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Thyroid UK
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Latest thyroid results

TSH: 0.07 (definitely below bottom of range, not a worry)

fT4: 18.7 (10-19.8)

fT3: 3.8 (3.5-5.5)

Ferritin now at 139, B12 at 744 so much improvement by way of supplementation all round. Cholesterol has also gone up, to 6.4; apparently a value under 5 is preferred.

I've hung around these here boards long enough to know that the fT3 value is a bit of a shocker, and may explain why I feel so knackered at present. I did not take my meds before the bloods were drawn. I do exercise a lot and have a feeling that this might be the 'problem', as in if I stopped exercising so much the T3 would go up. Is it worth adding in some T3 and, if so, how much? What would my GP need to know about the effect it might have on other tests? I seem to remember reading that if T3 is taken then the fT4 is essentially void, but is this when one is on T3 monotherapy?

Is there a preferred T3:T4 ratio?

11 Replies

If you feel not too bad otherwise, ask your GP to reduce levo by 50mcg levo and add 20mcg of T3 on a trial basis for 3 months. Your T3 is lowish and it does lower when we do exercise but if you don't have hypo T3 rises again normally. I think you will feel the benefit of adding T3. It might just lower your T4 but you are reducing levo anyway, so it might not make much difference.


Thanks, Shaws. I'm currently taking 150mcg a day and the T3 I'll be buying is Tiromel, only available in 25mcg tablets. Would your advice about dosing still stand given this info? And should I take my T3 with my T4 in the morning, at another time completely, or split the dose during the day? Levothyroxine has always worked for me (bang on 20 years) until now so I'm a total novice in the ways of combination therapy!


In that case I would take 100mcg of T4 and half of 25mcg T3 initially (25 T3 equal to approx 100 levo). Yes, just take both together once a day. I did as well when I was taking combo. See how you feel for about 2 weeks and if you feel well keep to this. If you feel you need a slight increase up by 1/4 but you may not have to. Hopefully you will feel much better. Sometimes we have to adjust meds to suit us.


When it comes to testing, should I still have both free T3 and T4 tested? What results should I be aiming for? I will need to explain all this to my GP, who is excellent and willing to be educated (and about to retire: oh hell).


Maybe your GP was trained when only NDT was available. That would make it easier. The main aim is for you to feel well and not dependent only on the blood tests. This is the preferable way to do things although the BTA might not agree.

It's how the patient feels which is the criteria.


If your GP still wants to do the TSH and T4 that's fine but he isn't to worry if your TSH is around 1 or below as long as you feel good.


Hose, with the addition of T3 your TSH will probably drop and may even become suppressed <0.04. FT4 often drops and FT3 should rise.

Shaws has advised well about starting with 12.5mcg Tiromel but I would split it into 2 doses 8-12 hours apart initially to see how you tolerate the T3.

I found that after an initial improvement in adding T3 I had an energy slump a few weeks later after my activity increased and that was my cue to raise dose. 6.25mcg increases are advised as it is easy to overshoot FT3 range once FT3 has started improving.


The interesting thing is that I'm mentally exhausted and suffering some physical decline too, but am somehow bloody minded enough to still run about 5 miles at the weekend. It is very much a mind over matter thing at this point: I worry that if I stop I'll never start again!


Hose, when you are used to the T3 you could try splitting the 1/4 tablet and taking a little extra 3.25mcg when you run at the weekend as exercise depletes T3.


Thanks, Clutter.


Just to be clear: would I take my last 150mcg dose of levo as normal one day and then start right in with the combination levo / tiromel the next day? And if I have blood tests would it be the usual advice of don't take meds 24 hours before the draw?

I would also guess that I should put more store by a combination of good free T3 results (should be at top of range or just anywhere over 75%?) and how I feel. I will tell my GP that testing my TSH is a waste of everybody's time and the NHS's money :) I've thought that for a long time anyway as it's not gone over 0.3 for the last ten years!


Hose, yes you could take last dose 150mcg today and start T4+T3 tomorrow. Leave 24 hours between last dose and blood draw.

FT3 is optimal in the top third of range. TSH is usually lower/suppressed when taking T3 but it isn't a valueless test. If, for example, TSH rises it may be indicate that the patient is not compliant taking thyroid medication or there is malabsorption preventing absorption and uptake of thyroid medication.


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