t4/t3 combination

[redjay999]

I am thinking of trying t3

I was on NDT for many years and it was great, had a few issues with my last batch using a different supplier and i went hypo again. Found it stressful trying to source Thyoid s so tried going back to t4. Not so good! My labs are in normal range but I feel like half a person!

Currently on 100mcg levo

My last blood test results

tsh 1.38

ft4 19

ft3 3.6

If i tried a combination of t4 and t3

what would be the best way to dose this please? I want to go gently gently.

SO sick of feeling rubbish. I want my life back.

[SeasideSusie Remembering]

redjay999

Can you please add the reference ranges for your results (these vary from lab to lab), this will enable us to see whether or not you need to lower your dose of Levo.

Also, before adding T3 we need optimal key nutrient levels, have you tested Vit D, B12, folate and ferritin?

[redjay999 in reply to SeasideSusie]

TSH Your result is 1.38 mu/LTSH levels normal (normal range 0.27 - 4.2 mU/L)

FT4Your result is 19 pmol/L

FT4 levels normal (normal range 12 - 22 pmol/L)

FT3Your result is 3.6 pmol/L

FT3 levels normal (normal range 3.1 - 6.8 pmol/L)

Nutrient levels all good. On decent regime of supplements for the above and also magnesium

[SeasideSusie Remembering in reply to redjay999]

tsh 1.38 (0.27-4.20)

ft4 19 (12-22)

ft3 3.6 (3.1-6.8)

Normally we suggest getting TSH to 1 or below to give highest possible FT4 before adding T3.

With your FT4 at 70% through range it might be OK for you to start adding T3 without adjusting your Levo dose.

Start with 1/4 of a tablet (6.25 or 5mcg depending on the dose of your tablet). Wait 2 weeks. If no problems or adverse reaction then add a second 1/4 of a tablet. You could take the first 1/4 with your Levo in the morning and the second 1/4 in the afternoon or before bed.

Personally once up to 1/2 a tablet (which may be all you need, although you may need more), I would wait 6-8 weeks and then retest to see how your levels have changed and how you feel.

If further increase of T3 is necessary I'd add another 1/4, either take 1/2 tablet with Levo and 1/4 tablet later on, or take 3 x 1/4 tablet spaced throughout the day. Again wait 6-8 weeks and retest.

I always wait at least 8 weeks, often 10 weeks, because my levels are still settling even after all that time.

Your FT4 level should fall when you add T3 but where you need it is very individual to you. Some members are fine with low FT4 as long as FT3 is in the upper part of it's range, some of us need both FT4 and FT3 reasonably well balanced over half way through range. It's trial and error and can take a very long time and much patience and tweaking of doses to find your sweet spot.

Nutrient levels all good.

Are they at optimal levels:

Vit D - 100-150nmol/L (or 40-60ng/L)

B12 - top of range for Total B12, if Active B12 then over 70 but preferably 100 plus

Folate - at least half way through range

Ferritin - half way through range although some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.

[redjay999 in reply to SeasideSusie]

That’s really helpful thank you So much. Nutrient levels good. Here’s hoping for improvement

[RockyPath]

Hi redjay999,

So sorry to hear of your travails.

According to one of the Thyroid-S vendors,

"Each (60 mg) tablet contains: equivalent of 38 mcg of Levothyroxine (T4) and 9 mcg of Liothyronine (T3)"

That seems to be usual proportions in a grain of NDT. If you want to try to return to that proportion using levothyroxine and T3 -- i.e. as close as you can get to 38 mcg levo and 9 mcg T3, or 75 levo and 18 T3 -- there's the rub. Clearly it's easier to take the NDT.

Here in the States my endocrinologist prescribes NP Thyroid or NatureThroid. Both were recalled in the past few years due to being sub-potent. I imagine the raw materials are sources from the same place. I just took to slicing the 1/2 grain tablets in half and boosting the dose to accommodate the lack of potency.

Hope you're back to feeling yourself soon.

[helvella Administrator in reply to RockyPath]

At one point, it was made quite clear that all USA desiccated thyroid medicines were manufactured from north American pigs. (I say that as some might have come from Canada.)

Whereas the Thai products would appear to be made from Thai or other Asian pigs. So, the same in principle, but possibly a little different.

I agree with starting somewhere near a direct translation from desiccated thyroid to levothyroxine and liothyronine - but the final dose that works best might be somewhat different. We have never really found out why so many do better on desiccated thyroid at the nuts and bolts level.