To T3 or to not T3 that is the question.....I will need to take it but it's a question of when

[Moog77]

Hi everyone quick question here as I value all your advice.

TFT results today after 9 weeks on 125 levo.

TSH: 0.6 (0.27 - 4.2)

Ft4: 18.4 (12 - 22)

Ft3: 4.2 (3.1 - 6.8)

Things are moving in the right direction for me but I'm not quite optimal yet. I clearly have conversion issues and have some t3 waiting in the wings...my question is would it be worth bringing t4 up just a little more - say 12.5 levo increase- to see if it increases ft4 just a hair before starting t3?

I felt AMAZING first 7 weeks on 125 levo (previously on 100) but last couple of weeks feel I'm backsliding a little. I think I'm almost there I just need to tweak a little which inevitably means introducing t3. Is it worth the bother to try to optimise ft4 if I'm going to take t3 anyway?

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking

Do you always get same brand

Presumably you are still working on improving vitamin levels from 2 months ago

Folate - 6.95 >3.89

Ferritin - 54 (13 - 150)

Vit D - 70.4 (50 - 200)

B12 - 83.1 (37.5 - 188)

Suggest you retest again in another 6-8 weeks, including vitamins

[Moog77 in reply to SlowDragon]

Hi slow dragon

Same brand always - accord - I never mix brands.

Been taking thorne b complex #12 daily alongside vit d. I take a large folate singular dose every few days and ferrous fumarate every other day.

Looks like t3 is not necessarily needed just yet - hopefully never!

[DippyDame]

Often happens when we need an increase.

Essential to optimise vit D, vit B12, folate and ferritin to support thyroid function/ conversion

Then optimise levo before adding T3..., if you are tolerating levo, as you seem to be.

By doing both that may raise FT3 enough to get you back to feeling " amazing"

It doesn't inevitably mean that you need T3...more Levo may suffice

Some people need FT4 high in ref range in order to achieve an adequate FT3 level

FT4 is 64% through ref range....you have room to increase.

Management of dose will be easier if you can cope with T4 mono

If that doesn't help, only then add T3.

T3 is not the panacea of all ills!

That's from someone who needs high dose T3-only to function!

We need what we need there are no strict rules.

[Moog77 in reply to DippyDame]

Hi dippy dame

I'm working on vits - vit d, folate, b12 and ferritin - and have been taking these religiously for past couple of months(although stopped my thorne b for 5 days before getting these bloods done).

I'm surprised but pleased t3 has finally moved as it seemed to be stuck for a while there.

With ft4 64% through range there definitely is room to improve. I always thought t3 was on the cards as I have coeliac disease but now it's come up a bit maybe the end is in sight on t4 alone.

[greygoose]

Your T3 is only 29.73% through the range. I honestly don't think that a 12.5 mcg increase in levo would raise the FT3 enough to be optimal. And, if your FT4 goes too high, it will make your conversion worse, not better. If it were me, I'd take the T3 now, and not bother any further with tweaking levo. That's my opinion, anyway.

[Moog77 in reply to greygoose]

Hypothetically speaking 😁 would it be the t3 protocol I.e. 5ncg in morning for a week the add in afternoon dose hold for another week and if tolerated add a 3rd 5mcg later in day then test after 6 - 8 weeks

[greygoose in reply to Moog77]

Two weeks, not one. If you increased by 5 mcg every week, that would be far too rapid. The body needs time to adjust. But, yes to the testing after six to eight weeks.

[radd]

Moog77,

You previously advised you were subclinical for years and then remained on 50mcg Levo for too long, and then 8 months ago you stopped your meds for a while.

The longer we remain under medicated the more likely the risk of nutrient & iron deficiencies, and you are more predisposed due to your celiac disease. You may finally have optimal FT4 labs but you won’t know they are working optimally to their best conversion until deficiencies have been rectified.

3 months ago you ended up in A&E with ectopic heart beats. Low iron with medicated thyroid hormone replacement meds is notorious for instigating tachycardia and unusual arrhythmias, etc. Have you had iron, VitB12, folate and Vit D recently tested? You may find by bringing these levels up your T4 -T3 conversion improves enough for well-being.

Optimised & effective thyroid hormones, & nutrients (particularly Vit D) contribute to calming other autoimmune conditions and you may see improvements in your celiac disease. Also there is research showing supplementing selenium can help improve T4-T3 conversion.

Adding T3 should only be the last resort when other avenues have been explored as medicating T3 if you don't clinically need it can impair both T4 & T3 meds from working well.

[Moog77 in reply to radd]

These are my vitamin results from January. They aren't optimal but they aren't terrible either. I have been actively taken the necessary supplements to improve these.

Folate - 6.95 >3.89

Ferritin - 54 (13 - 150)

Vit D - 70.4 (50 - 200)

B12 - 83.1 (37.5 - 180)

It might be worthwhile adding selenium in there as well then.