Getting ready to begin T3... YAY... but...

[wavedancers]

I found a swell Endo (unwilling to wait 6-12 months for the NHS referral), and he's prescribing Tybon Henning 20mcg tablets to chop up. I currently take 75mcg Levo and have done so for 20+ years. I feel like a slug, gained about two stone in the past 3 years, have chronic pain, no libido, a bit depressed, always cold, losing hair, dry skin... basically ALL the symptoms. I'm 68 and have RA as well. I have two questions:

1. His instructions for beginning T3 do not align with some of what I've read on the forum, so I'd like advice on dosing and balance of combo therapy. This is what he told me to do: 10mcg T3 (1/2 tablet) to replace 25mcg Levothyroxine. Start with 5mcg in the AM with 50mcg Levo for 3 days, then increase to 5mcg 2xday with Levo 50mcg. Further increase in T3 as needed.

2. What might I be able to expect as far as relief? I'm so horribly tired...

Here are my last blood results (I have posted them before, but may be helpful)

TSH 1.13 mIU/L (.27 - 4.2) 21.9%

Free T4 (fT4) 23.5 pmol/L (12 - 22) 115.0%

Free T3 (fT3) 2.4 pmol/L (3.1 - 6.8) -18.9%

T4:T3 Ratio 9.792 

Thyroglobulin Antibodies (TgAb) 89.1 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 600 IU/mL (≤ 34)

C-Reactive Protein (CRP) 0.35 mg/L (≤ 3)

Vitamin B12 150 nmol/L (37.5 - 188) 74.8%

Vitamin D 112 nmol/L (50 - 250) 31.0%

Ferritin 104 ug/L (30 - 650) 11.9%

Thanks in advance you lovely people 💙

[Lalatoot]

If those were my results I wouldReduce levo by 25mcg and wait a week for level to fall.

Add 5mcg quarter tablet t3 to levo dose. Wait 1 week.

If all ok add another 5mcg t3 as a separate dose. I take my 2nd dose at bedtime.

You can stop there wait 6 weeks and do bloods

Or

You can keep increasing t3 by 5mcg every 2weeks until your total daily dose equals 1 tablet. Then wait 6 weeks do bloods.

[TiggerMe Ambassador]

Brilliant 👏 with a fT3 as low as yours I would expect you to regain a whole lot of functions that must be a huge struggle at the moment!

How has he told you to introduce the T3?

My inclination would be to alternate T4 50/75 and add in 5mcg T3 for a couple of weeks to see how you feel as it might come as a big shock to your system! If that goes well add in a second dose of 5mcg 8 hours from the first and again see how that feels.... take it slowly until you know how if feels, if you have a surge and then drop off you might either want to add in another dose or alternatively just take one dose a day... it really depends how your system accepts it... 🤗

Your adrenals must be knackered having held you up for years so they might get the hump with this new stress to deal with

[wavedancers in reply to TiggerMe]

Hello Eeyore! Yes, I'm quite happy about FINALLY getting the T3 and also having a sympathetic Endo to boot!

His instructions:

10mcg T3 (1/2 tablet) to replace 25mcg Levothyroxine. Start with 5mcg in the AM with 50mcg Levo for 3 days, then increase to 5mcg 2xday with Levo 50mcg. Further increase in T3 as needed.

It sounded a bit too aggressive to me so that's why I posted. Thanks so much for your dosing reply!

[TiggerMe Ambassador in reply to wavedancers]

Very happy for you 🤗 isn't it such a relief 💃

I'd be a bit reluctant to drop T4 by 25mcg from the off as when I added it in my fT4 dropped from 100% to 50% without any reduction in dose.... later when I finally saw the NHS endo who agreed to take on the prescribing she wanted me to drop my T4 and it went down to 24% and I felt dreadful even with a reasonable level of T3 ( I was a little intrigued to see if I was going to be a T3 only case)

So I would say T3 is marvellous yet even when a bad converter like me I need to keep T4 around 60%

I would also add that timing of T3 makes almost as much difference as amount so don't be afraid to try each dose with different timings before moving up or down... I take all mine first thing with T4 and I tick over nicely all day... having tried splitting which created crashes 5 hours after a dose and bedtime dosing which had the wrong effect on my sleep 😕

So for me 15mcg in one dose is far more effective than 25mcg in split dosing 🙃

[TiggerMe Ambassador in reply to wavedancers]

I added a bit about timings too 🤗

[wavedancers in reply to TiggerMe]

Brilliant! Thank you!

[SlowDragon Administrator]

Which brand levothyroxine are you taking

Are you on gluten free and/or dairy free diet

What vitamin supplements are you taking

Was test done as recommended…..early morning, ideally just before 9am, only water to drink between waking and test and last dose levothyroxine 24 hours before test

Adding T3

Only start with 5mcg initially……

or possibly split as 2.5mcg waking and 2.5mcg later in day

Get a sharp craft scalpel to cut 20mcg into 1/4’s

Then cut 1/4 into 1/8th for first few days

Assuming that’s ok

Increase SLOWLY up over next 2-3 weeks

Initially to 5mcg twice day

Possibly waiting at this point and retest 6-8 weeks later

Or might increase to 3 x 5mcg first …..then retest

[wavedancers in reply to SlowDragon]

Hi SD, I'm on Teva and don't seem to have issues with it. I tested as per your directions and am strict GF + DF (vegan... have been for years). I supplement with Vite D, Liposomal B (has folate), Better You Iron + Zinc, Flax, Omega 3-6-9, and Red Marine Algae (calcium). I always wait 2 hours after Levo before having caffeine and 4 hours after for food.

Thanks for the dosing breakdown ~ It's very easy to follow. ☺️

[SlowDragon Administrator in reply to wavedancers]

Your Ft4 is high, but you’re only on low dose levothyroxine at 75mcg

How much do you weigh in kilo?

I would only perhaps only reduce levothyroxine to 67.5mcg ……especially initially when only adding 2 x 2.5mcg

We usually advise reducing levothyroxine 3-4 days before starting T3

[wavedancers in reply to SlowDragon]

I hate putting this number, but at 5'2" tall, I'm 78.6kg 😑 Good to know about WHEN to start the reduction... THANK YOU!

[SlowDragon Administrator in reply to wavedancers]

so guidelines for when only on levothyroxine suggests you might need 125mcg levothyroxine per day

So it’s very unlikely you need to reduce dose levothyroxine at all ……but to keep endocrinologist happy…..perhaps try 67.5mcg per day

Adding T3, as metabolism improves, many members see Ft4 fall and they then need to increase levothyroxine back up

[Hidden in reply to SlowDragon]

Sorry to butt in SD. Are you saying that when, on NDT, FT3 is high in range and FT4 low, we should add Levo to NDT?

[RedApple in reply to Hidden]

Everywhere2 'Are you saying that when, on NDT, FT3 is high in range and FT4 low, we should add Levo to NDT?'

There's no 'should' about anything when it comes to thyroid hormone medications. We need to experiment and find what suits us as an individual, not blindly follow the flock.

Personally, I find adding 25mcg levo to my NDT helps a lot. I know others do too, but that doesn't mean it's appropriate for everyone.

[Hidden in reply to RedApple]

Thank you. I misunderstood   SlowDragon post.

Adding T3, as metabolism improves, many members see Ft4 fall and they then need to increase levothyroxine back up

I’m still not clear about the ‘back up’ concept. I never gave it much thought until now.

[DippyDame]

Free T4 (fT4) 23.5 pmol/L (12 - 22) 115.0%

Free T3 (fT3) 2.4 pmol/L (3.1 - 6.8) -18.9%

Good grief, no wonder you feel unwell!

Your FT3 is rediculously low with over range FT4

Your T4 to T3 conversion is very poor and likely causing the high FT4

Adding T3 will eventually help lower FT4 and TSH

Essential to optimise vit D, vit B12, folate and ferritin to support thyroid function/ conversion

Your antibodies are high....a gluten free diet usually helps

You now need to work out how much T3 you need....we are all different so you need to use your labs and monitor your symptoms.

I would follow Lalatoot or SlowDragon's advice.

Testing and symptoms will guide you to your therapeutic dose but be patient...it will take time

How have you been advised to start T3? A larger starting dose than advised above may be too much for your system to initially cope with!

You ned to raise your vit D to at least 100 and ferritin to half way through range

No folate result....

Correct medication will make you feel better

[wavedancers in reply to DippyDame]

Thank you! I have edited my original post to show his instructions. For some reason, Medichecks said that my folate couldn't be tested and that sometimes that happens with certain patients' blood... 🙄

[Hidden in reply to wavedancers]

That’s strange!

[wavedancers in reply to Hidden]

Yeah, I thought so too. Hopefully with my next test they'll be able to get some results...

[Hidden in reply to wavedancers]

From Medichecks website

Read before you order: Folate failure rates.

Due to customer demand, a finger-prick option is available for this test. However, folate has a higher-than-normal failure rate on finger-prick samples.

[DippyDame in reply to wavedancers]

As I suspected he advises a larger dose than is recommended here.

SlowDragon has given you good, detailed advice, I would absolutely follow that.

Not a very helpful response re folate!

You may be able to order another test FOC

medichecks.com/blogs/blood-...

What happens if there is an error with my sample?

If our laboratory finds an error with your sample, we'll notify you by email as soon as possible. There is absolutely no reason to worry.

If it was your first time collecting a finger-prick test, many of our customers have a better success rate on their second attempt. You can order a new finger-prick test, completely free of charge by calling our Customer Care team (making sure you have your order number and PID to hand).

Alternatively, if you would like to upgrade your order and opt to visit one of our partner clinics or arrange a home visit, our Customer Care team will be able to organise this for you.