T4/T3 combo reducing Levo

[jrbarnes]

I worked my way up to 112mcg of Levo and finally added 10mcg of T3. After the introduction of T3 my T4 levels(around 40% in range) didn't change much after going up to 112mcg daily and my overall thyroxine levels came down further. I did try to increase to alternating days with 125/112mcg of Levo but felt bad and it was messing with my vision so I lowered it back down to 112mcg. Then stayed on 112mcg plus 10mcg T3 for the next few weeks but started to develop insomnia and aggravation. My TSH went down from 1.8 to 0.19 with 10mcg of T3 but I started to feel extreme fatigue. So I've slowly been lowering the Levo and then slowly raising the T3 and the aggravation subsided. I'm currently on 50mcg of Levo and 25mcg to 30mcg of T3. I'm definitely feeling that drop in Levo but I simply cannot tolerate any large amounts of Levo with my T3. I've been splitting my T3 three times a day which works, starting at 4am, then afternoon and evening. If I keep this up I'm probably going to end up on mostly T3 which isn't a problem but for obvious reasons I'd like to keep a little Levo in the mix. Anyone out there on higher amounts of T3 with a lower amount of T4? Also, my thyroid gland is non functioning and I rely 100% on hormone replacement. Thanks for your replies.

[greygoose]

I'm on 75 mcg T3 and zero T4. That's what suits me best.

[jrbarnes in reply to greygoose]

Thanks. That gives me a bit more confidence to keep increasing the T3 because 25mcg is certainly not enough for me.

[greygoose in reply to jrbarnes]

You're welcome.

[Lotika]

Hi jrbarnes,

I made similar steps. I am prescribed 112.5 T4 & 10 (2 x 5) T3. I felt a little over- baked (jittery) but still tired and low in energy. I somehow suspected that it was, overall, either too much medication, or too much T4. As I have an NHS endo and T3 prescription and an appointment (and therefore blood test) coming up, this impacts how I dose myself too, as I don’t want to give him palpitations with a low TSH, if it can be avoided, as it is a good excuse for him to withdraw the T3.

So, I dropped levo from 112.5 to 62.5 with 10 T3 for 8 weeks; felt no worse, but less jittery. I then dropped T4 to 37.5 just over a week ago and upped T3 to 10 in the am and 10 at lunchtime. At this point, I suspect that T4 is possibly a little on the low side for me. And I also suspect that two supra-physiological doses of T3 have likely pushed TSH into dodgy territory, but we shall see. Had some lovely sweet spot days when I first made the change, but I have been lethargic this week. My guess is that it is my body feeling that drop in T4 take effect. 50 mcg T4 is likely a sweeter spot, but I am, in part, playing the endo game, as stated. I am a shockingly poor converter, so my theory is / was that my body doesn’t have a massive use for T4.

in terms of my own dosing (I find writing really helps me to clarify my own thinking, so thank you for starting the thread!) I am now wondering if splitting the pm T3 into two doses (say, one lunchtime, one bedtime) might help me stay on a more even keel. I wake up feeling like a deflated balloon, as I would postulate that my fT3 must be v low overnight…

[jrbarnes in reply to Lotika]

Mornings are the worst when your thyroid hormone is low and today I'm feeling that drop in T4. Thought about dropping my T4 further but need to wait a few weeks and then see if T3 can be increased. Conversion is okay for having FT4 levels 60% in range but since I don't have a functioning thyroid gland, for the extra T3, it leaves me low and trying to push my FT4 levels up to the 80-100% in range results in debilitating symptoms. I suspect I'm a type of person that got a lot of extra T3 from my thyroid gland. I'm an endos perfect patient because Levo never suppresses my TSH at "1" or below even when my FT4 levels are over range but this leaves me hypo still. That T3 is the only hormone that will suppress my TSH but I suppose it has an affect on conversion when on a T4/T3 combo and it's about finding that balance. There were a few times I dabbled with NDT that I had a sweet moment for 2-4 days after dropping from a high dose to a lower one or directly from T4 only to 1 grain of NDT and the one thing in common was that the T4 dose was being dropped and a little bit of T3 being introduced. You have this good storage of T4 built up then you lower the T4 and add T3 so there's these 2-4 days you feel great until that T4 starts to deplete from your system then you feel poor again but then when you try to increase the T4 the conversion goes down and you feel poor again. It's like a cycle. The only thing I can do is to significantly drop the T4 and compensate by adding more T3. I agree that endos play a numbers game when it comes to treating and there's this institution in place to prevent doctors from stepping outside of it.

[Vileplume]

Hey jrbarnes, just wanted to check in and see how you're doing in regard to T4 and T3. Have you managed to work out a sweet spot with the ratio and dosages?

I feel the same way you described, where I can't nail down a "sweet spot" that only seems to occur when I drop my T4 and add some T3.

[jrbarnes in reply to Vileplume]

No! I'm still at it. I experience pain when increasing the Levo but if I cut it out completely my brain turns to mush. Seems I have to keep my T4 on the lower side to avoid these symptoms.

[Vileplume in reply to jrbarnes]

I'm with you. Have you ever tried a 1:1 T4:T3 ratio? That's what I'm currently trying, and my hands are warmer than with a high proportion of T4. Still have some brain fog though.

[jrbarnes in reply to Vileplume]

I've tried all sorts of ratios. How much Levo and T3 are you currently on? Around 20-35mcg of T3 seems to be the amount that I benefit the most from. For the past couple months I tried T3 only in amounts from 25-60mcg. Never felt normal but always warm and pain free,however still fatigued and weak. So it seems I need a little T4 in the mix. Then I transitioned back to 100/112mcg Levo and a small amount of T3. Couldn't handle that. The same old symptoms started up again. Not sure why I keep doing that to myself knowing the results are always the same! This morning took a half a 88mg tablet of Levo and half a 25mcg tablet of T3 and feel relief immediately. In December I tested myself on 44 micrograms of T4 and 20 micrograms of T3 and my Free and Total T3 levels were the same as when I was on 100% T4! So today I'm back on that combination and just going to tweak on either end. I have the 25 microgram tablets. My labs in December show that I had room to increase the T3. Like yourself my hands are warmer than when I'm on a higher T4 ratio.

[Vileplume in reply to jrbarnes]

Right now I'm at 50 mcg T3 and 60 mcg T4. I used to be on 30 T3 and 120 T4. With the higher T3, my sleep is much better and my hands are warmer. However, my basal body temp is still half a degree F below range. But I'm reluctant to increase my thyroid dosage further, since I think my current dose is substantial. I know some people (and Dr. Lowe) do well with significantly higher doses of T3, but I want to experiment more with diet before changing my dose too much more.

[jrbarnes in reply to Vileplume]

Looks like I'm getting closer to that kind of ratio if I keep increasing my T4/T3. I was 30 at the time I first started Levo and my FT4 levels were always top of range or over with FT3 levels at least 80% in range. Even with over range T4 it still left me slightly deficient in T3. Around 36 years my FT3 levels plummeted to bottom range, possibly due to my FT4 levels dropping a little in combination with under eating due to a low appetite caused by the hypo, after my partial thyroidectomy, or possibly the rest of my thyroid stopped functioning. I could have tried to increase the Levo but realized the lack of sufficient T3 is what got me in that state in the first place. A year ago I increased calories, specifically carbs, and my natural conversion of T4/T3 was dramatically improved but still needed the extra T3. The most difficult part is finding the right balance. I don't have a conversion problem but rather it's not normal to have really high FT4 levels and forced to live on conversion alone because we know healthy people get additional T3 from the thyroid gland. According to the professionals it's "so easy a caveman can do it" but from our perspective it's not that easy and takes time. Physicians have zero time and medical care is like a cattle call. I haven't had much luck dosing by body temp. Regardless of dose my body tends to keep my temp normal. However I do wear a Fitbit and track my heartrate. In addition to warmer hands when I lowered my T4 and increased T3 they don't hurt anymore. On Levo my knuckles would turn red with inflammation and pain. In your case sounds like you also benefit from more T3!

[Vileplume in reply to jrbarnes]

Very interesting about your experiences with diet in relation to thyroid, like increasing carbs helping conversion. I was hoping that improving hypothyroidism and body temperature would help my lifelong constipation, since several case studies have reported gastro improvements on T3, but my digestion is still slow, even with a lot of T3. Like you, I've struggled to increase my temps, despite the warmer hands and better sleep. I'm currently at 65 mcg T3 and 60 T4 (after an experimental increase last week), and my basal temp is even lower than it was back at 30 mcg T3 and 60 T4. I'm reluctant to increase T3 when it's not improving my temperature.

[jrbarnes in reply to Vileplume]

I experienced the same thing on T3 only. I was up to 60 mcg yet had constipation. Switched backed to a full replacement dose of Levothyroxine and everything started moving normally again. Increasing calories, focusing on eating enough carbs, increased my FT3 by 30-40% but at the same time I put on 20lbs for the first time in my life which increased my need for more thyroid hormone. I was on the same amount of hormone for ten years so it's been tough to find my dose according to my new weight. A few days ago I had to go back to my full dose of Levothyroxine. Can't seem to live with it, nor live without it! I need all that Levo but at the same time I need a little extra T3. Trying to get them to play nice together is the difficult part. Although my mood and other symptoms improve on T3 only or higher T3 combo I can't seem to function or sleep as I do on a full replacement dose of Levo.