Should I stick on current Levo dose or add a little T3 now?

[Localhero]

After I last posted here, my endocrinologist recommended I increase my Levothryoxine from 100mcg seven days a week, to 100mcg five days and 125mcg two days a week. He also suggested I return to 5mcg of T3.

healthunlocked.com/thyroidu...

Taking the recommendations of the forum, I decided not to do both changes at once. Instead, I was slightly naughty and did 100mcg Levo four days a week and 125mcg three days. This brings me out at around 110mcg a day, which is almost perfect for my weight, using the 1.6 per kilo formula. I was interested to see if an increase to my Levo might affect my FT3 levels and indeed my health.

I did a Medichecks test myself, under the usual conditions (early in morning, fasted, 24 hour gap from last Levo etc) and just got the results.

TSH: 0.29 (0.27 - 4.2)

FT3: 4 (3.1 - 6.8)

FT4: 22.3 (12 - 22)

Thyroglobulin antibodies: 10.7 (0 - 115)

Thyroid peroxidase antibodies: 11.7 (0 - 34)

CRP HS: 0.3 (0 - 5)

Ferritin: 146 (13 - 150)

Folate: 18.4 (>2.9)

Vitamin B12: >256 (25.1 - 165)

Vitamin D 139 (50 - 200)

I feel considerably better than I did six weeks or so ago. I’m less anxious, am sleeping better and seem to be able to do somewhat more than I was. But I’m still fatigued and achy. Weight is still creeping up. I’m in a quandary as to whether to stay at this level for a little longer and see if there’s more improvement, or to try T3 again. I must admit, I felt so awful on it at the end of my last foray into using it that I’m not jumping at the idea.

[radd]

Localhero,

And now FT3 isn't quite high enough.

You said you felt wired last time but had supposed COVID (and research is showing COVID to be associated with prolonged alterations of iron homeostasis btw) and then shingles. I agree the additional T3 could well have tipped a cortisol issue with all that going on.

But now FT4 is elevated and when too high risks preventing further good workings of thyroid hormone meds and you might find your FT3 lowering even more instead of rising because its about that ratio sweet spot for optimal conversion.

Every thing else is good and you say you feel less anxious, so if I was you I would resume the previous dose of 100mcg T4 + initally just 2.5mcg T3 (or a speck of dust as I now see it called on the forum 😁).

Your previous results of FT4 72% through range on this regime will easily allow for the reduction of 2.5mcg T3 which can be raised after a week or so. (T4 has a longer half life to carry you through.) Just see how you feel.

[Localhero in reply to radd]

Radd, thank you for such a thorough response. That’s interesting about COVID and iron homeostasis. I do think the T3 was involved in that cortisol issue, even if my endocrinologist disagreed.

Would you do the change you’re suggesting in stages? So, for example, stay on just 100mcg Levothyroxine for a few days, before adding the “speck of dust” 🤭😆 (2.5mcg T3)? Also, what time of day do you think it’s best to take the T3?

[radd in reply to Localhero]

Localhero,

As you are/have medicated both before I would do the switch together because you don't want thyroid hormones to lower any further. So say tomorrow if you take Levo first thing in morning take 100mcgT4 + 2.5mcg together.

Then after a week or so if you feel ok, take another 2.5mcgT3 in the afternoon. Then after a week or so if you feel ok you can either add the next 2.5mcg dose raise to the morning, or if you are still not confident split doses into three a day.

Splitting into three not only prevents such a large onset but prolongs the duration of its action so supporting the adrenals as opposed to stressing them that risks encouraging those huge adrenaline whooshes. Hopefully it would only be required for a few weeks just allowing adrenals to catch up with that increase in metabolism. I used to set my phone alarm and you have to work it around eating patterns.

Then you need to add the last 2.5mcg to the morning dose making that a 5mcg dose. When the adrenals are ok with that, join 2nd & 3rd dose together to make another 5mcg, so finally dosing just twice a day. This is protocol I had to follow with reactive adrenals that I spread over about 4-6weeks.

Anxiety is difficult to assess sometimes because we can unconsciously bring it upon ourselves and T3 is massive in influencing emotions because is a neurotransmitter as well as a hormone, but an inner heat, a headache, feeling jittery that continues for more than 4-5 days would mean you need to go back a stage and hold for longer.

Good luck 😊

[Localhero in reply to radd]

Thanks again, Radd. That’s a great, clear protocol to try. I’ll give it a go.

Anxiety is an interesting thing. In my case, some of it is definitely emotional and I’m learning to try to discern what is emotional (like a complex PTSD thing), from what is physical. They can be so interrelated at times. I’ll definitely pay attention to jitteriness etc while titrating.

I so appreciate your support here 🙏🏽

[radd in reply to Localhero]

Localhero,

I know. I hate when doctors say it’s all in our heads because anxiety is a physical symptom and as such there has to be a physical cause. It’s about Iearning management strategies and I found my control by investigating the science behind it.

Also breathing techniques, even laying on the grass & watching clouds. Ensure you have time for your protocol. Claim positivity and know getting better is possible. A more philosophical attitude helps dispel anxiety. I took charge and because I had managed to reduce antibodies low I knew I didn't have to rush. Obviously thyroid hormones mustn’t drop too much but you have time for a lazy meandering journey with the safety net of T4 behind you too.

[Localhero in reply to radd]

Yeah, me too, Radd. When I told my endocrinologist I was experiencing bad anxiety again, he said if it hadn’t resolved next time we spoke he thought I should consider anti-anxiety meds. My GP put me on SSRIs some years ago before I had my thyroid diagnosis and they just made me feel worse.

I saw from your profile that you’ve read and read around all this stuff. I’m at an earlier stage in doing the same thing, I think. I’ve read a lot about cortisol, hormones, HPA axis, the sympathetic/parasympathetic nervous system etc. It’s a complete work in progress but it’s a lot better than giving power to doctors and imagining they know what they’re doing. I’ve been using a thing called HeartMath to meditate - I found the idea in a Patrick Holford book called The Stress Cure. I think that is helping.

Something has definitely fallen into place for me recently about managing it all. I think after I posted here last I decided that the old “slowing down to speed up” philosophy definitely applied and I was going to break things down and experiment a bit more on my own. I think till then I’d imagined this thyroid lark would be a quicker fix and was getting really frustrated that I still hadn’t cracked it. But a different mindset has allowed me more space, if that makes sense?