How do I titrate T3 when adding it for the first time!? Please help if you are on t3 and t4

Hi there, I have been attending something called bodymorph my gp had referred me too (re weight and high a1hbc reading

Long story short. I told the dietician that I was self injecting B12 and was always banging on about my thyroid problems, how the medical profession had largely ignored me. she took it without batting too much of an eyelid, but the following day they rang me and said they would like to refer me to their endocrinologist!

she was nice and listened to me, I asked her if she would prescibe me NDT (absolutely not) but she is happy to prescribe me T3. She is going to write to my gp. I am currently on 125 levo and I think she said something about 10 or 20 T3.

Can any one tell me how one goes about adding T3 and reducing t4, ie timescales, amounts etc

Thanks peeps

Tan x

27 Replies

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  • I just added a small amount....quarter of a tablet for a few days then increased slowly to desired amount. This will take time, everyone is different and reacts differently to the medication amounts of t3 vary from one person to another. Take it slow, don't rush!!

  • cheers polly, I will take it very slow and keep a diary x

  • For example I take my t4 at nite and my t3 at 3.30am, 10am and 2pm half a tablet each time this works for me but might not for you! Good luck!

  • well, if the endo is giving you the T3, I am sure that when the GP receives instructions he/she will call you for an appointment to explain to you how they would like you to start, or the GP will write it down for you.

    An endo does not say 'ok I'll start you on T3' and does not tell you how to go about it.....

    or it will say on the prescription ie: take half a tablet twice day

    xx

  • thanks, I am going to make an appt with Gp, specifically to get her to explain it to me. I have ordered the book recovering with t3 too as I am a bit scared after what happened last time to be honest xxx

  • Lol. You don't know my gp! She gave me t3 once before about 18 months ago, never told me to reduce my t4 or anything, she's counting down to her retirement and never explains anything, its like getting blood out of a stone, she's a Scorpio and very tight lipped! I like her personally, but she's a weird doctor.....so when I took it last time, I went weird and hyper and thought never going to touch that again x

  • I'm sorry but then she should be 'struck off' and you should see a different GP, you might as well self medicate, so what is the point of having a GP? (or an endo as in this case it's the endo saying to take the T3?)

  • I have had the same gp, my entire life, and I guess I am used to her. my partner is always saying I should change. Whenever I have seen a different gp, say when I went with my mum or sister I am always amazed at their doctors and how they explain things.

    When I had a lump in my stomach(it was an irreducible hernia I later found out) I went to see her and told her that I had a lump in my stomach and could she feel it, she said she didnt have time. I went home in tears and it was my partner who made me go back, where I say a dif doctor who referred me for a scan. Of course I had a hernia because I suffered constipation for so long due to undiagnosed hypo!!!! sometimes I wonder how my life would have been different if I had a different doctor who picked things up, instead of waiting until I was on my last legs with something. .........dont even get me going on the cellulitis that was dismissed and the arthritis in my hip that a locum finally picked up on and by then it was bone on bone and time for a hip replacement.

    Actually reading this back I think I may take the advise of family and friends that have been telling me to change for years.

  • Patience. Know your baseline before you start for Total T3, RT3 and FT3 along with your T4's and TSH. I'm assuming your endo checked your actual B12 count as well? You should know this.

    Keep a diary. If you start it and then start to feel better - before it drops off again, this is down to overdoseage just as much as under dosage. Listen to yourself and shift just one up or down. Do not do them together - and listen to your own reactions. Do not change something else you do at the same time. This can cause symptom confusion and wrong attribution. Note your monthly cycle into this. Prepare for a period of time to get this right - probably careful work over 8 weeks or more. Allow at least a week before a next dosage change.

    T3 is the fast paced energizer - whereas your body through T4 should release a bit of T3 regularly as you need it, when you take this as a pill, it's a dumping mechanism and your body must process all of it whether you need it or not. If you take too much you can feel symptoms. Titrating is balancing your meds levels and really you must keep a symptom tracker including temperature, bp and resting heart rate. T3 increases your biotherm level and in too high a dose it will make you feel tired, anxious and increase your heart and BP. It's a balancing act. You should always attempt to split a dose of T3 and try not to take a dose later on in the day or before bed. It's 99% absorbed within a few minutes from taking it. Very different to T4 which must be in the gut and can take several hours.

    Recently I became disorganized with my T3 dosage and I'm paying for it now. You cannot mess with this and you must be disciplined - hard when you're not well in yourself. But you must try. It's definitely in my view much more powerful in its physical effects than T4 where an error I found unnoticeable. But on T3, yeah you can notice it and quickly in my experience. Good luck and don't worry. You'll never look back! xx

  • thank you desk plant for you thoughtful answer. I do not have an endo, it was a one off appt arranged through bodymorph. there is no follow up appt. All she said was to reduce t4 to 100 and that she would prescibe t3 that I had to split into 3 amounts throughout the day. I have no faith in my doctor so have just ordered the book recovering with T3 and am hoping that will help too.

    cheers Tan x

  • The endo will surely advise you, she is in charge. Dr Toft in his book "Understanding thyroid disorders" says about combined T4/T3 treatment, which I am on with good results.

    "If you change to this combined treatment the dose of thyroxine should be reduced by 25-50mcg and half a tablet (10micrograms) of T3, also known as liothyronine, added."

    In addition to T4 I take only 10mcg T3 daily, in two doses of 5mcg each. Once accidentally took the 10mcg all at once, heart rate rose about 10 mins later.

    Interrogate the endo, she should know the answers to all questions. From my own experience I have learned not to rely on GPs.

  • T3 is stronger than you might think.I have been on armour for 14 years and have tried T3 recently and it feels somehow stronger than the T3 in armour. 5 mcg twice a day, as nostoneunturned has just suggested, would be a good starting dose. I always know if I am on too much T3 because I poo more frequently and it is loose (worth mentioning!).The tablets are so small that it is difficult to cut them into quarters.

  • I use a pill-splitter to halve the pill accurately, then manually snap the half pill into halves of 5mcg each, or into three little bits, each approx. 3mcg, using thumbnail and tiny half pill on hard surface so little bits can be "chipped" off. Using a knife not OK for me as bits fly around.

  • A surgical scalpel is very useful for cutting small tablets, as the blade is thin, pointed and very very sharp. Some art supply places sell them or if not, Atlantis in London do. They do mail order. I use a size 26 blade which is bit bigger than the 10A if you aren't used to using a scalpel. (You also want a handle).

    A good way to do it so that bits don't fly in all directions is to lay the pill on a piece of kitchen towel on something like a hardback book - ie hard but with the tiniest bit of give in it. Then place the blade on the pill and cover it with the other half of the sheet of kitchen towel before you cut down on it.

    It's almost impossible to cut half a T3 tablet into three equal pieces - you will get crumbs at some point - but I'm going so slowly that I don't mind crumbs if that's all I can tolerate at the moment. :-D Even on that amount (taken at 3am) I'm still headachey and a bit dizzy and spaced out the next morning, though it seems to wear off during the day. I'm not expecting a blinding improvement (I wish!), just want to find something I can at least tolerate after all the nightmare of the past few months, and to feel that I'm chipping away at things rather than taking nothing at all, which I am scared to do after being on levo for 12 years until I became intolerant to it.

  • Liotir is t3 in drops available in Italy and therefore I would think maybe in Europe. Made by IBSA farmaceutical. Very easy to use and easy to get the correct dose.

  • Interesting stuff - ethanol (i.e. ordinary 'drinking' alcohol) and glycerol + liothyronine.

    This link is to a Google translation of some information about it:

    tinyurl.com/TUK-HU-LIOTIR

    It is not licensed in the UK so would not be readily available.

    IBSA also produce Tirosint - gel capsules of levothyroxine.

    Rod

  • I switched from Eutirox which is tablets of levothyroxine to Tirosint in mono doses in liquid form. Since the change about 6 weeks ago I have lost the worst symptom that normal levothyroxine in pill form gave me i.e.bad sweats. I have been on this site asking for help quite a few times. For now I am much happier with my liquid levo and I also have a small bottle of it with a dropper so that I can up or down the dose a drop at a time (7 drops = 0,25 mcg). Very handy for avoiding bad symptoms.

  • Sorry Miki, just noticed you switched to

    Eutitrox. Is it better !

  • Hi miki. Really interested in these liotir drops. The T3

    element must suspended/mixed with some sort of delivery liquid, so how can we be assured the exact

    amount of T3 is delivered each time I wonder. I know

    nothing about liquid form & might be clear on sight.

    But gather from posts that it's quite a pure form of

    T3, which is what I need. Is it very expensive ? And

    prescription ? Grateful any advice please. Thank

    you.

  • useful to know Jan! thanks

  • Sorry, just noticed you say endo was one-off, but she should still advise you how to go about this in order to discharge her professional responsibilities. Try reading this for an explanation of twice daily after-meal doses giving slower absorption, or thrice daily smaller doses (but in total equivalent to the total of the twice daily after-meal doses) on empty stomach giving more rapid absorption. You might want to slow absorption down after your past bad experience.

    thyroid.about.com/library/w...

    and for the different half-lives and effectivenesss rates:

    fudgedesign.co.uk/tuk/treat...

    These are from way back and I hope they still work!

    Remembering my own experience with just adding 10mcg daily all at once (no advice. like you in the past) I would be inclined to advocate the lowering of your daily levo dose by about 25-50mcg for every 10mcg of T3 for 3/4 days before beginning the T3 at no more than a total dose of 10mcg daily. This will lower the blood level of levo a bit and so you will not be taking the T3 at 10mcg daily, on top of a full blood level of levo. This is what I would have done all those years ago had I known then what I now know. Then start at a 10mcg total dose daily, choosing 2 x 5mcg after-meal doses to buffer the absorption rate, or 3 roughly equal doses about 8 hours apart on an empty stomach allowing it tol be absorbed very rapidly, bearing deskplant's advice in mind and what you have read. After about 10 days of this, increase the daily total of T3 gradually, bearing in mind that if you increase the 10mcg daily to 15mcg daily that means a 50% increase in the daily dose, which is a big increase, it might be better just to add a small increase of 2.5mcg to just one of your daily doses as you really want to avoid any repetition of your past bad experience which might put you off again. Careful monitoring as deskplant advises will show you your body's responses to increases in dosage and allow you to tailor the dosages accordingly.

    Some of us are more sensitive than others but if you take it very slowly then things will work out for you and you will have a better experience this time. Adding T3 made all the difference for me eventually, once I had stopped turning somersaults owing to too sudden addition and my own sensitivity to it.

    I hope this helps you in your considerations of all information sources and that you find the addition of T3 beneficial.

  • thanks very much for the info xxx

  • Depending on your blood tests and how you feel, you may not be required to alter the t4, just add t3 - slowly throughout the day.

    Possibly hold back a small t4 tablet to take at night if it suits you at some stage.

  • thanks Lynx x

  • Please remember to keep your T3, as well as your T4, well away from food as it will hinder absorbtion. I have been on a T3/T4 combo for about a year now and did all the splitting and timings thing until a very knowledgable lady on here advised me to take it, with my T4, last thing at night, just before I go to sleep. It stopped all the watching meals times and cutting pills into little bits and I have found it so much easier. Dr.Lowe also used to take his T3 all in one go of a night. Just something for you to think about.

    Also some on here report bad migrains when first starting T3 (I didn't get them), if you do they should only last about a week.

    Moggie x

  • thanks for that Moggie, Migraines is one of the things that the t4 treatment seems to have helped me with, I hardly ever get them now. Been plagued with them all of my life, It could be just my body changing, but will see.

    Do you take all your t4 and all your t3 together before you go to bed?

    Tan x

  • Hi Tan,

    Yes I do, I take 100mcg's T4 and my 20mcg's T3 at the same time just before I go to sleep.

    Some people on here will argue that you dont need to keep your T3 away from food but a lady on this site recently went to see a lead consultant at one of London's top hospitals and one of the first things she advised was to keep her T3 away from food. If you find this difficult you can always dissolve is under the tongue, as it doesn't taste horrible, which will the bypass the gut and go straight into your system.

    As with everything thyroid it will be a "what suits you" thing - some people really cant take their T3 at night but for me it works really well.

    You'll have to let us know how you get on.

    Moggie x

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