How to manage liothyronine and exercise

[Forestgarden]

Hi everyone, it's been a while since I last posted. I'm now on 87.5mcg Levothyroxine plus 15mcg liothyronine split : 7.30am 75mcg Levo plus 5mcg Lio, then 1pm 12.5mcg Levo plus 10mcg Lio. This has been working well for me the last few months. I was able to go on holiday and stroll round cities everyday, and even able to spend a few hours gardening, but no excessive exertion. As long as I keep things fairly gentle it's fine. Now I'm trying to get back to exercise classes. Nothing extreme! Just a 45min pilates class on a Wednesday and an aquafit class on a Thursday. However, the last couple of weeks these have absolutely wiped me out for days afterwards. Back to lying on the sofa all day. Any suggestions how to manage my Lio better to avoid this? Thanks x

[greygoose]

It's got nothing to do with 'managing' your lio. It's just that you're not ready for these classes yet. If you were, they wouldn't wipe you out like that. So, perhaps you need to increase your lio? When did you last have bloods done? What were the results?

Maybe try just doing one class, see how that goes?

[Forestgarden in reply to greygoose]

My bloods were done a few weeks ago: TSH 0.03 (0.27-4.20), Free T4 16.5 (12.0-22.0), Free T3 5.7 (3.1-6.8). My endo is happy with these results and so I need to really stick with this for the next few months. I agree I'm probably not ready and yes, I should just do the one for now. It was more to do with perhaps adjusting my timings ? Or, even adding in an occasional extra 5mcg lio for a boost?

[greygoose in reply to Forestgarden]

T3 doesn't work like that. Adding in an occasional extra 5 mcg wouldn't give you a boost, it would just be a waste of 5 mcg T3. You need to be on the exact same dose every single day for it to do what it's supposed to do. Occasionally taking extra would just confuse your body.

It makes me so sad when I read people saying 'my endo is happy with these results...' Maybe, but he doesn't have to live with them! He has no idea what it feels like to be under-medicated. And probably doesn't understand that some people just need high levels of T3 to feel well. And that if you're not happy, that's what counts, and apparently, you're not!

Your FT3 is about 70% through the range, which isn't excessively high. Could be you need more. Or it could be that you need to wait longer for your body to heal before you can get back to the level of exercise you used to be at. But whether your endo is happy or not is totally irrelevant. It's not his body we're talking about.

[Forestgarden]

OK, so no extra adhoc T3 then! I'm happy to have found an endo to prescribe T3 who's not obsessed by TSH so I'll be going along with their suggestions. Down the line I might add in extra T3 and reduce my T4 slightly, but not at the moment. I am able to actually get things done now which have been impossible for years, so progress, albeit slow. Thanks for replying greygoose.

[greygoose in reply to Forestgarden]

There is that, of course. Given the present state of thyroid treatment one has to be grateful for small mercies! But, if you do increase your T3, there's not reason to reduce your levo. It's only 45% through the range as it is - and that could be part of the problem - so you probably don't want it any lower.

[jimh111]

Try taking your 10 mcg lio at bedtime, I find this helps a lot. It's during sleep that we repair our body and T3 is needed then. You might find that although you are whacked out after exercise you will be better the next day.

[Forestgarden in reply to jimh111]

I will give this a go. I do struggle to get a good night's sleep.

[tattybogle]

definitely worth considering taking some of your T3 at bedtime, see these :

thyroidpatients.ca/2020/07/... dosing-t3-circadian-rhythm/

thyroidpatients.ca/2019/11/... free-t3-peaks-and-valleys-in-t3-and-ndt-therapy/

[Forestgarden in reply to tattybogle]

Thanks for the links, I'll have a read

[jimh111 in reply to tattybogle]

It's worth noting that the T3 peak in the middle of the night is small, around 6%. They zoom in on the graph giving a false impression.

[helvella Administrator Thyroid UK in reply to jimh111]

Yes - presentation does tend to emphasise these things.

It often feels as if the "default" view is that, of course, you are sleeping so your T3 will actually drop. As if T3 is only needed when you are awake and active.

Even if the peak is small, it does at least counter this default view that seems prevalent on the basis of assumption.

[jimh111 in reply to helvella]

The brain works very hard during sleep, it needs its T3!

[helvella Administrator Thyroid UK in reply to jimh111]

And the Free T3 level in our blood is a dynamic state - with factors such as T3 transport into cells, converted T4 released from tissues that can do so, any endogenous and exogenous T3 available, etc. Tests give us some sort of integral over time of all these factors.

It would be interesting to see the actual dynamic rate of T3 use within cells. Like nanograms per hour by tissue type. Or molecules per minute.

You could imagine a dynamic rate being out of step with the standard blood test levels.

[tattybogle in reply to helvella]

yes , probably very different .

blood levels of T3 more like looking at fuel tank gauge vs seeing a rev counter to see what engine is actually doing with the fuel. kinda thing.

[DippyDame]

Every cell in your body uses/needs T3.

If you work your body too hard you will use more T3

If you have a limited supply of T3 in your cells then you will get symptoms of undermedication....and end up on the sofa!

Your FT3 is at a reasonable level and should be reaching the nuclei of the cells where it attaches to the T3 receptors and becomes active

BUT...this doesn't appear to be happening yet

Have you optimised vit D, vit B12, folate and ferritin....essential to support thyroid function)

I would be inclined to gradually combine your T3 into a single dose of 15mcg....that can help "push" the T3 into the cells. Taken at a time that suits you best(

If that doesn't help, after at least 2 weeks you could increase your T3 by maybe 2.5 or 5mcg

OR....do this the other way round

You say you have been on your current dose for a few months...since you are still symptomatic you need to alter your T3 dose

I need 100mcg T3-only daily...splitting didn't work for me so I take it as a single dose at bedtime

BUT, we are all different and what suits Mary probably won't suit Jane!!

How long is "a few weeks ago".....more than 6 weeks?

A new blood test to include minimum, TSH, FT4 and FT3 will help point to the way forward

The dose must be consistent...it's not "as and when" like taking paracetamol for a headache.

Meantime, ease up on the exercise....your life doesn't depend on it....

...but ultimately your quality of life (in extremis your life!) depends on T3.

Be kind to your body!

[Forestgarden in reply to DippyDame]

My bloods were about 4 weeks ago and yes my vitamins are all good - I've focused on optimising them over the past year. I'll try some different timings with my t3 first before I think about adding in more. Thanks for all the suggestions