Should I reduce T4 or T3

[Lindsayf]

Hi all

My Dxa scan results are as follows (no ranges on the print out)

2 - score lumbar spine= -2.4

2 - score total hips= -2.0

2 - score neck of femur= -1.8

Below the expected range for age at the lumbar spine, borderline at the total hip and within the expected range for the age of the neck of femur.

I’m supplementing with a good VIT D and K2 and shall retest in 3 months.

My Thyroid results:

TSH <0.01 mU/L Range 0.35 - 4.94

FT4 13.4 pmol/L Range 9.0 - 19.1

FT3 6.1 pmol/L Range 2.4 - 6.0

The Endo wants me to reduce my 100mcg of T4 to 75mcg and keep my 25mcg of T3. She just wants my TSH to be 0.01 or above as she thinks the suppressed TSH is not helping with my bone density.

Would I be better to reduce my T3 to 20mcg (5mcg reduction daily) rather then my T4?

Any thoughts or help would be amazing. I don’t feel over medication and still feel tired in the mornings. I’m so scared to reduce my meds but done want my bone density to decrease.

Thanks

Linz

[SlowDragon Administrator]

was test done early morning and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Do you normally split your T3 as 2 or 3 smaller doses spread through the day?

Last dose T3 approx 8-12 hours before test

Yes….I would try reducing T3 by 1/4 tablet initially and retest in 6-8-10 weeks

…..rather than lower Levo any further

what are your most recent vitamin D, folate, B12 and ferritin levels?

Are you supplementing magnesium?

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Great article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Lindsayf in reply to SlowDragon]

Hi Slow Dragon

I take all my T4 and T3 together, upon waking. Bloods were taken at 9am and there was 24 hours between last Levo and 12 hours for T3 before blood test.

Ive taken the same brand of T4 and T3 for the last few years. I take 25mcg of Grossman T3. Would it be okay to start taking 20mcg of mercury pharma t3 or do I need to ween off one brand to go onto another brand?

VIT D 53 nmol/L and range is 50-120

I take 8 drops of VIT D and K2 of Nature Provides.

I recently had my B12, Ferritin and folate done and I need to dig out the results.

I’m going to buy some Magnesium as I’m not currently taking any,

[SlowDragon Administrator in reply to Lindsayf]

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or between 100-125nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

[SlowDragon Administrator in reply to Lindsayf]

You could cut your 25mcg T3 in to half and 2 x 1/4

Save 1/4 for next day

Only ideally ever change one thing at a time

So initially keep taking as single dose, same brand….just 1/4 tablet less

Retest in 6-10 weeks

You could then as separate experiment……try splitting T3 as 1/4 tablet approx every 8 hours

Retest in further 6-10 weeks

And as another separate experiment, (assuming you stay on splitting T3) ……..also try splitting levothyroxine …..as two smaller doses. Waking and bedtime……alongside T3

[Lindsayf in reply to SlowDragon]

Thanks for that… I’ve tried splitting my T3 dosage but as I graze and drink tea throughout the day, I struggle to have an empty stomach and time it with all my other supplements and iron tablets. When I take them in the morning as a single dose, I find it so much easier.

[SlowDragon Administrator in reply to Lindsayf]

Taking T3 as large single dose is probably more likely to result in suppressed TSH

[SeasideSusie Remembering]

Lindsayf

The Endo wants me to reduce my 100mcg of T4 to 75mcg and keep my 25mcg of T3. She just wants my TSH to be 0.01 or above

All that will achieve is an FT4 level lower than it already is. It's the T3 that's suppressing your TSH, it's just what it does, I'm amazed that doctors who are willing to prescribe/supervise T3 have no idea what it actually does.

she thinks the suppressed TSH is not helping with my bone density.

Suppressed TSH causing osteoporisis is a myth see 7 myths of hypothyroidism on ThyroidUK's website and scroll down to

The myth that a suppressed TSH leads to Osteoporosis

thyroiduk.org/further-readi...

You might find these previous posts on the forum helpful

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Over range FT3 is more likely to be a problem than suppressed TSH.

[Lindsayf in reply to SeasideSusie]

Thanks They sure know how to scare people. It’s been a consistent battle with my suppressed TSH. I’m going to reduce from 25mcg to 20mcg to see if that helps and brings my FT3 levels in range.

Can I stop taking one brand and take a new brand the next day or does that cause issues?

[SeasideSusie Remembering in reply to Lindsayf]

Lindsayf

Can I stop taking one brand and take a new brand the next day or does that cause issues?

All you can do is try it. Whether it causes issues is something you have to see yourself, nobody can tell you. The active ingredient (T3) will be the same, it's the fillers in different tablets that cause problems.

[jimh111]

I would try reducing your LT3 dose first and see how you go. If you have problems then swap over and try reducing the LT4. Your fT4 is around average so from a numbers point of view it seems reasonable to stay on the same dose.

It will take a long time for your bone density to improve (relatively for your age group) but exercise will help. I assume they have considered the effects of girly hormones on bone density, I've no knowledge on this.

[Lindsayf in reply to jimh111]

yes, I’m going to reduce my T3 by 5mcg. I have no idea if they take that into account to be honest and they haven’t mentioned anything. They just told me to start taking VIT D. I just don’t want my bone density to get any worse

[Zephyrbear]

If you feel well in yourself on the dosage you’re on, why do you need to reduce anything? You’re taking T3 which in itself will reduce your TSH below range (I hate the word ‘suppressed’) but your FT3 is good and your FT4 is only just within range. And as Seaside Susie says, the ‘link’ between T3 and osteoporosis is a mythological one!

By all means, play around with dosages if you think it’s necessary, but my advice would be to go by how you feel and not by the numbers your doctor feels comfortable with on your blood test.

[Lindsayf in reply to Zephyrbear]

I think I’ve scared myself because my bone density scan has shown that I have reduced density in my lumbar spine and boarder line in my hips. I’ve been having a bad lower back recently and I think it all just scared me to think is the suppressed TSH causing this. If my scan has come back okay then I would have remained on the same dosage. My FT3 is just over range so I thought if I reduced my T3 slightly would that help bring it back into range and increased my TSH a bit. I know it’s a myth but I’ve scared myself.

[Zephyrbear in reply to Lindsayf]

That’s why this forum exists… to help you not be scared and give you the answers you need.

[Lindsayf in reply to Zephyrbear]

yes and I really appreciate it and would be lost without this amazing site but I can’t help still feeling nervous.

[Zephyrbear in reply to Lindsayf]

That's only natural.

[Mugs19]

no range but -2.6 is the point at which it changes from osteopoenic to osteoporotic.

[Lindsayf in reply to Mugs19]

hi

So -2.6 is classed as Osteoporosis?

[Mugs19]

yes

[Lindsayf in reply to Mugs19]

agh great! Hopefully the increase in VIT D and K2 will help.