How to change from T3 only to T4?

[Nikkkita]

I'm currently self medicating on 50mcg Tiromel and have been for a few years. My doctor prescribed me 75 mcg Eutirox 5 x week and 88 on the weekends. It just wasn't working for me, so after a lot of reading I assumed I was just someone with a faulty conversion gene and decided to try alternatives. In the end I found 50 mcg Liothyronine was best for me, sometimes in the winter I take a little more, up to 62.5.However, it's stressful and expensive to self medicate. Although I have a reliable supplier, customs is an issue, I've had more than one order confiscated, and in the pandemic I ran out completely and more importantly I've just read here that the dosage of levothyroxine should be 1.6 per kilo!!! So at 92k I've never been properly medicated on levo. By my calculations I should be on about 150 mcg. I was started on 25 then 50 and then 75 and I just gave up on my gp and endo when they told me to stop supplementing vitamin D despite having a low level.

Anyway my question is, how would I go about changing to 150mcg of Eutirox from 50mcg of Tiromel? Should I just do it from one day to the next or slowly wean off one before starting the other, or wean off T3 while introducing levo??

Any advice would be greatly appreciated.

My latest test results are:

TSH 0.13 uUI/mL (0.35 - 4.94)

Free T3 3.03 pg/mL (1.58 - 3.91)

Free T4 <0.42 ng/dL (0.70 - 1.48)

Ferritin 210.67 ng/mL (10 - 204)

Folate 8.2 ng/mL (3 - 20)

Vit B12 486 pg/mL (187 - 883)

25-OH Vit D3 27 ng/mL (30 - 97)

[humanbean]

I've just read here that the dosage of levothyroxine should be 1.6 per kilo

You should read this link from helvella on the subject of using formulas for determining Levo doses :

helvella.blogspot.com/p/hel...

[Nikkkita in reply to humanbean]

Thanks humanbean, very interesting info.

[GlowCoach Administrator]

Its also ESSENTIAL to raise all key vitamins to OPTIMAL which it looks like you haven't done yet.

How did you take this test?

What time of day was it and when did you take your last dose of T3 & how much?

Your TSH is on the high side for someone on monotherapy where Iwould expect it to be very low if not suppressed. This points to needing more T3 at the moment.

Ferritin looks good, however can be falsely raised if you have inflammation. Was there a CRP test?

Both B12 & folate are too low. Suggest you find a good, methyl/active type B complex. I have attached the label for Thorne Basic B so you can see the qualtities of vitamins you are looking for.

Vit D is deficient.

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150.grassrootshealth.net/projec...

We need OPTIMAL levels of vitamins for our thyroid hormone to work well.

As far as switching I would suggest switching to 125mcgs Levo in 2 week stages. No doubt in the initiall weeks you won't feel great as T3 is immediate acting and Levo takes 2 weeks to begin converting. Perhaps try it in 4 stages?

Thorne B contents

[Nikkkita in reply to GlowCoach]

Thanks for your interpretation of my results Jaydee1507. I took the test privately and my last dose of T3 was 24 hours beforehand. I always take it once a day in the morning and wanted to compare to previous results although I have now read that with T3 you should take the last dose 12 hours before test. I'll do that next time.I agree about getting my vitamins optimal before changing. I have started supplementing B12, methylfolate and D3K2 again. I've also decided to go strict gluten free again as I've been eating gluten now and then despite testing positive for gluten sensitivity. I need to get back on track. I think I'll up my T3 by 6.25 while optimising my vitamins and perhaps next time also do a CRP test because Ferritin is a bit high.

If I do switch to T4 I will probably do it over a few weeks as you suggest.

[LynLyn]

Hi Nikkkita. I dropped 5mcg of T3 and added in 12.5mcg of T4. I continued with this until I was on 100mcg of T4. It took a long time (over 2 years) and a lot of patience. I’ve had a lot of ups and downs with thyroid treatment over my lifetime and I didn’t want to cause any more problems so went with the slow and steady approach which worked for me. I have read of people changing immediately but didn’t feel confident my GP would monitor things properly. Hope that helps. Good luck!

[Nikkkita in reply to LynLyn]

Hi LynLynWow you are very patient, I don't know if I could take so long to make the change. I don't think I'm going to do it yet, I want to get my vitamins optimal and get back off gluten first but I appreciate your input. Do you feel better on T4 than on T3? I hope so!

[SlowDragon Administrator in reply to Nikkkita]

Would suggest slow and steady as LynLyn has outlined is way to experiment

[Nikkkita in reply to SlowDragon]

Thanks SlowDragon. I think I need to look into this more.

[LynLyn in reply to Nikkkita]

Hi Nikkkita Yes, I feel a lot better. I now take 100mcg T4 and 10mcg T3. I’ve had my vitamins optimal and I’m now getting the maintenance doses right (I let my ferritin drop too far!) as I need these at a good level to feel my best. The T4 has improved my hair, sleep and general stamina. I’m thinking of it all as learning to live well with hypothyroidism!

[Nikkkita in reply to LynLyn]

Hi LynLyn, I'm glad you're feeling better on T4 and T3 combo, it's encouraging! I also love your positivity in seeing it as learning to live well with hypo. I agree with you, sometimes I find it quite fascinating, almost, but at other times very frustrating. You think you've found the right dose, optimal vits, good diet etc but it's easy to fall off the wagon or stop being so vigilant or things just change for no apparent reason and it's back to square one. But this forum is a great help. I'm glad to hear about hair and sleep improvements as I struggle with them too. Good luck with your ferritin levels!