rT3 halved under liothyronine (T3), fT3 & fT4 lower, what next?

[Cataceous]

Pre-treatment:
TSH: 2.8 (0.45 - 4.5 uIU/mL)
Free T3: 2.7 (2.0-4.4 pg/mL)
Free T4: 1.4 (0.82-1.77 ng/dL)
rT3: 23 (9.2-24.1 ng/dL)

I was prescribed liothyronine and told to start with 5 mcg/day and titrate up to a maximum of 20 mcg. I tried the 5 mcg dose for a couple weeks, then went to 10 mcg. I retested after four weeks:

TSH: 2.2 (0.45 - 4.5 uIU/mL)
Free T3: 2.6 (2.0-4.4 pg/mL)
Free T4: 0.9 (0.82-1.77 ng/dL)
rT3: 12 (9.2-24.1 ng/dL)
T4: 3.8 L (4.5-12 ug/dL)

Some pretty clear improvements have correlated with this treatment: better sleep, reduced brain fog and more motivation. My question for the community is: what to do next? I suspect things will be even better if I can get fT3 up. But can this be done with only T3 dosing, or would that just continue to push T4 down?

 

[Vince Carter]

Did you take your dose the day of your blood test, or not? I think the RT3 being halved has probably been the most benefit here! T4 being low on the scale is pretty typical and even normal.

 

[Cataceous]

Did you take your dose the day of your blood test, or not? I think the RT3 being halved has probably been the most benefit here! T4 being low on the scale is pretty typical and even normal.

Thanks, forgot to mention that the test was pre-dose.

 

[Vince Carter]

I think that you're supposed to take your thyroid meds before the test, take them like normal in order to see how high you're getting, probably why your FT3 still appears low.

 

[Vince]

I always take my thyroid meds after my labs. Every doctor is different, some prefer before and others after.
I would take some T4, the issue is if your body was held a free T3 it won't be able to make any without T4.

 

[Cataceous]

Thanks, guys. @Vince: What sort of T4 dosing is typical in cases like this?

 

[captain]

If you add T4 RT3 will go back up.

 

[Gman86]

Wow, just goes to show how important knowing your RT3 level is. Your Free T3 level basically didn’t budge, yet you’re noticing a positive difference now that there is less RT3 blocking you T3 receptors.

They are right, every doctor is different, in regards to lab timing. Here’s what they recommend on the STTM FB group.

 

[Gman86]

If you add T4 RT3 will go back up.

Do you think if he went in a low dose of T4, or low dose of NDT, that his RT3 would elevate again? Wouldn’t there be a chance that his RT3 could remain low if he keeps the T4 or NDT low, and gets the majority of his thyroid supplementation from T3?

 

[captain]

You use T3 to cut production of T4 to lower RT3. If you correct the cause of high RT3 it may stay lower.

 

[Gman86]

Thanks, guys. @Vince: What sort of T4 dosing is typical in cases like this?

I would personally try adding a low dose of NDT. No more than 1 grain. If you added in T4, I would use no more than 25mcg. People can get away with just using T3, but it isn’t optimal. Optimal is having a slight free T4 reserve. You want free T4 around mid range. I would just try a very low dose of T4, or NDT, and get labs done in another month to make sure it isn’t adversely effecting your RT3 level.

 

[captain]

You want Free T4 at .95 or less to lower RT3. Other methods are to not check RT3 levels.

 

[Gman86]

@Cataceous what brand of generic liothyronine are you using?

 

[Cataceous]

@Cataceous what brand of generic liothyronine are you using?

This was from Sam's Club, presumably the same as what Wal-Mart would supply.

 

[Gman86]

This was from Sam's Club, presumably the same as what Wal-Mart would supply.

It would still be from a specific pharmacy brand I would imagine. The brand isn’t going to be sam’s club or Walmart, that’s just where you filled the prescription. It’s not important, I was just curious.

 

[Cataceous]

It would still be from a specific pharmacy brand I would imagine. The brand isn’t going to be sam’s club or Walmart, that’s just where you filled the prescription. It’s not important, I was just curious.

They don't provide information about the manufacturer. Internally it must all be tracked, however.

 

[HarryCat2]

They don't provide information about the manufacturer. Internally it must all be tracked, however.

You can usually figure it out using the pill identifier:
Liothyronine - Pill Identifier | Drugs.com

 

[Cataceous]

You can usually figure it out using the pill identifier:
Liothyronine - Pill Identifier | Drugs.com

Bingo. It's Sigmapharm Laboratories, LLC. (E 18)

 

[Gman86]

Bingo. It's Sigmapharm Laboratories, LLC. (E 18)

Awesome, thanks. Was just wondering because clearly it’s working for you. I have Liothyronine tabs from both Sigmapharma and MaynePharma.

 

[Vince]

If you add T4 RT3 will go back up.

can cytomel by itself be used to treat hypothyroidism