First T3 prescription - advice on starting please. Fitting in Iron and Vit supplements too

[MrsT79]

Hello,

I’ve had my first Endo (private) appointment today and he has suggested a trial of T3 on a starting dose of 15mcg taken in 3 doses of 5mcg. I am to reduce my Levo from 125mcg to 100mcg.

I am hugely hopeful T3 will help to alleviate my debilitating symptoms and I can have my life back.

My questions are how and when to introduce these changes.

I currently take Levo at bedtime. I’m supplementing liquid iron and have been taking this first thing in the morning and then eating approx one hour later and taking other supplements of Vit C, Vit D, B complex and omega 3s.

I take liquid iron again mid afternoon between lunch and my evening meal.

The Endo would like me to switch my Levo to first thing in the morning, add 5mcg of T3. Wait 30-60 mins to take iron.

Take 5mcg of T3 again at noon and 6pm.

I would be very interested to hear opinions and advice of those who have been there as to how I am best able to introduce T3 and manage my current supplementation routine to best effect.

Endo has asked me to retest my bloods after 4 weeks of T3 at 15mcg and Levo at 100mcg and then speak again to discuss trial.

Thank you in advance for your help.

MrsT79

[SeasideSusie Remembering]

MrsT79

TSH 2.11 mU/L (0.27-42) 0.29 in June

Free T3 4.3 pmol/L (3.1-6.8) 5.5 in June

Free thyroxine 17.5 pmol/L (12-22) 21.5 in June

You posted these results a week or so ago. Are these the results that the endo has based his dosing regime on - the first results in each line?

If using these results, I agree with what SlowDragon said in reply to your previous post, that you should have had an increase in your Levo at that time. The aim of a Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well. I think you should have increased Levo, got your TSH as low as possible and your FT4 as high as possible then seeing where FT3 lay to decide whether or not you needed T3.

However, if you are going to go ahead based on these results then your endo is making the common mistake most of them make. You don't need to reduce your Levo based on those results, your FT4 is only 55% through it's range and taking T3 will lower it even more.

Also, starting at 15mcg T3 daily is too much too soon. It's best to start with 5mcg daily for a couple of weeks, see how things are, if you are OK with that then add a second 5mcg - say 5mcg morning and 5mcg afternoon or evening. Give it another couple of weeks and again if everything is OK and you feel you need more then add a third 5mcg either 3 x 5mcg or 1 x 10mcg plus 1 x 5mcg.

If you are comfortable with your current timing of Levo then don't change it, you don't have to do what the endo says. And you certainly shouldn't take iron within 30-60 minutes of taking thyroid meds, all advice is that iron needs to be taken 4 hours away.

If you take any other supplements they should be taken 2 hours away from thyroid meds and 2 hours away from iron supplement.

If you take B Complex or Biotin then this should be left off for 3-7 days before any blood test.

If testing iron then any iron supplement should be left off for 7 days and the test should be done after a 12 hour fast.

[MrsT79 in reply to SeasideSusie]

Thank you for your reply.

I’m not sure if the Endo based his decision on other results which included cortisol, DHEA, full female hormone panel as well as my history.

I did think 15mcg a day to start was a bit high. I’ll delay my follow up consultation to give me time to increase dosage.

I agree that I’m happy with having Levo at night and for supplements it makes life easier.

Thank you.

[greygoose]

I’m supplementing liquid iron and have been taking this first thing in the morning and then eating approx one hour later and taking other supplements of Vit C, Vit D, B complex and omega 3s.

Are you taking your vit D and B complex at least two hours away from your iron? If not, you won't absorb them very well.

It would probably be better to take your vit C at the same time as the iron, to help absorption. And to keep it well away from B12. Vit C affects the way the body uses B12 so they shouldn't be taken together.

[MrsT79 in reply to greygoose]

Thank you. I’ve been doing Vit D spray and Vit B12 spray close to having my iron. I will moved all supplements to lunch or evening meal and stick with iron and Vit C first thing. I’ll leave Levo at night.

Can I take T3 near to my iron supplement?

[greygoose in reply to MrsT79]

Best not to take your iron near to T3? Leave the same four hour gap as for levo.

[MrsT79 in reply to greygoose]

I’m struggling to see how I could take my T3 3 times a day. When would I take my iron? Could I move my Levo to waking and then my iron before bed?

[greygoose in reply to MrsT79]

Well, you could do that, but I don't really that that would help very much if you're taking T3 three times a day.

However, you don't have to take it three times a day. If you're starting on 5 mcg as advised, you could take that with your levo in the morning. Then, when you add in another 5 mcg, you could take that two hours after lunch. But, then you'd have to take your last 5 mcg four hours before taking your iron.

Maybe the best solution would be to take your T3 only twice a day - 10 mcg in the morning with levo and 5 mcg two hours after lunch.

Or, you could try taking it all at once in the morning.

[SlowDragon Administrator in reply to MrsT79]

Suggest 5mcg T3 waking

B vitamins and vitamin D after breakfast

2nd 5mcg dose T3 mid afternoon (approx 8 hours after 1st)

Iron and vitamin c four hours later

If/when add 3rd 5mcg dose T3, take with levothyroxine at bedtime

[Yeswithasmile]

Hi MrsT79

I am just going to reiterate what SeasideSusie has said. It’s very good advice.

At the start of this year my levels were about the same as yours. I was on 100mcg t4. Tsh lower than yours. I was given 75mcg levo and 10mcg t3. Advice on here was raise levo first. I had the t3 so took it against the advice. This was a mistake. Fast forward to now and on 125mcg levo mostly self sourced and 18.75 mcg t3 again mostly self sourced.

I have come to the conclusion that just because an endo is open to t3 does not mean that they have any idea at all of how to medicate with it. It is not magic. I have been so poorly a lot of this year. Worse than on 75mcg levo alone. So much so I am considering coming off it all to start again. It’s confusing and difficult to get the doses right.

I don’t want to be negative but I would suggest that a raise in levo first for 8 weeks could save you a whole lot of misery in the long run. Then maybe start to add in t3 if you feel it’s necessary. 🤷‍♀️ It’s your body and your choice but I am chipping in just to help you decide 🤞🏻🤞🏻

[thyr01d]

Hi MrsT79, I am glad to see you too find this tricky. I too am prescribed T3 taken 3 times a day and need iron and also calcium etc for bones. I don't leave the 8 hours suggested above between T3 doses. I take the first around 7.00 am though usually it's between 5.00 am and 6.30 am when I often wake, the next T3 around 11.30 (gives an hour before eating and allows a coffee around 10.30) and my final dose around 4.00 pm so it doesn't affect my sleep. Just taking supplements that could be taken together would then be easy, any time after 8 pm, but apparently we are not supposed to take some within 4 hours of each other, and I don't stay up that late but perhaps you do? Not sure if I've offered anything or just thought in print!!!