[Patrick Houben]

Im a long term thyroid replacement patient and always felt best when ft4 and ft3 are in the ref range. I require 175mcg t4 and 25mcg t3 atm (without GH use). Low in range ft4 has me depressed.

[Patrick Houben]

A TSH that high isnt normal, i´d increase the t4 to 125-150mcg and see where his TSH sits after six weeks.

[Patrick Houben]

I’m hypo as well and know many people that take over 200mcg of t4 to stay in range/ feel good.

If you’re feeling good on 250mcg, there’s no need to change anything imo.

[Patrick Houben]

Kuba, what doses do you typically take for your own t4/t3 replacement? I’m on both as well year round, just want to compare cause I feel I’m taking too much atm.

[Patrick Houben]

Can you explain what doses and how you take them (all at once vs splitting etc) thank you in advance

[Patrick Houben]

Jordan are you still on thyroid replacement t4+t3 or did you drop those when you decided to go back to trt+?

[Patrick Houben]

Free thyroxine IS free t4 so its included in the test. Ft3 above the reference range means your tiromel is legit.

TSH around 2 just shows that your thyroid meds are not fully suppressing your Pituitary-thyroid signaling, which is okay.

if you aint got a thyroid problem (hashimotos etc) to begin with, you could drop t3.

Otherwise i´d continue thyroid replacement at a lower dose of t3 with some t4 added in the mix.

[Patrick Houben]

IMo theres nothing wrong with adding in a low dose of t3, like 5mcg morning + 5mcg afternoon to get your ft3 up. Thyroid replacement with only t4 usually leads to high normal ft4 levels with lower ft3 levels. Most of patients feel fine with that, but a ft3 that low could lead to a slower metabolism than you want it to be

[Patrick Houben]

Thyroid replacement is usually just t4, or t4+t3arely t3 on its own. Get bloods done after you came off t3 for a month, you likely gonna need thyroid hormone replacement if you your metabolism was sluggish before starting t3. Your GP or endo is gonna base that on TSH, if you find a good one, he will treat you by your ft4 and ft3 numbers and prescribe t4/t3 to get those to a good level

[Patrick Houben]

T4 is low af on your bloodwork, t4 is the standard of care in thyroid replacement, ft3 highly fluctuates depending on various circumstances. In your case I’d just do t4, starting with 150mcg as 100mcg doesn’t even seem to bring your ft4 into the reference range. I suggested reading the thyroid replacement articles on hormonesdemystified.com

[Patrick Houben]

Ive had comparable issues when i wa susing too much t3 and not enougt t4. The t3:t4 ratio in NDT is 1:4, the human t3:t4 ratio in healthy individuals is usually between 1:10-20 t3 to t4. NDT is derived from pigs and has an unphysiological high amount of t3, which shows as well in your blood work (high ft3, low ft4).

If you use to take all of your 180mg NDT at once in the morning and didnt take it the day you did bloods (which would be the normal procedure), your ft3 levels would be a lot higher even right after taking all of your ndt in the morning.

t4 is the standard of care in thyroid hormone replacement because its easy, most of the t4->t3 conversion in otherwise healthy individuals occurs in the periphery and most people seem to convert just fine. Oftentimes, docs focus too much on keeping a “healthy” TSH, but in realitiy with t4 monotherapy your TSH should be below 1 or slightly supressed for best results imo. People often think they need combination therapy but didnt even bring their TSH low enough for maximum benefits.

That said, using combination therapy isnt a bad thing, but it should be done in a more physiological manner, meaning in a ratio of 1:10 up tpo 1: 20. If choosing combination therapy, i’d start with a ratio of 1 unit t3 to 15 units of t4.

i hope that makes sense. You can also do your own research and read the ETA or ATA guidelines. hormonesdemystified.com or tiredthyroid.com are also good resources.

[Patrick Houben]

Then it’s pretty sure your t3 is bunk. You should’ve gotten free t4 too btw.

[Patrick Houben]

at what time of the day did you draw bloods and how many hours before did you take the t3 tab? Do you split dose the t3 or all at once?

[Patrick Houben]

TSH of 6.73 is high af, and im pretty sure the increase from 112 to 125mcg t4 wont cut it. Id do blood again before doing a cycle, being hypo on cycle will just lead to more fat gain. Decreasing your dose to put on mass will result in just adding fat instead of muscle with increased calories

[Patrick Houben]

var, tbol, low test (<150mg), primo.. depends on the sides you wanna avaoid except acne