Next T4/T3 step - grateful for advice

[Zebra5]

Hi everyone. I am not progressing as well as I felt I was and would be grateful for an objective view and some suggestions for next steps, if possible, please.

I was diagnosed with autoimmune thyroid disease in 2019, am female, 67 years old, 5'5", around 10st.

My symptoms are feeling cold, exercise intolerance, lack of energy some days (fine others) - I cannot predict - dry skin, low libido and have lost a bit of the joy of life.

I am now (after a very long time) prescribed T3 on the NHS and am on T4/T3 combination therapy. This was because I was on an over-range dose of T4 to get sufficient T3/was not converting.

I take 100mcg Teva T4 per day in the morning; 2.5mcg T3 Morningside three times a day (so 7.5mcg per day). In June last year, I reduced T4 from 125mcg four days a week and 100mcg three days a week, to 100mcg per day. This was when I was under the consultant, and had officially been started on 5mcg T3 and then gone up to 7.5mcg. He wanted a much more dramatic reduction in T4 but I persuaded him I needed to take it more slowly. Now I think I am taking it too slowly! In the meantime, I have been discharged back to the GP.

I follow the protocol recommended on here for testing and haven't changed brands.

I feel as if I should reduce T4 a little and increase T3 but not sure by how much and what to do when. What do you think?

My last two results are above. These are both on same dose (100mcg T4 and 7.5mcg T3) after longer than eight weeks. Would also appreciate any comments on vitamins.

Thank you very much for your help.

[FallingInReverse]

Did the results accidentally drop off you post? I don’t see them.

[Zebra5 in reply to FallingInReverse]

They loaded as a solid black table so I took a photo and tried again. Hopefully you can see them now. Thanks for getting back to me - sorry about that.

[FallingInReverse]

I love reading your methodical, low and slow progress. Great results table : )

Incidentally I was at 10 t3 for a year, and most recently at 112 Levo. My t4 has always been mid range, but t3 went slightly over. So I am now on 7.5 t3 where I should have probably started in the first place.

Isn’t it interesting to see how different we all are : )

In my opinion I would plan

1) Levo reduction - t4 shouldn’t be over range, and should be as low as you can while still feeling well. I’m a 12.5 kind of gal… so would reduce to 87.5 a day.

2) t3 increase - but your t3 is definitely too low. So another 2.5 daily for sure.

Only problem of course is that it’s recommended to only change one thing at a time. T4 is too high, but dropping it will likely drop your t3 too, which is definitely low enough to likely be causing symptoms.

If it was me - I’d increase the t3 and in 6 weeks reduce t4. Then you’re probably going to need another t3 increase at that point. High/over range t4 is not good… but with t3 at that level, I think you’ll feel even more horrible if you start with a drop. Catch 22!

These 6-8 week waiting periods are so long when we are under replaced! But here we are.

You may get other opinions, but I think that’s what I would do.

ps - any thoughts on your ferritin jump? And your folate needs a boost, are you on a b complex?

[Zebra5 in reply to FallingInReverse]

Thanks very much FallingInReverse - and thanks for the compliment on my results table (appreciated as it took me long enough!).

I think you recommendation is a good one. I am going to seize the moment and type it out here to see what it looks like:

14 February 2025: increase from 7.5mcg T3 to 10mcg T3. Leave T4 at 100mcg.

31 March 2025 (a Monday): test TSH, T4, T3

3 April 2025: depending upon test results, probably reduce T4 to 87.5mcg per day. Leave T3 at 10mcg.

2 June 2025( a Monday): test TSH, T4, T3

5 June: depending upon test results, probably increase T3 by another 2.5mcg/day (so it will be 12.5mcg/day). Leave T4 at 87.5mcg unless still too high. See what forum thinks.

Ferritin - I don't know why it was higher last September. Is 148ug/L (Feb 2025) a reasonable level?

Folate - has always been a struggle - was around 5 for ages so I am getting there. I am eating more greens! I take Igennus Super B Complex, one a day. Would I be better taking two of these per day or having a separate methylfolate supplement, do you think? What level should I aim for?

Thanks again for your support - I've been dithering about and this is really helping me make a decent plan xx