Any advice on T3

[SilverSavvy]

Does anybody have any good advice on starting on T3 - particularly effective brands, when to take, whether it is okay to take at same time as Levo, etc. Do we have to pay attention to any special vit supplementation when on it?

It's been added to my prescription for a trial period and I'm keen to avoid any rookie errors.

Thanks so much.

[SeasideSusie Remembering]

SilverSavvy

It would help us to help you if you tell us how much T3 you have been prescribed and what the endo told you to do.

Also post your current test results as that will be a guide as to how you should proceed.

T3 can be taken at the same time as Levo, many of us do that.

Some people take their T3 all in one dose, others find they do better if they split it into 2 or 3 doses during the day, it's trial and error to find what suits you best.

I can't help with prescribed brands as I self source my T3 but it's probably like Levo - some brands suit some people but not everyone, so it's a case of trying it and see how you go. As it's prescribed (presumably on the NHS) you may not have a choice of brand.

No special vitamins but as with any thyroid hormone we need key nutrients to be at optimal levels, ie

Vit D: 100-150nmol/L

B12: top of range for Total B12, if Active B12 is tested then 100 plus is suggested

Folate: at least half way through range

Ferritin: some experts say the optimal level for thyroid function is 90-110ug/L

[SilverSavvy in reply to SeasideSusie]

Thanks SSusie and sorry for tardy response.

These are my most recent blood test results, all done as per TUK recommended guidelines:

TSH 0.454 (Range 0.27 - 4.2)

Free T3 4.14 (Range 3.1-6.8)

Free Thyroxine 20.2 (Range 12-22)

Ferritin 153 ug/L (Range 30-650)

Folate - Serum 18nmol/L (Range 8.83-60.8)

Active B12 89.1 (Range 37.5-188)

Vitamin D 75.9 (Range 50-250)

The Endo has recommended 20mcg cut in half, 10mcg am and same pm. Possibly 5mcg in pm if it causes insomnia.

Further bloods to be done in 6 weeks although I might get some done privately before then. I am also wondering about getting an MTHFR gene test as there is so much family history for PA and bowel cancer etc.

I have not got my Lio yet - pharmacy was struggling to fill order. I only hope they have given me tablets not capsules for obvious reasons.

[SeasideSusie Remembering in reply to SilverSavvy]

SilverSavvy

OK, so it looks like your endo is making a common mistake, starting you on 20mcg rather than building up to it.

We always recommend starting on 5mcg, so as you probably wont be able to cut the 20mcg tablets small enough to take 2 x 2.5mcg daily then just take 1 x 5mcg which can be taken with your Levo.

Many endos recommend reducing Levo when they start adding T3, this we suggest is a good idea when FT4 is high, ie over range or top of range. Taking T3 will lower your FT4 anyway but your level is possibly high enough to reduce Levo slightly but it's up to you. If endo hasn't suggested it then you may want to leave it as it is.

Take 5mcg T3 for a week or so, if all is well and you have no adverse reaction then add another 5mcg, again wait another week or two and add a further 5mcg. You might want to then wait a few weeks to see how you do on 15mcg T3, it's better to go slowly and build up as necessary than take a large amount all at once to start with and overshoot your sweet spot.

I would wait 6-8 weeks after reaching 15mcg then retest and assess how you feel. If you feel it's necessary then increase to 20mcg daily and again wait 6-8 weeks to retest and assess how you feel. I would delay doing tests for your endo until then, what he wants is too quick and likely to lead to him saying your trial has failed then stop your T3 altogether.

It looks like you've done a Medichecks test which was processed by INUVI lab, the ferritin range tells us that.

Your folate level is on the low side and we suggest at least half way through range which would be about 35 plus with that range. Do you take a B Complex? If not then it would be a good idea to consider doing so. It will help raise your folate level and bump your B12 level up a bit too.

I don't like commenting on ferritin when it's that range with Inuvi, it's so different from all other lab's ranges that it doesn't make a lot of sense to me.

Vit D looks like it could do with being higher, do you supplement?

[SilverSavvy in reply to SeasideSusie]

Yes I do supplement with a pre-methylated B Complex (BioCare) and Better You VitD with K2. Intending to stay on them til the next set of bloods and see if they are still going in the right direction. Vit D was bad at 38 earlier in the year. B12 is often on lowish side.

Not sure what to do about the T3 then: all I have on prescription is 20mcg which I have been told to cut in half (I guess it's cheaper in the 20's and this is NHS after all) so if they can be cut into quarters I will do exactly as you say.

I have been told that it is likely I may need to titrate down a bit on the Levo once I'm on T3 so that at least is correct advice.

I was also told to start on 10mcg of T3 morning and 5mcg evening but I will start small as you recommend and see how it feels. I often had to titrate up slowly with the Levothyroxine due to stomach issues. Luckily no palpitations or anxiety. My anxiety was often improved with increased dosage actually.

Thanks for your continued support.