[Jazzw]

This might be a slightly controversial view—but I wouldn’t reduce my levothyroxine. I’d just add T3, maybe 5mcg to start with, raising to 10mcg after a week or two if that didn’t seem to do the trick.

[AS14 in reply to Jazzw]

Thanks