Advice for starting T3 - dosage levels for T3 and T4

[Trisha15]

First of all, I want to say thanks for this site and to all those who have helped me get more informed about my thyroid. I am now looking advice with introducing T3 alongside my levo and would really appreciate some further advice. I believe my results and symptoms suggest I am not a good converter

I have been able to source 25mg of T3 and have a pill cutter so I can split into 4 doses of 6.25. Should I try and cut the quarter tablets in half at the beginning and work up to quarter tablet or would a starter does of 6.25 be okay?

Also, should I reduce the levo to 100 or perhaps reduce to daily 125?

Bit of a long pos, but here’s my background and bloods over the past year or so.

I trundled along for maybe 15 years, believing my GP when he said everything was fine and blood normal. Then menopause hit and send everything into freefall! But still my bloods were normal. Long story short – I was referred to and endo who increased my levo from 125 to 150. Then my TSH levels dropped below range and constant calls from GP to reduce my levo. Endo suggested I do alternate days on 150/125 but TSH still too low. I had started to feel better on the 150 and since reducing to alternate days symptoms returning. Still waiting on a review appointment from endo and still getting calls from GP about my low TSH.

As advised by this site, I did private bloods in July 2020 and discovered I had Hashi and had low T3. I have since gone gluten free and started supplementing with Vit D and B12 or B complex. In November 2020 when my levo was increased and my T4 went was just over range, my T3 was still on 21% through range. However, I felt much better and no signs of being over medicated. I have decided to try T3 and looking for advice before I start. I had wanted to discuss with the endo first but apparently, I did have a telephone call with him and have been discharged – this never happened (unless my brain fog is so bad I have forgotten it lol!) I am still waiting for the endo to get back, but as he told me he doesn’t really believe in T3, I’m not it will be worth my time or energy. The advice here is 100 times more valuable.

I have also attached my latest medi-checks results so any advice about vitamin levels would be appreciated. For reference I stopped the B12 around a week before the blood test and last levo was 24 hours earlier and done first thing in the morning. The GP blood tests were done after 9am or 10 with at least 24 hours since levo although I might only have been off the B12 for a few days rather than a week.

Results history ( hopefully I have calculated the % thru range correctly)

On 125mg levo

Jun-20

TSH: 2.47

T4: 17.6 or 56% thru range

Jul-20 (by medi checks and no longer taking levo with food)

TSH: 1.33

T4: 19 or 70% thru range

T3: 3.87 or 21% thru range

On 150mg levo:

Nov-20

TSH: 0.05

T4: 23.5 or 115% thru range

T3: 5 or 51% thru range

On 125/150 alternate days as GP worried about TSH levels

Apr-21

TSH: 0.03

T4: 20.5 or 85% thru range

T3: 4.7 or 43% thru range

Sep - 21

TSH: 0.07

T4: 17.9 or 59% thru range

Oct -21 (by medi checks)

TSH: 0.3

T4: 20.4 or 84% thru range

T3: 4.1 or 27% thru range

ranges:

T4: 12.0 - 22.0

T3: 3.1 - 6.8

In Jul 2020 my antibody tests were as follows. The Oct results produced an error so need to send them off again.

Thyroglobulin 571. Range <115

Thyroid peroxidase >600 range <34

Vitamin results from the Oct medi checks :

Ferritin. 70. Range 13-150

Folate 6.1. Range >2.9

B12. 154. Range 25.1- 165

Vit D. 77 range 50 - 200

A big thank you to everyone that has read this far.

😁

[SeasideSusie Remembering]

Trisha15

For reference I stopped the B12 around a week before the blood test

Do you mean B12 or do you mean a B Complex?

You don't need to stop B12 before a test because it doesn't affect the results; however, the Biotin in a B Complex does affect results and this is what you need to leave off before a test.

With your B12 at 154. Range 25.1- 165 you don't need a B12 supplement but with folate at 6.1. Range >2.9 you do need a B Complex.

Your Vit D level could be better, are you supplementing?

Oct -21 (by medi checks)

TSH: 0.3

T4: 20.4 or 84% thru range

T3: 4.1 or 27% thru range

As taking T3 is going to lower your FT4, if those were my results I'd just reduce Levo by 12.5mcg then wait a couple of weeks before adding 6.25mcg T3. You can take the T3 with your Levo. Leave it a couple of weeks to ensure you are fine with T3 then add a second dose of 6.25mcg perhaps one dose morning and one dose afternoon or before bed. After another couple of weeks if you feel it necessary add another 6.25mcg T3, either 3 x 6.25mcg 8 hours apart or 1 x 12.5mcg plus 1 x 6.25mcg.

I would then hold those doses for 8 weeks for levels to settle before retesting.

You might find 18.75mcg enough, you might need 25mcg. It can take a long time and lots of small tweaks to fine tune doses to find what you need to be optimally medicated.

I'm not medically trained and my comments are based on my own personal experience of adding T3 to Levo.

[Trisha15 in reply to SeasideSusie]

Thanks SeasideSusie

I think I’ve switched between B12 and a B complex depending on what was available as I have only been buying shop supplements. Same for the Vit D - the current bone says high strength but I can’t see what that actually means. Doctor wasn’t worried about my vit D but I will go on line and look forward stronger ones now. I’ll search on the site for some recommendations.

I understand your not medically trained but I’m happy to take your advice and experience. So if I reduce to 125 a day would that be ok, as currently alternating between the 125/150 or do you think I should reduce a little more?

[SeasideSusie Remembering in reply to Trisha15]

Trisha15

The B Complex keeps all the B vitamins in balance so we shouldn't take B12 on it's own. As you don't need B12 I would suggest you look at Thorne Basic B for your B Complex. If you look at different brands then look for the words "bioavailable" or "bioactive" and methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid) and avoid any that include Vit C as well because this keeps the body from using the B12 it contains. Vit C and B12 should be kept two hours apart.

For Vit D, the "high strength" you are using will have the dose on the bottle either in iu (international units) or mcg (micrograms).

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.

To reach the recommended level from your current level, you could supplement with 3,000iu D3 daily and retest in April to see if you need to adjust your dose.

Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.

For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

Experience has taught me to make changes gradually so I would just reduce by 12.5mcg Levo for now, so 125mcg daily.

[Trisha15 in reply to SeasideSusie]

Thank you for your detailed and very informative reply. And thank you so much for taking so much time to respond. I’m sure I speak for many here when I say we’d be lost without you and others on this site X

[Lalatoot]

Before starting you need to ensure that you have enough t3 for at least a trial of 6 months because adding t3 is not a quick fix.

Based on my experience I would reduce levo by either 12.5 or 25mcg. Wait 2 weeks. Then introduce 6.25mcg t3. Wait 1 week then add another 6.2t MCG as a separate dose.You may want to stop there and wait 8 weeks and then do bloods. Some folks only need a low dose.

If you continue add 6.25 MCG every 2 weeks until you reach 25mcg daily.

[Trisha15 in reply to Lalatoot]

Thanks LalatootI have 3 packets of T3. I didn’t think I’d need a full 25mg tablet so was assuming that would last me at least 6 months. I’ll look at sourcing more just in case I need a stronger dose than anticipated.