About to start liothyronine. Any tips?

[Wellhellothere101]

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.

[SlowDragon Administrator]

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

[Wellhellothere101 in reply to SlowDragon]

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)

[SlowDragon Administrator in reply to Wellhellothere101]

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.

[SlowDragon Administrator in reply to Wellhellothere101]

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

[Wellhellothere101 in reply to SlowDragon]

That all makes sense. Thanks again for your help.

[Wired123]

I start my T3 journey tomorrow, we should compare notes!

#inthistogether

[Wellhellothere101 in reply to Wired123]

Absolutely! I probably won’t get my prescription until next week but looking forward to trying it.

[fuchsia-pink]

Best not to change levo and start lio at exactly the same time. I'd drop levo by 25 mcg a day first for a week, then introduce lio as SlowDragon has suggested until you're up to 10 mcg of lio; then reduce levo by the additional 25 mcg for a week, then add the next doses of lio as slowdragon suggests.

I'd worry that if you reduce your levo too sharply before starting the lio it may be too quick. The full 50 mcg drop of levo may be too much - so re-test after 6 - 8 weeks on the "end" dose, and adjust as necessary in small tweaks until you are happy you have found your "sweet spot".

You can take your levo and lio together. Once you're up to the "full" lio dose, it's down to personal preference whether you take your lio all in one go or split into two or three doses x

[Wellhellothere101 in reply to fuchsia-pink]

That’s all great information. Thanks

[Dunkenb]

Once you start the T3 you start to feel warmer. It’s a good idea to keep an eye on your temperature as an indicator to whether or not you’re taking enough T3. The bloating should also go quite quickly ( your digestive system slows right down with low T3 ) Twice a day may leave you feel tired between doses as it starts to wear off after 5hrs. I take 20mcg 3 times a day .Multi vitamin with zinc in it will help.

[Harle]

When I was levo only, my gp had elevated me to 200mcg levo daily I was so very very ill with this as I cannot convert T4 to T3 very well. I saw someone privately who instructed me to come off my levo completely. Then as I was extremely adrenal fatigued, I started adrenal support and Co Enzyme Q10, after 2 weeks I introduced a porcine desiccated thyroid support at this point I had received my liothyronine and I started on half a tablet in the morning and half in the evening. I continued taking these medicines, vitamins and minerals for 2 weeks before introducing 50mcg levo (which has a 28 day half life) this allowed the levo to normalise in my system. I have since introduced zinc, vitamin D3 and Magnesium. I hope this helps.

[Wired123]

Strange there is such a difference in opinion across people. Some you need 3 doses, others say 1 dose is enough.

Struggling to understand the science if indeed the tablets only have 5-8 hours of active life in the body.

My endo has specifically told me to retest bloods 5 hours after taking T3 so that it’s out of the system by then.

[Zazbag]

I split my dose into two, take first one when I wake up then second between 3 and 5pm. I then take my levo before I sleep. This works perfectly for me.

[Wired123 in reply to Zazbag]

Have you seen a change taking T4 at night vs on waking?

[Zazbag in reply to Wired123]

I've always taken my levo at night.

[Wellhellothere101]

Thanks for the advice everyone. I have been on liothyronine for a week now. Started on 5mcg once daily for a few days then 5mcg twice daily. I feel absolutely awful! I can hardly walk with exhaustion. I feel completely drugged up and sleepy for hours after each tablet. The bedtime one is ok as I’m sleeping through the side effects but the morning one makes me woozy for hours. I am also developing a real rage and anger that isn’t like me! I’m usually very laid back and placid. It’s so disappointing as I really wanted these to help. I’m hoping the side effects wear off soon.

[humanbean in reply to Wellhellothere101]

You were on 125mcg Levo, which was then dropped to 75mcg Levo + 20mcg T3.

A 50mcg reduction in your Levo may have been rather too much all in one go. But it is difficult to say because your Free T4 was so much over the range before the change was made.

Opinions vary, but T3 is roughly 3 or 4 times as potent as Levo (T4). So your full T3 dose is equivalent to 60mcg - 80mcg T4.

You might have to raise your T3 at a faster rate than you have been doing because a 50mcg dose reduction in your Levo is a huge drop and it could have been too much. But I'm aware that others may disagree.

One thing has just occurred to me...

Have you changed your make of Levo as a result of the 50mcg drop in your dose? A lot of people don't do well on Teva Levo. Although some people love it, so it's impossible to generalise.

[Wellhellothere101 in reply to humanbean]

Oh I should have said that I have only dropped my levothyroxine to 100mcg as some posters thought it may be too much of a drop in dose to go down by 50. I was going to give it another week then go down to 75mcg levo and take 10mcg twice daily of liothyronine. I just don’t know how I’m going to increase my lio dose as I’m totally drugged up after taking just 5mcg! I think my brand is the same. I’ve had different brands of levo over the past year and I’ve always been ok with each one.

WRT equivalencies- so my levo dose should be dropped further? Maybe down by 75mcg?

Thanks for replying