T3 introduction help

[rouser]

30 years ago i had a total thyroidectomy due to uncontrollable graves disease. For 30 years 125 t4 replacement worked well. However, about then found i had hemochromotosis and 'required' about 50 phlebotomies. It seemed to compromise my converting of t4 to t3, ultimately resulting in no conversion.. Discovered an endocrinologist who has begun introducing me to t3 though until now she has said she hasn't been an advocate. Anyway, she altered my prescription from 100 mcg of t4 only, though for 30 years tolerated 125 mcg successfully. Of course on 100 mcg was really feeling dreadful. For the past 6 weeks I'm taking 50 mcg T4 along with 15 mcg t3 with following test results:

T3 = 2.4 range 2.00 to 4.4

T4= 0.81 range 0.82 1.77

Tsh. =0.580 range 0.450 to 4.50 please advise me on solid choices to encourage Dr. to press on by increasing t3 more. Thank you.

[jrbarnes]

You need to move your Levo back to 125mcg and then restart with 5-10 mcg of T3. You might feel terrible at first or you might feel better. Your Ft4 levels should be 1.4 or higher and FT3 towards top of range. There's no need to reduce your Levo when starting T3. I had a partial thyroidectomy and currently take 112mcg of Levo and 10mcg of T3 and weigh 130 lbs. It's still not enough but I'm slowly increasing based upon how I feel. I just reintroduced T3. I go to a functional med practice and manage adjusting my own T4 and T3 meds. My health care provider has hypo and takes 5 mcg of T3 with her Levo so she is a strong advocate. Refuse a dose decrease. Your endo doesn't really know what they're doing and spends more time managing people's diabetes rather than thyroid disease. I purchase my own labs through Ultalabs online and go to the testing lab when I feel like it's time. They email you your results. I've been trying these combos for a few years and like most of the advice here you will need a FT4 level and FT3 that is higher in range, especially those who have had a full or partial thyroidectomy. Check out Dr Westin Childs' blog on thyroid. Here's a link(see below). You could even print this out for your endo but honestly you may have to look for another doctor like functional medicine or an obgyn who focuses on women's hormones and specifically mentions T4/T3 conversion or T3. Levothyroxine is dosed based upon 1.6mcg per kg of body weight and is only 80% absorbed, which means you're not actually getting all of it. Doctors don't even consider this when prescribing.

restartmed.com/normal-thyro...

[SlowDragon Administrator]

was test done early morning, last dose levothyroxine 24 hours before test

Do you split your T3 as 3 x 5mcg

Day before test split T3 into 3 smaller doses spread through the day and last 5mcg dose approx 8-12 hours before test

Suggest you increase levothyroxine dose SLOWLY Upwards

Ft4 is now too low

Increase levothyroxine by 25mcg. Retest in 6-8 weeks

Meanwhile test vitamin D, folate, B12 and ferritin

What vitamin supplements are you currently taking

[Aurealis]

I don’t agree with other responses. I think you need more t3, as your t3 is low in the range, and t4 is also below

If you don’t convert t4 to t3,there’s little point taking more t4.

If you are converting t4 to t3, that’s why your t4 is on the low side.

Whichever is true, it’s an increase in t3 that is needed

The advantage of increasing t3 rather than t4 is that you will know very quickly if it helps and if you feel better. Also, that an increase in t3 doesn’t put more pressure on your ability to convert t4 to t3. Whereas it will take months to stabilise if you change t4 intake. And it may fluctuate depending on the factors affecting conversion

I’d strongly suggest you avoid changing both t3 and t4 at the same time, it makes the world go upside down

A dose increase to 20mcg t3 would seem to be the next step. I hope you’re soon feeling better.

[Maggie0652]

my doctor reduced my levothyroxine too much, like that, when I started t3, and it made me really ill.

I got it increased again. I was on 125mcg levo before starting t3, and after careful titrating of both, I ended up on 100mcg levo and 30mcg lio.

I needed both my t4 and my t3 near the top of their respective ranges to feel well.

[Batty1]

your currently only taking 50mcg of T4 and 15mcg of T3 …. It looks like you need more T4.

[Jaydee1507 Administrator]

So here's the %'s which might drive home to your Endo that you need more of something - ideally T3. Doctors do like their numbers. Baring in mind you need both numbers above 50% you have a long way to go.

FT4: 0.81 pmol/l (Range 0.82 - 1.77) -1.05%

FT3: 2.4 pmol/l (Range 2 - 4.4) 16.67%

That's a very low dose you're on and obviously an increase is required, probably best to go for T3 initially to help you feel a bit better although you might need T4 at a later stage.

How do you take your Levo by the way?

[rouser in reply to Jaydee1507]

thank you everyone for the feedback. All my nutritional levels are healthy. I keep my ferritin level at around 100.

But today my endo agreed to increase t3 5 mcg and let t4 be

I want to explore this direction as im really exhausted by now years of t4 complicating things for me. I also agree it makes sense only to cha nge t3 so that i know what it's effect is. Thanks everyone...one small step forward.

[Jaydee1507 Administrator in reply to rouser]

I'm glad your Endo agreed to an increase but 5 mcgs is a tiny increase compared to what you might need. 10 would have been more appropriate but hopefully you've broken the suppressed TSH issue and can add more in time. Good luck.

[rouser]

thank you, so helpful

[rouser]

i forgot to reply to a couple of your questions...I take my t3 and t4 together around 4am so to avoid nearness to other medicines. Also the day before re ent lab i forgot to break up t3 into 3 doses so that it was 24 hours later t3 was tested. I was tested about 8:30 am. How inaccurate would that mistake have made my t3 score?

[SlowDragon Administrator in reply to rouser]

the day before re ent lab i forgot to break up t3 into 3 doses so that it was 24 hours later t3 was tested.

so test was false low Ft3

You should have retested correctly

[rouser in reply to SlowDragon]

no, tbat is the previous report.. This time i took t3 slit up and final dose 12 hours before 8:30am lab work.