2 months on Liothyronine

[Roulette26]

I realise it’s early days but I’m a little confused by my blood results from the hospital today.

I’m on 100mcg levo, down from 100/125, 20mcg Liothyronine daily.

Last dose 8pm yesterday, blood tests 8. 10 this morning.

TSH 3.5 0.27-4.2. (Was 3.53)

T3 4.4. 3.1-6.8. (Was. 4.69)

T4. 20 12-22. (Was 20)

I have more energy, not as breathless when walking, clearer head, joint pain lessened. It’s not consistent but is an improvement.

I thought when taking lio my conversion would improve instead it’s worse, and my TSH has hardly moved. I’m expecting to have a difficult conversation with the Endo, can anyone help me to understand what’s happening and what my next move should be please.

[greygoose]

Who told you that taking T3 improved conversion? I don't think it does - not by much, anyway.

However, if you took your levo at 8 last night and had the blood draw at 8 this morning, you have a false high FT4. You should leave an 24 hour gap for levo, and 8 - 12 for T3.

That wouldn't affect your TSH, of course, but that's high because you're under-medicated. FT3 is much too low. And, on 20 mcg T3, one would expect it to be higher. Do you always take your T3 on an empty stomach, etc., just like levo?

[Roulette26 in reply to greygoose]

Thanks for your quick response. I did have a gap of 24 hours between levo. My first dose of levo and lio is on an empty stomach, the later lio I try to take 2 hours away from food and none after. I’m just confused, my conversion is worse instead of better.

When you say I’m under medicated are you referring to lio?

[greygoose in reply to Roulette26]

Yes, I'm referring to lio.

It could be that your conversion is worse because your FT4 is too high. When the level gets to a certain point, it starts converting to more rT3 than T3, so the FT3 drops slightly.

But, the drop really is only slight, Pretty insignificant, really. And, besides, when you are taking T3, you cannot tell how well you convert. You can only tell that when on T4 only.

I really wouldn't worry about it if I were you. But, I do think you need and increase in your dose of lio.

[Batty1 in reply to greygoose]

Does this 24 hour gap apply to thyroid-less people?

[Roulette26 in reply to Batty1]

I’m no expert, I had RAI so I can only assume that it does. There are far more knowledgable people than me on this forum!

[greygoose in reply to Batty1]

Absolutely, yes. Why wouldn't it?

[Batty1 in reply to greygoose]

Curious

[greygoose in reply to Batty1]

The 24 hour gap rule is to do with the levo you take, not the hormone your thyroid might or might not be making. In fact, if people with thyroids still in place, take enough thyroid hormone replacement to lower their TSH, their thyroids won't be making any hormone, anyway.

Thing is, if you take your levo too close to the blood draw, all you will be testing is the dose you just took. If you leave a gap of 24 hours, that will tell you your normally circulating level of T4, so you will know if the dose is too much, or not enough.

For T3, it is 8 - 12 hours, because the half-life of T3 is much shorter.

[jimh111]

When you say your conversion might improve I think you mean your fT3 might go up. It’s a bit strange your fT3 didn’t rise but I wouldn’t worry about it. I’d be inclined to give it a bit more time and be sure to tell your endocrinologist about your improvement.

The timing of your levothyroxine has minimal effect on the blood test, we store around 10 days worth of T4 so having the blood taken 10 or 20 hours after the latest dose will only make a difference of a few percent. About 12 hours after the dose is ideal but the timing really doesn’t matter.

[Roulette26 in reply to jimh111]

Thanks, I’ve still got another 2 months of the trial to go.

[SlowDragon Administrator]

Just tell endocrinologist that you feel much improvement with addition of T3

You could wait and leave doses unchanged and retest in 6-8 weeks

You likely need to add 3rd 5mcg dose …..3 x 5mcg per day at roughly equal 8 hour intervals

Retest in 6-8 weeks

What are your most recent vitamin results

Vitamin D, folate, ferritin and B12

Which brand of levothyroxine and which brand T3

Do you Always get same brand at each prescription

Are you gluten free?

[Roulette26 in reply to SlowDragon]

Thanks slow dragon. I’ll get back to you about vit and mineral levels in a couple of days when I get my Medicheck results.

[DippyDame]

When we refer to "conversion" we mean the conversion of the storage hormone T4 to the active hormone T3.

I've never heard of T3 improving conversion, I suspect that you are misunderstanding the function of T3.

T3 will raise FT3.....not improve conversion.

T3 is essential to almost every cell in the body and for good health must reach the nuclei of those cells in a constant and adequate supply.

When T3 is added both TSH and FT4 falls....that's how the body works

Your symptoms have improved because FT3 has risen so more T3 is available to the cells.

For further improvement you may need a little more T3....but you will need to test again in 6/8 weeks to allow the new dose to settle in the body first

What you are experiencing is to be expected your conversation with your endo need not be difficult ....don't dwell on the technicalities just tell him you feel better with the addition of T3 so that he continues to prescribe it....

If you raise any imagined negative issues about T3 you could lose that prescription!