My experience so far of adding liothyronine (T3) to levothyroxine (T4)

[Zazbag]

Hi everyone,

About two weeks ago I dropped my dose of levo down to 125mcg (from 150mcg) and added T3. I wanted to give an account of my experiences so far.

The first day I took 10mcg split in two doses of 5mcg. When I took the first dose of 5mcg I noticed a big improvement in my mood and mental clarity and energy levels within hours. Since then I have been trying to get familiar with how to dose it, and have increased the dose to 25mcg. I have done this because I noticed that when I was taking less than this, I would get hit with a sudden crushing fatigue at about 10pm so I assumed I needed more T3.

My period was only three days long and very light, which is unheard of for me.

My mood has been better, I've felt more motivated and naturally wanted to go out of the house without forcing myself to and be around people which I haven't felt since I started to develop hypothyroidism.

My energy levels have been so much better, I was able to exercise for several consecutive days and recover (which I haven't been able to do for a year or two). I did push myself too far though and ended up fatigued for a few days, so I decided to focus on losing weight purely through my diet.

It seems to be working because I've gone from 69kg to 67.3kg in two weeks! I haven't weighed less than 68kg in three years, no matter what I did. My normal weight is around 62/63kg. The T3 has really lowered my appetite, I get full now from a bowl of soup or a small bowl of porridge. I actually leave food on my plate because I get full, even when the portion is quite small. This is unheard of for me, since becoming hypo. I've been eating about 1500-1700 calories a day, at least 100g from protein. As I mentioned, I haven't been exercising so my calorie deficit is purely from diet. Previously when I was only taking levo, if I restricted calories I would be okay for about 4 days and would lose weight, but then suddenly I would be hit with crippling mental and physical fatigue and be absolutely starving hungry for however many days I'd been restricting my calories, and this increased appetite would be impossible to ignore so I would put all the weight back on within days. One thing I should mention is that along with the calorie restriction, despite drinking plenty of water and eating lots of fibre, I have had very painful constipation. I'm not quite sure why.

My hair is still falling out, but the last time I washed it, I'm quite certain there was less in the plughole than before.

I feel like I am sleeping better than before.

I feel like I am less irritable than I was on 150mcg levo (although I am still a bit irritable).

Anyway hope that was useful to anyone interested in trying it.

[shaws]

25mcg of T3 is equal to approx 100mcg of levothyroxine. I've taken T3 alone for some time and take it when I awake with one glass of water and wait an hour before eating. Food can interfere with the uptake of thyroid hormones.

[Zazbag in reply to shaws]

Thanks for your reply. T3 and levo aren't really equal though, right? Depends on your conversion...? On 150mcg of levo only I felt AWFUL, hyper and hypo symptoms at the same time. Now 125mcg levo and 25mcg T3, and I feel so much better. I'm not sure it's the right ratio but I feel a hell of a lot better than before.

I take both on an empty stomach, at least two hours after previous meal or caffeine and wait at least half an hour before eating.

[shaws in reply to Zazbag]

T4 - levothyroxine - is an inactive hormone and should convert to T3. T3 (liothyronine) is the Active thyroid hormone and our brain and heart have the most T3 receptor cells and we have millions in our body. I suppose you could call T3 the 'engine'. I take T3 when I get up with one glass of water and wait an hour before eating.

This suits me and I have a life without symptoms and feel well. On levothyroxine I was in and out of the A&E umpteen times with awful palpitations - usually middle of the night. The cardiologist was puzzled as I also had some overnight monitors and was considering putting 'something in heart '. Around that time T3 was added to T4 and I felt so much better then took T3 only. I have never seen a cardiologist since T3.

Millions of hypo parents do well on levothyroxine, but there is a section that cannot and do not feel better.

In the past we also had 'other' options of replacement hormones but these have now been withdrawn.

When you have a blood test always get the earliest possible, even if you have to make it weeks ahead. It is a fasting test, and allow a gap of 24 hours between last dose of thyroid hormones and the test and take afterwards.

Also ask for B12, Vit D, iron, ferritin and folate to be checked. Everything has to be optimal.

[shaws in reply to Zazbag]

You are now taking the equivalence of thyroid hormones of 225mcg. T3 is stronger than T4 as it is the active thyroid hormone and T4 inactive and has to convert to T3.

25mcg of T3 is equivalent to 100mcg of levothyroxine.

[Zazbag in reply to shaws]

I know all of this except for what you're saying about 25mcg of lio being equivalent to 100mcg of levo. I've seen plenty of people on here who are taking 125mcg levo and 25mcg lio.

[Zazbag in reply to shaws]

If I feel well then I don't see any issue. I'll have a blood test in a few weeks and check my levels but for now I feel good.

[SeasideSusie Remembering]

Zazbag

Please correct me if I'm wrong but are you saying that you have increased your dose of T3 from 10mcg to 25mcg within the space of 2 weeks?

If so why? In this thread you started on 1st September you said you were going to start by reducing Levo first then start with 5mcg T3 (split into 2 doses) and build up the dose of T3 gradually:

healthunlocked.com/thyroidu...

[Zazbag in reply to SeasideSusie]

I spoke to someone on the forum who said I wasn't likely to feel any benefit from 5mcg, and that there was no harm in going straight for the full dose of T3. I took 10mcg for a few days, then added 5mcg when I exercised just in case because exercise often makes me very fatigued, then noticed the crushing fatigue at 10pm, so added another 5mcg. That brought me up to 20mcg, then I decided to try 25mcg because 25/50mcg seem to be the most common dose strengths available. I may have acted irresponsibly, but I have felt absolutely terrible for the past two years, and I ran out of patience. I've been monitoring my heart rate, some days it's been 65 and others it's been 80 but I have been a bit stressed out. As far as I know, 60-80 bpm is considered normal.

[SeasideSusie Remembering in reply to Zazbag]

Zazbag

You may have run out of patience but unfortunately this is what hypothyroidism and finding the right dose and combination of thyroid hormone replacement is all about. By increasing too quickly you could very likely overshoot your sweet spot and may miss the right combination for you.

One person on the forum may have suggested that you go straight for the full dose, but the majority of T3 users would advise to go slowly and increase gradually, 5mcg every couple of weeks. And what is the full dose anyway? It varies from person to person so you wouldn't have a clue what dose you need until you've gradually built up and found it the sensible way.

[Zazbag in reply to SeasideSusie]

I understand what you're saying, and ordinarily I would have tried to be patient, but it was affecting my job performance and my relationships and I was feeling suicidal because of this. I'm also leaving the country in 6 weeks so I need to get this sorted while I'm still here. Plus I figured, if it was too high I could just drop the dose back down again. Since I no longer trust doctors, I'm not sure what else I'm supposed to do.

[SeasideSusie Remembering in reply to Zazbag]

Zazbag

Do you not trust your private endo who put you on T3?

[Zazbag in reply to SeasideSusie]

No, she doesn't usually prescribe T3 and wasn't confident giving it to me at all. She wanted to give me NDT. Tbh it feels like she is just trying to make money out of me.

[SeasideSusie Remembering in reply to Zazbag]

Zazbag

I'm the same as Lalatoot and it's taken me years, basically, to tweak doses to find my optimal levels and doses that give them.

I've been on as much as 31.25mcg T3 with my Levo and latterly was stable for a long time on just 12.5mcg T3. At the moment something is awry and I'm tweaking doses again but 18.75mcg T3 is giving me enough, any more and my FT3 would be over range.

[Lalatoot in reply to Zazbag]

I found that I did not need the full dose of lio and have spent the last 10 months reducing lio and separately increasing levo. Some of us need to balance ft4 and Ft3 carefully.

If you started lio due to a conversion problem like me you may find that all you need is a top up dose of lio to make Ft3 up a little rather than a full tablet.

[Meanbeannyc in reply to Lalatoot]

I’m with you lalatoot, even if t4 is inactive I like it higher, I lowered t4 for my T3, but that made me feel worse. Now I wanna put back up my levo. I was warmer on higher levo. I’m colder on lower levo. But the T3 was great for my blurred vision and mental clarity. Decisions decisions. My knees were better on higher T3. But my legs are weak on lower t4.

[Meanbeannyc in reply to Lalatoot]

And my face was less puffy on higher t4.

[asidist]

please update on how you’re doing 6 weeks from now once things have stabilized on your new dose - very interested to hear how it worked out