T3 medication advice

[Anja1234]

I am writing because I have a question regarding T3 medication. I was just prescribed liquid T3 medication Liotir drops (0.7 mcg liothyronine per drop) by my thyroid specialist doctor. I am prescribed 4 drops in the morning and 3 drops in the evening (7 drops per day equaling 5 mcg of T3). I was also advised to reduce the T4 medication from 100 mcg to 88 mcg (I am getting Tiche, the italian brand of Tirosint). I would like to ask the people that are already taking T3 for advise on how it is best to take this medication. I would primarily like to know how many hours apart it is best to take T3? Does the evening dose have to be on empty stomach - is 1 hour before and after eating ok? I read that taking the T3 dosages 8 hours apart works best. I would also like to ask if you have any side effects or if there is anything I should be careful about. I am really concerned about the potential side effects that is why I am asking.

I would also like to ask you whether you think I am a bad converter of T4 to T3. I am posting my results in TSH, free T4 and free T3 when I upped my dosage of T4 medication from 37 mcg to 100 mcg daily in the span of 1.5 years. My T4 kept increasing, but my T3 was even lower at the end as it was in the beginning. My last results on 100 mcg of levothyroxine medication were: T4 was 20.4 mcg (reference range 12 - 22) and my free T3 was 3.63 (reference range 3.1 - 6.8). Would you based on these numbers say that I am a bad converter? I am feeling extremely exhausted again, have no energy and also my mood is very low. I am basicaly feeling the worst I felt since I was diagnosed 2 years ago and by levothroxine dosage is at it's highest at 100 mcg. I weight 68 kg. I am really concerned about the possible side effects of T3 medication but I think living with no energy is by far worse. I tried to up my vitamins but I had a really difficult time because I also have bile gastritis and my stomach would hurt so it really wasn't a good option for me and I tried to get the T3 medication from my thyroid specialist doctor instead. I would greatly appreciate any advice or recommendation.

Here are my results:

Date TSH(0.27 - 4.2) T4(12 - 22) T3(3.1 - 6.8) Dosage of levothyroxine(mcg)

5.5.2023 5.09 12.63 4.2 0

7.6.2023 3.79 13.18 4.8 25

6.7. 2023 1.46 12.57 4.68 38

25.9.2023 4.43 15.7 4.89 38

12.10.2023 1.69 15.7 4.0 50

15.11.2023 3.68 16.5 4.76 50

16.1.2024 2.1 15.3 4.12 63

17.4.2024 2.36 15.6 4.03 63

21.6.2024 5.44 15.65 3.75 75

15.10.2024 1.76 17.7 4.49 88

5.12.2024 1.50 18.0 3.98 88

30.1.2025 2.71 20.4 3.63 100

My vitamins results:

Ferritin 47.1 (13 - 150)

Vitamin B-12 300 (145 - 569)

Vitamin D is also very low

Kind regards,

Anja

[Anja1234]

I just noticed my results didn't display right so I am writing them once again.

Results

[SlowDragon Administrator in reply to Anja1234]

Your vitamin levels need improvement

What vitamin supplements are you taking

Do you test as recommended early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

assuming yes

You do look like poor converter

No one in U.K. gets T3 liquid

It likely works very well

Adding T3 is always an experiment

I am prescribed 4 drops in the morning and 3 drops in the evening (7 drops per day equaling 5 mcg of T3). I was also advised to reduce the T4 medication from 100 mcg to 88 mcg

Perhaps start slowly with 2 drops in morning and if that’s ok 1 or 2 drops in evening

Increase slowly over 1-3 weeks

Retest after 6-8 weeks on constant unchanging dose

[Anja1234 in reply to SlowDragon]

Thanks so very much for your reply and recommendations. Thanks especially for the slow start recommendations. I took just one drop in the morning and in the evening today and I already felt a little bit better and a little bit less tired and fatigued. I will take 2 drops morning and evening in the upcoming days and reduce levothyroxine by 12 mcg.

I test blood like you recommended.

I am not taking any supplements at the moment. I recently had some problems with my stomach / gastritis and I had to discontinue the supplements. Previously I was taking folic acid, vitamin B12 and vitamin D. I was not able to take the most gentle form of iron as my stomach would hurt really bad. I feel much better now that I am taking T3 as I did when I took supplements (I didn’t really feel any difference then and my T3 blood level remained low).

Could anyone advise how many hours to take the morning and evening dosage of T3 apart? Is 8 hours ok or is 12 hours better?

Thanks so much,

Kind regards,

Anja

[SlowDragon Administrator in reply to Anja1234]

If only taking twice a day …..afternoon dose roughly 10-12 hours after morning dose

[Anja1234]

Thanks very much for letting me know. Can I ask the people who are taking T3 - do you have any side effects and has T3 affected your quality of life - helped you feel better?

[ElRR]

Best times to take medicine varies from person to person. I'd try a few different ways and see what works best for you. For me, thyroid medications are most effective at night, but I need to be careful as I won't sleep well if they're too high at night (at least since I've hit perimenopause). Others find morning to be the best time, or 3x a day.

Just be careful, you should take it on an empty stomach. And if you start vitamins, iron and calcium inhibit its absorption. And if you add B vitamins, stop anything with biotin a few days before any thyroid tests as they'll likely mess up your TSH levels. (I stop all my b vitamins just to be sure, but I'm probably just being paranoid!)

Also, how did you manage to get the NHS to prescribe liquid t3? Thanks!