Adding T3 to Levo

[AleB]

I spoke with endo yesterday, agreed to try me on T3 again. Currently I am taking 112 mcg of Levo per day. My last results on this dose were from 8th Sept '20

FT4 16.7 range 10 - 24.5

FT3 3.6 range 3.1 - 6.8

TSH 1.1 range 0.2 - 5.5

Been advised to reduce levo to 75mcg and add 5mcg of T3 x 3 per day.

Looking at my results regarding T4, I would think just dropping to 100mcg Levo and adding the T3? Could anybody advise me please. The last time I tried T3 was in February 2019, was only on it for 3 day's as I was told to come off it if I had any side effects (obviously having tried T3 in NDT I know what to expect now)! I really value any advice from other members, you have been a lifeline of support and information and I'd be very lost without your help. 🙏

[fuchsia-pink]

It's generally recommended here to build up "low and slow" on lio - so if 3 x 5mcg a day is the intended end dose, I'd start with 5 mcg for the first week or two, then 10 mcg for the next week or so and the full 15 mcg after that. Assume these are 20 mcg tablets, so you are quartering them? Not sure why you aren't aiming for a whole tablet eventually as that makes things easier, especially if you aren't that good at quartering tablets Either way, you can consolidate into one dose if that's easier once you're settled on the final dose.

At the same time, I'm not sure why you would reduce levo - your free T4 is pretty low at the moment - not even half-way though range. I'd try and keep it where it is and see how you are doing after 6 - 8 weeks on the full lio dose. If you do feel you should reduce levo, I'd wait until you are on the final lio dose (because the T4 result is currently so low) - it's best not to do two things at once, because if you do, and don't feel "right" you can't tell if it's reducing the levo or adding in the lio that isn't working for you.

Have you had key nutrients tested recently - ferritin, folate, vit D and B12? You need these to be "right" to gt the most from your meds.

Good luck x

[AleB in reply to fuchsia-pink]

Thanks Fuchsia-Pink, low and slow and I think 100mcg of Levo... don't want to upset Endo too much!

[Lalatoot]

You probably don't need a drop in levo dose as you are nowhere near top of range. But a drop to 100mcg would be ok.

Starting T3 isn't easy or a quick fix so you need to stick with it. I have been adjusting my combo doses for a year.

I would drop levo to 100mcg and wait 1 week.

Add in 5mcg of lio. Wait a week. If all ok then

Add second dose of 5mcg lio.

Now you can stop here and wait 8 weeks and do blood to see how your levels are. This would make it easier to fine tune to see if you would add back your 12mcg levo or increase another 5 mcg lio or

Wait just 2 weeks and add your other 5mcg lio.

Wait 8 weeks bloods which must include FT3.

[AleB in reply to Lalatoot]

Thank you, I appreciate your help and advice, as I have been looking over my past results over months/years on varying thyroid medication, T3 is always on the low side... I still have to try and go to work, so a gentler introduction this time and 100mcg of Levo seems a better adjustment. I don't want to be so, so I'll again that I am bed bound and I need to keep working to pay for supplements and medication... and now the endo's fee! I have to see Endo because I can't get T3 otherwise!

[SlowDragon Administrator]

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)

Is this how you did this last test?

If yes, Likely Levothyroxine doesn’t need reducing

Have you been prescribed 5mcg tablets?

If yes, suggest you cut in half and start on 2 x 2.5mcg doses ....waking and mid afternoon

Assuming going ok......Add 3rd 2.5mcg dose later in evening in week

Then slowly increase to 5mcg. Initially increase morning dose.

As you have Hashimoto’s are you on strictly gluten free diet?

Retest bloods 6-8 weeks after getting dose up to 3 x 5mcg T3

when 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