How soon should you leave a T3 increase before ... - Thyroid UK

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How soon should you leave a T3 increase before testing? Is it the same as for T4 increases?

Josephineinamachine profile image

Hi all

Sorry for another T3 question.

My Endo wanted me to have a blood test 4 weeks after introducing 15 mg T3. He wanted me to take 15 mg T3 from day 1. I haven’t done that and have instead increased the dose over 4 weeks. I’ve asked for a later appointment with the Endo which gives me another 2 weeks (6 weeks in total) before testing.

The reason I’m asking the question is that T3 feels like a more ‘immediate’ result on the body. I have been on the full dose now for four days. Yesterday I noticed pain in feet and legs returning and my sleep the past two nights has gone from very good to very disturbed. Resting heart rate is up slightly as well. Have a slight feeling of heaviness around my belly which had been going as well. I’ve had a few full on hot flushes yesterday and the day before.

I have a strong feeling that I’ve overshot my ‘sweet spot’ and now find myself slightly over medicated. I had the ‘knitting needle poking pain’ under my left scapula yesterday which happened every time I increased my Levo dose so I know I’ve felt the T3 in my body.

I’m now thinking of reducing back by 2.5 mg to see if that helps - maybe back to 10 given I felt relatively good on that.

I’m wary though of making all these rapid changes as I know that isn’t helpful - but I’m also wary of staying on too high a dose as well!

On 75 Levo. Taking T3 in one go with Levo at 4am. Just can’t seem to tolerate day time dosing of T3 as I fall asleep immediately.

Thank you

Jo 😊

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9 Replies

Not any help - but just an observation on the difference between endocrinologist; I’m not seeing mine for 12 weeks from start of T3 trial , which I’m grateful for as it gives me more time to adjust .

SeasideSusie profile image
SeasideSusieRemembering

I think you'll get different answers on this because people react differently.

In May I increased my T3 by 6.25mcg (left my Levo dose the same). I retested after 8 weeks. Results were where I expected them to be. However, 2 weeks later (10 weeks since the increase) I felt better than I did at 8 weeks, so obviously the full effect hadn't been reached by 8 weeks.

Don't forget that the T3 is going to affect FT4 level as well as it tends to lower that.

Josephineinamachine profile image
Josephineinamachine in reply to SeasideSusie

Thank you…so it takes way longer than I imagined! Just goes to show shouldn’t rely on imagination. Right. I’ll try and settle down and as Hidden says I don’t need to see the Endo that soon (as she has had a different approach which seems more reasonable) so I’ll email his secretary and ask for more time. Thank you!!

SeasideSusie profile image
SeasideSusieRemembering in reply to Josephineinamachine

I haven't retested since so I don't know if the extra time has made any difference to my levels, but it has to how I feel.

But everyone is different, it might not be the same for you.

Josephineinamachine profile image
Josephineinamachine in reply to SeasideSusie

Hi SeasideSusie sorry - this may be a stupid question but if T3 lowers T4 does that have an affect on how someone will feel? I assumed that T4 wouldn’t be needed as no need to be converted…but can it go too low and if so what problem would that cause? Thank you.

SeasideSusie profile image
SeasideSusieRemembering in reply to Josephineinamachine

Josephineinamachine

This is a very individual thing. Some people only need T3 and do very well on it. Some of us need both Levo and T3 and then it's a matter of finding the right balance for us personally. Some are fine with a low FT4, others need it higher in range.

I can't say how someone else would feel if FT4 is lower, I only know how I feel. It's something we have to find out for ourselves, the right balance to reach our sweet spot.

I lowered my dose to prove a point to the GP (long story, wont go into it here)

When my FT4 was 22% through range I felt dreadful so I had to increase my doses again to try and get back to where I was. This is how it worked for me, it wont necessarily be the same for someone else.

100mcg Levo + 12.5mcg T3 = 55% FT4 and 49% FT3 = didn't feel well.

112.5mcg Levo + 12.5mcg T3 = 74% FT4 and 62% FT3 = better but not right

112.5mcg Levo + 18.75mcg T3 = 65% FT4 and 78% FT3 = currently my sweet spot

You can see how the extra 6.25mcg T3 increased my FT3 from 62% to 78% and at the same time reduced my FT4 from 74% to 65% with no change in my dose of Levo.

My levels wouldn't suit everybody but at the moment I can say they're where they need to be for me.

It really is all about experimenting, taking our time, gradually changing one thing at a time, making small changes, wait and see what happens and don't be surprised if changes are still being felt weeks after you expected everything to have stabilised.

Good question ! I have had so many different trains of thought this week . It’s such an individual thing so in the end we have to be confident in how we feel and able to trust ourselves and follow it up with testing at the time we see fit.My Endo told me to cut Thyroxine from 200 to 100 on day one and take 10mg twice a day of Lio.

That sounded too drastic to me and many advised to take time over it.

So I took a view of where I was starting from .

I know that my T4 has been extremely high for years and at last test was something like 147% of range while T3 was around 50%. Therefore I reasoned that as I am adding T3 in up to 5mcg increments, I wasn’t worried about reducing T4 incrementally at the same time .

Taking into account the 6/7 day half life of Levo and the shorter action of Lio, I came up with my own trial timescale …..in theory, as the levo reduces and the Lio increases, therein wellness lies! 😊

This is day 7 and with the exception of one ‘dead’ day, I can say I feel improvements. The day that I felt awful, I believe, is because I had not had enough Lio and it was time to add a bit more .

On day 5 I had a long, active day and usually the following day would have been a write off . But, remarkably, I felt great, with no breaks - that’s the first time in years I have been able to do that .

I have taken my own BP and pulse. BP is good and seemingly unchanged. Like you, I noticed a slight rise in resting pulse but it dropped back down to my ‘’normal’ within a short time.

My sleep has been mixed but it often is / mainly disturbed by joint pain - last night I had to get up and take paracetamol - and then slept ok. I should remember to take it before I go to bed but prefer to do without if I can .

So a long message to say I am feeling my way with a mixture of logic and trusting how I feel.

I plan to do a MMH blood test at around the six week point.

Like you, I’d like to get to a once a day regime but think it’s a bit early for me to do that just yet.

It’s a journey - as they say ! 😊

Hope you are feeling better

Josephineinamachine profile image
Josephineinamachine in reply to

Ah good to hear you’re feeling improvements and I agree it seems a mixture of logic and intuition!

I dropped back from 15 to 10 today as was feeling really not good yesterday. Felt ‘off’ spacey and tired and had to push myself all day. Was looking forward to a good sleep as was so tired but then woke up as soon as I got into bed! 😖 feel more relaxed again this morning so will see where the day takes me.

I’m using my Fitbit to monitor sleep heart rate. Last night it was higher than my resting HR pretty much all night which I know isn’t right for me. I don’t monitor my blood pressure. How do you do that? Last BP test it was lower than should be (but that’s normal for me).

Definitely can see some weight (water?) loss already which is a huge relief. Don’t weigh myself but clothes looser (except felt bloated all day yesterday on 15mg). I know too much T3 might cause weight/water gain…

Such a puzzle!!

I hope you have a good day and can achieve all that you want!

Let me know how you get on? 😊

in reply to Josephineinamachine

I didn’t know that about water retention . I wonder if it settles as you become accustomed to the change ? I have an Omron BP monitor and it’s useful because it stores the readings. In fact I used the recorded readings to talk to the Endo because I noted that on days I experienced episodes of feeling very hypo, my BP dropped noticeably . It was too often to be coincidental.

My resting pulse is 60-65 but can drop to 50 on hypo days .

I’m a it bit tired today but I’ve had a busy few days . My BP is slightly above my normal but pulse is lower.

I am of course unsure of how significant all of this is but it’s something I can record to see if there is a pattern and over the course of a couple of years I definitely saw an incidence of low BP and pulse every time I felt very hypo.

Yes - it’s a multi-piece jigsaw !

I use my Apple watch for pulse readings during the day if I need to

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