Adding liothyronine to levothyroxine

[spookyscaryskeletons]

I have been on 50mg of levothyroxine for about a year. I finally had my first appointment with an endocrinologist. She added 10 mcg of liothyronine to my current t meds. She didn't mention any of the side effects listed on the pamphlet. I am nervous to add this after reading the side effects. Have any of you had any experience with both of these meds at once and what was your experience? I asked the pharmacy if I could take it at the same time I take my levothyroxine, but he said to ask the doctor. What are your thoughts on this? Thank you!

[Hennerton]

I have been on the combination for many years but distinctly remember my consultant telling me to add it very slowly, in order for the body to adjust to it. I still cut my tablet into four pieces and take two tiny pieces a day, one upon waking and one around 6pm. I originally started with just one quarter a day and stayed with that tiny dose for about ten days before taking the next quarter. I had no bad side effects by taking it slowly. I always take it at the same time as my Levothyroxine. (Mine is a low dose, as I am very thin)

[SlowDragon Administrator]

50mcg levothyroxine is only the standard starter dose levothyroxine

Why was dose levothyroxine not increased up to 75mcg daily first?

What are your most recent thyroid results

TSH, Ft4 and Ft3

Previous post 6 months ago shows high TPO thyroid antibodies

So Hashimoto’s confirmed.

Have you had coeliac blood test done.

Are you on, or tried strictly gluten free diet

Have you had vitamin D, folate, B12 and ferritin levels retested

[spookyscaryskeletons in reply to SlowDragon]

I am attaching a copy of my lab results. It was difficult to capture it all on my mobile device, but hopefully this will be clear enough for some insight. Thank you for looking at them!

lab results

[SlowDragon Administrator in reply to spookyscaryskeletons]

FT4: 1.36 pmol/l (Range 0.82 - 1.77)

Ft4 only 56.84% through range

So plenty of room for dose increase in levothyroxine up to 75mcg

FT3: 2.9 pmol/l (Range 2 - 4.4)

Ft3 only 37.50% through range

Vitamin D and B12 need improving

Improving low vitamin levels can help improve conversion rate of Ft4 to Ft3

what vitamin supplements are you currently taking

High TPO antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Always worth trialing strictly gluten free diet and/or dairy free diet

[spookyscaryskeletons in reply to SlowDragon]

Thank you! No supplements at this time. Will start though.

[SlowDragon Administrator in reply to spookyscaryskeletons]

low vitamin D

Look to improve to at least 40ng/mL (100nmol in U.K. units)

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...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

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...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator in reply to spookyscaryskeletons]

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

Ideally you should have folate levels tested

Seems very rare to get folate tested in USA

About 2 weeks after starting separate B12

Consider adding 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 improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

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 and continue separate B12

[SeasideSusie Remembering]

spookyscaryskeletons

She didn't mention any of the side effects listed on the pamphlet. I am nervous to add this after reading the side effects.

Would your doctor normally mention possible side effects of any medication you are prescribed? They don't here in the UK. The patient information leaflet included in the pack lists them and, of course, it's up to the patient to read it and be prepared, but if we thought we were possibly going to get any of them we'd never take any medication.

I've been on Levo since 1975 and Liothyronine since 2015 and I've never had any side effects from either. I take them both at the same time with no problem. I used to split the liothyronine into two doses but it never made any difference to me so I now just take it all in one dose with my Levo.

[Musicmonkey]

I agree that your Levo dose is fairly low, so it begs the question as to why you are having Liothyronine added? If you have confirmed conversion issues (T4 to T3) that may be why...

If you decide to go ahead with liothyronine, I suggest adding a small dose on a weekly basis to see how you feel on it. If no adverse reaction, you can gradually increase. Better to start low and slow because T3 is more potent than T4.

I think I imagined reactions to T3 when I first took it because of all the dire warnings from my specialist. Try to relax and don't overthink it. On a small dose you should be absolutely fine and you don't want to mess up what is probably the only chance you'll ever get to try T3 by taking too much too soon.

[spookyscaryskeletons in reply to Musicmonkey]

Thank you! Reading side effects can be so scary. I will do as you all recommend and add it slowly. I am supposed to have my labs retested in 6 weeks. If things are still wonky, should I suggest upping the dose of levothyroxine you think? I am attaching a copy of my labs, in case you have any insights. I appreciate your reply and reminder to not worry so much

lab results

[Musicmonkey in reply to spookyscaryskeletons]

Your T4 could be slightly increased, but it doesn't look a bad idea to add some T3 as that is quite low. It really depends on your symptoms. If you are not feeling optimal on your current regime, then your Dr's approach seems to be reasonable.

[wakeham]

Hi spookyscaryskelton, sorry that you are uncertain about your medication but I must say that I agree with what Musicmonkey make the most of being prescribed liothyronine as not a lot of people have the opportunity to try it! Slow and steady, make notes as you go on improvements, hopefully it will improve your condition. Best of luck.

Wakeham

[SlowDragon Administrator]

personally I would ask your endocrinologist to increase levothyroxine dose to 75mcg first BEFORE considering adding T3 and work on improving low vitamin levels

and as you have Hashimoto’s, get coeliac blood test done BEFORE trialing strictly gluten free diet and dairy free diet