T Nation

Need Help on Levothyroxine/T3 Protocol

Hi guys! It’s been a while since I’ve posted here, since my last post I was unable to get RT3 tested; I finally have.

I’m on 100MCG of Levothyroxine which brings my TSH to 1 (0.5-4.2 ref range), FT3 and FT4 to high-normal range. RT3 came back very high. I’m doing this all on my own, i’ve wasted alot of time and money on doctors and none of them have helped with anything except for draining my wallet lol.

I’ve gotten a doctor to write me up a prescription for T3, what should my T3 dosage be? Should I lower T4? I read somewhere that T3 dose should be 10% of T4, what are the proper guidelines. Thank you!

Also T4 seemed to have made my symptoms worse, which are:
Debilitating fatigue
Memory issues
Extreme brain fog
Inability to focus
Loss of motivation

Maybe you need to lower the t4 medication a bit. Can make a difference.

Having high t3 can cause some undesirable symptoms. Like heart paps, anxiety, hair loss .

Adding t3 needs to be last resort imo

You have a conversion issue, too much of your T4 is converting to reverse T3 and you know what that means. To get around that, you need T3. The 10% protocol probably will not work for you.

Makes sense. So how much T3 will I need then?

I don’t think that lowering t4 medication will be the fix as I had normal FT3 and FT4 before treatment, but still had hypothyroid symptoms and high tsh. I think I should have just taken T3 by itself from the beginning.

R u on trt and for how long?

Having good ft4 and ft4 could have been from other things like pituitary or adrenals.

Pituitary releases TSH.

So if your free t3 and free t4 was good and pituitary keeps releasing TSH The problem is at the pituitary. Yes you may still need to treat for hypothyroidism but if just got on trt that may have helped stuff out.

I am on TRT, i’ve been on it for approx. 6/7 months, TSH was a 6.3 pre-treatment with very bad fatigue even though I was on TRT.

It would be helpful to know your labs results. Especially fT4, fT3, rT3 and SHBG. So, just a guess, looking at your symptoms, I would stay at 100mcg T4 and start 20mcg T3 in addition.

A large percentage of patients treated with T4 only preparations continue to be symptomatic. Thyroxine only preparations should not be considered the treatment of choice and are often not effective in conditions associated with reduced T4 to T3 conversion, reduced uptake of T4 or increased T4 to reverse T3 conversion.

You should look at Armour Thyroid. I take this as prescribed by my Dr. Its desiccated pig thyroid and contains both T3 and T4.

Hmm, okay but don’t you think that 100MCG of t4 + 20mcg of T3 is a hefty dose though? cause on google the hypothyroidism recommendation for combined therapy is to take half the t4 and around 12.5 mcg’s of T3. If 100MCG already brings me down to a TSH of 1.0, wouldn’t adding 20 mcg of T3 make me hyperthyroid?

Not available in my country unfortunately.

I was referring to bioidentical compounding, which can be customized to the patient. With your elevated rT3, you’ll need a larger dose of T3 to overcome that. Your TSH should bottom out, but the important lumber is free T3. In fact, it can be argued we should not even look at TSH. For you, it’s all about reverse T3 and free T3.

Oh okay, sounds good. Will keep you updated, also will post my labs (FT3 and RT3) if you don’t mind. Also, my prolactin has shot up while on Levothyroxine; is that a side effect of having higher RT3?

Interesting, yes, inadequate thyroid replacement can result in hyperprolactinemia.

Update: my doctor reccomended I discontinue the T4, and do T3 only.He said that my RT3 could be high because of a conversion issue. He did not tell me a specific dose to take of T3, if I were to do T3 only could I take the standard 25mcg dose? Thanks.

Not sure about that. Do you know if the T3 is time released? Though not impossible, going with T3 only preparations makes this a lot more difficult to manage.

Not sure if it is time-released, how do I know? Also, how often do I take Liothyronine (T3) can I just take 25mcg in the morning?

Forgot to mention he also said that since my FT3 and FT4 were normal before treatment, and that only RT3 and TSH was elevated; it was a mistake to ever take T4 since that would only increase RT3 further.

The prescriber should know. Compounding pharmacies will make a time-release formula. The issue with T3 only preparations is it is fast acting with a short half-life reaching a peak quickly and out of you in five or six hours. The half-life of T4 is about a week, hence the need to take a combo so you’ll have a steady source of T3. Yes, the rT3 is of concern, however with the bioidentical T3 in the combo you’ll overcome that. I think taking a single dose of T3 only, unless it is time-released, would be a mistake. If time released, 25mcg may work.

Okay, makes sense. I’ll try 100mcg with 25mcg and see how it goes, thank you so much for your help! Will keep you updated.

Hey man, I got my old test results back.
This was on my old dose of 125 mcg:
RT3: 236.6 (90-215 pg/ml)
FT3:5.64 (3.1-6.80 pmol/l
So should I stick to 100mcg with 25mcg T3 dosage?