Hi everyone.
I was referred to an endocrinologist to ask if I could be started on liothyronine based on the following blood results from July 2020-
TSH low 0.13 mlU/L (range 0.27-2.50 mlU/L)
fT4 high 22.70 pmol/L (range 9.30-14.70 pmol/L)
fT3 low end of normal 4.00 pmol/L (range 3.5-6.5 pmol/L)
This was after a few increases to levothyroxine to try and increase my T3 levels. They were previously low (3 to 3.5) despite high T4 levels. I saw the consultant a couple of days ago and he agreed I might not be converting T4 to T3 well. He reduced my levothyroxine from 125mcg daily to 75mcg daily and started me on liothyronine 10mg twice daily. I haven't started these yet but should get them next week. My main recurring symptoms are abdominal bloating (all checked out-CA 125 normal, had abdo ultrasound and CT all normal. I've cut out gluten and lactose), feeling cold and tired. I still get on with my busy life as an ICU pharmacist and the usual stresses as life as a parent but I feel I need help in the energy department!
Although I'm a pharmacist I don't have a lot of experience with this drug and thought I'd ask all the experts here for any practical tips and if they agree with the dosing based on my blood results and finally if this might help me feel a little better!
Thanks all.
Generally we suggest starting low and slow
Starting by just adding 5mcg in morning
See how that goes
After 4-7 days add 2nd 5mcg dose mid to late afternoon
If ok
Either increase dose in morning to 10mcg or add 3rd 5mcg dose at bedtime
Some people find 2 doses per day is ok
Others prefer 3 doses at 8 hour intervals
Add last 5mcg
Retest in 6-8 weeks
You may find dropping levothyroxine by 50mcg may cause Ft4 to drop too much ...keep an eye on Ft4 levels at next test
Looking through previous posts couldn’t see any test results for vitamin D, folate, ferritin or B12
Ideally these should be optimal BEFORE adding T3
What vitamin supplements are you currently taking
Thanks SlowDragon. I’ll start liothyronine slowly as suggested.
No doctor has ever agreed to a Vit D test. I stay in Scotland and each time I ask my GP tells me that it’s not recommended as we are all deficient anyway! Therefore I take high dose Vit D (4000iu or 100mcg daily) so I’m hoping my results are normal.
I also take organic selenium 100mcg daily.
I take a probiotic and Zinc supplement daily.
My Vit B12 levels are high at 864pmol/L and I think that’s because I take a magnesium supplement to help with sleep at night which contains Vit b12 (ZM6)
I’ve never had my folate or ferritin checked. I guess I could try and get these privately but I would hope they would be normal as I have no other signs of anaemia Hb is 137g/L and haematocrit is 0.41% (range 0.36 to 0.48)
Vast majority of members test privately
NHS postal kit test £29
vitamindtest.org.uk
Or via monitor my health
ncbi.nlm.nih.gov/pubmed/286...
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
endocrine-abstracts.org/ea/...
Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.
With Hashimoto’s we frequently have extremely low vitamin levels. It has little to do with how good your diet is
Low Ft3 will almost always result in low stomach acid and low vitamin levels
B12 needs all the other B vitamins in order to work well
Recommend getting ferritin and folate tested
That all makes sense. Thanks again for your help.