T3 and lowering Levo guidance and opinions?

[jrbarnes]

Nine days ago I reduced my Levo from 88mcg to 75mcg to increase adding T3. My previous lab results on 88mcg Levo alone put my T4 at the top of the range 1.6(.82-1.77ng/dl) and T3 is usually around 2.6 to 3.0(1.2-4.9 ng/dl.) As you can see my T3 is barely 50% of the range. I need those T3 levels to get over 4.0. It's clear I have a conversion issue and only half a thyroid which doesn't function normally. My surgery pushed me into overt hypo, however going on Levo created a bigger problem for me because it robs me of a percentage of T3, which my body was compensating for before the Levo. Surprisingly, even with a TSH of 5, half a thyroid and some slight fatigue I felt better and lived normally without Levo.

My question is, with my T4 levels being higher do you think it's a reasonable move to reduce the Levo when making room for the T3? Currently I'm at 12mcg of T3 and feeling fatigued with joint pains like when my T3 levels are low and my hands are cold. I'm clearly not overmedicated. Before switching to a synthetic T4/T3 combo I tried 120mg of natural desiccated which is 76mcg T4 and 18mcg of T3 and after two weeks I tested because I was feeling a tad sweaty and overheated and my TSH was .05, T4 was 1.2 and T3 was 3.8. Same reference as above. It looks like I need a lot of added T3 to compensate.

Is it okay to need higher amounts of T3? Anyone out there with the same? Would anyone recommend to stay on the 75mcg of Levo and increase the T3 to say 15mcg?

I've noticed since reducing the Levo and increasing the T3 I have less stomach bloating and teeth clenching. I've also gone gluten free for over a week and limited dairy. I've worked to get my B12 and Folate optimal, Vit D was already optimal and also working on increasing my sub optimal ferritin. I've been avoiding caffeine around meals and drinking a little orange juice instead to increase iron absorption.

[JAmanda]

I wouldn’t reduce the T4. It’s not that high and they do say on here to make one change at a time I’d add in a little more t3 as you say. You do need to wait at least 4 eeeks to see the results - pref double that.

[jrbarnes in reply to JAmanda]

Thanks for your reply and advice. I've upped back to 88mcg this morning with 5 mcg of T3. I took natural desiccated earlier this year but had an issue with needing to individually adjust the T4 and T3, which you can't do so I was trying to recreate that ratio on synthetics but with slightly less T3. It didn't go very well. NDT and synthetics feel like two different worlds.

[Hashihouseman]

Without converting your t3 and t4 units to the pmol/l I’m used to I’m still prompted to respond to your comment about % of range..... %of range isn’t as good a clinical reference point as the most common (modal) healthy values which are quite narrow in comparison to the lab ranges or to discovering (by dose titration and tsh ft3 ft4 function tests (TFT)) your individual optimal levels, which are likely to be narrower still. Lab ranges do not come from randomised clinical trials of large numbers of healthy compared to hypothyroid individuals...... so how could they pinpoint the narrow healthy individual range?!?.... it’s not clear why you may be targeting the levels of ft3 and ft4 you mention apart from symptoms and zone of lab range and you don’t say what TSH is in relation to your 88mcg levothyroxine dose levels....

. I found levothyroxine to be quite a disruptive and difficult customer unless I split the dose into at least 3 a or even 4 separate doses with split t3 combined Edith each levothyroxine dose, so creating a synthetic combination dose like a natural desiccated thyroid product but with physiologically human t3:t4 ratio..... this changed my blood levels and my symptoms for the better without much change in absolute dose. The whole process of titrating dose takes months if not years and careful observations and test to optimise ft3 ft4 and TSH together with least worst symptoms..... why not aim for what would be a healthy normal set of TFT for your peer group then adjust if necessary according to physical symptoms after allowing at least 6-8 weeks for each change in dose to settle?......

So, you could emulate a normal healthy thyroidal output of about 100mcg t4 and 7-10mcg t3 with split combo dosing starting bedtime and finishing about midday, to allow the circadian TSH rhythm a chance to operate - TSH does more than just stimulate the thyroid gland so we don’t want to suppress it too much unless it’s clinically necessary. You may find your optimal levels are nothing to do with whatever percentage of the lab range seems reasonable and that too much t4 in one hit really does harm cellular t3 conversion by negative feedback......

[jrbarnes]

I've taken some of the advice from his writings like taking the T3 in the very early morning and then around noon.

[SlowDragon Administrator]

You don’t want to change too much too quickly

Are you currently taking taking 12.5mcg as 2 x 6.25mcg split roughly 12 hours apart

Wait 6 -8 weeks and retest

[jrbarnes]

Currently, I'm taking 88mcg Levo and I have the 5mcg T3 pills. I take 5mcg of T3 upon waking early, again 5mcg around 11am and 2.5mcg around 4pm. I've been trying different times. I'd like to take more at once but feel unwell when I do. Without T3 my FT4 levels are at 82% in range and FT3 barely 39%. I'm very hypo right now as my bones are cracking and it's a labor to walk and I can't remember anything. I have these troubles when my T4 to T3 ratio is high.