This narrative paper at least understands the basic dilemmas of previous attempts to rationalise therapy without any influence from T3.
Current Medical Research and Opinion Volume 37, 2021 - Issue 12
Triiodothyronine alongside levothyroxine in the management of hypothyroidism?
Ulrike Gottwald-Hostalek & George J. KahalyPages 2099-2106 |, Published online: 12 Oct 2021
Great, NDT fits the bill perfectly: ‘Future clinical trials using LT4 + T3 tablets better suited for combination therapy will resolve the outstanding research questions relating to the place of LT4 + T3 combination therapy in the management of hypothyroidism’
They still don’t get it tho:
Nevertheless, better-standardized FT3 assays, with measurements made before ingestion of the day’s thyroid medication may provide a useful adjunct to thyroid care for patients without concomitant, non-thyroidal disease (such as many of the large population of younger patients with hypothyroidism)
I despair…..only useful for the young hypothyroid 😡😡😡 it just shows they have no real understanding at all. How can they monitor combination therapy WITHOUT free t3? On NDT My TSH is very low my ft4 is very low there’s only ft3 left to get any information from (top third of range or slightly above). I feel well.
How can they be so blind? Combination therapy won’t work if they don’t understand how to interpret blood results for optimisation.
Still things are moving on….glacially
I’ve superficially skimmed this paper. Of concern is the statement “Achieving a physiological FT4:FT3 ratio should be a key objective”. Whilst this should be a general objective (higher fT4 carries cardiac and cancer risks) the evidence from this and other forums is that restoring normal fT3, fT4 levels does not work for most patients who do badly on levothyroxine therapy. The key objective should be to find the fT3, fT4 levels that work and then attempt to find out why. The evidence is perfectly clear, achieving normal serum T3 and T4 levels does not work for many patients with severe signs and symptoms whilst on levothyroxine. A methodical, scientific approach is needed, not a presumption that normal serum hormone levels will sort everything.
Exactly. I have to leave off T3 for 12-15 hours to show it in range, so that my Endo doesn't have a heart attack because of an over range T3. He is already having heart attacks because my TSH is suppressed and that, he assumes, means I'm overmedicated.
He's now desperately searching for another cause for my symptoms and even says I was borderline hypothyroid on diagnosis! My TSH was normal at 2.9, but my T4 was below the range!! Borderline?!? 😱
He recently arranged a range of hormone tests which show low cortisol (212). I think this means I am still under medicated, especially since I have severe Carpal tunnel in both hands that need operating on.
Thyroid treatment in this country is inadequate if you don't fit the easily treated category. There aren't enough adequately informed doctors to go around.
Exactly, my view is TSH regulates deiodinase and so insufficient TSH will lead to low fT4 but more importantly low fT3, especially T3 levels in tissues that rely on local T4 to T3 conversion. You can’t correct this with normal serum fT3 levels. Hence the importance of doing good science and observing what hormone levels are required to treat various forms of hypothyroidism.
Mm,
As you have stated both low cortisol & carpal tunnel are symptoms of inadequate thyroid hormone. I thought you were buying your own T3 so why are you reducing meds to placate an endo?
No, got an NHS prescription 2 years ago, so under the direction of the Endo.
Do you get sight of your T3 prescription? If so you can scan & upload it and buy your own T3 to supplement what you get on the NHS, to see if you can find a point where you feel well. I've heard of someone else whose carpel tunnel went away when she increased T3.
Thank you. I know I could do that, but if I went into hospital, or care (hopefully not for a while yet!) I would not be able to declare what I am taking and it wouldn't be dispensed to me. Or if I had a surprise blood test my results would give me away. I'm trying to educate my Endo, but it's not easy 😥
I was just thinking, in between endo appointments, you could trial extra T3 and see if your carpel tunnel went away.
I told my Endo that I was upping my dose by 5mcg and asked him to change my prescription. He hasn't done that yet, but I don't think my GP is looking at my prescription requests too closely at the moment, so I have some tablets in hand for now.
When I was given T4 only, I had severe palpitations especially overnight palpitations with pulse over 144 and cardiologist couldn't figure out why this was happening.
All calmed when T3 was added to T4 but all palpitations resolved completely when I took T3 alone.
It’s the number of similar reports I’ve seen on this forum that led me to consider T4 has a specific non#genomic effect on the heart. This is quite a surprise because like the endocrinologists I always assumed T3 would have higher cardiac risk because it bypasses deiodinase mechanisms that could have a protective role. However, you have to follow the evidence, even if it goes against your instincts and the evidence is that some T3 seems to resolve some cardiac problems.
We do wonder what is happening when our thyroid hormone replacements don't seem to be resolving our horrible symptoms.
I have also reduced T3 recently, and I still feel well and no heart palps.
Also Dr John Lowe prescribed T3 as well as NDTs. He'd never prescribe levo as he stated it was due to payments made to Endos that levo becamethe No.1 prescription.
Yes, Dr Lowe treated a cohort with quite severe hypothyroidism not in general caused by a failed gland. I suspect they had endocrine disruption but sadly he died just before I could discuss it with him.
I don’t subscribe to the levothyroxine conspiracy mainly because the same manufacturers also made liothyronine and NDT and I suspect they have much bigger profit margins.
exactly . find out what works , then find out why .
when you already have 'the answer' to something , then it's sometimes possible to work the 'why ' out backwards.
first find out what works by intelligent experimentation , or ask some thyroid patients who already feel well by self medicating , then make groups of people who 'x ,y or z' protocol worked best for .. then try to find out why it works for that group by looking for what those people have in common.
even if the 'why' is still elusive... once you've identified what things they have in common , you can look for those things in new patients, as a way to guide who might be likely to do best on 'x',y or z'.
Don’t be silly, I presume you mean Endos. That’s way too complicated for their simple minds, especially when a TSH test tells them all they need to know 😵💫
god no , i wouldn't expect endo's to be able to work like that ... i was thinking of people with thinking and listening skills .
I couldn't help but laugh at your response.
😜
I was also diagnosed (a while before diagnosing myself) and was told I had a 'web' in my throat' and if not removed I may choke.
Underwent an operation but no-one came to see me after op and I then went home none-the-wiser.
At my next appointment I was in the waiting room and he popped his head around the door but didn't seem to notice me - the only person in the waiting room. (later on I realised he wasn't looking for me but my daughter who had led my original consultation by asking so many questions).
After a while I just went home but at my next consultation he told me I didn't have a 'web'! Well doctor what was on x-ray? He couldn't respomd and he didn't return the money I paid. I should have insisted..
Some months later I was diagnosed as hypo.
I tried but cant take it in thanks though
Should I reduce dose slightly? T3/T4 combination therapy
Combined T4 / T3 therapy Tests
T4 Monotherapy Versus T4/T3 Combination Therapy
Studies on TSH for those on combined T3 T4 therapy 
