I’ve listed below two levo only lab results in April & May, then the first after doing the combo for 5 weeks. Not much change.
Then a total first for me, yesterday after 12 weeks on combo: TSH extremely low and FT3 above range! Only FT4 hasn’t changed.
Theoretically I should be feeling much better. In fact, generally I’ve not seen any improvement on combo, except slightly less joint pain that has now returned with colder weather. And now I’ve been feeling terrible for the past week, exhaustion and increase of all symptoms, on top of high BP and tachycardia that started a few weeks ago.
A few days ago I was wondering if I should do T3 only then maybe back to levo only, or tweak the combo, and basically I haven’t a clue! Help much needed and appreciated.
Last four labs were:
On Levo only, 88 T4 alternating with 94 T4 - 7 April & 18 May:
So currently taking 25mcg T3 daily as 2 x 12.5mcg is that correct
Was latest test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Ideally day before test split into 3 doses
12.5mcg waking, 6.25mcg mid afternoon and at 9pm
Last 6.25mcg dose T3 approx 8-12 hours before test
Essential to regularly retest vitamin D, folate, ferritin and B12
-I’m taking half of that: 12.50 T3 daily as 2x 6,25 mcg. Plus 62/69 T4
- Yes, latest test done 7:30 am, only water, split 2nd 6.25 day before to take 3,12 T3 at 11 pm
I was going to do vits but had forgotten not to take B 12 and iron a week before. Last vit D test in July was a third of range, B, was good and ferritin could be a little higher in range. Folacin was done earlier in the year but is always very good. (Don’t have lab recent results, lab forgot to send them. am testing vit. next week.)
Can you please explain why FT4 hasn’t budged whereas TSH went down so much with FT3 over range?
Do I stay on combo or reduce T3 or T4 or go back to levo only or on to T3 only?
For what it’s worth, after test on 8.10 and yesterday I only took 6,25 T3 and finally feel more relaxed than I have in the past 3 months…
Thank you very much for your advice, Slow Dragon. I will answer your questions and then ask you to explain raising Levo, because I still don’t understand how it works.
- My highest dose levothyroxine was alternating between 94 and 88. About increasing the dose to 100, well yes, I was often advised to do so since end of 2019 and – I kept trying! Just couldn’t do it. (Least of symptoms being laid out flat as a pancake all day and since I live alone, not possible to maintain for any length of time…)
- I haven’t checked weight in many months, will do. Could be anywhere between 60 and 65 Kilos. (I was up to 70, until this winter when I lost 10 kilos).
- I take Euthyrox. T3 is Unipharma only here. T4 Euthyrox felt smoother than T4 Unipharma, that I used many years previously. Was told here that it didn’t matter to take T4 and T3 from different brands. (?)
- You said “Perhaps reduce T3 to 3.25mcg twice day and increase levothyroxine
Suggest you increase levothyroxine to 75mcg daily and retest in 6-8 weeks”.
- I have a question about increasing to 75 mcg T4 (from 62,50/69mcg): I understand that having added T3 suppressed my TSH – and therefore didn't raise my FT4? However, since TSH & FT4 are low, shouldn’t I take less T4? Or do I take more so as to raise FT4? Will that not raise TSH again?
Okay for trial and error - and caution - which will hopefully become trial and Bingo! some day, hitting that famous sweet spot.
So recap: I’d always read that low TSH indicates to take less T4 to raise it and the other way around.
But why FT4 reacts the opposite way i.e. a low FT4 indicates take more to get higher (which is less counterintuitive) I still don’t get. But I trust your advice and will up levo and reduce lio and see what happens.
More recently I found out that a very low TSH (I’m now 0.80 on scale 0,20 – 5,00) is okay and I can go down further.
I’d been wondering about T3-only because of not doing well on levo and trying to raise it but you seem to dismiss this option entirely. NDT you didn’t mention. I did a 5-day trial which was very unsuccessful but I wasn’t used to T3 at all then. If you have any thoughts on the subject please let me know. As it would be nice to know there’s an alternative if this combo doesn’t work out.
Always grateful for your time and patience. As many have said, where would we without the Forum and people like you?
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Lab Results on 2 grains NDT - Switching to T3 Only
Conversion from T4/T3 combo to T3 only- experiences/advice? 
Please have a look at two lots of test results? And advise on how to reduce t4?
