Add a bit of liothyronine or just increase levothyroxine?

[Camelias]

My results on only 100 levothyroxine is

tsh 0.25(0.42-4.2)

ft3 4.2 (3.6-6.5)

ft4 16 (12-22)

I have access to liothyronine so would be able to start low dose on that to add to my levothyroxine. Would you recommend starting liothyronine or just increasing levothyroxine?

[SlowDragon Administrator]

FT4: 16 pmol/l (Range 12 - 22)

Ft4 only 40.00% through range

FT3: 4.2 pmol/l (Range 3.6 - 6.5)

Ft3 20.69% through range

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)

Was test done like this

Assuming yes….You have plenty of room to increase dose levothyroxine

How long have you been on 100mcg and which brand

When were vitamin D, folate, ferritin and B12 levels last tested

What vitamin supplements are you taking

[Camelias in reply to SlowDragon]

Thanks.

I am taking my levy twice a day so last dose was 12h before test the night before. Would you think it would be a good idea to add 5mcg liothyronine instead of increasing levy since ft4 is higher in range than ft3?

[SlowDragon Administrator in reply to Camelias]

So if you had taken last dose levothyroxine 24 hours before test Ft4 would have been even lower

So definitely increase levothyroxine as next step

And get vitamin levels tested

If your hypothyroidism is autoimmune get coeliac blood test before trialing strictly gluten free diet

[Camelias in reply to SlowDragon]

I was on 100mcg a year ago and the results were:

tsk 0.12

ft3 4.9 (3.1-6.8) 48.6%

ft4 19.8 (12-22) 78%

Would it be ok to add liothyronine this time instead of adding more levo since the conversion wasn't great?

[SlowDragon Administrator in reply to Camelias]

I would increase levothyroxine FIRST

Currently not on high enough dose levothyroxine

Try 112.5mcg daily….retest in 8 weeks

[TiggerMe]

Increase levo as your level of fT4 is low, adding T3 becomes an option once your fT4 reaches the top of range and your fT3 isn't high enough 🤗

[pennyannie]

Hello Camelias and welcome to the forum :

We generally feel at our best when the T4 is up in the top quadrant of it's range so at around 80% through the range with a T3 tracking slightly behind at around 65% through it's range -

or put another way - oon T4 monotherapy once the T4 is up in the top quadrant the T3 should be coming in at around a 1/4 ratio - T3/T4 - ( just divide the T4 reading by the T3 reading ) .

Your conversions looks ok - but your T4 just not hgh enough in it's range yet to fully maximise it's conversion and relieve symptoms.

No thyroid hormone replacemnt works well until your core strength vitamins and minerals are up and maintained at optimal levels .

Do you have any results and ranges of ferritin, folate, B12 and vitamin D ?

There is nothing on your profile page - what is the reason for your hypothyroidism - what were you diagnosed with and when ?

[Fencerope]

hi, personally I would try increasing thyroxine first, as that should bring the t3 up a bit, best to try just 25mcg at a time and see how you feel before increasing. Have you been prescribed t3? It’s rarer than hen’s teeth to get it on the nhs now , so if you have a reputable supplier, please let me know as I will need some soon, hope this helps.