If anyone is able to give me any advice about this, I would be very grateful.
I currently take 200 mcg levothyroxine, 100 in the morning and 100 before bed. I believe I have unresolved symptoms on T4 only and I know that I have the DIO2 gene polymorphism so I believe that I have conversion problems. Last year I asked my GP to refer me to an endocrinologist because of this, and she did. However, the hospital wrote back saying that they believed that my treatment was adequate and refusing to see me. So now I feel completely adrift and I don't know what to do next.
A few years ago I used to take NDT and felt quite well on this, but I stopped because of sudden weird symptoms of panic etc - I thought I might have had a bad batch.
Anyway, I now have some 5 mcg T3 tablets but am unsure how to start taking them.
Should I get private blood tests done first? Should I reduce levo for a few days first? How much by? And perhaps cut the T3 tablet in half?
Thanks in advance for any advice.
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Repton1
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5 mcg liothyronine equates to 15 mcg levothyroxine. I would adjust your levothyroxine to aim for fT4 near mid-interval and then introduce the liothyronine. It's a small dose so I would take it at bedtime as I have found T3 gives better sleep quality which helps cognitive function during the day. You can take half in the morning and half at night if you want. You will probably need 10 mcg liothyronine at least. Try to keep your TSH above e.g. 0.3 if you can.
Repton, You need to ensure that you have an adequate supply of T3 to give it a fair trial. It doesn't always work straight away for folks and it takes time to adjust doses - so make sure you have a decent supply first.
Get bloods inc. vitamins done.
If ft4 is around the top of its range, reduce levo by 25mcg per day and wait a week for levels to drop.
Then add in 5mcg T3 per day. Wait 1 or 2 weeks.
If all ok add in another 5mcgs either as a separate dose or added to the first dose. I take mine first thing and bedtime along with my levo.
You can stop there - wait 8 weeks and do bloods. Or you can continue adding in 5mcg levo every 2 weeks until you reach a daily total of 20mcg. Personally I'd stop after 10mcg daily total and see what your levels are at before deciding whether or not to add in more.
I only need 7.5 mcg T3 added to my original daily dose of levo to bring my ft3 levels up. It took me 2 years of adjusting doses of levo and lio to find what suited me.
with conversion issue you are going to find T4 very hard to use and it is likely to make you feel grotty. I struggled with T4 and NDT for similar reasons. I chose to go T3 only using Paul Robinson’s book “Recovering with T3” supported by his Facebook group. It’s worth checking your cortisol status ahead of it, blood can be done by GP and saliva test with medichecks or Genova. It’s a hard drug to dose and find your sweet spot.
with conversion issue you are going to find T4 very hard to use and it is likely to make you feel grotty. I struggled with T4 and NDT for similar reasons.
You may have struggled but please don't tell other members that this is going to happen to them too. It is your personal experience not a given that everyone is going to feel the same. There are many members here, me included, who take a combination of Levo plus T3 who do very well once settled on the correct dose for them and I, and others, have certainly not felt "grotty".
You are welcome to tell us of your experience but please don't cause worry for members considering this step by making out that this is going to be the same for everyone.
I have just started to feel well again when starting Levo and T3. It took a good few months to sort out but I am nearly there now. Everyone if different so it's a bit hit and miss to start with.
I was on NDT for years until it changed. I did take a full thyroid and vitamin blood test before starting and am just about to have another one. Good Luck
I’d definitely get the thyroid bloods done before any changes. What is your T4 level as you could be over medicated. What is your TSH now. And how well are you converting to T3. When I started to add T3 routinely my T4 was at the top of the range. T3 at the bottom of the range. TSH was over range. I’m a poor converter with Hashimoto’s and positive result from DIO2 gene test. I didn’t change my T4 dose initially as it wasn’t over range. I added 5mcg T3 twice a day 8hrs apart. 7am and 3pm. I’ve never felt so good coming from a place where I felt decrepit. Do check your bloods first or you could be off to a bad starting position. Also check your vitamins D, B12, folate and ferritin. They should all be optimal not just scrapping into the levels.
After some months I reduced my T4 levothyroxine by 10% that’s all My TSH is virtually always in range now and my T4 and T3 levels are midranges
Thanks everyone for your advice. I will get blood tests done first as suggested and then start adding T3 slowly. One of my worries about reducing my T4 is that I am prescribed 200mcg daily which is in 100mcg tablets. I suppose I could cut these tablets in half. I feel like my GP won't be amenable to prescribing them in lower amounts.
Some folks use a pill cutter and others a sharp scalpel. It is possible to quarter levo too . Though your best bet would be 200 one day and 150 the next if your body doesn't mind differing doses.
Thanks. I can tolerate differing doses. I had forgotten that I did used to do that for a while on the advice of a GP when I seemed to need an inbetween dose.
Just wanted to add that - after 2 plus years - I FINALLY received ideal test results. Initially I found the 5 ml pills of T3 too much to tolerate, so broke them in half and took only 2.5 (which wasn't enough). I wondered if I'd be able to take them at all. Now I am taking 1.5 pills per day all in one go (early in the morning) and have no problem - so it's possible it does take some getting used to. Still though, I think the biggest effect on TSH is the amount of T4 your take. Taking just one additional 'half pill on Monday' reduced my TSH over a 10 week period, from over 10 to less than 1. For the first time in a long time myTSH is low and I'm not hyper. Oddly, when my TSH was high (above 30), I felt fine - could sleep better - but that's not healthy, particularly when you've had thyroid cancer. For awhile I thought maybe my endocrinologist was engaged in a guessing game and that he didn't know any more than I did - but over time, all the micro adjustments he recommended finally got us there. Good luck and be patient.
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