Endo wants me to reduce T3 and raise T4 - Thyroid UK

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Endo wants me to reduce T3 and raise T4


It's been a while since I have posted here regarding my thyroid and any results, been feeling great, graduated from C25K and continue to run 3 x a week, weight has reduced but last few weeks has plateaued, lost an inch though. Niggly symptoms still around, my hair which was growing back has now decided to start shedding again, quite a lot too, and at times I get this feeling in my throat that my thyroid has swollen, it can get very painful for a few days then it subsides.

Reason for my post is my latest blood results from seeing the Endo last month. Used to see him private til my GP referred my to him on the NHS so now I don't have to pay. Endo also provided a script for T4 and T3 which took nearly a month for the pharmacy within the GP surgery to source T3.....but I now have some MP 20mcg. Previous dose was 100mcg T4 and 20mcg T3 and I omitted the night before's dose as i knew I was being tested. (I take T4/T3 once a day before bed)

Latest results:

Free T4 11.3 pmol/L (10.3 to 24.5)

Free T3 4.3 pmol/L (3.5 to 6.5)

TSH: <0.01 mIU/L (0.3 to 5.5)

Vitamin D 89 nmol/L (Therapeutic target: > 80nmol/L)

Vitamin B12 661 pg/mL (180 to 1100)

Serum Ferritin 54.7 ug/L (20 to 300)

Serum Folate 8.1 ng/mL ( 3 to 13)

and then loads of others like WBC, RBC, HB, HCT, MCV, MCH etc etc

I also tested negative of EBV VCA Igm and IgG

He has advised to reduce T3 to 10mcg daily (taken twice @ 5mcg) and raise my T4 to 125mcg daily. Honestly I thought the T3 should go up to 30mcg daily with the increase in T4 (I have the DIO2 issue where I only convert some of the T4 not all) He said because of my weight loss my thyroid replacement requirements have improved and also suggest a stricter low carb/high fat diet to help with my sugar cravings.

Does the hair loss mean I should increase T4? Or that my weight loss would mean to reduce T3?

Thought I would ask the very knowledgeable people on the forum what their thoughts are?

Many Thanks :-)

12 Replies

Low ferritin causes hair loss.

Just looking at your result for ferritin, mid-range would be 160 ug/L. Yours is only a third of that.

Do you supplement iron?

KT304 in reply to humanbean

Ah okay yes I did, but recently not been so great on the extra supplements. Take b12 and d every day. I have some Solgar iron tablets 25mgs I think. Also not taken any zinc or selenium but will fill up my daily tablet pot now. Thanks Humanbean 😊

humanbean in reply to KT304

Ferritin is a measure of the iron stores in the body. If your iron gets low, then (usually) ferritin starts to drop. Although there are no guarantees, supplementing iron will usually increase ferritin.

KT304 in reply to humanbean

Brilliant thank you, have taken one already and my bad for stopping the iron. It got a bit much for a while with the amount of tablets to take....kids thought I was crazy sick! Back on the program and will test in 6 to 8 weeks. Xxx

I'd try what he says for a few days, you'll soon know if he's reduced T3 when he should have increased it. Maybe you misunderstood him ;) so if it doesn't work try the dose you want :) hair loss likely to be due to too low a dose I think

KT304 in reply to Aurealis

He wrote to me, and copied in the GP 😐

Will try it, but I have my own supply of t3 so can pretty much add whatever I like to it. I wanted my t3 in the top quarter, not the bottom! Thank you xx


Looks like he wants to raise your low FT4 which should raise FT3 too, even with the reduced T3 dose.

KT304 in reply to Clutter

Thanks Clutter...will give it a go. FT4 always been low...now that the t4/ t3 combo works for me I would be interested to know how much t4 I could cope with without the dreaded side effects.

Lovely thank you, much appreciated Clutter xxx


I have exactly the same dilemma .... LOW thyroid hormones with me feeling (just) well but plenty of room for expansion with the cumulative effect of good healthy living & wonderful T3 hormone which encourages everything to work so much better. Just give me TIME ..

.... BUT even taking into account the DIO2 impairment , endo now wants to REDUCE T3 and increase T4 ! ! ... when I say at least ANOTHER year on these doses to reverse some of the deep biochemical imbalances caused by years of incorrectly medicated or undiagnosed Hashimotos.

I think it the squeeze that National Health endos (who prescribe T3) find themselves under ! ! ... It's so ******* CRAP ..... :o(((( ..... I have another 3 months supply and then my National Health T3 supply is being withdrawn anyway ! ! ! ...

DON'T reduce as your symptoms show you are ONLY just holding out (like me). How will extra T4 convert when you have a genetic conversion impairment ? ? ..

However, you could probably save a bit of your (precious) T3 levels by restricting your running ... oooh the luxury ! ! ! ... No, I wouldn't dare ... Perhaps take up yoga (like me) and then the anger you feel towards your (stupid callous) endo would dissipate nicely ...........

Oh .. and ferritin a little low. Are you supplementing ? ? Thyroid hormone needs iron to supply thyroid peroxidase required for production & conversion of T4 to T3 (deiodinase activity).

KT304 in reply to radd

Hi Radd,

It did take a good few years to finally be medicated, I was pretty poorly for 3 years before the diagnosis so I knew it would take time to get back to fighting fit.

To be honest I'm feeling good (apart from my hair falling out but give it a couple of weeks) Since Jan this year gluten free, paleo diet, running 3 x week plus walking and cycling. My cognitive function is back to where it should be, I study so the brain fog must have gone! I'm not saying it was easy, but knowing the impairment and taking T3 have improved my well-being drastically.

My endo is to be fair aok. I used to see him privately but my GP wouldn't act on his medication instructions unless it was on NHS letter headed paper so they referred me to see him on the NHS. No bad thing, I don't have to pay £200plus to see him nor pay for a private prescription!

I think as well I'm quite lucky in that as soon as the GP had the NHS script they were on it, and I've just got back from the docs this morning and they are now sourcing 5mcg T3 even though I have a 3 month supply upstairs of the 20's :-) (The pharmacy is actually in the surgery) Have you been told why your T3 is being withdrawn?

Do I remind him of my impairment? I might drop him an email to kindly jog his memory ;-)

I have a blood test due in 6 weeks, and seeing the endo Feb 2017. So in the meantime after the next blood test if I don't feel right I will be playing with my meds and testing myself via BH. When I say playing, I won't be drastically altering the dose but making slight changes to get the T3 up into a decent percentage. What I do struggle with is I take my dose at night before bed, so if I need a blood test I don't take the meds til after, which means it's 36 hours since the last dose. On this forum it's advised 24 hours, so I'm wondering if that extra 12 hours is further reducing the T3 level when tested.

Just taken my T3/T4 dose and I have the warm feeling in my tummy...Doc said to not start new dosage till I have the 5mcg tablets. So I stick with my 20's til I get the call.....and will not stop running!

Best wishes Radd :-)

PS: Iron supps resumed :-)

radd in reply to KT304


When undiagnosed hypothyroidism and autoimmune conditions remain undiagnosed for so long I think all the key issues we address and rectify (as best we can) exert a cumulative effect.... so the longer we retain these key issues, the better we progressively feel.

I was undiagnosed for years ... in fact had lymph problems most of my teenage years, and know I have a way to go yet so will not be reducing my dose as it will take me under T3 range.

You sound in a much better place than I and a reduction may work for you with the extra T4 converting enough to replace the reduced T3. After all our impairments come in varying degrees and your healthy life style will help considerably.

Exercise encourages muscle growth which stimulates thyroid hormone secretion and improves tissue sensitivity to the hormone but remember your T3 level is not high to begin with and excess exercise will use progressively more as your body strives to keep up.

Eating extra protein (or protein powders such a whey//pea) will help T3 reach the muscles & cells where it increase protein synthesis and mitochondria (power factories).

I am sensitive to T3 but also have 5mcg T3 which has enabled me to dose three times a day, reducing the rapidity of onset and prolonging the duration of its action throughout the day. This has eliminated my brain fog but adrenal issues resurface along with tinnitus, etc if I overdo things. I used to cycle too but now only walk but am managing 2-3 hours which is great considering last year I could hardly get out of bed ! ! ... let alone know who I even was ! ! .... I also practice daily yoga.

I don't know about the implications of leaving meds off for 36 hours before testing. We recommend 12-24 hours on the forum although I have read that the TSH can raise decrease slightly after 12 hours ... the exact opposite of what we want . I have lost the data so stick with what I already know (for now.)

Hooray for T3 .. I wish you well too.

Please remember that any doctor is an ADVISOR only and cannot force you to do as rhey say! DO NOT under any circumstances go by blood tests alone as they are misleading to say the least. Demand a full physical examination if your doctor or endo insists on reducing your meds.

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