Hello – We have heard mixed reviews from patients about adding T3. Some patients feel that adding T3 to their regimen helps reduce fatigue, but others have found that it actually caused a recurrence of their hypER symptoms. The process is generally to start patients on T4 only (Synthroid, Levoxyl, etc.). The U.S.-based medical agencies are generally opposed to adding T3. The Europeans recommend T4-only therapy for at least six months and ensuring that the patient is compliant with dosing guidelines (taking meds consistently on an empty stomach, avoiding soy/calcium/iron within 4 hours, etc.). If the patient is still experiencing symptoms after that time, they recommend a *short* trial of synthetic T3, with a follow up evaluation to see if symptoms improve.
Interestingly, the U.S.-based guidance on treatment of hyperthyroidism stresses the importance of NOT relying on TSH for patients who are being treated with ATDs or RAI, but it *only* mentions TSH for patients who are post-TT. Honestly, I don’t know why this is the case. The section on TT starts on page 605 of the original journal article or page 13 if you download it as a PDF doc.
(Note on links: if you click directly on the following links, you will need to use your browser’s “back” button to return to the boards after viewing, or you will have to log back in to the forum. As an alternative, you can right-click the link and open it in a new tab or new window).
http://thyroidguidelines.net/sites/thyroidguidelines.net/files/file/THY_2010_0417.pdf
As for B12, this isn’t something that endos don’t routinely test, but if you suspect you might be deficient (vegetarians and vegans are at particular risk), it’s worth pushing your doc about testing. Here’s some additional info on B12:
http://ods.od.nih.gov/factsheets/VitaminB12-QuickFacts/
Take care!
