Help with T3 Please

[AleB]

Please could anyone help with my question, I posted 16 days ago mentioning that I had been given a trial of T3 again. Since then, I have my latest iron results from my GP from 6th October

B12 651ng/L (180-1000) range

Ferritin 47ng/ml (10 - 300) range

Folate 23.9 (>4) range

Disappointingly, my Iron stats have dropped from 83.4 (29/05/20) to the current position of 47. When I do the iron panel blood test, I make sure I stop all B12 and iron supplements a week before the test. It seems that any change in thyroid medication seems to just 'flush' the B vitamins down further, and I have to start all over again. Since March of this year, I have taken Ferrous Sulphate x 3 per day. I reduced my Levo to 100mcg on the 1st of October for 7 days, I then introduced 1.25mcg of T3, then another 1.25mcg at 2pm. This week I added another 1.25mcg of T3 in the morning dose, but kept the 1.25mcg for the afternoon dose. I noticed that I feel a bit woozy in my head and I still continue to have to sleep at around 11.30am - am I going too quickly with adding T3. I noticed that my temperature has increased to 36.9 and I feel at times too hot. Endo originally wanted me to lower Levo to 75 and add 3 x 5 of T3 per day - my T4 taken on 8/9/20 was not over range, so lowering it further doesn't make sense, and yet I know T3 is more potent. Do I stick with the 1.25mcg for a while longer or try to increase?

[Lalatoot]

1.25mcg is a very small dose each time. I don't think you are going too quickly.

I wouldn't lower levo any more. Based solely on my own experience we need what we need of each hormone and if you are adding T3 because of inefficient conversion you are topping up your FT3 to make up for that bad conversion.

It is hard to advise any further as only you know your body. I started on 5mcg per day and added in 5mcg every 2 weeks. Others on here have dosed in 2.5mcg increases. Maybe one of them will come along and advise.

[DippyDame]

From previous post, your conversion is poor. If you have optimised nutrients then you may find adding a little more T3 beneficial.

1.25mcg x3 = 4.75, still a low daily dose when your T3 is clearly low.

Given your symptoms I would be tempted to add half a T3 tablet ( whether 20 or 25mcg) to your 100mcg levo combined in a single dose ( timing from food etc as previously advised) then wait 6 weeks and retest. Note any symptom changes in a diary.

You ask, "Do I stick with the 1.25mcg for a while longer or try to increase?" Do you mean 3 x 1.25mcg as you describe above? You need to express your dose clearly otherwise it causes confusion.

Note - some people benefit from splitting the dose but I've always taken mine ( T3-only ) in a single dose at bedtime. No set rules...depends on your body's response.

Your endo made a reasonable suggestion of 75 levo + 15mcg T3. Did you trial this? How did you feel? Maybe a very slightly lower T3 dose for a couple of weeks then raise 15mcg. Hard to be specific.....listen to your body!

He probably decided that since your conversion is poor you are better adding T3 than relying on a low amount generated from impaired conversion. FT3 is the important reading!

Since we are all different with bodies that have different thyroid hormone needs, dosing tends towards trial and error, with regular testing ... but ensure FT3 in within range as you go. As you progress you can trial slowly reducing the levo and adding a tiny bit more T3.....numbers are well and good but the aim is to feel well not to tick-box numbers.

For good health TSH needs to be close to 1 and FT4 and FT3 about 75% through their respective lab ranges?

Best...

DD

[SlowDragon Administrator]

Considering that each T3 tablet only has tiny % of active ingredients it’s likely better to increase the amount you are taking

Most people start on 5mcg

Wait 5-7 days

Add second 5mcg dose mid afternoon

Assuming all ok

Add 3rd 5mcg dose at or near bedtime

Retest after 6-8 weeks

You could go more cautiously at 2.5mcg doses initially

[AleB in reply to SlowDragon]

Thanks SlowDraggon, going to try and reduce levo for a few days and then try again with t3, I feel as though that's what my body is telling me to do as if I increase the T3 slightly I feel my heart thumping and feel jittery! Thanks for your help again. 😊

[SlowDragon Administrator in reply to AleB]

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

[AleB in reply to SlowDragon]

Very strict GF diet... also, very little dairy (a small amount of natural Greek yoghurt), that's it!

[AleB]

When I try to increase the T3 I feel overmedicated, however I was wondering about lowering the t4 slightly to allow for the increase in T3. Levo reduction 100/75 alternate days, which is a reduction of 11mcg. To top it all, my chemist can now only supply Teva brand Levo... I usually take Actavis, something else to get used to now!

[SlowDragon Administrator in reply to AleB]

Best to never accept different levothyroxine.

Try different pharmacies until, you get brand you need

Teva, is a Marmite brand, some people love it, many can’t tolerate it. Have you ever had Teva before?

Teva poll

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

[AleB in reply to SlowDragon]

The prescription always says 'Actavis brand please'. The chemist is usually good at dispensing the right brand, but on collection today and my query, he said it was all he could get at the moment, and can't guarantee they can get it in... Supply issue!

[SlowDragon Administrator in reply to AleB]

Pharmacy probably wasn’t aware it’s changed to Accord

That’s standard response to patients when they hand out different brand

[SlowDragon Administrator in reply to AleB]

Activis is now called Accord

Apparently exactly same ingredients, though some members say Accord and Activis seem different

[AleB in reply to SlowDragon]

I read on online that Actavis and Teva are the same!?

[SlowDragon Administrator in reply to AleB]

No

See list here

healthunlocked.com/thyroidu...

[AleB in reply to SlowDragon]

Thanks SlowDraggon, I will have a look at these in more detail tomorrow... I do feel slightly hesitant at changing, but then I've felt rubbish since February going back onto Levo! Sorry to keep asking the questions, I don't seem to have much joy with the docs.

[helvella in reply to AleB]

Teva at one point bought the whole worldwide Actavis company. But they were only allowed to do that if they sold off some parts - such as the bit which makes generic products for the UK market. Otherwise they would have been too dominant.

The company Accord bought that bit of Actavis.

Now, some time down the track, Accord are re-branding the Actavis products as Accord.

So for a tiny period, yes, Teva did own the company in Barnstaple.

Teva and Actavis products have never been the same products. Certainly, Teva and Actavis levothyroxine have never ever been the same.

[AleB in reply to helvella]

Thank you Helvella, I will have a look through the link SlowDraggon sent...