Transcription
Hey guys, it's Dr. Child's here. Today, we are going to be talking about adding T3 to your T4 medication. And we're gonna be talking about signs that indicate you may need to do this. And this is episode number 22, so we're moving right along. So let's jump in here.
I have a study pulled up that I wanted to talk about briefly. And this study can be found on PubMed. And it is titled "Combined therapy with levothyroxine (which is a T4 medication) and liothyronine (which is a T3 medication) in two ratios compared with levothyroxine monotherapy (which just means levothyroxine alone) for people with hypothyroidism." And it's a double-blind randomized controlled clinical trial. So it only had about 141 patients, but I want to talk about this just for a second.
So if you go down, you can read through the information here, but I want to, I just want to touch on a couple of points here. So first is that of the patients who preferred the LT4 and LT3 therapy, which means the combined T4 and T3 medication, a lot of these people had a low TSH. So about half of them had a TSH which was less than 0.11. So already off the bat, we're seeing an interesting sign. And that is that most patients were prefer it or feel better if they have hypothyroidism when their TSH is pretty low.
And then secondly, it talks about that yes, unsurprisingly, most patients preferred the combination of T4 and T3 compared to just T4 alone. That's not really surprising, but we'll talk about that. And it showed that of those people who had the combined T4, T3 medication, they experienced changes in mood, fatigue, well-being, neurocognitive functions, so like reduction in brain fog and cognition and things like that. And they also had a decrease in body weight. And that was a big factor for those people and why they preferred to have that combination therapy. And so that's a big, big, big reason one that we're gonna be focusing on today.
So just, just to put this out here so you understand what we're talking about. T3 is a type of thyroid medication. It's the active thyroid hormone, okay? And that should be differentiated from T4, which is levothyroxine or Synthroid or Tirosint. That's most medications that doctors prescribe. They fit into the T4 only, but that isn't the active thyroid hormone, okay? So if you add T3 medication, which is the active hormone, a lot of patients do better. And so what type of patients tend to do better? That's what I want to talk about.
So basically, we're going to be discussing signs or symptoms that you have or put that you potentially have low T3 or that you would benefit from adding T3 to your current medication. So I think one of the most common, will common presentation for patients that fend in this category is they have a normal TSH, but they have low free thyroid hormone levels. And in order to find out if you fit this category, you're going to have to ask your doctor to order more than just the TSH. So they, probably your doctor is probably just ordering the TSH and looking at your other, other or and just dosing your medication based off your TSH. You need to go beyond that. You need to ask him or her to order free T3 and free T4 levels. Those are your free thyroid hormones. So it's possible to have a low or normal TSH but low free thyroid hormones. And people who fit that category, they tend to feel poor. They tend to have problems with weight gain. They tend to experience the symptoms of hypothyroidism, and they just don't feel well, okay? So that's a big sign.
Number two is they have persistent symptoms of hypothyroidism despite being treated. Okay? What do I mean by that? I mean that let's say you have hair loss, you have weight gain, you have fatigue. Those are your hypothyroid symptoms. If you take thyroid medication of any kind and it's working, those symptoms should go away. It just makes sense, right? Because you're fixing the problem with the medicine. If you're taking the medicine and they're not going away, you have a problem, okay? Obviously, there's an issue because that shouldn't occur. And so the, one of the potential reasons for that could be you need more T3.
Number three, in terms of signs, would be you have a difficulty losing weight or you feel like your metabolism is damaged. This might be accompanied by a cold body temperature, or a lower, not a really cold body temperature, but anything less than 98 degrees, or a low resting heart rate. So something like in the 50 to 60 range. Now, of course, that assumes you're not taking, you know, beta blockers or something like that. But those are potentially signs that your, that your metabolism, you're just holding, your whole body is slowing down. It's feeling a little sluggish. It's not, it's not operating the way that it should.
And then I would say lastly, would be other hormone problems. So patients who have thyroid issues and they're not being treated adequately often have other hormone imbalances. And the reason for that is thyroid hormone is one of the master hormones in your body. So it helps regulate other hormones such as estrogen, progesterone, testosterone, insulin, and even leptin. So if you have a problem with thyroid hormone, it's not uncommon to also have problems in those other areas. Now, what you'll see a lot of the times is patients have difficulty and treating their thyroid. And so they have all these other problems, and they're trying to, you know, play whack-a-mole with all these problems when the main issue is their thyroid. And so one of the potential solutions for treating the thyroid is to add that T3 medication in.
And T3, let's see if I have it here. Well, we'll talk about in just a sec. So T3 medication, different names for this medicine include liothyronine, Cytomel, and sustained-release T3. Those are medications that have T3 only in them. And these medicines can be added to your existing thyroid medication. So if you're taking Synthroid or you're taking levothyroxine, you can add T3 to it, and you might actually feel a lot better by doing that. So it can be added to it.
Important things to note. T3 is about three to four times more powerful than T4. Sometimes, I would say it depends on the person, it could be even more powerful than that. But I'm trying to say you don't necessarily need a high dose. So if you're taking something like a hundred micrograms of T4, you may only need five to ten micrograms, which is, you know, one twentieth to one tenth of the dose of your T4 medication. And oftentimes that's enough.
Now, special cases would be in individuals who don't have a thyroid. If you don't have a thyroid, you may need more. And that's because if you don't have a thyroid, your thyroid is producing about 80% T4 and 20% T3. And so the, the ratio I gave you earlier was about, you know, one in twenty to one in ten. And you might need about 20%, which is, you know, four to two times or two to four times higher than the 5 to 10 microgram dose I gave you previously.
And so, so as you're doing this, I want to give you some, some goals to look for because it's perfectly possible, and I've done it before, I've done it with a lot of patients, and it's perfect, it's doable to take T3 and not impact your TSH negatively and to also increase your free T3. And so basic, what I want to say is to, as you take your T3, aim for these two things. It's okay for your TSH to be low normal. You do not want to suppress it, but it's okay for it to be low normal. And there have been studies that have shown that TSH in the low normal range, even if it's low but not suppressed, they don't have those negative side effects such as heart issues or cardiac enlargement or atrial fibrillation. So aim for a low normal TSH and a high normal free T3. So if you look here, you can do 3 to 3 in total 33, but I say at least in the upper half of the reference range, but even higher than that is okay. So manipulate the T4 and the T3 to the point where you get the low normal TSH and the high normal free T3. And that's usually where you'll find the best results.
Now, does that mean everyone needs T3? No, not at all. In fact, I would say probably only about 15% of people would do really well on it or actually truly need it. Now, you may feel better even if you're not in that 15% just by taking it. That's certainly possible. But I would say about 15% of people truly, truly need it. And that's because about 15% of people, if we're just looking at statistics, have genetic problems with the way that their body metabolizes thyroid hormone. So not everyone needs it.
Some people that take it will experience, they'll be very sensitive to it. They'll experience heart palpitations, they may experience hair loss, and they might get nausea and headaches and things like this. So not everyone does well on it. And some people may do better on combination T4, T3 medicines like natural desiccated thyroid. So it's not your only option to add T3. If it doesn't work for you, you can still try NDT or something like that.
And if you can't find a doctor who's willing to give you T3, because let's face it, sometimes it can be difficult to get, you do have other options. So you can look at some supplementation. So you can look at supplements which try to increase the amount of conversion that occurs between T4 and T3. So you can look at T4 to T3 converting supplements. And you can also look at supplements designed to support other your adrenal systems and other, other hormonal systems in your body. So you do have some options. But it's usually best if you combine all these things together. But, you know, it could be frustrating if you don't have a physician that's willing to work with you. So just keep those in mind.
But anyway, that's about it. So it's, this wraps up episode two. If you have any questions about adding T3 to your T4 medication, how you do it, what, what to look out for, why you should do it, anything like that, please leave it in the comments section below and I will do my best to get back and answer those questions. Otherwise, I'll see you guys in the next one.