Thyroid UK
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Adding T4?

I just got my labs back after 5 weeks of switching back to Nature Throid 97.5mg:

TSH: .03

Free T4: .83

Free T3: 2.32

I tried a combo of Tirosint and Cytomel for 4 weeks before that. Labs at that time were:

TSH: .002

Free T4: 1.2

Free T3: 2.86

The only plus from being on this combo was that my hair started growing back. I gained 16 pounds. I was hungry all the time, but I didn't eat that much more. I was also very angry (not like myself). I'm thinking these were hyper symptoms? Or maybe just too much too fast.

So now...I have to decide what to do. Endo says that I respond better to a higher t4, so he's willing to let me stay on Nature Throid, but moving me back down to 1 grain (60mg) and adding some T4 (synthroid). He's willing to keep me at the same "dose." He liked that my TSH was improving. How much t4 should I be on? Is this a good idea?

3 Replies

Do you have the ranges for your latest tests. It is helpful as ranges are different in many labs.

I don't know why the Endo doesn't just raise your NDT instead of adding T4. T4 is synthetic whilst NDT is not and contains all of the hormones we require. 1gr of NDT is equal to around 75 to 100mcg of levo.


TSH .03 (.4-4.7)

T4 .83 (.71-1.48)

T3 2.32 (1.71-3.71)

When I went from 1 grain to 1.5 grains, my T4 didn't budge, my T3 only increased slightly, but my TSH went from 2.43 to .3, later to .13 then to .002 (when I switched to t4/t3 combo). I felt horrible the first week after I increased the Armour to 1.5 grains. My face (especially my eyes) was so puffed up, it looked like I was having an allergic reaction to something. However, after the first week...I felt AMAZING for about a week. Literally better than I'd ever felt in my whole life. I had energy. I was happy. Then, it slowly started to decline. By the end of 4 weeks, I decided to switch to the t4/t3, which raised my t4 and t3, but suppressed my tsh even more...and I had bad side effects. So, the doc's rationale is that I was starved for more thyroid hormone...and so initially I felt great with the increase, but now I'm actually "overmedicated" and he wants to decrease my meds if I stay on Naturethroid only. He's willing to keep me at this level and not decrease with a mixture of synthroid and naturethroid by dropping me back down to 1 grain and adding .25 of synthroid. Some symptoms did improve when my t4 went up a little. My T3 always seems to stay the same no matter what...but when I added cytomel, it made me very irrational and face broke out in was no good.


I admit that sometimes to get to a dose or combination which makes us feel can be difficult. Bearing in mind I'm not medically qualified, I wonder is your Endo treating you according to your TSH alone and doesn't best understand how to treat with NDT? A usual dose is around 3 gr.

When we take T3 (as in NDT) our T4 will be lower because of the T3 in it. Besides your dose is a bit on the low side. Usually, when beginning on NDT it is raised about every 2 weeks till we begin to feel better.

The TSH is variable throughout the day and is highest in early morning and then diminishes. These are two links which you might find helpful and this is an excerpt:-

Have one of these been true of you?

a) being held on a starting dose longer than two weeks (such as one grain, 1 1/2 grains or less)

b) being bound by the directives of a TSH-obsessed doctor. The TSH lab test only keeps you sick.

c) failing to get a raise of desiccated thyroid until the “next labwork”, which can be weeks and months away

Excerpt from below:

There’s a very explainable, and very correctible reason why NDT or T3 doesn’t work for the vast majority who are saying it doesn’t work…

1) First, we learned that there are a certain percentage who have stayed on a starting dose too long or have simply stayed on too low a dose, thus a worsening of your hypothyroid situation and symptoms

I hope these links are helpful.


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