Did t4 really need to be reduced.

[AS14]

Hi

Im 12 days into adding t3 and doctor reduced levo from 150mcg to 125mcg before adding the t3. Doctor prescribed 2 x 10mcg but Im gradually increasing dose and today Ive just upped dose to 7.5 mcg before breakfast and 5mcg afternoon.

Two months previously he increased levo from 125 mcg to 150mcg and my t3 rose to the highest its ever been, it went from 3.4 to 4.6. My symptoms were the same so t3 was added and Im gradually increasing my dose .

On 125mcg my results were

Tsh 0.78 (0.27-4.2)

T4 15 (12-22)

T3 3.42 (3.1-6.8)

On 150mcg my results were

Tsh 0.20 (0.27-4.2)

T4 20.2 (12-22)

T3 4.6 (3.1-6.8)

Am I correct in thinking any benefit I got from increasing 125mcg -150mcg is going to be lost and the t3 Im taking could just be replacing what I lose in the reduction of levo. Its early days but so far I have no improvement in symptoms but have some side effects which I hope ease in time.

I asked why he was reducing the levo and he said my tsh is low enough and he doesnt want to suppress it as its not good for bone or heart health. I know thats not true and I did question it but he was already losing interest so I just took my prescription and left.

I know everyone is different so its impossible to know how much t3 you need at first but Id hoped that with my level finally getting to the best its been so far that it wouldnt take a lot of t3 to get to raise it to where I need it to be well.

I cant say I have a lot of faith in this doctor hes pretty much the same as the rest Ive seen, but hes agreed to prescribe t3 for now albeit I have to pay for it.

Should my levo of been kept as it was at 150mcg ?

Any advice would be much appreciated .

[Lalatoot]

Probably. But as you say it is early days yet.

What I would do is to work your way up to the T3 dose. Wait 8 weeks and do bloods.

Then you can see what your levels are and decide if the next step is to add some more levo back or some T3 if you are still symptomatic.

[AS14 in reply to Lalatoot]

Thanks very much

[jimh111]

It's a good idea to reduce the L-T4 (perhaps by 50 mcg) so that you end up on a similar dose and can judge the effect of the L-T3. Also, TSH stimulates T4 to T3 conversion, especially within cells, so lowering your TSH will reduce this activity. This is important because taking T3 justs adds T3 to the blood which isn't quite the same as having your body convert it.

It may be that eventually you need more L-T3 or L-T4 but this is a good starting point, lowering your L-T4 when you start L-T3.

[AS14 in reply to jimh111]

Thanks very much

[Hashihouseman]

Your doctor may be right and you’re lucky he is more thoughtful and open minded than most about replacing t3 as well as t4. Your bloods suggest 125 and 5-7.5 levothyroxine/liothyronine would work well but you need to establish the regime for 6-8 weeks or longer to see where it all settles. Healthy normal levels are about tsh 1, ft4 15 and ft3 4.5 but after being kicked around by so much levothyroxine and insufficient ft3 it will take a while on a physiologically normal dose to stabilise and for you to feel benefits and improving symptoms. Oh and by the way 20mcg liothyronine is way way too much, unless you don’t convert at all..... but your bloods suggest you are simply a slow/low converter and the healthy thyroid gland compensated for this by secreting variable amounts of t3 and that’s what you need but to top up the t4 but..... t4 should remain as the main supply because that’s what the intra cellular thyroid metabolism works on! Something else doctors don’t get is that too much levothyroxine, particularly in one dose or cumulative will reduce t4 - t3 conversion by cellular negative feedback loops!....Try split dosing the levothyroxine and the liothyronine e.g. 2.5 liothyronine with 50 levothyroxine x 2 and one 2.5 + 25 dose on retiring then waking and then middle of the day... this will be much closer to normal thyroid secretion patterns and you can fettle the timing and the dose combination after each blood test and according to how you feel (but making small changes and waiting to see (keep a symptom and medication diary if you don’t already). Then, after you prove all that works you should make a formal complaint you are not getting liothyronine on the nhs! The more we get this prescription delivered by the nhs the more affordable and normal it will be for all.. it does exist e.g. morning side healthcare produce 5mcg liothyronine in blister packs and it’s easy to half the pills, other manufacturers also market 5 mcg pills, full lists available elsewhere on her. It’s totally medieval to be taking big doses of levothyroxine and liothyronine in one lump and prescriptions need to be more flexible so patients can be....

[AS14 in reply to Hashihouseman]

Thank you

My doctor is one of the recommended ones and in some respects he is open minded compared to previous doctors, he does see that some people need higher t3 and that sometimes extra t3 is needed . However when my symptoms remained after an increase in levo he tried to tell me I have fibro, or its something else and asked how my mood was and went on to tell me how t3 isnt proven to work, he contradicted what he initially said. I corrected him, this is hypo and after an uncomfortable discussion he agreed to prescribe t3, but only for 3 months as a trial.

I know you have to wait 6-8 weeks between dose changes but the increase in levo was given enough chance to work, it was actually longer than 8 weeks.

I dont have a thyroid so Ive already lost some conversion and I know Im a poor converter anyway and could well be a slow one too.

Im hoping a relatively small amount of t3 is enough to get me well, Id prefer not to have to go up to 20mcg. However how much we need is individual and as to what level t4 and t3 should be again thats individual, the levels you suggest may well be good enough for some but theyre not for me.

I am keeping records of everything and I know its a slow process so I have to give it time.

I understand why staggering t4 and t3 through out the day could be beneficial but as I already take other medications spacing everything out as you suggest just isnt possible. I take calcium and thats got to be 4 hours away from levo and t3 but I will rethink timings at later date if need be. Ive got 6 alarms set on my phone already to make sure my timings are good.

Im having to pay for this doctor and prescriptions and theres no way I can do this for long but Im desperate, very unwell and havent got any other choice at the moment. However when Im well I fully intend to go back to the nhs to fight for my prescriptions but for now Im just to ill to do that.

Thanks very much for your advice its very much appreciated.