Hi there, can I please get some advice. I’ve been on 25mcg T4 and 45 T3 (20mcg at 8am, 15mcg at 2pm and a final 10mcg T 3pm) for a while. Was feeling fairly stable but not quite back to normal. Last few days I’ve been feeling really tired in the morning and then by 5pm feeling less tired but very spaced out, confused, breathless, hot and a bit jittery. My heart rate is in the mid 60s for much of the day but peaks into the 90s after my last dose before falling back and then weirdly peaking again about midnight. I can’t work out if I’m over medicated or if my dosing schedule is wrong.
last tests were conducted on 13 July 2023 at 8 am prior to daily doses of T4 or T3.
TSH 0.04 mlU/L [0.38 – 5.33]
T3 5.3 pmol/L [3.8 – 6]
T4 3.7 pmol/L [7.9 – 14]
I’ve a GP appointment tomorrow and he’s very supportive so will probably suggest a retest. I have an NHS endo but I’m not due to be seen until November and so far they’ve not responded to my call asking for advice.
I’m tempted to reduce T3 to 40mcg and maybe take my last dose later in the day. I definitely feel better with T4 in the mix so also thought another strategy would be to add in another 25mcg and reduce T3 to something like 30mcg.
Be great to get some advice or shared experience, I really thought I was making progress so I’m a bit hacked off.
I can see I posted about this a month ago when the main problem was the return of fatigue.
Please excuse the typos - it’s a mix of poor eyesight, a tiny phone keyboard and giant fingers
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Hashiboy
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Hi Hashiboy, I’m wondering if the high heart rate later on could be the t3 wearing off as your last dose is at 3?
I am conscious that you feel the benefit of the t3 but as a hunch I would say the dosing isn’t high enough in either. A small dose of t4 and a small dose if you were completely t3 only. Have you tried raising the t3 any higher? What is your temp and bp like? ☺️
Thanks for the reply Beau55 I think you are right and I’ll have to experiment with an increase or a change of timing. I’ll ask my GP to check out my T4 and T3 levels to get an am idea.
Hi Hashiboy, I take a similar dosage of both T4 and T3(although my T3 is slightly higher at 50mcg/day). I find that I too need that 25mcg of T4 to feel at my best, but I take my T3 divided into only two doses. The largest dose of 30mcg is taken at 6am with water after which I’ll snooze for a bit (at least half a hour) before getting up and having a cup of tea. Then my second dose will be 20mcg at around 4pm (no restrictions on drinking coffee or tea before or after that dose) I take my 25mcg T4 at bedtime. I used to take my T3 in 3 doses during the day, but found reducing it to just 2, with the larger dose being in the morning, being better for me. My blood test results are very similar to your with my FT4 just being slightly higher at 5.3, but I feel well on it and haven’t noticed any strange increase in heart rates.
That’s really helpful Zephyrbear . I just spoke to my GP and agreed to do tests then make some adjustment and see how that works in eight to ten weeks. So trialing a regime like yours might be a good option.
I am not as knowledgable as the other members here, but your lab tests are a bit confusing to me. Your TSH is very low, T3 is high and T4 is low BEFORE any meds. So, I don't understand why you are taking T3. Shouldn't you be taking T4, if at all. In any case, T4 therapy is the standard one as T4 gets converted to T3 by the body, as and when it needs it, and giving T3 directly is going to give you the kind of ups and downs that you are experiencing and is generally prescribed only for those who do not convert T4 to T3 well. Also, since T3 was already high, why was further T3 prescribed? Feeling hot is a definite symptom of too high T3.
Hi am111 sorry for the confusion, the tests aren’t before starting treatment with any meds at all they are before my first dose of the day. Lots of people test first thing before medication to avoid any recently taken medication showing up as a spike in T3 or T4 test result that doesn’t reflect the range across 24hours. In a perfect world we’d have continuous T3 monitoring to see how we are doing across the day to help plan dosing - but that doesn’t exist yet. I take T3 because I am under the care of an endocrinologist for severe hypothyroidism and I failed to recover after years of T4 mono therapy and I carry the genetic polymorphism linked to poor intracellular T4 to T3 conversion. Even though I am currently having a little problem I still do much better on T3 and T4 combo.
So far in my limited experience of T3 is that when my heart rate picks up (and horrible frightening powerful palpitations) I need my next dose. I have to say after umpteen times in guidance by SlowDragon I finally had the courage to attempt taking more rather than less, or even stopping, which I have on other ocassions. Your message from your body might be about just adjusting the timing of your doses. I would try that first before mucking about with dose size.
I came across this the other day & found it very interesting, it may help you ... I also read somewhere that too much T3 can cause flushes & other symptoms ... Great that your doc is supportive ... We're all so different it's just finding what works best for your body ... Good luck with it all🍀
Thanks CocoBaloo yes, I’m lucky to have an enlightened GP (he’s always seemed more helpful than most endocrinologists I’ve seen). Thanks for the good shamrock ☘️
I read that article before and have to admit I got the gist but it was much to complicated to put into practice.
I’ve been feeling really tired in the morning and then by 5pm feeling less tired but very spaced out, confused, breathless, hot and a bit jittery. My heart rate is in the mid 60s for much of the day but peaks into the 90s
You might find this interesting-
"If on T3 you experience symptoms, including anxiety, insomnia, shakiness, sweating, dizziness, feeling spaced out it's a strong sign that you may need adrenal support." (Tpauk website)
Thanks Hidden I've no idea where to start with adrenal related stuff. I has a morning test for corsitol and a 24 hour urine test a few years ago and think that ws all normal? I'd really appreciate any practical pointers or recommended reading , thanks again.
Just took a look at Tauk and they have a post that gives the list below - does that sound useful?
1.Go to bed by 10 p.m.
2. Eat breakfast by 7 a.m.
3. Avoid excess sugar and starch.
4. Eat low glycemic index meals every 5 hours, i.e., meals in which the rapid-to- digest sugars and starches do not exceed by weight the slow-to-digest meats, fish, poultry and eggs. Better yet, skip the sugars and starches (including the inflammation-inducing grains) in favor of not-overcooked vegetables.
5. Avoid gluten grains if you have a grain intolerance. Feed children sprouted grains to avoid or delay gliaden-intolerance.
6. Maintain erect posture and avoid prolonged periods of sitting or flexion posture (such as fetal position during the night).
7. Control pain.
8. Manage emotional stress. (Following the first 7 guidelines provides a good foundation for accomplishing guideline number 8.)
Preservation of a normal circadian rhythm and preservation of adrenal hormone precursors will delay many of the so-called aging processes. Restoration of circadian rhythm and replenishing adrenal reserves will result in reversal of many of the processes that one assumes are irreversible ravages of time and aging.
thanks Hidden I’m sure you’ve told me that before. I’ll actually read it this time. It’s easy to drift along feeling a bit crappy but then forget to act on the good advice given here.
It took me a good 2 months to collate all the stuff in the bio and get my head around it all, so I understand it’s overwhelming to the point it can feel off putting.
Hi Hashiboy
While I'm not on separate T4 & T3, I take compounded which includes both and recently when I was over-medicated, TSH and FT4 took a dive and the FT3 rose too much.
I was experiencing return of fatigue/hand tremors and wasn't sure it was under or over medicating until blood tests showed over.
Definitely get your results back before deciding what to do.
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