new results after liothyronine trial

[Mag999]

hi all, latest results after first 2 months on 50mcg levothyroxine and 5 mcg liothyronine

I’m thinking I’m a bit low on t3 and 4 so wonder if 75 and 10 is a reasonable next step ?

[greygoose]

Never change two things at the same time, or you won't know which one helped - or made things worse. I would start by increasing T3 by 5 mcg, if I were you, and see how it goes.

[Lalatoot]

Mag those results do suggest a need to increase. Only increase 1 at a time though so you know what is causing any symptom or benefit.

[Buddy195 Administrator]

In your last post you said you felt feverish, had a headache, felt irritable & tired. Has any of these symptoms lessened at all?

As others have said, an increase in medication seems sensible, as your FT3 and FT4 are very low in the range. I’m a fan of ‘low and slow’ when adjusting (as I get adverse symptoms from making changes too quickly), so I would add 2.5mcg Lio for a few days (until we’ll tolerated)and then add another 2.5mcg.

[arTistapple]

OK I am watching your experience and have read through your posts and bio. It’s not that I can help I am afraid. I am trying to learn from your dosage history what might be happening to me. greygoose Lalatoot Buddy195 Your T4 seems to have run ‘high’ for quite a while. So from that, it’s my understanding that T3 can reasonably safely be introduced. From the point of view that introducing T3 when your T4 levels are high, you are less likely to make yourself more hypo? However since the intro of T3 now your T4 and T3 are both running low. I am wondering why the preference is to raise T3 particularly? GG and Buddy seem to agree on which should be raised (T3). Mag you don’t say how you are getting on here. What is your reason for wanting to change your dose? Unwell or thinking of adjusting your dose in response to the blood test results only? I really would like to know as I have had so much trouble introducing T3.

[Mag999 in reply to arTistapple]

I feel low, less energy, I dropped the levo on advice of doctor as t4 was top of range so I’m surprised how much it’s dropped also t3 only 0.3 higher than pre liothyronine so 5 mcg not done much. I think 75 levo is right for me I was around 18-30 but I hear what people are saying about changing one thing at a time, thanks for reminder 🤣. Have messaged private gp who prescribed liothyronine with my results interested to see what she suggests so will report back. I do feel I’m on a better track than levo alone.

Am away with little Wi-Fi so may not reply unless I’m in a pub but very grateful for all responses.

[greygoose in reply to arTistapple]

I am wondering why the preference is to raise T3 particularly?

Because T3 is the active hormone which causes symptoms when it's too low. T4, whilst some people need quite high levels of it, is basically a storage hormone that doesn't do much until it's converted into T3. So, as Mag is a poor converter, to feel well, she needs higher T3 as a priority. She can see if she needs to raise her T4 later.

[arTistapple in reply to greygoose]

The words I understand. It’s the concept I am still unsure about. So Mag (sorry Mag for speaking about you on your post but this is a big learning curve for me) agrees she feels low enough to adjust her dose. No dramatic symptoms since introducing T3, therefore it’s safe enough to increase her T3. Ok I think I get that - if that’s something approaching the reasoning behind the T3 increase. My circumstances were different. I could not even make it to the blood test!

[greygoose in reply to arTistapple]

Well, all our circumstances are different. But we have to understand the concepts and adapt them as best we can to our needs. I'm afraid I can't remember your history, so I can't really comment. Nor, really, do I understand what you don't understand in all this.

Increasing T3 at Mag's level is obviously 'safe'. In fact, even going over-range isn't that much of a problem if it's what you need. If you don't need it, it'll make you feel so bad that you'll reduce it again pretty quickly. I don't think the word 'safe' really has much to do with T3 therapy. It's not a drug.

[SlowDragon Administrator]

take 2nd dose T3 Approx 8-10 hours after first dose

Or if you have 5mcg tablets…you could cut in half and add 2.5mcg mid afternoon…….and week or so later add another 2.5mcg at bedtime

often T3 improves sleep

If T3 initially keeps you awake try taking earlier in evening of late afternoon …..but may find can slowly move last dose later after few weeks/months

Retest in 6-8 weeks

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test

Then likely results will show need further increase…..wait to see results before considering whether to increase levothyroxine or T3

Meanwhile essential to maintain OPTIMAL vitamin D, folate, ferritin and B12

[Mag999 in reply to SlowDragon]

Very helpful, thanks and yes have been optimising all other vits and mins for past year so getting there now!

[LAHs]

I agree with the increase in T3 first but here is another factor: Take your blood pressure before you increase your T3 dose, stay on the increased T3 for a couple of days then take your blood pressure about an hour after your T3 (let's assume that's the morning) and then about 8 hours after your T3 (say, evening). I mention this because when I was fine tuning my T4/T3 doses my blood pressure shot up to begin with so I had to reduce the T3 - although I felt great. It would not have been a good idea to assume I had hit the right level of T3 by how I felt alone since it had affected my BP significantly. The difference in BP (if any) between the morning and evening measurements are significant and it might be of interest to repeat measurements of BP throughout the day to find out when your BP stabilises and at what pressure it does so.

[Mag999 in reply to LAHs]

Thanks I didn’t know about this. I do have low bp all the time so will be interesting to see what the effect is

[Mag999 in reply to LAHs]

Can I ask what happened with your bp? T3 definitely raising mine too high diastolic 104 3 hours after taking it. This is since adding the second 5 mcg dose. I need t3 according to blood results but obviously I don’t want to cause more problems. I’m getting t3 via a private gp who didn’t warn me about bp changes or take my bp so I’m on my own. My own gp will just tell me to stop. Is it a question of slower increases, did you manage to adjust safely?

[LAHs in reply to Mag999]

Hi Mag999, first off is that really your diastolic? If you really meant systolic then there is no problem, if it really is diastolic, read on.

Systolic is the "first" and higher reading, diastolic is the "second" and lower reading. A typical pair of readings is 120/60 for a young adult.

It is a bit tricky to hit the right dose of T3 because you only get to alter the dose every 24 hours. I hope you have one of those small BP meters you can buy at the chemist. Before you take the extra 5mcg, take your BP, if it is the normal state you are familiar with then instead of 5mcg of T3 cut it in half and take 2.5 mcg. Wait about 20mins then take your BP again - both systolic (sys) and diastolic (dia). Now, (before taking the T3) if your BP was still high from your last (yesterday's) dose, wait 24 hours before doing what I just described.

So, if your sys and dia pressures are reasonable (what you are familiar with) then 2.5mcg is a good dose for you, stop there. If your BP is still elevated, halve the dose again and repeat the measurements. Of course you may reach the limit of how far you can cut that pill but I think you will get to the sweet spot before that happens. Do not take T3 to the detriment of your BP, that might be the basis of the saying that "taking T3 affects the heart" - which is one of the reasons docs won't prescribe it.

Yes, I did reach a balance of a T3 dose which made me feel good but my normal BP is now 130/60 instead of 120/60, but this is not in the concern level and certainly not in the danger level of higher BP.

Now, if any increase in your T3 dose does not do the trick as far as BP goes there is one other thing you could try. First get a blood test which includes your selenium level. Selenium is needed for the T4 to T3 reaction (it's called the catalyst), if you have none or very little selenium then you will not generate any T3 from any of your T4. Get a selenium supplement or eat good quality Brazil nuts - or any other natural source of selenium. Do that for about a month then measure your T3 level again, it will probably have increased.

Hope this helps, don't get discouraged because of the time all this takes, it is very frustrating. It took me at least two or three years to get normal.

[Mag999 in reply to LAHs]

Yes it was my diastolic so was a bit worrying. It did go down after 4 hours to normal for me at 105/75

Thanks for spelling out how to go about this, hopefully I can get stable readings as the t3 does help on so many other ways.