T3 advice - heart palpitations: I’m going back to... - Thyroid UK

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T3 advice - heart palpitations


I’m going back to see my Endo in a few weeks, need some advice again.

I have been on T3 ( Liothyroxine) for around 3 months, I was prescribed 60mcg per day with 50mcg of (Levothyroxine). I checked here first before I started taking it. I got some good advice about starting with small dose like half a tablet of T3 a day, I did this and built up the dose over 2 weeks. I got hyper symptoms and decided to lower the dose to half a tablet a day and now I’m on 20mcg per day . I was also having and allergic reaction, I had skin itching and rash. I started taking Antihistamines, I’ve been taking that everyday since.

I am feeling better than just on T4, I have more energy in the evening so thats good, also really good quality sleep (getting up in the morning still very hard) but main concern is I’m having heart palpitations, not all the time but 3 / 4 times per day. I’ve had It much worse than this before. I have put on some more weight, I’ve not changed my diet (low carb - high protein)

My questions are - do having heart palpitations do any long term damage to your heart?

What are my other alternatives to Liothyroxine / brands (he's going to take me of Liothyroxine I think)

Is there a way I can do a natural method or do without this medication.

I had a TT done for Graves in 2013

Hope you can help guys.xx

35 Replies

Hi Nicky,

From what I'm learning from Dr. Bergman's videos which I have been posting lately and they are wonderful, you have to be a detective regarding the symptoms. I would say that your heart is reacting to something and that actually is a good sign. You have to find out what it is reacting to. I've had more on T4 and no palpitations with T3 at all. But you also have the allergic reaction. Do you think the Levo brand you are taking may have some filler in it? A rash means that your body is trying to release a toxin. Would your doctor consider an NDT since the T3 suits you?

Nicky, palpitations are uncomfortable but they aren't damaging. It's common to have raised pulse, heart rate and palpitations about an hour or so after taking T3 and they usually subside within the hour.

The rash is likely to be due to one or more of the fillers in Mercury Pharma Liothyronine. Mercury Pharma is the only Liothyronine available on the NHS but you can fax or scan your prescription form to buy other brands from Germany via thyroiduk.org.uk/tuk/treatm... or via overseas online sites. Alternatively you can buy Greek and Turkish T3 online without prescription.

Natural dessicated thyroid (NDT) which contains T4 and T3 is not licensed for use in the UK so few NHS doctors will prescribe it but it is available without prescription online.

Btw high protein can also cause palpitations as it pushes adrenal glands work a bit harder. 1 g for every kilo you weight is recommended, 1.25-1.5 for active and above that is not recommended for a normal person.

Also just low carbs can be the culprit.

Nicky74 in reply to Justiina

Hi Justiina

I started on this diet and found I could actually loose weight, but now I think my body is use to it and started putting it on again. I eat fish 3/4 times per week the rest is veggies/ dairy and protein shakes in the morning. I don't eat other meats. I would love to start on the carbs again, I love bread and pasta cereal . Any ideas?


Justiina in reply to Nicky74

I have a book written by Diana schwarzbein which states that protein shakes are bad for adrenal glands if one has so called adrenal fatigue.

Balanced meals are the key with proper protein.

In the book there are also lots of sample menus.

Books I have are called principle II and program.

In the book it also says that you don't have to lose weight to be healthy , you have to be healthy to lose weight.

In order to treat your adrenals you need moderate amount of good carbs. I get mine from potatoes, millet, quinoa, oat, berries and fruits.

Nicky74 in reply to Justiina

Sounds good, ill see if I can find the book. thanks for the advice.

I found that palpitations were the T3 wearing off - if that's after 8 hrs then take your 2nd dose after 7hrs to avoid them etc.

Hi Heart palpitations should be taken seriously. I find my heart is worse if not on just the right dose, for me, i.e. too much or too little.


Please don't ignore palpitations. I read loads of blogs and books that said they were normal so I ignored mine and had a stroke caused by atrial fibrillation (a type of palpitation) caused by excess T3. I was on 60mcg of T3 only. I was 43 so rather a shock. My advice is get your palpitations diagnosed (I had 7 day heart monitor) and work with an endocrinologist. Go slow with T3, divide your doses and don't ignore blood tests. If you have palpitations that don't stop or your heart races get to A&E - their quick response to stroke reversed my symptoms and possibly saved my life.

Good advice Sarah thyroid. I am hypo and have atrial fibrillation, and I worry about posts that refer to palpitations that have not been diagnosed. You need an ECG taken at the time, and this will indicate whether you are having AF or if something else is going on. Untreated AF can lead to stroke. The risk is at least x5 normal for your age.

silviageci in reply to Hilaryjm

I have atrial flutter (another heart arrytmia) for which I have to take Amiodarone, that lowers T3 levels, that happened to me, my endocrinologist decided to add 10mcg of T3 to the 50mcg of T4 I was already taking (I am hypothryoid even before the arrytmia), my concern is that one of the things it is said is thatT3 could be proarrythmic, but I read in this blog that T3 actually helps with the heart, I am confused and also worried. Endocrinologists hate Amiodarone and Electrophysiologists (doctors that specialize in Heart Arrythmias) hate T3, but again I read here that sometimes the heart races for lack of T3 not for taking it???

If you are waking up and feeling almost hungover and having palps I would look to get an adrenal saliva test - I had this and my adrenal out put was quite low from years of being hypo

Thyroid meds need a good supply of cortisol to work properly

I wake up feeling exactly as you describe -slightly hungover. My saliva tests show almost no cortisol and below range dhea for years but I have no idea how to fix this. Can anyone recommend anything? I am on 4 grains of Erfa but free t3 is well below range with t4 at v bottom of range. Could this be adrenals?

Hidden in reply to Angela23

There are a host of quality Adrenal supplements available, both adrenal extract and supplementation suitable for vegetarians. If your Adrenal glands are sub-par (and they are for most of us, because of the long term ill health and stress we're under) then taking a pot should do much good and cannot do harm. Adrenal function needs to be good in order for thyroid hormones to work well.

Tests for cortisol levels are notoriously unreliable.

Angela23 in reply to Hidden

Thanks Humphrey. I have finally pressed 'order' on the adrenal supplements I have been contemplating:)

faith63 in reply to Angela23

Angela..it looks like you aren't absorbing your meds well. Do you have issues with your Gut..like Celiac or Anemia, for lack of absorbtion? You are very undermedicated, what ever the reason.

Angela23 in reply to faith63

Thank you for the reply:) I am apparently 'ever so slightly anaemic' so am supplementing with iron and vit c in addition to the usuals. Getting tested in Cyprus in August hoping for improvement but feeling v poorly today:( Thank you so much again, this is why this is such a great forum.

Adrenal Glands need a good supply of Thyroid Hormone, to work properly as well.

silvisilvi in reply to faith63

Can someone advise,just did kortizol saliva test,results,morning 1.25(ref. 0.5-5.7) noon 1.71(ref. 0.2-3.6) afternoon 1.57 (ref. 0.2 -2.4) evening 1.23 (ref. 0.2-1.3) almost thesame as morning,my endo said nothing,have problems sleeping.Hypo and hasimoto,60 years old and taking only 0.12 micrograms of eutyrox.

Thanks to all,

Thank you all for the good advice, I don't know what I would do without this community so many lovely and helpful people. I will investigate the other brands from Germany and watch them Dr. Bergman's videos.

As for the palpitations, I'm not that worried as they are mild. it's just because I've been having them on and off for 4 years all linked to the meds, just like Jackie, and I wander about long term damage thats all. BTW Sarahthyroid that sounds very scary I'm glad I just taking the 20mcg not 60mcg, of T3 as I was up all night with the palpitations, I was worried.

Thanks again

good luck everyone

Cheers xx

I'm on T3 only. I do find it a difficult medication to get right although I'm adapting to it. I get palpitations if my next T3 dose is delayed or is taken too early. So I am constantly trying to find the "sweet spot". I actually feel that I am very close to my ideal dose. I currently take 1 and 1/4 tablets of Tiromel per day - a very low dose compared to many people, I know, but I'm not very hypothyroid compared to many who use this site. I think another quarter tablet is likely to be sufficient for me.

What I've been doing over the last few weeks which has been an interesting exercise, and very well worth doing, is I have been experimenting with the number, timing and size of each dose, without actually changing the total amount of T3 I take. I'm currently taking 5 quarters of a tablet per day, and some of the dosing patterns I've tried are :

Single quarter of T3 taken at 5 separate times throughout the day

First thing : 2 ; Early/mid afternoon : 3

First thing : 3 ; Early/mid afternoon 2

First thing : 5

First thing : 1 ; Early/mid afternoon : 3 ; Bedtime : 1

First thing : 2 ; Early/mid afternoon : 2 ; Bedtime : 1

I tried a lot of other combinations too - the list above is very far from complete. I'm currently using the last combo I gave and it is working extremely well for me and palpitations are now rare. If it ever starts going wrong I will experiment more, and I will probably add another quarter tablet to my daily total.

The thing is, with some of these combinations I got palpitations. But in every case I was taking a total of 5 quarters of T3 per day. So bear in mind that the total dose may not be the problem, it may be your pattern of dosing that is wrong.

faith63 in reply to humanbean

Why not one dose?

humanbean in reply to faith63

I tried a single dose at different times of day. My heart was going like the clappers not long after taking the T3 (close to or just over 100 beats per minute), and later in the day I was completely wiped out. I really have to spread my doses out in order to have any hope of feeling almost human.

faith63 in reply to humanbean

That's too bad. I remember what a problem i had doing it 2x per day. I would always get hungry right around the time my dose was due...probably a mental/psychological thing!! At least you feel almost human. I am not at all, but do not have the heart issues with t3, but cannot raise dose any higher, still very symptomatic. I beleive my Hashimotos just makes me feel ill and swollen. My stomach is a mess too. I am looking into an Integrative Medicine Program and will see a Nuerologist for my odd brain, eye swelling issues. It is just devastating what has happened to so many of us!!

Nicky74 in reply to humanbean

Wow humanbean, how to you remember when to take time? maybe I do need to take smaller doses throughout the day. How are you cutting the tables into quarters without disintegrating? Cheers for the advice

humanbean in reply to Nicky74

I have various techniques. I write notes for myself, and I use the reminder and alarm functions on my phone. But mostly I use my own body - it tells me when I need a new dose if I forget. My heart starts misbehaving - heart rate goes a bit fast, I get palpitations etc. and of course I also run out of energy.

Now that I've found a dosing pattern that works for me it is easier not to forget.

I organise my stock of T3 as well - most of it is kept in the freezer. One strip is taken out of the freezer and kept in the fridge. I put about 6 pills at a time in a little pill box which is kept at room temperature. And I have another tiny pill box which I normally carry around with me which has exactly the amount of T3, already cut up, that I need for one day. It is topped up just before bed for the next 24 hours. I can always tell whether or not I've forgotten a dose just by seeing how much T3 I have in my pill box.

I use a craft knife or hobby knife or scalpel to cut up my pills - they always come with spare blades which is helpful. I never found a pill cutter that worked - they always crushed the pills. Do a search on Amazon for scalpel or craft knife. They aren't expensive.

Humanbean I've been doing exactly the same as you and got to very similar timings of treatment except I'm one tablet first thing, another one early afternoon and half a tablet early evening - I've yet to experience palpitations but have definitely noticed more energy and concentration all day - I'm reluctant to increase any more as it seems a lot to be taking and really underlines just how much I wasn't getting and why I felt so bad.... it is difficult to know when you've got to the optimal balance isn't it :-/

humanbean in reply to Lisasones

Yes, it is difficult.

There are so many variables. For instance, I know I have high cortisol first thing in the morning, according to two adrenal stress profiles I've done. And I think this is why I can't tolerate a high proportion of my dose being taken first thing in the morning. I'd like to be able to take more first thing because I don't feel I have enough energy in the morning. But I just can't because I end up feeling overdosed.

I've found that reverse T3 levels have also had a HUGE impact on my need for thyroid meds, and T3 in particular. A long-lasting and serious non-thyroidal illness raised my reverse T3 to well over the range, I had severe iron deficiency, and I was extraordinarily insensitive to T3 meds and took a huge amount as a result. But fixing and slowly recovering from all those problems has had a major impact on my need for T3.

Thankfully I'm self-medicating and so I can be flexible and make changes to my choice of meds and dose of meds as I see fit. I don't have to convince anyone else that what I'm doing is right. It is hugely liberating! And, at times, terribly frustrating. But if I had to beg for more meds or different meds it would be a thousand times worse.

Yes I too am self-medicating and addressing all other possible causes, such as B12, Magnesium, Vit D & K2, B-complex, methylfolate, iron tablets, and gluten and dairy free to help give my body the best chance of repair (oh and adrenal support too) so that, like yourself, the more my body recovers hopefully I can reduce the T3 and it will be able to regulate itself better, best wishes to you, Lisa x

I am amazed that your doctor would have prescribed 60mcg liothyronine/T3 with 50mcg levothyroxine/T4. I don't think you should go off liothyronine; I think you need to get to the correct, lower dose.

Estimating an appropriate full replacement dose should use criteria like the following. It appears your doc doesn't use this information.

F full T4 replacement dose, ~1.7mcg/kg body weight

P T3 power factor (multiplicative factor estimating how much more powerful T3 is than T4), ~4

R T3:T4 ratio, typically in the range 1:4 - 1:10

To illustrate what I mean: I am a male who weighs about 76kg. So, my full replacement dose of T4 is 76*1.7=129mcg. I am actually on a daily dose of T3+T4=15+75, so my T3:T4 ratio is 1:5. Using the power factor, I compute that my T4-equivalent is my T4 dose (75mcg) plus my T3 dose (15mcg) multiplied by 4. That is, 75+15*4=135mcg. 135mcg is close to my T4 full-replacement of 129mcg.

How do I know that T3+T4=15+75 is my right dose? If I independently boost T3 from 15mcg to 19mcg, I will feel hyper effects within 1-2 days. If I independently boost T4 from 75mcg to 88mcg, I will feel hyper effects within 7-10 days.

Being highly gluten-intolerant, I use Cytomel because it is guaranteed to be gluten-free and I've never had a reaction to it, with correct dosage. I have avoided generic liothyronine because the manufacturers won't guarantee it GF, nor will they tell you exactly what is in it (probably because, since ingredients are sourced from China, they don't know).

Nicky74 in reply to Eddie83

Thanks for this I need to do some sums clearly , I still weigh myself in pounds and stone, I also hate weighing myself these days (sad).

I can take this info to the endo not to say, what are you thinking more give me more time to get the dosage right. I have my brain back, I want to keep it that way.


One other point. As I said above, I weigh about 76kg. Some years back, I was on T3-only for a little over a year. I found that a total of 62.5mcg T3/day was sufficient to support my needs. That's another reason I am surprised that a doc would put you on 60mcg T3, plus 50mcg T4.

May I ask what area of the country you are in? I'm looking for that amount of T3 daily, and just wonder if your doctor is within driving distance of the Baltimore metro area?

Nicky74 in reply to Klagh

Hi Klagh

I'm in the Uk northwest , It was hard getting this far (getting a prescription) I really want this to work, thats why this community is vital, you won't hear any of this information from the doctors (not the one's I've seen)

Good Luck, cheers


Klagh in reply to Nicky74

We might as well get rid of the GPs. I've not found a one in 14 years who could help me. We definitely need surgeons, but when we have to turn to these groups to advise each other and find the meds we need, that means GPs are as useless as tits on a boar.

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