Bloods advice on dosage please

Hello everyone

I’ve had my recent Medichecks bloods back on 100mcg Levo and 15mcg T3. I have been splitting my T3 10mcg am and 5mcg late afternoon as a trial.

My current bloods taken according to protocol and venous blood draw:

TSH 0.47 (0.27-4.2)

T3 4.16 (3.1-6.8)

T4 15.8 (12-22)

My previous bloods 8th September same dosage but splitting T3 into 3 doses:

TSH 0.77

T3 4.9

T4 16.8

I feel my bloods are low and I feel undermedicated/ unwell. I do have better days but very inconsistent. A better day then back to feeling awful. I’m not sure what my best next steps would be. Previous help had suggested an increase in T3. I’m aware my TSH is getting lower.

Any thoughts would be very welcome as I’m due to see my private Endo in a few weeks.

Thank you in advance for any suggestions x

[SeasideSusie Remembering]

Butterfly1942

Did you feel better when taking T3 in 3 doses?

I feel undermedicated/ unwell.

Your FT3 supports this as it's currently only 28.65% through range (previous test shows 48.65% through range)

Previous help had suggested an increase in T3. I’m aware my TSH is getting lower.

I would agree with that, even at 48.65% an increase in T3 dose would seem the right thing to do. Most people on combination thyroid hormone replacement are best when FT3 is in the upper part of it's range. Taking T3 is going to lower TSH and may even suppress it, it's just what it does, but as long as FT3 stays within range there should be no problem.

[Hidden in reply to SeasideSusie]

Hi Seaside Susie

Thank you so much for replying. I think I did feel a bit better on the split so will do that from tomorrow. If I was to go up to 20mcg T3 would the best way to be 10 am, 5 afternoon and 5 at bed? X

[SeasideSusie Remembering in reply to Hidden]

Butterfly1942

If I was to go up to 20mcg T3 would the best way to be 10 am, 5 afternoon and 5 at bed?

Sounds a good place to start. See how you get on, you can always change later if you think it's worth experimenting.

[Hidden in reply to SeasideSusie]

Thanks Seaside! I think my anxiety has been comparing my dosage to when I felt ok early 2021- around the 100/125mcg Levo only. But my thyroid had been running wild with thyroiditis since then and is likely more damaged. I was worrying as I’d read 5mcg Lio is like 15mcg Levo so my current dose would put me at the 145mcg mark. When I’d gone on 150mcg I’d gone either overmedicated or very likely chronic thyroiditis adding to levels. I’d assumed it was Levo but I’m now wondering if that was a ‘flare’ and I may well need I higher dose given my current bloods.

Thanks so much for being there. I’ve lost confidence in my Endo and realise I may need to take matters into my own hands at this point. I know he’d not be happy with any increase and will tell me these bloods are good.

X

[SlowDragon Administrator]

FT4: 15.8 pmol/l (Range 12 - 22)

Ft4 only 38.00% through range

FT3: 4.16 pmol/l (Range 3.1 - 6.8)

Ft3 only 28.65% through range

how much levothyroxine were you taking before T3 was added

Do you always get same brand levothyroxine at each prescription

Did you feel better splitting T3 as 3 doses …..it appears to give better results

3 doses at roughly equal 8 hour intervals

Waking, mid afternoon and bedtime

Have you tried also splitting levothyroxine as half dose waking and half dose at bedtime

What vitamin supplements are you currently taking

When were vitamin levels last tested

[Hidden in reply to SlowDragon]

Hi SlowDragon

Thank you for reponding! I’m in a pickle and very fed up with feeling unwell. I take Accord Levo same brand. My levels were much better on the splitting as nothing else has been changed. I had a trial of split dosing on Levo some months ago so will trial this again.

Prior to adding in T3 I was on 100mcg of Levo and both T3 and T4 were low in range, but my Endo reduced to 75mcg to add I the 15 Lio. I think/ felt this set me back.

What are your thoughts Re increasing T3 over T4? I know I only need to change one thing.

Pre T3 on 100mcg Levo at six weeks my bloods were

TSH 2.47

T3 3.22

T4 15.9 (same ranges as above)

I’m currently taking Better you Vit D and K2- four sprays and my last result was top third of range. I take zinc, selenium, A, C and E 3 times per week. My last vitamins were all in top third- B12, folate etc so I’ve left of my B complex. My Ferritin is only about 70 and I’m working on adding liver pate to increase. All other iron is in upper range. I’m sure there’s something odd about my Ferritin and I do ‘feel’ anemic, but I’ve posted results here and the overwhelming view was to not add iron.

X

[SlowDragon Administrator in reply to Hidden]

Pre T3 on 100mcg Levo at six weeks my bloods were 

TSH 2.47

T3 3.22 

T4 15.9 (same ranges as above) 

These results suggest you should have had next dose increase in levothyroxine to 125mcg before considering adding T3

Now

Personally I would increase levothyroxine as next step ….up by 12.5mcg per day

Then retest at 6-8 weeks…..possibly increase T3 after next test

[Hidden in reply to SlowDragon]

Thank you SD. I think the doctor was so eager to get my T4 out of range bloods down we sped past what was actually needed and landed on the (undermedicated) 100mcg. Lesson learnt 🙄! I really appreciate the help for you both thank you x

[Aurealis]

It’s fascinating isn’t it, just how unhelpful the blood tests can be. Did you leave the same interval between last dose and test each time? I’m not sure how big the tolerance is on the TSH test but its possible that both TSH results are within the margin of error / tolerance, so unhelpful to inform dose change.

However, it sounds as if you are certain you need to increase t3. I would do it in 5mcg notches, testing after each increase.

What time interval are you leaving between two doses? I’d move at least 6 hours apart, 8 if possible, and take 10mcg each time

Good luck

[Hidden in reply to Aurealis]

Hi Aurealis

Thank you for replying! Yes I do try to leave the same time as near as possible. I was doing my T3 eight hours apart (before the trial of 10 and then 5 later). I’m going to go back to this now as a 3 split 8 hours apart. The TSH does seem to jump about and I agree about not using for dosing as the T3/T4 usually matches how I’m feeling.

Thank you so much for your help and advice! I’ll keep

You posted and do hope you are keeping well x

[Aurealis in reply to Hidden]

I used to take 3 doses per day but eventually was able to settle down on 2. But I take NDT too.

I found that for me, the third dose of T3 sometimes seem to disrupt sleep.

More frequent doses are needed for T3 only than if on T3 and Levo combo.

Good luck!

[Hidden in reply to Aurealis]

Thank you Aurealis

I actually liked the ease of two doses and the 10 in one go was easier to tolerate than I thought it would be. But it’s the only change I’ve made and my bloods aren’t as good. I may try again further down the line but think maybe a split dose of the Levo might be my next step. I tried late last year but didn’t feel a difference but I was not well at all at the time so maybe influenced things. I’m glad you’ve found a schedule that works so much trial and error and all things move slowly! X