Tips please: T4 to T4+T3 transition

Beebop

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There's plenty of advice about starting on thyroid supplements, but I haven't seen any yet about transitioning from T4 to a T4/T3 combination. (If that advice is already out there could you point me in the right direction?)

Has anyone done this? Do you have any advice?
The main thing I'm wondering is:
Should I switch all in one go, or make a gradual change?

I'll be taking two separate synthetic supplements, levothyroxine and liothyronine.

Thanks!
 

juanitacarlos

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Hey Beebop. I've done that. I went from synthetic T4 to NDT, which is I think about 1:4 T3 to T4. I started tapering down with the T4 whilst starting on the NDT at a low dose. I think I was off the T4 totally within about 2 months or so. I also increased the NDT I think once during that period and then once more after being totally off T4.

Yes - go slow. My transition was pretty good but you won't feel great everyday.

Let me know if I can help in any way. Good luck!
 

Beebop

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Thanks ttramone!

Interesting that you raised you dose twice. I was thinking about starting off by just adding a little bit of T3 without removing any T4, just for a couple of days to see the effect. And then lowering the T4. Not sure about that.

So, do you feel better on NDT now, compared to T4 only?
 

juanitacarlos

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So BB, are you currently just taking levothyroxine? And now you're adding the liothyronine? If you don't mind me asking, what is your current dose? And why did you initially start taking T4?

I do feel a little better on the NDT. It has definitely made a difference. The first few days I took it I really felt the T3 work. And then that feeling subsides, but it was good to have a reference point to what I should feel like. I think for me, I still have the underlying problem of possibly poor liver function, which inhibits conversion of T4 to T3. I don't think I will truly feel the effect of the NDT until other issues ie excess estrogen, serotonin, PUFA etc. are dealt with. But NDT for me, is an improvement on just T4.
 

Beebop

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That's right I'm prescribed levothyroxine, I have Hashimoto's so I don't so much see taking these things as 'supplements', more as 'medication'. But now's the time to take T3 as well, I just don't want a bumpy ride!

Good to hear you felt a difference on NDT.
 

charlie

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I would wanna do this as a ratio thing. The ratio of porcine NDT thyroid is very close to what human is. I think its somewhere in the neighborhood of 3 to 1 T4 to T3 but I cannot remember the exact ratio at this moment. I will look into it a bit later when I have some time if you want.

And remember. Its most likely the T3 is going help use the T4 better now. So if it were me I would probably come down on the T4 a bit until I see how its gonna effect me. At the same time watching for "too much thyroid" symptoms.

Ratio ratio ratio. :thumbup:
 

juanitacarlos

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That's good advice Charlie. I'm on a 4:1 ratio of T4/T3. That mimics what the body would normally do. The NDT I'm on is 9mcg T3 and 36mcg of T4 per grain.

Just for some kind of reference: I was on 200mcg of sythentic T4, and now I'm 144mcg T4, with the added 36g of T3.

And yes, you may need to reduce slightly your T4 as you take your T3 - just go with how you feel. I'm not against blood tests for additional data to help you track things.
 

Beebop

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Thanks for that advice Charlie. I was reading that article the other day, and this has stayed with me:

Although most synthetic combination thyroid products now use a ratio of four T4 to one T3, many people feel that their memory and thinking are clearer when they take a ratio of about three to one.

So, I guess I'll aim for 3:1

What I don't know is, is 1mcg liothyronine equivalent to 1mcg thyroxine?

I'm currently on 137mcg thyroxine.
 

Beebop

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This chart shows that 25mcg liothyronine is equivalent to 100mcg thyroxine:

http://thyroid.about.com/b/2007/01/25/c ... nother.htm

One doctor recommended I take 100mcg T4 and 30mcg T3 (split up over the day).
The other recommended 75mcg T4 and 30mcg T3.

But both of those would be the equivalent of taking much, much more than I was originally taking (137mcg). Confusing.
 

Beebop

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But then Peat says this which sounds like he works out the ratio much more simply without using "25mcg T4 = 100mcg T3"

An effective way to use supplements is to take a combination T4-T3 dose, e.g., 40 mcg of T4 and 10 mcg of T3 once a day, and to use a few mcg of T3 at other times in the day.

So this is my current plan:

100mcg T4
+ 30mcg T3, give or take depending on symptoms, (25mcg would be 4:1, 33mcg 3:1)
 
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