Advice about combination of T4/T3

[Grechka]

Hello!

Previously I was taking Levothyroxine 125 mcg, but later started to feel tachycardia more then usually, also my TSH was 0.3 and I've decreased Levothyroxine to 112.5 mcg.

About 6 weeks ago I've started to take T3 and added 1/4 of the tablet every week. Of course still little bit better than with just T3, but still feel tachycardia and it's hard to breathe sometimes.

My results after a month on 100 mcg T4 and 25 mcg T3.

TSH - 0.1 (0.550 - 4.780)

fT4 - 16.1 (11.5 - 22.7)

fT3 - 5.51 (3.50 - 6.50).

From this week I've started taking 87.5 mcg of T4 and 25 mcg of T3 plus 1/8 of T3 else in the morning. Could you please advise if I should change something, increase or decrease something?

[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)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Can’t see any vitamin test results in previous posts

Recommend getting vitamin levels tested before changing anything

Vitamin D, folate, ferritin and B12

Are you on strictly gluten free diet or tried it?

[Grechka in reply to SlowDragon]

Thank you for your reply!

I'm taking T4 in 24 hours before the test and T3 before sleep, so I have at least 9 hours after T3 before analysis.

I can share some vitamin test results that I have.

Ferritin - 59.3 (10 - 291)

Zinc - 16 (11 - 18)

Copper - 10.2 (12.6 - 24.4)

Magnesium - 0.83 (0.66 - 1.07)

B12 - 598 (156 - 672)

Also I have very old Vitamin D test result, it was done a year ago. 84.37 (30 - 100). After that I was taking 5000 vitamin D and from the middle of October I'm taking 7000.

I'm trying to eat gluten free, but sometimes I eat gluten.

Btw, I have also Hashimoto disease.

[SlowDragon Administrator in reply to Grechka]

Presumably vitamin D is ng/ml

That’s very high vitamin D

Suggest you reduce dose

[Grechka in reply to SlowDragon]

Yes, it's ng/ml. What is the optimal result for vitamin D in the case with hypo and Hashimoto disease?

Anyway, I'm going to make a test soon I hope.

[SlowDragon Administrator in reply to Grechka]

84.37 ng/ml is 210nmol

That’s extremely high vitamin D.

endmemo.com/medical/unitcon...

[shaws Administrator]

25mcg of T3 is equal, in its effect, to approx 100mcg of T4.

[Lalatoot]

A month after a change in dose is too soon. Better 8 weeks as this gives the body time to adjust.

You need to take things slowly otherwise you risk making too many dose alterations and missing the optimum.

It is an individual thing. Some folks manage on Combo manage with lower in range ft4; others need it well over halfway through range. Yours is 41%.

For me your ft4 result would be too low and would give me symptoms. Instead of increasing t3 again I would have increased levo which in turn would have given Ft3 a little boost. Your Ft3 is already 83%through range so I would be looking for it any higher really.

[Grechka in reply to Lalatoot]

Thank you for your reply!

So it's better to proceed taking 100 mcg of T4 and 25 mcg of T3 and then check the results again in 4 weeks?

[Lalatoot in reply to Grechka]

I wouldn't be looking to increase my lio dose with those results so I would stick with 25mcg. Testing 8 weeks after dose change.

[shaws Administrator in reply to Grechka]

It's better to listen to your body i.e. are you feeling better on the increase or decrease.

25mcg of levothyroxine versus 25mcg liothyroine (T3) does not have the same action in our body.

25mcg levo (T4) is just that (should convert some to T3) but 25mcg T3 is approx (in action) equal to about 100mcg of levo.

[shaws Administrator]

25mcg of T3 is equal, in its affect, to 100mcg of T4, so you might be overdosing.

[Grechka in reply to shaws]

It's better to decrease T3?

[Lalatoot in reply to Grechka]

Grechka I have just noticed that you have been increasing by a quarter of a t3 tablet every week. That is too quick. Recommended is a quarter of a tablet increase every 2 weeks. This is so the body can adapt.

You need to make changes slowly.

[Grechka in reply to Lalatoot]

Yes, I got it. But I don't think it makes sense to start from the adding a quarter of T3 every 2 weeks, when I've already decreased it to a tablet per day. Or do I need to move it back and increase slowly?

[Hashihouseman]

Too much t3! 10 mcg max then adjust t4 for comfort split dose everything!

[adin]

You split your T3 dose or you take it all at once

[Grechka in reply to adin]

I split it and take 4 times per day.