next move with combo therapy

[HornM]

Hi everyone

For those following along, I've recently tested thyroid levels after a little more than 6 weeks on 87.5mcg levo and 20mcg t3 daily. There's been a definite positive change, which is wonderful, and the first time I've been able to say so in about 2.5 years fiddling with doses.

I have significantly better baseline energy, and seem to bounce back quicker from energy crashes, but still deal with fatigue, weakness, brain fog, etc. So yes, definitely room for improvement.

I got my recent pathologyr results today and am pondering whether to add 2.5mcg or 5mcg, and see how that goes after another 6 weeks. I have the option as I have 2.5mcg capsules on hand.

25/10/22:

TSH .01 (.40-3.5)

T3 4.9 (2.6-6.0)

T4 11.6 (9-19)

my results prior to adding t3, on 87.5mcg of levo only (17/3/22):

TSH .86 (.40-3.5)

T3 3.1 (2.6-6.0)

T4 10.9 (9-19)

My temptation is to go with another 5mcg, but does anyone feel I'm at risk of missing my sweet spot then?

With thanks for any input...

[SlowDragon Administrator]

FT4: 11.6 pmol/l (Range 9 - 19)

Ft4 is only 26.00% through range

FT3: 4.9 pmol/l (Range 2.9 - 6)

FT3better at 64.52% Through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org/

Ft4 is low

Suggest you try increasing levothyroxine to 100mcg daily or alternate days 87.5mcg and 100mcg

Dose levothyroxine should have been increased to 100mcg after test in March

FT4: 10.9 pmol/l (Range 9 - 19)

Ft4 only 19.00% through range

FT3: 3.1 pmol/l (Range 2.9 - 6)

Ft3 only 6.45% through range

[HornM in reply to SlowDragon]

Hi SD, thank you! This was tried before adding t3. I tried increasing and couldn't tolerate it - became sleepless about 10 days in and it was a very small amount, I believe it was 12.5mcg that I added.

Something happened to my t4 levels after my second covid vaccine. They dropped, and I couldn't tolerate an increase.

My t4 levels used to be at the top of range and my conversion to t3 was still very low. I struggle to understand the point in being on t4 at all tbh, as t3 has been the only addition to actually make me feel better.

Is there any harm in just increasing my t3 further, seeing as that's what seems to be delivering?

[Buddy195 Administrator]

I agree with SD, I would try a Levothyroxine increase before adding more T3. I find a pill cutter really handy to help split tablets. I need to adjust doses super slowly, eg 12.5mcg Levo increases (alternate days at first), although other members are fine with larger dose increases.

[HornM in reply to Buddy195]

hi buddy, thank you! You'll see in my reply to SD above that I have had tolerance issues with adding t4, but only since the second vax. Perhaps it's worth trying this even smaller increase, like you say, but I wonder what the point is given my conversion rate was always so low, even when my t4 was at top of range.

What is the rationale behind increasing t4 if conversion is poor? I don't understand.

[Buddy195 Administrator in reply to HornM]

I am also a poor converter, but still able to convert some T4 to T3, hence the benefit of combination treatment.

[HornM in reply to Buddy195]

right, yes, I think maybe I just need to go with my gut on this one and see what happens if I up my t3. I just haven't had any stand out benefit from higher t4 in the past, so struggle to see the point..

I may find myself increasing t4 if this doesn't get me where I need to be!

[arTistapple]

Whatever you decide HornM please come back and keep us posted. I will be very interested to see how you get on. I am having broadly similar problems at the moment with increasing my levo. I am not on T3 yet but struggling with pushing the new T4 increase, no matter how gently.

[HornM in reply to arTistapple]

mmmm.. it's tough, isn't it. At this stage I think I'll go with my gut and see where I land after increasing my t3 by another 5mcg. It may be that I try increasing levo again at a later date (and in smaller amounts..).