T3 advice

[Flycatcher]

I have been prescribed a three month trial of T3 by my NHS endo. I currently take 75mcg of Levothyroxine daily. He wants to cut my Levothyroxine down to 50mcg a day and to take 12.5mcg of T3 twice a day, morning and evening. This seems a large amount to start off on and I wondered if I should start with a lower dose and build it up slowly. Any advice on this and the best time to take it would be welcome. Thank you

[Buddy195 Administrator]

I personally would add 5mcg Liothyronine per day as a first step, adding a further 5mcg once well tolerated.

What was your most recent thyroid blood test? Unless your FT4 is very high in the range, I wouldn’t lower to 50mcg Levo, as 50mcg is the usual starter dose on Levo.

[SlowDragon Administrator]

post a year ago showing Ft4 only 60% through range

75mcg only one step up from standard STARTER dose

Did you not get dose increase after last tests year ago

Vitamin levels were low and cholesterol high ….typical of being under medicated

What are most recent results

Adding T3 invariably lowers Ft4

[Flycatcher in reply to SlowDragon]

Thanks for the reply SlowDragon

My Doctor wouldn't increase my Levothyroxine because my TSH was low. I paid to see the endo privately and then transferred to NHS and he agreed the trial.

My latest blood results are above.

I would welcome your advice.

Test results

[SlowDragon Administrator in reply to Flycatcher]

puzzled by the T3 at 12.5mcg twice day

In U.K. T3 is 20mcg tablets

Or 10mcg or 5mcg

What size tablets have you been prescribed

I would initially only reduce Levo by 12.5mcg …..wait 3-4 days after reducing before adding 2.5mcg T3 in morning and 2.5mcg in mid-late afternoon

Assuming that’s ok …….after week or so …..possibly reduce levothyroxine by further 12.5mcg …..before increasing T3 to 5mcg waking and 5mcg mid afternoon

Retest after 6-8 weeks

I would expect Ft4 to reduce too much ….and may then need to increase Levo back up

Extremely important to maintain GOOD vitamin levels

Vitamin D at least over 80nmol and 100-125nmol may be better

B12 is good

Folate could be better

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)

Ferritin nearer 100 …..increase iron rich foods in your diet

[Flycatcher in reply to SlowDragon]

He has prescribed 20mcg and 5mcg tablets and told me to cut them in half. I take vitD+K oral spray

B supplement

I don't eat red meat so struggle with ferritin. Could you suggest a good supplement?

[SlowDragon Administrator in reply to Flycatcher]

You need full iron panel before taking iron supplements

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.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement - derived from meat

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Ferrodyn supplement

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

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...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[SlowDragon Administrator in reply to Flycatcher]

He has prescribed 20mcg and 5mcg tablets and told me to cut them in half.

5mcg tablets are much more expensive than 20mcg

25mcg T3 per day is high dose……. especially to start on

Most members on Levo plus T3 are on between 7.5mcg per day (3 x 2.5mcg) to 20mcg

Not many are on higher dose

And starting low and slow recommended

[sparkly in reply to SlowDragon]

I'm with you on this one. Starting dose definitely too high, 5mcg and work up. What I don't get is why is the endo wasting valuable nhs funds on prescribing 5mcg tablets. Surely 20mcg split to 10 and 5mcg doses should have been the answer. Different if starting dose would have been 2.5mcg

[SlowDragon Administrator in reply to Flycatcher]

My Doctor wouldn't increase my Levothyroxine because my TSH was low.

TSH will almost always drop extremely low or suppressed on any dose of T3

So you will need endo to write to GP …..

[jimh111]

I would take it morning and bedtime, I find the bedtime dose more effective in reducing fatigue and brain fog.It's a large dose, I would take 6.25 at bedtime initially and introduce another 6.25 at breakfast after a few weeks if you are not better. Since T4 has a much longer half-life I would skip a couple of levothyroxine doses when starting the T3.

Liothyronine is about three times as potent as levothyroxine. You endocrinologist seems to be equating 25 mcg liothyronine with 25 mcg levothyroxine. Do they know what they are doing?

[McPammy]

I wouldn’t start on 12.5mcg T3 twice a day, that seems far too high a daily dose. I take 5mcg t3 twice a day and 8hrs apart. I take mine at 7.30am then again at 3pm. That is works well for myself. My private endocrinologist didn’t advise to drop the levothyroxine either. My levo wasn’t over the level so we left it as it was. 6 years on and I’m still taking the sane doses. I feel brilliant and energised. I am symptom free now. Aim is get your levels similar to a healthy persons with a TSH around 1.00 which means keeping both t3 and t4 levels in range always, by always I mean just after taking meds as well as just before you take your next med. so do blood checks at both ends prior to med and after meds until you reach your sweet spot and keep it there.