I have added 1 x 25 mcg T3 to my 50 mg of T4 in the end of February as I wasn’t feeling better on T4 . Since then, I have been having heart arrhythmia, weak heart feel, tight chest. I was taken to a&e as the heart beat was too fast and irregular. It seems to be more frequent now.
Does anybody else experience this?
50mcg levothyroxine is only a starter dose
Previous post says your TSH had gone up to 13
You should have had 25mcg dose increase in levothyroxine rather that adding T3
Levothyroxine is increased slowly upwards in 25mcg steps until TSH is always under 2
When adequately treated, TSH will often be well below one. Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
When were vitamin D, folate, ferritin and B12 last tested
What vitamin supplements are you currently taking
How are you taking your T3
T3 must be added extremely slowly.
Splitting dose into 3 smaller doses at roughly equal 8 hour intervals.
Suggest you get full testing done
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last dose T3 at roughly 8-12 hours before test
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
NHS easy postal kit vitamin D test £29 via
Very few folks can get away with jumping right into a 25mcg dose of T3.It is more usual to start at 5mcg. Then increase in 5mcg the second week. Following that increasing 5mcg every 2 weeks until you feel enough has been added or you reach a total of 20 mcg or 25mcg per day
Some of us need only a little T3 to top up our ft3 , nothing like a full tablet per day.
Some take T3 as a single dose while others split it into 2 or 3 daily doses.
It has taken me 2 years nearly of altering levo and T3 doses to find a regime that seems to suit me .
It is not a quick fix .
previous posts and answers indicate you have been on T3 previously and then didn't have any for a year . and then took it again recently.presumably T3 didn't give you heart issues before ?
how long were you on it?
what was previous dose T4/T3. ?
Why did you start at 25mcg T3 this time, was that the dose you were on before ?
I was on T3 from 2016-2019, mostly on 25mcg daily taken all in the morning although I started with divided doses according to Paul’ s Circadian dosing. Then I stopped completely in 2019 as I run out of the supply. I did try T4 for a short while but didn’t like it. I was on no thyroid medicine till last December when I started to feel ill, cold and achy with high TSH. Funny while I didn’t have any episodes of weak heart or heart arrhythmia during the time while on no medication. I was feeling mostly ok, of course not amazing. I feel that T3 help with lowering my blood pressure, give me more energy, but the heart thing is so worrying. I will see an endo next month but have a feeling that she won’t listen to me much.
My T4 was so low, well out of the range. I don’t know what is the best way forward.
Thanks everyone for listening.
Why are you on such a low dose of levothyroxine? Just to put it into perspective, I'm on 150mcg levothyroxine and 20mcg liothyronine. I feel great on this dose. I think it might be worth lowering your liothyronine dose and increasing your levothyroxine. Have you had your levels tested on this dose?
i suspect that period of 'no medication at all' might have not done you any favours. and even though 25mcg T3 was OK before, it might have come as a bit of a shock to a now more 'hypo' body after having nothing for a while. So perhaps you needed to start back on a lower dose than 25mcg and build up slowly.
Or perhaps your cells deiodinases have adjusted how they function to accommodate to the period of no meds. which might mean you now need to consider adding bit of Levo (T4) as well as T3 ?, or it might just mean you need to lake it more slowly while it gets used to T3 again ?
If you have blood results from when previously on 25ncg T3 and feeling Ok ,perhaps see what the current bloods say, and try and gradually adjust T3 ( ? add levo ) to see if you can get back to those blood levels over several months.
(I think) ....the body does have the ability to semi- permanently reset its efficiency of conversion of T4 to T3, and to change the ratio of T4 to T3 that the thyroid produces in response to sustained changes in levels of T4 /3 supply.... and stopping all meds will have forced your system to try harder to produce/convert T3 faster and reset TSH level in response .. so i wonder if when you restarted T3 your body was perhaps getting more T3 in total than when previously used to 25mcg T3 tablet. This will probably change slowly as body gets used to having some T3 added again.
TRIODOTHYRONINE26/04/2021
3.5 pmol/L
FT3 levels normal (normal range 3.1 - 6.8 pmol/L)
THYROXINE
26/04/2021
2.9 pmol/L
FT4 levels low (normal range 12 - 22 pmol/L)
THYROID STIMULATING HORMONE
26/04/2021
1.79 mu/L
TSH levels normal (normal range 0.27 - 4.2 mU/L)
Above is my latest number. I definitely need T4. I have been doing 50 mcg T4 for 5 months now. Should I increase levo by 25?
Should I just stay on one T3 tablet? Or cut it down. I don’t know why T4 has dropped to such a low level over the last 5 years. What other tests should I ask endo to do? Thanks.
just checking ..when on T3 previously, were you also taking Levo or just T3 alone ?
No t4 at all
26/04/2021 after 50mcg levo (+25mcg T3 since end feb )
FT3 3.5 [3.1 - 6.8]
FT4 2.9 [12 - 22]
TSH 1.79 [ 0.27 - 4.2]
if last dose levo was 24hrs before test, and last T3 8-12 hrs before test ?
then it certainly looks like adding 25mcg Levo is logical next step.
I'm not sure what to say about the T3 dose. as normally we wouldn't want to change 2 things at the same time , and the fT3 result certainly doesn't suggest the T3 dose is too much. (if test done not 'too long' after taking last dose ). so on the basis of just the blood results you would think it was fine to just keep T3 at 25 and increase levo to 75mcg... but given the recent 'heart too fast' issues i'm not sure if that is wise or not.
I don't take T3 so i'd better leave that question to those who have more experience with heart wobbles and taking T3.
As for why T4 has dropped .. if reason for your hypothyroidism is autoimmune ? then maybe thyroid is just more damaged now and can't produce as much T4 as it could before.
Not sure what other tests to ask for apart from usual vitamin etc suggested by slowdragon,... what is the cause of your hypothyroidism ? do you know.
A few thought PingS ...
Do you have any recent lab results? If not that's your first step. Follow SlowDragon's advice.
TSH, FT4 ,FT3, folate, ferritin, vitD, vit B12 and antibodies
Is your T4 to T3 conversion poor....indicated by high FT4 with low FT3. Was this why you added T3?
Are the nutrients optimal, low nutrients impair conversion.
Are you still on no thyroid medication?
High TSH suggests undermedication
What was your maximum dose of LT4 before you tried adding T3? That dose may not have been adequate, hence the symptoms.
Why are/were you taking T3? Is this prescribed or are you self medicating?
FT3 is the most important reading. T3 is the active thyroid hormone vital for almost every cell in the body in a constant and adequate supply. Ideally this comes from converted LT4.
Your body will be confused by med changes/no meds....you need a stable dosing protocol
Your symptoms suggest undermedication, the heart needs a lot of T3, initially from conversion of adequate LT4 and if that is low then adding T3 is the next step. T3 only is the last resort.
Post new labs and members will get a better idea of what is going on.
We're all in this thyroid mess together...take care.
Than you for commenting, DippyDame.My nutrients levels seem to be ok. The t4 level is v low. I only got upto 50mcg before I added 25 mcg T3. See my numbers in my reply to Bogle.
Oh dear, you really have been messed about, you are bound to feel rubbish!
26/04/2021 after 50mcg levo (+25mcg T3 since end feb )
FT3 3.5 [3.1 - 6.8]
FT4 2.9 [12 - 22]
TSH 1.79 [ 0.27 - 4.2]
Who on earth thought 50mcg was an appropriate dose, how long were you left on that inadequate amount. After 6 weeks you should have been retested and the dose increased by 25mcg ...that repeated until you felt well.
Whoever was treating you had no idea about thyroid hormones...not unusual unfortunately. Many medics seem to play guessing games with lab numbers while crossing their fingers!!
If they see results vaguely within ref ranges they conclude " normal" . Normal only means within the ref range and since we are all different with different needs that is nonsense....you need an optimal dose which makes you well not a dose that ticks a box on the medics computer screen.
Your Frees were/are miserably low with not enough serum T4 to convert to T3.
So, we cannot easily see your T4 to T3 conversion rate... high FT4 with low FT3 indicates poor conversion. If that is established then adding a little T3 could help
Vitally important are nutrient levels...again optimal!
And who suggested increasing levo by 25mcg while also adding 25mcgT3....you were set to fail! No wonder you felt unwell.
Starting with 25mcg T3 in all probability is the reason for your heart symptoms. Intro. dose should be a quarter tablet ( 5 or 6.25mcg depending on tab strength)
25mcg was putting you in " overdrive" and your heart was telling you that!
It may have settled slightly but dose is still too high. I wear a fit bit and monitor my heartrate daily that helps avoid overmedication. As you will know T3 is a very powerful hormone and must be treated with respect.
I have Thyroid Hormone Resistance and need high dose T3.....I've travelled a long bumpy road and have had to read extensively and learn about T3 in order to recover, so I'm talking from personal experience....with much support along the way from experienced members here. Medics were clueless!
We are advised to change only one hormone at a time otherwise it's well nigh impossible to know what is doing what. You changed two....with a wallop!!
Given your recent labs I suggest you start again with (probably, based on above dose)100mcg levo see how you feel on that and test after 6/8 weeks then take from there. You may need a higher dose still
Your " ducks (labs/optimal) all need to be in a row" before considering adding T3 and yours are flapping all over the lake from starvation/ undermedication and fright/ excess T3.
Taking T3-only is the last resort.
Time to feed those ducks!!
Take care
DD
Suggest you increase levothyroxine by 25mcg and retest in 6-8 weeks
Meanwhile split the T3 into 3 doses and take at roughly equal 8 hour intervals
1/2 tablet at 7am, 1/4 tablet at 3pm and 1/4 tablet at 11pm
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last dose T3 at roughly 8-12 hours before test
Aiming for Ft4 and Ft3 approx 50-60% through range
Though everyone is different as to what suits them.....starting with that aim....and then tweak if necessary
Does being Hypo give you tinnitus?
Are you adding t3 to NDT? Why and does it work for you?
Does anybody have Heart Failure (therefore on Betablockers) and also take T3
Increased heart rate on T3
