T4 plus T3

After being on T4 (75 mcg currently) for 2 years and never feeling well, I have been to see a consultant recently who has agreed to me taking a small amount of T3 also for a 3 month trial. She wants to reduce the T4 to 25mcg and add 10mcg of T3. She explained that T3, because it is a more powerful thyroid hormone and short acting, can cause a sudden rise then fall in active thyroid hormone level within the blood. She said the rise may cause anxiety, palpitations and flushing and the fall can cause profound fatigue before the next dose. I haven't yet started this combination so wanted to find out if anyone has experienced these reactions.

17 Replies

  • My recent blood test result from my doctor came back with a high TSH reading 6.93 (0.3-5) indicating I needed an increase but I told the doctor I didn't want to increase the T4 as it seemed to make me feel worse previously so we discussed trying T3. She said it would need to be under the guidance of a consultant. When the consultant confirmed the dosages she wants me to take, I'm now wondering if she also didn't notice on my notes that I needed an increase from the 75mcg! She said something about wanting to give the T3 some space to work. It was only the TSH level that was tested recently. Previously in June - B12 was 341 (200-960), Ferritin 62 (22-350), Folate 7.5 (3.0-18), Vit D 63 and weakly positive thyroid peroxidase antibodies.

  • Give the T3 some space to work? Do they have special Christmas crackers for endos, where they get these nonsensical phrases instead of jokes? What on earth does it mean?

    Seems to me she's set you up for failure by lowering your T4 too much, so that when you feel worse, she can say, there you are, the T3 doesn't work!

  • Absolutely that is what she has done.... Love the idea of the christmas crackers!


  • :D

  • Due to taking T3 only myself, I don't believe her explanation. It may be what she has been told and I've just read a bit from the BTA guidelines (taken from the American Thyroid Association) today in a similar vein.

    Believe me T3 calmed my whole system down. I haven't had a palpitation since I stopped levothyroxine and haven't even gone to the doctors for any other ailment.

    T3 is, of course, absorbed into our system extremely quickly and some might (not me) feel a 'little rise' but it fades quickly. By then the T3 is being absorbed into our T3 receptor cells which then send out 'waves' which last between one and three days. I know that to be true as I did miss a day's dose and I had no ill effects.

    The reason I don't think your combination of T4/T3 might not do what it is supposed to do is that she's reduced your dose of levo by 50mcg and replaced it with 10mcg of T3 = 30mcg of levo, so in fact you will be on a lower dose of the thyroid hormones altogether and the amount of 55mcg instead of 75mcg. - I doubt if that will be helpful unless you've just recently been diagnosed.

    She also quotes:-

    the rise may cause anxiety, palpitations and flushing and the fall can cause profound fatigue before the next dose.

    Well, I will tell you now I had all of these on levothyroxine except fatigue. I was in and out of the A&E,by ambulance sometimes, and it was hell. Husband frantic etc etc.

    These doctors aren't scientists they seem to make up these 'incidents' in order to frighten the patients. They also state levothyroxine is the 'perfect' hormone replacement and it would appear that the 44,000+ on this forum don't.

    The following link is by a Scientist/Researcher/Doctor who has published many books etc but has now died. He himself took 150mcg of T3 which enabled him to function as a perfectly well human being with a brilliant brain. Ask your Endocrinologist - 'what part of the body' finds the most benefit from T3 (bearing in mind levothyroxine has to convert to T3 as it is inactive and T3 active).


    Also keep in mind that particularly in the USA, I believe, that the Endocrinology Depts are assisted by the Pharmaceutical Companies who produce levo and the blood tests - they also (I believe) pay for the Conferences and, again, in the USA medical personnel get paid to prescribe levo alone. Scare stories have been told about NDT the original thyroid hormoneused safely since 1892 and liked by many patients, even till today many have a healthy lifestyle.

    We are all different and many of us need options, options which relieve our clinical symptoms which few, if any, modern endocrinologists appear to know as they diagnose upon the TSH alone (so I believe).

  • Thank you so much for such a detailed reply - it is really interesting! Also re-assuring that you find T3 works well for you without any major issues. I think I may raise the question about the dosage before I start taking it as I don't want to risk feeling worse if the dosage isn't enough!

  • She may be annoyed her medical decision is being queried and she is following the procedure that she's been told. The problem is if it backfires on the patient who is/has been struggling for a long time before being diagnosed and then being surprised they aren't improving as imagined.

    We have to read and learn and ask questions and sometimes it does take a while to reach a dose/thyroid hormones which suits us. Options should be available but I believe Endocrinology worldwide follows the same path. Of course there is holistic doctors who might be better at treating the person rather than the blood test.

  • Yeah that is a bit of a drop in levo. The endocrinologist did the same to me and I let them as I was so happy at getting the T3 trial. It took 6 months for them to get my dose working, so a three month trial is not enough. Due to the drop in T4 - mine went from 100mcg to 50 mcg, I ended up severely underactive, possibly the worst I've been even before I managed to get medicated for hashis. However at the same time, I started noticing good effects from the T3, such as being able to read a book all the way through, less mental confusion and mental fatigue. I felt like my brain woke up again. I was seeing my own GP every 6 weeks and they were doing full tests and then upping my dose of T4 while keeping the T3 the same at 20mcg over two doses each day. I could have told them that I would have needed to be on 100mcg of levothyroxine as when I first started taking the T3 I felt amazing for a few weeks as I still had T4 in my system.

    Forward to now and I feel pretty good, I've got energy, I can go hillwalking all day and I can even do exercise again. I've started a Masters degree too :-) Therefore it was worth it, though I wish my doctor/endo had told me how ill I was going to get before I got better! I haven't got my exact blood test results but TSH is suppressed at 0.03, free T3 is in the upper half of the range and T4 is above the middle of the reference range (need to go and get my results from the doctor). Hope this helps you.

  • It's a bit of a delicate situation as I don't want to get off to a bad start with the consultant if I query her decision but I also don't want to get off to a bad start on my trial of T3! Great to hear that you are feeling pretty good now! 😊

  • Good luck, it may be worth querying her and saying you're just a bit worried with dropping your levo by that much. I don't think that is getting off to a bad start but being concerned about your own health.

    Best :-) xx

  • If your thyroid was working and everything was good, you woukd be making 100mcg of t4 day, which would convert into 20 mcg of t3 and this would be added to the 8 or 9 mcg if t3 made by your thyroid.

    Assuming all your conversion systems work as they should, the daily ideal appears to be100 t4 and 10 of t3. ... Of course you dont know what your thyroid is making or how well you can convert, but your endo seems to be way off the mark.

    Ihavent dreamed these figures up..... But i cant remember where i found them.... Will have a look through my bookmarks and add a reference link when i find it....

    Xx g

  • Have you ever had results for FT3 and FT4? Without these, I can't see how they can make any sensible decisions about what you need to take.

    In my case, they wanted me to drop my T4 by 25mcg and then add 20mcg of T3. As they then refused to prescribe it, I was free to do it my own way, and as I already knew that my FT3 was below range, I just added the T3.

    After doing that for several months, I finally felt slightly over-medicated. It was as if I needed more for a while to top up my tank, but then my maintenance needs were less. So now, I take only 12.5mcg T3 but I still take the 125mcg T4 that I have taken for about 16 or 17 years.

    What I see now in my blood test results is mid-range FT4, and FT3 just under mid-range (which is OK because it will go higher when I take my next dose right after the blood test).

    The important thing is to hang onto the same level of T4 if you can (even if you choose to experiment with less). Once they've dropped the dose, it's sometimes hard or impossible to get them to put it back up.

  • I have recently been put on T3 and reduced my Armour medication, which is a natural desiccated thyroid that contains both T4 and T3 unlike Synthroid or Levo. But if you can not convert T4 which I was having problems with, T3 is a good way to relieve that problem. I have not had any palpitations but I divide my 30mg dose of T3 into 3 - 10 mg doses spread out over the day. You will know right away if you feel palpitations, it is not pleasant but easily remedied by taking less T3. I have not had any trouble with feeling profound fatigue but spreading the dose out may have prevented that. Good luck!

  • Also, you may want to be tested for Hashimoto's (test fro TPO antibodies) and have your T3 and RT3 tested. These are the active thyroid hormones in the blood and tell you much more about what is really going on. Synthroid and Leve only have T4 in them which is a storage hormone that your body has to conver to T3, T2 and calcitonin but if you have trouble converting due to stress, illness or Methylation issues it is worthless and it would be better for you to try a natural desiccated med like Armour, WP(not Westhroid) or another NDT. Most doctors are so brain washed by big Pharma that they will not prescribe them without a fight. But with perseverance you may convince your doctor. I was on Synthroid for over 30 years and was miserable! It is amazing how informed doctors are and how lightly they dismiss the other disorders that can arise from Under treated thyroid; heart disease, depression, fibromyalgia, memory loss, high cholesterol, joint pain, etc.

  • Thanks - I am beginning to wonder if perhaps my body is having difficulty converting due to work stress.

  • Stress presents it's own set of problems for hormonal balance. If your thyroid is under treated your adrenal glands will produce more adrenaline to help compensate and supply you with energy but it will burn out your adrenal gland and cause adrenal fatigue. Then it's a slippery slope trying to get them healed and recover. Good luck!

  • Thanks - that really makes a lot of sense! I'm going to have to avoid stress as much as possible!

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