Combi T3 and T4 dosage suggestions

[Carmen72]

Hello..I'm without thyroid since 2009 and use Levo since than. Back in 2018 I used IBSA 125 (74Levo+21Lio) and I was feeling great up to when they take off market. I did a combi for one year between Levo and Liotir but something went wrong (probably I canculated the dose wrong) an I had collateral like sweeting, hot flashes and heart rate increased and I went in some kind of insulin resistant loop caused by too much T3 (probably). My TSH was undetachable so suppose to be in hyper but I was gaining weight so no possible.

So I was scared and interrupt T3 and went back only on T4. Since 2022 I gained loads of weight that I cannot get rid off even with diet/gym, plus menopause the situation is unbearable, so I decide to try again with the combi. I started today.

Can someone advice on the dosage? Anyone knows if T3 and T4 needs to be in a exact %?

For example 80% T4 and 20% T3? I was wondering because IBSA worked for me and the other combinations didn't work out.

I was on 125mcg Levo and today I did 75mcg Levo and 5mcg Lio. My plan is to go up slowly with T3 to avoid bad reactions.

[greygoose]

Hi Carmen72, welcome to the fourm.

I'm afraid you reduced the levo by far too much. 25 mcg would have been quite enough - if you even needed to reduce it. It's not always necessary because taking T3 will reduce the FT4 level.

But, did you have labs done before you started the combo? You really should know where your FT4 is before starting. And in any case, it's not a good idea to reduce levo and start T3 on the same day. If you're going to reduce the levo, it should be done about a week before adding the T3.

But you were right to start on 5 mcg and work up slowly. That's the best way to do it, increasing by 5 mcg after two weeks. Then, if you get up to 20 mcg, without feeling over-medicated, hold that dose of six weeks and retest.

[Carmen72 in reply to greygoose]

Yes I did my blood test on Friday so results on Tue and I'll know my starting point.

Ok then your suggestion is to reduce levo to 100mcg for 1 week than add 5mcg of T3 and wait 2 weeks and see how it goes right?

I reduced to 75mcg because in the IBSA there is 74 T4 that's why.

Anyway for one day I think it will be not a big problem, I can start form today

[greygoose in reply to Carmen72]

Yes, maybe there is 75 mcg in the IBSA, but you were taking 125 mcg. And reducing by 50 mcg in one go is too much. Too much of a shock for the body. The body doesn't like big changes. It would have been better to reduce to 100 mcg, a week later add the T3, then see how you felt and if you really needed to reduce the levo by any more. But, as you said, after only one day, it's not a problem.

[Carmen72 in reply to greygoose]

ok great thanks for the suggestions! I'll make small adjstment without shocking the body

[pennyannie]

Hello Carmen and welcome to the forum :

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mg + a measure of T4 at around 100 mcg. and with T3 said to be around 4 times more powerful than T4:

The original first line treatment for hypothyroidism and used successfully for over 100 years was and is Natural Desiccated Thyroid which contains all the same known hormones as the human gland and derived from pig thyroids dried and ground down into tablets referred to as grains with each grain containing a 1/ 4.2 ratio T3 / T4.

eg :- the leading most well known brand Armour states and declares each grain of Armour contains 9 mcg T3 + 38 mcg T4 - and whilst most people find this T3/T4 ratio works very well for them - some do add in a little T3 or a little T4 when finding their unique set point for metabolisation.

So if we divide your IBSA preferred T3/T4 medication I'm getting around a 3.5 ratio T3/T4 :

In the UK the other thyroid hormone treatment options would be individually dosing synthetic Big Pharma options of T3 - Liothyronine and T4 - Levothyroxine and trying to find your own unique ratio of T3 and T4 to give you back your health and well being and your ' you ' :

Currently in the UK - T4 monotherapy is the only readily prescribed treatment for hypothyroidism -

even if without a thyroid -

but you can be referred to an endocrinologist for assessment as to your ' need ' -

but it does appear financial constraints rather than medical need take precedence in certain areas of the country -

though of course if one can afford to go privately - all thyroid hormone treatment options are available - as they were 20 odd years ago on the NHS.

It is said that T3 is around 4 times more powerful than T4 - but there are so many variables to consider regarding conversion within the body, it's not that simply for some and it's probably best to keep an open mind.

I am with Graves post RAI thyroid ablation 2005 and became very unwell on T4 monotherapy around 8 years later and after being refused both T3 and NDT on the NHS in 2017 started self medicating NDT and it works very well for me :

I do need to maintain my core strength vitamins and minerals - ferritin, folate, B12 and vitamin D at optimal levels and eat clean, cook from scratch and avoid gluten and processed foods.

[Carmen72 in reply to pennyannie]

I'm vegetarian so the desiccated thyroid from pigs is not an option, however I heard about it. Anyway you need a medical prescription to get it. I agree on NHS behaviour, I have required T3 long time ago 2017 to NHS and they said NO (this is why I went on IBSA, buying it in Italy), I asked to be referred and also the doctor (2023) at the hospital said my values are fine and the fatigue, incresed body weight it is not due to thyroid but something else (not identified). No one helped. Than the NHS doctor gave me Orlistat but I don't even reach 30BMI and anyway I eat very well and healthy right quantity and I train 5 times a week in the gym. That Orlistat gave me anxiety and I stopped very quickly. My body composition of today is 73.9% muscle and 23% fat, even that I seems like a baloon when you push air inside..and it's becoming worster. I'm mediterranean woman I have been tin in the upper body all my life.

I know my incresead weight is hormonal my face seems bloated, like a baloon ..even my arms are bloated so I'm going for self medication because I can get Liotir in Italy easily, the problem is to guess the right dosage, I'm a bit scared reading the instruction in the product is terrifying. My partner reached by himself the perfect balance he got his thyroid but hipo so he is now on 50mcg Levo and 10 drops Liotir and he feels great, always in shape. So I'd like to reach the same point but how it's my problem.

I take also metformin for insulin resistan patology, 500mg 3 times a day after meal

[pennyannie in reply to Carmen72]

You can self medicate NDT in the UK - as I do as I couldn't afford to get a private prescription.

Ok then so the ratio in your preferred medication was around 1 / 3.50 - T3/T4 -

so to achieve that ratio on synthetics you would be looking for your T3 dose to be around 35% of your T4 dose :

The accepted conversion ratio when taking T4 monotherapy is said to be 1 / 3.50 - 4-50 T3/T4 with most people feeling at their best when they come in this range at 4 or under.

So you have already established you feel best running at around a 3.50 conversion ratio so presume you need to build back T3 and T4 to this ratio your found when purchasing the IBSA hormone replacement combo of T3/T4 :

I have no experience of Liotir from Italy - is there a measure per drop suggested ?

I would suggest you do not undertake too much exercise until you are optimally medicated and with a strong core strength as these may down regulate T3/T4 conversion further when running on limited thyroid hormone hormones.

[Carmen72 in reply to pennyannie]

Liotir is 20mcg/ml so 1 drop is 0.71mcg. To do 5mcg you need 7 drops and to do 20mcg you need 28 drops. My feeling is that IBSA in pills was less strong compared to the drops, I don't know why. At this point to reach IBSA125 I need 74 Levo and about 21 Lio (it means 28 drops). It seems to much to me that was the problem I had when I passed from IBSA to the combi I never guess the right dosage for me and I start having this tachicardia and hot flashes. Maybe because menopause come in and my body changed or maybe because drops are stronger and I messed up the calculation.

I never understood why it was called IBSA 125 mcg if there was only 74 Levo and 21 Lio maybe the other 30 mcg are something else important for the drug to work? Do you know something about it?

Maybe I should stay with this dosage you wrote here:

"A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mg + a measure of T4 at around 100 mcg"

In this case it will be 100mcg Levo and 14 drops Lio = 10 mcg

What you think?

[pennyannie in reply to Carmen72]

I think a liquid is faster absorbed and utilised in the body.

A tablet needs to be digested and broken down in the stomach and tablets can include ' fillers ' which can make the tablet slow release ( SR ) it's contents which may well have been used in this IBSA tablet - we do not know - but would make sense when trying to replicate one's own natural 24 hour cycle of thyroid gland production.

I'm afraid it's all trial and error and whether staying on these drops, or taking T3 tablets - a case of trial and error.

Rule of thumb is to only change either T3 or T4 at any one time - and go low and slow -

and yes these presumed values of production of T3 and T4 in the human gland are just that - but a guide -

When I started self medicating NDT I monitored twice daily - am and pm - my blood pressure, pulse and body temperature so I could track some physical symptoms as I went through slowly increasing my medication -

and whilst the first two remained constant I did see my temperature slowly rise from 35.4 to 36.6 so this gave me some confidence that I was going in the right direction.