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Hi. I've been on 100mcg Synthroid and 5mcg of Liothyronine 3.5 years. I take both at the same time, usually between 1a.m. and 5 a.m. Not always consistent, just whenever I awake over night.

The blood drawn for these May labs was done approx 13 hours after I took my meds (so around 4 p.m. if time matters).

May 2019 labs:

TSH < 0.01 (mIU/L) because of this, the doc wants to reduce Synthroid by 12 mcg (100 to 88) for 3 mo. and order TSH in 8 weeks for Hyperthyroidism. He insists that I'm hyper based on the TSH alone. I don't agree although at times after months taking both T4 and T3 I get a certain feeling that tells me to miss one day of both meds or just cut out the T3 for a couple of days. Then the feeling goes away but I don't know if it's psychosomatic or what.

FT4 1.5 (0.8-1.8 ng/dL). (after 13 hrs I feel that is a good result but might it have been even higher hours before the draw?)

FT3 2.7 (2.3 - 4.2 pg/mL) (that's about as high as it's ever been so I wonder if it's because the Ferritin increased so much). I eat lots of dates these days and figs....and bison.

December 2018 labs:

*Ferritin finally increased after having been in the teens for many years

Reverse T3 21 (8-25)

Ferritin 64 (10-232)

Vit D, 25-OH,Total,IA 31 (30-100) (trying to get this up)

In general I feel better with the T3 than without but worry about the long term cardiac effects of it although I don't have any heart related issues.

And I have a feeling that TSH will never increase, even if I don't take T3 (isn't it low also because I don't have a thyroid and/or because I have Graves and Hashi's)?

The doctor thinks dropping the T4 dose to 88 but continuing to take the T3 will raise the TSH. I'm thinking I'm probably gonna feel like crap like I did once before when I tried that. Even taking the T3 about 10 days on 88 I felt terrible....but maybe my Ferritin was lower???

What are your thoughts? Thx.
 

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This is the challenge of combination treatment with doctors that go only by TSH. I think you are right to be concerned about long term effects, which probably have not been studied. Although, your free numbers look fine (if not a bit low on the FT3)...so that makes it seem like you are fine as is.

I don't believe doctors have much experience with combination treatment because it's not as common with conventional doctors. It does appear that TSH often gets suppressed when doing combination treatment. Though I know Endocrinologists tend to still want the TSH in a nice range even when doing combo. In your case, I don't see how a change will help without putting you in a hypo state.

However, the moderators on this site have much more experience with this. Especially since you had a TT. If anything, my guess is they will say you need an increase of your T3 medication. Often it's advised to take it twice a day (early afternoon for second dose as to not impact sleep). Split up to keep the T3 from spiking in the morning. Plus, it's half life is short.

Good luck and I hope the others on here can give more info.
 

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Hi. I've been on 100mcg Synthroid and 5mcg of Liothyronine 3.5 years. I take both at the same time, usually between 1a.m. and 5 a.m. Not always consistent, just whenever I awake over night.

The blood drawn for these May labs was done approx 13 hours after I took my meds (so around 4 p.m. if time matters).

May 2019 labs:

TSH < 0.01 (mIU/L) because of this, the doc wants to reduce Synthroid by 12 mcg (100 to 88) for 3 mo. and order TSH in 8 weeks for Hyperthyroidism. He insists that I'm hyper based on the TSH alone. I don't agree although at times after months taking both T4 and T3 I get a certain feeling that tells me to miss one day of both meds or just cut out the T3 for a couple of days. Then the feeling goes away but I don't know if it's psychosomatic or what. I get the same feeling about cutting my dose. Unfortunately - I have had labs prior to cutting dosage a few times and they were actually in a good place.

FT4 1.5 (0.8-1.8 ng/dL). (after 13 hrs I feel that is a good result but might it have been even higher hours before the draw?) I would not get too hung up about that - your levels will be slightly up or down throughout the day. (( 1.3-1.55)) are the 1/2 - 3/4 lab ranges which makes your 1.5 perfect.

FT3 2.7 (2.3 - 4.2 pg/mL) (that's about as high as it's ever been so I wonder if it's because the Ferritin increased so much). I eat lots of dates these days and figs....and bison.If that's the highest it's ever been - you are still grossly under dosed on your lilothyronine. Your 1/2- 3/4 ranges are ((3.25-3.725)) which means you are not even at 1/2 of the range

December 2018 labs:

*Ferritin finally increased after having been in the teens for many years

Reverse T3 21 (8-25)

Ferritin 64 (10-232)

Vit D, 25-OH,Total,IA 31 (30-100) (trying to get this up)

Ferritin levels definitely have an impact on how we process synthetic thyroid hormones - my labs show I need less than in the past. Menopause might also be part of that for me.

In general I feel better with the T3 than without but worry about the long term cardiac effects of it although I don't have any heart related issues. Doctors seem to be clueless in the whole FT-3 issue. I for one have not had any measurable TSH since my thyroid was removed. If any shows up my FT-4 and FT-3 levels are hypothyroid ranges.

And I have a feeling that TSH will never increase, even if I don't take T3 (isn't it low also because I don't have a thyroid and/or because I have Graves and Hashi's)? It's low because of that and the fact you have stimulating antibodies that mimic the TSH thus your body when tested has no TSH with a hypo FT-3 and an in range FT-4

The doctor thinks dropping the T4 dose to 88 but continuing to take the T3 will raise the TSH. I'm thinking I'm probably gonna feel like crap like I did once before when I tried that. Even taking the T3 about 10 days on 88 I felt terrible....but maybe my Ferritin was lower??? Ask your doctor to drop the T4 hormone but add 5 mcg of lilothyronine. Then make an appt with a different doctor for future treatment. Your current endo is going to keep you hypo based on dosing you on TSH only. You have absolutely no cardiac symptoms so why does he base his dosing on that??

What are your thoughts? Thx.
I will respond above in a blue text - what my opinions are...

I used to print this stuff out and give it to my endo's and GP's - their eyes usually glaze over. Just keep pushing until you get the med's you need. Find a new doctor if necessary.

http://jcem.endojournals.org/cgi/content/full/86/10/4814

Suppression of Serum TSH by Graves' Ig: Evidence for a Functional Pituitary TSH Receptor

Leon J. S. Brokken, Jolanda W. C. Scheenhart, Wilmar M. Wiersinga and Mark F. Prummel

We conclude that TSH receptor autoantibodies can directly suppress TSH levels independently of circulating thyroid hormone levels, suggesting a functioning pituitary TSH receptor.
 
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I was really thankful the other day when I logged in and received such detailed input.

Lovlkn I think what you're saying (your opinion) is try the 88mcg and continue taking 5mcg of T3? [And my thought is wld decreasing the the dose by 12mcg make my FT4 lower but would not change the TSH since it's already low. And also I would expect that the FT3 wld stay about the same.

Or continue on the 100mcg dose but increase the T3? [so act six hours later add in another 2.5 of T3]. I would thing the only thing that would change wld be an increase in the FT3, no change in FT4 and not sure what happens with the TSH since it's low but sounds like that doesn't matter in my case anyway.

Last question: If I take my meds at say, 1a.m. daily how many hours later should I wait before having labs drawn? 8 ( so about 9 a.m. that morning) or some time later that afternoon, say around 4-6 pm (which is about 15 hours later?

I will say that whether I've gone 7 hours later or 14 hours later, my TSH, FT4, FT3 has always, always fallen in about the same range.

Again thanks to you both and to anyone for your input.
 

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I was really thankful the other day when I logged in and received such detailed input.

Lovlkn I think what you're saying (your opinion) is try the 88mcg and continue taking 5mcg of T3? [And my thought is wld decreasing the the dose by 12mcg make my FT4 lower but would not change the TSH since it's already low. And also I would expect that the FT3 wld stay about the same. NO - lower your T4 to 88 and add 5mcg additional T3 hormone - you should split it 6 hours or so apart, meaning take 5mcg as your first dose and another 5 mcg around lunch or shortly after.

Or continue on the 100mcg dose but increase the T3? [so act six hours later add in another 2.5 of T3]. I would thing the only thing that would change wld be an increase in the FT3, no change in FT4 and not sure what happens with the TSH since it's low but sounds like that doesn't matter in my case anyway. Your FT-4 is in a good place - by reducing your T4 hormone and adding the extra lilothyronine your FT-4 will naturally rise thus you need to reduce a bit when adding the additional 5mcg of T3 hormone.

Last question: If I take my meds at say, 1a.m. daily how many hours later should I wait before having labs drawn? 8 ( so about 9 a.m. that morning) or some time later that afternoon, say around 4-6 pm (which is about 15 hours later? I also take my meds in the middle of the night to avoid interaction with calcium I take. I never take my meds the night/morning prior to my lab draw which I try to have between 8:00 - 9:00 am. I usually go back just to have labs drawn. I've taken meds in the morning and done a later draw and the difference was only slight. Consistency is key - Some people report TSH is lower if they take meds prior to their draw.

I will say that whether I've gone 7 hours later or 14 hours later, my TSH, FT4, FT3 has always, always fallen in about the same range. Confirmation of what I said above - just be consistent in your lab draw timing.

Again thanks to you both and to anyone for your input.
 
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Yay! I got it now. Thx!
 
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Day 1 and 2

I took 88mcg of Synthroid and 5mcg Liothyronine. Both days abt six hours later I felt fatigued so I added a half tab of T3. (started there to see how my body would tolerate it).

Day 3

Continuing on the same dose. No fatigue.

Day 4

When I awoke around 5 a.m. I felt terribly hyper but w/o palpitations. I skipped both meds (but thinking now that I should have at least taken the Synthroid).

Day 5

Today I'm back on schedule but approaching six hours after taking my meds I felt fatigued. Took a nap. Every time I wanted to get up, I lacked energy. I eventually peeled myself off the sofa, got a light snack but feel that I could sleep again. Not really in the mood for food. Just sleep. I need to take that second dose of T3 but afraid of how it will make me feel later.

I want to try this new dose if it's necessary to bring my TSH into range and FT3 a bit higher (2.3 - 2.7 is normal for me). But what does not make sense is if taking Liothyronine is said to lower the TSH, wouldn't adding more keep it low? The dr is dropping me from 100 of Synthroid to 88 hoping to raise TSH. He said keep taking the 5mcg of Liothyronine. But he's not an endo. Last endo went by the TSH as well and wanted me on 88 and keep the 5mcg of Liothyronine. I felt fatigued after 5 days. Couldn't stand it and went back to 100 and 5. That was a year or so ago.

Crazy thing though in spite of the weird symptoms, I feel like adding the extra T3 (just 1/2 tab more) might've helped improved my thinking these few days.

---Feeling so overwhelmed and confused by the whole things.
 

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Well about 4 pm I was still feeling fatigued so I took the extra dose of T3 (1/2 of a 5mcg tab) I feel better. I just read somewhere on this site something that makes sense, I'm 5'3" my weight fluctuates between 160 and 165 so that dose of 88 mcg just might be too low. Also post TT no matter what I think that TSH will be low with or without taking the Cytomel. Lovlkn you state that yours run low because of the antibodies. I've never had that TBII test run just the TSI pre surgery.......

This all may have been explained but my brain doesn't quite work they way it used to
 

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I don't think you " got it".

My suggestion was to reduce your T4 hormone to 88 and add 5mcg lilothyronine to the 5 mcg you were taking with the original 100mcg T4 dose

So you would take 88mcg T4 and 5 mcg T3 then a 2nd 5mcg dose of T3 six hours after your first dose.

This will hopefully get your FT- 3 to go up
 
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Thanks Lovlkn.

I understood completely. Only thing I'm barely tolerating even 1/2 of that second dose (much less the whole pill) due to the discomfort and feeling of unwellness while adjusting to the addition. I've been down this road before, so I believe I can get there.

It's been week today I will try to take that second dose, the full dose, give it 4-6 weeks, test and report the results.

One thing that doesn't make sense is dropping to 88 because surely my TSH is going to be crazy low with the addition of more T3. I guess I have to deal with that when I get to it, guess it's all part of seeing what works for you.

Thanks again. I have a tremendous appreciation for your input and patience. Aside from the physical, there is the mental fatigue so I'm not always the best at articulating my thoughts. Trying to find the words. Trying to string them together.
 

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What is your Ferritin level? I found more difficulty adjusting to Additional T3 hormone when my Ferritin levels were low.

Also consider your D levels.
 
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Same here.

Dec 2018 Ferritin was 64 (10-232) - For a lot of years it was in the 30s. Started eating more dates, figs, eating bison w/Vit C for better absorption and it increased. Gotta keep up with that. Another thing my hair got thicker around the edges as the level went up.

Vit D, 25-OH,Total,IA tend to be low to mid 30s. Never above 40. Still have a lot of work. Management and watching numbers. I've been slacking this year.

For the most part I felt fine on 100 and 5 mcg of T3 but if I can be better, I want to get there. Maybe there is a happier place for me too
party0045.gif
 

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Any Thyroid hormone movement can cause hyper or hypo symptoms. By skipping an entire day /dose you are only compounding the situation.

I have found it helpful to take food with my 2nd dose. Meaning I eat lunch when I take my 2nd dose. For some reason it helps with the 1/2 punch the T3 hormone can give me about 2 hours after my 2nd dose.

Try sticking to the 1/2 pill on the 2nd dose until you are not having any issues. You can even split that pill into tiny 1/4's and take 2 doses if needed.

Slow and steady wins this race. Hang in there!
 
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