How quickly can you increase dose of T3?

[zoechal]

I am slowly increasing my dose of T3 upto 60mcg by ,5mcg every three weeks? Is that an ok speed? I am very under medicated with TSH of 6 and Ft3 in low 20% through range. Last week increased dose from 40mcg to 45mcg but still feel so.unwell that thinking if going to 50mcg today. Just worried about affect increasing too quickly could have on my heart 🤷

[tattybogle]

would it not be better to get a test done on the 40 / or 45 before deciding to increase further ?

I just wonder if you should allow for the possibility that your last TSH of 6 on 35mcg was maybe a 'one off' because previously you've had TSH of 1.5 on 30mcg , and your fT3 on that test was a false low.

Your last test *in july* didn't have fT3 done , so really we don't know where your T3 is on any T3 dose, and going from 35 to 60 is doubling the dose.

Edit*

[zoechal in reply to tattybogle]

Yes I see what you mean about the false low but listening to my body I am just constantly having flares. The last month has been particularly bad where the symptoms haven't gone which is always tricky with a house to run and children to amuse!

! Serum TSH level - 6mu/L 0.27 - 4.20mu/L

patient phone consultation required

**[[Set=TSHR]]**

19-Nov-2020

! Serum free T4 level - (hesterblaber) - 4.6pmol/L 12.00 - 22.00pmol/L

Serum free T3 level - (hesterblaber) - 3.7pmol/L 3.10 - 6.80pmol/L

I didn't think I had had a TSH of 1.5mcg on 30 but I will go back and check results asap. This time I wasn't surprised to get a huger TSH because I felt like I had before diagnosed. I will up it to 50mcg and then get a test before going further

[tattybogle in reply to zoechal]

This one , i think on 30mcg ?

!02-Jul-2020Serum TSH level - (hesterblaber) - Tell patient satisfactory 1.5mu/L0.27 - 4.20mu/L

**[[Set=TSHR]]**

02-Jul-2020! Serum free T4 level - (hesterblaber) - Tell patient phone consultation required<3.0pmol/L12.00 - 22.00pmol/L

**[[Set=FT4R]]**

TSH is consistent with adequate replacement for primary

hypothyroidism. TFTs suggest this patient is on T3 only"

[zoechal in reply to tattybogle]

Yes Tattybogle you are right however as GreyGoose says a TSH of 1.5 is still too high for someone on T3 only. I will wait another week before increasing to 50mcg and seeing if I feel any better. Am currently doing the Amy Myers diet and working on all the vits so hopefully will get there. Appreciate of reply

[tattybogle in reply to zoechal]

Agree with Helvella , ie. hope some 't3 only' takers come along,...but go carefully, and remember that it's notoriously difficult to tell slight over medication from slight under medication, and that it will often take weeks to start to feel settled after any change.

[zoechal in reply to tattybogle]

yes you are quite right it's a real tightrope. I guess right now because I constantly feel I have the flu and aches everywhere I would happily take overmedication but of course in reality it would be grim!

[helvella Administrator]

I don't understand how you can have an end-point of 60 micrograms.

It is a journey. Each step needs to be considered on its own - and only then a decision made on the next step.

(Not meaning that you can't guess or estimate that you might need 60 micrograms. But you could just as easily find yourself adequately dosed at 55 micrograms or need 65 micrograms. That is, fine to guess, but keep remembering that it is a guess. )

[zoechal in reply to helvella]

I see what you mean but I had always thought 60mcg was the maximum. At least that was what the endo had led me to believe

[helvella Administrator in reply to zoechal]

The standard documentation suggests that people might need a dose up to 60 micrograms. But there is nothing definite about that.

You might need less. You might need more. Some people need unbelievably high doses. Though I suggest most of them have impaired sensitivity to thyroid hormone (thyroid hormone resistance) and it is unusual. Others only need a few micrograms.

You need what you need. Any piece of paper suggesting a specific dose is just a piece of paper.

I don't take T3 and would be delighted if people who do would help you from here.

[zoechal in reply to helvella]

Thanks so much for your replies especially on a wet day in January! I just felt nervous about increasing too quickly as previous endo had said T3 not great for heart so felt couldn't win. But then hypothyroidism isn't great for heart either frankly! I will give it a but longer on 45mcg and then go upto 50mcg and see what's occuring

[helvella Administrator in reply to zoechal]

I'd go along with excess T3 not being good for the heart. But there is plenty of evidence that the right level of T3 is an important factor in heart health.

[Hidden]

I am on T3 only (currently 50 mcg daily) and I follow Paul Robinson's protocol in his Recovering with T3 book. You really should go by 'signs and symptoms', that is, monitor your heart rate, BP and resting temperature just before and a couple of hours after every T3 dose, and keep records of any symptoms you are having. This is essential to monitor how your body is adjusting to T3.

How are you dosing the T3? Are you splitting the daily amount into 2 or 3 doses? When do you take your first dose?

When I started on T3 I increased very slowly, a 5 mcg increase at a time, spaced about a week apart to begin with but later on as I moved up to higher doses, then around 2-3 weeks.

There are also other things to consider, such as your cortisol levels (if you have low morning cortisol you can increase that by taking a 'circadian' dose of T3 (Paul Robinson describes this method in detail in his book). Also you really need to have optimal levels of ferritin (over 80 and preferably even higher) in order to fully benefit from your thyroid hormone, as well as good levels of B vitamins and vitamin D3.

There is no fixed point at which you should aim to reach on T3. The right level is where you have symptom relief. However you may not get symptom relief if other nutrient levels are not optimal.

[zoechal in reply to Hidden]

Thank you so much that's very helpful! I had a cortisol test but looked normalish although I haven't had it interpreted. I will look at the circadian rhythm technique