Do I need more t3 or more t4.. or less?

[Giugiugiu]

Hi there everybody,

I’m Giulia and this is my story. Diagnosticated with subclinical hypo in October 2019 and not a single endo believed me on my symptoms. At first I tried levo only but I gaine quiete a lot of weight, feeling very fatigue and always sore. In February 2020 I started to automedicate and I went on 50 mcg levo and I started winth little t3 (liotir). I immediately felt better, mood was up, weight started to go down and I thought all my problem disappeared! I’ve slowly increase t3 and t4 and now I take 75 mcg t4 and 19 mcg t3 but I’m slowly gaining back the weight I lost.

My blood test currently are:

Tsh: 0,09 (0,51-4,94)

Ft4 1,08 (0,89-1,76)

Ft3 4,2 (2,3-4,2)

Now, I know this weight gain is not normal yet I do not know what to do now. Any suggestion?

Sorry for my bad english, I’m Italian.

Thanks,

Giulia

[SlowDragon Administrator]

Did you do this test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test and last 1/3rd of T3 8-12 hours before test?

You need to also test vitamin D, folate, ferritin and B12

These are very often too low when hypothyroid and we often need to take vitamin supplements to improve levels

Also need Thyroid antibodies tested to see if cause of your hypothyroidism is autoimmune thyroid disease (hashimoto’s)

About 90% of hypothyroidism is autoimmune thyroid disease

Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

[Giugiugiu in reply to SlowDragon]

I did test following these rules. My vitamins and ferritin are all well in the range and I also got my antibodies tested last year and they were all good. No signs of hashimoto or autoimmune disease.

If I just look at the blood tests... Everything seems good.

Also, can you really gain weight from overmedication?

[SlowDragon Administrator in reply to Giugiugiu]

what exactly are vitamin results and ranges?

Have you had ultrasound scan of thyroid

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

[Giugiugiu in reply to SlowDragon]

Yes, I had the ultrasound scan last year in October, nothing was wrong, no nodules or changes in shape or anything else.

My levels are:

Ferritin 138 (10-291)

Vit. B12 512 (300-900)

Vit. D 29 (20-40)

Folate I can’t find it, I’ll retest it soon

[SlowDragon Administrator in reply to Giugiugiu]

Perhaps try very small increase in levothyroxine

75mcg 5 days a week and 87.5mcg 2 days a week

Vitamin D might be better around 40ng/ml

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

[Giugiugiu in reply to SlowDragon]

In Italy we just have the 25 mcg dose, so I can just increase it to 100 mcg. I take tirosint, a liquid form.

My antibodies:

ANTICORPI ANTI-TIREOPEROSSIDASI

<28 (<60)

ANTICORPI ANTI-TIREOGLOBULINA

< 15.0 (<60)

[Giugiugiu in reply to SlowDragon]

So, do you suggest to up my levo and not my t3?

[knitwitty in reply to Giugiugiu]

Ciao Giugiugiu

If you cut a 25mcg tablet in half it will allow you to increase your dose to 87.5mcg on the two days as suggested. Euthyrox tablets are available in Italy you can get them in 25,50,75, 100 mcg doses.

You can cut tablets with sharp knife or scalpel or get a pill cutter on Amazon.

I take 75mcg and 87.5mcg on alternate days.

[Giugiugiu in reply to knitwitty]

Hi there knitwitty, I don’t take eutirox. I’m on tirosint that is a liquid form of levo. It comes in singole doses so it’s really impossibile to split!

Thanks for your comment btw!

[knitwitty in reply to Giugiugiu]

Apologies , that would make it difficult to split up. I am not familiar with liquid levo.

Good luck with getting it sorted out.

[Giugiugiu in reply to knitwitty]

Thank you, I hope I’ll feel better (in a few days, maybe?). Ok Thursday it’ll be two weeks since I changed my doses! Wish you the best!

Goodnight

[pennyannie]

Hello Giulia and welcome to the forum :

No thyroid hormones work well if your ferritin, folate, B12 and vitamin D are not maintained at optimal levels, so I would suggest getting these tested and then post back on here the results and ranges for considered opinion.

Do you know if you have an AI thyroid disease and have high thyroid antibodies ?

This also needs to be checked out if you have never been diagnosed as having a thyroid

auto immune disease.

Dosing with T3 and T4 is a fine balance and only you can know when you have found your optimal dose., You know you were right to introduce Liothyronine as it has helped you regain better health, and you might find this improves further with a stronger core of vitamins and minerals as detailed above.

No need to apologise for your English, it's very good.

[Giugiugiu in reply to pennyannie]

Thanks,

As I replied to slowdragon, all my blood tests seems pretty normals. Antibodies are low and I have no story of hashimoto in my family. I thought I was over all this thyroid thing this spring, when I was feeling really well but now it all changed and I don’t even know why!

[pennyannie in reply to Giugiugiu]

Thank you, our posts must have crossed over each other over France !!

I don't think thyroid issues are ever " over " as I'm 2 years into self medicating and I'm not " as good " as where I was when I first started despite being on the same dose and maintaining, as best as I can, optimal vitamins and minerals.

I've also read that conversion can be compromised because of dieting, ageing, depression, inflammation, and physiological or emotional stress so all we can do is tweak doses and find what suits us best at any one time.

[Giugiugiu in reply to pennyannie]

Yea, I think you’re (sadly) right. I find it hard mentally to deal with this condition, and even harder to change meds alone... so I hope to find soon a new med combo that will work fine.

[pennyannie in reply to Giugiugiu]

The brain needs an awful lot of T3 to function well -

I'm dyslexic and I found my cognitive functions greatly reduced when just on T4 ;

It was only when I added T3 that I was able to read something once, and have a good understanding of the content.

Currently your T3 is at 100% of the range, whilst your T4 is at only 22% - maybe this balance needs adjusting, to bring both T3 and T4 into balance ?

Do you have the results from the spring when you thought you had it sorted ?

[Giugiugiu in reply to pennyannie]

I always had ft4 low, in spring when I was feeling very well, lab tests were not so different:

Tsh: 0,061 (0,51-4,94)

Ft4 1,12 (0,89-1,76)

Ft3 3,6 (2,3-4,2)

Infact, I was wondering If I should increase levo and leave t3 like this. I really don’t know what to do!

[pennyannie in reply to Giugiugiu]

Hey there ;

Well- it looks as though your T3 was around 68% and your T4 around 26% in the spring - so yes, your T4 is still lower than T3 but not so acute :

I read that adding T3 lowers TSH and T4 but don't know the relevance of this here :

So, to get back to where you were in the spring you need to drop down a little of the T3 dose and add a little more T4 :

I've overdosed myself on T3 when I switched to a T3/T4 combo and my brain became like mashed potato - does that translate ? Is that a thing in Italian ? I couldn't function at all and my head felt like it didn't belong to my body.

[Giugiugiu in reply to pennyannie]

Yeah mash potato really dosn’t sound funny, sorry for that. Did you have other symptoms? Like palpitations, tremors (is this the right word?) etc? Adding t3 definitely lowered my ft4 but it has always been low (like never over 1.28) even on levo alone. I don’t know why honestly

[pennyannie in reply to Giugiugiu]

No - only that I couldn't function for about 10 days - very strange place to be :

I have lingering Graves BUT never even experienced a heart palpitation even when I had my thyroid :

I had RAI thyroid ablation in 2005 and became very unwell about 8 years later when on monotherapy with Levothyroxine and being dosed and monitored on a TSH blood test only.

I then found myself on here looking for answers, as the NHS service didn't help me, and started self medicating, firstly with adding adrenal glandular, and then vitamins and minerals.

I then trialled T3 with a lowered dose of T4 and messed up !!!

My fault entirely but I couldn't sustain the supply of the T3 I liked and the replacement bulk purchase I ordered gave me terrible headaches so I had a rethink.

I've moved across and taking NDT - which is pig thyroid gland, dried and ground down into tablet form referred to as grains. Each grain contains around 9 T3 + 38 T4 giving a fixed ratio of about 1/4 - T3 to T4 and this ratio seems to suit me well.

NDT was used successfully for hypothyroidism for over 100 years prior to the introduction of the ' science ' of blood tests and ranges and the new, superior ? thyroid hormone treatment - Levothyroxine.

The drawback for some people is this fixed ratio and read some people add back in a little T3 or T4 when they are very close to finding their " sweet spot " : I found my sweet spot, and then, maybe, went just past it, and am " looking again " but even for all this - so much better than just being on Levothyroxine.

You too had your " sweet spot " and that's where you need to try and get back to :

[Giugiugiu in reply to pennyannie]

Thanks for your help and for sharing your story. It’s a long and hard way this disease of ours but it’s a little better to know we’re not alone in this!