Overwhelming fatigue – do I increase T3?

[Goldfinch7]

Hi – looking for some advice!

I have been on 10 mcgT3 and 75mcgT4 for 5 weeks (I titrated up slowly for 2 weeks before starting on 10mcgT3). For the last 3 or 4 weeks I have been having overwhelming fatigue and my body aches and I get very edgy. Even a short walk leaves me drained and washed out . I haven’t really had any good days even on T3 (but much less fuggy). I have a follow up appointment with my endocrinologist in a few days so I would really appreciate thoughts/suggestions on what I need to discuss with him. Do I need to increase the amount of T3 or should I be giving this dose I am on a bit longer. Is my body just exhausted from the last year when I have been trying out so many variations on T4 doses ( and I think constantly underdosed)?

My thyroid results (taken before 9am; 24 hours after T4 taken and 10 hours after T3 taken):

15/11 75T4 10 T3mcg; TSH 1.41 (0.27- 4.2); T3 5.4 (3.1- 6.8) 62% ; 15 (12- 22) 30%

The results for my vitamins (from medicheck) are see below:

There are some odd ranges here and I have seen recent posts discussing these ranges. Does it look like I am now low on B12 and still low on folate? I have been taking Thorne B but only 1 capsule – should I be taking more…? I need to add magnesium and have read several helpful references in posts – can I just check with slowdragon – do you take the Thorne magnesium citramate?

Could the fatigue be due to low B12 ?

Thank you so much !

[SlowDragon Administrator]

Suggest you need small increase in levothyroxine as next step

Which brand of levothyroxine are you currently taking

Do you always get same brand at each prescription

can I just check with slowdragon – do you take the Thorne magnesium citramate?

Yes I do….I tip powder out into small cup of water. Taken after dinner (at least 4 hours before levothyroxine and T3 at bedtime)

I have been taking Thorne B but only 1 capsule 

Presumably you stopped vitamin B complex 5-7 days before test. Folate levels drop rapidly. Personally I take a separate folate supplement in that week before test (Jarrow 400mcg methyl folate)

[Goldfinch7 in reply to SlowDragon]

HI Slowdragon - thank you for replying.

and thanks for the advice - I split the T3 to 2.5 mcg at 6am, 12 am, 6pm and 12pm - so it may be an idea to add 2.5 to the 6 am morning dose. (I take the T4 at night)

I take 50mcg accord and 25 mcg wockhardt. I spoke to the chemist to see if I could get 25 mcg in accord but they said they only get wockhardt in 25.

Yes I did stop the vitamin B complex 6 days before the test - so I will do the same as you next time! But can I just check - should I be taking one or 2 thorne vitb capsules?

I will order some magnesium now!!

One last question - is the TSH reading interpretable - now I am taking T3 do I ignore?

[SlowDragon Administrator in reply to Goldfinch7]

I recommended increase in levothyroxine (not T3)

perhaps 75mcg and 87.5mcg alternate days initially

This would improve low Ft4 and increase ft3 a little

Eventually you might be on a bit more levothyroxine and perhaps only 3 x 2.5mcg T3

But only ever change one thing at a time

Accord don’t make 25mcg tablets

You could cut a 50mcg in half to get 25mcg

And cut 25mcg in half to get 12.5mcg

Wockhardt only make 25mcg tablets.

Many people like Wockhardt

I would think you only need one vitamin B complex

TSH likely too drop on T3

But because you are taking as 4 x 2.5mcg you perhaps have managed to keep TSH higher 👍😀

Much easier if TSH doesn’t become suppressed as Medics get uptight when it does

[Goldfinch7 in reply to SlowDragon]

Ahh thanks for picking up my mistake!

I am splitting the T3 too - so I will soon become an expert pill cutter !

Thank you for your help and support - its very re-assuring as this whole process is very complicated!

[SlowDragon Administrator in reply to Goldfinch7]

I now split my levothyroxine and T3

Been splitting T3 as 3 doses (6.30am, 3pm and 11pm) approx since prescribed in 2017

Initially use to take levothyroxine waking…..on advice of endocrinologist switched to taking all my levothyroxine at bedtime approx 10-12+ years ago

Noticed more members saying they preferred to split levothyroxine too

Started experimenting with splitting levothyroxine about a year ago. Initially as 100mcg at bedtime …and 25mcg waking with first dose T3

Now I literally cut 100mcg in half and 25mcg tablets in half……half dose waking and half at bedtime

[Goldfinch7 in reply to SlowDragon]

it was the endocrinologist who suggested i took the Levothyroxine at night too ! I have my follow up appointment soon so this will all be really useful.