Adding more T3? or keep as is?

[Kava3]

Hello All,

I am looking to see any suggestions regarding adding more T3 to my current regimen.

I am on 175 Tirosint T4 and 10mcg T3; I have Hashimoto’s and have been working on my iron by adding iron bisglycinate, which has helped as I am not dizzy, lightheaded, and have more focus. I also noticed I have been sleeping better. I will also include my iron labs below as well. I had several symptoms previously to adding the following - T3, iron bisglycinate, liquid potassium, liquid B12. I have not checked my cortisol as I cannot do the saliva testing. I do feel that my iron has been an issue, though.

I am listing below my previous results from 10/2023 as the first number, then the next number with * is the latest on 2/2024. I took the test first thing in the morning with no medication prior or the night before. I usually take the 175 tirosint in the morning and 5 mcg T3, then around 3pm take the other 5mcg T3.

Free T3 lowered from 3.1, *2.7 (range 2.3 - 4.2)

Free T4 lowered from 1.0, *0.8 (range 0.8-1.8)

TSH increased from 0.67, *1.35 (range 0.55 - 4.78). * lowered again this week to 0.67

Reverse T3 - lowered from 12, *9 (range 8-25)

Aldosterone increased 12, *17

range says

Upright 8:00-10:00 am < or = 28 ng/dL

Upright 4:00-6:00 pm < or = 21 ng/dL

Supine 8:00-10:00 am 3-16 ng/dL

IRON, TOTAL 100 (range 40-190mcg)

IRON BINDING CAPACITY 303 (range 250-450)

Saturation 33 (16 – 45 range)

Ferritin 15 (16 -232)

My Sodium is 135 (range 135-146)

Potassium 3.8 (range 3.5-5.3)

B12 698 (range 180-914)

Folate 9.1 (range says normal is above 4)

VIT D,25-HYDROXY 46 (range 30-100)

Previously, on 9/2023, before adding the iron bisglycinate

IRON, TOTAL 64 (range 40-150mcg)

IRON BINDING CAPACITY 337 (range 245-400)

Saturation 19 (15-50 range)

Ferritin 13.25 (10 to 291)

The symptoms I am remaining with would be weight gain; I gained 30 pounds in 3 years being on T4 ONLY. I exercise 3 to 4 times a week and eat healthily. It's like I am stuck!! I also have more joint pains.

My lightheadedness, dizziness, and sleep problems resolved when I started taking care of my iron and added 10 mcg of T3 four months ago.

This is the response I received from the doctor when I asked to increase my T3- She is basing this on a recent TSH test only that came back at 0.67. Note - the other labs I did on my own since the doc does not believe in testing the free T3 or T4 and I have been advocating for myself.

the Doctor said that any symptoms that have not resolved are not thyroid-related and the T3 is providing a stimulant effect for me.

The doc said - If I want to increase my T3 to 10 mg twice daily (20 mg per day), my Tirosint T4 needs to be reduced from 175 mcg to 125 mcg.

I am now on 175 T4 and 10 T3 so she wants to go 125 T4 and 20 T3

I don't think I need to reduce my T4 if I add only 10 mg of T3. Thoughts...?? As I feel I have been improving overall.

The symptoms I remain with would include weight gain, I gained 30 pounds in 3 years being on T4 ONLY. I exercise 3 to 4 times a week and eat healthily. It's like I am stuck and imbalanced! I also have more joint pains and 3-week menstrual cycles.

My lightheadedness, dizziness, and sleep problems seemed to resolve when I started taking care of my iron and added 10 mcg of T3 four months ago. Occasional sleep issues but nothing like before.

Thoughts on increasing T3 to help with the above?

Any insight or suggestions are appreciated.

Thank you!

[SlowDragon Administrator]

Your ferritin level is terrible

Low ferritin can also cause weight gain

Aiming for ferritin over 70 minimum

have you significantly increased iron rich foods in your diet

Red meat daily, liver once a week

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

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

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and weight gain

and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

[Kava3 in reply to SlowDragon]

Thank you so much!! This is great information!! No, I have not signifigantly added in red meat daily. I though the iron suppliments were enough. I will add in the red meat and iron rich foods daily.

So if I get my Ferritin up that should also help my frees increase.

[SlowDragon Administrator]

I usually take the 175 tirosint in the morning and 5 mcg T3, then around 3pm take the other 5mcg T3.

Day before test move 2nd dose T3 to 8pm …..and test following morning at 8am

suggest you look at increasing your Tirosint levothyroxine first

most people on levothyroxine plus T3 need BOTH Ft4 and Ft3 at least 50% through range

Currently your Ft4 is 0% through range

Previously only 20% through range

This will increase Ft4 and Ft3

[Kava3 in reply to SlowDragon]

Ok I will do that next time. thought the 175 t4 dose was high? In the meantime Ill work on my ferritin

[SlowDragon Administrator in reply to Kava3]

Yes 175mcg is relatively high dose

How much do you weigh in kilo

Many thyroid patients have poor absorption issues

academic.oup.com/edrv/artic...

[Kava3 in reply to SlowDragon]

88 kilos now ..

I agree. I did mention that to my doctor, and her response was I do not have an absorption problem because I was gaining weight!!!!!

Thank you again for responding to me!!

[SlowDragon Administrator in reply to Kava3]

So 88kg suggests guideline dose of 140mcg

So you are currently taking more than typical

So suggests you do have issues absorbing levothyroxine

[Kava3 in reply to SlowDragon]

Okay, the article you referenced is very good and detailed. I can check for H. pylori as well. In your experience, are you aware of anything relating to taking T4 and T3 with lemon juice in water to help with absorption? I basically need to rule out all gut issues. I'm just looking for something I can try immediately as well. Thanks.

[SlowDragon Administrator in reply to Kava3]

Yes some people find taking with (slightly) acidic water may improve absorption

[helvella Administrator Thyroid UK in reply to SlowDragon]

Given Kava3 is taking Tirosint, I suspect that acidulation will make no difference.

[SlowDragon Administrator in reply to helvella]

Yes true……hadn’t considered that

Perhaps Tirosint isn’t as strong as tablets

Though it’s supposed to be better absorbed

[helvella Administrator Thyroid UK in reply to SlowDragon]

Most people who end up taking Tirosint end up on a numerically slightly lower dose. Though if it makes a big difference, and is absorbed much better than tablets, it could be a substantially lower dose. But that is fairly unusual, from what I have read.

[Kava3 in reply to helvella]

Would the acid help with the T3 since that regular tabs?

[helvella Administrator Thyroid UK in reply to Kava3]

I don't think that there is a known issue with T3 dispersing, dissolving and being absorbed.

[Kava3 in reply to helvella]

Okay... Thank you

[Kava3]

Ok, will try that as well.