Should I reduce dose slightly? T3/T4 combination therapy

[CatACat1]

Hello lovely people.

I recently had my bloods done and met with my endocrinologist, and wanted to ask your thoughts.

I am currently on 87.5mcg Levothyroxine and 25mcg T3 daily. I feel better than I have in a long time, though possibly slightly anxious (difficult to tell though as I am prone to anxiety anyway).

Bloods taken 8th Jan am, following protocol recommended on here:

TSH 0.005

T4 21.2 (12-22)

T3 6.5 (3.1-6.8)

As you can see, my levels are right at the top of the range. Endo was happy for me to continue on this dose as I feel good, but I guess I was a bit spooked by how near the top of the range these both were, and he said perhaps I could try reducing the T3 very slightly if I was concerned.

I am 42 currently. If I were to (hypothetically) maintain these levels for the next 20 years, would that be likely to cause any long term health problems, eg osteoporosis/ heart issues?

Any thoughts gratefully received, thank you!

[greygoose]

First thing you need to understand is that ranges are only a rough guide, not a cast-iron barrier that you mustn't cross. They are just telling you what average levels are, but that doesn't mean to say that yours have to be the same. You might need more, you might need less. Hypothyroidism is a very individual disease. You might find this article interesting:

ncbi.nlm.nih.gov/pmc/articl...

That said, recent research has found that long-term high FT4 can be implicated in the development of some cancers. See the posts of jimh111 for further information on that. So, it might be a good idea to reduce your levo slightly. But, as far as I know, the FT3 is fine.

[CatACat1 in reply to greygoose]

Thank you, this is helpful about the ranges, and also slightly worrying about the link to cancer - I think I’d read that on here a while ago and forgotten - thank you so much for the reminder!

[greygoose in reply to CatACat1]

You're welcome.

[Buddy195 Administrator]

We are all differently CatACat1 and it’s very much trial and error to find the dose that’s optimal for you. Personally, I’ve found my anxiety increases if my FT4 is high in the range (although I’m fine with FT3 being high in the range). When I was on a similar dose to yourself I lowered Levothyroxine from 87.5mcg daily to alternate days 75/87.5. Alternatively, you could try reducing Lio from 25 to 20mcg day. From experience, I would urge you just to adjust one thing at once…. I got in a terrible muddle trying to change different medication at the same time!

[CatACat1 in reply to Buddy195]

Thank you - interesting that you find the T4 more closely linked to anxiety. Had read lots of posts about people struggling to increase T3 doses because of getting anxiety, but didn’t think about the T4 in relation to that. In conjunction with Grey Goose’s post about the link to cancer, I might try what you suggest with the alternate days - not quite as drastic as reducing back down to 75mcg every day. Thank you!

[SlowDragon Administrator]

What are your most recent vitamin D, folate, ferritin and B12 results

What vitamin supplements are you taking

Is your hypothyroidism autoimmune

I would agree with Buddy195

Perhaps a TINY reduction in Levo ….

Eg

Try 75mcg twice a week, and 87.5mcg 5 days

Which brand of levothyroxine are you using

[CatACat1]

Yes, I think you might be right about the Levothyroxine - thank you.

I am on Wockhardt 25mcg - and use a pill cutter for the extra 12.5mcg.

Vitamin results below - hopefully readable

Thanks!

Blood test 2/12/2023

[Brightness14]

Mine results are very like your own. Near the top of the range to feel very well. I am 77 years old with no heart or bone issue and no thyroid.

[arTistapple]

And CatACat1 just living without good quality support from our ‘medical helpers’ does not exactly fill us with confidence. Concerned all the time that they may change our medication because they are erroneously calculating on TSH alone. Re: anxiety being hypo has all sorts of challenges. It’s always a work in progress - it seems.

[serenfach]

The initial range for TSH was arrived at by testing 29 men. Try telling that to a GP!

Think of the ranges like shoe size. Some people take size 13 adult shoes, but the range would say they need size 6. And your body has not read the book that said there are ranges.

You seem to have a good endo there, so hang on to him!

[Simplyred57]

Hi my results 7 months ago were identical to yours and my endo wanted me to reduce my thyroxine , so with the advice on here and Seasidesusie who was so kind and knowledgeable I reduced by just 50mcg per week Tuesday & Saturday and it’s reduced both my levels slightly and I feel fine 😊

[CatACat1 in reply to Simplyred57]

Interesting, thank you!

I’ve got another blood test next week just to double check where I’m at, then I think I will give the same thing a go 🙏