T4 + T3 Combination

[JonnyA]

36 y/o M. I've been on low dose levothyroxine for about four months now (37.5 mcg per day) having being diagnosed with subclinical but symptomatic hypothyroidism. Long story short, the treatment has made little difference to either my bloods or my symptoms (fatigue, brain fog, low mood, weight gain etc.).

My latest bloods are as follows:

TSH - 3.1

T3 - 4.8 pmol/L [3.1 - 6.8]

T4 - 18.5 pmol/l [12 - 22]

Having caught up with my endocrinologist today, her assessment was that my T4 is 'ok', but that my T3 is still not very good, as inferred by my stubbornly high TSH. We discussed a few options and she decided to prescribe the following:

- 37.5 mcg levothyroxine (as per current dosage)

- 7.5 mcg liothyronine (3 x 2.5 per day)

I guess I'm just looking for opinions as to what I can expect from here. From research, it sounds as if T3 based medication tends to be quicker to influence both bloods and symptoms, though is more inconvenient to take. I'm less bothered about the convenience side of things, I will make it work, I'm just desperate to feel better.

I know that many on here have commented that the levo dosage I have been on is very low, but should I expect more from that kind of dosage of T3?

Thanks.

[radd]

JonnyA,

37.5mcg Levo is a pretty mean dose but given your 65% through range, I am surprised your endo has given T3 so early on in treatment as there is room for another Levo raise, ie you are not optimally medicated yet. T3 is already 46% through range on a small dose of Levo so be careful T3 levels don’t start climbing too high.

However, as endo has prescribed T3 (& depending on what you read T3 is 3-4 times as powerful as T4), start with a 2.5mcg T3 dose for a week or two. It can be taken with your Levo.

Expect a possible headache and/or inner heat, which only lasts a few days and then hopefully symptoms will start improving. Then add another dose, and then finally the last dose after a further week or so.

Retest after six weeks on final dose, taking Levo 24 hours before blood draw, and T3 12 hours, no later than 9am, nothing to eat/drink except water.

Multi-dosing T3 reduces the rapidity of onset & prolongs the duration of its action. I too started with three doses for several months due to adrenals issues, but then switched to twice a day on which I have remained as is so much easier to manage.

[jersey-jazz in reply to radd]

Dear JonnyAYou have asked for my opinion. I am happy to give comments on my personal experience which may or may not be helpful to you. First of all, I am sorry that you are going through all this mess with your thyroid. In my unprofessional opinion, the sooner you get a significant increase in your liothyronine, the better. Currently, I am in the USA and on 75 mcg livothyroxine and 50 liothyronine. I feel quite balanced. I lived in Scotland for many years. There, the endocrinologist prescribed 120 mcg liothyronine and no livothyroxine. That also worked but this feels better in my head. Because of Hashimoto's disease, my thyroid has been largely destroyed. There is little or none left of it.

[radd in reply to jersey-jazz]

tagging JonnyA

[JAmanda]

Your Endo doesn’t seem too clueless to be fair. I’d go along with that and see how you feel.

[SlowDragon Administrator]

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?

As a young male your still on ludicrously low dose levothyroxine

Have you had thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s?

Have you had vitamin D, folate, ferritin and B12 levels tested

What vitamin supplements are you currently taking

The problem with starting any dose of T3 is it is likely to suppress TSH, shutting down your own thyroid

You might not even need T3 if you get dose levothyroxine increased up to full dose

Which brand of levothyroxine are you currently taking

Suggest you increase to 50mcg levothyroxine ASAP

retest 6-8 weeks after each dose change or brand change in levothyroxine

Likely to need several further 25mcg increases in levothyroxine

[shaws Administrator]

I don't agree with "though is more inconvenient to take.' . I take T3 alone with one glass of water. (when I awake) and feel fit and well). II wait an hour before I eat.

T3 -is also called liothyronine and is the 'active thyroid hormone' and we have millions of T3 receptor cells in our body and brain and heart have the most. The T3 receptor cells have to be saturated and send out 'waves' throughout the day.

T4 is inactive and has to convert to T3.