What should be the ratio of T3 / T4 supplementation ?

[raghav]

I am currently taking 150 mcg Thyroxine (T4) under supervision of an Endocrinologist for the past 18 years. I am getting Cytomel T3 tomorrow. So in what ratio should I take T3 and T4 ? 50 mcg : 100 mcg ? or should I start with 25 mcg T3. Endocrinologists in India have no idea or experience giving combination of t3 and t4. So what side effects if any that I should be on the watchout for ? Thanks in advance.

 

[BadBadBear]

NDT is around 1:4. If you take too much T3, it suppresses T4 so its possibly problematic to use too much T3. As well, doses should be divided.

My NDT has about 9 mcg T3 to 38 T4 per grain, and I divided my dose of 2.5 grains into 3 doses.

Overall, my body still didn't use T4 and I have to be on T3 only.

 

[Learner1]

NDT is different.

I'm on 137mcg T4 and 50mcg T3. I used to feel the same on 75mcg of each.

It's not a one to one conversion. Instead of the extra 25mcg T3 I used to take, it took 2.5 times more T4. Other recommendations are 3x to 5x the amount of T3 to T4, which you'd going from T4 to T3.

Ideally, your rT3 will be normal and your FT3 and FT4 will be midrange and you won't have hyper or hypo symptoms. Your TSH may be suppressed if you take T3, but just go by the other labs and how you feel.

 

[raghav]

Thanks @BadBadBear and @Learner1 Labs in India dont offer rT3 test. Anyway let me start with 25:125 (t3:t4) and see how it goes.

 

[Learner1]

You will likely end up hyperthyroid. You might try going down to 75-100mcg of T4.

 

[raghav]

If I go hyperthyroid immediately my hr will shoot to 90. So I will know. Anyway will take what you said into account. Thx.

 

[BadBadBear]

Thanks @BadBadBear and @Learner1 Labs in India dont offer rT3 test. Anyway let me start with 25:125 (t3:t4) and see how it goes.

That will be approx the equivalent of 225 mcg of T4 only. I would expect you will need to drop the amounts quite a bit to hit your current dose of 150 mcg of T4.

I would start at 100 mcg T4, 10 mcg T3 which will be closer to your current T4 dose. But it will take weeks for your T4 levels to normalize on your new dose, which is a reason to go up slowly on your T3 dose and let your body adjust.

 

[CFS_for_19_years]

I am currently taking 150 mcg Thyroxine (T4) under supervision of an Endocrinologist for the past 18 years. I am getting Cytomel T3 tomorrow. So in what ratio should I take T3 and T4 ? 50 mcg : 100 mcg ? or should I start with 25 mcg T3. Endocrinologists in India have no idea or experience giving combination of t3 and t4. So what side effects if any that I should be on the watchout for ? Thanks in advance.

Cytomel (T3) is about 4 times as effective as thyroxine (T4). If you want to introduce Cytomel slowly, you could start with the first combination:
5mcg Cytomel + 130mcg thyroxine
10mcg Cytomel + 110mcg thyroxine
From here on you might think about taking half of your total Cytomel dose twice a day.
15mcg Cytomel + 90mcg thyroxine
20mcg Cytomel + 70mcg thyroxine
25mcg Cytomel + 50mcg thryoxine

See http://www.allocca.com/papers/Calculating_Thyroid_Replacement_Hormones.pdf

I think the proper ratio for taking T3 and T4 is an individual thing. Most of my thyroid replacement comes from Cytomel because I can't convert T4 to T3.

 

[Ema]

I take 75 mcg Tirosint (T4) and 5 mcg of Cytomel (T3) in the morning and 25 mcg Tirosing and maybe another 5 mcg of Cytomel in the mid afternoon.

ETA: Whoops, forgot a dose!

 

[Learner1]

Cytomel (T3) is about 4 times as effective as thyroxine (T4). If you want to introduce Cytomel slowly, you could start with the first combination:

5mcg Cytomel + 130mcg thyroxine

10mcg Cytomel + 110mcg thyroxine

From here on you might think about taking half of your total Cytomel dose twice a day.

15mcg Cytomel + 90mcg thyroxine

20mcg Cytomel + 70mcg thyroxine

25mcg Cytomel + 50mcg thryoxine

It's individual. That ratio doesn't work for me.

 

[ebethc]

What's the typical dosage of T3, if there is one? asking b/c I've never heard that ratios are that important...

 

[Hip]

I am currently taking 150 mcg Thyroxine (T4) under supervision of an Endocrinologist for the past 18 years. I am getting Cytomel T3 tomorrow. So in what ratio should I take T3 and T4 ?

The normal average T4 to T3 conversion rate is 35.7%, or around one third. Ref: here.

So if you are taking 150 mcg of T4, then you might expect that to convert to 50 mcg of T3 in normal healthy people.


And if you are taking an extra say 10 mcg of T3, then you might consider subtracting 3 x 10 = 30 mcg from your T4 dose in order to compensate.


Bear in mind that the half-life of T3 is around a day or so, which means that you may want to take your daily T3 dose in two divided amounts, to ensure you have reasonably uniform blood levels. The half-life of T4 is longer, around 5 to 7 days, which is why for T4 once daily dosing is fine.

 

[BadBadBear]

Bear in mind that the half-life of T3 is around a day or so, which means that you may want to take your daily T3 dose in two divided amounts, to ensure you have reasonably uniform blood levels. The half-life of T4 is longer, around 5 to 7 days, which is why for T4 once daily dosing is fine.

I think the half life does not predict the bioavailability. I need my T3 in 4 doses per day. If I take fewer doses, I have symptoms of too much T3 per dose, and I run out of T3 over night and wake with high adrenaline.

I have heard of other people who can take a single dose in the AM or at bedtime and be just fine.

Seems to vary quite a bit.

 

[CFS_for_19_years]

It's individual. That ratio doesn't work for me.

These are all different ratios. None of them would work for me either since I rely mostly on Cytomel.

 

[raghav]

Thanks folks for the suggestions. I am also taking Testosterone gel 25 mg topical every morning. My endo wants me to go to the full dose of 50 mg of testosterone gel since my testo leveles are below that of the minimum of a 90 year old male. So this will also have to be factored in. Any way I will be testing thyroid and testosterone levels after a month or so.

 

[pattismith]

@raghav , do you take TH to treat hypothyroidism?

T3 should be taken three times a day, this is what showed up in this study by Pr Jonklaas (2016) (below)

Her results (table A) match pretty well with what I noticed when taking T3 with non genomic effect starting an hour later and ended 9 hours after intake.


Daily Administration of Short-Acting Liothyronine Is Associated with Significant Triiodothyronine Excursions and Fails to Alter Thyroid-Responsive Parameters

in this study where they used T3 or T4 with three intakes per day, they found:

"The dose of l-T3 was 0.57 ± 0.08 μg/kg · d, whereas the l-T4 was 1.68 ± 0.33 μg/kg · d with a microgram/microgram l-T3 to l-T4 ratio of 0.34 ± 0.05"

which means the dose to achieve the same TSH result, was T4 daydose = T3 daydose/0.34= 3 x T3 daydose, which is the same @Hip quoted.

By the way this study found that the effect of three daily doses of T3 has much more effects on many metabolic parameters (lipid metabolism) than T4.

I noticed that Heart rates were not different (about 80 BPM at rest)

 

[Nine lives]

I take AM base dose T4 50 mcg and divide Naturethyroid (preferred WP but slow coming back online) AM , 2PM, and 9 PM (1/2 a grain each time).

Splitting doses helped lower my high SHBG somewhat. Paradoxically, dose just before bed helps with sleep.

 

[pattismith]

@Nine lives
if you look at table 2 in the study I quoted below

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205882/table/T2/?report=objectonly

you will see that 3 doses/day T3 increases less SHBG than 3 doses/day T4....

@raghav , do you take TH to treat hypothyroidism?

T3 should be taken three times a day, this is what showed up in this study by Pr Jonklaas (2016) (below)

Her results (table A) match pretty well with what I noticed when taking T3 with non genomic effect starting an hour later and ended 9 hours after intake.
.........

in this study where they used T3 or T4 with three intakes per day, they found:

"The dose of l-T3 was 0.57 ± 0.08 μg/kg · d, whereas the l-T4 was 1.68 ± 0.33 μg/kg · d with a microgram/microgram l-T3 to l-T4 ratio of 0.34 ± 0.05"

which means the dose to achieve the same TSH result, was T4 daydose = T3 daydose/0.34= 3 x T3 daydose, which is the same @Hip quoted.

By the way this study found that the effect of three daily doses of T3 has much more effects on many metabolic parameters (lipid metabolism) than T4.

I noticed that Heart rates were not different (about 80 BPM at rest)

 

[Nine lives]

Interesting since natural porcine thyroid has a lot of T4. Will check SHBG again in a couple of months. If still high, one way to go may be smaller T3 only doses.

 

[Seven7]

which you'd going from T4 to T3.

What?
Do you mean T4 = 3 XT3?