Hi quick question I get terrible fatigue my tsh free t3 an free t4 are fine iron , vit d, etc I've got them all in top end of range I take recommended supplements diets good when I go the gym I'm ill the next day can take a week to recover I don't have a conversion problem could a t3/ t4 combo help me or would that only Benifit me if I had a conversion problem ? Tia

53 Replies

  • It really doesn't sound like your freeT3 is fine if you need a week to recover from exercise. This means you have little cellular reserve. A separate T3 might help but if cortisol is high, it will probably make you feel hyper.

    " “Changes in pituitary conversion of T4 to T3 are often opposite of those that occur in the liver and kidney under similar circumstances. The presence of this pathway of T3 production indicates that the pituitary can respond independently to changes in plasma levels of T4 and T3…Given these results, it is not surprising that a complete definition of thyroid status requires more than the measurement of the serum concentrations of thyroid hormones. For some tissues, the intracellular T3 concentration may only partially reflect those in the serum. Recognition that the intracellular T3 concentration in each tissue may be subject to local regulation and an understanding of the importance of this process to the regulation of TSH production should permit a better appreciation of the limitations of the measurements of serum thyroid hormone and TSH levels (148).”


  • Thanks for reply my vit d is now top of the range as well was only 4 but it's been fine for a while x

  • I have take vit d 5000

  • Hi thank you would I need a reverse t3 test to see if that's the case

  • shay, are you talking to me? I didn't see it, sorry. Some people think the T3 pools in the blood and then you appear to have high T3 but not all of it is entering receptors. I've asked others about it but I don't know whether it would show up as reverse T3 as well. You would need both free t3 and reverse t3 done at the same time and should register as a ratio of 20 to 1. Everyone has SOME reverse.


  • I get mine check out

  • Sorry. Gym?

    Why are you going to a gym?

    If you're overweight then you need more meds.

    If you're not overweight you've got a thyroid condition, you have less energy than someone who doesn't. Don't waste it at the gym, keep it for your life.

    Give up the gym for a week and see if you feel better you're probably just overdoing it.

    Are you taking Adcal? When I was first diagnosed I was takibg calcium and D and thyrioxine and they had to have a four hour gap. I did my gym early morning and if I took Calcium and D before the gym and thyroxine after. I had more strength than the other way. Then I worked out that I was using valuable energy at the gym that I needed for home.

    Sorry but you may have to accept that you have limitations.

  • I'll just reuse my old adage here. " If I get the urge to exercise, I just have a lie down until it passes!"

  • I am taking calcium

  • Anecdotally, I had my levo raised from 75 to 100 as like you, I was going to the gym a few times a week and could barely stay awake after. This is now much improved after the increase.

    My TSH was 2.55 - now barely registering. Maybe worth posting your actual results.

  • I will post them later Hun but they are fine my tsh is 1.4 I can't increase on the I go hyper I've had recent bloods done yesterday so will see what they say I'm not ever over doing it at the gym I cut down to 40 mins twice a week an I can still have bouts of fatigue even if I don't go the gym just if I go the gym the fatigue is defo going to happen an worse

  • I would feel pretty bad with a TSH of 1.4. I keep mine down at 0.1. Some people need their TSH to be very low for their FT4 and FT3 to be high enough to feel well. After all, it's not what goes into the thyroid but what comes out of it that counts.

  • If I increase I go hyper an even slightly hyper gives me awful palps

  • you get hyper

  • Your TSH is irrelevant if your Free T4 and Free T3 are not towards the upper part of the range. T3 does all the work.

  • I get my blood check when the time is

  • I was taking 75 and now on 100mgs

  • It's worth looking at what you eat and if you have any intolerances. Giving up gluten, sugar and alcohol and following a Paleo diet with a good amount of high carb veg made me feel 16 again! Like you my bloods were all good and top of the range. Also, how old are you? Menopause had huge impact on me.

  • I'm 40 I've started getting rid of gluten need to go the whole hog with this

  • How is your B.12? It needs to be close to the top of the range.

  • My b12 was low but in range I've got that towards the top of the range as well

  • What is the top of the range? I've seen some very low tops of ranges, but B12 is optimal at 1000. :)

  • I feel pretty similar after the gym too. I think my meds need an increase as I'm only on 50mcg but the endo told my GP that my TSH should stay around 1 (was over 3.5 before meds).

  • It's awful isn't it I was diagnosed 15 months ago my tsh was 75.6 I've done everything I can to help myself I go the gym for my mood I use to suffer with anxiety an panic attacks it was going the gym that got me through it now I can't go I can feel my mood slipping

  • Oh wow, I felt like death with a tsh under 4! It's just a constant struggle isn't it?

  • I have one panic attacks

  • I do not go to the gym

  • Do you know what your B12 level is? If this is low you get symptoms that include dreadful fatigue, aches, pains, numbness, mental confusion. A lot like low thyroid in fact. It often accompanies underactive thyroid. Best wishes MariLiz

  • Thanks Marliz I will route it out it was low but it is top of the range now

  • If we are not on an optimum of thyroid hormones, exercising depletes our T3 unfortunately and it is the only hormone which is needed in our receptor cells.


    If we want to exercise when not on optimum - it has to be 'exercise to tolerance'.

    If it is to try to lose weight it might have a reverse effect due to the lowering of hormones.

  • Me weights fine shaws thyroid levels are OK was slightly hyper but I'm ok now that's why I asked is a t3/t4 combo only for when theirs a conversion problem or could I maybe benefit from a combo because I'm not getting their with just Levo all my vit levels are fine I've done everything I should of done

  • Personally, I think that everyone should have T3 added to T4. I found it of immense benefit as I was very unwell on levo as I think lots of people are. Unfortunately for those without internet connections they will continue being unwell maybe for years and eventually die wondering why they've always been unwell but told its nothing to do with the Thyroid as they are 'fine' normal' 'nothing wrong with you etc etc. have this prescription (for the symptom only).

    I take T3 only now. Considering that T3 is the active hormone and if levo doesn't convert (that's its job) or dose is too low we will have insufficient so we will still have symptoms.


  • Thanks shaws I haven't got a conversion problem but I'm sure I'd benefit from some t3 well I won't no unless I try had my first endo appointment before Christmas I go back next week I told him everything I had done to help myself I mentioned a trial of t3 combo he said he's not totally against the idea he done bloods an said he's going to adjust my dose according to my bloods to try an fine my sweet spot he said if I'm still in well we walk talk about t3 so I've got my fingers X

  • Insist (in as nice a way as possible) for a trial of T3 to your T4. I hope he will agree.

  • Well I got a 3 month trial of t3/t4 combo fingers X it makes a difference I'm picking it up tomorrow

  • That's great and hope it makes a big difference. What's the dose, i.e of T4 and of T3 you've to take daily.?

  • Went to get it a bit of a journey an it wasn't ready got to go back for it I was that excited I can't remember the dose I think he said now I was on125 Levo that's reduced to 75 an I'm sure he said 10 mcg of t3 twice a day will post when I finally get the prescription

  • Shaws I've got it I was on 125 Levo now I'm on 75 Levo an 10 micro of liothyronnie twice s day I usually take my Levo at night

  • I wish you well on your new regime. I've always taken mine once daily and have been fine and it makes life easier.

    Best wishes.

  • Shaws shoul I take those doses right away or should I cut them up to introduce them slowly or should that be ok x

  • No, you don't need to 'introduce' as you've already been on levo. It's just being adjusted.

    You can take T3/T4 in one dose if you wish, and remember to have an empty stomach as food interferes.

    75mcg T4 plus 20mcg of T3 is equal to approx 135mcg levo.

    If you prefer you can take levo separately and take 20mcg T3 at another time as long as stomach is empty. (it takes about 2 to 2.5 hours to digest food as our digestion is slow too)

    "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"

  • Thanks shaws I didn't no if it was ok to take t3 all st once cos my body's no use to it

  • have you had your glucose and b12 checked

  • Yep that's all fine

  • yes

  • After I cleaned up my diet, got the right supplements, had all the blood tests, had good TSH, fT3, fT4 levels, I still felt low energy. The missing piece of the puzzle for me was adrenal support. I take Standard Process desiccated adrenal each day. Started with two and now have cut back to one. I don't go to gym but I do take a walk. We have steep hills. Now I can walk them without feeling as if I'm dragging a hundred pound weight behind me. But I also agree we must pace ourselves. I can't do as much as I used to do but then I'm not getting any younger either.

  • Did you have your adrenalins tested ?

  • Endo did one blood test, said they were OK. I think not.

  • Yes my endo has just done a blood test for it but ppl have said the test is useless it needs to be a saliva test

  • Hi Shaybenholly,

    The fatigue thing confounds me too but Shaw's advice, and link, makes a lot of sense if all your other markers are OK. Some, like magnesium and B12 are often quoted as unrelaible at truly reflecting what your body is actually taking up.

    Your gym workout could be likened to booming and busting, and my question, still is my question, is, how can our bodies meet replacement demands when we have used up our levels externally provided at a fixed dose quota; how does that fit in with the excercise uptake differential and replacement - unless we store reserve amounts at optimally dosed levels that arealso debateable, it seems? I'll ask that elswhere but might relate to us contuing-post-exertonal-fatiguers.

    I am a lot older than you but have a physically demanding job. Fortunately, working for myself, I can usually factor in crashes....some are so spectacular I can barely move. Scary too. I have also found booming can seriously deplete my blood sugar levels unnexpetedly, contributing to post extertional fatigue and muscular pain long after I get my levels back up. I was told that we cannot expect a pill to do what our thyroids did. Some do better than others but I believe that there must be a way we can monitor and replace more closely in line with our own energy patterns and expenditure. I take ndt once a day and slowly trialing divided doses. Sometimes I top up with a tiny dose of T3 when I have pushed myself to hypothyroid symptoms often evidenced by a big slump in body temp with matching symptoms. But I believe this is a harmful remedy if hypo coincides with adrenal crash. I personally feel them as distinctly different set of co symptoms. Taking t3 to prompt more energy might just knacker my adrenals and adrenal fatigue can be mistaken for hypothyroidism.

    Your post has opened another flood of circling questions for me and prompted me to revisit this (below) great article on magnesium....you might also find refs to fatigue interesting as us hypos often have compromised mitocondrial function, mythelation, ATP etc ..and low cortisol can cause fatigue and pain. One could type search hypothyroidism alongside any of the article's main points and find data on shared presentations. I added a couple more links but dont worry if you have already read, or dont wish to. We can look all day!

    Maybe you just need to pace a bit more. So frustrating but I am glad to be functioning eventually. Maybe...lots of maybe's..you need a bit more time to recover from damage done prior repacement therapy. It can take longer than people commonly think. Also, a lot of folks say that they feel better when tsh below 1. I feel better when mine is suppressed.

    Good luck :)



  • Thank you it is a lot to think about it's a very complicated illness x

  • Exercise uses up precious T3 so beware!

  • I had to take vit d and iron supplement .

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