T3 dosing

[Mj1986]

Hi all,

apologies for the constant posts. I was wondering if anyone might be able to help with t3 dosing. I have 100 x 25mcg t3 pills coming on Thursday. I am currently on levothyroxine 150mcg only but my labs are trash. TSH 0.07 (0.2-4.4), T3 4.4 (3.1-6.8) T4 31 (range 10-23). I was thinking of not taking any levo until the weekend and then reducing levo to 100mcg and starting with 12.5mcg of t3.

[SlowDragon Administrator]

Too much of a reduction to stop levothyroxine completely

Suggest......Just reduce by 25mcg 3-5 days before starting T3

Only add 1/4 tablet T3 initially first thing in morning

Assuming that’s ok, 5-7 days later add 2nd 1/4 tablet mid- late afternoon

Retest in 6-8 weeks

[Mj1986 in reply to SlowDragon]

great thanks. The only reason I was going to stop completely is that need my T4 levels to be in normal range in a weeks time as I am due to start fertility treatment and I cant cancel it for numerous reasons. Do you think it will come down enough with just 100 mcg. Can you get symptoms from high T4?

[SlowDragon Administrator in reply to Mj1986]

Then you probably don’t want to start T3

Levels need to be stable

As soon as conception is confirmed, dose levothyroxine is typically increased by 25mcg

[radd]

I wholly agree with SlowDragon

In order to conceive you will need balanced and stable thyroid hormones and so it would be unwise to make such drastic changes at this late stage.

Also once you have conceived adequate thyroid hormone is immediately essential in preventing risk of miscarriage and ensuring baby's healthy development. This is mediated by the TSH which must be kept low but introducing T3 will alter TSH to levels only a T3 specialist would be familiar with. There is also the risk that T3 meds might not be tolerated well should you have iron or cortisol deficiencies.

Yes, you can have horrible symptoms from medicating too much T4 as the excess risks preventing the amount needed from working properly. Some have thyroid resistance and need to medicate huge amounts of thyroid hormone replacement but the majority of us need to be within range.

Are you experiencing hypo symptoms?

[Mj1986 in reply to radd]

Some symptoms but ok more often than not I just dont think my t3 is optimal. Do you think its manageable to get my T4 in range in 2 weeks?

[radd in reply to Mj1986]

Mj1986

FT3 levels are subjective. If you are still feeling some hypo symptoms with over range T4 it could be insufficient T3 levels, or an excess of T4 preventing sufficient T3 from working effectively.

A dose reduction now could reduce your FT4 enough to be seen as within range but as symptoms often lag behind good biochemistry so does well-being as many bodily systems have to catch up. Hence the six week wait between dose adjustments and retesting

Is there no way you can postpone fertility treatment? That way you could optimise thyroid hormones so they are working effectively and ensure nutrients, folate, iron are adequate too. After conception thyroid hormone replacement is generally increased to support baby’s needs that are wholly reliant on a mothers supply, and not to make adjustments to pre-existing inadequacies that might risk neonatal complications.