Levo t4 vs t4 and t3 treatment

[Ajva]

Is it possible to do well on levo t4 only? I was on armour before and many people talk about only doing well on t4 and t3 treatment (whether that is combination drug or separate synthetic). Just looking for peoples opinions.

[Shkmigmo]

Hi, Ajva!

I've been on combo T4/T3 (Prothyrid) for a year and feel much better than when I was on T4 only. I'm hypo hashi since 2018 and my first medications were Letrox and Euthyrox - but every couple of months I had to increase the dose because all my hypo symptoms would creep back. Also, when on T4, my T3 had always been below the range.

I'm obviously a poor converter (T4->T3).

Still, there is room for improvement, but compared to the period when I was on Levo only - it's like somebody has switched the light on in my head and I don’t feel sluggish anymore.

If you have any specific questions I'll be glad to help and share my experience!

[fuchsia-pink]

Yes.

The vast majority of hypos - well over 80% - are on levo-only. I'm sure there are many who have useless GPs and aren't on the best dose - but they can't ALL be feeling horrible. I was perfectly happy on levo-only for a good 10 years.

This forum necessarily self-selects those who aren't doing well - and many here remain happy with levo-only once they are on the correct dose.

More importantly, because this forum helps those who aren't happy with their general GP care, it can feel as if lio (T3 meds) and/or NDT (which contains T4 and T3) are the holy grail ... but these very often only really suit people who are "poor converters" and there are quite a lot of people who get hold of it who convert pretty well then get really disappointed when it isn't a "magic wand" [or indeed diet pill] for them.

The only really important thing is to be on the right meds for you x

[SlowDragon Administrator]

Which ever type of thyroid replacement we take only works well with optimal vitamin levels

Frequently we see members find significant improvement when all four vitamins are tested and improved to optimal levels

Addressing food intolerances often a hidden issue too

[Hidden]

Most doctors seem to think that taking levo is enough as T4 will always be sufficiently converted to T3 as needed in the body.While it´s true that correcting nutritional deficiencies can improve T4 to T3 conversion in some patients, I recently read (in the book "The thyroid patient´s manual" by thyroid patient Paul Robinson) that around 1/3 of T4 to T3 conversion takes place in the thyroid gland itself, and that patients without a thyroid (either due to thyroidectomy, RAI, or end-stage Hashimoto´s) on levo only have lower FT3 levels than healthy individuals.

I don´t know if it´s true that 80-85 % of thyroid patients are happy on levo only. Doctors like to claim that it´s true.

I was OK on a high dose (200 mcg daily) of levo for some years, but then no amount of levo resulted in complete symptom-relief. Interestingly enough, 20 years after being diagnosed with Hashimoto´s, my thyroid gland turned out to be atrophied. I wonder if the complete destruction of my gland meant I ended up T3 deficient despite taking high doses of levo? Anyway, I now take NDT and feel much better. This proves to me that our hormone needs are not static but may change over time.

[Mikico in reply to Hidden]

Hi PurpleCat71 -

What NDT brand do you take? I have always been on Levo for 20+ years but am keen to try NDT because am a poor converter. However, I am living in Spain and not sure if can find it here however will ask my Endocrynologist.

Thanks 🙏

[Hidden in reply to Mikico]

I take Thai brand Thyroid-S.

[waveylines]

Many people do do well on levothyroxine. However the most common mistake GPs make is to prescribe according to the TSH level when they should be looking at the thyroid hormone levels (ft4 & ft3). Treating by the TSH has been proven to lead to under prescribing but is the practise doctors are trained in. They should also be considering the patients symptoms but the majority no longer do so and arent trained to look out for them. So for many its about get the levothyroxine up so optimally precscribed alonside ensuring ferritin, folate, vit D and B12 are also optimal. With these in place most people do well. For some though this isnt enough and they require meds that include T3 &T4 to feel well and for few T3 meds only.

[Hidden in reply to waveylines]

I agree doctors are not trained to recognise signs and symptoms of hypothyroidism. Once the TSH is anywhere in range, they seem to think all remaining symptoms have nothing to do with your thyroid!

[pennyannie]

Hello Ajva :

I believe around 80% of those on T4 only are perfectly happy with their medication and treatment but of course, they won't be on here asking questions as they are well and happy and getting on with their lives.

Generally speaking if you have an auto immune thyroid condition the system fails you as there is no cure through conventional mainstream medical and the onus put back on the patient.

This is where we can jump in and offer some constructive help in the way of optimal vitamins and minerals and getting as strong a core strength as possible to help overcome some of the known pitfalls we know of in the treatment of thyroid health issues.

Many people find the monitoring and treatment in primary care sadly lacking and so we have options now to go private and this forum can explain our medical print out for us and offer suggestions which we may choose to follow or not, as the choice is that of the patient.

Knowledge is power and all that matters is better health for all thyroid patients and knowing there are options if you feel you are not being listened to and feel you are not responding to the medication as you thought you would.

P.S. Full thyroid hormone replacement will also likely be needed by all those people who are without a thyroid gland most often, those having had a medical intervention, whether it be surgery or RAI ablation

[tattybogle]

my auntie was perfectly fine and very active all her life on Levo . (after a hemi thyroidectomy for ?graves)... but she did take about 200mcg /day and 'forgot' to go for blood tests for many many years at a time. No idea how she managed to get GP to keep prescribing without testing, but it was quite along time ago , and she was quite scary ... so maybe her GP was happy to 'forget' about her too .....

[SlowDragon Administrator in reply to tattybogle]

In the recent past ….many/most thyroid patients were prescribed much higher doses than today….200mcg was not uncommon as standard dose

But with arrival of the dreaded TSH test ….dose levothyroxine has been reduced lower and lower…..leaving many people with very poor/non existent quality of life

[tattybogle in reply to SlowDragon]

She 'd been on that dose since the mid 1950's but she was still getting away with 'forgetting' to have bloods done in 2015 ..i think GP was reluctant to confront a battle axe despite the 'advances' of TSH . Mind you .. she did then have a stroke. but she also had a very full life first.

I remember the day i found out she was on 200mcg... i thought "oh , i'm not as ill as you if i only need 150mcg " ... i felt like a hypochondriac for not being as well as she was on Levo . shame i didn't think to learn more about it back then instead of believing the Doc.

[waveylines in reply to tattybogle]

I font think they bothered about regular testing back then.....nor were they required to do so.