Update

[Eccleston]

Hello folks,Firstly, many thanks for all the guidance and information from this site. It has proven to be invaluable.

Following a DNA test it has been established that I have a problem with converting T4 into T3. A subsequent blood test revealed a reading of 36units of Reverse T3 compared to the 'max' of 24units. I take it from this that my body thinks that I have adequate T3 and hence suppresses TSH.

My NHS Consultant has placed me on T3 at the rate of 20mcg daily whilst reducing T4 from 200mcg to 100mcg. I am taking T3 in one dose at the same time as T4 on an empty stomach and an hour or more before eating.

I am only at day nine of this regime but have noticed no significant changes in the way I feel. Am I expecting too much too soon?

One concern is that the T3 may only just be replacing the loss in T4-T3 conversion by the halving of T4 intake. In this scenario one could not expect to feel any better.

I would appreciate any comments pse to aid my decision making process.

Thanks

Eccleston

[Buddy195 Administrator]

To reduce Levo by 100mcg in one move seems very extreme and unusual. I personally would proceed more slowly, reducing by 25mcg- 50mcg as a first step. I also would not introduce 20mcg Liothyronine in one step- consider half this amount until well tolerated.

I did not experience a ‘eureka’ moment when introducing Liothyronine, just saw steady improvements over time. It is key to retest levels 6-8 weeks after being on a consistent dose.

[Sparklingsunshine]

I think there are too many drastic changes at one, no wonder you are feeling no benefits, halving Levo is drastic, its common for Endos to halve Levo dose but there is really no scientific basis for doing so. T3 suppresses FT4 levels anyway and it could be halving your Levo was unecessary, perhaps a 25mcg- 50mcg max drop was all that was needed.

Plus adding 20mcg of T3 is often too much too quickly. When I started I was advised to start on 6.25mcg once a day ( 5mcg in your case), wait at least a week or more to see how I felt, then add a second dose of 6.25mcg.

Then stay on this dose and test 6-8 weeks later. I think you are setting up to fail with the amount of dosage and medication changes here.

[helvella Administrator]

The change would indeed only replace (or increase) your T3 if you were converting 20% (or less) of your T4 into T3. But if you were managing, say, 25%, you will have less T3 than before making the change.

If standard UK T3 tablets were 25 micrograms, you can pretty well bet your last dollar on him having told you to take 25 T3 and reduce dose by 100.

In other words, the lure of simple numbers that line up with physical tablets is greater than getting the right dose for you.

(This oversimplifies. T3 molecules are slightly lighter so a direct weight conversion of a T4 dose to a T3 dose doesn't actually work. But I'm pretty sure medics don't take this into account. Also, you can expect to absorb T3 slightly better than T4.)

helvella - How much more potent is T3?

A discussion about the relative potency of T4 and T3.

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

[greygoose]

Following a DNA test it has been established that I have a problem with converting T4 into T3. A subsequent blood test revealed a reading of 36units of Reverse T3 compared to the 'max' of 24units. I take it from this that my body thinks that I have adequate T3 and hence suppresses TSH.

Sorry, but that's not right at all. The genetic test only tells you if you have a potential conversion problem, but the only way to know how well you are actually converting is to have the FT4 and FT3 tested together and compare them. If the gap between the percentage of the FT4 through the range is much higher than the FT3, then you are not converting well.

rT3 has nothing to do with TSH. There are many, many causes of high rT3 - such as low-calorie diets or taking beta-blockers or having an infection - but only one of them has anything to do with thyroid. And that is when you're a poor converter and your FT4 is much too high in-range. In which case, more T4 will be converted to rT3 than to T3. But the rT3 itself is not a problem.

Therefore it is cheaper, and more useful, not to test rT3, and just get the FT4 and FT3 tested, and they will tell you all you need to know.

So, it sounds like you do possibly have a conversion problem, but without the other numbers it's impossible to tell.

Also, if you are taking T3, your high rT3 is unlikely to be caused by high FT4, and is more likely to be due to one of the other many causes. And your low TSH is due to taking T3, because that's what T3 does. So on't worry about the rT3 on any account.

[SlowDragon Administrator in reply to greygoose]

He’s on 60mg propranolol per day too

[greygoose in reply to SlowDragon]

OK, so that could be the cause of the high rT3. In any case, the high rT3 itself is not any sort of a problem.

[SlowDragon Administrator]

My NHS Consultant has placed me on T3 at the rate of 20mcg daily whilst reducing T4 from 200mcg to 100mcg

Any changes should be done SLOWLY

We always recommend only adding max 5mcg T3 initially and only reducing levothyroxine by maximum 25mcg at any one time

As discussed in previous posts as you are on 2 x 30mg propranolol daily this will be significantly affecting your thyroid hormone levels and how you use them

[arTistapple]

It seems to have become the ‘norm’ such huge drops in Levo when endos start T3. However I have never found any literature explaining the ‘why’. I think it’s either purely a guess (or planned failure) because of the lack of dosage research. In fact, if I recall correctly when Professor Toft started his ‘push’ to include T3 the drop was very much less.

No-one seems to be doing any research around dosage but I think it’s vital.

I am a bit of a “less is more” kind of view, re:increases. I recognise many people will need more but slow increases allow better control and much more likely to find a ‘sweet spot” more easily.

I thought my endo was discussing something radical when 25 to 50% was suggested to me and I was game. Stupidly before I actually got the T3 prescription, I dropped my Levo 25% in ‘preparation’. How extra stupid was I, when nearly six weeks later his decision was not to treat me!

It’s now taken me four months working my way back to the dosage I was on when I attended the consultation - and that level was not great!

I know the likes of Professor (NAME REDACTED BY ADMIN AS PER FORUM GUIDELINES) is pushing this dropping of Levo even without a T3 prescription. I can’t recommend it AND I had already warned others not to accept that - then went and did it myself!

What a plonker?!

[Mothebear]

Greygoose and Slow Dragon on this site guided me very well when I was poorly converting and needed T3.

My symptoms were very severe (had lost all my creative brain function and very seriously low mood) so I noticed immediately with my T3 replacement, but my T4 which was 75mg per day was dropped Monday, Wednesday and Friday to 50mg so I would imagine bigger drops of T4 would be a shock to the system.

I had 20 symptoms which gradually resolved over a period of many months so not everything is resolved quickly with Liothyronine.

Wishing you the very best.