What do you think of my T4-T3 ratio?

ilovethesea

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Feb 9, 2013
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I'm trying to figure out how I should change my thyroid dosage and could use some help.

Background if you haven't read my other threads: I only have 1/2 a thyroid (cancer) so have been taking meds for 5 yrs now. I believe I am hypo (cold hands and feet all the time among other symptoms) and was so even before I got thyroid cancer. In the past couple years I mega dosed iodine which caused me have to lower my dosage, but I've stopped that now so I'll definitely need to increase/change my dosage.

I read this quote from Peat about how he suggests supplementing:

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. Keeping a 14-day chart of pulse rate and temperature allows you to see whether the dose is producing the desired response. If the figures aren't increasing at all after a few days, the dose can be increased, until a gradual daily increment can be seen, moving toward the goal at the rate of about 1/14 per day

Currently I take the natural dessicated thyroid from Erfa plus some Synthroid.
Erfa has 18 mcg T4 and 4 mcg T3.
My Synthroid is 50 mcg.

So all up I am getting 68 mcg of T4 and 4 mcg of T3 daily.

So that's WAY off the 4:1 ratio that it sounds like Peat is suggesting. It's 17:1!

Problem is, whenever I've tried to lower the T4 by cutting the Synthroid dose in half I've not felt as good and had terrible breakouts. But according to my bloodwork, my ranges are fine with either 50 or 25 mcg of Synthroid... not that that proves anything.

What I'm thinking of doing is doubling my Erfa (so that would mean 36 mcg T4 and 8 mcg T3) and reducing my Synthroid in half (25 mcg) for a total of 61 mcg T4 and 8 mcg T3. This would be an 8:1 ratio though, so not sure if that is too dramatic of a change from 17:1.

If anyone has any thoughts on what may be happening with me and ideas on what I should do now, I would be very grateful. Why do I seem to need so much T4 and have an adverse reaction when I lower it? What would be the best way to change my meds to fix this hypo situation?
 

ilovethesea

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Just realized I made a mistake in the above, I am getting 85 mcg of T4 and 8 mcg of T3 daily... so an 11:1 ratio.

I actually wrote to Dr. Peat and this was his reply:

The liver has to convert T4 to T3 for it to be effective. It needs glucose and selenium to make the conversion. Adequate protein, at least 80 grams per day, is necessary. Sea food, once a week will provide selenium, two quarts of milk and a quart of orange juice would provide many of the other essential nutrients. Taking T4 at bedtime sometimes is helpful. Most people feel best on a ratio of T4:T3 of 4:1 or less. Checking the relaxation rate of the Achilles reflex is a quick way to check the effect of the thyroid on your nerves and muscles; the relaxation should be instantaneous, loose and floppy.

So I guess he's not going to give me any specifics on where to start with my dosage other than to try and get it to a 4:1 ratio (if not 3:1).

Based on what I am currently taking that could mean keeping my dose the same in the a.m. and just adding 25 mcg of T3 (Cytomel) split up every few hours throughout the day. That would get me to a 3.1 to 1 ratio. However I'm not sure if it's a good idea to start with so much, maybe I better build up to all that T3 gradually.

Also I suppose adding more T3 may gradually reduce my need to have the T4 so high?!... argh this is so confusing :(
 

ilovethesea

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@jnhermann, why do you recommend ditching the Erfa? I read a quote from Peat saying he personally uses Cynoplus (a T3/T4 combo) and Cytomel (T3 only). Are you saying this because the ratio is better with the Cynoplus (a perfect 4:1 instead of 4.4 to 1 with the Erfa)? Or some other reason?

Whenever I have lowered my T4 from 85 mcg to 60 mcg (by halving my Synthroid) I don't feel as good and I break out.
If I got rid of the Erfa then I'd only be taking 50 mcg of T4 so I imagine I'd feel even worse.
Unless I increased the Synthroid dosage up to 75 mcg to make up for it.

I guess I don't understand what's so bad about Erfa?
 

jnhermann

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Feb 13, 2013
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Nothing against erfa, just that its natural and results can be a mixed bag. So you are now taking some synthetic t4, plus some natural t4 and natural t3. Probably would be easier to stick with synthroid for t4 and add cytomel or cynomel for t3. If you want to watch a very good video series on how to take and increase thyroid go to www.hopeforhashimotos.com. its free. He shows you exactly what to do, including if you are already on synthroid/t4. You need to monitor pulse and body temperature. Labs wont tell you when you are optimal but pulse and body temps will. You want to start very small with t3. Maybe 5 micrograms for 7+ days, then bump up again. Watch the videos. He explains it very well.

Have you tested your thyroid antibodies? Apparently about 9 out of 10 people that are hypo have antibodies. If you do, the antibodies will act on the dessicated thyroid, possibly hindering its effectiveness. Thus, synthetic would probably be a better choice in this case.
 
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