Hi, I was diagnosed with Hashimoto's and hypothyroidism when I was 14 years old.
Despite having optimal TSH, Ft4, Ft3, vitamins during most of my life, I've realised I've lived for all these 30 years with symptoms that have become much worse in the last two years.
Like many here, I've had no luck with NHS and am seeking to start a trial with liothyronine at my own risk.
Can anyone please advise on the best brand and where can I get it without prescription once we're allowed to buy 90 day-prescription abroad? I am afraid of buying a fake one.
I have a close friend in the US and family and friends in Italy, in case prices there are good and they can get it over the counter to send me by post.
My other doubt is: should I start a combined therapy with levothyroxine and liothyronine or I can go straight on only liothyronine? I'm currently on 137 micrograms (Synthroid that I source as this was the brand I always used in Brazil and I've tried all the brands available in the UK and I just got worse.) In either scenarios, what would be the proportions and how to take them?
I'm aware that you have to message me privately for this kind of advice. Thank you so much in advance and sorry if my English writing is a bit confusing.
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My medicines document lists many of the liothyronine products around the world.
I don't quite understand what you mean by "once we're allowed to buy 90 day-prescription abroad"?
Liothyronine is not available over the counter in the USA. There have been varied stories about Italy - but they get Liotir - a liquid product.
I'll leave your post open so that you can reply - and others too - on issues other than identifying sources.
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. It is sectioned by UK - rest of the world, and by T4, T3, desiccated thyroid, etc.
Thank you so much for getting back to me. I meant that anybody can import up to 90 days of a prescription only medicine for their personal consumption into the UK, is that right?
I forgot to mention I also have friends in Germany and Holland in case it helps.
I've heard Thybon Henning is well tolerated and it has a good price. But before I get Liothyronine, I need to be sure on the right dose and if I should start with a combination therapy with levo.
It is often suggested that 90 days supply is reasonable but there is, so far as I am aware, no legal basis for this. Just a way of saying if you import a lot, the Border Force/Customs could block it.
But it is impossible to say what constitutes 90 days supply for someone just starting! You might need anything from 5 to 60 micrograms - or more.
In Germany and Holland, liothyronine is very much prescription-only. Thybon Henning is a good quality product which it appears most are happy with. But difficult or impossible to get without a prescription.
I'll leave dosing issues to those who have experience - I don't take liothyronine.
I just want to feel more physically and mentally stable. Open to hear your thoughts on liothyronine or NDT, in case you think it's better. Thank you again!
I have no personal experience of anything other than levothyroxine. Which is why I tend to duck out of questions like this. There are many who have tried all the options and are almost certainly better able to advise.
Welcome to the forum btw, I see this is your first post. Thing is, being hypo means that we can get low vitamin levels. Many people here have got well by raising their vitamin levels and making sure they have enough Levo. What were your most recent thyroid results with ranges? Have you had any vitamin levels tested lately?
Thank you Jaydee! I'm kind of new. I've made comments before and have been always reading the posts here in order to know my condition better. Really thankful for having this space to share and learn.
I had my last blood tests done just 5 months ago, including all the vitamins recommended here in the forum and everything is optimal. GP has ruled out any other health problems, including rheumatoid arthritis because of joint pain and pre-menopause because I'm 43 years old.
My symptoms range between hypo and hyper and have got much worse in the last couple of years. I read about thyroid storms in people with Hashimoto's but that doesn't explain everything. In 30 years suffering from hypothyroidism, I'm feeling the worse. My BMI went from 22 to 29 in two years. 137 mcg of Levothyroxine, has been keeping my TSH under1,0 and FT4 and FT3 are in good range.
If your FT3 is good in the range then I'm not sure how taking T3 will help? people who need T3 generally have low in range FT3. Maybe you should put your latest results of thyroid and vitamins here so people can see if they can spot an issue somewhere?
Not necessarily. The more I read about deiodinase polymorphism, I relate to a possible cause of my persistent symptoms, despite being biochemically euthyroid.
Besides that, the NHS states the following under their guidance on prescribing Liothyronine:
'In rare situations where patients experience continuing symptoms whilst on levothyroxine (that have a material impact upon normal day to day function), and other potential causes have been investigated and eliminated, a 3 month trial with additional liothyronine may be appropriate.'
I'll try to post my latest results. Thank you again!
Whatever you do, don't swap straight from Levothyroxine to T3 only! The shock would be immense.
If your FT3 really is at a good level then T3 won't help you. It might mess you up. You are just at the right age to be seeing the start of perimenopause. That's really hard for a GP to diagnose as they don't have enough knowledge and they reply on a blood test, which at this stage of life is different from one day to the next.
Share your thyroid results here for comment. But if they really do look optimal, then you need to look at the impact menopause and perimenopause has on a woman. It's not all about hot flushes. This web site is the most up to date and thorough collection of menopause information out there.
Hi! I never saw your comment sorry. Thank you so much for your help!
Is it true that although my thyroid looks good on paper I could still have problems absorbing T3 in the tissues and cells? I wonder if I have a deiodinase polymorphism.
I agree that menopause and perimenopause could be the cause of some of symptoms, but most of them I've been carrying with me for my entire life. I had my last blood tests in Brazil so the some results are different to pmol/L and I couldn't convert them properly on those automatic calculators online. My results are:
TSH 0,36 Ui/mL (normal range 0,30 to 4,61 Ui/mL)
FT4 1,50 ng/dL (normal range 0,91 to 1,76 ng/dL)
FT3 2,73 pg/mL (normal range 2,42 to 4,36 pg/mL)
Ferrintin 71,6 ng/mL (normal range 13,0 to 150,0 ng/mL)
Vitamin B12 490,0 pg/mL (normal range 197 to 771 pg/mL)
Vitamin D 28,3 ng/mL (normal range above 20 ng/mL) I was taking Vit. D to increase that.
Folate 4,95 ng/mL (normal range below 5,38 ng/mL)
I had so much done, like saliva cortisol, antibodies etc
Your FT4 looks like it could stand another increase. But your FT3 is rather lower than it should be with your current FT4 results. So there could be a conversion problem. Your blood panel isn't showing anything drastic is out of range. I'd keep on with the vitamin D supplementation though.
So you might not be converting well. Was your test done early morning? That makes a difference to results.
You might find you benefit from a little T3 added to your medication (in which case you would not increase your FT4 further) but it's hard to say without a trial. It's telling that you say you have had these issues for years.
Thank you so much for taking time to read my results! I'm so glad I've found this forum. I'll make notes of all this and discuss in my next appointment with the NHS consultant endocrinologist.
Your nutrient levels aren't all particularly good. I would optimise these before doing anything about T3, we need optimal nutrient levels for good conversion.
Recommended optimal levels are:
Ferrintin 71,6 ng/mL (normal range 13,0 to 150,0 ng/mL)
This isn't dire but some experts say that the optimal level for thyroid function is 90-110.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Vitamin B12 490,0 pg/mL (normal range 197 to 771 pg/mL)
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Folate 4,95 ng/mL (normal range below 5,38 ng/mL)
I think you are mistaken about the normal range there. Usually we see ranges like
>3.89
3.89-19.45
8.83-60.8
So it do doesn't make sense that your range should say that normal is <5.38 as that would be low folate level when you consider what our guidelines say:
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
So your level of 4.89 is a little over the indeterminate zone, this would be classed as "in range" but it is low and would be better in double figures.
A good quality, bioavailable B Complex will help improve both folate and B12 levels. I have used Thorne Basic B for a long time and always been happy.
If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.
When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).
Vitamin D 28,3 ng/mL (normal range above 20 ng/mL) I was taking Vit. D to increase that.
The Vit D Society, Vit D Council and Grassroots Health all recommend a level of 40-60ng/ml with a recent blog post on Grassroots Health recommending at least 50ng/ml.
You might want to check out a recent post that I wrote about Vit D and supplementing where you can work out what the recommended dose would be to raise your current level to the recommended level:
There are important cofactors needed when taking D3.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Another important cofactor is Magnesium which helps the body convert D3 into it's usable form.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Once your nutrient levels are optimal then check your thyroid levels again, if FT3 remains low with a high FT4 then that's the time to consider adding T3.
Thank you SeasideSusie for taking the time and effort to help me by reading my results and giving me such a deep insight. It's quite moving to have people who care and understand what I'm going through. I suffer from hypothyroidism for 30 years now and I never had that, so a genuine thank you!! I'll read all these carefully over and over again and make notes to take with me to my next appointment. Regarding the folate results, I'll whether I made a mistake listing my results for you.
Hi SeasideSusie! I'm finding difficult to choose which magnesium to take. I'm very keen to get either the magnesium chloride (to boost my metabolism), magnesium malate (to boost my energy) or magnesium taurate (try controlling palpitations). I've been having insomnia and all I don't need is to make it worse. Which one should I get? Will all of them help me to relax if I take them before going to bed but give energy during the day? Also, you mentioned about starting only one vitamin at a time. Should I start with magnesium and D3, as they work well together? Thanks once more!
I'm afraid I can't choose for you. The amount of elemental magnesium per day is suggested to be 350-450mg. You can use more than one form or perhaps alternate.
I would start with D3 first, then a week or two later add in magnesium, then add in Vit K2-MK7.
Thank you so much I'll think about which one to get. Do you have any brands you could recommend for magnesium, D3, K2-MK7? Also, please can you be specific regarding which Thorne Basic B you take? When I search for it there are different types and I am confused.
I like Doctor's Best D3 softgels, nice clean supplement, no excipients, easy to swallow small softgel.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form
I can't help with magnesium other than I take Tom Oliver Magnesium Taurate, I buy direct and get their 3 bottle bundle. If you register for their emails you get sent discounts from time to time.
A big thank you again! I'll look into this and put all of them in my Christmas list haha I think I'll go for the magnesium taurate just like you and try to resolve my palpitations issues at night.
I have commented on your nutrient levels, I would also add that it would be worth checking levels after, say, 3 months to see how they are and whether anything you are supplementing needs adjusting. Once you have reached optimal levels they need to be maintained so retesting once or twice a year is recommended.
As your tests are a few months old they're not reliable now but at the time this was your thyroid status:
TSH 0,36 Ui/mL (normal range 0,30 to 4,61 Ui/mL)
FT4 1,50 ng/dL (normal range 0,91 to 1,76 ng/dL) = 69.41% through range
FT3 2,73 pg/mL (normal range 2,42 to 4,36 pg/mL) = 15.98% through range
The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. Your results clearly showed poor conversion at that time. Optimising nutrient levels might help a bit but they're certainly not so dire as to be wholly responsible for your poor conversion.
However, things change and we can really only make suggestions on current results. I would suggest that you need to get a new thyroid panel done before adding T3. This is so that we can see if you need to reduce Levo when adding T3 (would likely be necessary if FT4 is near top of range or over range) or whether your conversion has improved to a point where T3 isn't needed (probably not considering how poor it was with this test).
We have recommended private labs who have many different test bundles on offer.
Basic thyroid test (TSH,FT4, FT3) - cheapest is Monitor My Health.
Thyroid/vitamin bundles - Medichecks Advanced Thyroid Function Test or Blue Horizon Thyroid Premium Gold (both can be done by fingerprick or for an extra charge you could arrange phlebotomy).
Check out discount codes and details through links on ThyroidUK's main website here:
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