Adding a bit of T3 to Levo

[elizedge]

Got my MD to lower my levo from 112mcg to 75 (titered over 6 months) History- started levo at 50mcg 10 years ago, slowly upped as TSH climbed, MD kept it at under 1. Blood pressure kept climbing, no other reason. I convinced her to try lowering. It worked, but I gained 20 pounds (no other change in diet etc.) And my total T3 has always been at or just below range, so I've got 5mcg T3, taking once a day at 1pm (I eat twice a day, 9 am and around 4-5 pm, take the levo at bedtime, 10pm)  I already wake up at night to pee (I'm almost 67) I cannot set al alarm to wake up in the middle of the night to take a 2nd dose (I work full time, I get up before 6am)  QUESTION: Anyone else have a good result with once daily T3 added to T4? thanks

[gimel]

If your doctor won't even order tests for Free T4 and Free T3, you need a new doctor.   As detailed in the link, adjusting thyroid meds based on TSH does not work.   You really don't have to wait 6 weeks to test, 4 will do.   Since your last ferritin test was below 100, I suggest that you also get that tested as well.  As you raise your FT3, it is important that ferritin is adequate.  

Please let us know how you are feeling as the changes take full effect.  And when you have your test results, please find this thread and post results and reference ranges shown on the lab report and we will be happy to assess and advise further.  

[elizedge]

Okay here's the results. I don't know this any change in how I feel. In fact, my sleep is very disturbed at night. I wake up every hour or two and while I've stopped the gaining weight, I haven't lost any

TSH 1.2   .5-4.7
TPO 14  0-60
Ft3 2.7  2.1-4.2
Ft4 1.3 .8-2

[gimel]

Just to confirm, how long after the reduction in T4 and addition of the 5 mcg of t3, was blood drawn for those tests?   Also, did you take your thyroid med before the blood draw for those test results?

[elizedge]

This was 6 weeks of t3. Actually the t4 had been reduced for 6 months and I took the blood in the morning about 18 hours after I took the t3

[elizedge]

Oh and I take the t4 at night

[gimel]

Okay, so your FT4 was at 42% of its range, and your FT3 was at only 28.6% of its range.   Everyone can have different FT4/FT3 levels at which they feel normal.  Some people have hypothyroid symptoms with those levels.  So please review the following symptoms typical of hypothyroidism and tell us which ones, if any, you have.  

Tiredness.
More sensitivity to cold.
Constipation. (use laxative or fiber)
Dry skin. (use skin creme)
Weight gain.
Puffy face.
Hoarse voice.
Coarse hair and skin.
Muscle weakness.
Muscle aches, tenderness and stiffness.
Menstrual cycles that are heavier than usual or irregular.
Thinning hair.
Slowed heart rate, also called bradycardia.
Depression.
Memory problems.

[elizedge]

Tiredness weight gain with no change in diet weakness. Would it makes sense to maybe add another five first thing in the morning?

[gimel]

With your FT3 at only 28% of range, that is the right direction.  A good target for FT3 is at least 50% of range.  Along with that I suggest that you also supplement with iron to get your ferritin up to 100.  This is especially important when increasing FT3 levels.  CVS has a good iron supplement called Iron plus C.  If you take it, and have stomach issues (constipation), just add some Vitamin C as needed. .  

[elizedge]

Thank you. I don't take any supplements. Well that's not true. I take methylated folate a couple times a week to keep my homocysteine down but I have an unusual diet and supplementing one thing can throw something else out of balance. It's not quite that simple for me

[gimel]

You can certainly take some amount of T3  once daily.  As you increase the dose  above maybe 10 mcg you might want to consider taking some when you wake up.  It doesn't have to be taken on an empty stomach.  That only affects absorption.  the most important thing is to try and stay consistent with when you take doses.  

By the way, adding 5 mcg of T3 is not equivalent to lowering your T4 dose by 37 mcg.   To be about the same effect you would need 10 mcg of T3.  

I hope the doctor is not one that adjusts your med based on TSH level.  That doesn't work for many people.  Ideally what you want is to increase your FT4 and FT3 enough to relieve hypo symptoms without creating any hyper symptoms.  Along with that it is best to have Vitamin D at least 50 ng/ml, B12 in the upper part of its range and ferritin at least 100.  If not tested for these you should ask the doctor to do so.  f you want to confirm what I say, please read and give your doctor a copy of our paper in this link.  And ask to be treated clinically, for symptoms and FT4 and FT3levels, as described in the paper.  

https://thyroiduk.org/wp-content/uploads/2022/10/Patients-Guide-Final-V5.pdf

[elizedge]

the reduction was to lower my bp and it worked, TSH went to 1.3 I think. But I cannot get her to order free T3 and Free T4 to I ordered my6 own and will test after 6 weeks of adding the T3 at 5mcg 1x/day. Thanks you for the printout also!

[elizedge]

Oh I haven't had some of those tested since October but my B12 was at 760 my ferriton at 72. I take no supplements and I've only had vitamin d tested once. It was at 47 probably a year ago