Decision about T3 and T4 dosing

[FleetRose]

My endo agreed to add T3 to my Levothyroxine last summer. I have been taking 2 x 5mcg T3 and 50mcg T4 for some months. My results are:

August 2023 - 2 x 5 mcg T3 plus 50/25mcg alternating T4

TSH 0.19 (0.35-4.94)

T4 10 (9-19.1)

T3 3.7 (2.4-6)

November 2023 2 x 5mcg T3 plus 50mcg T4

TSH 0.05 (0.35-4.94)

T4 10.7 (9-19.1)

T3 4.5 (2.4-6)

Because the TSH has dropped below 0.1 my Endo wanted me to halve T3 dose to 1 x 5mcg tablet warning me that low TSH is a risk factor for heart disease and osteoporosis (I already have the latter). I queried this and she, recommended

T3 5mcg 2 x daily and reduce T4 to 25mcg

or

reduce T3 to 5mcg 1 x daily and remain at T4 50mcg.

She will issue a prescription accordingly, including the option of staying on T3 2 x 5mcg and T4 50mcg if I want to accept the risk. She is very flexible and helpful!

I am in a dilemma. I'm already trying to reduce daily steroids (prednisolone for Polymyalgia) and really don't want to go hypo as well. T3 and T4 already do not look high to me!

What would people suggest as the best way forward? Also does anyone have a link to research showing that low T3 is the risk factor and not low TSH?

PS All tests taken as per protocol, vitamins all good but due for retest.

I am petite, 44kg and 74 yrs.

Thank you as always for your time in helping me.

[SlowDragon Ambassador]

You need to change endocrinologist

On almost any dose of T3 your TSH will be very low or suppressed

Most important results are ALWAYS ft3 and Ft4

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)

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

is this how you do your tests

How do you feel

All you results suggest under medicated

Approximation how much do you weigh in kilo

What dose levothyroxine were you taking BEFORE adding T3 ?

What vitamin supplements are you taking

Come back with new post once you get new vitamin test results

Many people on levothyroxine plus small doses of T3 find they need BOTH Ft4 and Ft3 at least 60% through range

August results

Free T4 (fT4) 10 pmol/L (9 - 19.1) 9.9%

Free T3 (fT3) 3.7 pmol/L (2.4 - 6) 36.1%

November results

Free T4 (fT4) 10.7 pmol/L (9 - 19.1) 16.8%

Free T3 (fT3) 4.5 pmol/L (2.4 - 6) 58.3%

suggest you increase levothyroxine to 50mcg and 75mcg alternate days (67.5mcg per day)

Retest in 8-12 weeks

Likely to need further increase after that

[FleetRose in reply to SlowDragon]

Hi SlowDragon

Thank you for your very prompt and helpful reply. To answer your questions:

Tests were done 9.30am with water only before. T4 24 hrs before, split T3 dose 8 hours before.

I weigh 44.5 kg.

I was on 75mcg before T3 trial with tests showing T4 at top end of range and T3 at bottom end. I've had deiodinase test and know I do not convert well.

I have been feeling quite good (improved with T3) considering my muscle aches from polymyalgia (could also be hypo symptom) and steroid side effects. Maybe a bit breathless on exertion.

I take D3, K2, calcium, magnesium, Vit C, zinc, selenium and a multi B vit (stopped one week prior to test).

As you suggest I will post again after my next set of tests.

Thank you for your help. I agree that I am under replaced - just worried about the low TSH and how to get round this.

[SlowDragon Ambassador in reply to FleetRose]

You can’t improve low TSH when taking T3

That’s just what happens

If your endocrinologist is TSH obsessed you will need different endocrinologist

[FleetRose in reply to SlowDragon]

Ok, thank you. So increasing T4 will not improve it and presumably could lower it further (as some will convert to T3)?

[SlowDragon Ambassador in reply to FleetRose]

Yes and yes

Many (possibly most) on Levo plus T3 their TSH 0.01

[Petgirl2]

Look up Dr Childs

[FleetRose in reply to Petgirl2]

Thank you Petgirl2. I did hear about Dr Child’s some time ago so will look him up and see what he has to say on the matter.