Advice re T3 T4 dose adjustment please - Thyroid UK

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Advice re T3 T4 dose adjustment please

JoanC645 profile image
6 Replies

Hypothyroid with T3 consistently below range - several years on levothyroxine.

Recently started on T3

Most recent doses:

Levothyroxine: 70mcg daily

Liothyronine: 7mcg daily (split over 3 doses)

Results from blood tests on Monday 9th September:

TSH: 0.2 (0.27 - 4.2)

FT4: 18.2 (12 - 22)

FT3: 3.8 (3.1 - 6.8)

Bloods taken before 9 in morning, nothing to eat and only water to drink, 24 hours after last levo dose and 11 hours after last T3 dose.

All other relevant tests (folate, B12, vitD etc) in range.

How do I adjust the doses to raise the T3 level please?

Many thanks for any advice.

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JoanC645
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SlowDragon profile image
SlowDragonAdministrator

Free T4 (fT4) 18.2 pmol/L (12 - 22) 62.0%

Free T3 (fT3) 3.8 pmol/L (3.1 - 6.8) 18.9%

Levothyroxine: 70mcg daily

Liothyronine: 7mcg daily (split over 3 doses)

Did you mean 75mcg levothyroxine daily

Which brand are you using

That’s a very low dose levothyroxine

How much do you weigh in kilo

What dose levothyroxine were you taking BEFORE adding T3 and what were results

Suggest you initially increase levothyroxine by 12.5mcg daily

Retest in 6-8 weeks

Then consider increasing T3 after that

All other relevant tests (folate, B12, vitD etc) in range.

Please add actual results

JoanC645 profile image
JoanC645 in reply toSlowDragon

Thank you very much for your reply SlowDragon.

I have been treated with levothyroxine since 2007. The dose has alternated between 75, 100 and 100/75 alternate days. GP reduced dose if TSH was significantly below bottom of range, and I would request an increase if I felt worse hypo symptoms.

I weigh 57kg.

Yes, I did mean 70mcg levo daily - I use a pill cutter and micro scales.

The brand is teva.

I was on 75mcg daily before starting T3.

My anaemia profile results could not be taken by Monitor My Health from Monday's draw, so I will post my latest results.

Thyroid
JoanC645 profile image
JoanC645 in reply toJoanC645

09/09/2024

Vitamin D: 84

10/07/2024:

Folate: 6.8

Active B12: 51

Ferritin: 115

SlowDragon profile image
SlowDragonAdministrator in reply toJoanC645

Both B12 and Folate low

Typical result of being on inadequate dose levothyroxine/T3

what vitamin supplements are you taking

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

SlowDragon profile image
SlowDragonAdministrator in reply toJoanC645

Taking almost any dose of T3 will significantly lower or suppress TSH

Experiment with SMALL dose adjustments

Retest 8-10 weeks after any dose change

Are you sure Teva brand suits you?

Personally it’s taken 6-7 years of experimenting to eventually settle of dose of Levo and T3 and also timings of T3 doses.

JoanC645 profile image
JoanC645

Wow! That is a lot of helpful information. Thank you so much. It will take me some time to go through.

I don't take any supplements. I had lupus and have a kidney transplant so was advised to be careful with supplements.

On 27 Feb 2024, my B12 was 76. But I have had very little meat this year as I was getting a lot of stomach issues. I am also gluten free for the same reason.

I don't know anything about brands - I have always taken whatever I was given by the GP/pharmacy!

Thank you again for your help and advice.

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