Add t3 to my treatment

[genomaccan]

good morning everyone,

I am new to the group but I suffer from haschimoto since 2013. My doctors have always given me only 75mg levothyroxine, and in all these years the values ​​have been in range, but unfortunately my symptoms have never gone away. In the last blood tests the values ​​are no longer in range, and my symptoms have also worsened:

TSH. 5.55 (0.465 - 4.6)

FT4. 7.6 (6.5 - 18.98)

FT3. 2.8 (2.77 - 5.27)

vit d 72 (30 - 100)

vit b12. 800 (200 - 900)

ferritin 145 (125 - 180)

when in the past I tried to increase the dose of levothyroxine I have bad symptoms from hyper I think: profuse sweating, tachycardia, nervousness.

What do you think about maintaining the levothyroxine dose, and adding t3 to my treatment?

My t3 / t4 ratio if I'm not mistaken is that of a poor converter

thank you all

[Jaydee1507 Administrator]

If you struggle adding levo then you'll be worse with T3. At the moent you just need an increase and possible more.

You don't have a folate blood result which would help but your other vitamins look OK.

[genomaccan in reply to Jaydee1507]

so i have no chance to improve? can't add t4, can't add t3, must i stay under range and hypo symptoms forever?

[JAmanda in reply to genomaccan]

I’d try again adding a small increase if t4 and keep building it up over time. Sometimes what you think are symptoms that the body doesn’t like the Levo is actually the body saying ‘yes at last what i need’. Just a theory! But you are terribly under medicated so need to do something. Go gently

[Jaydee1507 Administrator in reply to genomaccan]

What is the reason you can't add T4? It might be that you need to try a different brand of Levo with different fillers. What brand do you take?

You're really very hypo at the moment so no wonder you are suffering symptoms. You probably need a few dose increases and getting vitamins optimal to feel well. Takes time.

[genomaccan in reply to Jaydee1507]

when I increase the dosage of t4 I begin to have tachycardia, nervousness, sweat.

I want to try to switch to liquid levo (I have taken pills so far), leave 75mcg in the morning and add a small dose in the afternoon, could it be useful?

[Jaydee1507 Administrator in reply to genomaccan]

I would do what SlowDragon suggests and each week add a tiny bit more for a few weeks.

What brand are you taking at the moment?

[genomaccan in reply to Jaydee1507]

Now i want to take the liquid form, here in italy the brand name is Levotirsol. I always have been taking tablets called Eutirox (full of many components)

[ICE187 in reply to genomaccan]

My doctor started me on 75mcg of levo. I had bad palpitations and high heart rate. I started splitting my dose in half. No more palpitations. 6 weeks later, I took the full 75mcg dose again. I had mild palpitations for a week and then those stopped. 6 weeks later, I was put on 100mcg of levo. My palpitations got worse. After a week, they went away. It seems like being under medicated triggers it.

[shaws Administrator in reply to genomaccan]

When I was prescribed levothyroxne initially, when first diagnosed, I had severe palpitations day and night.

All of the awful symptoms resolved when I was prescribed T3 and I still am prescribed T3 since then. I am well, and have no clinical symptoms on T3 alone.

[genomaccan in reply to shaws]

Have you ever been on combo treatment t4 + t3? If so what was your experience?

[SeasideSusie Remembering]

Genomaccan

My t3 / t4 ratio if I'm not mistaken is that of a poor converter

That is not possible to tell at the moment. To know how well you convert you need to have TSH 1 or below to give the highest possible FT4 level then you look at the FT3 level. The only way to do this is to take Levo to bring your TSH down and increase your FT4 level.

You need to increase your dose of Levo, if necessary try a different brand and increase by small amounts, even splitting your dose of Levo throughout the day.

You definitely don't need to consider T3 at this stage.

[genomaccan in reply to SeasideSusie]

ok thanks, i will try to switch to liquid levothyroxine, thanks for the advice to split

Coda do you think you keep 75mcg in the morning and add 25mcg in the afternoon?

[SlowDragon Administrator]

Having been left on too low a dose a long time it can be VERY difficult to increase dose

Try increasing very slowly

75mcg x 6 days per week and 100mcg one day

Stay on this 4-6 weeks

Then increase to 100mcg on 2 days per week …..waiting 4-6 weeks again before increasing

Etc etc

As you have Hashimoto’s have you had coeliac blood test done?

I think everyone in Italy is tested for coeliac?

Assuming test is negative…..try gluten free diet anyway for at least 4-6 months

[genomaccan in reply to SlowDragon]

thank you,

I have not tested for antibodies this time but they have been very high for years, they have never gone down. I forgot to mention that, among other things, my thyroid has shrunk over the years and has inhomogeneous tissue.

I have never been tested for celiac disease, but for about six months I have adopted a gluten free lchf diet. A lot of things have improved, including the hyperinsulinemia I had, but the thyroid gland seems to have worsened in recent months

Could my new diet have worsened my thyroid or is it a mere coincidence in your opinion?

[SlowDragon Administrator in reply to genomaccan]

when were the results above done

Before changing diet or 2-3 months after going gluten free and low carb?

[genomaccan in reply to SlowDragon]

these blood tests are about 6 months after changing diet. Before that I was vegan and lived on a lot of carbohydrates. I switched to a gluten free low carb diet and my hyperinsulinemia improved greatly, but sometimes I doubt that this may have affected the thyroid.

I often read that diets low in carbohydrates lead to a temporary and physiological decrease in thyroid hormones, but at the same time I read about many people on low carb who do not have any problems with their thyroid.

I don't know what to think sincerely

[SlowDragon Administrator in reply to genomaccan]

You need full iron panel test for anaemia

High ferritin can be misleading with Hashimoto’s

Inflammation of Hashimoto’s can cause high ferritin, but iron levels can be low

Important to test folate and B12 and vitamin D too

[Snoopydog11]

Just to add I am one of those people who cannot tolerate more than 25 msg levo although I need more thyroid support. Therefore I take 1 1/2 grains Natural Dessicated Thyroid in addition to the 25 mcg levo and this is working well for me. I split the dose of NDT as follows - the 25 mcg on waking together with 1 grain and an additional 1/2 grain NDT with my lunch.

I cannot take it all in one dose, its too much for my adrenals as I have adrenal insufficiency and also have to have 6 mg Prednisolone daily for this.

I have had my genetics done through 23andme and its interesting that I have a genetic polymorphism (SNP) that stops the enzyme working properly that converts T4-T3. I find this very interesting and a probably reason for needing some T3. It makes a huge difference to how I feel and what I can do physically/mentally.

Originally NDT was prescribed by a private Endo but for many years I have bought it myself and my GP does know about this but I cannot say he is happy about it either. Earlier this year when I had a spike in my bp he was trying to tell me it was due to the NDT but I had been taking a slightly higher dose for 20 years so it couldn't be that but I did lower the dose to just 1 grain which didn't make any difference to my bp.

The only thing that changed for me last year was 3 Covid injections which might just be a co-incidence but who knows.

Thankfully my bp is now back to normal but it has taken 8 months for this to happen and I did need a bp medication.

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Have you tested your adrenal function? I have read a lot about this being the reason why people can't tolerate thyroid medication.