Hi,This is an update following on from earlier posts. It is pleasing to be able to state that my local NHS Endo has signed me up to Combination Therapy, to be managed at GP level, following a three month trial. Previously taking 200mcg T4 daily now to be taking 100mcg T4 plus 20mcg of T3 daily. Experience has shown that T3 taken in one dose suits me well but 'flagging' occurs late pm each day. The 'Thyroid Symptom Score' showed improvement. (The ' Thyroid Symptom Questionnaire ' is a locally produced version of what appears to be a nationally recognised document but does, in my opinion, not include all symptoms that one who is Hypo may experience.)
My initial diagnosis some 30 years ago was that I suffered with Myxoedema and I now fully agree that the diagnosis was correct.
Now I am looking forward to happy sailing in the future and in the right direction. Current thoughts are to supplement T3 privately as I feel that the proposed dosage, as has been taken for 3 months, is inadequate.
Eccleston
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Eccleston
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How long have you now been on current 100mcg and 20mcg T3
Presumably you have new blood test results ?
Many members find they need BOTH Ft4 and Ft3 at least 50-60%. Through range
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 ALWAYS split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Also important to regularly retest vitamin D, folate, ferritin and B12
Hi, Three months on 100mcg T4 plus 20mcg T3. Endo suggests splitting t3 (an absolutely tiny tablet) so as to reduce flagging. I consider this to be wasteful of T3.
Hi, T4 at 200mcg daily taken am at least one hour prior to food, drink or other medicines proved inadequate hence my quest to investigate via private blood tests and a dna test. The last blood test revealed a very high concentration of reverse T3 which may have been the cause of very low TSH levels being recorded. The DNS test revealed that DI01 appeared not to be functioning as it should.
Hi, I am going to have to sit back for a while to consider my next move. It is my opinion that my discharge from Endo back to the care of GP is premature. Propranolol is still being taken. It has not even been considered by Endo. I asked the Endo for an opinion as to how higher levels if T3 might affect Insulin Resistance - their response denied knowledge of my treatment for T2 Diabetes. This is the same Endo who has treated me for 30 years!
When the Liver specialist was asked about any connection between T3 and the liver the response was negative and unhelpful.
The Endo when asked about effects on NAFLD and NASH declined to comment.
The last blood test which was prior to my first appointment with the Endo showed
TSH 0.21 Range 0.27 to 4.2 mIU/L
FT4 20.6 Range 12.0 to 22.0 pmol/L
FT3 4.1 Range 3.1 to 6.8 pmol/L
Reverse T3 36.0 Range 10 to 24 ng/dL
I do plan to have a further blood test in February when work commitments reduce. It will be interesting to then compare results.
See GP to discuss changing propranolol to a different beta blocker
I saw 6 leading thyroid specialists, including 2 leading professors, over the 20 years I was on propranolol. Not one of them understood the implication of poor conversion of Ft4 to Ft3
Or that propranolol lowers Parathyroid levels
I ONLY made progress once off propranolol. Took approx 6 months to ween off 40mg per day
I raised this with both my GP and Liver specialist to no avail. The view seems to be 'you cannot have it both ways'. Propranolol was prescribed to control Portal Hypertension. I have taken the view that if they will not prescribe a different beta-blocker then they can prescribe T3. Obviously cost does not come into it!
Propranolol decreases plasma T3 and increases plasma rT3 in a dose-dependent manner due to a decreased production rate of T3 and a decreased metabolic clearance rate of rT3, respectivel
Propranolol increases reverse T3 (rT3). Possibly by increasing the conversion of T4 to rT3, and by reducing it’s metabolism and clearance from the body.
What is interesting is that T4 will often rise, and TSH does not appear to be influenced by Propranolol. So consider you are put on a beta blocker. After a period of time you start to have low thyroid symptoms; tired, fatigue, weight gain, edema, dry skin, etc. You see your primary who runs a TSH with fT4 reflex panel.
Since the beta blocker does not influence TSH it may look normal. If it is high and fT4 is run, it to will be normal or possibly high because beta blockers raise T4 levels.
You will be told you don’t have a thyroid problem because these two labs are normal. If however a comprehensive thyroid panel was run to include T3 and rT3, we would be able to see that the beta blocker is inducing a cellular hypothyroid state.
This is a case of Drug Induced Hypothyroidism. The beta blocker induces the hypothyroid state as well as hide the impact because limited thyroid panels are often performed.
Propranolol is a non-selective, lipophilic beta-blocker with two additional features: On the one hand, only the non-beta-blocking d-enantiomer inhibits the conversion of thyroxin to triiodothyronin, whereas only the l-enantiomer shows beta-blocking effects (16,17). Thus, a major part of the efficacy of Propranolol in patients suffering from hyperthyroidism resides exclusively in the non-beta-blocking d-enantiomer.
you could cautiously start reducing propranolol by 5mg per day …..then wait 4-6 weeks before reducing again
Get 10mg tablets so it’s easy to manage
But BEFORE starting this get FULL thyroid and vitamin test done , with correct timings
Likely to see Ft4 is extremely low, possibly below range as you had huge reduction in Levo dose
So likely to first need to increase Levo by 25mcg to improve low Ft4
Getting Ft4 and Ft3 fine tuned and vitamin levels optimal essential
As Slow Dragon suggests below: I’d recommend adding 25mcg of Levo before increasing Lio. This worked for me. I know everyone is different, but it’s a safe approach.
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