Optimum level T4.T3

[1839]

I am due to have a review with my Endo shortly, currently on 50mcg T3 and 50mcg T4. Recent blood results gave;

TSH at 2.27 range 0.270-4.2 Free T3 4.4 range 3.1-6.8. Free Thyroxine FT4 7.00 range 12-22

Total Thyroxine T4 43.00 range 59-154. I do not feel I am on an optimum dose as yet. Started this journey from originally being on 200mcg T4. Welcome thoughts on current dose of T3/T4 and adjustments.

[SlowDragon Administrator]

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

When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last 1/3rd dose T3 at roughly 8-12 hours before test

Your results show you are under medicated

Ft4 is below range

That was huge drop in levothyroxine from 200mcg to 50mcg

Suggest you increase levothyroxine to 75mcg and retest in 6-8 weeks

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

[1839 in reply to SlowDragon]

Thanks for the advice about timings, stick to that where I can.Have had tests for Folate, Ferritin etc but results not back as yet.

Thanks for advice about Levothyroxine.

Take it you would suggest the T3 would stay at present level with just adjusting the Levothyroxine?

[SlowDragon Administrator in reply to 1839]

We only change one at a time

Increasing levothyroxine will/should increase Ft3 as well as Ft4

Which brand of levothyroxine are you currently taking

Do you always get same brand at each prescription

[1839 in reply to SlowDragon]

Mercury Pharma brand and have kept to same brand for a while now

[SlowDragon Administrator in reply to 1839]

Did you get vitamin D, folate, ferritin and B12 results?

What vitamin supplements are you currently taking

Remember to stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results

Important that last dose levothyroxine is 24 hours before test

Last 1/3rd of daily T3 approx 8-12 hours before test

Are you on strictly gluten free diet

[1839 in reply to SlowDragon]

Hi SlowDragon. The Endo has considered current dosage of T3 and T4 and increased T4 from 50mcg to 75mcg. You were spot on

[SlowDragon Administrator in reply to 1839]

Probably looking for Ft4 roughly 60% through range...

But we are all individuals and what suits most doesn’t suit everyone

Retest after 6-8 weeks

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

[1839 in reply to SlowDragon]

Hi What would your advice be on time of day to take T3? Currently I am on 20mcg Morning, so have tried taking this at 7am or earlier, anything between 3.30am-6am. Then 15mcg late morning, 10mcg teatime, 5 mcg bedtime. I feel tired late morning and early afternoon. Varying the time of first 20mcg does not seem to make a difference to this tiredness. (Take T4, now 75mcg with morning dose of T3)

[SlowDragon Administrator in reply to 1839]

That’s a huge dose of T3

Was last dose T3 approx 8-12 hours before test

Most people on levothyroxine plus T3 are on much smaller doses of T3

Eg

10mcg (2 x 5mcg approx 12 hours apart)

Or

15mcg (3 x 5mcg roughly 8 hours apart)

Or

20mcg (10mcg and 2 x 5mcg roughly 8 hours apart)

Or

30mcg (3 x 10mcg roughly 8 hours apart)

Suggest you try

20mcg 7am

20mcg 3pm

10mcg 11pm

You might need to reduce T3 as levothyroxine increases

[1839 in reply to SlowDragon]

Thanks for the advice, i started on T3 at 5mcg and under advice have increased at 5mg amounts. The 20, 20, 10 at 7am, 3pm and 11pm sounds good.

[shaws Administrator]

The aim is a TSH of 1 or lower with both Free T4 and Free T3 in the upper part of the ranges. 25ncg of T3 is equal to approx 100mcg of T4 in its 'effect'.

[1839 in reply to shaws]

Thanks.