combined levo and liothyronine

[Rowing2]

hi, hope everyone is well, or as well as they can be.

Since December 21, I have, with the knowledge of my doctor, been trialing t3. I had felt I was getting absolutely nowhere with levothyroxine and I felt dreadful. I sourced it from abroad. I started by quartering the liothyronine. I decided to work on a total of 150 mg. I took into account that a 25mg t3 tablet equated to 100mg of levothyroxine. I changed the amount at each blood test until I got to a full 25mg of t3 and 50 of levo. On my last visit to the gp we discussed the new ruling for t3 ( I’ll include the article) , he hadn’t heard anything new so I forwarded it to him later. He said I’d still need to see an endocrinologist again and he’d need to refer me so I could get see if I could get them on the nhs , so I obviously agreed and the appointment is now booked for November. We also spoke about my arthritis in my hand ( he’s the first to say what I’ve said for ages, other said carpel tunnel an a minor op, but I knew it wasn’t ). I will ask the endocrinologist about this too. Although his knowledge isn’t brilliant regarding hashimotos , I like him as he asks me how I’m feeling. I told him I’m now taking one 25 mg t3 and 50mg levo and felt the best I’ve felt in years. I can’t actually believe this but my goitre has actually visibly reduced in size which in turn has reduced my migraines as I believed it was pressing on the nerves in my neck. He was amazed . Bellow is my result when I visited him

Free t3 5.9 pmol/L (3.5-6.5)

Free t4 8.0pmol/L (9-23)

Tsh <0.05 miu/L (0.35-5.5)

(My tsh has been <0.05 mui/L since starting t3) I told him I wasn’t worried by this as liothyronine can compromise the reading, but he asked me to increase levo by 25mg which I did. I can’t believe such a low dosage can make me feel so bad, but it has. These were my most recent result of a few days ago.

free t3 8.2 pmol/L (3.5-6.5)

Free t4 13 pmol/L (9-23)

Tsh <0.05mui/L(0.35-5.5)

any help or advice would be really appreciated. Thank you.

[SlowDragon Administrator]

A few questions first

Looking at previous posts you have Hashimoto’s

Have you had coeliac blood test done

Are you on absolutely strictly gluten free diet and/or dairy free diet

What vitamin supplements are you currently taking

When were vitamin D, folate, ferritin and B12 last tested

On any replacement thyroid hormones we must have OPTIMAL vitamin levels

Please add most recent vitamin results and ranges

Is the T3 Tiromel

Are you normally splitting T3 into 2 or 3 doses spread through the day?

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Your most recent test results suggest you probably need further increase in levothyroxine

Extremely common mistake to reduce levothyroxine too much when adding T3

Ft3 is too high

How long before test was last dose of T3?

And how much T3 was last dose

Majority of patients on levothyroxine plus T3 need BOTH Ft4 and Ft3 at least 50-60% through range

Was test done as recommended

Testing early morning, ideally before 9am, and last dose levothyroxine 24 hours before test

Day before test always split T3 into 3 doses …..Last 1/4 tablet approx 8-12 hours before test

[Rowing2 in reply to SlowDragon]

Hi there , hope your well.Sorry forgot to mention, yes I have hashimotos.

Yes I’ve had coeliac test done , I’m not

I am gf

I take b12, was taking magnesium, but not sure if it compromises meds?

Vitamin D

Selenium

T3 is tiromel

I don’t split, I tried and had no different effects I don’t feel ant different later in the day so just take one dose

I always take 50 mg accord and when 75mg the 25 was wockhardt

I reduced levo gradually and had bloods each time so 25mg less each 8 weeks

[Rowing2 in reply to SlowDragon]

All testing is done as above and recommended beforeMarch 22. folate 9 ng/ml (3.3-99,999)

B12. 286ng/L (190-910)

Ferritin 42ng/ml 16pmol/L (9-23)

[SlowDragon Administrator in reply to Rowing2]

No vitamin D result? Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Ferritin - range is normally 15 -150

Can you check your results

Folate and B12 are too low

What B12 are you currently taking

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

How other member saw how effective improving low B vitamins has been

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to Rowing2]

free t3 8.2 pmol/L (3.5-6.5)

Free t4 13 pmol/L (9-23)

Tsh <0.05mui/L(0.35-5.5)

Shows Ft3 is too high

And Ft4 probably too low

How much levothyroxine are you currently taking

Suggest you reduce T3 by 1/4 of a tablet

Ideally wait 6-8 weeks retest ….then probably increase levothyroxine a little higher

[Rowing2 in reply to SlowDragon]

Hi slow dragon. Thank you so much for you as always incredibly informative reply. I did have my vitamin D taken but I need it taking again at my next appointment, it was 91 nmol/L (50-99,999). I also can’t see any iron results. At the time of the test I was taking 75 mcg levo, but reduced it back to 50 as I felt dire. I take I tablet of t3. ( it’s quite tricky to make smaller as it crumbles with the pill cutter and is worse with a knife). In your expert opinion do you think I should be increasing levo to 100, not doing what I’ve done which is reduce it.

[Rowing2 in reply to SlowDragon]

I’ve just read something else on the forum. Should I not be taking my levo with my lio as that’s what I’m doing at night . Should I be leaving an hour in between.

[SlowDragon Administrator in reply to Rowing2]

It’s fine to take T3 and levothyroxine at the same time

Suggest you get a sharp craft scalpel to cut T3

Recommend splitting T3 as 3 doses per day…..1/4 tablet per dose

Ft3 is too high and Ft4 too low

In my opinion you need to reduce T3 by 1/4 tablet and increase levothyroxine by 25mcg

Retest in 6-8 weeks

Meanwhile working on improving terrible vitamin levels

Daily Vitamin B complex and separate B12

Significantly increasing iron rich foods in your diet

Get vitamin D tested

[Rowing2 in reply to SlowDragon]

Hi slow dragon. Just to clarify when b12 is up stop b12 and continue B complex. Last time I’m sure I was told to do the other way round, stop complex, continue b12 which is what I did, maybe that where I went wrong too.