I’ve had my appointment with my thyroid specialist today and she wants me to increase my T3 from 15mcg a day to 25mcg a day and keep levo at 100mcg. However I’m really hesitant to do this as last time I increased my T3 (see my original post below) I got my T4 to 6 and felt awful. Plus I’ve got used to taking the 15mcg all at once with my Levo in the morning which seems to suit me much better than when I was splitting the dose but specialist says to now go back to splitting into an am and pm dose but this didn’t suit me before I felt very up and down with it whereas with just an am dose I feel more steady throughout the day. Also I’m sure I’m perimenopausal (41) got loads of peri symptoms but specialist has said to try increased dose of T3 for 8 weeks before trying HRT?
I’m just so confused and frustrated as I’ve already tried a higher dose of T3 last year and even though my bloods looked good (see post below) I felt the worst I’ve ever felt so I don’t see the point in trying this again?
I asked her this and she said my T3 isn’t at an optimal level so wants to see if an increase will help with all my symptoms but it didn’t last year so why would it now?
Don’t know whether to try this again or try HRT instead?
Also could I take 25mcg T3 all in one go with my levo in the morning?
Would welcome any advice because I really don’t know what to do for the best!
This was my previous post:
I was diagnosed with underactive thyroid over 12 years ago and have taken levothyroxine ever since. However after a lot of research and reading of my own I felt that I had a conversion issue as my TSH was always really low 0.10 or lower but my T4 and T3 were always at the low end of the range especially my T3 which never got above 3 no matter my Levo dose. I therefore started seeing a specialist privately 18 months ago and she agreed I had a conversion issue and suggested I start taking t3 as well as my levo. She kept my levo dose the same which was 112.5mcg and we started on 2.5mcg of T3 three times a day, this was then steadily increased to 20mcg a day spilt into two doses am/pm. However I started to feel so much anxiety and had low mood, heat intolerance, didn’t feel like myself anymore and after 3 months on this dosage my bloods came back:
TSH - 0.005 (ref 0.270 -4.2)
Free T3 - 6 (ref 3.1-6.8)
FT4 - 19.9 (ref 11-22)
My specialist thought due to how I was feeling that I may be a little over treated so lowered my levothyroxine to 100mcg and t3 to 15mcg a day. I also struggled splitting the t3 dose so started taking the 15mcg with my levo first thing in the morning before any food or drink. I initially felt much better on this dose and more like myself, however over the last couple of months (been on this dosage now since August 23) I’ve started to feel low again in mood and energy, anxiety creeping back in and just don’t feel I have much get up and go!
Just had bloods done and they are now:
TSH 0.005
Free T3 4.7
FT4 16.6
So the lowering of my meds has now lowered my T4 and T3 levels and I just don’t know what do next? Do I up just my T3 to see if that helps and keep my levothyroxine on 100mcg or do I need more levothyroxine? I’m just disappointed as I really thought adding T3 was going to make me feel so much better but to be honest I don’t feel much different to when I was just taking Levothyroxine even though my levels are now better. I just don’t know what to do next, I just want to have my zest for life back, to feel refreshed after 12 hours of sleep and to actually want to go out and do things but instead I just want to stay home all the time as have now ooomph to do anything! I feel like life is passing me by!
all my vitamin levels are good. I’m massively into health and fitness. I take vit D, B complex, magnesium, selenium, iron, multivitamin, vitamin c, symprove for gut health, drink loads of water, eat a high protein diet, weight train, get my steps in each day. Honestly I don’t know what else I can do to feel better?!
Sorry for the loooong post but any advice would be greatly appreciated! 😊
Thank you! Xx
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Fallleaves
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My suggestion would be to try an extra 5mcg T3 added to your single dose in the morning (if it works for you, as it does for me then don't mess with it) and within a couple of weeks you will know if this is suiting you or not and if not could always drop back to 15mcg and try adding 12.5mcg T4 every other day to nudge your fT4 up above 50%... I'm afraid the fine tuning is down to you as they always adjust things by too much which makes you seesaw... trust your own instincts 🤗
It's surprising how important getting your fT4 level right is when adding T3
Thanks TiggerMe, I did try upping my Levo back up to 112.5mcg at the beginning of Feb but 2 weeks later I started being unable to get to sleep and had heart palpitations so dropped it back down to 100mcg.
You’re so right, it’s so hard to find that sweet spot!
Previously Fallleaves has been sensitive to changing T4 dose which is a long drawn out change and then change back, with T3 being quicker to show how it will effect her it is probably the better option to tweak hopefully after the trial two weeks the picture will be clearer
I've no experience of T3 only, in general with T3 when you have adjusted the dose you have a pretty good idea whether to stick with it or not within two weeks, I wouldn't suggest testing then as it certainly takes longer to completely settle in, whereas with T4 adjustments you often have to push through a bumpy couple of weeks before things settle down
I totally agree with your advice TiggerMe , an increase of 10mcg T3 would be a significant jump for me. I like your idea of trying 5mcg and keeping the possibility of adding a little T4, it sounds really practical and easier to tolerate or correct if need be.
I'm on NDT now, but found recently that raising my dose just made me feel worse and made my numbers worse. So I dropped back down by a quarter grain, which is 9.5mcg T4 and 2.25mcg T3 and sat there for a few weeks. Definitely felt better, but still way off. So then I added in 12.5mcg Levo and that made a good difference but I soon felt over medicated a little so I dropped another quarter grain and after a couple of weeks I put the Levo up to 25mcg a day. I don't do well with low T4 but taking any T3 drops my T4 like a stone. At this level I really feel I can tell when I make a mistake or need to correct something slightly and can make the changes much more quickly than 6-8 weeks. Earlier on in the dosing history I could not do that. I would not test now sooner than 8 weeks and preferably 12 weeks. But the little tweaks I will do sooner. I always have a rough couple of weeks when I alter Levo. I usually feel a lot better for the first week, then I'm not right at all for 2-3 weeks and then it calms. We have to learn to read ourselves quite a lot.
I currently feel as though I might eventually have to drop another 1/4 grain. But for now I'm holding. I don't want too much T4. But I'd like it around 50% of range I think.
Hi FancyPants54 totally agree with you and after a long journey have ended up in a similar place to you. I take t4 and t3 and now make changes slow, low and steady. Still not quite there but a lot happier with this approach. Fallleaves dont know if this is relevant to you but a private endo jumped me up to 60 T3 and dropped my T4 to zero over a four month period. It really wasn’t great. The NHS have slowly moved me to 100 T4 and 15 T3 and will explore some tweaks to that but only slowly, this seems to be much better for me.
If you like the science stuff Professor Jacqueline Jonklaas, has written a few papers on what an optimum combination of T4 and T3 might look like.
Hi you, it sounds like you are doing everything you can.... but I wonder if its too much.
When you say " I’m massively into health and fitness. " this may be something to look at. Are you doing hours of cardio? Running? Spin? I have listened to so many podcasts recently saying to perimenopausal or fatigued women they need to STOP and just do weights, maybe 1 HIIT a week and the rest resistance/pilates/yoga. Its quite a change, diet changes too, less carby more protein... just a thought. I just bought the book Forever Strong and also listen to Dr Amy Shah. Liz Earle is another one with a good podcast I blame TiggerMe for that one.
When a physio and a podiatrist told me to stop running 3 years ago I cried, and cried... and cried. I was bereft. (I was doing 8km 3 times a week, daily HIIT and allotmenting). However, a yoga session with my local Iyengar Yoga (not floppy yoghurt pot yoga but the full headstanding strong yoga stuff) and 3 years on I am now stronger than I've been in a long time and my hormones are settling down. (75/100mcg T4 15mcg T3) 63kg 50 years old still with regular menstural cycle) I was more perimenopausal in my 40s than I am now. have dabbled with HRT and with the exception of Ovestin cream I am better off without it I think at the moment, I think I have excess oestrogen.
Anyway same physio at the podiatrist told me NO when I said can I try running again, NO NO NO and again I cried. Get some resistance bands she said. You will just make yourself sick and hungry. So .... I just ordered some dumbells. I accept my fate ... sending hugs. 🌱
I used to be a cardio queen but I completely changed my workouts last July to 4-5 weight training workouts a week with only one HIIT session and then doing 10,000 steps a day for my LISS instead. I also massively increased protein as wasn’t eating nowhere near enough. This has all definitely helped but still feel like I’m on a rollercoaster of hormones, sometimes up or level but then come crashing down!
When a physio and a podiatrist told me to stop running 3 years ago I cried, and cried... and cried.
Me too.
Of all I’ve accepted I still can’t face that this one thing has been taken away from me.
Fallleaves
, I just want to have my zest for life back, to feel refreshed after 12 hours of sleep and to actually want to go out and do things
For me, I had a big lightbulb go off when I began to understand how cortisol and adrenaline can compensate for the thyroid.
For all the marathons I ran - I look back now and see that I was running on adrenaline.
If you are hypo, although I see your great Free Ts, realize that the stress of exertion will stress your struggling thyroid and in turn will stress your adrenals. How much and for how long is personal.
But that’s the physiology of it.
I pulled out the above quote from your post because not feeling refreshed in the morning after a full nights sleep can be due to cortisol issues. I know there are varying opinions on whether “adrenal fatigue” is a thing, but if you’re working out that much, worth considering since your Ts aren’t bad and you’re still symptomatic.
Also - I see you take a multivitamin, which usually does us hypo folks no good and depending on what’s in it, might do some harm.
Ps I haven’t read your other posts or all responses above, might be missing something.
Nailed it….. I very much ‘run on adrenaline’ I did have it under control but you have helped me spot something I’d missed, thanks for the timely reminder, I’ll dig out that adrenal supplement again. 🌱
Please note change of midday ref range inline with Pilger et al 2018. Saliva Cortisol - 16:00 - 20:00 * 2.60 <6.94 nmol/L
Saliva Cortisol - Midnight * 1.80 <7.56 nm
I’m having them done again in 8 weeks time.
The multivitamin I take is Multibionta Vitality - unsure if I should just stop this?
I was also concerned that my Ferritin serum level was on the low side? 58ug/L (30-150ug/L) I do take Active Iron - 14mg a day but wondered whether to increase this to a stronger daily dose?
when you felt over medicated, your specialist reduced both your Levo and lio. It might well have been better to just reduce one of these at a time.
At first, on the lower dose you felt better as your levels went down, but now it appears you’ve just gone too low and overshot your sweet spot.
So, if I were you, I’d increase either the Levo or the lio, but only a tweak! As she’s suggesting T3 is too low, just tweak the lio a tiny bit and see how you go. Lots of people take all their dose in the morning so you could continue to do that. I would not go up to 25 mcg at this stage, 20 is plenty! You’ll know very soon if it feels right, and then be able to make a further decision about action.
hi, from my experience yes you can take 25 lio all at once. But, this time, why not do it a bit differently- and really really slowly increase the dose maybe splitting it? Defo try 20 for several months before going to 25. 10 is too big a jump.
Lots of helpful comments here, but honestly as someone who thought the same about my conversion (low) I have supplemented with T3 and also felt very little difference from my previous 125mcg T4. I’m on 100mcg T4 + 6.25-12.5mcg T3 depending how much energy I need. But I think having a combo is better for me - I was convinced on here by jimh111
What I do think has really helped is HRT, which I started at age 53 ( I’m 58 now) I have a Mirena coil and use Estrogen patches and I feel good. It took a while and some tweaking - we’re all used to that here! I play a lot of tennis and do strengthening pilates regularly and when my HRT dose is right, I don’t have aches or pains. When it’s wrong, I have had frozen shoulder and plantar fasciitis- but that’s me. I think we all have our own menopausal symptoms, perhaps yours is morning energy. I’d recommend you try.
Thank you for your reply Meno56. I just don’t know what to do for the best. Unsure whether to keep trialling the T3 or try HRT, so confusing what causes what!
Sorry I can't help except but can I ask why your endo doesn't freak out at such a suppressed tsh please? Are you in UK, private or NHS? I was of the understanding that tsh will become suppressed when we take T3 but my NHS endo will under no circumstances endorse an increase in either levo or lio as my tsh is below 0.1, its 0.07. I really want to increase my meds a little as I definitely don't feel optimum.
The normal circadian rhythm of T3 production by a healthy thyroid shows levels increasing about 10 p.m. Then they gradually reduce during the day but not by a huge amount. Why not try to take the 5 mcg at bedtime and then your 15 mcg in the a.m. with the Levo? The way you are doing it now, your fT3 would be lowest during the night when the body needs the boost for healing during sleep.
I'd do it the other way around but taking the 15 mcg in the a.m. is what you are used to doing.
If I'm struggling to go to sleep or to sleep at least modestly well, I love a nibble of T3. Even a crumb (which is what I tend to get when trying to cut a tablet into 8ths) helps get me off into good sleep.
Thanks for this, it’s so confusing because my specialist has said to never take T3 after 5pm as it’ll keep me up at night but I’ve read many people on hear like yourself who take it before bed to get to sleep?!
It might keep some awake. Arguably that could be because they are taking too much of it. Our bodies produce larger amounts of T3 at night to facilitate the overnight repairs of our bodies and brain.
I went through a period after a very nasty weeks long cold and chest infection,, where I kept waking up around 2-3am in a blind panic, anxiety through the roof, heart pounding and so afraid of the dark I had to put all the lights on and sit trembling waiting for it to pass. After a few nights I thought that this might be happening because I didn't have enough thyroid hormone to support the toll the illness had taken. So I gingerly took about 2.5 mcg, probably even less as I was timid. It took 20 minutes for me to suddenly feel all that anxiety and fear melt away and then I went to bed and slept well until morning. I took up to 5mcg every night after that. I love it at night. All the problems just disappear.
I am doing better on NDT than T3 and T4 now though so it's harder to take a bit at bedtime as I probably need to work my dose a little higher to spare it from the morning first. But if I can, I will try to put either some NDT or a small amount of T3 back in at bedtime. Don't be afraid to try it. When I was on T4 and T3 I regularly took a T3 dose around 7pm. That would be a bigger dose and it never stopped me sleeping.
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Anyone taking levo and T3 ? 
Increasing Levothyroxine made my blood work worse
T3 over range
