How do I reduce T3 intake to increase T4? Is there a specific order or method when working with both types of thyroid meds simultaneously?

[ChronicTonic]

I’m currently taking 75mcg Levothyroxine in the morning, and 25mcg T3 twice daily (morning and night). I’ve been taking this exact combination for a few years now.

The bloods above show my most recent results.

On the advice of the NHS Endocrinologist I saw, my GP’s increased my Levothyroxine from 75mcg to 100mcg in order to reduce the T3.

How do I taper down the T3 and titrate up with the T4?

Is there a system I should follow?

Eg: Should I reduce T3 by a quarter each morning at night for a week, and then once it’s settled down take 100mcg T4? Instructions please!

I’ve not been feeling great for a while, but put it down to the perimenopause (I’m 44). Now I’m wondering if actually it’s too much T3: I’m having fierce sweats (especially after I eat, when my face and body feel like they’re burning up), and I wake drenched at night even though the heating’s off. I’m also struggling with insomnia anyway.

I’ve put on more weight around my middle but thought it was because of the progestogen-only Mini Pill they’ve put me on to manage the perimenopause symptoms.

I have a permanent sore throat (scratchy and sore, visibly red and raw like a viral infection) which I thought was due to the COVID I had back in March as that’s when it started. I’ve since been diagnosed with Long COVID as I have plenty of other symptoms which haven’t gone, but now I’m wondering if my sore throat could also be due to overmedication of T3.

Anyway, I digress. First things first: I feel yucksville and I’m a hot mess (literally!) and would appreciate instruction or methodology on how to reduce my T3 intake to increase the T4.

Any and all advice gratefully received.

Thank you!

[Foreststream]

Take your t3 down ever soooo slightly and then add in iodine and L-tyrosine. These two things will help you convert T4 to T3. If you look at your labs you are what we call an underconverter

[Foreststream in reply to Foreststream]

Also remember when you are boosting magnesium,,,take it separately from your thyroid as it will interfere with absorption.

[ChronicTonic in reply to Foreststream]

Yes! Thank you for your input

[Angel_of_the_North in reply to ChronicTonic]

But be aware that if you could manufacture thyroxine properly from iodine and tyrosine (which are readily available in the diet unless you are vegan), you wouldn't be on such a high dose of thyroid meds - so it might well be a waste of time and money

[SlowDragon Administrator]

These are same results as post four months ago?

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

When you did this test was last 1/3 of daily dose roughly 8-12 hours before test

Suggest you increase levothyroxine too 100mcg/75mcg alternate days

3-4 days later reduce T3 by 6.25mcg (probably evening dose)

Assuming that’s ok

After 2-3 weeks increase levothyroxine to 100mcg every day and few days later reduce morning dose by 6.25mcg

Retest after 6-8 weeks

Personally I find it much better to split daily dose into 3 - at roughly 8 hour intervals.....so after reducing, you would be on 12.5mcg 3 x day ....7am, 3pm and 11pm

[ChronicTonic in reply to SlowDragon]

Yes: same results - I haven’t had the finances to do another load of tests. As always I took my bloods following your protocol.

I haven’t taken any supplements for a while as again, my finances are pretty dire at the moment.

I ended up splitting my T3 doses into twice daily rather instead of three times daily as I eat lunch and drink (tea) at irregular times which was interfering with my afternoon T3 intake - and vice versa. At least with twice a day I know I’m taking it regularly.

Thanks for your thoughts on the way to reduce T3 and increase T4. I had no idea!

[SlowDragon Administrator in reply to ChronicTonic]

T3 isn’t as fussy as levothyroxine about gap between food and drink

Yes I sometimes move mid afternoon dose around a little...to fit around afternoon cup of tea

[ChronicTonic in reply to SlowDragon]

EXACTLY. Afternoon tea *extremely* important

Wasn’t aware I could drink milk around T3. That’s good to know!

[SlowDragon Administrator in reply to ChronicTonic]

So are you leaving roughly 12 hour intervals between the 2 doses?

[ChronicTonic in reply to SlowDragon]

It’s more like 12 or 13 hrs: 7am-ish and 9pm-ish

Thanks for your thoughts

[SlowDragon Administrator in reply to ChronicTonic]

Personally I can’t tolerate just two doses T3 a day.....so I have to take 3 doses

Occasionally I might take 3pm dose at 2pm or 4pm

[ChronicTonic in reply to SlowDragon]

I started with three doses, SlowDragon but twice daily ended up easier.

I suspect I’m overmedicated on my current T3 doses anyway. Be interesting to see how I feel dropping a little T3 and adding 25mcg Levothyroxine; better, I hope!

Thanks so much for your time, as always.

[SlowDragon Administrator]

Never supplement iodine unless confirmed as iodine deficient and especially if Hashimoto’s

Levothyroxine has all the iodine required

[fuchsia-pink]

Go slowly so you don't miss your sweet spot. SlowDragon 's suggestion makes a lot of sense - doing one thing then another rather than both together. Absolutely don't add iodine - your levo contains it and too much iodine is one of the worst things you can do if you're hypo x

[ChronicTonic in reply to fuchsia-pink]

Thanks for this

I’m aware of the iodine thing, but others who may read this aren’t, so it’s always worth repeating!

[JAMuir]

25mcg T3 twice a day would be equivalent to 200 Levo so I would think you should feel horrible. If you were trying to replace 50 levo then that would be 1/4 of a pill twice a day. I learned that the hard way when I started taking T3. My dose prescribed was 150 levo so I take 1/2 a T3 and 100 levo.

[ChronicTonic in reply to JAMuir]

Thanks JAMuir I've been taking these doses for a few years now - 75mcg Levothyroxine in the morning, and 25mcg T3 twice daily (morning and night) - and it's only the past 6 months or so that I've begun to feel not-OK.

I put it down the perimenopause shifting my hormones, and to COVID in March which has left me with all sorts of weird symptoms. I think my body's had a bit of a rejig recently - and taken a battering, too.

After being undermedicated for hypothyroidism for 25 years, adding T3 a few years back changed my world for the better. Since my GP's finally increased my dose to 100mcg T4, I can now reduce the T3 (which apart from anything else is harder to get hold of than T4!). Like you I feel I need more/ a combination approach, so it's great to hear your thoughts on the matter. Thank you

[Sumiko_no_mono]

A silly question: have you skipped meds 15 hours prior to testing?

If yes, problems with tolerating t3 is all about cortisol and iron. (I am on a much higher dosage of t3)

[ChronicTonic in reply to Sumiko_no_mono]

Hi Sumiko_no_mono ! Yes, thank you: I always follow the testing protocol advertised here.

As I said, I've been taking these doses for a few years now - 75mcg Levothyroxine in the morning, and 25mcg T3 twice daily (morning and night) - and it's only the past 6 months or so that I've begun feeling weird.

I feel the perimenopause and Long COVID have something to do feeling overmedicated/ hot and sweaty, but I do very much need a reset.

In terms of cortisol, I feel like my adrenals are shot at the moment, and I'm not sure why. It feels like it's all happening internally. Reminds me of when I was first ill with ME 30 years ago. So I think you're right and something's off with my cortisol levels.

I'll work on my iron levels again: I may have let those slip a little. Thanks for the reminder

Are you taking T4 with your higher doses of T3?

[Angel_of_the_North]

Many people feel fine with under range FT4 as long as their FT3 is good. Taking more levo will not lower T3, but raise it if you are able to convert at all - I don't think your endo knows what he's doing. I would go back to the dose you felt well on. If you didn't feel well before, I'd just reduce T3 by 1/4 tablet a day and see how you feel, and then increase levo by 25mcg a day if you feel hypo. But if you felt well there is no ned to change just to fit in with an endo's ideal numbers.

[ChronicTonic in reply to Angel_of_the_North]

Absolutely Angel_of_the_North - couldn't agree more! Thank you for your input.

I disagreed fundamentally with my Endo. In fact she made me cry with her thoughts on T3 - when to me it's proved lifechanging in the past few years! Managed to hold the tears in 'til I was in the car on the way home, though

I've been feeling fine on the same combination of doses the past few years, it's only the past 6 months with the perimenopause and COVID I've felt increasingly strange and kind of overmedicated/ possibly just hormonal. I can't tell!

Also, a few months ago the docs put me on a progesterone-only Mini Pill to help regulate my hormones and it's really not helping anything. They won't give me HRT as they say I'm too young (44). But it really doesn't suit me - my brain's gone to mush and my ADHD meds aren't working anymore. I definitely need oestrogen too. That's another battle I'm having to fight!

So there's a lot going on. However, I already felt weird and overmedicated before I started taking the Mini Pill. I've had sweats and a racing heart, but haven't lost weight, or felt panicky and like my eyes are out on stalks like last time I went obviously hypERthyroid (I've had that before and know what it feels like!). I don't know how to feel better.

That said, my instinct is to reduce the T3 by 1/4 once (or twice?) a day, before maybe increasing the T4. But I'm so scared of being undermedicated for my thyroid again. It's hard to come back from decades of hypothyroidism mismanagement with confidence!

[ThyroQueen in reply to ChronicTonic]

Also there is a group on here for HRT/menopause and they are so good! Interestingly, lots of the folks on there can't tolerate progesterone. They all talk about how they hate the days when they have to take it! Whereas I love it and it was the estrogen I had to get rid of. I lied to my doctor to get HRT, because they don't give it to you until full menopause in Germany, and I am glad I did, because I was in hot flash hell. It's possible that you would respond better to micronized progesterone than to the mini-pill, if you could get a doctor to give you some!

[ThyroQueen]

I don't know anything like the experts on here, just my personal experience. However I became desperately ill after reducing my T3 and increasing my levo two years ago (on endo insistence), at a time when I was in the last years of perimenopause. I followed instructions on here to bring my T3 back up, and I am somewhat recovered, and finally out of the terrible end of perimenopause.

I did experience a small amount of insomnia and increased hot flashes/sweats when I slowly increased my T3, but my body stabilized when I hit the sweet spot - mine is 37.5, taken all at once in morning, of all things. If I were in your position, which I kind of am because I have chronic fatigue and a lot of other post-viral MFS symptoms, I'd be terrified to reduce my T3. But of course if you follow the folks on here and do it slowly you will know how you feel and that is the best guide

[FancyPants54]

Having perimenopause crashing together with hypothyroidism and a GP who says age 44 is too young for HRT (idiot!) is a lot to cope with. If you are on FaceBook, I recommend the closed group The Menopause Support Network. It's a fantastic group, led by a menopause trained councillor who offers 1-1 sessions if necessary. But the wealth of knowledge in that group is huge. There are lots of files to read through, advice for doctors and patients and copies of the necessary guidelines. I've been around a few, but it's the best place for reliable information and help that I've found.

facebook.com/groups/3848494...

[ChronicTonic in reply to FancyPants54]

Hi FancyPants54 I really appreciate your sympathy and understanding - the combination's driving me bananas; I don't know if I'm coming or going! And the progesterone-only pill is making me feel a zillion times worse. Ugh.

And the 'too young for HRT' scenario - despite having perimenopausal symptoms for over 3 years - is reminding me of the whole 'T3 isn't a thing' attitude, despite my 25+ undermedicated years. It's like banging my head against a brick wall. And I'm so tired of fighting for myself!! It's emotionally exhausting: I feel like I need a PA or representative to take over the advocating for me (I have ME, Fibromyalgia and Tranverse Myelitis too).

Anyway, knowledge is king, and I've joined a few FB perimenopause groups, but not The Menopause Support Network, so thanks so much for the share. I'll join it now.

Thanks so much, FancyPants x

PS: If anyone else reading this would like support for the peri/menopause I've found these Facebook groups helpful:

HRT & Hormone Help (Peri & Post Menopause Support Group)

Perimenopause Hub

Perimenopause - Thriving and Surviving!

Peri/Menopausal ADHD Women

^ Only if you have ADHD too: ADHD is hugely affected by oestrogen levels to the extent ADHD meds can stop working during the perimenopause ^

[jrbarnes]

I tried to take the mini pill when I had fibroid pain but it made me feel terrible. I'm 40 but I don't think I've started to enter perimeno.

[Murphysmum]

I can’t really help Abi but I wanted to chip in with my tuppence-worth!

I’ve been stable too on T3 only but recently it’s gone off and I can’t seem to get it right.

Back at the start of the year i felt great, the best I have since I fell ill three years ago. I was back to great energy levels and living life to the full again.

Since around August though it’s been peaks n troughs. I’m blaming peri menopause too - hence my reply really - as nothing else has changed! I can’t increase, I can’t decrease, but I’m having big swings in my well being and I can’t seem to fix it.

So watching this space abs feeling it with you! I’m back on progesterone cream after around a 9 month break to see if that helps.

Fingers crossed for you - hormones are a pain, aren’t they? 🙈

[ChronicTonic in reply to Murphysmum]

Ugh yes! It’s so frustrating, isn’t it Murphysmum? Been pootling along actually NOT feeling hypothyroid after so many years, and now the perimenopause has proved the proverbial spanner in the works.

It’s all so much harder too, when we have to monitor, source and dose the T3 ourselves. Such a lot of work just to feel better on that side, and then...hormones!

This means another search for the best hormonal treatment for the individual, and ultimately, potentially the fight for HRT - which can be tricky to get hold of in the UK, even though no other country is having the same issues!

HRT is another sticking point with undereducated GPs, who barely give the menopause a glance in their medical training (like the T3 they’re misled; it’s not their fault!).

There’s so much to juggle and so much more to work on getting Goldilocks right. And meanwhile our quality of life is hugely impacted.

I feel like we need to have our very own, open-minded, holistic and widely read GP on standby just for people like us and the frequent fluctuations we’re going through! Or maybe we just need a wife for emotional support and TLC. Hahaha.