Struggling With Side Effects on Combi Therapy

[Sparklingsunshine]

I've been on combi therapy since December, I source my own T3. I did feel an improvement in energy, fatigue levels etc. However in the last few weeks I've been struggling with side effects like sweating.

I know that we've had hot weather but the sweating seems totally disproprtionate, its not just glowing but proper sweating, which is really uncomfortable and embarassing. And its all over, not just the usual places like underarms. I've cut out the Tiromel the last two days and just taken Levo, and the sweating has pretty much stopped. Before even very minor exertion would induce it.

I'm in a quandry now, do I stop T3, reduce it, reduce my Levo? I'm reluctant to stopT3 altogether as prior to this I did feel better and I'm noticing that not taking it is making me feel yuck.

But nor do I want to be a sweaty Betty either. Temperature control is an issue for me anyway due to having EDS and having autonomic dysfunction is common with that condition.

I'm on 150mcg Levo and 3 x T3 daily 5mcg. I dont have any recent bloods to share as I'm in the process of getting an MMH one ordered.

[TiggerMe Ambassador]

I'd be inclined to drop 5mcg T3 a day and see how that feels

[Sparklingsunshine in reply to TiggerMe]

I've often wondered if my Levo dose is too high as a lot of other people on combi therapy seem to take 75-100mcg a day plus 10-20 mcg of T3. I'm taking 150mcg which seems high?

[QUE6T-33 in reply to Sparklingsunshine]

Do you keep a check of heart rate & temperature, as can be useful. Especially keeping a daily check on average temp. Can offer guide to whether thyroid or adrenal issue. Personally, I sweat when adrenals over stimulated, Particularly late evening when temperature remains higher than norm.

[Sparklingsunshine in reply to QUE6T-33]

No I dont tbh. I only notice if my heart rate is very fast, which it isnt. I've had periods of palpitations which I've always had, as again it goes with EDS but actually being on combi therapy had reduced those.

Its why the sweating has taken me by surprise. I was overmedicated, badly when I tried NDT, so I'm familiar with how it feels and I've never felt like that on combi therapy so the sudden sweating is odd.

[TiggerMe Ambassador in reply to Sparklingsunshine]

What level does that keep your fT4 at? I like mine 55%... dose really comes down to how well you absorb and then a bit of experimenting to find your happy place

[Sparklingsunshine in reply to TiggerMe]

I think my last test on combi was in February ( I'm so overdue to test) . FT4 was 17.3 (12-22) and FT3 was 6 ( 3.1-6.8).

[TiggerMe Ambassador in reply to Sparklingsunshine]

I'd drop the T3 down a little and you'll know within a few days 🤗

[arTistapple in reply to Sparklingsunshine]

I have come (late) to truly respect Levo/T4 levels. I know the Forum suggests fairly high T4 levels but I just wonder if this is just not appropriate for some of us - possibly those who may (pure conjecture) actually need T3 very much indeed -just maybe even in some circumstances T3 alone!

The high T4 low T3 may be (again I am at the end of the road and getting pretty desperate) of more than considerable significance to some of ‘us’. The Canadian site seems to highlight this again and again. Good levels of T4 far from guarantee good levels of T3 and as I now much more fully understand “it makes some patients more hypo”. I never truly understood that before. Of course there are so many dramas to work through on this road to understanding.

High T4 can inhibit T3 production. I think I saw greygoose put that in a reply only just today. I think I have found that to be the case but dropping my T4 level’s without adding T3 has done me few favours.

Those on T3 only mostly have had to go it alone. Hats off to you guys for your courage on that one.

Another step nearer pure self medicating.

Nightmare.

[Sparklingsunshine in reply to arTistapple]

I've been diagnosed as hypo since 2020 but as with most of us its very likely I've been struggling for far longer. I've obviously tried Levo at all doses, eventually going upto@ 200mcg daily. Which resulted in a very high in range FT4. I'm aware a consistently high FT4 isnt ideal for longterm health. It was at point it became obvious that I needed to add some T3.

It seems dropping Levo a little can improve conversion, which seems counterproductive if you think about it and we've seen too many members who've had dose reductions who've seen their FT4 and FT3 plummet. I wish this dosing lark was straightforward.

[arTistapple in reply to Sparklingsunshine]

Absolutely agree. However I can’t find any research really about dosing. I think it’s an ethics thing but really for hypothyroid patients it’s particularly nasty status quo or whatever the description might be. Euthyroid people definitely do not work like hypos. If anything this information works directly against us. I wonder how hypothyroids would feel about taking part in such a thing?

Dropping Levo and T4 levels is often counterproductive but perhaps more intriguing is that it is counterintuitive. Worth a proper bit of research - unless it’s been done and I don’t know about it - perfectly possible.

[Barrett582]

Everything about thyroid is very individual. I need my FT4 at the bottom of the range and my FT3 about mid range. I feel the best at this level. I have also found that 1.25 µg ofT3 makes an incredible difference in how I feel.1.25ug increases is too much, and I feel terrible.1.25ug decrease is too little and I feel terrible. You have to find out what works for you, and it does take a lot of trial and error.. You can try what other people do and make notes about how much you take and how you feel. I take 50 µg of levothyroxine and 17.5µg of Liothyronine. My T3 is divided into 3 doses. I take my T3 with food. It seems gentler that way. I have Hashimotos and have no thyroid left. You have to go very slowly with exogenous thyroid hormones. You also have to settle in to a dose change, even a small one. Good luck.

[arTistapple in reply to Barrett582]

This is very interesting to me indeed.

Unfortunately I have had another terrible night and I am not able to question you further, which I really would like to do.

Would you be averse to a PM sometime?