t3 starting dose?

[samking5]

ill be starting t3 medication in the next week or two and was looking for some suggestions on what might be the best starting dose.

Im thinking either 2.5mcg once/twice per day or 5mcg once per day. I'm wondering if anyone has experience in beginning t3 that would be able to advise me on the safest and most sensible option. I definitely dont want to overdo it. Would even 2.5mcg once daily possibly create a noticable change?

I need to decide as it will effect the strength of medication I order.

last test result 2 weeks ago (9am) on 100mcg levo

TSH 10 - was surprised as have felt worse at this level, had expected it to be lower tbh.

FT4 18.1 (12-22)

FT3 5 (4-6.8)

At the moment ive been fluctuating between feeling pretty good and not too not great, generally an okay space but defo space to improve. my main symptom is muscle pain and slow recovery, my interpretation is that the thyroid hormone is just not getting in there fast enough as it used to before I became hypothyroid, and a bit of t3 will just speed up that recovery process?

I've already tried increasing ft4 dose to lower TSH many times over the last two years and it doesn't make my symptoms any better and risks pushing me into overmedicated territory.

my endo has diagnosed me with TSH resistance - my tsh just doesn't drop very easily and doesn't usually suppress even when ive been overmedicated with FT4 over the range while I felt terrible.

interestingly during these periods of levothyroxine overmedication my FT3 levels did not increase but decreased (a protection mechanism?). Ive never had FT3 levels higher than about 50% through range. highest ft3 level was actually when I was diagnosed when ft4 was lower.

So ive never experienced what mid upper range FT3 + FT4 feels like. Im hoping it will be my ticket.

[GlowCoach Administrator]

What size tablets have you been prescribed becasue that willmake a difference in your decision as to how much to take initially?

The usual starting dose recommended by members here is 5mcgs working up to 10mcgs after a few weeks. Usually a small amount of Levo needs to be dropped to allow for the T3, such as 25mcgs.

Free T4 (fT4) 18.1 pmol/L (12 - 22) 61.0%

Free T3 (fT3) 5 pmol/L (4 - 6.8) 35.7%

Your FT4 is low enough already that you shouldn't need to drop any levo as adding T3 will drop it slightly anyway.

What are your most recent results for ferritin, folate, B12 & d3?

What supplements are you taking?

[samking5 in reply to GlowCoach]

hi well my endo prescribed me 10mcg and said i could split them to begin with but since that size tablet is extremely expensive the options are either thybon henning 20mcg (could be quartered) or compounded capsules from roseway pharmacy. so im gonna request a new prescription from him.

Yes I had reduced my dose significantly from a previous dose as I kept being overmedicated (was on 150mcg then reduced to 125 but levels didnt drop) so i dropped to 100mcg and then just stuck at that. I kind of expected I would need an increase eventually and since the ft4 is on the lower end of what can probably work for me so I thought it would be a good time to try t3.

Supplements omega 3, licorice root (for adrenals + aldosterone improvement), vit d, b12, zinc+selinium, occassionaly some others.

havnt tested d in a while, last result was 35 ng/ml on 2000 in march, ive actaully continued taking that but its been summer so figured I would be getting more d from sunlight, think I will re test soon and increase to 4000iu if its around same.

ferratin always around 77 (cant remember the scale), it could be higher but my TSAT and serum iron are alway s on higher end or over range so didnt think supplementing iron a good idea.

recent b12 + folate tests:

Serum vitamin B12

472 pg/mL 197 - 771

Serum folate

10.1 ng/mL 2.9 - 26.8

[GlowCoach Administrator in reply to samking5]

In that case I'd opt for 5mcg doses from 20mcg Thybon Henning when you can get that. 20mcg tablets though are too big to be trying to cut into 2.5mcg size and wouldnt be accurate.

Its usually reommended to take a B complex that contains methylfolate. Both your B12 & folate are not yet optimal.

This B12 sublingual is very good and you may need that as well as the B complex. cytoplan.co.uk/vitamin-b12-...

This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

[samking5 in reply to GlowCoach]

hi

yes I was thinking to start 2,5mcg with the compounded then if all goes smoothly move up to 5mcg and if that is ok then move to the thybon henning quarters as will work out cheaper. Im wondering if 2.5 would be noticable or likely not, some on here seem not to be able to tolerate even 5mcg though.

Yes with the b complex just got annoyed with the biotin and forgetting to stop before thyroid tests but hopefully once im changing dose less it would be less of a problem.

[GlowCoach Administrator in reply to samking5]

2.5mcgs isn't really a working dose so I doubt you would notice any difference with that. If you're particularly sesnitive to dose changes then try it.

[Hibs1 in reply to GlowCoach]

I split Thybon Henning into 2.5 doses and have no problems cutting it. It does make a difference with me when add that amount in

[samking5 in reply to Hibs1]

just got my thybon henning and split it into 8 although not terribly accurately. any tips on how to do so?

Also did you find that you felt a bit weird when introducing t3. I started t3 2.5 yesterday, it could be placebo, but not sure if i feel a bit rushy, but not necessarily in a bad way.

[Hibs1 in reply to samking5]

I use a pill cutter to divide up. Not always equal but it balances out. I never noticed the t3 added for about a week. No weird feelings with 2.5

[samking5 in reply to Hibs1]

yeah it could also be placebo 😅

[Hibs1 in reply to samking5]

Probably yes!😀

[Allergy in reply to samking5]

Hi is it a private prescription for roseway my consultant priced it for me

[Lalatoot]

Add 5mcg liothyronine to your current levo dose. If all ok after a week or two, add the other 5mcg as a separate dose.

I take my levo and lio in two doses 50mcg levo and 5mcg lio first thing the 50mcg levo and 2.5mcg lio at bedtime. I am lucky that I get 5mcg tablets on the nhs so I can split them to get 2.5mcg. If you go for the 20mcg tablets then probably best just stopping at quartering them.

[samking5 in reply to Lalatoot]

hi lalatoot, thanks.

sure, from reading some people here I was a bit worried 5mcg initally could be too much, hence why i was thinking starting with the compouded capsules 2.5mcg.

Obviously the 20mcg couldnt be split further than quarters.

hopefully eventually can get on nhs but the thybon hennning is cheap so ok if not.

[Hidden in reply to samking5]

I have thybon henning and I manage to split it into 2.5 using a pill cutter 🙂 they are a bit fiddly and small but it’s possible. I sometimes just spend 20 mins or so cutting up 10 tablets into 2.5 bits so I don’t have to fiddle every day.

[samking5 in reply to Hidden]

thats interesting! do you know if the contents are evenly distributed though? Sam

[Hidden in reply to samking5]

I think so because my bloods are reflective of my dose increases and if I go up by 5 instead of 2.5 I can definitely feel the difference and I don’t much like it! Id imagine the distribution is even throughout the tablet, as otherwise even just snapping them in half wouldn’t be recommended.

[samking5 in reply to Hidden]

so how much do you take?

[Hidden in reply to samking5]

I personally take 30mcg, but I started on 2.5 and increased over time.

[samking5 in reply to Hidden]

ok sure, 2,5 once daily?

[Hidden in reply to samking5]

Yes initially 2.5mcg in the morning, then 5. Then added 2.5 at midday and then 5. Then added 2.5 at 4pm and then 5. Then increased morning to 15, midday to 10.

Everyone does it differently tho, some people just take it all in one go.

[samking5 in reply to Hidden]

interesting to hear your procedure. I think I will try something similar.

[Hidden in reply to samking5]

Not everyone does this, but I invested in an old Apple Watch, BBT thermometer and bought a BP machine. It’s been very important to me to be able to track my vitals along side my dose increase. Heart rate in particular can really show how you are responding.

[Hibs1 in reply to Hidden]

Sane here

[samking5 in reply to Hidden]

did you have a special technique to do so? tried this yesterday and defo wernt perfect 8ths so just starting with the smallest pieces probably about 2mcg haha.

wondering if when you started t3 you felt a bit weird, it could be placebo but im feeling a bit rushy, wondering if this will subside.

[Hidden in reply to samking5]

No, I made my peace with pieces not being perfect and it wasn’t long before my dose rose and i was up out of the crumbs. It’s not that your body is waiting for you to deliver it perfect eighths, it’s that it wants a slow introduction to T3, so I’d just pick the smaller crumbs over the bigger ones until you reach 5mcg and then you’re fine.

Yes, T3 can make you feel a bit rushy, it’s stimulating 🙂 personally I am a big fan of monitoring vitals - BBT, BP, HRV, RHR etc. those can help x

[samking5 in reply to Hidden]

hey thanks for your reply. yes im debating if i am actually feeling something or its placebo. I wasnt feeling to well earlier in the week (moderarate flair up + illness) and last couple of days had to do some very intense physical work and managed ok, yesterday was the first t3 day so wondering if it may have been helping beside the rushy feeling, ive had a similar expereince when i moved from 50mcg to 100mcg levo and had weird feelings for a week or so.

Yes i am very sensitive to thyroid medication so wanted to take it slow, but as I said before when ive been overmedicated on levo my ft3 levels actaully decreased and would end up with ft4 100%+ and ft3 around 40%. perhaps a protection mechanism, so ive never felt what say 60+% both ft3 and ft4 feels like, Ive felt pretty ok at this dose of ft4 but still having bad dips, which i feel may be to do with the conversion process just not keeping up.

How many weeks did you stay on 2.5?

[Hidden in reply to samking5]

Yes, that protection mechanism could perhaps have been rt3, hence your falling FT3.

I did 10 days on 2.5 and then increased, but you’ll find different places say different things. Sources generally range from fastest being 5mcg every week to 2.5mcg every 2 weeks. The closer you get to “optimal” the slower you go. I find BBT etc (also called “signs”) and symptoms useful, they should help guide you where bloods can’t. Bloods are helpful but only tell us what’s in the blood, not the cell.

I’m not you, and can’t speak to your experience but in my own experience with thyroid hormone it’s rarely ever an imagined experience or placebo.

[samking5 in reply to Hidden]

yes i think so, wondering if high rt3 can also cause symptoms. i defo had a lot of classic hyper symptoms such as tremor but i think they were caused by high t4 rather than low t3, the really bad muscle aches i experienced when overmedicated may have been due to low t3.

yes defo gonna take it slow, probably will test in between just to be sure too.

[Hidden in reply to samking5]

Rt3 gets heckles up a bit in thyroid world. I think it’s significant, others say it isn’t, both have their reasons. How much T4 are you on?

[samking5 in reply to Hidden]

now on 100mcg, but was on 150 earlier in year, my tsh doesnt really reflect whats going on accuratately so going more of how i feel now.

[Hidden in reply to samking5]

Oh god yes you don’t want to give TSH any attention, it’s a red herring once you’re in replacement.

100 T4 is still enough to make substantial rt3, but see how you get on with the T3 good luck.

[samking5 in reply to Hidden]

yeah I mean ive tried to keep increasing t4 to get my tsh in range and it doesnt make much difference meanwhile ft3 levels dont change, and if the ft4 levels get a bit too high i react 10 fold to it and it takes months to get over it so dont want to repeat that anymore

[Hidden in reply to samking5]

Pill Cutter, Opret Pill Splitter with Blade for Small Pills Large Pills Cut in Half Quarter for Tablet Vitamin Medicine amzn.eu/d/9zBMHCy

[Lalatoot in reply to samking5]

I started on 5mcg daily without any probs.

[samking5 in reply to Lalatoot]

interesting, how long did it take you to feel benifits + work out if you needed more? I guess comapred to ft4 if its too much you can reduce or stop and bad symptoms go away much quicker?

[Lalatoot in reply to samking5]

It wasn't as straightforward as that!!! An endo was involved!! I was getting t3 on the NHS so I had to obey the endos protocols for a start. So I had to reduce my levo by 50mcg (even though my ft4 was only 60% through range)and add in 20mcg t3 lio. This was meant to be done overnight. That was the first bit I ignored. I gradually worked my way to the prescribed doses - 2 reductions of levo and adding in 5mcg lio every 2 weeks.

Kept on dose for 8 weeks then bloods. I felt awful. TSH was supressed, ft4 0% through range and ft3 78% through range. Then a blessing - lockdown happened. I kept getting the prescriptions for T3 but not having to see the endo. I was able to get an increase in levo too. So over the following 2 years I was more or less able to get on with it. Ended up back on the 100mcg levo that I had previously been on with 7.5mcg lio. This keeps my tsh undetectable, ft4 50%, ft3 72%.

[Hidden in reply to samking5]

Yes - In my experience if you have a dodgy reaction to a T3 dose it tends to be a matter of hours before you feel better because of how it is metabolised (so long as you don’t keep repeating that same aggravating T3 dose.) for instance if you got raised heart rate or anxiety from a T3 dose you can usually just wait it out and you’ll go back to how you were before you took that aggravating dose. T4 is a different beast.

[samking5 in reply to Hidden]

Yes having suffered through many months of levo dose changes, especially when I’ve ended up overmedicated and it just takes months to feel over it I want to avoid changing ft4 dose as much as possible, it’s just horrible always waiting not knowing how things are going to turn out.

[Hidden in reply to samking5]

Yes T4 is so slow and steady, when is stopped T4 mono to trial T3 mono it took 8 weeks for me to notice changes.

May I ask, if you are feeling overmedicated on T4, why would you add T3? Being overmedicated is indicative of being able to convert your T4 well.

[samking5 in reply to Hidden]

Well maybe better to think of it as excess ft4 because when I was overmedicated my ft3 levels actually dropped. So I think the symptoms of those came from the excess ft4 + potentially ft3 going lower

[Hidden in reply to samking5]

Oh yes, I just saw your labs on your previous post.

Your TSH is very curious, I wonder if you have some thyroid hormone resistance? Have you ever looked into that? I think the premise of TH resistance is a high TSH in spite of FT4 and FT3 being in range.

Your conversion actually looks quite good to me! Do you just feel hypo even tho your FT4 and FT3 are acceptably within range?

[samking5 in reply to Hidden]

I’m not sure, my tsh is so resistant to come down but jumps up quite easily. I mean the ft3 is quite low in lower half of range meanwhile ft4 is in upper half so not sure, I just react very badly to excess so wouldn’t want to add t3 when I have too much ft4. I’ve been at tsh say 4 with ft4 20 and I cant say I felt any better than now and ft3 was the same. But I’ve never felt good on levo at any tsh, pretty ok but mainly my muscles just don’t seem to feel like they used to, more achy and easily fatigued. Since 20% of t3 is made in thyroid and if your hypo you lose some or all of that the conversion process in levo only has to work overtime and I think for many people it just can’t or the body is sensitive to a small lack in t3

[Hidden in reply to samking5]

Yes, I see.

Good luck with your T3 trial. I hope it makes a difference. Wonder if your TSH will be more reactive to direct T3.

[samking5 in reply to Hidden]

Yes that’s what I was also thinking

[samking5 in reply to Hidden]

my ft3 is usually around 5, when overmedicated it dropped to 4.8 and 4.2 once . It’s never been higher eg up near top of range

[TasJSA]

I would be really interested in your decision and any other contributions as I’m awaiting my blood test results to explore T3 and T4 and B12 supplements at the moment. Thanks.

Hope it all works out for you.

[Litatamon]

I started on a 25 mcg pill cut into 12.5 mcg to add to levothyroxine, so not everyone starts low. In stating that I am not trying to detract from the upside of starting low at all. Just want you to know not everyone does it that way. I started with just the 12.5 for a week? Two weeks ? And then onto the full 25 mcg.

But I had taken Thyroid S previously, so my body had had a t3 pre-show. Makes a difference.

(Reading with curiosity of your issues, as my TSH was 28 on high amount of levothyroxine with that relatively high liothyronine addition. And 33 on three plus grains of Thyroid S. I have a crazy town TSH)

[samking5 in reply to Litatamon]

hi sure, ok thats good to know its not gaurenteed to be a crazy hit on a small amount. oh so you TSH doesnt want to come down that easily either?

[Litatamon in reply to samking5]

No, not at all. Do not know why. Since my thyroidectomy I have had one lab out of about six with it in the normal range, and I felt the worst then with that one 'good' lab (225 mcg Synthroid only - they just kept upping it to get the TSH normal). And I felt fine with a TSH of 33 on NDT, so go figure! A ton of rapid weight gain but fine nonetheless.

[Hidden]

You’ve received excellent advice and I hope your journey into medication with T3 is a smooth one.

I’m always very perplexed about why, four hours after a total thyroidectomy, I was prescribed 3 x 20 mcg of T3 a day. My TFTs were tested just before surgery and were optimal (including FT3). My levels would have taken a while to drop and yet I never felt overmedicated on the T3. From Day 1 I felt great - probably the best days in my memory.

As an aside, it’s a pity that everyone who is scheduled for a total thyroidectomy doesn’t have TFTs done before surgery. My thyroid was removed as a result of cancer so the results, unlike those who have thyroidectomies for Graves, were those of a normally functioning thyroid.

It took many years of messing and changing doses before my levels became stable. The dose which was the ‘right’ one includes T3. All attempts to treat me with Levothyroxine alone were disastrous. I do believe that everyone who has had their thyroid removed by surgery or by radioactive iodine needs T3. it should be standard practice to give T3.

Interestingly, my thyroid levels now that I take exogenous hormones are almost the same as they were before TT. If only the oncologist had tried to achieve these levels much earlier in my very distressing thyroid journey.

[Litatamon in reply to Hidden]

Yes, yes & yes. So frustrating, isn't it? Same with my thyroidectomy (TT) Suffered badly on levothyroxine only. And struggled to get anyone to care about that fact (despite being mouthy! 😁) or to get an alternate prescription for a long time.

[JAmanda]

Don’t listen to me but I found 5 and 10 lio made little difference - so I jumped to 20 and it did the trick. But others have wildly different reactions!

[samking5 in reply to JAmanda]

Thanks yes I am quite sensitive generally so there is a good chance 5mcg will do quite a lot

[JAmanda in reply to samking5]

Yes we just have to experiment on ourselves really - and be relaxed about it. And also to be aware that you don’t see results quickly.

[samking5 in reply to JAmanda]

But with t3 much faster than t4 no?

[JAmanda in reply to samking5]

Well I’d say no to be honest. So yes you defo feel the t3 quickly but for me it took months til it actually fixed my terrible hip pain and tightness. We’ll at least I’m ascribing the improvement to the t3!

[Hidden in reply to JAmanda]

Mmm. I’m a bit of a ‘jumper’ but I wouldn’t recommend it to others

[anglobike]

When starting T3, it's always advisable to take 100mg of magnesium alongside it.

[Hidden in reply to anglobike]

Not at the same time!

[anglobike in reply to Hidden]

Really? Why is that? Not being argumentative, just curious.

I always take my T3 with food and magnesium generally away from food (I have had conflicting advice about that, so I never quite know what to do on that score).

[Hidden in reply to anglobike]

See my comment be,ow. 😉

[arTistapple in reply to anglobike]

Could you give an explanation please. I have not seen this anywhere. Is it the ‘relaxation’ potentially from the Magnesium?

[Hidden in reply to arTistapple]

When I was prescribed T3 by Thyroid Oncologist, I was told to take it in same way as Levo. ie. Any from food and calcium, magnesium and iron. I duly obeyed.

Many years later an endocrinologist told me that taking it with food, magnesium, calcium, iron wasn’t a problem.

When I’m taking T3 now I take the middle road. Don’t mind about taking it with food but don’t take supplements. I think there are mixed views here on the forum about whether it has to be taken without food.

My mantra is always whatever you do, be consistent. If your levels do fluctuate you can always adjust T3 dose.

It’s not really a big deal. When you’re in hospital they dole out all your meds with breakfast. 😎

[arTistapple in reply to Hidden]

Totally agree about consistency. When you have an established routine it’s important. Eg I have followed advice on the forum which seems to be that any ‘metal’ supplements should be taken four hours away from levo in particular. It’s allegedly a ‘fussy’ hormone. Just interested in what you say because of the potential to be calming/settling.

[anglobike in reply to arTistapple]

See my reply to Samking 😊

[samking5 in reply to anglobike]

I’ve never found magnesium to do that much for me

[Hidden in reply to samking5]

I take 400 mg a day. It. Definitely relaxes muscles and helps constipation

[anglobike in reply to samking5]

I am sorry to hear that you haven't felt any benefit from magnesium so far. What kind have you taken in the past?

I do well with Mg glycinate and I definitely need it, especially if I am physically active or sweat a lot.

Taking the T3 will rev up your metabolism, so you will use up more ATP. Magnesium is one ingredient of ATP so it can be quickly depleted if you are already low in it.

Some people also get raised adrenaline from T3, and magnesium can help to tamper the adrenaline response.

[samking5 in reply to anglobike]

oxide, glycinate and citrate, the latter does not agree with me at all! others cant really say I was concisely aware they were doing anything for me.

[SarahJane1471]

I started on 2.5 in the morning only. Then after a couple of weeks up to 6 mornings only. But recently felt a bit over medicated even on that. So I have dropped back down to 2.5. We are all different and react in different ways. 🤷‍♀️

[samking5 in reply to SarahJane1471]

Ok, where were your levels at before starting the t3?

[SarahJane1471 in reply to samking5]

FT4 75% FT3 25% through range so I needed a little bit of T3. That was after 18 months of Levo only. TSH just below range

[samking5 in reply to SarahJane1471]

sure, my last test t4 at 35% ft4 at 60%, ive tried many times increasing with levo and FT3 never rises proportionally to ft4, always end up with high ft4 low /mid ft3.

[SarahJane1471 in reply to samking5]

Ok so perhaps try a little T3. It’s worth a try 🤷‍♀️

[rick2525]

Hi samkingAs Sarah Jane says everyone is different. I was prescribed 20 mg T3 exactly a year ago. My introduction to T3 was with 5 mg tablets. My endo reduced my Levo from 125 mg to 100mg and I was recommended to introduce T3 gradually. I started on 5mg daily and increased to 10mg after 2 weeks. Then to 15 mg after 3 weeks. You will notice some reaction to the introduction perhaps (mine was slight tremor) but I found that this wore off eventually as my body accepted it. After 3 months I was put on 2 x 10mg capsules by the pharmacist as they were deemed cheaper than the tablets ( this is NHS saving money on cheapest option). I was quite ok on this. My advice to you is start on low and monitor your own body reaction on when to increase.

[BrownBella]

Hi, I was splitting a 25mg tablet into 4 and taking a quarter twice a day, didn’t take levo as it raises my blood pressure and made me pre diabetic. I take Metative tablet twice a day also. Don’t feel 100% but my blood has gone back to normal and no longer pre diabetic.

Hope t3 works for you.

[marinria]

Hi! I am quite small and sensitive to medication, and I only take 2.8 mcg of T3 daily of liquid liotironine. When I used NDT I only took half grain (less than 5 mcg of T3) + levo. This small amount of T3 is enough to bring my FT3 to midrange. I guess it happens because T3 stimulates my adrenals and helps conversion of levo to T3. So I suggest you start low and if you feel ok retest your hormones before further increase.

[marinria in reply to marinria]

Sirry, I only take 2.8 mcg T3 and 63 mcg levo

[KHSC]

Hi

I started on 3 x compounded 2.5mg tablets for 2 weeks, then increased to 3 x 5mg.

Prescription filled via Roseway, £225 for 90 tablets.