I had a recent experiment with adding 6.25mcg of T3 to my existing T3/T4 combination and had to give up because of feeling hot and getting uncomfortable sensations in my chest. I still have symptoms such as cold intolerance, mental slowness, constipation and severe bloating and I don't know what to do.
I've been thinking about trying NDT. Could that be appropriate in my situation? When I added extra T3 I felt bad so I don't know whether the high T3 in NDT could be too much for me. On the other hand, NDT is proportionally lower in T4 so maybe that would offset taking more T3? Any advice would be grateful received
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TiredDad
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If you want a lower dose of t4 so you could take more t3 why did you not just lower your dose of levothyroxine? That is the benefit of combo - you can alter the doses individually.
Yes, you're right. I was trying to only alter one thing at a time but I should have adjusted the T4 too. To replicate the ratio of NDT I could try 18.75mcg of T3 to 75mcg of levo. That seems quite low for levo. I'm not sure how long to reduce the T4 for before adding T3 either.
Reduce levo by 25mcg and wait 1 week. Add in your extra lio. Wait ideally 6 weeks and bloods. See how you feel. Then if necessary reduce levo by another 25mcg.I had to reduce levo by 2 X 25mcg and build up lio to 20mcg and that is how I did it. This was to reach my prescribed dose. However I have spent 2 years adjusting levo and lio to get to doses I am happy with. I currently take 100 levo and 7.5 lio.
Thanks. That sounds like a sensible way of going about things. I'm due to see my endo on Tuesday. If he refuses to to consider me having more T3 I will probably do as you suggest and drop the T4 down by 25mcg for a week before adding the T3.
I would say to stay away from NDT if you are intolerant of T3 and instead look to the reasoning why your body isn’t tolerating T3 if your labs are indicating you are needing it.
Common reasons are low iron levels, elevated thyroid antibodies, elevated cortisol levels, etc. I haven't seen your numbers, but just because you can’t tolerate T3 at this moment in time doesn't mean you don't need it. It maybe that the conditions surrounding the introduction weren't right for your body to be able to utilise it yet, ie sort a possible low iron or testosterone level and T3 will work.
Medicating synthetic T4 & T3 is easier as each amount can be titavated individually. However, once T3 is tolerated then T4 or T3 can be added (or not) to a basic NDT dose if required.
Thanks, I appreciate your perspective on this. There isn't any obvious reason why my body can't tolerate more T3. My cortisol level in January was normal at 287 nmol/L (113 - 456). My ferritin result a couple of weeks ago was 107 ug/L (30 - 400) and my thyroid antibodies were low (I think). To be precise, the thyroid peroxidase antibodies were 12.4 IU/mL (0 - 34) and thyroglobulin antibodies were 20.3 IU/mL (0 - 115 R). I have no idea about my testosterone levels are so maybe I should look into it. My ferritin levels could also perhaps do with improvement.
Yes, ferritin is only 20% through range. An iron panel would give a more comprehensive picture of iron status if you are thinking of supplementing.
‘Total Testosterone’ test will measure levels in the circulating blood and SHBG will offer a gauge as to how much testosterone is going to the bodies tissues. Both need to be tested together because SHBG is influenced by many factors, ie increased by oestrogens or weight loss but decreased by androgens and some adrenal issues.
Low SHBG levels may mean too little bound testosterone & excess ‘free’ even when 'total' is low, or elevated SHBG may bind too much leaving too little ‘free’ even if you were to have adequate or high ‘total’ amounts.
Both of these options are good starts to your investigations but having just read your previous posts you are actually still in very early stages of raising thyroid hormone to optimal. Last lot of labs your FT4 was 52% & FT3 46% through range so you still have room to raise T4 which would hopefully raise T3 levels by conversion anyway.
Not everyone needs much T3 adding to their T4 meds. I don’t & in answer to your previous post I felt an inner heat & headache for about three days after each dose raise. I initially made it up to 20mcgT3 but have since drastically reduced as my body is just functioning & utilising replacement meds better.
Hypothyroidism can cause puffiness & swelling known as edema. It is mainly caused by reduced GFR & kidney function that disrupts fluid balance & blood filteration, and/or a reduction in enzymatic activity resulting in the buildup of molecules called mucopolysaccharides. These are proteins & sugars that encourage fluid & salt retention within the layers of skin. Bloating should hopefully improve once you are optimally medicated and meds are working effectively.
Thanks, I think I'll invest in getting the testosterone tests and iron panel. I had some blood tests done by my GP recently, including what what described as an iron test, but I imagine it didn't include everything in a full iron panel. Is it common for men with hypothyroidism to have problems with low testosterone?
Thanks for taking the time to look at my results. My initial thought after seeing my results was that T3 is the active hormone and my level of FT3 is lower in range that FT4, and therefore it would make sense to directly address it by adding more T3. After my bad reaction to adding more T3, I had assumed that decreasing levo while adding more T3 would be the way to go. It's interesting that you suggest T4 could be the way to go instead and it does make sense. In the past when on levo monotherapy I've proven to be quite a poor converter, only getting up to 4.8 pmol/L (3.1 - 6.8) FT3 when on 175mcg of levo with a TSH of .011. It makes me wonder if adding more T4 would make much difference to my levels of T3. I suppose every little will help and there isn't much risk in adding extra T4 because the body won't convert more than is necessary. Do you agree that adding more levo is less risky than adding more T3? Getting my endo to agree to increasing my dose is another matter and I am probably facing having to self-medicate and source the extra levo for myself if I choose to add higher doses.
The bloating I suffer from is different to the type you describe. It's more of a gaseous build-up that increases over the day as I eat and drink, and has come along with a reduction in my appetite and excessive weight loss. It can be brought on even by just drinking water. I have little idea what could be causing it, but have wondered if having a higher metabolic rate could demand more energy from my digestive system, speeding things up, and reducing the bloating. The doctors I've spoken to have gone back and forth on whether they think it's IBS or reflux, but neither of them seem to quite fit my symptoms. I'm going to get a private referral to a gastroenterologist and am hoping they'll be able to give a more precise diagnosis.
Yes, low levels of testosterone are common in males with hypothyropdism, but are reversable with optimal & effective thyroid hormone replacement meds. Remember meds become more effective with optimal iron, Vit B12, etc ….
Do not think that every little bit of thyroid hormone added will help towards your cause because no dose raise of either works in isolation but will effect numerous workings of your body.
For some of us T4 mono-therapy doesn’t work (for whatever reason) and years of being undiagnoised and poor health can cause further conversion blocks and receptor uptake insufficiencies. And as we continue to take T4 levels higher & higher in a failing bid to accomplish enough FT3, it becomes counterproductive as the body will start turning more to RT3 as can not tolerate excessive T4 levels. Too much RT3 is another factor that prevents thyroid hormones from working effectively.
Often addressing iron /nutrient deficiencies, reducing antibody levels, addressing gut issues can improve tolerance of Levo but for others the loss of conversion incurred by a low TSH after medicating Levo, and impaired converting abilities means they will never get enough FT3.
If you have read Dr Peatfields book or saw him as a patient you will know how fond he was of adding a little T3 or a thyroid glandular to help conversion for those whose abilities were impaired. He claimed we only needed a little bit because adding T3 gives you the amount you medicate (say 10mcg) plus improves the conversion of T4 meaning your total FT3 ends up more than the 10mcg you are medicating.
This is because there are three enzymes (deiodinases) present in different tissues in the body that determine cellular activity or the deactivation of thyroid hormone, & each has a different response to various physiologic conditions. For an extremely brief incite I can explain that due to the way they work the presence of a little T3 induces the enzyme D1 to convert further T4 - T3. Hence someone on T4 mono-therapy might have D1 activity considerably slowed as a result from a lack of T3. Remember although GP’s & many endos only check TSH & FT4 if we are lucky, hypothyroidism actually occurs when there is not enough T3 to bind to the cell receptor.
Ensure to wait six weeks between each dose adjustment to prevent other bodily systems from getting out of sync. I can not say that Levo is less risky than T3 because neither should be risky. We are only suppose to medicate what we need. The temptation is to rush but are you waiting six weeks between dose adjustments?
Investigate ‘deiodinases’ because they are truly fascinating 😊.
Radd you raise some interesting issues around Testosterone and SHBG which sadly a lot of Endos don’t really understand that well.
Either they will say “you are ok, that’s how you were made” or the other extreme is to prescribe Testosterone injections which come with many side effects.
Do you have any info on how to improve Testosterone?
Nope, because when caused by low thyroid hormone it won’t be an isolated problem with one easy answer.
In men testosterone (testes) is produced in response to LH (pituitary) & dependant upon GnRH (hypothalamus), with a little bit derived from the adrenals. In both men & women low testosterone coupled with low LH & FSH indicates hypothalamic/pituitary suppression possibly caused by low thyroid hormone but which is reversible, ie elevated prolactin in men interferes with the GnRH secretion resulting in decreased testosterone production. Prolactin may become elevated due to the compensatory extra release of TRH (hypothalamus) to encourage TSH (pituitary) & more thyroid hormone, but TRH also encourages prolactin.
I previously replied to your post re weight gain & possible cortisol issues & insulin resistance. Large weight gain can cause adipose tissue to start converting testosterone to oestradiol, decreasing gonadotropin activity. Elevated oestradiol can also encourage more prolactin. Also the usual pro-inflammatory cytokines all possibly intensified by Hashi risk inhibiting the HPT axis at many levels. That is why the rule of thumb is to keep thyroid antibodies low to discourage systemic inflammation & high CPR levels.
Interestingly as balanced androgens play a protective role in autoimmune disease (much like O & P in females), research shows that men with low testosterone are more likely to be diagnosed with Hashi, & men with elevated testosterone are more likely to have hyperthyroidism/Graves. Maybe this is when supplementing with testosterone/DHEA would be beneficial to break that vicious cycle but I really don't know enough about it to suggest routes and it would take a very experienced functional doctor to work it all out.
These are so many reasons for low testosterone & my examples above are simplistic. Low thyroid hormone causes insidious changes over many years that can equally take a long time to reverse. My advice would be to keep plugging away at enhancing the good effects of thyroid hormone replacement meds to reverse this created damage. And if meds still aren’t working effectively after addressing the fundamentals of adequate iron, VitB12, etc, look deeper.
We've already discussed balancing blood sugar issues so try looking at gut issues (& that’s a really big one), clearing the liver where TBG is produced to carry your thyroid hormone to the tissues where they are cleaved, maybe testing/supplementing zinc, selenium, Vit E, Vit A, etc, all known to be essential for cellular sensitivity to thyroid hormone. There is plenty to work on 😊
Your knowledge continues to astound me and is way beyond the simplistic understanding that Endos seem to enjoy!
It’s a vicious cycle that with weight gain, testosterone falls and then it’s hard to burn the fat off with low testosterone. Same with insulin resistance, makes it harder to lose weight again.
Thanks for another informative post. What you've said about testosterone makes me wonder if I should test my levels, but there are also so many other things I'm led to believe may be worth testing such as selenium, iron, other hormones, vitamin A, calcium etc. Obviously, the price adds up and it's hard to know which tests are worth paying for.
If I read you correctly, you're saying that I shouldn't assume extra levo will make any difference (but it could), and I should pay attention to other factors such as iron/nutrients, antibody levels and gut issues. Regarding the other factors you mention, I think my antibody levels are okay, my nutrition is okay apart from iron ( thanks to supplementation), and I have gut issues but have no idea how to address them other than going to see a gastroenterologist and trying to get a more precise diagnosis. The GPs just oscillate between saying "it's IBS" or "It's reflux".
I may get Dr Peatfield's book. A lot of the sources of information for thyroid patients online seem to be of dubious scientific credibility. What you say about deiodinases is interesting. I hope adding a little more levo to my fairly small dose of T3 (12.5mcg per day) may lead to more T3 in my system.
In answer to your question, yes I'm being very slow and patient with dose changes. My endo has held me on the same dose for over 4 months to see if it works. Two weeks ago I tried adding more T3 and seemed to not respond well, resulting in me giving up on the extra T3. As I was only on the extra T3 for about 10 days, I don't know if I need to wait 6 weeks before trying anything else. In any case, it will probably take me quite a while to get extra levo because my endo is unlikely to want me to have anymore. If anything, he'll want me to reduce my dose because my TSH is 0.22
It is only worth having tests done if the results are useful and can be acted upon. Testosterone is quite a specialised area and it is not just a case of adding a bit more. However, if you were tested it might decide you to seek specialist help.
If funds are short I would say testing & supplementing the deficient nutrients are more important because might encourage thyroid hormone to work better which in theory should reverse any testosterone issues which are low thyroid hormone based.
If I were you I would test Vit D, Vit B12, folate, possibly zinc (I was deficient upon Hashi diagnose because a raised TSH uses zinc up) and buy the best sups you can afford. Members will guide you of the best brands. Your GP might test some or all of these nutrients if you are lucky.
Gut issues are a minefield and if symptoms are ongoing it is worth doing a stool test to eliminate infections. Your GP might be accomodating, or not. I saw in a previous post you were sceptical of the low-thyroid-hormone-results-in-low-gastric-acid theory so have included a link below.
I highly recommend Dr P’s book and still dip into my copy sometimes, and another excellent read is 'Why Stomach Acid is Good for You: Natural Relief from Heartburn Indigestion, Reflux and GERD' by Jonathan V. M.D. Wright and Lane Ph.D. Lenard 😁.
Deiodinases (Apparently there are a few small mistakes within this article but it does offer a rounded & good easy to understand explanation of how the deiodases work.
Thanks again. I'm not so short of cash, I'm just wary of throwing loads of money at tests if they aren't likely to be relevant. Mind you, if they reveal something they would be a very worthwhile investment. I already get Vit D, Vit B12, folate, and ferritin tested with my thyroid levels. I might well get zinc tested as well. Selenium and iodine also seem to get brought up a lot so I might fork out for them too.
As you say, gut issues are a minefield It seems difficult to get an accurate diagnosis, especially if the GP is used to telling hundreds of people they have IBS/reflux. I'm not against the low stomach acid theory but there isn't a lot of peer reviewed evidence to support the idea in high quality journals. I've found a few things that mention it and it definitely isn't complete bunk. I read this recently which has been cited by a lot of other authors:
I'm off to see my endo today. Given my low TSH levels (0.22) I don't think he's likely to support an increase in my dosage without reducing my intake of the other hormone. It'll be interesting to see in which direction he wants to alter the ratio of T3 to T4. I think I'm also going to ask him about the possibility of being prescribed liquid levothyroxine, as my gastric issues may be interfering with absorption of it.
Thanks. I've been careful and systematic so far but there is a temptation to try to speed things up. I like the point about keeping objective records (e.g. body temp records) to aid decision making.
Thanks. I added the smallest amount possible to my existing dose (6.25mcg) and it just seemed to be too much for me at the moment. Lowering my intake of levo and increasing the ratio of T3 to levo may be the way to go.
Some do just bits like 2.5 across a day. That said, I tried 2.5, 5 bits across a day then 10s and always found I got a headache and earache a few hours later… and then I read on here that the symptoms could be your body saying ooh T3 I’d like some more of that so I just woke up and took 20 in one go and felt great! I took 20 every morning for a while then decided to split the dose to give me smallest high and lows and that worked ok too. My feeling is that T3 is not hard to take at all but somehow I had to get body to accept it. I now take 32.5 and I took that spilt on three doses for a month but now have split it into two doses… and I might even go to one dose at some point for convenience.
That's interesting. Your experience sounds wonderful! How amazing to get such a dramatic change. My experience was a bit different in that adding more T3 made me feel too hot at times and a bit scared by funny sensations in my chest. My resting heart rate never climbed at all but the peaks were getting more dramatic. For me, I think it means I will need to be a bit more tentative and incremental. Great that another approach worked for you though.
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