Thyroid UK

If you were given the choice to be on T4, NDT or combo of T4 and T3 which would you choose first?

This is a hypothetical question. Please excuse me if there are more alternatives to those in the heading as I am new to hypothyroidism.

I haven't started my pitiful dose of 25 Levothyroxine yet. I've started on Ferrous Sulphate, vitamin C and B12 (introducing the recommended other ones in the next week or so) my vitamins and gone gluten free. I may extend this to dairy and soy in the next few weeks (get it all out of the way quickly).

Currently, I'm going through the stages of grief and stuck between sadness and denial. Have been making enquiries into wigs and laser eyebrow tattoos!! But whatever - come Thursday I want to have made a decision as to where I will start.

On Thursday I will see an Endocrinologist for the first time.

I am a very proactive person and like a lot of people on here will immediately take my health into my own hands if I am not supported by my GP/Endo. Right now - neither of them can support me as I am simply not armed with enough information to formulate a good enough argument to put to them.

I have a private GP that I have used in the past and I have spoken with him regarding NDT. He will prescribe but has made it clear that that is the extent he will do i.e. cannot advise on the administration.

If you were me and had all three choices what would you do based on these results?

TSH 13.31 (0.27-4.20)

T4 74.4 (64.5-142.0)

Free T4 11.48 (12-22)

Free T3 4.45 (3.1-6.8)

Anti-Thyroidperoxidase abs 140.0 (<34)

Anti-Thyroglobulin Abs 240.8 (<115)

Vitamin B12 397 nmol/L

Serum Folate 12.07 (10.4-42.4)

I have had ZERO symptoms for the past two weeks and before then they were intermittent.

P.S. I had another post a couple of days back with these same results.

Thank you

9 Replies

Start with Levo and give it a chance, it works for many people and is free.


I am scared to start anything for fear that loads of symptoms will kick in. Pregnancy has been the only time in my life that I have been consistently ill for any length of time. Looking back now the crazy weight gain of 4.5 stones barely eating was the hypothyroidism going into overdrive.



It's amazing you have no symptoms with TSH >13 and FT4 below range but unless you start taking replacement you will become symptomatic.

People are as likely to have adverse reactions to T3 and NDT as Levothyroxine so you might just as well bite the bullet and start taking 25mcg Levothyroxine.


I know I have to take the medication and sooner rather than later. I am shocked I don't have many (currently none) symptoms with my levels ... but they seem to have ramped up recently so left untreated - it's only a matter of time.

Seeing the consultant will make me start treatment and that's not far off.

Thanks for your help.



If you are <60 without heart disease your GP could certainly have prescribed a higher starting dose of 75-100mcg. Most people recover on Levothyroxine once they are optimally dosed but 15-20% remain symptomatic and require T4+T3 combination, T3 only or NDT.

I've been on T3 only, T4 only and T4+T3 combination. I prefer the combination.

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's) which causes 90% of hypothyroidism. 100% gluten-free diet may improve symptoms and reduce antibodies. Soy is very thyroid unfriendly so it is worth avoiding all forms of unfermented soy.

For maximum absorption Levothyroxine should be taken with water 1 hour before or 2 hours after food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose.

You should have a follow up thyroid test 6-8 weeks after starting Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

Most people will find symptoms resolve after their TSH drops to around 1.0 with FT4 in the upper range but symptoms can lag a couple of months behind good biochemistry.


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.


Interesting question Helena877 and I think you'll get varying answers :)

I have had Levo only, Armour Thyroid, T3 plus Armour, T3 only and generic NDT and what has worked for me is Levo/T3 combo.

My answer would be the same as bantam12. Start with Levo, if it works for you it is easy, no prescription charge and you get your blood tests done with your GP. It does work for many people but you don't see them on here, they have no need to come because they are well and getting on with their lives.

If that doesn't work and there's evidence of poor conversion my next step would be adding T3 and finding the right combination of Levo/T3. A synthetic combo gives more flexibility than the fixed amounts in NDT, you can keep your Levo prescription and T3 is easily sourced at a reasonable price - the only down side is whether to tell your GP and risk losing your Levo and NHS blood tests if he doesn't agree, but that would probably happen if you went onto NDT anyway.

NDT would be my last choice.

Purely my own opinion and there will be others who don't agree, but I think those that do answer will base it on personal experience.


I would start with Levo. If it works then life would be so much easier when dealing with the medical profession.


Reading some of your previous replies, you said eleven days ago that you were taking B12 already - so this low result for B12 is/was probably even lower than that

You also mentioned taking kelp. This is NOT a good idea with Hashimoto's. Especially once you start taking thyroid replacement.

When taking B12, we should also take a good quality vitamin B complex - one with folate in not cheaper folic acid. E.g. Jarrows or Thornes are most recommended on here. We need to keep the level of all the B's together. This will also improve your low folate too.

Vitamin D very important. Have you had level checked? Needs to be at good level (typically about 100) -.not just "in range"

Most people do find standard Levothyroxine works ok, especially if got nutrients at good levels and gluten free. Why not start with that......see how you get on. This is by far cheapest option, keeps you in standard NHS care and easiest to manage (assuming it worksOK)

Your GP has only prescribed tiny starting dose of 25mcg. Normally started on 50mcg, unless elderly or other issues going on.

With any dose, we take for 6 weeks before retesting. Increasing in 25mcg steps until TSH remains at around 1 (or slightly lower) and symptoms have disappeared.


I agree with all the others - start with levo and see how it goes. Ignore the horror stories, they only happen to a small minority of people. Besides, what if you started with NDT, and went through all the rest, only to find that the only thing that suited you was levo! lol Could happen because we're all different.

However, if you are still consuming any form of unfermented soy, you want to stop that right away! It will nullify any thyroid hormone replacement that you do decide to take because it stops the hormones getting into the cells.

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