Thyroid UK
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Thinking of adding T3 to my levo dose


i had my thyroid checked 6 weeks ago and here were my results:

TSH 3.5 (0.3-5.5) my endo is aiming for less than 2

FT4 16 (10-22)

FT3 3.7 (3.1-6.8)

As a result of this i had my levi increased to 100mcg and I'm due to have a retest tomorrow morning, minus the FT3 as my GP is refusing to admit it's necessary to do again...grrr

I want to trial adding T3 to my T4 to try gain more energy, stop the hair loss & thinning and lose some weight eventually.

Anyone else had experience with this and how to start it off? thinking of following the STTM protocol.


8 Replies

purplejuicy If you want to add T3 then you need to have FT4 and FT3 tests done at the same blood draw. If you don't there's no way of knowing how well you are converting, how much T3 you need, if you need to reduce your levo, etc. You need to start low, go slow and gradual with T3. Taking T3 when you don't need it, or taking too much, will send your FT3 over range and may cause you to be ill.

At the moment you should be aiming for a TSH around 1 and FT4 in upper third of range (18+ in your range) with FT3 in upper quarter (5.9+ in your range) and you are far from it with those results 6 weeks ago. After your increase in Levo to 100mcg you need to see how things lie now. If your GP won't do an FT3 test then why not get one done with Blue Horizon?

How are your vitamins and minerals? Are they all optimal for thyroid hormone to work properly. Are you taking selenium to help with conversion? You have Hashimoto's, are you addressing that to help reduce the antibody attacks?

If you haven't had vitamins and minerals tested then their Thyroid Plus Eleven covers everything, if you do have your Vit and Min levels then their Intermediate Thyroid Profile will be enough.

If you have had vitamins and minerals tested then post the results, with reference ranges, so members can advise of any deficiencies and suggest supplements that can help.

PS - I've just noticed you mention hair loss. This can be due to low ferritin as well as hypothyroidism.

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Hi seaside susie, thanks for your response. I was hoping for a different answer but knew deep down I'd need to test FT3 at the same time. Damn doctors!!

Would a intermediate thyroid test by BH suffice? I'm struggling too much with money after spending so much on tests that I can't do much more for a while. (That tests TSH, FT4 & FT3)

I've just had magnesium & calcium tested along with the thyroid so will post those on Monday.

My ferritin was on the low side 2 months ago so I've been taking 10mcg of food state iron every day since. I also take a probiotic, 200mcg of selinium for Hashi's, gluten free (except for the last 8 days on holiday I've been indulging in dairy & gluten!) 15mcg of zinc, digestive enzymes, a b-complex (with the correct form of folate) , 2 g of vitamin c, ACV, and just started taking 400mg of ashwaghanda for my adrenals.

As soon as I can afford the BH test I'll get it done and post. Until then I guess I'll have to be patient!


Oh, purplejuicy , sorry to disappoint :( but you really do need to know if you need it and how much.

You might have read on other posts that vitamins and minerals need to be optimal for thyroid hormone to work, so that means b12, Vit D, ferritin and folate. Ferritin must be at least 70, half way through range is good. Thyroid hormone cannot work otherwise. So all these things must be in place before swapping meds. If you have recent test results for all these, and you have optimal levels, then the BH intermediate thyroid test would be enough. If you don't have those Vit and Min results then you won't have the full picture to work with.

Iron is usually in mg tablets rather than mcg, so if that's 10mg elemental iron you're taking it's quite a low dose if it's one a day. GPs usually prescribe Ferrous Fumarate 210mg, which contains 65-70mg elemental iron per tablet, and the usual dose is 2 tablets per day, so 130-140mg elemental iron. Ferritin takes a while to rise so it might be an idea to know your current level and adjust your dose accordingly. Eating liver and other iron rich food will also help.

Has your B12 been tested? I see you're taking a B Complex but no mention of B12.

As for your Hashi's, has eating some gluten made a difference? For most people being scrupulously gluten free makes a great deal of difference and even just one small slip has long reaching consequences.

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thanks for your reply...

my B12 was middle range so thats why I've been taking a b complex which has b12 in for the last couple of months. Vit D was actually above optimal 3 months ago so i stopped taking a supplement as i have got a lot of sunshine this summer luckily :) folate was optimal and ferritin was on the low side but like i said, I've been supplementing for 3 months now. It's low amount because it is in a food state supplement meaning it's much more bioavailable than most other forms so need less. i am feeling heaps better and tonnes more energy lately so things have definitely improved. i am a qualified nutritional therapist so research these things along with getting access too some of the best supplements on the market.

my magnesium has come back 0.93mmol (0.7-1.1) which I'm guessing is ok along with my calcium being 2.24mmol (2.15-2.6)

so my TSH has gone down to 0.77 (0.3-5.5) and T4 is 21 (10-22) and there is a note to talk to my GP about possibly reducing my levo as 0.77 is too low (my endo wants to aim for 2) I'm feeling better than i have done for years though so I'm dubious about this but i know this doesn't mean much without a T3 reading which i will do again in the next couple of weeks.

just want peoples opinion if they have been in this situation and where to go next. I'm all out of testing ideas really, my GP won't do any more and i am not willing to test anymore except T3 etc.


purplejuicy With those new results there's no real need to reduce your dose. Your TSH is in a perfect place ie 1 or below to put your FT4 in the upper third ie 18+ and you're feeling good. All that's missing is knowing if your FT3 is in the upper quarter. It's so maddening that GPs/endos don't get this. FT3 is the important one, the one that has to be kept in range so why aren't they testing yours before messing with your meds and how you feel.

Your TSH isn't too low, it's within range. How come when a patient is looking for a diagnosis and has a TSH over range, doctors don't always attach much importance to it and refuse a diagnosis and treatment. Yet, here we are, your TSH is still in range but it's not good enough for your doctor, you're feeling better than you have for a long while, yet that's not taken into account. Nothing is out of range so they don't need to lower your meds based on those results.

With your first tests mentioned in your original post, your FT3 was low in range with a mid-range FT4 and a too high TSH. Your conversion rate was 4.32 : 1. Good conversion takes place at 4:1 or lower so yours wasn't too far off.

The increase in meds has had a good effect, seems to be absorbed properly, has reduced your TSH and increased your FT4 which is exactly what should happen. The obvious step would be to see how much your FT3 rose along with the other changes. It could be that the extra T4 is converting to enough extra T3 to put your FT3 at tje upper end of it's range.

If your FT3 had been tested along with these latest tests, and had come back quite low in range (say low to mid-range), then that would indicate you're not converting that well and the ideal way to deal with that would have been to lower your levo a bit and add in a bit of T3. Then some tweaking could be done to get your T3 up. I don't understand why this is so hard for doctors to get into their heads.

Do you know, I'm quite mad on your behalf. You feel pretty good, your results are in range, but they want to mess about, lower your meds and make you feel unwell. Why? Because the endo likes the number 2. What's so magic about 2? Don't you just wish they could have hypothyroidism and someone insists they can't have enough meds to make them feel well, that they have to be kept ill with a myriad of symptoms and get told 'tough boobies, live with it!'

I'm rambling, sorry. Here's something that you can show to your GP and endo, maybe challenge them to go against the guidelines of one of the leading endos in the UK.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote this in a Pulse Online magazine article:

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

If you email she will let you have a copy of the article which you can print out and show your GP and endo because they seem to need educating.

And if all this fails, in your shoes I would just go along with them, take your prescription for Levo, say thank you very much, then buy your own T3 and tweak your meds yourself, keeping an eye on your test results by doing Blue Horizon tests. It sounds bit scary but there are plenty of members here who do it and can help you.

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Hi there, thanks for your reply and I totally get why you rambled! I'm in the very large group of sufferers that gets extremely frustrated with poor knowledge and treatment from their GP. It's like banging your head against a brick wall & I understand why so many self test & self medicate.

All that being said, things have turned upside down quite drastically for me as I feel really unwell now, have done since Tuesday but it's getting worse. 😞

I've had a constant headache since Tuesday, throbbing throat, air hunger, insomnia, muscle aches and sharp pains all over body - just generally feel unwell like I'm going backwards. It's my time of the month so initially thought that was the cause but this is much more.

I'm starting to wonder if I'm not converting all this T4 and its pooling into RT3 giving me these hypo symptoms? As soon as my money clears next Wednesday I'll be getting a BH test but I simply cannot afford the all singing all dancing one with RT3 inc. but I will see how well I've converted this higher dose of T4 and formulate a plan.

I'm in half a mind to drop down to 75mcg on alternate days...? What do you think? Will that interfere with my blood test next week?


purplejuicy I'm sorry you're feeling so unwell at the moment. Can you pinpoint anything that has changed since you started feeling unwell? Been in contact with anyone who is poorly? Maybe picked up a virus? Added a supplement?

I would say that you are converting T4 reasonably well - figures explained in my post above, good conversion takes place at 4:1 and your conversion rate on the set of results where FT3 was tested is 4.32 : 1. If you weren't converting well that would be something like 6:1 or 7:1 or higher. So on your higher dose of Levo you can see why you need the FT3 test to be done at the same time as the FT4 test to see whether conversion is the same or worse.

Personally I wouldn't reduce your dose at the moment. If you change it now you won't get a true picture with a Blue Horizon test in the next week or two. Any change of dose must be given 6 weeks to fully take effect otherwise the result will be skewed. I would stick with 100mcg Levo, do the test, the results will be back within 2 days, see what they're like and then decide what you want to do about the dose and whether you need some T3.

How long have you been on 100mcg Levo? Hopefully 6 weeks or more.


so i'm now on 50 mcg of T4 and 2 x split doses of 12.5mcg T3 and not feeling great - do i need to reduce my T4 now? as according to the conversion im now getting an equivalent of 125mcg of T4 which i was only on 100mcg before i started this experiment. i didnt really think about it tbh! today has been the first day of having 25mcg of T3 but i havent been sleeping well for a well and getting bad hypo symptoms at night like throbbing pulse in head and neck, headache, heart palps, racing thoughts...that could be my adrenals though.

again, im back to being confused as to what to do for the best now?


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