Advice on test results after starting on T3

[TiredDad]

Please could you give me the benefit of your opinion on the test results below?

As background, I've been ill for two years with Hashimoto's and have been on various levels of levothyroxine without it restoring me to good health. On the instruction of my endocrinologist, two months ago I started taking 12.5mcg of T3 (tiromel brand) per day (2x 6.25mcg), while reducing my dose of levothroxine from 150mcg to 75mcg. I thought such a big drop in levo would make me feel worse but I'm actually feeling better and a lot warmer, although I still have bad indigestion and some fatigue and coldness. My latest results show that since October 26th my T3 has dropped slightly from 4.34 to 4.26 and my T4 has plummeted from 18.8 to 11.1. My TSH has climbed from 0.29 to 3.01 so there should be some room for manoeuvre with changing my dosage. What would you do if you had these results?

TSH

: 3.01 mIU/L (range 0.27 - 4.2)

FREE T3

: 4.26 pmol/L (range 3.1 - 6.8)

FREE THYROXINE

: 11.1 pmol/L (range 12 - 22)

[fuchsia-pink]

If these were my results, I would increase my meds.

But that's because I like both free T4 and free T3 to be high in range, and don't care if TSH becomes suppressed. Your free T4 is now under-range suggesting that the decrease last time was too much - so I'd be increasing this up to 100 mcg a day and re-test in 6 weeks.

Have you tested key nutrients recently?

[SeasideSusie Remembering]

TiredDad

I agree with fuchsia-pink .

When taking T3 it's usual to see TSH low in range or even suppressed, and FT4 lowish in range but not below range. FT3 would generally be in the upper part of the range.

Your results suggest that you are now on too low a dose of Levo. Increase the Levo, this will reduce your TSH, increase your FT4 and should also increase your FT3 depending on how much natural conversion you have. Tweaking doses of Levo and T3 to find the doses required to give you optimal results and be symptom free can take a long time and be incredibly frustrating!

Never change dose of both at the same time, either Levo or T3. This is because you need to know what effect changing each one has and if you change both at the same time you wont know which has made the difference. Retest 6-8 weeks after each dose change.

I am like fuchsia-pink, I am on Levo plus T3 and I am best when FT4 and FT3 are fairly well balanced at around 70% through range (some people are fine with a lower FT4). My TSH is always suppressed.

[SlowDragon Administrator]

Endocrinologists ALWAYS seem to drop levothyroxine too much

Suggest you increase levothyroxine to 100mcg /75mcg alternate days

Retest in 6-8 weeks

Should see both Ft4 and Ft3 increase

Likely to need to increase to 100mcg daily

Obviously essential to retest vitamin D, folate, ferritin and B12 too. Likely to have dropped as you are now under medicated

[TiredDad]

Thanks all. I’d wondered if it might be better to increase my T3 because it seems to have really helped since I started on it. I can see the sense in what you’re saying about upping the T4 though. I’ll have to see what my endo recommends but it’s really helpful to hear the views of experienced patients like yourselves.

I tested all my key nutrients with the thyroid hormones. They were all okay apart from my iron which has dipped to 57.7ug/L (range 30 – 400). Since starting on the T3 I’ve found it a bit harder to fit in taking iron supplements due to the need to leave a gap from other vitamins and my T3. I'm going to make sure I fit it in now though.

I hope that Brexit isn't going to make it a lot harder, or even impossible, to get T3 from the continent.

[SlowDragon Administrator in reply to TiredDad]

Which brand of T3 are you currently taking?

Is this private prescription

Vitamins will start to drop with such low Ft4

[TiredDad in reply to SlowDragon]

I'm taking 12.5mcg of Tiromel. I was prescribed 10mcg per day but I haven't got the prescription yet because I'd need to drive for over an hour to my endo's hospital to collect it. I was frustrated to hear they can't post it. Anyway, I managed to get hold of the tiromel which, when split in two, is 2.5mcg more than the 10mcg I was prescribed.

From what I read, having a private prescription may no longer be much use with getting T3 from the EU.

I'll bear in mind what you say about vitamins and Ft4. Thanks.

[SlowDragon Administrator in reply to TiredDad]

Getting private prescription of EU T3 - (usually Thybon Henning from Germany) is now possible via specialist U.K. pharmacy

No longer available from Germany to U.K. patients due to Brexit

PM me for info