Levo/lio?

[Lowkeylowt3]

Hello! Question:

If you decrease your dose of liothyronine and increase levothyroxine will you have hypo symptoms while you wait for Levo to kick in? Such as fluid retention and brain fog.

[TiggerMe Ambassador]

Welcome aboard

Very likely, assuming you were put on T3 as you are a bad converter of T4 and T3 works quickly in the system there is going to be a rebalancing period... also it rather depends on size of dose changes?

Do you have your latest result along with ranges and current dosing?

If you give us more detail it would help, you can do this by filling in your profile

[Eliota in reply to TiggerMe]

Hello, how does one know or guage how well we convert t4 to t3?

[TiggerMe Ambassador in reply to Eliota]

When you first start treatment it will be with T4 and a full thyroid panel will show how much is being converted to T3

[Eliota in reply to TiggerMe]

Thanks for this. I guess I was wanting to better understand the numbers. Like if someone is a good converter of Ft4 to Ft3, am I right in thinking their Ft3 should be a similar percentage through range? I read many people, especially with Hashimoto’s, are poor converters of Ft4 to Ft3 and it's common to see Ft3 at roughly half the percentage of Ft4? I don't know much about the numbers and my Endo seems even less informed than me. She can't tell me if my thyroiditis is hashi or not. Anyhow, thanks for your last response!

[TiggerMe Ambassador in reply to Eliota]

Sounds a bit worrying if your Endo doesn't know how to order an antibodies test 😕 you could just buy a private full thyroid panel to find this out

Yes, generally for a good converter fT3 tracks just behind fT4 when everything is optimised if your fT4 is top of range and fT3 near the bottom then very likely to have the DIO2 gene which often makes for poor converters

[Eliota in reply to TiggerMe]

That's interesting. Thanks for that gene info. Yes, I just did a full thyroid panel myself and that's why I'm trying to interpret the results myself since my Endo seems to think everything is always fine and just because I was born with a small thyroid gland (no evidence I was born with a smaller one at all, it likely shrunk) and she says all my symptoms are "peri menopause". I currently live in Germany for work and so finding a new English speaking, knowledgeable Endo isn't easy.

[TiggerMe Ambassador in reply to Eliota]

If you put your results into this it will give you a fT4-fT3 ratio thyroid.chingkerrs.online/

[Eliota in reply to TiggerMe]

done. thank you

I punched my results into the percentage calculator and TSH is 30.5%, my FT4 is 42.6% and FT3 is 36.9%... I assume those are not great ranges but not terrible? Guessing I just need to raise my Levo a little.

[TiggerMe Ambassador in reply to Eliota]

Found your post and answered there 😉

[Lowkeylowt3]

I was on 10 mcg liothyronine for a couple years and then I started to feel fatigue so my dr added in 50 mcg levothyroxine. After a month my TSH dropped to 0 .4 and Ft3 increased slightly to 3.1 (previously was 2.6). I felt great! Then about 6 months later I started to feel icky. Most recent labs:

TSH 0.36

Ft4 0.91

Ft3 1.8

Rt3 11.6

She switched me to 30 mcg armor and it gave me brain fog and weird fake energy feeling. The dr then put me on lio 15 mcg lio and 25 mcg levo. And that was too much t3 for me…may have gone better if I started with lower dose of t3 and worked my way up?

Now I’m taking 25 mcg levo and 5 mcg lio and having hypo symptoms (cold, brain fog, carpal tunnel, fluid retention.) I tried to add 2.5 mcg lio back and made my hands hurt more the first day (yesterday). But maybe I need to give lio increase more time? Or am I not tolerating more lio b/c the ratio is off?

Question is do I increase Levo to 37.5 and lio 7.5? Or leave Levo at 25 and try again to increase lio? Or decrease Levo and increase lio? Or stop Levo and increase lio as tolerated?

I’m not familiar with ideal t4/t3 ratio but my dr mentioned most people like a 5/1 ratios?

[TiggerMe Ambassador in reply to Lowkeylowt3]

If you could add the ranges for these results as they vary between labs

Also if you have any current results for folate, ferritin , Vit D and B12 as these need to be optimised to aid uptake

Have you previously been on a full replacement dose of Levo?

[Lowkeylowt3 in reply to TiggerMe]

No folate or b12 results. D and ferr WNL

D3: 53.8

Ferritin: 112

Labs

[TiggerMe Ambassador in reply to Lowkeylowt3]

Really low fT3 and fT4

Free T4 (fT4) 0.91 ng/dL (0.82 - 1.77) 9.5%

Free T3 (fT3) 1.8 pg/mL (2 - 4.4) -8.3%

Generally people do well with 60 - 80% levels

What is the highest dose of T4 you have tried before adding T3 and what were your results?

Is D3 ng/ml or pmol/L? If ng it's good if pmol it's almost deficient

[Lowkeylowt3 in reply to TiggerMe]

D3 is ng/ml

I started on t3 only. I always had low range normal Ft3 but was symptomatic. Basically subclinical and 10 mcg worked great for 4 years. Then my Ft3 never improved much and I started feeling hypo so she added in too much T4.

I think I was over medicated when I added 50 mcg t4 my thyroid got angry and totally plummeted my TSH and t3 six months later.

[TiggerMe Ambassador in reply to Lowkeylowt3]

Interesting, it's usually the addition of T3 that drops the TSH to rock bottom, I don't really know how you work out what you need if you started on T3 only as most people would start with levo and only add T3 if they didn't convert well.

Have you got results you can look back on to see where your levels were when you felt well? At the moment you don't have enough of either but it could be that T3 only suits you better if your issues started when adding T4?

You are on low doses of both at the moment but your original question was about lowering T3 and adding more T4, I wouldn't worry what the TSH is as taking T3 for years will have down regulated the HPT loop, I concentrate on your free levels

[Kapuna]

I have danced the dance with liothyronine and levothyroxine for at least seven years. My TSH has not changed from < .02. If I vary my T3 even a small amount I can feel the difference. I have not had a thyroid for at least 25 years and started out on levo. I thought I was ok when the docs added T3 and lowered my T4 and things went ok until my endocrinologist said I was hyper and it would affect my heart. I am 80 and have insisted that quality of life is more than quantity.

Please let us know the answer to your question. I have also wondered what the result would be if I lowered my thyroxine and increased my T3!

[radd]

Lowkeylowt3,

Welcome to our forum,

If levels and/or ratio of thyroid hormone levels aren’t correct (either too high or too low of either T4 or T3), it can induce hypo symptoms.

Levothyroxine requires optimised cofactors (iron & nutrients) to convert to T3 well. When thyroid hormones are inadequate and T4 is medicated, the body should convert what T3 is requires.

However, some people can’t convert enough T3 from Levothyroxine to regain and retain wellbeing so then add some T3 meds, but it is not usual to start thyroid hormone replacement with T3 meds only, and by doing this you now can’t assess your conversion abilities.

T4 & T3 meds don’t just replace what is missing but have other functions regarding the thyroid converting enzymes and many members need a very specific individualised level & ratio of T4 as well as T3 for wellbeing.