recently prescribed t3 alongside t4

[hippy66]

hi all, I spoke with my Endo last week and he has prescribed 20mcg of liothyrine to be split am &pm and reduced my levo from 112.5 daily to 75mcg one day and 50 mcg the next. Just wondering if 20 liothyrine is too high as a starting dose. I have taken it for about a week and have experienced sweating particularly at night. Don't know if it's the reduced t4 or introduction of t3 that's causing it. Any thoughts would be welcome

[Jaydee1507 Administrator]

It's probaby best to reduce the Levo for 5 or so days before adding a small amount of T3. 5mcgs T3 would be a good amount to start with. 20mcgs is a high dose to be taking right from the start and would be better worked up to slowly at 5mcgs every 2 weeks to avoid 'overmedicated' type symptoms.

[hippy66 in reply to Jaydee1507]

Thanks for this. He's reduced my levo already so will reduce the T3 and build it up gradually.I was so relieved I had seen an endo who was happy to try T3 so didn't think to ask him about gradually adding it! 😀

[Jaydee1507 Administrator in reply to hippy66]

When you’re on multiple doses, split them into 2 then 3x a day about 8hrs apart.

[hippy66 in reply to Jaydee1507]

Thanks for this info. I have kept the lego at the reduced rate of 75/50 every other day and have reduced to 5mcg this morning. As I've been taking 20 mcg for a week would it be too much to drop to 5mcg?

[Jaydee1507 Administrator in reply to hippy66]

Probably kinder to cut down by 5mcgs every few days.

[jgelliss]

Congratulations for getting T3. From my own experience I found that when I was finally given 5 mcg T3 my than Endo reduced my T4 drastically. I felt awful . I than realized that either the Endo did not understand how to dose with T3 . I felt like a set up for failure. I learned from this experience that I felt best when I had enough T4 for my T3 to feel my best. Lowering the T4 dramatically at the same time adding high doses of T3 for starters in my opinion is not the way to go for a successful outcome. You don't turn two dials at the same time for starters. Best wishes .

[cbraffe]

Hi Hippy66,I had a similar experience when a private endocrinologist prescribed 15mg of t3 to be taken three times daily and reduced my t4 from 125mg to 75/100 on alternate days . I was very unwell with palpation, joint pain and severe sweating both during the day and at night. I sought advice here and took the matters in my own hands. I started taking 10mg t3 with 100mg in the morning and the last dose of 5mg at night. This has worked for me. There was no room to split the dose three times as I have to take my supplements and BP medicines away from the t3. For the 1st time since having a thyroidectomy, I can say I feel great. Beat of luck.

[hippy66 in reply to cbraffe]

Hi cbraffe

I pleased to hear you are feeling great, it's such a mind field trying to maintain optimum levels of levy and other supplements. I should have come here first but got so excited at being prescribed T3 I took my foot off the gas, lesson learnt 😀

[SlowDragon Administrator]

pity you didn’t ask here first

It’s important to start T3 very SLOWLY

What was Ft4 and Ft3 results on 112.5mcg levothyroxine

Likely that’s far to big a dose reduction

How long since levothyroxine was reduced

Which brand of levothyroxine are you currently taking

Is this always same brand at each prescription

vitamin levels need to be optimal too

Couldn’t see any recent vitamin results on previous posts

When were vitamin levels last tested

What vitamin supplements are you currently taking

As you have Hashimoto’s are you on strictly gluten free diet and/or dairy free diet

[hippy66 in reply to SlowDragon]

Hello Slowdragon,

You're absolutely right, I should have sought help here before I started T3. As I mentioned to cbraffe, I was so anxious about the end potentially fobbing me off I got way too giddy when he prescribed the T3 and tricked me into believing he knew what he was doing, silly me😀My levels on 112.5 were :T4 17.8(range 12-22), T3 3.77(range 3.1-6.8) , TSH 0.28(range 0.27-4.2). The TSH sent my GP into meltdown and so I was able to argue that I needed to see an end as my T4 and T3 were rubbish.

Cortisol 275-needs to be at least 430nmol/l at 9am. End wants to check this again after I've been on T3 for 6 weeks

MCV-78.6(range 80.0-98.0fl)

MCH 25.5(range 27.0-33.0pg)

both these are low but again he said to wait 6 weeks to retest

I can't see Vit D on there but he said it's normal.I've got my own finger prick test to do for this.

I have pernicious anaemia so have b12 injections every 3 months, however no other vitamin levels have been checked and I don't take vitamin supplements. I take tumeric tablets each day as an anti inflammatory but am changing to Guduchi to try and give my liver some support as I have high triglycerides and cholesterol. Interestingly I was also pre diabetic from bloods done by the GP last year but that seems to have settled down as the end said they were normal.

I was previously on levo100mcg Aristo and 25mcg Teva split each day.

The levo was reduced on 14 December and the brand is now Almus 50mcg and Teva 25mcg

the Liothyrine brand is Roma 5mcg capsules.

I have tried a gluten and dairy free diet in the past and didn't feel any different. I was also checked for caeliacs which came back ok though I know that us hashimotos can still react badly to gluten and dairy. There is so much conflicting information on the internet about what you can and can't eat with hashimotos my brain gets frazzled and I give up trying to make sense of it. I've opted for looking for healthy meals to try and heal the cause of the autoimmune disorders I have as I understand this can be from having a leaky gut and low stomach acid. I am at the start of this journey but I want to take my recovery into my own hands and I think addressing the cause as well as the symptoms is the way to go for me. I only have toe confidence to do this because of the fantastic support I get on here. Left to the medics it would feel like swimming through treacle!

[SlowDragon Administrator in reply to hippy66]

So

FT4: 17.8 pmol/l (Range 12 - 22)

Ft4 was only 58.00% through range

There was plenty of room for dose increase in levothyroxine to 125mcg BEFORE considering adding T3

And didn’t need to reduce levothyroxine before adding T3

FT3: 3.77 pmol/l (Range 3.1 - 6.8)

Ft3 only 18.11% through range

So obviously poor conversion

First step is always to test folate, vitamin D and ferritin

And get these at optimal levels

You’re legally entitled to copies of your test results

Get hold of most recent results or test these privately

Optimal vitamin levels are

Vitamin D at least over 80nmol and between 100-125nmol might be better

Folate and ferritin at least half way through range

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help maintain B12 levels between injections too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20 

If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

previously on levo100mcg Aristo and 25mcg Teva split each day. The levo was reduced on 14 December and the brand is now Almus 50mcg and Teva 25mcg

Never change dose and brand of levothyroxine at same time

You were on all lactose free levothyroxine

Now on Almus which contains lactose

Having dropped levothyroxine ridiculous amount …..Likely your Ft4 is now below range

[Lalatoot]

Hippy, endos seem to expect folks to jump from levo only to what they consider a full combo dose overnight. This is too much of a change for the body and the change should be done in gradual steps so the body has time to adjust.Endos seem to have a protocol for giving a 20mcg dose of t3 and reducing levo by 50mcg daily. You will have to try the prescribed dose as I did, but be aware that the endo really has no idea what combined dose will work for you and that it is an individual thing.

I was on 100mcg levo. Put onto 50mcg levo and 20 lio T3. After 2 years of slow adjustments the dose I ended up on was 100mcg levo and 7.5mcg lio daily. If only the endo had left my levo alone and gradually added lio t3 I might have found my dose quicker and easier.

The gentle way to add t3 is

Week 1 reduce levo 25 mcg. Wait week for level to drop.

Àdd dose of 5mcg lio. Wait a week.

If ok reduce levo to final dose. Wait week .

Then add 5mcg lio every fortnight until you are on your 20mcg dose. Wait 8 weeks and do bloods.

[hippy66 in reply to Lalatoot]

Hi Lalatoot, thanks for your response.It sounds like you've had a long journey to get your dosage sorted. I'm glad you got there in the end. With the levo my original dose was 112.5 so 25 off that would be 87 so I'd need to round it up or down. Today I have taken 75mcg levo and 5 mcg Lio. As I have been taking 20mcg Lio from 14 December up until today I'm concerned dropping to 5 would be too much of a change but I am only surmising this to be the case.

[FancyPants54 in reply to hippy66]

I could not drop that much at once. It would give me anxiety and other symptoms. If you were taking 2 doses a day, today you should still take 2 doses, of 5mcg each. Not such a massive drop. You need to find a way to get more Levo. You could consider buying some. It's cheap enough. I would have reduced to 100 Levo per day when adding the 5 T3. So you might get away with 75 every day with 10 T3. But you might need a bit more.

Your endo has set you up to suffer. They usually do. It's best to just use them to get the prescriptions and then sort the rest out yourself with help here.

If you feel settled on the 10mcg T3 per day I'd sit on that for 2 weeks at least. I'd not go to 5mcg if you don't have too. But any signs of over-medication on 10mcg then you must go back to 5 and start again.

[cbraffe]

I know the feeling, I also almost stopped taking the t3 but held on and it paid off. Also, stress affects everything. I believe the starting dose is too high. You can stop and reintroduce afterwards and see. My ferritin was so low, my GP stated in was fine however, the members here advised to supplement. It is a battle but we have to keep going as we have no other option.

[hippy66 in reply to cbraffe]

I had low iron levels which corrected themselves the treatment for hashimotos started around 7 years ago. It is low again now. I have some ferrous sulphate but don't cope too well with it. Can I ask what supplements you take ?

[SlowDragon Administrator in reply to hippy66]

if your ferritin levels are low …....no wonder your conversion rate of Ft4 to Ft3 is terrible

Before considering adding T3 we must get all four vitamins tested and at optimal levels

[FancyPants54 in reply to SlowDragon]

Ideally, but she is where she is now, and needs to sort things out from here so stopping everything and working on vitamins isn't really an acceptable option, better to work on both by lowering the T3 and working on the vitamins. Life is rarely ever black and white sadly. Especially with Endos messing things up.

[cbraffe]

I take iron on and off. Try the one that is gentle on the stomach. Also, I take B12 and selenium

[hippy66 in reply to cbraffe]

I think ferrous numerate is better on the tummy. I have b12 injections for pernicious anaemia. I tried selenium but it really bloated me to I've stopped it. I think once I get my levo Nand Lio levels rightI'll try it agian. Thanks for your help

[FancyPants54 in reply to hippy66]

Try a different brand. It could be the fillers that affected you. If you get levels right and then add Selenium back in it will mess up the levels again. Best to have as good a conversion as you can get from the start.

[cbraffe]

It very difficult to get everything in order. Beetroot juice and dark chocolate is good too. I drink it instead of tea. That has helped me to stop the iron tablets 4 now

[hippy66 in reply to cbraffe]

I like both of these so won't be difficult to incorporate into my diet though I can't function without a cup of tea in the morning

[cbraffe]

My case is worse as I am vegan too. No diary whatsoever

[SlowDragon Administrator]

Gluten and/or dairy free

The only improvement some people see….is better conversion rate on gluten free/dairy free…..so Ft3 level might improve

Similarly splitting dose levothyroxine might help improve conversion

See my reply right at bottom of thread discussing this

Splitting dose levothyroxine and/or gluten free diet significantly improved conversion 

healthunlocked.com/thyroidu...

See Tattbogle’s reply in this post re splitting levothyroxine dose 

healthunlocked.com/thyroidu...

Why gluten intolerance can upset cortisol levels 

kalishinstitute.com/blog/gl...

 

[SlowDragon Administrator]

how low is ferritin level

Have you had full iron panel test done

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Also See page 7 on here 

rcn.org.uk/-/media/royal-co...

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

different iron supplements

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

[hippy66 in reply to SlowDragon]

Hi SlowDragon, there was no mention of ferritin in the results just low MCV and MCH. The endo said this possibly indicates I am iron deficient but wanted to recheck after 6 weeks of taking new Lio with levo. Historically I have been iron deficient but this has been ok until recently. I am a vegetarian so have to rely on non meat food for iron so usually end up with supplements. I just read the link yo shared on splitting T4 dose. It sounds like it's helped some so I will be giving that a try. I think I'll arrange my own blood tests to check ferritin and iron levels. I've significantly reduced my gluten intake and will opt for alternatives to dairy when possible. Thank you for all the links to further information SlowDragon, it's much appreciated.

[SlowDragon Administrator in reply to hippy66]

is endocrinologist aware that you are vegetarian

As a vegetarian you are likely to need iron supplements at some level pretty much continuously

[hippy66 in reply to SlowDragon]

I can't remember if I mentioned it but I'll check with him.

[tattybogle]

Chopping the Levo dose in half to 62.5 was asking for trouble . (especially when it wasn't even too high in the first place).. even if fT4 had been highish , a small reduction to 100mcg or 87.5mcg would have been a much kinder idea .

Same with adding 20mcg all at once . that's just asking for trouble , far too heavy handed.

Next time you see this clown ask them if they know how to spell the word 'subtle'.

You'll probably have to go with it for now ,(barring a slight reduction on T3 to add it in more gradually if you think needed) since you've got the trial and you've already reduced the Levo ... but don't led them fob you of with ".. oh it didn't work ? well put you back on levo ", if you don't feel better by the time you have your review..... make them adjust doses again (properly).

[rustyempire]

My starting dose is 5 mcg …20 even split is pretty high IMO! You’ve already had great advice here however so I’ll remain silent on dosing… Did you have heart palpitations tho?

I see you are supplementing to help your conversion of T4. How’s your selenium levels? It’s an important part of helping us convert T4 as well.

Arent we lucky to have this forum for great advice! Best of luck

[hippy66 in reply to rustyempire]

hi, yes I’ve had great advice and feel very blessed to have this forum to seek advice. Not particularly, I became heat sensitive and just felt a bit weird if you know what I mean . I tried selinium on the recommendation of the endo before he prescribed T3. It made me feel bloated and caused some discomfort around my gall bladder/ liver area. Having said that I think long term T4 sitting in my liver and not converting to T3 hasn’t helped so it’s a vicious circle🙄I intend to try selenium again once my thyroid and iron levels have improved