Adding in more T3/Reducing T4

[JUUJOO]

I felt brill initially when adding in the T3 to my thyroxine, but 6 months down the line I feel terrible again. I'm settled on 4 x 125/3x100 T4 and 1 x5 T3 but I am still craving more hormones! My digestive system is so slow, im only going to the loo every 2-3 days. Im also tired and forgetful and have no energy.

My endo has agreed that I can add in another 5mg of T3 to take at 2pm every day , so Il'l be taking T4 at bedtime, T3 at 7am then again at 2pm, but he is saying I have to reduce my T4 to 100 daily. I said I was worried about reducing to 100 a day but he insists each 5mg is equivalent to 25 of T4 and i'll be ok. What do you think?

My latest bloods were taken following the normal guidelines on here.

TSH 0.02 ( 0.27-4.2)

FT3 4.8 (3.1-6.8)

FT4 21.0 (10.8-25.5)

They didn't test my ferritin, vitamins etc, so I'll arrange a medichecks for 8 weeks once ive settled on my new regime to see how i'm going.

Do you think I need to reduce my T4?

Thankyou so much in advance!

[FallingInReverse]

What were your results when you felt “brill” : ) ?

Re t4, eyeballing it looks like you are 70% through range I think? If so that seems like a great place to be, probably room to go up or down a little depending on your own personal sweet spot. We do want to avoid over range ft4, but you are nowhere near that.

Your t3 is middling so more might help… if your GP gives you an extra 5, I’d suggest adding in only 2.5 to start for a week then going up as you feel.

And keep in mind that t3 can have the effect of reducing your t4 (not sure by how much).

My personal opinion if it was me I’d hold the line on t4 and only change your t3 (low and slow).

For reference I am on 112 Levo and 2x5 t3 daily, and I’m opposite you… my t4 is middling and my t3 is high (prob too high right now, which is my next puzzle to solve.)

edit: I haven’t met or heard of a doctor yet who didn’t want to reduce t4 when adding t3. I also have not yet read here a definitive answer on whether one way or another is recommended/better. My conclusion is that it’s highly personally just like many nuances of our dosing.

So I do wonder if you can convince your doctor NOT to reduce your t4 if that’s what you choose.

[JUUJOO in reply to FallingInReverse]

Thankyou for your comments. I felt my best when I first added in the T3, but as my body adjusted to less T4 over time, I then didn't feel great. At that initial time my endo wanted me to reduce my T4 from 6*125/1*100 to 100 daily. I felt like he was setting me up to fail. So I didn't reduce as he wanted as I've learned over the last 3 years I don't do well on dose changes. So I went slowly to 4*125/3*100 and thought I would adjust further if needed to get to his target. But here I am. I couldn't reduce further. I have 6 months to try and figure this out before I see him. Low and slow is probably the best way for me.

[Simplyred57]

hi I’ve just posted something similar, not sure whether to increase T3 or revert back to my previous dose of higher thyroxine by reducing by an extra 50mcg of thyroxine a week my T3 has plummeted to 5.1 and my T4 has hardly moved , it’s so hard this juggling things to feel well😞

[JUUJOO in reply to Simplyred57]

I agree, It's so hard to figure out what to do for the best, especially when I've realised that the people on this forum who've been dealing with dodgy thyroids for years have more insight than my endo!

[jimh111]

fT3 is about four or five times as potent as fT4 in the blood. In tablet form T3 and T4 have different absorption rates and elimination half-lives. As measured by their effect on TSH liothyronine is about three times as potent as levothyroxine.It's an amazing display of stupidity that many endocrinologists think that the ratio you put in your gob will be the ratio that ends up in the blood.

I would try reducing your levothyroxine just to see if you get better.

[Simplyred57 in reply to jimh111]

Hi Jim I was hoping you would see mine and JUUJOO’s posts and reply , not sure which way to go on this one ? Im I saw a post from you that said your T4 shouldn’t be too high when your on a combination treatment which is why I tried to reduce it , but it’s barely moved and T3 back to 5.1 .

[jimh111 in reply to Simplyred57]

I think perhaps you only reduced your levothyroxine a little, some days on 100 some on 25. You probably need to adjust 25 mcg daily to see an effect.

[Simplyred57 in reply to jimh111]

Yes reduced from 100mcg a day to 75mcg 2 days then a further 2 days at 75mcg so 85.71 per day and my t 4 only reduced from 21 to 20 but my T3 went from 6 to 5.1 I’m scared to reduce to 75 per day while my T3 is so low so maybe the way forward for me is to increase T3 and maybe that will bring my T4 down a bit ( it didn’t when I first started using it ) but what I really wanted was to convert as much as possible and just top up with a small amount of T 3 . I had RAI so don’t have a functioning thyroid.

[jimh111 in reply to Simplyred57]

Your fT4 is a little high for most people on 100 mcg levothyroxine. It's possible you still have some functioning thyroid tissue. An fT3 of 5.1 is quite good, slightly above average. It's preferable to get most of your T3 from converting T4 as much of this is done by type-2 deiodinase which takes place close to the cell nucleus near the receptors. This appears to be stimulated by TSH so ideally you wouldn't push your TSH down although this is sometimes unavoidable.

[Simplyred57 in reply to jimh111]

thank you jimh111 ideally I would like that but as my t4 now is 72% and T3 is 55% should they be more balanced?

Previously T4 81% & T3 78% I did feel better with these numbers 🤷🏼‍♀️

[jimh111 in reply to Simplyred57]

For an average healthy person you have plenty of hormone. Sadly many of us do not get better with normal hormone levels. We need to get better but higher levels carry risks, as does remaining hypothyroid. So, in some cases there's no correct levels. To answer your question if I needed higher levels I would keep my fT4 just below average and adjust my T3 levels keeping am eye out for signs of thyrotoxicosis.

[JUUJOO in reply to jimh111]

Really interesting perspective thankyou. I didnt drop as much T4 as my endo wanted and adding in the T3 was not enough to feel well. So again im doubting what he says about T3 being 5 times stronger. I think I will reduce half way, like I did before and see how I go in 3 months.

[jimh111]

pmc.ncbi.nlm.nih.gov/articl... levothyroxine liothyronine equivalent doses.