Hi - I was diagnosed with hypothyroid about 5 years ago - TSH was over 100 & endo was shocked I was not in a coma! Also Hashimotos with antibodies over 400. Have been on 100 mcg Levothyroxine since diagnosis. I am now 62 and weight is 60 kg. My recent blood work was: TSH 2.14 (Ref. 0.38-5.33); T4 free 0.93 (ref. 0.61-1.12) and T3 free 2.7 (Ref. 2.5-3.9).
A year ago my TSH was 0.74 (Ref. 0.38-5.33); T4 free was 0.91 (ref. 0.61-1.12) and T3 was 2.83 (ref 2.5-3.9)
Endo wants to reduce my Levo to 100 mcg 6 days/week (instead of 7 days/week). Should my free T4 and T3 be higher and will a reduction in Levo accomplish that? I thought I should be increasing the Levo. Any thoughts from anyone?
Written by
GretchenBuster
To view profiles and participate in discussions please or .
I don't know why he wants to reduce levo. TSH is still relatively high for someone on levo and your "frees" aren't over range - free T4 is 62.7% though range and free T3 is a pretty feeble 23.5% though range. How are key nutrients?
If you don't feel tip-top, I'd be asking about poor conversion and possible increase in meds to get T3 higher - you want that at least 2/3 through range really.
Thanks for your reply. I have had vertigo episodes lately, though controlled thru maneuvers. And I feel sluggish. A couple years ago I had vitamins tested and adrenals, etc. and all were in normal range. Those tests are very expensive here (Central America) and so I really don't want to do them again. Also never had Hashimotos retested as endo said that will "never" change. I did ask her this last time about increasing the Levo mainly because my TSH was higher than it has been in the past couple years. I forgot about the T3/T4 ratio, etc., so I did not bring up the T3 conversion. That being said, I did not decrease my dosage even though she suggested I skip one pill per week.
I don't know what its like where you are in terms of getting T3 meds prescribed (in the UK it's really tricky as its soooo expensive) - so I'd have a chat about keeping levo where it is AND starting T3 meds - or if that's a non-runner, increasing levo by say 25 mcg a day. Increasing overall meds is the only way to get TS down and your frees up ...
If you do get T3 meds, best to take it low and slow to start with, eg 1/4 a tablet initially, increasing every week or so until you're on a whole tablet, hold for 6 - 8 weeks and re-test THS, free T4 and free T3 and see where you are then
Don't forget to have early morning blood tests (when TSH is highest) and a gap of 24 hours from previous levo (take the next dose immediately afterwards) and 8 - 12 hours from T3 meds - eg if you normally take in the morning, split the dose the day before x
I have no idea about the availability of T3 here and I'm afraid to ask my endocrinologist. Maybe I'll just check with the pharmacy. Most drugs do not require prescription here.
Sounds a really good plan! As I say above, best to introduce slowly, working up to a whole tablet over a period of several weeks. Hold for a 6 - 8 weeks and re-test. You should notice the increase in free T levels x
Thanks for your quick reply. I learned that the only dosage available is 75 mcg of the T3. When I wrote the doc with this info, she said I could try the 75 mcg, but to take it only every two days they are capsules, so cannot be cut. She doesn't want to increase the T4 due to my age, 62, and possible cardiac side effects . What do you think about the 75 mcg every two days?
Suggest you start a new post with this info so that more people see it ... but that sounds very odd to me. T3 is quite powerful and 75 mcg is a HUGE dose. (I currently take 10 mcg x 2 a day). It's also got a very short half-life so taking it once or twice a day is usual - taking it every two days means that you will have much too much in your body on day 1 and potentially very little still in your system on day 2 - but as I say, do a new post about this and see what other people say x
Thanks for the advice. Before I start a new post, I am going to try to contact my doctor again to verify that I understood her correctly, and if she wants me to continue on the 100 mcg of T4 at the same time; also, I will reach out to the pharmacy again to see if there is some way to get the T3 in a lower dosage. Yesterday they said no; but I think it's worth me checking again. Lastly, my doctor said I could get the 25 mcg thru a special lab (which is 4 hours away from me). I can reach out to them to see if they have a delivery service. Also - I am thinking about biting the bullet and paying privately, again, for a repeat TSH, Free T3 and Free T4 blood test to see if my numbers have changed since my last test that was at the end of August. I read online about the T3 being powerful, like you said, so it's a little scary. Once I get more information, then I can start a new thread.
In terms of daily dose , if you increased by one (presumably 100mcg?) pill a week, that would increase your dose from 100mcg to approx 115mcg a day. which is perfectly sensible. You wouldn't want to be adding more than 25mcg's a day at a time, and 12.5 mcg increases/decreases are enough for me to feel better/worse.
However i wouldn't want to add a whole extra 100 mcg's on one day, i'd want to split my dose so it was near as possible the same each day, Some people don't mind taking alternate doses ie 100 /125 on alternate days, but i would notice the change each day and not like it.
Adding T3 to get your FT3 higher sounds like a good idea.
I have read your answer to fusciapink above , where you say only 75mcg T3 is available to you, and cant be split...... i agree with her comment's , T3 is meant to be taken the same every day, not alternate days. it would have a very uneven effect if taken on alternate days. because it has a much shorter half like than t4.
I also think 75mcg is a huge amount, I would say that even 25mcg a day might be too much to start, with and the experience of many here is that they need to start T3 very gradually ....many people start on 5mcg and increase gradually, people often find it too much to add 25mcg in one step.
Make a new post to ask advice on the best way to add T3 to levo. and for any ideas on how to get a smaller starting dose than 75mcg.
I don't have experience of taking T3, but many others on here do.
I sent this to fushiapink, but also wanted to send it to you because I want to thank you again for your advice. Before I start a new post, I am going to try to contact my doctor again to verify that I understood her correctly, and if she wants me to continue on the 100 mcg of T4 at the same time; also, I will reach out to the pharmacy again to see if there is some way to get the T3 in a lower dosage. Yesterday they said no; but I think it's worth me checking again. Lastly, my doctor said I could get the 25 mcg thru a special lab (which is 4 hours away from me). I can reach out to them to see if they have a delivery service. Also - I am thinking about biting the bullet and paying privately, again, for a repeat TSH, Free T3 and Free T4 blood test to see if my numbers have changed since my last test that was at the end of August. I read online about the T3 being powerful, like you said, so it's a little scary. Once I get more information, then I can start a new thread.
That sounds like a good plan....... it's beyond me why it has to be this hard to just get our hands on the dose we want ..... can you imagine if diabetics had to mess around like this to get their correct insulin dose..... I think thyroid patients must be the most patient patients in the world..... oh well ... onwards. Hope you can find a more adjustable option than 75mcg in one dose, that dose would scare me to be honest.
But at least you have a doctor who is willing to try T3,, most of ours are too scared of being told off by their boss to even admit it has a function.
Once-upon-a-time doctors used to diagnose hypothyroid patients through their clinical symptoms alone and gave us NDT (natural dessicated thyroid hormones) which they gradually increased until symptoms were relieved. NDT is made from animals' thyroid glands so contain all of the hormones a healthy thyroid gland would have.
Unfortunately for us, those who we'd expect to know better removed NDT from being prescribed (last year I believe) despite it being the only replacement since 1892 up until levothyroxine was introduced. Big Pharma saw a way to improve their profits especially if the person had to take extra prescriptions to try to control clinical symptoms.
T4 is an inactive hormone, and should convert to T3 - the active thyroid hormone and it is needed in our millions of T3 receptor cells - brain and heart contain the most.
Many people seem to do well on levothyroxine but I'm one who cannot improve whatsoever, so have tried various options - although these are getting scarcer and scarcer.
I can split T3 quite easily by using a pill-cutter. I use this one from Amazon:
A doctor (now deceased) was a specialist in thyroid hormones (especially with those who were 'thyroid hormone resistant) took T3 himself due to being 'thyroid hormone resistant'. He didn't split doses but took 150mcg of T3 in the middle of the night so that nothng interfered with the uptake.
You take thyroid hormones on an empty stomach with one glass of water, to prevent tablet sticking in throat usually when we awake but some prefer a bedtime dose. We should wait an hour after taking T3 before eating.
I wont say what I think of the 'experts' advice, i.e. to take 25mcg of liothyronine (T3). I think this proves that she is unaware that 25mcg of T3 is equivalent to around 100mcg of T4. Rather a high dose and you might feel over-medicated.
Those who are supposed to be 'knowledgeable' aren't and once we're on a dose, the increases should be very small and we stay on that dose for a few weeks and increases should be slow and careful.
Doctors seem more concerned about the blood results than the patient s' clinical symptoms and it is the symptoms we want resolved. The aim is that we feel 'normal health' and no symptoms.
A 'Full Thyroid Blood Test' consists of TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.
Also B12, Vit D, iron, ferritin and folate should be at good levels.
I will also state that I'm not medically qualified but had to 'learn the hard way' that few doctors know very much at all (unless they're hypo themselves) . Our aim is a TSH of 1 or lower, and FT4 and FT3 in the upper part of the ranges.
Thanks for your reply. Yes, now I am concerned about the advice I am getting from my doctor. Since 25 mcg is hard to get here, and 75 mcg is easy to get, she said I could take the 75 mcg three days per week, and keep up with the 100 mcg levo daily. Based on what i have learned in this forum, I think that is excessive. To slow things down a bit, I am going for repeat blood work tomorrow. My last results which I posted here are from July 30th, and I feel worse now than I did then. So I'll see what the new levels are and then send her that info. Also, I reached out the to pharmacy here that makes the lower dosage (25 mcg) and am waiting to hear back from them if they arrange delivery through the postal service since I live five hours away from them. I think I've decided there is no way I will take the 75 mcg in addition to the Levo. But I do wonder about monotherapy with liothyronine and if that's something to be considered. I can start a new thread once I get new results, more lab info, etc.
Hi, I am not taking any vitamin supplements. I had my Vit. D tested a while back and it was 49 (with the corresponding reference showing that over 30 is optimal.)
Vertigo is often a symptom of too much hormone but is definitely not in your case, there must be some other cause.
Your hormone levels are a bit low. Patients on levothyroxine usually need their fT4 in the upper quartile and this brings fT3 to near the middle of its interval. You need an increase in leovothyroxine or pehaps some liothyronine.
Everyone seems to agree except my endocrinologist! I feel like just upping the dose myself and see how my bloodwork reads in a few months, and how I feel.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Suppressed TSH but still under medicated?
Am I under or over medicated
Please help new lab test antibody is so high
Am I overmedicated? T3 mono (under endo)
