First bloods on T3 query

Hi everyone

I’ve recently been prescribed a trial of T3 due to poor conversion since starting Levo 2 years ago. (There’s a bit if an overview on my profile.)

My bloods previously at 6 weeks on 100mcg Levo only were:

TSH 2.47 (0.27-4.2)

T3 3.22 (3.1-6.8)

T4 15.9 (12-22)

My Levo had been reduced from going over range in November due to an autoimmune ‘attack’. I’m thinking my increase in TSH was a response to then going undermedicated.

I introduced T3 at 15mcg ( split dose into 3 across the day) and reduced Levo to 75mcg as advised by my Endo 3 weeks ago.

My bloods at the 3 weeks mark are:

TSH 0.8

T3 4.57

T4 12.7

( Same ranges and followed the blood draw protocol with medication)

I’m due a review in 3 weeks and will repeat bloods again, but what might these early bloods indicate for a dose change. Is it too early to tell?

Any experiences from others on introducing T3 and how long it took to get back to feeling well would be gratefully received.

I’ve just had full vitamins tested and awaiting results.

Thanks in advance, as always, for any input.

🦋 x

[SlowDragon Administrator]

Was test done as recommended

Testing early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Day before test did you take last 5mcg dose T3 approx 8-12 hours before test

How do you feel?

Many people on levothyroxine plus T3 find they need both Ft4 and Ft3 at approx 50% minimum through range

You may find that Ft4 result is too low for you

See what endocrinologist says ……perhaps he might suggest increasing levothyroxine to 87.5mcg daily and retest 6-8 weeks later

Do you always get same brand levothyroxine at each prescription

Looking at previous posts

Can’t see any recent folate or B12 results

Add vitamin results when you get them

What vitamin supplements are you currently taking

Have you had coeliac blood test done

Are you on strictly gluten free diet

[Hidden in reply to SlowDragon]

Hi SlowDragon

Thank you for taking time to reply. I did get the bloods done before 9am and Levo 24 hours earlier and last dose 5mcg T3 was 11 hours before. I’ve had a negative coeliac a couple of years ago (am GF now 3 months) but I’m awaiting a new screen for this along with one for PA along with all my vits so will update when the results are in.

My last vits tested: Jan 2022

Ferritin 38.7 (13-150)

Magnesium 0.79 (0.7-1)

B12 104 (37.5-150)

Vit D 136 (50-200)

I supplement:

Vit D Better you with K2

Magnesium

Zinc

Omega 3

B Complex (not at the moment due to having frequent blood tests)

Selenium

Turmeric

I always have the same brand of Levo (Almus/ Accord)

I’m definitely feeling improvement in some symptoms and have some days where I can feel an increase in energy, but then have a ‘crash day’ (or 2) and a return of the weakness, joint aches, headaches etc sinus problems. The T3 seems to be improving sleep so I’m very grateful for this as I’ve been sleep deprived for some months.

I’ll update results from vitamins as soon as they are in this week. Thanks again for responding x

[SlowDragon Administrator in reply to Hidden]

No point testing for coeliac if on gluten free diet

Vast majority of Hashimoto’s patients are gluten intolerant not coeliac

If you have tested negative for coeliac in past no point repeating

Obviously ferritin still has a way to go

Is it improving from previous test?

Looking for ferritin at least half way through range

Likely to need dose increase in levothyroxine as next step

[Hidden in reply to SlowDragon]

Thank you SlowDragon. I’d not had ferritin tested previous to the January one but I know it was requested for the bloods yesterday so it’ll be interesting to see what it looks like. I have a review with my Endo in early April so will ask about a dose increase then. I really appreciate the help- thank you x

[DippyDame]

How do you feel after adding T3?Not great by the sound of things

It's still very early days.

You have Hashi's so your labs are likely to fluctuate.

A flare is maybe not the best time to alter dose

I don't have Hashi's so others will be able to better advise re this.

TSH does rise if undermedicated, this is caused by the pituitary signalling (more TSH) the thyroid to produce more hormone

Conversely for over medication

High TSH = low serum thyroid hormone

Low TSH = high " " "

15mcg is a large starting dose and that is reflected in those labs

A lower dose may have been an easier introduction

We usually change one hormone at a time

Adding T3 lowers T4 so adding T3 and lowering T4 has resulted in FT4 dropping to bottom of range.

That reduction is likely to be far too low.

You should have had vital nutrients tested before adding T3

Any deficiencies can impact on conversion

Optimising nutrients may have improved thyroid function with less T3 then required

3 weeks is too soon to test after a dose change....

Usually best at 6/8 weeks

This allows the new dose to settle in the system

However, that done, you will now need to wait and see how both your next thyroid labs and the nutrition results look.

Hopefully the labs look better and you feel better.

Don't be surprised if you need further dose changes

Post your next labs and members will have a look and offer advice.

I'm afraid there is no quick fix, you need to be patient....and I know how frustrating that is!!

No reason though why you won't improve given time

Just a few thoughts.

Take care.

[Hidden in reply to DippyDame]

Hi DippyDame

Thank you so much for the detailed reply. I’m very grateful as this is a new experience and a big step so it’s reassuring to hear from experienced members.

I have noticed improvements but get set back days as I mentioned to SD. It’s heartening to hear its still early days and there’s a way to go on the T3 journey. As things have been so desperate, I’m sometimes in too much of a rush to see things change. I’ll be honest in that I did jump in straight away with the regimen suggested by the Endo as I was keen to get started. The good news is that I think my flare has subsided (🤞) as there is no way I could have introduced the T3 back in November & December. The fluctuations were wild at that time and it would have been more difficult to track what was going on in my bloods, wouldn’t it?

Thank you for your positive message and the feedback on what might happen next.

X

[SeasideSusie Remembering]

Butterfly19342

It's too early for your hormone levels to have settled and considering that Levo has a half life of 7 days and it takes up to 6 weeks for levels to settle after a dose change, it's likely that your FT4 will reduce even more.

Considering that your FT4 was 15.9 (12-22) before addingT3 then there really was no need to reduce your Levo, just adding T3 is going to do lower your FT4 anyway, combine that with the reduction in Levo dose then you are bound to end up with a very low FT4 level, it has barely scraped into range after 3 weeks so it's possible it will be at the very bottom of the range in a few weeks' time.

Some people are OK with a low FT4 as long as FT3 is in the upper part of it's range, but many need both FT4 and FT3 at decent levels. It's something we have to find out for ourselves by gradual tweaking of doses and noting how we feel. I take Levo plus T3 and if those were my results I'd probably be bedbound with that level of FT4.

[Hidden in reply to SeasideSusie]

Thank you SeasideSusie for the explanation on what’s happened. I’m so new to this all that I’m trying to learn as much as I can so I can get some kind of hold over my health.

It does seem likely then that I’ll need an increase to bring my T4 back up, but I know I don’t cope well with high T4 so I’ll be sure it’s a small increase for the time being.

I do feel undermedicated and very hypo on my bad days so it’s good to hear that a small increase could help towards improving things.

I’m very glad I started the T3 as the overall progress, even in 3 weeks, has been noticeable and I can certainly feel things shifting, even though it’s not consistent.

The first improvement was feeling like someone switched a light on with my cognitive function. I’m still experiencing brain fog, but I have good pockets where it lifts and I can concentrate 👍

Thanks again for taking time to respond x