I’ve been struggling to find the right thyroid dose for literally ages now. Currently I am on 75mcg T4 5 days a week and 50mcg T4 on teh remaining two days and 6.25mcg T3 everyday of the week. I take both the doses at around 6am first thing in the morning. I’ve tried splitting my T3 but hasn’t made any difference so just having it once along with my T4 now. My latest labs are:
FT3 4.09 pg/ml Range 2.6-4.2
FT4 0.89 nd/Dl Range 0.58 - 1.64
TSH 0.509 Range 0.38-5.33
The last dose of both T4/T3 was taken 24 hours before labs. Labs were done at 7am in the morning. No B complex/Biotin in the last month or so. Same dose for about 6 weeks.
I feel a little hyper a couple of hours after my dose and can feel some stress on my heart. After a lot of experimentation I’ve realised that I need 6.25mcg T3 at a minimum to function. Tried reducing T3 but it made me very hypo. Plus we get only 25mcg T3 and quartering it is already a hassle. Further halting a quarter only leaves me with powder!
Since the conversion looks good, I’ve tried stopping T3 and I feel good for a couple of weeks. Then it’s downhill and my Ft3 tanks to about 20% of the range in about 2 months.
Just want to know whether reducing T4 a bit will be of any help. I’ve never been able to tolerate a high T4 dose(max I could ever take was 88mcg and that too ended me up at a cardiologist with chest pain and palpitations) We don’t have Reverse T3 test here so I really have no idea what’s happening there.
My Vit D is optimal as I supplement with one 60,000IU Cholecalciferol once every 2 weeks. I also supplement with sublingual B12. No other medicines/supplements.
Any insights will be of immense help as doctors here have no idea and just want me to stop T3
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Arturito
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I was in a similar position - suppressed tsh, t4 around 30-40% through range and t3 top of range.
I was ok but not great.
I chose to increase Levo (moving from 75 through 87.5 to 100 then 112.5). (Have also had a steady t3 at 10 mcg a day for a while). Palpitations upon dose increases and while under-replaced have been a constant worry for me. I’ve posted here about them, and read every post I see to try and figure it out.
I know you say you can’t tolerate more levo. But I am curious how long you stayed on the 88 when you tried before giving up and going back to 75.
For me - every dose increase is volatile from about week 2 through at least 5 weeks. At five weeks I usually feel like Ive made a mistake. Then by 8-9 weeks and longer everything calms down.
I’m not saying you do or don’t have heart issues. Always check it out when worried. But will point out that palpitations or randomly fast heart rate are a very common symptoms of being under replaced and of dose changes themselves.
Really thankful for your reply!! Actually I was on 88mcg Levo for a couple of months when things went crazy.. FT4 became high and surprisingly TSH was also high. That’s when my endo reduced my T4 to 75 and added 12.5mcg T3. Felt amazing for a few months, maybe 5-6 months with my endo constantly reducing mu T4 as he like TSH within range. Ended up messed on 62.5mcg T4 and 12.5mcg T3. Then experimented with T3 only for a couple of months and it was a disaster. Slowly added back T4 and reduced T3. In a much better place now with 67.85mcg T4 and 6.25mcg T3 but definitely feel hypo and hyper at the same time. But I get your point.. I’ve also realised that reducing the dose always backfires after a couple of weeks.. perhaps I need to be very very patient and maybe try 75mcg T4 daily for a few months without chopping and changing anything.
I did get my heart checked out, treadmill test, echo, ecg all ok. Cardiologist said no problem in the heart.
Did you take anything to soothe the heart palpitations when on a dose increase?
If your Endo is trying to keep your TSH within range and you are taking some T3 then you never will find the right dose. T3 naturally lowers TSH by a lot and to be optimally replaced your TSH is going to be below range of not suppressed completely.
Have you tested vitamin levels recently? They should be tested at least annually and vit D twice a year until you know how much you need in different seasons.
Most members need a B complex to help balance out all the B vitamins. Currently you dont take any folate.
B complex suggestions: Slightly cheaper options with inactive B6:
I never considered there was a way to stop them other than waiting it out. This forum has been essential for talking me off the ledge when I want to change things too much or too fast.
1) Were all your tests done with last doses Levo 24 hours and t3 12 hours split dose day before? Fasting as close to 9 am?
2) Dosing to TSH is a sure fire way to feeling bad - T3 will suppress it ( mine has a couple zeros after the decimal)
3) reducing dose (and some people who (often foolishly) go off entirely) feel awesome for a week or two. It’s just what happens… and then the crash… so yeah, that makes sense too.
4) Many here say and experience we feel best when on Levo/t3 when both are ~75% through range. That’s not everyone. But me personally I’m a firm believer that before I mess with anything else or zig zag and whiplash mid- process - I’m going to get both my t3 and t4 to that level. Then if that doesn’t work I’ll take it from there. T3 is there for me. T4 I’m working up from 40-50%. In the middle of going from 100-112.5. A couple weeks in. Palpitations. A little bit of insomnia. A touch of anxiety. But I am making no conclusions until a full 6 weeks and then some.
I might end up reducing something in a month. Or I might hit optimal. Or I might need a bit more.
If you took your last dose of T3 24 hours before the blood draw, then you have a false 'low' FT3. Your FT3 is probably over-range in reality. Which is ok, some people need their FT3 slightly over-range to feel well. But that would suggest that you have some level of resistance to thyroid hormone - i.e. difficulty absorbing it at a cellular level. And people like that - me included - are often better on T3 mono-therapy. Have you ever tried that?
Forget rT3, it's a red herring. Your FT4 is only 29.25% through the range, so hardly likely to be converting to excess rT3. And, even if it were, rT3 is not a problem in itself - it is inert and only stays in the body for about 2 hours before being converted to T2, and no, it doesn't block T3 receptors - the problem is the low FT3 from poor conversion. But, you say you don't have a conversion problem anyway, and your FT3 is high. So, in no way, shape or form do you need an rT3 test.
The very fact that my Ft3 is high-ish even 24 hours after my last dose was freaking me out a bit. Reading your reply gives me some reassurance that it’s ok to have it a bit high.
I did try T3 only for a couple of months but ended up being very messed up. Went the whole hog, read Paul Robinsons book and tried to follow everything. Split the doses and increased slowly. But hit a roadblock at around 18.75-25mcg T3.. any raise beyond that I got heavy palpitations and chest tightness. Adrenaline reactions were horrible on T3 only. Even slight stress would wipe me out. I was a sweaty mess. So gave up and again added back T4. So that was my T3 story!
Thanks a lot for your insights regarding RT3. I have been trying so hard to get it tested but in India only a couple of labs do it and that too only one day a month and the samples are sent abroad for testing. ( problems of the third world!) And the test costs a bomb! Plus doctors don’t write a prescription for it either. So not needing to test it gets a load off my shoulders!
Thanks a lot. I have been a fan as I’ve learned so much by reading your replies to posts!! 😊
Ranges are only very rough guides about what the majority of the population have. Doesn't mean it's right for you. Maybe this article on the subject would interest you:
To be on T3 only, you need to have all your nutrients optimal. That's very important. And, you need your cortisol at good levels. So, all that needs checking before you every even attempt it. And, you don't have to follow Paul Robinson's protocol, that's just for a certain group of people, not everyone. I don't follow it. I take 75 mcg T3 daily, all at once when I get up. Splitting it up like he says wouldn't help me in the least because I need a large dose to flood my receptors in order to get anything into the cells. It used to be 225 mcg! But I've been able to slowly reduce it over time.
India isn't the only country that doesn't test rT3. The UK doesn't, for a start. In fact, I believe that the US is the only country that does test it! Although I could be wrong. But here in France, I've never even met anyone in the medical community that has even heard of it. And for good reason: it just isn't that important in the general run of things.
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Eyebrows have started growing again : )
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