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Thyroid UK
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Starting dose and raising

I started ERFA 10 days ago with this status:

TSH 3,01 (ref. 0.27 – 4.20 mIU/L)

T4 17,42 (ref. 12-22 pmol/L)

T3 4,82 (ref. 3.59-6.8 pmol/L)

Morning temperature around 36,3 C and afternoon around 36,7.

I started 2x30mg grains, all together 60mg per day. Within 7 days I didn't notice any changes so I increased it to 90mg per day (45mg at morning and 45mg afternoon). After 10th day I was even more hypo, my temperature dropped and all hypo symptoms raised.

Today after 11th day I tested hormone status again:

TSH 0.72 (ref. 0.27 – 4.20 mIU/L)

T4 13.34 (ref. 12-22 pmol/L)

T3 4.79 (ref. 3.59-6.8 pmol/L)

Yesterday afternoon temperature 36,2 C, today morning 36,1 C.

As you can see T3 stayed the same due TSH as result of feedback loop and then compensated with t3 from NDT. Which makes me confused, why I got more hypo if my body have the same T3 amount. This is my first question.

Most of the people say I should raise slowly about 30mg per 2 weeks. But my body already lowered TSH and I already ended up with less t4 and t3. Now this is my second question:

Should I wait more days before raising it again? It is just 10 days and I already raised it on 7th day to 90mg.

Tnx for any response!

5 Replies

If you raise your dose too fast it can backfire. It has to be gradual every two weeks.

The purpose of thyroid hormones is that you have to give your body sufficient time to adjust to a particular dose and then we can raise it and then so on until we feel good.

The purpose is to make us feel well then the bloods can be taken.

With levo the rise is every six to eight weeks.

With T3 and NDT it is every two weeks or thereabouts.

60mcg of NDT is also 1 grain which is equal in effect to 100mcg of levo approx.

1 like

Thank you. Do you think that 90mg in day 7 was too high starting dose, could this cause temp. drop (based on my today blood test and the fact that I didn't use thyroid medicine before)? I am worried now if I should start all over again with smaller dose.



You haven't completed your profile and I have no history to refer to, i.e. When were you diagnosed.With what have you been diagnosed, i.e. Hashimotos, or Hypothyroidism? Have you been taking levothyroxine previously?. What dose. Do you have a copy of your latest blood test results with the ranges?


I never been diagnosed by doctor but myself, they don't listen to me. I have no energy, tired all the time, sleeping problem, hair loss, very dry skin, low temperature. This has been like this from when I was child. My mother and sister both have thyroid problems.

Hashimotos antibodies are negative. Iron, b12, selenium and zinc status has been always ok, vitamin d was very low which I normalized with supplements. I was iodine deficient but I normalized this after 2 years of taking iodine and now kelp.

I haven't been taking any medicine until 12 days ago when I started with erfa. My blood results with ref. ranges are in my question (see the above).


You are the best judge to decide whether or not your symptoms correspond with being hypothyroid. Dr Skinner and Dr Peatfield treated according to symptoms not blood tests - like most doctors of their period. You cannot come to harm by taking thyroid hormones on a trial basis. You either begin to feel well or not.

Normally, the starting dose is 1/2 grain and remain on that for two weeks, taking pulse and temp about 3 times a day. Then by 1/4 tablet every 2 weeks till you feel better and relief of symptoms. Sometimes we feel we might take just a little more but that can then be too much and we may not be able to distinguish between sufficient/too much but can drop down to previous dose. :)

"I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions"


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