Hi all, please see my bloods after 4 weeks on Sigma Liothyronin 10 mcg (taken 5 mcg in the morning with 150 mcg T4 and another 5 mcg T3 at 2.30pm). Also included the previous set of tests before starting T3.
I took the bloods at 1pm, 5 hours after taking 5mcg T3 that morning at 8am - this was the doctor's protocol so he can see the T3 peak.
I had T4 at 8am the day before, so 29 hours prior to blood draw.
My first 2 weeks on T3 were a dream (after the uncomfortable first few days), I had more energy, a buzz, great mood, and my muscles were not as stiff and tight as they usually are (confirmed by my physiotherapist).
The biggest change was my brain felt it had woken up after 15 years of brain fog.
Since then the buzz has sadly gone but my energy is still better than before T3, the muscles are tight again which is annoying. I get a lot of pain from computer usage (RSI).
My Endo felt I was over medicated so has asked me to take my T4 down to 125mcg (alternating daily 100mcg and 150mcg). After only a few days of that I’ve started to feel quite lethargic, brain fog coming back and my muscles feel extremely stiff.
Any advice would be gratefully appreciated. Should I continue on 125mcg and give it time or should I maybe take 100mcg twice a week and keep to 150mcg the remaining 5 days?
I don’t want to lose the benefits of T3 and T4 combo.
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Wired123
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One particular new symptom is since reducing my T4 a few days ago, I start to really flag at around 5pm and feel very tired and just in need of lying down.
I have experienced exactly the same late afternoon and early evening slump on dropping my T4 by 50% to accommodate T3, as per endo’s instructions... It looks to my (caveat - very uneducated and inexpert) eye, that you need only tiny tweaks to get the T4 and T3 within range!
I have a question, too! Why do you think your T4 result is higher on the second test given that the amount of T4 you were taking stayed the same and there was more than 24 hrs without T4 before the test? Is that a fasting / non fasting thing, do you suppose? Or has adding T3 some how slightly increased T4? I am idly speculating without having a clue again, but I wonder if that is because the body is not needing to turn it into T3 as you are doing the job by adding that? Perhaps someone more expert than me knows whether that would or wouldn’t be a thing?
Anyway, I am tuned in, as we’re on the same journey... my endo cut my levo from 100 mcg to 50 mcg to accommodate 2 x 5mcg lio... I feel the cut in T4 is too high as I’m a groggy and foggy, but happy-groggy-foggy, so we soldier on for another 5 weeks!
One more thought - personally, if I were in charge of my own treatment and had your results, I’d be wanting to drop the T4, but as little as possible, until I found my sweet spot. So, I would be tempted to get 25mcg tabs and cut them to a daily dose of 137.5 mcg, if I could. Or alternate 125 with 150 on T4. But that’s me being instinctive rather than knowledgeable... I don’t know how much a drop in dosage influences where the T4 will sit in range... but given that you felt good and are only just over on T4 and T3, I feel that it isn’t a sledgehammer we need, but the lightest of touches...
Can't really compare those test results as they were taken at different times of day and one is fasting and one not. But both sets of results look OK, given time of day etc. Might be better to try 150 and 125 levo on alternate days.
Bloods were retested too soon after T3 was started..should be 6-8 weeks
Always get test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test and last 5mcg T3 8-12 hours before test
Reducing levothyroxine by 25mcg per day is quite a lot.
Suggest you get bloods retested 6-8 weeks time...
You may need to add in extra 5mcg T3 ....or tweak levothyroxine dose back up a bit
ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12.
I’d reduce the Levothyroxine slightly before reducing any T3. As long as T4 is within range you should be feeling ok. Your T3 is slightly over but I wouldn’t reduce this yet. I think you are feeling over medicated feelings and that’s why your buzz and energy are not as good as when you started out on T3. You were building it up now it’s gone over. If I go over medicated I get tired and lack in energy quite quickly. This has been proven by bloods tests I’ve had that went over when feeling this way. You’d think it’d be the opposite but it’s not always. I was surprised. Your body goes into reverse, could it be reverse T3 RT3 making you feel lacking. It’s dumping T3 either converted or T3 you’re adding. Lower the Levothyroxine, it’ll take about a week to lower in your system, then you should start to feel better and more energised and buzzy again. It’s all about keeping the T4 and T3 hormones balanced, our bodies don’t like going over range. When I go over it’s like trying to drive with the handbrake on. As soon as I lowered my Levothyroxine dose I felt better. You may even need to take 5mcg T3 then 2.5 and a further 2.5 at 6/7hr intervals. The tired feeling and brain fog is over medicated as much as it can happen being under medicated.
And I’d try to stick to same amount of Levothyroxine daily not up and down doses.
Thanks. A lot to consider and I didn’t realise that over medication would give the same symptoms as under medication!
I’m only a tad outside the range and I didn’t think it would be a massive issue. I’ve dropped the T4 slightly but maybe the drop is too great so I need to increase it a bit so I can find that elusive sweet spot.
You could adjust the fuel/air mixture - with the engine putting out smoke and running poorly when rich, and running poorly/failing to start/run when too lean. Easy to appreciate whether you need to make it richer or leaner.
Carefully adjust the screw until it is running nicely. Engine happy.
If you now turn the screw a very, very small amount, the engine will run less well. But when it is very close to right, it makes little difference whether you make the mix richer or leaner. Both are worse but not by enough to get black smoke or fail to start.
Whether slightly too rich or slightly too lean, the engine will lack power when pushed. You know it isn't right, but less easy to be certain which way.
Ah ... those were the days.And after you'd got your Honda 175 running sweetly to pass the MOT, you could take the factory exhaust off and put some sawn off E-type jag exhausts with no baffles left, back on , adjust your carburettor all over again, and make it sound like a BSA
But i'm not sure what that sort of immature behaviour is an analogy for.....
I'm so sorry the Dr is doing this to you. I would switch to a Dr that goes by symptoms and not by some paper. Lab results are just ad snap shot of the moment you had labs. Symptoms are much more telling since the are cellular results.
I would in addition suggest that many of us that feel tired in the afternoon what helped me verymuch was splitting my T4 too. It makes a tremendous difference for me. You might want to try it too.
First of all I think that even though we are all individual, it is useful to know what the normal values are. When you were on T4 only, your ratio of T3:T4 was 0.215, lets say 0.22 which is too low. This means that you are a poor convertor of T4 to T3.
Now you have opted to add T3. To be optimal on T4/T3 therapy you have a suppressed TSH, FT4 midrange and FT3 in upper quadrant of range. In the ranges you have given that means a FT4 around 17 and an FT3 at 5.9 or higher.
I think that your T3 reading after taking your morning T3 dose is not useful for the purpose of measuring if you are optimal. For this, you need at least 16 hours after your last dose of T3.
You say that your first 2 weeks on T3 were a dream and then it changed. This is probably because at first your body was still producing T3 (although not enough) and this T3 along with the T3 that you took brought you up to the T3 that your body needs to feel good. After the first 2 weeks your TSH went down and that cut off the T3 produced by your body and you went into deficit again.
I think you should gradually aim to get your levels nearer to the optimal for T4/T3 therapy as described above, and I do mean gradually. Make a small change and measure every 6 weeks. Do a test before you start to get a useful T3 reading and then do your subsequent tests at the same time every time. Reduce your T4 and increase your T3 very carefully. With patience and time you will hopefully start to feel better in a sustainable way.
Some people find that they do better with a little NDT in the mix. This may be because NDT has all the thyroid hormones, including T2.
"I think that your T3 reading after taking your morning T3 dose is not useful for the purpose of measuring if you are optimal. For this, you need at least 16 hours after your last dose of T3." Hi June, I'm interested in your thinking . Why 16 hrs ? seems really long.
The endo's suggestion is clearly to see the highest possible level , which i agree is not helpful either , unless that is what he's specifically looking for, but won't your 16 hrs show an unrepresentatively low level of T3 ?.
Thanks June, I liked your reply. I agree that perhaps after the first 2 weeks my body reduced its own T3 and therefore I don’t have enough T3 in the body. The test result for T3 is showing peak T3 (which is what my doctor wanted to see) but that doesn’t mean I’m well medicated the rest of the day. He’s insisted I do all my tests in this fashion, perhaps I need to do both so we have the 9am fasting as well as the 1pm T3 peak to be looked at together.
My FT4 and I imagine the FT3 from conversion of the T4 tablets will undoubtedly come down now I’ve reduced my T4 dose slightly to 133mcg (taken daily 150, 150, 100). So whether the doctor will then put me on a higher dose of T3 after the next set of results.
Could you explain this again please as I don’t seem to understand the point you are making:
“Do a test before you start to get a useful T3 reading“
"Do I test my free’s after a dose of thyroid meds?
We’ve sure learned the hard way that it’s a no!! That is because there is a slight rise of T4 after taking meds, and a definite high rise of T3 after taking T3-containing meds. We don’t want to test those temporary rises. We want to know what we are hanging onto. So we take our meds as usual one day, then test the next morning BEFORE taking our thyroid meds for the day. (If on a T3-containing treatment, best to take it twice, or three times a day, before the next day morning test)"
So what is useful for your doctor is not the same as what is useful for you to determine if your meds are optimal or not. I've never had an unrepresentatively low level of T3 when I tested in the morning before my meds (NDT). The one time I tested at lunchtime after my morning meds my T3 reading was over the high limit. That's not a problem so long as you don't have hyper symptoms. T3 levels do vary quite a bit more than T4.
"Do a test before you start to get a useful T3 reading“
Sorry I phrased that wrong. If you are working with your doctor then I guess you have to go along with how he wants to do it. The danger I see is that the doc might underdose your T3 because of going by the maximum peak reading which has in fact just exceeded the upper limit of the range. I don't see any harm in persuading the doc to do at least one test before 9am and before your meds. That way if you still feel undermedicated you'll have a case for increasing your T3.
Hope this helps. I'm not a doctor, just trying to find my way the same as you. There's a lot to learn.
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