Is 50 mcg levo +10 mcg t3 too little? - Thyroid UK

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Is 50 mcg levo +10 mcg t3 too little?

Tussa profile image

Hi!

I wonder because I feel slightly over medicated. Since I had Graves I know the signs. I now take 75 mcg levo + 5mcg t3 at 6 am and 5 mcg t3 at 11 pm.

I’m 53 kilos and when I calculated 1,6x53 kg I’m supposed to take 84,8 mcg levo.

I read here that t3 is 4 times stronger than levo and that equals 106,4 mcg when taking my dose of t3+t4.

With 50mcg levo+10 mcg t3 I would end up at 90 mcg.

My doctor thinks I should try 66,5 levo+ 3x5 t3 and the endocrinologist said I should continue with my dose as it it. He “strongly discourages taking more t3 since it fluctuates” and said I will go hypo on 50 mcg levo.

I just don’t know whom I should trust, which doctor or myself. I would really appreciate your advice!

23 Replies

What are your recent blood results?I recently felt hyper like symptoms on 125mcg Levo and 10mcg T3 & as blood results showed over range T4, I reduced to 100mcg Levo. After 2 weeks on reduced dose my tremor and anxiety have thankfully reduced. I’m planning on rechecking my levels in another 4 weeks.

Tussa profile image
Tussa in reply to Buddy195

My blood levels two weeks ago:

Tsh : 1,1( 0,3-4,2)

T4: 18 ( 12-22)

T3: 4,5 ( 3,1-6,8)

How do you take your 10 mcg t3. Once or twice? At what time?

Buddy195 profile image
Buddy195 in reply to Tussa

I take 100mcg Levo and 5mcg T3 before bed and 5mcg T3 in the morning.

Tussa profile image
Tussa in reply to Buddy195

Like me then. Thank you!

I’m 53 kilos and when I calculated 1,6x53 kg I’m supposed to take 84,8 mcg levo.

People often put far too much emphasis on this formula based on weight. It is not intended to be used as a guide to treating people permanently - it is just intended to give some idea of what dose they need to take at the start of treatment - everybody needs to start somewhere.

Once treatment has been initiated, it should be adjusted up or down as necessary, based on testing, not the patient's weight.

Despite this formula existing, a lot of doctors ignore it and start patients on ridiculously low doses of thyroid hormone, and then do everything they can to keep doses too low.

I read here that t3 is 4 times stronger than levo

There are differences of opinion on this. Some people say T3 is probably just three times more potent than T4, some say four times and some say five times. Personally, I always assume it is three times more potent than Levo, but others may disagree.

The important thing is how you feel. And if you feel over-medicated then you need recent blood test results which include both Free T4 and Free T3. If you don't know what those are then your TSH by itself won't tell you what you should be doing.

I noticed on your last post that you mentioned having Covid. I have read a very few anecdotal reports that Covid has had effects on the thyroid and people have needed more or less thyroid hormone treatment.

In a healthy person who gets ill, the body will reduce T3 output and will instead create more Reverse T3. The effect of this is to make people feel less energetic, and forces them to take things easy to give the body time to recover. Eventually when they feel better their normal T3 / Reverse T3 balance is restored to what it was before they got ill.

So, whatever you choose to do, if you reduce your dose of either T4 or T3 it is possible you might want to go back to a higher dose eventually. So don't ask your doctor to reduce your dose - you could reduce it yourself and then raise it again if the experiment doesn't work.

SlowDragon profile image
SlowDragonAdministrator

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

As you have Graves’ disease are you on strictly gluten free diet

What are your most recent results and ranges

Dose by weight is only a guide (usually to get dose increase in levothyroxine)

Tussa profile image
Tussa in reply to SlowDragon

Levels two weeks ago:

Tsh : 1,1( 0,3-4,2)

T4: 18 ( 12-22)

T3: 4,5 ( 3,1-6,8)

Vitamin d: 109

Folate, ferritin and b12 were last tested one year ago. I supplement daily with b-complex.

I never had any problems with gluten. I did try once to go gluten free but it gave me anxiety. I love pasta and bread :)

SlowDragon profile image
SlowDragonAdministrator in reply to Tussa

Was 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 dose 8-12 hours before test?

Ft4 is 60% through range But Ft3 only 37% through range

Suggests you need increase in T3 to 3 x 5mcg.

(3 doses at 8 hour intervals)

Tussa profile image
Tussa in reply to SlowDragon

Yes test was done as you described.

I would like to take 3x5 T3 ( that’s also what the dr suggested) but I find it hard to fit in with food and supplements. Why is it better than twice a day? Morning and evening?

Do you know if I can take T3 and one hour later eat yogurt?

The reason why I ask is that I’m on a trial of quitting calcium supplements and I have to make sure I eat enough calcium.

SlowDragon profile image
SlowDragonAdministrator in reply to Tussa

3 doses at 7am, 3pm and 11pm

When do you take your levothyroxine....am or pm?

T3 is less fussy about food...30-45mins gap between taking it and food is likely fine

Personally I can only tolerate T3 as 3 split doses

Tussa profile image
Tussa in reply to SlowDragon

So it’s just with calcium supplements you have to leave 4 hours? I take Levothyroxine at 6 am.

Thank you for your help! I will consider the plan you suggests as soon as I know how it goes with the weaning of calcium.

SlowDragon profile image
SlowDragonAdministrator in reply to Tussa

Were parathyroid glands damaged during thyroidectomy

Is this why you need calcium

Tussa profile image
Tussa in reply to SlowDragon

I had a thyroidectomy but the parathyroid glands were not damaged. Yet I haven’t been able to keep my calcium above reference without calcium supplements and had terrible symptoms.

My pth is normal and now my calcium was in the middle of reference so the dr thinks I might cope without adding calcium supplements. I keep my fingers crossed 🤞 . It would really change my quality of life to the better.

SlowDragon profile image
SlowDragonAdministrator in reply to Tussa

For good calcium levels you need good vitamin D

Vitamin D looks pretty good

Do you supplement magnesium and vitamin K2 as well

Tussa profile image
Tussa in reply to SlowDragon

Yes I do and more vitamin D this last year than the years before. Maybe that’s why my calcium levels are better.

Vitamin D 2000 ie

Magnesium glycinate 375 mg

Vitamin k2 100mg

Since I had Graves I know the signs.I too was hyper, had RAI and am now hypo. For me many of the symptoms I had hyper I also have when undermedicated hypo. I lose weight, have a faster heartbeat, have anxiety. The only way I can tell if I am over or undermedicated is by feeling not right and then going by blood results.

Tussa profile image
Tussa in reply to Lalatoot

Thank you! That’s interesting.

Totally agree with humanbean about dosing by weight. It's a nonsense to say that your full replacement dose is found by multiplying your weight but any number, because there are so many variables: how much you absorb in the gut, how well you conver, how well you absorb at a cellular level, etc. It's just a rough guide to a starter dose - but might actually be too much for some people when starting. Thyroid hormones should be increased slowly from your starter dose until you reach your sweet-spot. Which has nothing to do with your weight.

I read here that t3 is 4 times stronger than levo

Once again, it depends on the individual and how well they convert. It's absolutely not something you can calculate exactly. You just have to try a dose of T3 and see how you get on with it. There are no clear-cut, hard and fast rules with thyroid. It's all a question of trial and error. If you feel over-medicated, no matter what your dose, it's best to get tested and see what the results say. Could be that you're actually under-medicated, because so many symptoms can be due to both over and under-medication. Labs settle the dispute. :)

Jazzw profile image
Jazzw in reply to greygoose

Once again, it depends on the individual and how well they convert

...and how well they absorb the thyroid hormone replacement in the first place. So many variables.

Tussa profile image
Tussa in reply to greygoose

My results two weeks ago

Tsh : 1,1 ( 0,3-4,2)

T4: 18 ( 12-22)

T3: 4,5 ( 3,1-6,8)

I felt really good just 4 weeks before this test. Labs then:

Tsh 1,2

t4 17

t3 4,5

I know from before that it really makes a big difference for me with just one number up and down in t4. That’s why I think it might be to much t4. And it has nothing to do with my t3 levels because it never increases ( without liothyronine. Poor converter)

greygoose profile image
greygoose in reply to Tussa

Your FT4 is only 60% through the range. I would be very surprised if that were too much for you. Especially after having Graves, where the body becomes used to having high levels of thyroid hormone. And, I would be very surprised if a difference of one number up or down had so much effect - especially as T4 is the storage hormone and doesn't usually cause much in the way of symptoms.

I would say you were under-medicated with an FT3 of only 47.84%. Most hypos need it higher than that. But, we're all different, and the only way to find out is to try reducing your levo slightly, and see if it makes you feel any better.

Thank you everyone for responding! My labs 2 weeks ago:

Tsh : 1,1 ( 0,3-4,2)

T4: 18 ( 12-22)

T3: 4,5 ( 3,1-6,8)

beh1 profile image
beh1 in reply to Tussa

Doses:Now 75 T4 2x5 T3

Doc says 66.5 T4 3x5 T3

Endo says continue on current dose.

You’re asking about 50 T4 2x5 T3

Your blood results look ok to me, perhaps a little low on T3 result, yet you feel a bit overdosed.

As the above experts said, we are all different. You could try 62.5 T4 and 2x5 T3, and that could get rid of your hyper feelings. But it will probably reduce your T3 result further. Only you can judge if that’s right for your body. As others have said, trial and adjust as necessary.

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