Advice please

[lisan1]

With these results what would you increase levo or liothyronin?

tsh 0.03

FT3 4.4 (3.6-6.3)

Ft4 12 (12-22)

[Sybilla14]

I’d increase Levo as I need it quite high in range to feel good. This should also increase your Ft3 a bit.

[lisan1 in reply to Sybilla14]

Thanks! How do you feel when your ft3 levels are ok but you have low FT4 levels? I was supposed to up t3 to 20mcg but lowered back to 15 because I thought I felt a bit agitated and not balanced and calm. Do you think it could have been the t3?

[Sybilla14 in reply to lisan1]

When my ft4 was lower I felt hypo: tired, poor sleep and concentration. When my t3 dose was too high (25mcg) I had different symptoms altogether. The weirdest one was my legs felt uncomfortable/heavy/weak and I couldn’t tolerate standing up. Also, I had diarrhoea and a strange sense in my nostrils like my breathing was heavy. Also I had a spiky ache behind my left eyeball. I got these a couple of times when I was trying things out so I expect they’d come back if my dose was too high again. Personally for me agitation is more related to being low than high, my moods improved with t3, but there’s no set way for us all. Have you been on a too high dose before so you could recognise it? What are your symptoms now?

[SeasideSusie Remembering]

Increase Levo. Get that FT4 up further into the range, it should also increase the FT3.

Retest 6-8 weeks after increase then reassess.

Remember when testing that last dose of Levo should be 24 hours before test, last dose of T3 should be 8-12 hours before test (splitting dose into 2 or 3 and adjusting time the day before if necessary).

Also remember no B Complex or Biotin for 3-7 days before any blood test.

[lisan1 in reply to SeasideSusie]

Thanks! By 25mcg or 12.5?

[SeasideSusie Remembering in reply to lisan1]

Since being on combination thyroid hormone replacement I have always made small changes, they can make a big difference. I would increase Levo by 12.5mcg at this stage and see what difference that makes. I find that any changes need 8 weeks for levels to settle and I'm still noticing differences in how I feel at 10 weeks.

Remember to change only one thing at a time, never both Levo and T3 together. T3 by 1/4 of a tablet if you need to change that, and further along the line even 6.25mcg Levo could make a big difference.

[lisan1 in reply to SeasideSusie]

So even though I was previously well on 100+20 you think it would be better to just increase to 87.5 first?

[SeasideSusie Remembering in reply to lisan1]

My own experience has taught me to go slowly and I have found small changes can make a difference. But the choice is yours.

[lisan1 in reply to SeasideSusie]

Thanks! Will try it for another couple of weeks before increasing further.

[SlowDragon Administrator]

Suggest you add 12.5mcg levothyroxine daily and get FULL thyroid and vitamins tested in 6-8 weeks time

What vitamin supplements are you currently taking

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

Always test as early as possible in morning before eating or drinking anything other than water

Last dose levothyroxine 24 hours before test

Last 5mcg dose T3 approx 8-12 hours before test

Do you always get same brand levothyroxine at each prescription

[lisan1 in reply to SlowDragon]

Ok, will try to make them take all of those. Yes the same brand every time.