Results and help with T3/T4 dosing, please!

[Lilacsocks]

Hello again all,

Some of you might remember me starting my T3/T4 trial a few months ago. I had been feeling well but things have been slowly getting worse and now my fatigue is really bad, brain fog, headaches and digestive issues. I feel under treated.

Here are my results and doses.

125mg levo

14th April 20222

TSH 0.03

T4 20.6 (12-22) 86%

T3 4.75 (3.1-6.8) 44.5%

I was feeling fairly okay, about eighty percent well but I have been waiting a long time to try T3 and I know I wasn't at 100% wellness.

100mg levo, 2x 5mg lio

25th May 2022

TSH 0.11

T4 15 (12-22) 30%

T3 5.16 (3.1-6.8) 55.7%

Intially I felt fine, even a slight improvement initially but as time went on the hypo symptoms crept back in. So I upped my levo to 125mg three days a week

111mg levo, 2x 5mg lio

25th August

TSH 0.02

T4 13.8 (12-22) 18%

T3 5.51 (3.1-6.8) 65%

No improvement, feeling worse and T4 has dropped even further.

What should I do now? I am feeling really grim and wishing I hadn't messed with thing when I had a quality of life I could cope with. I'm thinking levo needs to go back to 125 but should I give up on lio? I'm worried my t3 will go too high if I increase my dose. Any insights much appreciated.

LS

[jrbarnes]

I already left a comment on another member's post about the same issue but I also started to take T3 again and my FT4 is 50% in range so if this were my situation I would increase the Levo. Try adding in a couple more days on the 125mcg and see if you feel a little better. I'd wait 4-6 weeks after that increase before you make another. I'm also on 10mcg T3. I think it's going to be small increases on both ends until you find the right amount. Some people need low T4 and high T3, some need mid range T4 and high T3, and some need high T4 and and high T3. I'm not quite sure where I fall yet. Once upon a time when I was younger I had high T4 and high T3 on Levothyroxine alone but these days I seem to only tolerate mid range T4 and higher T3.

[Lilacsocks in reply to jrbarnes]

Thanks for replying. Maybe I'll try a smaller increase then. Would you expect my T3 level would increase too with an increase of levo?

[jrbarnes in reply to Lilacsocks]

I wouldn't anticipate it going over range by increasing Levo a few days but you never know how the body will respond.

[Lilacsocks in reply to jrbarnes]

Thanks, any thoughts on why T4 went lower when I increased levo?

[jrbarnes in reply to Lilacsocks]

I read somewhere that by taking T3 it can lower amounts of FT4 in the body but where I read that I can't remember.

[Lilacsocks in reply to jrbarnes]

I read that too, but I hadn't changed my lio...

[jrbarnes in reply to Lilacsocks]

I noticed when I first started taking the Lio that it seemed to make me feel a little more Hypo like it was making less of my T4 available. Perhaps the body recognizes the T3 and dumps some T4. I don't know the reason as to why.

[Lilacsocks in reply to jrbarnes]

Interesting, how long did it take to settle?

[radd]

Lilacsocks,

I presume you are referring to the’ frees’ and not ‘totals’?

If test's were taken like-for-like it’s a mystery why your FT4 has dropped after you increased meds, but the Levo increase was very small and TSH has rightfully risen inline.

I agree your FT4 could be too low. If you are absolutely sure iron and nutrients are good I would increase Levo back to 125mcg and reduce T3 to just 5mcg. This will have a double impact of increasing FT4 levels by the extra amount you medicate but also because you are lowering T3 meds. (T3 naturally lowers T4 levels, just as it lowers TSH more severely than T4).

When we medicate just a tiny bit of T3, the converting enzymes up-regulate and makes the T4 work better by improving convertion of T3. Just as some members gain well-being on pure T3, others including myself need both hormones and those necessary conversion processes to take place.

If you do not have sufficient iron, this will be directly impacting how thyroid hormones are utilised and you may not be able to feel your sweet spot until iron is raised to a more adequate level. This also goes for elevated bodily inflammation that can alter the deiodinase behaviours in a negative fashion encouraging more RT3. Thyroid antibodies can create unwanted inflammation so if elevated supplementing selenium can be useful, also fish oils and ensuring Vit D is optimal.

Other things to help are using Betaine HCL + pepsin with protein rich meals if you have digestive issues as this will help absorption and encourage better secretion of further gastric acid. Also ensuring you have adequate cortisol levels as the HPT & HPA axis are interconnected & dependant upon one another.

You said your anxiety had reduced. I'm on NDT + Levo and still split dose everything as it just appears kinder to sensitive adrenals. You will need to retest thyroid hormone levels in six weeks to see where levels lie and assess symptoms. It can be useful recording symptoms to gauge improvement. Also taking temps & pulse can indicate if levels are heading in the right direction.

[Lilacsocks]

Helpful, thank you. Yes I mean the 'frees' and they were taken like for like..

I don't think my iron is great actually with ferritin level at around 40ug/L but it is much improved from 16 and I am working on it. I had been vegan for 10+ years and I have had two pregnancies in the last 4 years. I have read in this forum to aim for about 100, so I'll keep going. I take an iron supplement for the week after my period each month and have introduced red meat to my diet.

B12, D and folate are all good. When I last tested my antibodies were low.

My lio comes in as a 5mg capsule so I wouldn't be able to spilt it, is there a different brand I could request that does tablet form?

Thanks again.

[radd in reply to Lilacsocks]

Lilacsocks,

By tradition a daily dose of Levo is taken all in one go but I split dose Levo after several members have claimed this has helped them tolerate it better.

Probably not a helpful comment regarding your T3 as it's such a small amount that you appear to tolerate fine. So just take 5mcg T3 as a whole dose, early morning is best as matches closest to body's natural secretion. If you chose to raise levels at a later date you could take the second dose in the pm.

[helvella Administrator in reply to Lilacsocks]

Yes - there are tablets. But:

They are not (officially) splittable;

They are more expensive than the capsules (therefore less likely to get prescribed);

They contain more excipients.

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.

From Dropbox:

dropbox.com/s/wfhrlmb5983co...

From Google Drive:

drive.google.com/file/d/11z...

[Lilacsocks in reply to helvella]

Oh, thank you. Would you also suggest sticking to once a day 5mg in that case?

[Lilacsocks in reply to helvella]

Wow this is an amazing document! So thorough. What is the image on the cover page? My GP is pretty quite helpful I'm wondering if it worth making the case to have a spilt dose. What do you think?

[helvella Administrator in reply to Lilacsocks]

An image of a Helvella crispa fungus!

[Lilacsocks in reply to helvella]

I spoke to the GP today, she was supportive of going back to 125mg Levo and taking lio down to 5mg a day in a spilt dose. - in theory! But exactly you predicted shes not able to prescribe this on the NHS because its too expensive and was not supportive of taking lio all in one dose.