T3 arrived - how should I start?

[Decant]

Hi again,

I posted my results the last week, but my Liothyronine has finally arrived (unofficial). I bought this in response to blood results taken in May 23rd (I was on mono 112.5mcg T4/day) : -

* TSH: 6.33 mU/l (0.27 - 4.2) 154.20% - way overrange!

* FT4: 18.3 pmol/l (12 - 22) 63.00% - could be a bit higher?

* FT3: 3.8 pmol/l (3.1 - 6.8) 18.92% - low in range

I'm a 55 y.o. male with symptoms of low energy, low mood, some brain fog, etc. I'm Hypo after having RAII in 2006. Antibodies and everything else (apart from insufficient D3 (44 nmol/L) and slightly low neutrophils) are OK.

After these results my GP increased my T4 from 112.5 to 150mcg/day (I twisted his arm to go so high in one go). I am now taking a 8,000IU of vitD + K2, and 100mcg Mag also.

Elsewhere people suggest that I'm a poor converter T4 => T3, hence I bought the T3. Can anyone recommend please: -

* Should I start on the T3 now, or wait until my next blood tests on 150mcg (25/July = 5 weeks)? I'm not a patient guy and would like to improve my symptoms ASAP!

* What T3 dose should I start at? I bought both 5mcg and 25mcg (SigmaPharm)?

* By what amount should I reduce my T4 to compensate?

* Is there an online T4/T3 calculator I could use?

I sent off bloods for low-T yesterday, which also includes TSH and fT4, so maybe I should wait until I get those results in next few days before starting T3? Perhaps it's too early to use the TSH and fT4 from those results.

Many many many thanks x

PS. should I put all the history in my profile to avoid repeating it every time?

[SlowDragon Administrator]

Really you want to wait, at least until you get TSH and Ft4 results back and really want to wait 6-8 weeks after increasing levothyroxine to test TSH, Ft4 and Ft3

How long have you been on 150mcg levothyroxine

TSH is slow to change.

Was yesterday’s test done, early morning and last dose levothyroxine 24 hours before test

[Decant in reply to SlowDragon]

Hi SlowDragon,

Thanks for your reply! Be patient? Boo! But I do understand your point and was why I asked.

I started 150 mcg T4 last Wednesday.

Yesterday's testosterone test was done fasting at 9am but only 10 hours after my last T4 dose.

If TSH is so slow to react (I hear a 5 - 7 days), why is the recommendation to leave 24 hours?

Also, should I take the T4 morning or evening? I used to do morning but moved to evening when my wife received advice as such. Perhaps it clashes with food?

Thank you x

[SlowDragon Administrator in reply to Decant]

TSH takes more like 4-6 weeks to change

TSH has diurnal rhythm, so testing in morning for highest results

Ft4 levels vary depending on how long before test last dose is

Ideally we measure at lowest point….24 hours after last dose levothyroxine

Certainly more convenient taking levothyroxine at night for many people. And often better absorption

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[SlowDragon Administrator in reply to Decant]

You don’t really want to start T3 until TSH is down around 1 and vitamin D is improved

Retest vitamin D after 2-3 months

[Decant in reply to SlowDragon]

Thank you, and thank you again for all you do for everyone here! I shall wait, but in fevered anticipation 😀

[Yeswithasmile in reply to Decant]

Hi Decant

Just wanted to say…

Patience really is a virtue here. I didn’t have any and trialled t3 18 months ago. Rushed it. Didn’t feel better and ended up starting again on levo only about 5 months ago. Just about to add some t3 again now.

SD knows her stuff so I can only say please don’t make the same mistakes as I did. It is a slow old process unfortunately and it really cannot be rushed.

The thing to remember is that symptoms of under medication are very similar to over medication and so cramming hormones to get high in the range results isn’t necessarily the way forward. I get all the same symptoms back when I’m higher in the range for ft3/4. This is all about finding the right balance for you.

The best of luck 😊

[Decant in reply to Yeswithasmile]

It's a pain isn't it - we all want to be better yesterday!

[Yeswithasmile in reply to Decant]

I know. It really is but honestly, from a fellow impatience sufferer, taking the above advice is going to be quicker in the long run.

I thought t3 would be the miracle I needed. It wasn’t. I needed my t4 higher first and that’s why I back tracked. 🤞🏻 you have the patience to take it slow.