thyroid meds

[Miss81]

hi,

can levothyroxin be taken at a dose of 75mg and T3 at a dose of 10mg straight away without gradual increase?

[tattybogle]

as in "start again after not taking any thyroid hormone at all" for a few months ?

Not a good idea to start at those sort of doses ... no .

you used to be on about 40/50mcg ? levo + a couple of doses of T3 ( dose ? )

Then it looks like you stopped at some point because 3 moths ago you wrote :

"I am no longer on T3 or T4 meds. I stopped any pharmaceutical synthetic rubbish. I struggled to make it work as I was not converting the T4-T3. It was becoming a nightmare with T3 in the mix. I stopped taking meds."

How long have you been taking no Levo / T3 ?

What other things have you been taking in the meantime ?

more detailed information would be helpful to answer your question properly ,

also ,any blood test results on whatever dose of Levo + T3 you were taking previously would help .

[Miss81 in reply to tattybogle]

thanks for your comment. Yes I was on the synthetics first T4 50mcg until I found out I was a bad converter to T3 which took 2 years to discover! Then I starting taking 2.5mg and gradually got to 7.5mg of T3 to sometimes 10mg of T3. However my fsh was high and still had irregular periods. On this dose my tsh was 1.3 and T4 13-14, T3 4.6. It was probably too low a dose as I believe 75mg and T3 10mg would have been perfect for me to get optimal T4 at 16 amd T3 at 5 but then my tsh would have been 0.01. The reason why I didn’t go high like this was because when I would increase T4 just a little bit more I would feel the thyroid suppressed and hurting almost it didn’t like it. Hence why I was sick of the synthetics and went on thyroid glandulars which have T3,T2,T4 etc. however with those I found that the more months I took them (same dose 2 capsules a day) the more the build up of hormones happened amd I found myself having tsh at 0.01 and T4 16, T3 5 but my fsh was still high and my periods were non existent. So I am not sure what to do?! Where are my periods and why are they not coming? I feel as if I have tried everything! I am taking regular supplements everyday!

[tattybogle in reply to Miss81]

unfortunatly i can't help ,( my periods were regular even when i was hypo for few yrs before starting levo , and the time when i was overmedicated on Levo a few yrs ago i had already been through menopause .. so i have no experience of thyroid hormone levels impacting periods). Sorry i can't be more help . Others with experience in this area are on the forum though, so don't give up .

Let them know what/ if any thyroid hormone you are currently taking.

what dose for last 6 weeks.

and add the [lab /reference ranges for those fT4 / fT3 tests .. they cannot be interpreted correctly without the lab ranges.... fT4 13/14 means 'fairly low' if the lab range was eg [12-22] .. but it means 'fairly high' if the lab range was eg. [7-14]

[Lalatoot]

No it would be a mistake to start with those doses. Going straight in like that would be too much for your body to adapt to.You should only do one thing at a time so that if you have new symptoms or benefits you can tell what change has caused them . So you should start on the levo and once established on that then think about adding in t3 if necessary. I would advocate starting at 50mcg levo and building up to 75mcg over several months. This will give your body time to adapt.

After you've been on your 75mcg levo dose for 6 to 8 weeks it would be better to do blood tests tsh, ft4 and ft3 to see what your levels are. This will then guide you to know when and how to add in t3. You can't predict how much levo and t3 in combo you will need. It is very individual. For example I was told to work my way to 50mcg levo and 20mcg t3 as the endo thought that would be fine. Those dose made me ill. The doses that suit me are 100mcglevo and 7.5 t3 but I only found this out by making gradual changes.

Unfortunately the body needs time to adapt to changing levels of thyroid hormones. There are lots of knock on effects that need time to happen. It is a slow process. To use the thyroid hormones efficiently the body also needs a healthy gut and good vitamin levels so for max effect I would monitor those too as you go along.

[Miss81 in reply to Lalatoot]

thanks for your comment. Yes I was on the synthetics first T4 50mcg until I found out I was a bad converter to T3 which took 2 years to discover! Then I starting taking 2.5mg and gradually got to 7.5mg of T3 to sometimes 10mg of T3. However my fsh was high and still had irregular periods. On this dose my tsh was 1.3 and T4 13-14, T3 4.6. It was probably too low a dose as I believe 75mg and T3 10mg would have been perfect for me to get optimal T4 at 16 amd T3 at 5 but then my tsh would have been 0.01. The reason why I didn’t go high like this was because when I would increase T4 just a little bit more I would feel the thyroid suppressed and hurting almost it didn’t like it. Hence why I was sick of the synthetics and went on thyroid glandulars which have T3,T2,T4 etc. however with those I found that the more months I took them (same dose 2 capsules a day) the more the build up of hormones happened amd I found myself having tsh at 0.01 and T4 16, T3 5 but my fsh was still high and my periods were non existent. So I am not sure what to do?! Where are my periods and why are they not coming? I feel as if I have tried everything! I am taking regular supplements everyday!

[SlowDragon Administrator]

Having stopped replacement thyroid hormones, it’s very likely vitamin levels have dropped significantly unless you have been supplementing

You need vitamin D, folate, ferritin and B12 levels tested

If vitamins are low it makes it very hard to tolerate taking replacement thyroid hormones

[Miss81 in reply to SlowDragon]

thanks for your comment. Yes I was on the synthetics first T4 50mcg until I found out I was a bad converter to T3 which took 2 years to discover! Then I starting taking 2.5mg and gradually got to 7.5mg of T3 to sometimes 10mg of T3. However my fsh was high and still had irregular periods. On this dose my tsh was 1.3 and T4 13-14, T3 4.6. It was probably too low a dose as I believe 75mg and T3 10mg would have been perfect for me to get optimal T4 at 16 amd T3 at 5 but then my tsh would have been 0.01. The reason why I didn’t go high like this was because when I would increase T4 just a little bit more I would feel the thyroid suppressed and hurting almost it didn’t like it. Hence why I was sick of the synthetics and went on thyroid glandulars which have T3,T2,T4 etc. however with those I found that the more months I took them (same dose 2 capsules a day) the more the build up of hormones happened amd I found myself having tsh at 0.01 and T4 16, T3 5 but my fsh was still high and my periods were non existent. So I am not sure what to do?! Where are my periods and why are they not coming? I feel as if I have tried everything! I am taking regular supplements everyday!

[SlowDragon Administrator in reply to Miss81]

Well 50mcg levothyroxine is on the standard starter dose levothyroxine

So hardly surprising you weren’t well

Dose levothyroxine should be increased slowly upwards in 25mcg steps until on approx 1.6mcg levothyroxine per kilo of your weight per day

Unless extremely petite likely to be at least 100mcg levothyroxine per day

Suggest you start back on just levothyroxine at 50mcg initially

After 4-6 weeks increase dose to 75mcg

Hold at that dose for at least 6-8 weeks and then get retested

ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test

Meanwhile vitamins tested and improved to OPTIMAL levels

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

For good conversion of Ft4 to ft3 we need optimal vitamin levels

No point considering adding T3 until on full replacement dose levothyroxine and vitamin D, folate, ferritin and B12 all at OPTIMAL levels

[Miss81 in reply to SlowDragon]

what are your thoughts on thyroid glandulars. They have all the hormones and easier to take..? Do you think I need 3 months on optimal levels which would mean tsh at 0.01 and T4 at 16, T3at 5 to see an improvement in my period becoming regular and fsh dropping?

[SlowDragon Administrator in reply to Miss81]

I would give levothyroxine and decent go

It typically takes 6-12 months for metabolism to adjust as you increase dose levothyroxine SLOWLY upwards in 25mcg steps until on approx 1.6mcg levothyroxine per kilo of your weight per day

Approx how much do you weigh in kilo

Come back with new post once you get vitamin results

[Miss81 in reply to SlowDragon]

I am interested in why you think levothyroxin would be better than thyroid glandulars when the glandulars have all the hormones including T2. But maybe the synthetic hormones work better when someone has autoimmune thyroid issues? I don’t know but interested to see your reasoning for levothyroxin instead of thyroid glandulars.

[helvella Administrator Thyroid UK in reply to Miss81]

We do not have details of any possible thyroid hormone content of glandulars.

That is one reason I'd be less likely to consider taking them.

Formal desiccated thyroid, such as Armour, Erfa, etc. is another matter. They declare thyroid hormone content.

[SlowDragon Administrator in reply to Miss81]

you can read my profile

Many Hashimoto’s patients find NDT has too much T3

Essential to get all your ducks in a row before considering adding T3

Vitamin levels optimal

Trial gluten free and dairy free

Almost any dose of T3 (or NDT) will significantly reduce or suppress TSH

Important to get metabolism up high enough before adding T3

[Miss81 in reply to SlowDragon]

ok thanks for the info guys 🐢