I spoke to my endocrinologist today who is putting me on a trial of T4/T3.
She’s giving me 50mg T4 and 10mg T3.
I am currently on 82.5mg T4.
How do I work out if the trial dose is enough?
Recently my T4 was reduced to 75mg and my T3 went down to 3.4 (range 4.3 - 6.8).
She said over-medication can damage the heart yet a private endocrinologist told me years ago that it can (and in my case it did).
How do I work out if the trial dose is enough?
You can't 'work out' if the dose is enough. Only time will tell, when you have your next labs done.
She said over-medication can damage the heart yet a private endocrinologist told me years ago that it can (and in my case it did).
And, how do you measure over-medication? A suppressed TSH or an over-range FT3. Given that doctors rarely test the FT3, and only look at the TSH, I'm guessing the former. But, you can't tell if you're over-medicated just by looking at that. A suppressed TSH by itself does not damage the heart. It has to be long-term very high FT3, or Graves.
Thanks. She said they’ll only go on TSH with the trial as they can’t measure T3. I’m sure no medication for many years plus under medication affected my heart so I don’t want any further damage. I’m grateful for the trial though
Ah, yes, UNDER-medication could damage your heart, but you said OVER-medication. 
Dosing by the TSH is wrong, wrong, wrong. Especially with T3. Why can't the test the FT3? Is this your GP or your endo saying this? Endos can test T3.
Thinking about it, it sounds like they're setting you up to fail. Taking T3 almost always suppresses the TSH, so they're going to say you're over-medicated, and take you off it. I don't like the sound of this at all, and I'm not sure your doctors know what they're doing.
Sorry I wasn’t too clear in my first post. The endo today said overmedication will damage my heart. The private one had said not being medicated would damage it. So they have different views.
If they don’t test T3 I will get a private test. She said you can’t test T3when you’re on a combination. I’ll probably still have trouble with dosing but at least it’s a start.
I just haven’t got a clue about the dose she’s giving me and whether it’s enough as I don’t want to be undermedicated again.
My GP reduced my Levo earlier this year and I felt terrible. I told her if she reduced it my T3 would go under range and it did.
She was lovely when she phoned me with the result and increased it again straight away.
The endo today said overmedication will damage my heart. The private one had said not being medicated would damage it. So they have different views.
Well, no, they're not talking about the same thing. Hearts do need thyroid hormone, that is clear. So, not being medicated when you're hypo would be bad for the heart. The private endo didn't say anything about being over-medicated did he. Today's endo is also right in a way. He just doesn't really understand that it would take a hell of a lot of thyroid hormone replacement - more than anybody would actually want to take, because they wouldn't feel good - to have that sort of effect on the heart. Being over-medicated is not the same as having high levels of FT3 due to hyperthyroidism/Graves. He doesn't know the difference.
She said you can’t test T3when you’re on a combination.
Oh dear! Where do they get these weird ideas??? lol That's exactly when you do need to test T3!
I just haven’t got a clue about the dose she’s giving me and whether it’s enough as I don’t want to be undermedicated again.
One thing you have to understand is that you can't be put on the exact right dose straight away. First of all, there is no way anyone can know what that dose might be, and secondly that wouldn't be good for your body. With all hormones, you need to start low and work up slowly. You possibly will be under-medicated at first, but the dose should be increased in that case. I think this is something that doctors find difficult to understand.
And, there's nothing a doctor enjoys more than reducing doses of thyroid hormone. Any excuse is good! They don't really know what they're doing. Which is why we have to learn as much as we possibly can about our disease.
Yes it’s a bit crazy that in this day and age we have to push for proper treatment. They should be telling us.
No, actually, it's logical. Everything doctors learn in med school is controlled by Big Pharma. And Big Pharma don't want hypos to get better because they'd lose a lot of money from the drugs used to 'treat' hypo symptoms: statins, Beta Blockers, slimming tablets, antidepressants, the list goes on. So, that's why they don't learn much about it in med school. And, as they're taught that thyroid is no big deal, they don't have the interest to learn any further after med school.
This is a new problem, so I suppose that it makes sense that the problem just gets worse and worse.
In a way they are both correct .. un treated hypothyroidism will damage it and so will overmedication, but the question is "how to define 'overmedication' ?"Certainly not by using TSH alone (especially in someone taking T3)... they need to look at TSH + fT4 + fT3 together, (+ symptoms!)
It's daft to say they can't measure T3 when on combination therapy.. obviously you can't tell which bit of fT3 came from the T3 dose and which came from conversion of T4 to T3, but that doesn't mean you cant measure T3 levels ... you don't need to know "which came from what source"... you need to know if you 've got too little /enough / too much, and that's what the fT3 test is for... and in someone who is taking T3 in a tablet you then need to take into account how many hours before the blood test the last T3 dose was taken.
Thanks. I’ll make sure they test it all in the future. I’ll no doubt be back on here asking advice 😂
I’ll make sure they test it all in the future...
I hate to be the harbinger of doom ... but i suspect you'll be back asking us for the details of the blood test services we all have to use cos the blummin Endo /Doctor /Lab etc won't agree to test fT3. and some of the really closed minded ones won't even test fT4.
That’s good - thanks
What, the working out bit? But, it's still not something you 'work out'. There are protocols. You start low and increase slowly. I would have said that if anything, the T3 dose was too high to start on. 5 mcg might have been better.
Hmf...
Some endos work to the idea that 5 mcg T3 is equivalent to 15 mcg T4 and some say it is equivalent to as much as 25 mcg T4. In my experience of dosages, 15 mcg feels closer to the truth.It’s worth remembering too that we vary dramatically in our ability to absorb medication, so the truth of the thing will probably be a bit different for all of us.
Of the tests, I believe that fT3 is the least reliable, but it still seems strange not to test it at all and to only go by TSH.
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