Edit** T3 reduced to 5mcg 2x daily retest mid march. Palps are slowing 🤞🏼
Hello everyone, I have been on T4/T3 therapy now for around 6 weeks. Currently taking 75mcg Levo everyday & 20Mcg T3 split into 2 doses, usually 7am and 3pm. Weeks 2,3,4 I felt fantastic last 2 weeks have been suffering with heart palps. 6 weekly bloods TSH 0.08, FT4 13.9 AND FT3 8.6. Obviously aware T3 is over by quite abit as top end range for my lab is 6.8. And TSH is quite suppressed.
Any advice you could give me as still waiting for my endo to call me (it's been a week)
Thanks
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Ninney2019
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Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and last dose levothyroxine 24 hours before test
On T3 - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last dose 8-12 hours before test
So taking 10mcg waking, 5mcg early afternoon and 5mcg around 9pm ….assuming test 9am next morning
Is this how you did your test?
Please add ranges on Ft4 and Ft3
Do you always get same brand levothyroxine at each prescription
Are vitamin D, folate, ferritin and B12 levels optimal
I took my doses as normal on day of bloods. FT4 ranges 12.9-22 FT3 3.9-6.8
Always have the same brand for the last 3 years as only one tolerated. All vits etc are optimal. I do not take any supplements as try to get all vits naturally by eating a good diet.
Hi, yes I have hashimotos. Not GF, just normal eating habits. I do have a fitbit and my RHR has remained the same, although my temp was usually around the 36.4-36.6 range I'm now coming in around 37.3-37.7 not sure if that's relevent😂
Starting too quickly can frequently be too much initially
Suggest perhaps dropping back to 3 x 5mcg …..
Have you tried splitting your T3 as 3 x 5mcg doses spread through the day ?
Waking, early/mid afternoon and early/late evening
Many people find taking 5mcg dose T3 at or near bedtime improves sleep
But not everyone does
Your Ft4 is very low, that may be too low
Presumably levothyroxine was reduced when T3 was added. How much levothyroxine were you on before T3 was added. What was last Ft4 test result on just levothyroxine
Frequently dose levothyroxine is reduced too much when T3 is added
Many of us on levothyroxine plus small dose of T3 find we need both Ft4 and Ft3 around 50% through range
So you might need to reduce T3 by 5mcg
and perhaps at same time, or as a separate step …..
increase levothyroxine by 12.5mcg to 87.5mcg daily
I was reduced from 100mcg to 75 on commencing T3, when on 100mcg I was slightly over on T4, TSH was always below 1 and T3 sat in middle of range. I have taken 5mcg T3 this morning and so far no palps - usually they'd have started by now.
So if you then take 2nd 5mcg dose 2pm and 3rd 5mcg dose around 6-9pm ….perhaps try 6pm and then try moving last dose bit later over next few weeks ….see if taking at bedtime suits you
You want to retest after 6-8 weeks
Day before next test take last dose 9pm day before
Depending on next results, you may need to increase dose levothyroxine a little
Essential to regularly test vitamin D, folate, ferritin and B12 at least once a year minimum
LT3 is about three times as potent as LT4, so you are on the equivalent of 135 levothyroxine which is perhaps too much. I would switch to 75 LT4 plus 10 LT3, taking 5 LT3 at breakfast and 5 at night. Give this a try for a couple of months or more and see how you go.
Your dose has jumped around considerably so it will help to settle on a more stable dose for a while. I can see why. Your doctor started you on a high dose but I think they panicked, TSH can go very high but also comes back down on a normal dose of hormone.
I did wonder whether to change T3 down to just 5 twice a day and see how that goes. Just concerned my TSH has suppressed so much being on T3. 😑 I'm assuming that's normal for T3 takers🤷🏻♀️
A study found that 10 mcg LT3 suppresses TSH to the same extent as 30 mcg LT4. Patients seem to experience more suppression. This could be because they don’t split doses or perhaps the patients who most need LT3 have an underperforming pituitary. Dropping to 10 mcg will reduce your overall hormone dose by about 20%, so your TSH might pick up.
Took 2 years of close monitoring by my endo to establish the perfect dose and timings. I had monthly ECG, and day clinic appointments to ensure T3 didn't cause any damage to my heart.
I take my T4 -75 MCG and T3 - 5 MCG one hr before any food or drink in the morning. Then take another T3 - 5 MCG 5-6 hours after.
It work well for me.
Before t3 was included I was taking 135/150 alternating days T4.
I think that your endo has made the mistake that most of them make, that is starting you off on too high a dose of T3. Endos often say to either start with 20mcg or 10mcg and increase to 20mcg quite quickly.
Here we tend to suggest that you start of 5mcg (or 1/4 of a tablet which would be 6.25mcg if self sourcing 25mcg tablets without prescription), wait 2 weeks, add another 5mcg. Some might then go on to a third 5mcg and hold at 15mcg for 6 weeks and retest, or even hold at 10mcg and retest at 6 weeks.
With your symptoms and FT3 result, I just think you've gone too high too quickly, it's a shame endos don't advise to increase more slowly.
Taking T3 usually tends to suppress TSH, it's just what it does, I hope your endo knows this.
Your FT4 is very low in range, presumably your endo advised you to reduce your dose of Levo. Sometimes this takes FT4 level too low. Some patients are fine with this when FT3 is at a good level, but some need both FT4 and FT3 in the upper part of their ranges, it's a very individual thing and we have to gradually tweak our doses to find our sweet spot
I understand. But that's what's happened. You're not over-medicated, you just took your T3 at the wrong time. Normally, one would leave a gap of 8 to 12 hours between the last dose of T3 and the blood draw. So, nothing to worry about, just carry on on the same dose until your next blood test.
Don’t change dose - retest with correct time gap or try slight reduction to 15mcg - as 3 x 5mcg doses
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
On T3 - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last 5mcg dose 8-12 hours before test
Suggest you retest TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
Well spotted greygoose …..I had assumed she meant last dose was 3pm day before test ……obviously Ft3 going to be over range if test soon after taking 10mcg in morning
Thanks, my endo said he will retest every 6 weeks till I'm on the right doses so it's just a waiting trial and error game to find what suits me. Apart from the palps I feel ALOT better than I have done for the last few years... Sleeps better, hairs better, digestive system (tmi sorry) works as it should.
Hashimoto’s patients frequently develop leaky gut this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal
Something to consider in few months time ….only make one change at a time …adding T3 current change being trialled
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
GP or Endocrinologist have presumably done this already
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Reading your previous post of two years ago I see you were suffering with palpitations then. I believe that was before the introduction of T3.
I have seen you mention that your vitamins and minerals are optimal but cannot find the actual results with ranges. Do you have them for B12 - Folate - Ferritiin - VitD ? Low Iron can cause palpitations - so where in the range was your Ferritin ? Also iron plays its part in conversion of T4 into T3 which may have contributed to your problem in the first place ....
I was given a trial of T3 because I remained very symptomatic, my endo advised it could be what's needed. My levels have somewhat yoyo'd for quite some time and he is trying to help me.
That yo-yoing is typical of Hashimoto’s, and why it’s so essential to regularly test and maintain vitamins at very good levels, not jus somewhere within range
Seems a really high dose of t3 to start. I know I was told by endo to start with only 10mcg split into three across the day. And stick to that for a couple of months. So maybe too quick a start?
20mcg liothyronine is a lot, and your TSH reflects it. For comparison, I weigh about 172 lbs and am on 100mcg levothyroxine plus 7.5mcg liothyronine. I have read many places that, if your body can efficiently convert T4->T3, then all you need to replace is the ~5mcg T3 made within the thyroid gland ( most T3 is made peripherally). So how am I doing on 7.5mcg? I have TSH=0.6 and my FT3 is just below the midpoint of the 2.77-5.27 pg/ml range my lab specifies (tested in the morning, before I take my T3 for the day, so my FT3 is likely near top of range after I take T3 for the day). I feel well on this dose. However, when I had been on 100mcg levothyroxine and 12.5mcg liothyronine, my TSH was quite low and I definitely felt revved-up, or even hyperthyroid.
Hi, thank you!I felt the same, I have now spoken to my endo and he has said to lower my dose to 5mcg 2x daily and retest mid march. Will see the bloods then and he will adjust t4/T3 accordingly.
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T3&T4 combo - continued ...
Time before meals/ T3+T4 Blood tests
Why does adding T3 to T4 stop my palpitations?
T4/T3 Combination 
T4+T3 combo
