T3 T4 Dosing

[JoanC645]

Hi,

I took levothyroxine only for years (since 2007) - constant adjustment of dose between 75mcg and 100/75mcg alternate days as always had hypo symptoms.

Most recent dose 100/75mcg daily.

Just seen endo (well endo's registrar actually) and started on T3/T4 combination therapy. He put me on a dose of:

50mcg levothyroxine

10mcg Liothyronine Sodium to be slit 2 or 3 times a day

Upon starting:

TSH: 2.8

T4: 17

T3: 3.1

I was expecting to start on a lower dose of T3 and for my levo dose to be decreased by around 10-12%

Also, is the ratio of T3:T4 being 1:5 okay?

Any advice welcome please.

[SlowDragon Administrator]

what’s the range on Ft4 and Ft3

With TSH over 1 you look like you needed dose increase in Levo first and certainly not such a large dose reduction

Was test done early morning,ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

ESSENTIAL to test vitamin D, folate, B12 and ferritin

These need to be OPTIMAL for good conversion of Ft4 to Ft3

We advise only starting T3 SLOWLY

Initially adding 5mcg in morning…..after 4-6 days increase to 2 x 5mcg

Retest 6-8 weeks later

Highly likely Ft4 will drop far too low on only 50mcg

[JoanC645 in reply to SlowDragon]

Thank you so much for such a fast and helpful reply.

TSH 2.8 (0.27 - 4.2)

T4 17 (12 -22)

T3 3.1 (3.1 - 6.8)

Vit D 76

Ferritin 115 ug/L

Active B12 51 pmol/L

Folate 6.8 ug/L

All tests arranged myself prior to meeting via Monitor My Health.

Yes, I always have tests taken early morning, before 9, only drinking water and 24 hours after last levo dose - thanks to advice on here.

Thank you!

My son suggested dropping levo to 70mcg and taking 6 mcg T3 (split into 3 doses) to start and only ever make small changes - so similar to what you have advised.

[Mollybob]

Joan, I did exactly the same for years and never felt good. I have been on compounded t4/t3 extended release (one pill per day) for five years. I had to go to a holistic doctor to get compounded thyroid medication as my endocrinologist would not prescribe. It works better for me than anything else I've tried.