Thyroid UK
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Was doing well on T4/T3 Combo but symptoms have returned after 1 year on the same dose

Hi everyone, can anyone help me? A couple of years ago I spent quite some time experimenting with T4 & T3 combinations until I found the dose that worked best for me which was 75mcg levothyroxine & 18.75mcg T3 (in 2 doses). I didn't recover 100% but it was the nearest to it . I had come a very long way compared to the way I was & was happy that finally I could lead a normal life. On this dose my results were:

TSH - 0.11 (0.3-5.0)

FREE T3 - 2.65 (1.5-4)

FREE T4 - 0.93 (0.8-2.0)

After a year on this dose I started getting symptoms again. Although nowhere near as bad as I was, a lot of the symptoms, in particular the fatigue, has returned even though I have continued taking the meds on the same dose. I had my blood tested a couple of weeks ago. Results were as follows:

TSH - 0.90 (0.3-5.0)

FREE T3 - 1.83 (1.5-4)

FREE T4 - 1.00 (0.8-2.0)

I know the changes are only slight but they are enough to cause me symptoms that are beginning to affect my life again. I really don't want to go through what I went through a few years back. I've found an endo in Cyprus who is willing to prescribe T3 for me but that's just about it. I'm not sure if he knows much about it. I took him the results & he suggested I increase T3 to 25mcg (taken in 2 doses) & keep levothyroxine as it is. I've been on this dose for a couple of weeks but there's no difference.

Please note that my vit D is within range - 52 (30-100) (I take supplements) & my iron & ferritin levels are fine.

Does anyone know why my T3 levels dropped even though I was on the same dose & doing fine? Also should I increase or decrease my dose of levothyroxine &/or increase T3? I would be grateful for any advice. Thanks : )

7 Replies

Can you please edit your post and put in your ferritin and haemoglobin results plus vitamin B12 and folate if you have it. Many posters state their ferritin, haemoglobin, vitamin B12 or folate levels are "fine" but they are not optimal for someone who has thyroid issues.

Your vitamin D level if it is in nmol/L is not actually high enough. If the measurement is in nmol/L you need a level of over 75 but preferably around 100. If you level is ng/ml then yes your level is adequate.


Hi bluebug, I'm not sure how to edit the original post but the reference values for Vit D are 30 -100. Ferritin was 102 (10,0 - 140.0) & iron 100 (40 - 145). I didn't test for B12 as I've had this tested a couple of times & results have always been between 470 & 520 (187 - 883). Thanks : )


Do you have hashimotos? I see a post listing high anti-bodies, have you had this repeated recently? It could be that you have lost a bit more thyroid tissue to this and now need a higher dose to replace this lost capacity. Do you take selenium? Have you tried a gluten free diet?

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Hi startagaingirl, yes I do have Hashimotos. I take selenium on & off. I'm taking so many supplements that I take a break from some of them & then re-introduce them. I also suffer from eczema around the eyes that I'm sure is indirectly related to hypothyroidism although doctors disagree. It's only been a week but I've cut out gluten to see if it helps. I have been gluten free in the past & found that I was less bloated (although other hypo symptoms continued) & that it helped with the eczema around my eyes (although it didn't cure it). So I'm gluten free on & off too. Thanks : )


I am also Hashis (though just been diagnosed) and have just started gluten and dairy free. In my case it first showed when I started eating a lot more dairy than normal due to a diet plan. Also my daughter has very bad eczema and dairy is one of her triggers - is it possible that could also maybe be one of your triggers? I have read that it can take up to 6 months to remove symptoms caused by gluten so it might be worth sticking it out. I am with you on the supplements - if you were to shake me at the moment I would rattle lol! But I am starting to feel a lot more energetic again so something is obviously working. In the meantime your numbers do seem to say say that you need more medication, but i am not an expert on the T3/T4 dosing methods to help with that. Good luck & hope you feel better soon.


Thanks for your reply, glad you're on the road to recovery...: )


Hi Eljii, you're right, when I was experimenting with doses a couple of years ago I found that I felt good when my FT3 was 70% within range. I always worry about increasing Levothyroxine as I felt so bad on this alone (before introducing T3) but I guess going from 75mcg to 100mcg won't be too bad & I can always go back to 75mcg if symptoms get worse. I'll wait & see what others suggest too. Thanks so much : )


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