Advice on reducing T3 medication

[Timmersby]

Hello,

I have Hashimotos and have been taking Novothyral (combination of 100mcg levothyroxine / 20mcg liothyronine) for many years and feeling, generally, very well. My TSH has always been suppressed due to the inclusion of T3, which my previous Endocrinologist was always ok with.

However, I have recently had to change Endo's due to moving to another country, and my new medico insisted that I lower my dose due to what he describes as an unacceptably suppressed TSH level!

However, my problem is that with this current (revised) dosage - 100mcg thyroxine 5 days a week and the Novothryal combination 2 days a week - I have started putting on weight and feeling tired and not sleeping etc. all the usual hypo symptoms are returning. A complicating factor is that I can no longer access my Novothryal from this country so will need to source T3 to augment the standard thyroxine ...but that is another battle for another time !

For now, I am feeling miserable and would love some advice from the veterans on this page as to what kind of tweaks I would need to make to my meds in order to get my labs into an optimal range please.

My most recent lab results are:

Free T4 11.50 pmol/L (ref range 9.00-19.00)

Free T3 3.38 pmol/L (ref range 2.63-5.70)

TSH 0.0479 (ref range 0.3500-4.9400)

Thank you all in advance !

[SlowDragon Administrator]

However, my problem is that with this current (revised) dosage - 100mcg thyroxine 5 days a week and the Novothryal combination 2 days a week

Well you can’t dose like that. T3 must be taken at same dose everyday

And taking any dose T3 is likely to suppress TSH

[Timmersby in reply to SlowDragon]

Thank you SlowDragon; of course that makes sense. Incidentally, this Endo is also the one who told me I could cut my HRT transdermal patches in half to get the correct dosage, which of course is also nonsense !! Blah, will see if I can get some T3 to supplement the thyroxine and try and a small daily dose (5mcg?) to see if that helps. I appreciate your feedback - thank you.

[FancyPants54 in reply to Timmersby]

I know this is old, but there is nothing wrong with cutting your transdermal HRT patches in half, or quarters. It's how most of us manage them if we need a tailored dose.

[greygoose]

Sounds like this endo needs shooting! You are never going to make him happy without making yourself ill. Optimal is how you feel, not numbers on a lab sheet. And you are never going to feel well going from 20 mcg T3 a day to zero T3 a day. And, if you take T3 it's going to suppress your TSH because you don't need the TSH any more when taking T3. That is basic thyroid 101, and if the endo doesn't know that, then he shouldn't be treating hypothyroid patients. And, I can't see there's any way round that except for putting your foot down and say 'no! My body, my TSH, I'll keep it suppressed if I want to.'

[Timmersby in reply to greygoose]

Thank you greygoose; you are of course absolutely right. I need to take more control over my own health. I was trying softly, softly to establish a supportive relationship with a new Endo, but clearly that is not going to work. I live in a remote location, so finding a new medico will be tricky and even if I did, they would probably be just as ill-informed.

So, I will try and get myself feeling well by adjusting my own dose; without wanting you to give guidance you are not comfortable with, what would you suggest I start with based on those results above (bearing in mind they were taken when I was taking 100mcg thyroxine 3 days a week and the Novothryal combination 4 days a week).

Perhaps I could start with 75mcg Thyroxine and 15mcg T3 ? Are you an advocate of splitting T3 into two doses ? I apologise for these questions; I have done lots of my own research, but it is conflicting and I would appreciate guidance from other patients.

Many thanks for taking the time to respond.

[greygoose in reply to Timmersby]

Free T4 11.50 pmol/L (ref range 9.00-19.00) 25%

Free T3 3.38 pmol/L (ref range 2.63-5.70) 23.43%

I think maybe it would be best to start by increasing your levo, and see what that does to your FT3. Both are pretty low, you've very under-medicated. But, if you want to start by adding T3 to your levo, I certainly wouldn't reduce your dose of levo. Adding the T3 will decrease the level, anyway. And, you don't really want it any lower, I shouldn't think.

As for splittin or not to split, that is a very individual thing. And, the only way you can find what suits you best is by trial and error. I take mine all in one go, I find it's better for me that way. But, that wouldn't suit some people at all. We're all different.

[Timmersby in reply to greygoose]

Thank you once again greygoose for your advice; where are all the decent endo's in the world - they are rare beasts it seems, so thank goodness for people like you in forums like this !

[greygoose in reply to Timmersby]

You're welcome.

[SlowDragon Administrator in reply to Timmersby]

Suggest you take 5mcg T3 everyday ….or 2 x 5mcg T3……

trial and error what suits each person……

start by splitting T3 as 2 x 5mcg at approx 12 hour interval…..or 2.5mcg twice day

plus 100mcg levothyroxine

Retest in 6-8 weeks

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

Day before test Split daily T3 dose into 2 doses and take last 1/2 of daily dose approx 8-12 hours before test

As greygoose says….your Ft4 is low …..you might need to consider increasing levothyroxine after next test

But only change one thing at a time

Important to test vitamin D, folate, ferritin and B12 at least annually

[Timmersby in reply to SlowDragon]

Many thanks SlowDragon; there is definitely a risk in me wanting to dive in and change everything at once which as you point out, is not wise. I will take it slowly and see how I feel then get tested in a couple of months. As greygoose has stated, the endo cutting off my supply of T3 overnight after having had a daily dose for years has really mucked me up and I am feeling ghastly.

So I think adding back T3 on a daily basis is a good idea and hopefully that will get both my T4 and T3 up towards the higher end of the reference range where I always felt better.

Thanks again for taking the time to send me such great advice.