T4 levoythyroxine and T3 Cytomel combination therapy for under active Thyroid

As cannot get help via GP and Endocrinologists, am sorting myself out from the massive fatigue of under active thyroid so obviously not converting T4 into T3 the active form that conserves and access energy from food in your body.

The one thing I cannot find out from any American site so far, is whether to take the T4 tablet before breakfast, wait half an hour, eat breakfast and then take the half dose of T3?

Diagnosed under active Thyroid and through blood test now 100 mg generic Levoythroxine 100 mg.

Through American websites worked out that medication is

T4 dose (Levoythroxin) divided by 6 for the T3 dosage.

In UK, T3 is £100 a box of 28 so unaffordable, for a source manufactured in England.

Can get T4 just fine through GP prescription, as it costs pennies to the GP's funding.

Getting it abroad in pills of 25mg and cut up the pill in half, as cheaper and can buy over the counter abroad, the branded Cytomel made under licence from the USA parent, in that country.

The Americans say to take the T3 after breakfast and after supper in 2 doses. Tablet too small to cut into 4. Tablet too small to work in pill splitters even into 2 equal halves.

Any suggestions of pill splitters that work on small pills please?

The T4 is prescribed to take half an hour before breakfast.

But most breakfast food items are told not to eat til 2 hours after taking T4.

Up til now been surviving re fatigue against doing anything, by taking the natural supplement Ashwagandha (Holland and Barrett own brand) at least 2 hours from any medicine, as informed by Ayurvedic practitioners online articles. Taken with meals.

The Ashwagandha is prescribed by some American doctors along with the T4.

We cannot get prescribed Armour Thyroid in the UK, which is all the thyroid hormones as it is dessicated pig's thyroid, and was the treatment for 110 years just fine til the middle of the 20th century. Can't get that in UK any more as too expensive and not licenced in the UK.

I will not do the trial on myself abroad, but will take the Ashwagandha (2 tablets) that is tried and tested over a year, taken at least 2 hours with a meal after the T4 levoythryoxine and works to deal with the very bad fatigue that I can Rip van Winkle syndrome.

The fatigue puts me in fear of heart attack or coma, that is final symptom of under active thyroid. Any effort makes my heart pound out of my chest, as the energy reserves are just not there.

As my Endocrinologist and GP do not know what I am talking about, when showing them American and European paperwork on T3 or of asking for tests on levels of T3 or Free T3 or Reverse T3 tests, I have to sort myself out, as I said at the beginning of this post cum question. No help from blood tests but only by seeing how my symptoms lessen.

Anyone taken Ashwagandha, T4 and T3 all in combination?

Ashwagandha has no hormone in it of any kind and only naturally stimulates the thyroid.

But anyway, keeping Ashwagandha 2 hours away from either T4 or T3 doses.

Need to get rid of this very great fatigue as it is lessening my mobility with my osteo arthritis by all this sitting and lying down.

29 Replies

T4NotWorking, T3 is only available on prescription in the UK although it is available OTC in several European countries. You can take T3 with T4 30-60 minutes before breakfast. You may be able to cut a half tablet in two with a thin knife or craft blade but I admit I wasn't too successful.

The T3 on prescription in UK is made in England and costs £100 plus a box of 28 tablets. I will get mine abroad over the counter, for the weaker brand made in Greece at 25 mcg tablets. The Americans say that 100 mcg Levoythroxine gives a dosage of T3 by dividing T4 by 6, so can take up to 15 mcg. With arthritic hands it will be seen how I can cut the tablet in half.

T4NotWorking, if your GP will prescribe you T3 it will not cost you anything if you have an exemption certificate. I have seen T3 claimed to be 3, 4 and 5 times stronger than T4, but never 6 times. ncbi.nlm.nih.gov/pubmed/204...

Pillmate is a good cutter and cost £2.99 from my pharmacy.

My GP will not prescribe anything but Levoythyroxine. Only wanted me to have a private prescription at £100 a box for 28 T3 tablets. My endocrinologist never tested anything to do with T3 levels and just prescribed an extra 25 mcg of Lev when last 3 blood tests said T4 was just fine on current prescription, so, in effect, trying to poison me with over-prescribed T4, which I cannot convert into T3 and could have flipped me from under to over active which is life threatening as well. There is no help where I live. I will look into getting the Pillmate. Thanks.

You can order private FT3 tests from Blue Horizon and Genova via thryoiduk.org

I was very unwell on T4 until I added in some T3. I hope you find it as beneficial as I did.

Has your Ferritin



been tested ???

because fatigue and heart pounding can be because you are aneamic or b12 deficient

please also see my PM

My Endo and my GP are part of the British medical institution belief that Thyroid is only a T4 deficiency and nothing else. My Endo said my T4 was normal but said as symptoms persist just give more Levoythryoxine, which is dangerous beyond that shown by the blood tests as can flip from under to over active thyroid. So no help there.

You can have a genetic test to see if you can convert T4 to T3. There is a private Dr in London, Harley St that does it and will do a T3 trial with you if you have the faulty gene. He is on the Thyroid UK list of Drs. He will also write to your GP to request they prescribe T3 for you.

may i ask who the doctor is ?

I am too poor to go to a private doctor in Harley Street. Got the under active thyroid in poverty early retirement, nil benefits, nil state pension at 60, unable to work as disabled and have this exhaustion under active thyroid. As no benefits sometime in future will find agencies give no vouchers to food banks.

Try Dr's name deleted, who can prescribe you what you need, including Armour Thyroid, if you need it, if you are in London. Have you considered adrenal problems as underlying your fatigue? Ashwaghanda is just one of the helpful herbs you can take...there are many others. You also might consider whether you have Candida and vitamin and mineral deficiencies, leaky gut, low stomach acid(supplement with zinc, it helps), or low iron, which you should take apart from zinc. Give up gluten, which damages the gut lining, where much of your t4 is converted. I found it helped me a lot taking Biocare's Mycopryl 680, and also Alfalfa, at times. Are y lactose intolerant, and do you have food allergies?

Edited by Clutter in line with posting guide #24. Do not post contact details of endocrinologists or doctors on the main board without their permission as this may result in unwanted attention from certain areas of the medical profession.

Cortisol is stabilised by Ashwagandha so that sorts the adrenal problem. I have no knowledge about the rest as not offered by GP or Endo. The blood test result showed not anaemic so low iron not present. As suffer acid reflux know have sufficient stomach acid. Paying to have food allergies tested is not possible as poor old disabled and paying taxes for our beloved politicians to enjoy a life of wealth and privilege.

sorry, you can get t3 over the counter in Europe? where and what brand and how do I know I'm getting the real deal? Sorry, but two years ago the UK had a shortage and I had serious health problems trying to do without it as I literally can't breathe without it. I really wouldn't mind having a stash of it under the bed just in case!

PM me cazlooks for details

You cannot keep medicines beyond their end date. In Greece the T3 tablets are a weaker version and made under licence from USA manufacturers. Cytomel Τ3 Liothyronine Sodium 25 mcg, in 30 tablet boxes. But unknown if you can buy them online. Above is someone who orders them online from Mexico.

I agree with everything you say T4notworking, I have been down this road for a long time. I agree also with the osto arthritis bit I have this in my left foot and cervical spondylosis. I believe all of this is due to long term ill treated Hypothyroidism for 20. Have studied and studied (was a nurse), and what I am finding out on a daily basis never ceases to amaze me. I am now on T3 from Endo and T4 still putting on weight and numerous other ailments such as fatigue depression and bloating. I know that it is expensive the T3 that is why we have such a job getting in and even the Endos don't seem that informed. It was only because I had trialed it myself first that I got it I think. Hang in there. Did you manage to get some T3. Hope you get better, as we all do with this terrible illness. Good luck

Will get a supply when go to Athens Greece and see if it helps me. It would have been better to have Armour Thyroid (USA name) as that was the medicine for under active thyroid for 110 years just fine til the mid-20th century. But all the main belief of endocrinologists in UK does not follow the fact that thyroid problems are complex and complicated as followed in North America and Europe.

I get my T3 from Mexico, I believe it is a little stronger than you get in the UK? is very reasonable price and it works well for me, I cut it with a thin sharp blade, I do think it should be introduced slowly along with the Levothyroxine, if on mixes medication.

is it cytomel? or other generic name?

is called cynomel from there, sold in 25mcg tablets, is very good.

I agree with this I bought the cynomel from Mexico and found it a lot stronger than the NHS T3 that I am on now.

can I ask what dose your on and how long you have been taking it, if you don't mind telling me, I got a bit hyper when I first tried it, so I am sort of starting again.

I had built up to 50mcgs taking twice daily one time but reduced as found it too hard. I sometimes take one half of a 25mcgs and my 20mcgs NHS as I want to use them up. I find them more effective than the nhs ones.

thanks marmaris, at least if you go over a bit, you find out pretty soon with the T3, I think I forgot they were stronger when I started, good luck with yours.

Good luck with yours too.

Ive had hypothyroidism for nearly 30yrs and I am still on levothyroxine 150mg per day....... I have no idea about T3 or any other treatments for it........

Bowler, if you feel well on Levothyroxine (T4) there's no need for anything else. Liothyronine (T3) is helpful for people with thyroid hormone resistance, low FT3 and those without a thyroid who aren't doing well on T4. Some can't tolerate synthetic T4 and T3 and take natural dessicated thyroid which contains pig thyroid with natural T4 and T3.

I have no choice but synthetic T4 and T3 as I cannot afford private medicine. Hope the synthetic T3 helps me. My endocrinologists did not test any aspect of T3 and crossed out many T3 tests saying they could not be done. Obviously the rest of the world is wrong then :-(

The people who do not feel well under just Levoythyroxine have a further problem of being unable to convert the inactive T4 that is Levo, into the active form of T3 which gives energy accessed from food. Thyroid problems are far more complex than UK endocrinologists believe in the mainstream. You are lucky. I have to self medicate and look up the internet. Fortunately the Americans give a lot of information. I have survived so far with the herb Ashwagandha to give me energy when I go out of the home to do anything.

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