Advice Pls

[SilverSavvy]

Having been put on a trial of T3 because I don't convert levo very well, I have my first blood test results back today. Six weeks in. I following SD's/this forum's advice on how to get them done. Normal NHS ranges rather than Medichecks or other private labs.

Free T3: 5.7

Free T4: 20.5

Serum TSH: 0.07

The duty GP (who is not the one treating me) has said that I should reduce my levo from 100mcg daily to 75mcg/100mcg every other day because my TSH is too low. I am inclined to think they might be right...wondering if I am at risk of suppressing the TSH too far - which I think is a common issue when introducing T3 is it not?

My last blood test result on T4 monotherapy indicated that I was only converting 25% into T3 on 100mcg levo daily.

Any words of wisdom gratefully received.

[SlowDragon Administrator]

presumably endocrinologist prescribed T3

GP shouldn’t be meddling

Free T3: 5.7

Free T4: 20.5

Serum TSH: 0.07

We need to know what NHS ranges are

How do you feel

Suggest you stay on current dose and retest in another 6-8 weeks

[SilverSavvy in reply to SlowDragon]

Results with NHS ranges

Free T3: 5.7 (3.1-6.8)

Free T4: 20.5 (11 - 22)

TSH: 0.07 (0.3-4.2)

So all looking pretty good apart from the TSH.

The endocrinologist suggested I take 15mcg per day split into morning dose of 10mcg am and 5mcg pm but members of the forum said that was far too big a dose to start on so I went with 5mcg per day to begin with. Then, because I knew the tests were imminent, two weeks ago week I went up to 10mcg per day although I felt a bit odd on that so reduced it back to 5mcg for the days prior to the test.

I do feel generally much better on 5mcg T3 however, I am a bit whizzy this week and my average daily heart rate has gone up to 63 from an average of 59. But that's a good thing, right? Shows the metabolism is finally ramping up.

However, since it's clearly the T3 I need more than the (25% working T4), maybe I SHOULD do what he says and reduce the T4. My own doc did say I'd probably need to reduce the levo if the T3 worked.

What would be the symptoms of being overmedicated look like? I don't want to cause myself major problems and I won't get to speak to my own doc for a good ten days.

[SlowDragon Administrator in reply to SilverSavvy]

You could reduce levothyroxine to 75mcg twice week initially…..and increase T3 to 2 x 5mcg …..retest in 6-8 weeks

Day before test…..take 5mcg waking, 2.5mcg mid afternoon and 2.5mcg about 9pm

Test 8.45am following morning

[SlowDragon Administrator in reply to SilverSavvy]

what size T3 tablets have you got

You could try 3 x 2.5mcg per day

[SilverSavvy in reply to SlowDragon]

They are 20mcg tablets

[seveneleven in reply to SilverSavvy]

You can still break/cut the quarters into halves again to get 2.5 - I do this because my tabs are 20mcg but I take dose sizes of 7.5 at times. Bit fiddly, but certainly doable!

[SlowDragon Administrator in reply to SilverSavvy]

I started on 2.5mcg twice day ….and only had 20mcg tablets

Cutting into 1/4’s relatively easy with very sharp craft scalpel

Cutting 1/4 in half ….yes it’s a small crumb

Mop up any tiny crumbs with damp finger

[SilverSavvy in reply to SlowDragon]

feel like a drug dealer as it is when I'm chopping them into quarters...the idea of mopping up residue with a damp finger is making me slightly hysterical Now, where's that craft scalpel I bought.....

[SlowDragon Administrator in reply to SilverSavvy]

Oh yes…..definitely……😂😂😂

6 years on ….I am still “Cutting the crack”……chopping 20mcg into 4 x 5mcg per day

[SilverSavvy in reply to SlowDragon]

Are you on mono T3 or are you a mixer, SD?

[seveneleven]

SD is right - GP should know better. Your TSH will always be suppressed once you introduce T3 and is no longer a useful indicator. You should only be paying attention to T4 and T3 levels. The 'danger' is really only when T4 starts going over range/gets too high. Yours looks maybe near top of the range but still within? If you've been on that dose of levo for a while though, and your T4 hasn't been dramatically increasing, then the dose is fine.

[SilverSavvy in reply to seveneleven]

Oh, thanks seveneleven..that's very interesting. Maybe he didn't notice I was on T3 (rare as it is round by us) and was just thinking about someone being treated with usual T4. It's good to know that.

Am I right in thinking that some people don't even have T4 and just use T3?

[seveneleven in reply to SilverSavvy]

Oh he probably knows about the T3 because it would be on your file, but that doesn't mean he understands anything about treating thyroid other than the misguided TSH-is-everything approach. They're essentially trained to put everything on TSH and freak out immediately if it goes below 1, even when someone's on T3. Yep, some people end up on T3 only where T4 either does nothing for them or it makes them feel worse. Plenty are on combo though and find they need both to feel well. If you're generally feeling better these days and improving, I'd take that as a sign that you're on the right track and to not drastically change anything. Would make sense to sit on the levo dose for a while longer, as SD suggested, or only slightly decrease part of the week, and try a small 2.5 T3 increase soon (going from 5 to 10 is doubling your dose, so probably why you felt odd). You seem to be sensitive to the T3, so you may not need much at all.

[SilverSavvy in reply to seveneleven]

Thanks both. Will take your advice and also confer with my own GP in ten days' time. I do feel better for the T3, definitely. I can still work a bit in the late afternoon and generally have more energy in daytime, greater concentration and even better sleep at night. I've been titrating up on the levo for 2 years now and there has been very, very gradual improvement but at only 25% conversion rate on 100mcg daily I have been wondering what happens to the other 75% of the drug Improvement on commencing T3 was almost immediate within the first week or so, but there obviously needs to be yet more fiddling about to get it just right. I ate a lot more red meat than usual last week too so can't help wondering if some of the whizzy effect is down to folate improvement too. It's quite the balancing act isn't it?