Increase needed but do I increase T4 or T3?

[Guineapiggy]

I have added liothyronine to my levothyroxine. My latest results indicate that an increase in one or the other is needed. Medichecks and Monitor My Health use the same ranges.

18.8.23 Medichecks (112.5 mcg levothyroxine only)

TSH 0.101 mu/L (0.27-4.2)

FT3 3.9 pmol/L (3.1-6.8) 21.62% through range

FT4 24 pmol/L (12-22) 120%

31.10.23 Monitor My Health (100 mcg levothyroxine, 6.25 mcg liothyronine)

TSH 0.03 mu/L

FT3 4.3 pmol/L 35.14%

FT4 21.6 pmol/L 96%

2.1.24 Monitor My Health (87.5 mcg levothyroxine, 12.5 mcg liothyronine)

TSH 0.02 mu/L

FT3 4.3 pmol/L 32.43%

FT4 18.7 pmol/L 67%

18.8.23 Medichecks Advanced Thyroid Test

CRP 0.859 mg/L

Ferritin 198 ug/L (30-650)

Vit B12 148 pmol/L (37.5-188)

Vit D 159 nmol/L (50-250)

Folate test failed but previously on 11.8.22 it was 18.8 pmol/L (3-20 )

I realise that I should have only increased the T3 intake rather than decrease the T4 as well, but I felt that T4 at 96% through the range was too high.

Should I keep the liothyronine dose the same and go back to 100 mcg levo first or increase the liothyronine to 25 mcg and keep the levo at the same 87.5 mcg? I don"t think an extra 12.5 mcg levo alone (going back to 100 mcg) will make much difference to my free T3 levels and may put me back at the top of the T4 range, and I don"t know is if this is a good idea (or not).

I would be grateful for any advice/comments please.

[Buddy195 Administrator]

2.1.24 Monitor My Health (87.5 mcg levothyroxine, 12.5 mcg liothyronine)

TSH 0.02 mu/L

FT3 4.3 pmol/L 32.43%

FT4 18.7 pmol/L 67%

I would keep the Levo dose the same and add Liothyronine. We all have different ‘sweet spots’ where we feel well. For me, it’s having FT4 around 60-70% and FT3 70-80% (I only found this out through trial & error/ ending us in A and E with ‘hyper like’ symptoms when FT4 went over range)

I’ve personally found it easier to go low and slow when making changes, so I don’t miss this ‘sweet spot’. I use a pill cutter and add an additional 2.5mcg Liothyronine at first, until well tolerated. However, other members are fine adding larger amounts.

[Guineapiggy in reply to Buddy195]

Thank you. That was my feeling. Having T4 at 67% rather than 96% hasn't made any difference to how I feel so I could tolerate it but don't feel happy with it that high. However, it may be that I need it as I think some conversion is happening and the drop in T4 has offset the increase I made in the T3.

[Brightness14]

I would increase your T3 to get it nearer the 6 range. Leave Levo at 87.5 for now.

Increase the T3 to 18.75. Your may need 25mcg what T3 are you on now.

[Guineapiggy in reply to Brightness14]

Thanks. I was thinking that a jump to 25 mcg would likely be OK as the existingT3 level was low enough to sustain it.

[Brightness14 in reply to Guineapiggy]

It depends on you, personally I can't increase by so much. But you could and it would then sort out your FT3 results. When I started on T3 I had to cut up a 25mcg into eights.

[Guineapiggy in reply to Brightness14]

I found cutting it into 4 bad enough!!

[Brightness14 in reply to Guineapiggy]

Exactly what a nightmare.

[Zephyrbear in reply to Brightness14]

At that level of division I would have thought the old mirror and razor blade technique would be more accurate than trying to cut an already small tablet into eighths…

[Brightness14 in reply to Zephyrbear]

I used a craft knife these are scored, so first into half, then quarters and then eights.

I am back on NDT Thyroid s now thank goodness.

[Zephyrbear in reply to Brightness14]

It’s hardly accurate though… it’s bad enough cutting them into quarters, even with a scalpel (my preferred method) because they tend to crumble, so cutting a quarter in half again must be very hit and miss.

[Brightness14 in reply to Zephyrbear]

I only had to do it for two or so weeks, then onto 1/4 and so on. I couldn't get on with T3 anyway so not for long.

[J972]

I’m watching responses to your post with interest, I’m in a similar position - have added T3 and a test last week suggests I’m still hugely undermedicated, plus I’m still very symptomatic (I’ll sort a separate post at some point, I’ve got Covid so am feeling blurgh).

How are YOU feeling on these results?

[Guineapiggy in reply to J972]

Actually, I don’t feel too bad. Certainly better as soon as I introduced the T3. My energy levels are reasonable. I feel my eyes are more tired on the lower T3 levels. The change in meds for the last test did not make any difference to how I felt but then the T3 didn't increase probably because I reduced the levo.I was previously on Metavive before I started an experiment to see if I could manage on levo alone (see previous posts). I found that I couldn't so introduced the T3. However, I felt a lot better on Metavive with my T3 at 100% through the range and T4 at only 42% so, if my experiment does not work very well, I may go back to Metavive and hope it still works as well as it did.

Sorry you have Covid. I've been lucky and never (knowingly) had it. Hope you feel better soon.

[TiggerMe Ambassador in reply to Guineapiggy]

I'd be looking to get similar results to the ones you felt well on with Metavive so an increase in T3, I also found timings made a big difference turns out 15mcg T3 first thing works better for me (no slumps) than 25mcg split across the day so worth experimenting 🤗

[Guineapiggy in reply to TiggerMe]

I've been taking the one dose of 12.5 T3 and levo around 3 am when I wake up during the night as I didn't want it first thing when my husband brings me a cup of tea in bed in case the tea affects absorption!! I always took my Metavive on the morning with my tea and it seemed to work OK. Based on this I could probably increase T3 to 25 mcg and have it first thing in the morning.

[TiggerMe Ambassador in reply to Guineapiggy]

Me too! 😁 no one want's delayed tea! I'd say do it in stages so that you don't miss your sweet spot 🤗 at least when adjusting T3 there isn't the tedious wait!

[Guineapiggy in reply to TiggerMe]

Thanks

[Brightness14]

If you were on Metavive 1 or 11 i.e. porcine that would lower your FT4. The bovine one has more T4 in it. How much were you taking.

[Guineapiggy in reply to Brightness14]

I took Metavive Pro (equivalent to 2 x Metavive II) one day and Metavive Pro with Metavive I on alternate days. This worked for me even though I was told by SlowDragon that I should not take a different dose on different days when on Metavive, but it was impossible to take the same dose as it comes on capsules. I have tried splitting caps but Metavive I is tiny and can only be split by eyeballing it!

[Brightness14]

I see I did try some Metavive too but I couldn't sort out the dosage. I still have 540 x Met 1

to use up. I have no thyroid so don't have any reserve of T3 in place. You sound as if it suited you why did you change to Levo plus T3.

[Guineapiggy in reply to Brightness14]

I went on to Erfa and then Metavive through a private doctor. I switched back to levo because I never tried increasing my levo dose first before trying NDT. I wanted to see if a higher dose of levo would work so I could go back to having an NHS prescription rather than having to pay. I funded private levo whilst reducing the Metavive and when I got to the point where I was on levo only I asked my GP if she would resume NHS funding and she did. I told her that I would fund my own T3. I am now waiting for an endo appt in the hope that they will fund the T3. Unfortunately, I live in an area that does not follow the guidelines so it probably means I will have to source the T3 in future. However if I can't get optimal results then I will resume Metavive.

[Brightness14]

I understand now it's expensive funding your own meds. I live in France and get prescribed Levo plus T3 free of charge but it doesn't suit me. I am back to taking Thyroid s which I took for years before it was changed after Covid in 2022.

It's a cheap alternative for dosing I hope that it works for me again and that you get your T3 on the NHS soon.

[Guineapiggy]

Thanks. Sent you a private message as well.

[Brightness14]

Thank you for the information.