I think I’m ready! I have got some 25mcg Tiromel, I have my tablet cutter on standby, and I have my most recent bloods - below:
Vitamin D 85 (75 to 175) - I am on 4000iu a day, so should I increase this?
Folate 45 (8.83 to 60.8) - I’ll keep on with the supplement, 5mg every other day.
Ferritin 182 (13 to 150). 200mg daily - Guess I should stop the supplement for a bit?
B12 - I have injections every 12 weeks so didn’t test this.
Thyroid:
T3 4.6 (3.1 to 6.8)
FT4 22.1 (12 to 22)
TSH 0.1 (0.27 to 4.2)
T4 172 (59 to 154)
Thyroglobulin Antibodies 24.3 (0 to 115)
Thyroid Peroxidase Antibodies 17.8 (0 to 34)
In case it’s relevant, my resting heart rate used to sit around 55bpm but for the last 3 months it’s been hovering around 60bpm.
So… I currently take 150mcg levothyroxine every morning. I’m struggling with energy levels so don’t feel that this is my optimum dose. The more I read about taking T3 the more confused I get
I would be so grateful for some advice on how to start introducing T3… what sort of dose to start with and how much to reduce my levo by.
Thanks so much to the resident experts on here - so many of us would be lost without you!
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Jooju2004
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The usual - and I think the best - advice is to reduce your levo by 25 mcg - given your FT4 level (you can always increase it again if you feel it necessary). And start with a 1/4 tablet of T3. Increase by 1/4 tabelt after two weeks, if all goes well. Same again two weeks later. Then, as your FT3 isn't drastically low, I would think it best to hold for six weeks, retest and see how you feel.
I would start by reducing Levo by 25mcg. Wait a week then add 1/4 of a tablet of T3. You can take it with your Levo.
Wait two weeks.
If all OK add a second 1/4 of T3, maybe late afternoon, maybe evening or before bed (assuming Levo and first dose of T3 is taken in the morning).
You could then add a third 1/4 of T3 after another 2 weeks or you could take it more slowly. None of us know how much we will need, I got up to 31.25mcg T3 at one point but after years of tweaking I actually now just take 12.5mcg added to my Levo and my results are more stable on that and suit me better.
It takes a long time and a lot of patience when adding T3, you may or may not feel something straight away, I felt nothing until a few months later it dawned on me that I didn't feel as bad as I used to on Levo alone and it took years to find the right dose.
Wherever you decide to stop and wait, give it 6-8 weeks for levels to settle and then retest to check levels. TSH may go even lower, FT4 should have lowered due to taking less Levo plus taking T3 will tend to lower FT4, FT3 should increase.
You then have to tweak, if necessary, slowly and gradually, no more than 1/4 of a tablet at a time and give each dose change a good 8 weeks or so for levels to settle.
Vitamin D 85 (75 to 175) - I am on 4000iu a day, so should I increase this?
If you make Vit D naturally from the sun during the summer months you may not need to do anything, just retest at the end of October to check your level. If you decide to increase dose I wouldn't go higher than 5,000iu daily. 100-150nmol/L is the recommended level according to the Vit D Society and Grassroots Health.
Folate 45 (8.83 to 60.8) - I’ll keep on with the supplement, 5mg every other day.
Is that folic acid or methylfolate you're taking? If so I don't think you need it, you're now at a good level. I would just take a good quality B Complex such as Thorne Basic B (contains 400mcg methylfolate which is the norm for a good B Complex and should be enough to maintain level), which you should be taking anyway as you take B12 injections, when taking B12 in any form we need a B Complex to balance all the B vitamins.
Ferritin 182 (13 to 150). 200mg daily - Guess I should stop the supplement for a bit?
I would if that was my result. Then I'd retest in 3 months to check my level. You can eat iron rich foods to maintain a good level (liver, liver pate, black pudding, etc).
Please do an iron panel which measures serum iron, transferrin saturation percentage, total iron binding capacity and ferritin - if serum iron and saturation are high you shouldn't take iron tablets. Medichecks does this as a home fingerprick test - Home Iron Test - £39
Thank you! Sorry yes, I take 5mg folic acid (on prescription from GP… someone on here mentioned I shouldn’t need that much so I’ve been taking it every other day for a few months). I had no idea I should’ve been taking a B complex for the past few years🤦🏼♀️ - I’ll get some Thorne Basic B ordered instead. I’ll also do a full iron panel when I do my next thyroid tests.
Vitamin D - I’m allergic to the sun (polymophic light eruption) so sadly I don’t ever get enough vitamin D from being outside - despite having horses and spending most of my time outside lol. I’ll give 5000iu a go.
Thanks so much for the advice and taking the time to help
I can't sit out in the sun so I don't make it naturally either, my maintenance dose to keep my level around 140-150nmol/L is 5,000iu x 6 days a week.
Do you also take D3's important cofactors - magnesium and Vit K2-MK7?
Magnesium helps the body convert D3 into it's usable form.
D3 aids absorption of calcium from food and Vit K2-MK7 directs calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as calcification of arteries and kidney stones, etc. So both are important when taking D3.
For Vit K2-MK7 90-100mcg is enough for up to 10,000iu D3. I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid. They are both a German brand and not always available. I tend to find them on Amazon or Ebay. If the 100mcg dose isn't in stock I buy the 200mcg dose and take alternate days.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Hello - sorry I just realised I didn’t reply to this - thanks for the tips, I’ve taken them all on board (although still to scared fo try the magnesium because I’ve seen what happens to my horse if he gets too much of it :))
Quick question - I’ve nearly done my first 2 weeks taking quarter of a T3. You mentioned increasing this by another quarter but I’m being dumb and can’t work out if I’m supposed to reduce my levo by another 25mcg first 😬 - please could you advise? Thanks so much again!
You mentioned increasing this by another quarter but I’m being dumb and can’t work out if I’m supposed to reduce my levo by another 25mcg first
No, keep Levo at your current dose. You have already reduced by 25mcg which will reduce your FT4. Taking T3 will reduce your FT4 as well, so leave Levo as it is now, the extra quarter of T3 will probably reduce FT4 a little more so you're going to need to retest after adding this second quarter of T3. Advised to wait 6-8 weeks after dose change before retesting to allow levels to settle, personally I find I need a good 8 weeks.
Finding the right level of both hormones takes time, patience and a fair bit of tweaking doses.
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