Thank you for your help in getting me this far - I’ve spoken to a private consultant who is going to trial me on T3. I will be reducing my current dose down to 125mg daily (from 137 and 150 on alternate days) and taking 5mcg of T3 three times a day. I’m most anxious about it affecting my sleep - I’ve had problems (A long time ago) with over medicating with thyroxine alone causing me awful insomnia. I have no sense of what an average dose is of T3 but assume this trial dose is quite low to begin with? Grateful for any pointers pls!
Many thanks in advance
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Thyroidrunner
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It's good that you have found an endo who is willing to trial you with T3 but unfortunately he is making the same mistakes that most of them do, ie he is lowering your Levo when there is no need and adding T3 at too high a dose, it should be added at minimum dose then gradually increased.
Assuming that your results posted last time are what your endo based their decision on:
TSH 0.09 (range 0.27 - 4.2)
Free T3 4.4 (range 3.1 - 6.8)
Free Thyroxine 18.3 (range 12 - 22)
Your FT4 is only 63% through it's range, if it was 90% through range or higher then yes, reduce Levo, but at only 63% through range there is no need. Adding T3 is going to lower your FT4 anyway.
T3 should be started at 5mcg daily, if all OK after 2 weeks then add a second dose of 5mcg (daily total 10mcg). See how things go. You may or may not need more T3, it's all a case of taking things slowly, giving your body time to adjust to the new levels of hormones, tweaking finely and gradually. Endos tend to go in with a sledgehammer then they can say things didn't work out so end the trial.
I'm afraid I didn't see your last post but if I had I would have commented on the following:
Ferratin 56ug/L (range 13-150)
This is low. Ferritin is recommended to be half way through range and some experts say that the optimal level for thyroid function is 90-110ug/L. A good ferritin level (along with other optimal nutrient levels) is necessary for conversion and for thyroid meds to work properly.
I would have also mentioned that although your Vit D level of 83nmolo/L isn't too bad, the Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.
Thanks for your advice SeasideSusie . I double checked and i realise i got the T3 dose wrong - he is starting me on a 1/4 of a 5mg tab three times a day. I will double check what my latest levels are on D and ferratin against your advice. Thank you so much for your help - you are so knowledgeable!
I double checked and i realise i got the T3 dose wrong - he is starting me on a 1/4 of a 5mg tab three times a day.
Are you sure? Nobody has ever said their endo has started them on such a low dose, it's usually 5mcg 3 times a day which we usually tell them is too much to start with.
Hi SusieSorry for the muddle - I've just received my T3 tablets and can confirm it is as you suggested ie a 1/4 of the 20mcg tablet three times a day. For my own peace of mind I paid to have a Medichecks test to see where my levels are at currently. If you wouldn't mind taking a look? I have been taking 137 and 150 thyroxine on alternate days and have felt quite an improvement since doing so. As is suspected, my TSH has come back below range again. The only time i feel a marked improvement is when my TSH is too low. I don't understand it?? Is TSH really the be all and end all or if T4 and T3 in range it's not an issue? Worry about osteoporosis...
TSH 0.04 (mIU/L 0.27 - 4.2)
Free T4 19.2 (pmol/l 12 - 22)
T3 4.3 (pmol/L 3.1 - 6.8)
I have also gone back to taking spa tone and vitamin D supplement more often.
I have a real fear of over medicating as it effects my sleep badly which makes me very anxious about coping with work/life/kids/everything. My instinct tells me to reduce my thyroxine a little for a few days before starting T3 and i will start on one quarter T3 tab a day and build up gradually. Not what my consultant told me to do but feels like the safest way to avoid any anxiety.
Are these results with you taking 137/150mcg Levo for at least 6-8 weeks before testing?
My instinct tells me to reduce my thyroxine a little for a few days before starting T3
Your FT4 is 72% through range. Taking T3 will lower this. However, if you feel more comfortable reducing your Levo before starting T3 then go with your gut feeling. Most endos tell patients to reduce their Levo regardless of where their FT4 is but it isn't always necessary.
i will start on one quarter T3 tab a day and build up gradually. Not what my consultant told me to do but feels like the safest way to avoid any anxiety.
That's what we always suggest. Take it low and slow.
Lots of tweaking may be necessary. You may feel, further down the line, that your FT4 has gone too low and you may want to try increasing it a bit to see what difference that makes. It's very individual and we have to do a lot of fine tuning to find our own sweet spot.
my TSH has come back below range again. The only time i feel a marked improvement is when my TSH is too low. I don't understand it?? Is TSH really the be all and end all or if T4 and T3 in range it's not an issue? Worry about osteoporosis...
TSH is useful for diagnosis, once on thyroid hormone replacement it becomes more or less irrelelvant, although doctors are taught it is the gold standard and the only way to see thyroid status. It's not a thyroid hormone, it's a signal from the pituitary to the thyroid to make more hormone if it detects there's not enough. With an FT4 of 19.2 (12-22) your pituitary is satisfied that there is enough thyroid hormone so it's not signalling the thyroid to make any so TSH is low. It's a pity doctors don't understand this.
My TSH has been suppressed for the 20 years I've been keeping a record of my results, possibly even longer as I've been taking Levo for over 45 years. I don't have osteoporosis and I don't worry about it.
Have you tested Vit D? This is important for bone health. Low Vit D increases risk of osteoporosis.
I agree completely with seasidesusie. You don’t need to lower your Levo. I wouldn’t take it three times a day to begin with. Maybe take 5mcg when you wake snd then a further 5mcg 8hrs later. T3 only has an 8hr span peaking at hour 4. It does have a half life of about 2 days too. Take it easy I’d say. See how you go for a couple of weeks on two doses then work up to 3 if necessary. If you feel wired or can’t sleep on 3 doses then go back to 2 doses 8hrs apart.
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