Finally got T3 meds!!!

[LeilaD]

Hi, after years of begging and trying all the possible ways of trying to get T3, my endocrinologist prescribed me T3 (Thybo Henning) and I am about to start using it. Just wondering what are suggestions of time of the day from your experience? I was on 150 Levotyroxine for (since I was 19, and now I am 43). Now my endocrinologist said that I should use 1 tablet of 20mg Thybo + 125 Levotyroxine. Do I have to split tablet on half and use morning/evening. I was just too excited of being prescribed it that forgot to ask (silly from me, I know). Any suggestions?

[Regenallotment Ambassador]

Hi good for you!

My advice would be not to take 20mcg in one go from day 1.

Start with 5mcg with levo in the morning for a few days, see how you go.

then add another 5 mcg in the afternoon, wait a few days then another in the evening and then switch to 10 in the mornings and build up gently. It could take weeks to get to 20mcg. Thybon (I take it) breaks along the groove with a finger nail and the two halves split into quarters pretty easily.

Its very individual, some feel fine and smooth, others feel like they've been caffeinated in a sauna!!

Signs I've gone to fast are palpitations, hot face, upset tum etc.

Have you got a recent pre T3 blood test result? Its good to have this to compare to as you increase.

Good luck! Let us know how it goes 🌱

[LeilaD in reply to Regenallotment]

Thank you so much, very valuable information 🙂 yes, I had all bloods done. I just hope that finally I will feel as a human being, not just exist every single day.

[FancyPants54 in reply to LeilaD]

Speed, or rather the total opposite of it, is vital here. You need to allow plenty of time for your body to get used to being given the T3. As above, start with 5mcg in the morning with your levo and hold that. Personally I need to hold my dose increases for at least 2 weeks before I could think of increasing. You have been starved of T3 for decades. Increasing slowly, 2 weeks at a time, is nothing in the grand scheme of things. You will regret it if you rush. Your endo is setting you up to fail if he thinks you will cope with a drop in Levo and 20mcg T3 a day from the start.

[SlowDragon Administrator]

Well done

please add most recent Ft4 and Ft3 results and ranges

Plus vitamin D, folate, ferritin and B12 results

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Definitely follow Regenallotment advice to start SLOWLY

Initially reduce levothyroxine by 12.5mcg per day

Wait 4-5 days…..then add 5mcg T3

After 3-6 days add 2nd 5mcg dose approximately 10 hours after first dose

Assuming all ok…..possibly reducing levothyroxine by further 12.5mcg …..before adding 3rd 5mcg dose

Spread out at roughly equal 8 hour intervals

Eventually, possibly adding 4th 5mcg …..and you might be able to then take as 2 x 10mcg

But don’t rush ….you might not need full 20mcg

[LeilaD in reply to SlowDragon]

Hi. Thank you for your answer 🙂 My recent tests are. TSH - 9.19; T3-3.7; T4-13.1; Vitamin D- 31; B12- 108; Ferritin- 12.

[SlowDragon Administrator in reply to LeilaD]

Sorry didn’t realise this is your first post on forum

So on 150mcg levothyroxine daily your TSH is 9.19?

This suggests malabsorption

Which brand and do you always get same brand at each prescription

BEFORE considering adding T3 you most likely need dose INCREASE in Levo

BEFORE considering adding T3, TSH should be around 1, and definitely below 2

Ft4 at least 70% through range

Are you taking levothyroxine correctly

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

Please add ranges on Ft4 and Ft3

Was test early morning and last dose levothyroxine 24 hours before test

Vitamin levels look terrible and need improving BEFORE adding T3

What vitamin supplements are you taking

Doesn’t look like you are taking any?

Ferritin is obviously deficient as below 30

Vitamin D insufficient assuming test is nmol U.K. units

B12 - please add range

No folate result?

[LeilaD in reply to SlowDragon]

Hi, thank you so much for all this information. I am now really confused and, if you don't mind, I will ask perhaps some stupid questions. Ranges, first. T3 3.7 (3.1-6.8) T4 13.1 (12-22), vitamin D - mine is 31 (30 - 55), B12 is low, I am taking it now 1000qg per day; I take vitamin D - 4000per day and iron - I take 50 mg twice a day in liquid ampules (started taking just recently, after blood tests), my hemoglobulin is fine 13.9 (12-15.3). With Levotyroxine - I do not have the same brand, it is literally what they have in pharmacy, unfortunately, sometimes it changes every single time. I did test without taking Levo 24 hours before, however, I returned from France 2 days before the test and I did not take Levo in France properly for a week (I skipped approximately 4 days in that week by accident). Can I ask WHY TSH need to be below 2 prior to considering T3? I think maybe I will delay taking T3 straight away and do tests after using Levo correctly (I have been now) - I have an opportunity to do it as I am in Latvia (that is where my endo is) from 2nd of November for a week. I managed to get my D from 13 (30-55) to 31 after taking vitamin D for a year, however, even 31 is not ideal.

[Lily905]

Congratulations 🎉

Everyone takes their T3 differently. I would start with half of the T3 dose & build up gradually. I'm on 3 x 20mcg T3 daily & I take all three in the morning with two mugs of coffee & no food. Some people avoid coffee & T3 because they say it messes up the T3 absorption - but it's the way it works best for me

[SlowDragon Administrator]

Neither levothyroxine or T3 will work well without GOOD vitamin levels

Malabsorption

Is your hypothyroidism autoimmune

Have you had coeliac blood test

Test for H Pylori and SIBO

[LeilaD in reply to SlowDragon]

It is autoimmune, I had test for H Pylori that is negative - the reason for that is constant diarrhoea at least 3 times per day, but everything apparently is ok. Never had coeliac or SIBO tests done, however, I can get this all done in Latvia very easy in November

[SlowDragon Administrator]

what’s endo prescribed for your anaemia

are you vegetarian or vegan

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

[LeilaD in reply to SlowDragon]

I am not a vegetarian, neither vegan, however, I try to eat gluten free, I tried gluten an dairy free but that did not work very well for me. I am just wondering if it is possible to develop gluten intolerance later in life, as I feel that, whilst I was in France and ate bread (of course), my stomach was not happy at all.

[SlowDragon Administrator in reply to LeilaD]

very common to develop food intolerances with Hashimoto’s when start on levothyroxine

Especially gluten and dairy

While still eating high gluten diet ask GP /endo for coeliac blood test first as per NICE Guidelines

nice.org.uk/guidance/ng20/c...

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

[SovietSong]

The addition of T3 was a huge game changer for me and hopefully you will have the same experience.It is strong stuff and takes lots of tweaking.After much chopping and changing I am back to my normal self.I take a quarter tablet(6.5mcg)on waking and an eighth around 2.30pm.The addition of the eighth helps me avoid the mid afternoon slump and there is still enough in my system until the following mornings dose.I found my levo didn’t need reduced much, I still take 125mcg daily apart from Thursday when I take 100mcg.Great to be full of energy again,I walk approx 4-5 miles per day and have lost 16lb.Really hope it does the trick for you,look forward to reading your results.