Starting t3 while decreasing t4

[Ganggywaller]

After a lot of thought i have decided to take plunge and try adding t3 to my regime. I recently found out i had a very low t3 result, due to poor conversion. Just wondered best way to go about it. At present i take 5×100 mg levo , then 2×75 mg. Weekly. My endo wants me to introduce the t3 10mg a day split doses and lower the levo by 25 to 50 per day. Wondered what other peoples thoughts and experience were on this through experiences. To make the transition as easy as possible. Eventually the endo wants me to be on a dose of 10 mg t3 and levo 50mg per day. Sorry for the very long post .

[Jazzw]

Just linking to your last post about this for ease of reference: healthunlocked.com/thyroidu...

I’d be really surprised if 10mcg T3 and 50mcg levothyroxine was enough (once you get to that “final” dose). That’s probably going to be too low a dose. Not sure that your endo is particularly experienced in using T3–at least, that’s how it comes across. Still, at least they’re open to you trying T3, which often isn’t the case.

Have you ever been on 100mcg levothyroxine 7 days a week?

Anyway, not the question you were asking. Let’s stick to that. 🙂

It’s best to go low and slow with the introduction of T3. So I wouldn’t necessarily change my levothyroxine dosage at all to start with. I think I’d start by leaving the Levo dosing the same and adding 5mcg liothyronine a day in 2 divided doses of 2.5mcg each (assuming you can split the tablets? Have you been given tablets or capsules?).

Once your body has got used to the T3 after a few weeks, it’s then that I’d add a bit more T3 and consider reducing my levothyroxine dosage.

Have you ever posted the FT4 and FT3 results that led to your endo suggesting this route? It would be interesting to see these results ahead of suggesting how best to go forward.

[Ganggywaller in reply to Jazzw]

Thankyou jassw, i have posted my results previously. My endo also thinks im overmedicated at the moment as my t4 is at upper end of range but always has been . I am a little scared to add t3 but feel like i must to feel better. I am very anxious at present

[SlowDragon Administrator]

what are your most recent Ft4 and Ft3 results and ranges

Do you always get same brand levothyroxine at each prescription

What are your most recent vitamin D, folate, B12 and ferritin levels

What vitamin supplements are you taking

[Jazzw]

OK. So I’ve found some results for you from about 9m ago (have you had any more recent ones?)

TSH 1.21 (0.27-4.2)

T3 2.5. (3.1-6.8)

T4 22.2 (12-22)

THYROGLOBIN 15.6 (0-115)

THYROID ANTIBODIES <9 (0-34)

When you have a thyroid blood test, do you take your levothyroxine on the morning of the test?

 healthunlocked.com/thyroidu...

[DippyDame]

We really need to see your lab results with reference ranges for FT4 and FT3 so the we can see what is going on and what needs to be done.

When initiating T3 you don't need to reduce your T4 because T3 naturally lowers both TSH and FT4.

Starting on 10mcg T3 would be too much, too soon, for most people.

Suggest you start on 5mcg daily....or even 2.5 mcg if you wish to go even slower..... and with 2 week gaps slowly add the remainder until you reach the 10mcg T3

I wouldn't bother splitting the dose so long as you build it up slowly as above.

I need 100mcg T3-only daily and I take it all in a single dose at bedtime.....it saves a lot of time faffing around with tiny doses and with clock watching

Test after6/8 weeks on 100mcg T4 + 10mcg T3

Those results will guide your dosing.

I doubt 50mcg levo + 10mcg will be enough to restore your health

I don't think this endo is very conversant with T3 or confident in thyroid hormone use. It is perfectly safe (like any other medicatiom) so long as used correctly! Medics lack of knowledge is their problem!!

My endo also thinks im overmedicated at the moment as my t4 is at upper end of range ....

So he wants to half your T4 dose ...in doing that he is going to cause you to lose the benefit of the T3 converted from the 50mcg T4 he is cutting. Just when you need more T3!!

He is flying by the seat of his pants I'm afraid!

There is a difference between being overmedicated and being wrongly medicated and right now he doesn't seem to understand that difference

So long as your FT3 remains in range you are unlikely to be overmedicated

It would help greatly if you added current lab results.... we are in the realms of guesswork without these. It also saves us time searching through your previous posts for this

[pennyannie]

Hey there again :

Considering you have had RAI thyroid ablation please ensure your core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D are optimal before you start this T3 trial.

I now aim to maintain my ferritin at around 100 - folate at around 20 - active B12 125 ( serum B12 500++ ) and vitamin D at around 125.

It is essential that you are not dosed or monitored on your TSH - BUT on your T3 and T4 readings / ranges.

[jgelliss in reply to pennyannie]

👍👏👏👏👏

[Transalp]

The Thyroid Patients Manual by Paul Robinson is worth reading for T4/T3 dosing and in general.

[humanbean]

Quite a few people in your situation have found that their Free T4 reduces naturally when they add in some T3, without reducing their T4. It did for me and it has been reported on the forum quite often by others.

At present i take 5×100 mg levo , then 2×75 mg. Weekly.

This averages out to 92.8 mcg per day, so your T4 dose isn't particularly high. But I think your endo wanting you on 50mcg per day with 10 mcg T3 is either going to be disappointed or he might end up under-dosing you. Let's hope he just ends up disappointed and you get the dose you actually need.

[humanbean in reply to humanbean]

When endos swap some T4 for T3 it is assumed by them that T3 is about 5 times as potent as T4. So for every 10mcg T3 they prescribe they usually remove 50mcg T4.

I don't think that equivalence is true, but people do differ in how well they well they absorb T3, and how much they make on their own. T4 is made by the thyroid (if there is one), but T3 is made by the thyroid (if there is one) and by conversion of T4 (whether that T4 comes from the thyroid or from pills).

In my personal experience T3 is about 3 times as potent as T4 - so 10mcg T3 is roughly equivalent to 30mcg T4. So, in my opinion, endos remove too much T4 from the patient when they prescribe T3.

[tattybogle]

as an example of how fT4 can lower 'by itself' when adding T3 :

I added T3 to my levo earlier this year.

I lowered levo very slightly by just 12.5mcg when i added T3 , because the fT4 was top end.

I have since had to put levo dose back up because fT4 fell much more than i was expecting for such a small reduction (i also felt rubbish ~ sort of hollow . not solid , not grounded , and rather unstable/ unsafe ..can't describe it really .....anyway , putting levo back up made a more or less instant improvement to how i felt)

previous results (before taking any T3) :

on 100mcg levo ....... fT4 was 22.1 [12-22] 100%

on 87.5mcg levo ..... fT4 slightly lower 21[12-22] 91%

75mcg Levo with 9 mcg T3 ... fT4 fell to 17.6 [12-22] 56%

p.s i didn't add 9mcg all at once , i started with 6mcg (hoping i could avoid the faff of splitting 25mcg tablets into tiny pieces) but after a week i decided i needed to split that into 2 doses of 3mcg , then after a few more weeks added another dose of 3mcg ..I have since reduced that slightly to 8mcg (2 doses of 4mcg) ~ easier to cut and taking 3 doses was a faff. ... but even that small amount still sometimes feels like too much, even though i've been taking it for several months now ..... and occasionally i need to miss a dose if i haven't been very active . so i'm not sorted out yet . I'm currently feeling 'reasonably functional but not jumping for joy' on about 92 mcg levo with 8mcg T3 . waiting to test again in new yr.

your endos suggestion would have been a large shock to my system , i suspect it would have made me feel very unwell , and probably put me off continuing with my efforts at T3 .

[Otto11]

Hi when I started on T3 a year ago when was taking 112.5mgs Levo. The Dr prescribed 10mcgs T3 twice a day & suggested reducing my Levo to 50mcg. With everything I had read on this group I asked if it could be 75mcgs & he agreed. I initially started very slowly with 2.5mcgs of T3 then gradually built up over about 4 months to the dose suggested. What then happened was my T4 decreased to 13 which is too low so I have slightly increased my Levo & am currently taking 87.5mcgs of Levo to increase my T4. This is working & slowly my T4 level has increased from 13 to 18. I would suggest that dropping your Levo to 50 mcg is too low. That would be a shock to your system. Also take a much lower dose of T3 & increase slowly otherwise that too will be shock to your system.