Just wondering if anyone can give me a little bit of guidance regarding adding a bit of T3 to my T4-only medication. I have Hashimoto's, and am finding that T4-only medication just doesn't have me feeling well. I still have muscles aches, terrible insomnia, feel cold when other people aren't and my skin & hair feel & look like crap! I'm currently on Oroxine (Australian T4-only). My latest labs are:
TSH: <0.05 (0.20 - 4.00)
Free T4: 21 (15-30)
Free T3: 5.1 (2.8 - 6.8)
My doctor is telling me I'm over-medicated, however after all these years of not doing so well on T4-only I really want to add a little T3 to see if it helps.
I have already sourced T3 over the internet (Tiromel) - doctors here in Australia don't prescribe T3 unless in extreme circumstances. If I add in, say 6.25mcg then 12.5mcg T3 after a couple of weeks, how much do you think should I reduce my T4 dose by (currently taking 125mcg)?
Would really appreciated any replies and/or guidance.
Thanks heaps in advance!
Tracie
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This is what I will be doing shortly. 1 mcg of T3=4 mcg of T4. So my formulation is that for every 1 mcg of T3 I take, I reduce my T4 by 4 mcg. You may need to round of because you might not be able to exactly get the right amount. I am not familiar with that T3 make. In Australia (I live in Melbourne) Tertroxin is the one I get from my doctor and is only available in 20 mcg dose. Compounding pharmacies can make more specific amounts.
Other people on this site may have other ideas, but that is what I will be doing.
hello Dril...I was looking for this formula for ages as I am going to GP Dec 5th with all my investigation. I can follow what you are doing, the part I cannot figure out is: how you get to the percentage. I believe I am low....here are my numbers:
saltcoats FT4 range (11.0 - 26.0) - the upper quarter of that range is 22.25+.
26 - 11 = 15.
15 x 0.75 = 11.25.
11.25 + 11 = 22.25
However, I've read that FT4 should be in the upper third of the range so that would be 21+
FT3 range (3.1 = 6.8) - the upper quarter of that range is 5.875+
6.8 - 3.1 = 3.7.
3.7 x 0.75 = 2.775.
2.775 + 3.1 = 5.875
With your FT4 at 14.9 and your FT3 at 4.0 then you are very low for both.
Formula for working out your percentage through range is:
(z-x) divided by (y-x) x 100
z = result
x = bottom of range
y = top of range
So your FT4 is
(14.9-11) divided by (26-11) which is
3.9 divided by 15 = 0.26 x 100 = 26%
Your FT3 is
(4-3.1) divided by (6.8-3.1) which is
0.9 divided by 3.7 = 0.24 x 100 = 24%
Both of these calculations are the same as when you put them into the Polish calculator in this thread healthunlocked.com/thyroidu...
Also, as explained in your previous post, your FT4:FT3 ratio is 3.75:1 and that is pretty good as it needs to be less than 4:1 for good conversion. FT4 divided by FT3 = 14.9 divided by 4 = 3.75
thanks seaside sue. I have an apt with GP on dec 5th and just wanted to get as much info (or ammunition) as possible. I just wanted to spell out how I got to the percentage. I did use the Polish calculator but just wanted the finer details......thanks for the info.....more to put into my folder to see him....thanks again
Hopefully, as an educated man (he ought to be as he's a doctor!), he will get the maths! Whether he will agree that's where your free Ts ought to be and let you have an increase in dose is another matter! He may just be one of those who say 'You're in range so you're normal and you can't be still having symptoms', hopefully not.
Good luck with your appointment, make a new thread to let us know how it goes
will do....I have been to this doc before, they don't seem to be all that interested in thyroid...he sent me to the expert....got nowhere with him. He increased .25 and that was it....I am more educated now and have lots of info to bring to my appointment, so lets hope. Or I will just start crying in his office....lol maybe then he will do something....lol
ha ha yes seaside Susie that is my plan.....funny thing in all this thyroid issues, that is one thing I'm not is depressed....very up beat....but I will not leave his office until he either gives me something or up's my meds.....
Well I got an appointment today with my GP. I blinded him with my numbers and he totally agreed with me...I am too low. so he is increasing Thyroxine .25.....(we do a bit at a time) . I quizzed my Vitamin D etc he says that they are not big on testing these other vitamins. So my pitch was...for everything to work well I need these tested....I have an app next thurs to get my vitamins & minerals tested. He also said that studies indicated that your TSH should be O to non existent I am at 2.08 but he said if the T4 goes up the TSH will come down, they work opposite. Back in 8 weeks to get T4 tested again to see if it improved. So all in all good meeting.....and I thanked him.
When you go for your Vit and Min tests, double check that you're getting
Vit D
B12
Folate
Ferritin
and maybe, if it's not there, just ask "Oh, no full iron panel, I thought that was being tested"
We need to give your GP his due, he actually knows that TSH should be very low and that a low TSH should produce a higher FT4 (and FT3), that is how it should be - TSH 1 or below and FT4 and FT3 in the upper part of their respective reference ranges if that is where you feel well.
Don't forget, next thyroid test make the earliest appointment of the day, fast overnight (water only) and leave off Levo for 24 hours.
When you get your new results (Vits and Mins) then post them for comments and suggestions if you're showing any deficiencies. Include the reference ranges, and it would be better to start your own thread as your posts aren't going to be seen here hidden in someone else's thread. Also when you get your next thyroid test results.
thanks, I feel like I won the lottery....will open a new post when I get the vit and min test results...but off of holiday next week so will post the results of vit and min in two weeks.....
Posted this new post......just in case it gets lost........This site helped me realize, and helped me to analyse my bloods results for underactive thyroid. I was under medicated, and my doctor agreed with me, so thank you to those who helped me. I am in the process of increasing my thyroxine. Today I received my Vitamin and Minerals results and I would like to know if I am low with these as well.
Here is what they say:
Vitamin B12 537.0 (211-900)
Ferritin 70.1 (12-300)
Serum Folate 4.5 (2.4-20.0)
If there is anything else you need to know please let me know as I had quite a lot of blood work done....thanks so much
I have done some calculations for you below but I just want to say that what I did for Tracie above was NOT about calculating a percentage for her T4 and T3. What I did was to quantify the top range for each of her T4 and T3 reference range and then to compare her results in relation to the top 25% of that range.
Now I had to use a slightly different formula and that may have something to do with different reference ranges in Australia.
T4: Start by subtracting the reference range of the T4 i.e. 26.0-11.0=15.
Multiply 15 x 0.50 (not the 0.75 I used with Tracie)=7.5. Then add the 7.5 to the 15 figure from the reference range=22.5. 22.5 is the beginning of the top of the range and your result of 14.9 is below that. So to be effective (as I understand it) your T4 result needs to be 22.5 or above.
T3: With your T3, subtract reference range 6.8-3.1=3.7. Multiply this by 0.50=1.8.
Add 1.8+3.7=5.5. 5.5 is the beginning of the top range of your T3, so you can see your T3 level of 4.0 is below this number and therefore low.
This is how I do my own numbers, so I hope that this helpful.
thanks Drill , it's a complicated business.....we all struggle with the same symptoms. Doctors need to listen to us.......perhaps I should get a demonstration arranged with placard's......lol...lol
I was in my doctor's surgery only 2 days ago to get my latest numbers/bloods. He kept asking me if I was anxious because I questioned all my results which were within the normal range (for my doctor) but not for me. Anxious? Only cause he wasn't listening.
Actually your FT3 is not too bad at all - it is often suggested that the FT3 should fall in the upper quarter of the range - which would be 5.8 - 6.8. At 5.1 you are doing a lot better than most of us - including me
Of course it does depend on how you feel. How are your levels of Ferritin - Folate - B12 - VitD ? They need to be optimal and not bouncing along the bottom in order for you to feel really well. Have they been tested ?
I am not a medic - just a Hashi's girl with a B12 issue !
Hi everyone, thanks so much for your replies, I really appreciated you taking the time to respond! Thanks Loy, I will definitely take it very slowly, and reduce my T4 for every tiny T3 dose. I definitely think there is room for improvement for sure. Looking forward to seeing if the T3 makes a difference
And thanks Anna & Marz for the advice regarding other factors such as Ferritin, B12, selenium, etc. I already take Vit D and Selenium every morning, but will definitely get my levels check in all those things next time I get tested.
It's all an extremely long work in progress isn't it! I did go gluten-free 1.5 years ago, and that has seen my Hashis antibody level pretty much halve!
I am doing the same as you and have had one go already, previously, which didn't make me feel any better, however, I am having another go, over a longer period. if you calculate your dosage of t3 as being x3 more potent than t4, then you can reduce that calculation of your t4 and reduce the dosage of t4 accordingly. over time, increase dosage of t3 say over a period of 1.5 months. Give that a go. Right now, I have been doing it for a few weeks and I feel a bit out of sorts. I am going to persevere. Good luck and hope this has been useful.
Thanks FlippinThyroid (great name by the way!) - sounds like it's definitely a "go slowly" thing - as in very low dose & not increase too fast. Thanks for letting me know about your experience with it and for your advice - much appreciated. I just feel it may be the missing piece of the puzzle, however I guess time will tell. Just gotta be patient by the sounds of it and not get too carried away too quickly. Good luck with your T3 journey as well - keep me updated how you're going if you think of it
Anna_Huysse, Your comment is confusing. It's my understanding that Hashimoto's thyroiditis is considered to be both a thyroid disease and an autoimuune condition.
Also, you wrote Selenium is essential for the conversion of T4 to T3 and increases the inflammation. I expect you mean to write decreases the inflammation?
It is also helpful if you give a link or two that people can refer to when making assertions such as Selenium is essential for the conversion of T4 to T3. Members need to understand for example, how much selenium they can safely take. As with most things, overdosing on selenium is something to be cautious of.
I use a trace mineral supplement that provides selenium (as selenomethionine) at 200mcg. I believe that is a safe daily dose. I have read that selenium may be safe up to 800mcg per day, but I would rather go slow/low. en.wikipedia.org discusses selenomethionine. Also, look at their article on deiodinase (enzymes).
Thanks. I tend not to buy into the standard MD line about "your diet supplies all you need" because of trends in agriculture. However going from 200mcg to 100mcg daily might be appropriate, though I do not have any of the symptoms listed for selenosis. Is allopathic medicine able/willing to do selenium testing that is sufficiently accurate? Do you suggest any specific test, or is there a URL in your document where testing is discussed? I did not find "testing" in the doc.
I'm on day 6 of a reduced T4 dose and adding T3 as I have raised RT3 and wasn't feeling great again on T4 only (actually felt good for a few months on 100mcg but stupidly did strenuous exercise whilst tackle bg adrenal issues!)
I was advised on here that you cannot be certain about how much T4 = T3 as everyone is different and converts differently. I know that doesn't really help but it's about finding your own dose on how you feel.
I halved my usual dose of T4 to 50mcg & added 6.25mcg of T3 daily and to avoid pooling in T3 I was advised to only raise after 7-8 days instead of 3-5 but I must say I'm starting to feel rather crappy again with hypo symptoms like insomnia, headaches, palpitations, air hunger & slow digestion so I'm going to add another 6.25mcg of T3 today but around 6 hrs after my first dose do it's not in one hit. Also because T3 has a shorter life span that T4 so lots of patients find it useful to split the doses.
Going from my experience with talking to others, I'd drop your dose down to 75mcg T4 & add 6.25/6mcg (depending on your T3 tablet size) everyday and raise after 7 days, or when symptoms return like myself.
I'm no expert mind, this is just from others advice on here and on the FB groups. It's your choice at the end of the day.
It's wise to look at b12, folate, vit d & full iron panel to work on those ASAP too.
Thanks Purplejuicy for your words of advice - really appreciate it! Yes I do agree with you, everyone is different and it's a matter of seeing how you feel and going slowly but surely. Sure don't want to go hyper - sounds like that can be worse than being hypo. Just a tad frustrating - sometimes it feels like we're walking a tightrope!! Good luck with adding 6.25mcg to yours as well - fingers crossed for both of us.
I still can't find what your current dose of T4 is at the moment. I agree with Clutter, why are you reducing your T4. She was responding to Purple juicy but if you are under medicated now and reduce your T4 you may still be under medicated even when adding T3.
You seem to be converting T4 to FT3 but that can be a false reading.
From Stop the Thyroid Madness Now:
Dysfunctional adrenal output can result in high amounts of T3 from your thyroid medication to build in the blood (which we call pooling), making your free T3 labs look high in range with continuing hypo symptoms, or causing hyper-like symptoms from excess adrenaline on doses of desiccated thyroid or T3 which shouldn’t produce those symptoms. The latter can include anxiety or nervousness, light-headedness, shakiness, dizziness, racing heart, sudden weakness, nausea, feeling hot, or any symptom which seems like an over-reaction to desiccated thyroid, but are in reality the result of low cortisol, or a mix of high and low in the early stages of sluggish adrenal function. Low cortisol can also keep you hypothyroid with hypo symptoms.
Well I've had several other admins on STTM T3 groups advise me you can't be certain of T3 equivalent so this is all very confusing and conflicting. My results are obviously different to this ladies and I'm trying to clear RT3 as my T4 was on the high end but T3 was below optimal (according to stop the thyroid madness info) so the protocol is to lower the T4 and add T3 otherwise my body will still be converting the T4 into RT3. This is my understanding anyway. Maybe I should increase to 75mcg of T4 then.
Unless you have had rT3 tested you are assuming it is high. High FT4 with low FT3 does not guarantee rT3 is over range. If you do have high rT3 it is probably better to stop taking T4 for 4 months and take T3 only. Taking the lowest dose T3 you can cope on is the quickest way to clear high rT3 but it is likely to take 14-16 weeks. STTM only recently suggested that reducing T4 dose might help reduce rT3. It's a pity STTM don't warn people that they will feel hypo when dose is reduced to clear rT3.
Yes I posted my high RT3 results on here 13 days ago and another admin suggested reducing Levo but to only 75 not 50. I just followed the advice of that on STTM groups in the end as it was all conflicting but up to me to make a decision. Doubt I was ever going to feel great clearly RT3 anyway but now all this conflicting advice is a lot to take in. STTM definitely don't advise stopping T4 all together.
I'm going to add another 6.25mcg of T3 this afternoon as it's been 6 days of a reduced dose and like I say, feeling hypo. Hoping my body can handle the increase of T3 after 6 days now
I was on T3-only for over a year and found it effective. My dose worked out to about 0.82mcg/kg body weight, which I supplied as five 12.5mcg doses daily.
Hi clutter, I have located several charts from compounding pharmacies who speak about 1:4. It is confusing and I don't mean to be picky, but that article in your link above says approximately 1:3. I have to say this stuff drives me crazy at times because information can be so variable, and thats before I get to see a doctor.
I wouldn't get hung up about it, 1:3 or 1:4 isn't a significant difference ie 100mcg T4 is equivalent to 33.33mcg or 40mcg T3, whichever ratio you choose.
FT4 and FT3 are within range so I suspect your GP thinks suppressed TSH means you are over medicated which is rubbish, of course. I don't think it is necessary to reduce T4 dose if you are adding 6.25mcg T3. If you add more than 6.25mcg you should probably consider reducing dose by 25mcg otherwise you are likely to be over medicated with FT3 above range.
Hi Clutter, yes, the all-hallowed TSH - what is it with GP's and their love of it!! That sounds like a great plan - will start off with adding in 6.25mcg without lowering my T4 and see how it goes - can't wait to get started. Thanks so much for the advice, much appreciated
Anna, are you saying that you should take the selenium at the exact same time as the thyroid hormone replacement, the two pills together? That goes against everything we've ever believed - i.e. thyroid hormone should be taken on an empty stomach, one hour before eating or drinking anything other than water, and two hours before other supplements or medication. I would be very wary of taking the two together.
How about providing a few links to that assertion? I cannot see why they should be taken together. They are both going to be absorbed into the system, and the selenium should exert it's effects there. Conversion is not going to happen in the stomach, is it.
Awesome, thanks for the link to that article Stuart - have downloaded it and will read it property tomorrow when I have more time to do it justice - it looks very interesting. Yeah I will stay at my current T4 dose & just add 6.25mcg T3 for the moment - feel happy with that plan - thanks
Low selenium intake is associated with a higher prevalence of thyroid autoimmunity, but evidence that selenium supplementation may lower TPO antibodies and prevent subclinical hypothyroidism remains inconclusive.
Selenium deficiency impairs thyroid hormone metabolism by inhibiting the synthesis and activity of the iodothyronine deiodinases, which convert thyroxine (T4) to the more metabolically active 3,3′–5 triiodothyronine (T3). Hepatic type I iodothyronine deiodinase, identified in partially purified cell fractions using affinity labeling with [125I]N-bromoacetyl reverse triiodothyronine, is also labeled with75Se by in vivo treatment of rats with75Se−Na2SeO3. Thus, the type I iodothyronine 5′-deiodinase is a selenoenzyme. In rats, concurrent selenium and iodine deficiency produces greater increases in thyroid weight and plasma thyrotrophin than iodine deficiency alone. These results indicate that a concurrent selenium deficiency could be a major determinant of the severity of iodine deficiency.
Hidden , nobody doubts that selenium aids with conversion - most of us have known that for a long time.
What we are contesting is the idea that you can take it at the same time as your thyroid hormone, without compromising absorption of the hormone. That is the point in question.
My endo has allowed me to add T3 to my treatment on a trial basis. I was on 125 Levo and she has reduced that to 100 and added 10 T3. So far I feel much better! Managing to stay awake past 8pm again and sleeping through! Touch wood the improvements will continue! Xx
Your results look OK to me, and you don't seem to have a problem with converting t4 to T3. How are your D3, ferritin, folate and B12 levels? More Omega 3s might improve skin.
Having said that, even when my free T3 is the same, I feel better on T3 only than on NDT or anything with T4.
You tsh is suppressed, should get a rt3 test done too with this. I basically had to smuggle in decicatted thyroid into Canada and tell my doctor if he didn't get me a prescription I would keep taking these. He then did get me a prescription. Seems the t3 does help. It's funny, because .125 my t4 is when I had enough. Lab results showed good but I felt worse. No experience myself with synthetic t3, but I hear you need to start off really low. If you have high rt3 this will help.
Is your 125mcg T4 dose appropriate for your weight? I always suggest the Abbott estimate of 1.7mcg/kg body weight. You might want to first decide what your T4 full-replacement dose per Abbott is, in case you are too high.
When you decide to go on T3, you could use the "T3 Power Factor". The Power Factor (in the range 3-4) tells you roughly how many micrograms of T4 are equivalent to 1 microgram of T3. So if you add 2.5mcg T3, you should reduce T4 by 7.5-10 mcg. It would be best to reduce T4 say, a week before you add T3, since T4 has such a long half-life. However, if you don't reduce T4 and go hyper, stopping T3 should get you out of hyper quickly.
Medicine really is experimental, so you should try T3. However since your FT3 is 58% up in its range, you might not get a startling result. On the other hand, if you are T3-resistant, maybe you will.
HI Eddie, well I'm only 48kg - but if I was to dose by weight, I would go severely hypo!! Anyhow, about to start with just 6.25mcg T3, I'll never know unless I give it a go - fingers crossed. Thanks!
Hi tracie, the doctor is obviously only looking at your TSH to come up with that. Your FT4 is low so possibly you are under medicated. I think adding T3 is a good idea and since you have room for increase in the FT3 range. Your Tiromel is a 25 mcg. tablet and you are cutting them into quarters I assume. Need to know what amount of T4 you are taking.
Hi Heloise! Thanks for the advice - I'm currently on 125mcg T4 - just want to add a little T3 to the mix, give it a go anyway - I'll never know unless I try! So I'm going to add just 6.25mg T3 (Tiromel) - fingers crossed. Doctor is definitely just looking at TSH - as most of them do!!!
tracie, you could also consider NDT. (I've been on all of them) I think the benefit of natural is all the components: T1 T2 T3 T4 plus calcitonin. You would get 9 mcgs. of T3 in each grain of NDT. But I guess the next best thing is the combo of T4 and T3 but I have misgivings about T4 for some people.
Thanks Heloise - I did try NDT but it didn't agree with me for some reason - my levels went all over the place! So adding a bit of T3 is my last avenue - I have a good feeling about it, fingers crossed! Started on 6.25mcg two days ago and it's going well so far - getting a few headaches, but I read that that can happen while your body adjusts to the T3 - thanks for the advice!
Oh, sorry tracie. I guess sometimes that does happen that synthetics work better. I do hope that this time it all comes together and I think it will. But if it doesn't, I also took straight T3 for two years and it was easy and fine as well.
That is why I take thyroid medication but feel like it's of no benefit at all. I continue to suffer with allergies 365 days of the year. If it's not hayfever in the spring, it is tree pollen in the autumn and then if I dare to walk through a cloud of cigarette smoke outside a restaurant or pub then I am sneezing and blowing my nose. If I spray perfume on my or spray under my arms I am sneezing and blowing my nose again. In the morning, after a couple of glasses of wine I am suffering with sever rhinitis in the morning. I bend over to brush my teeth and the nasal drip is embarrassing. It runs out of my nose like a waterfall. I have been to allergy clinics. Never did they tell me that my autoimmune disease was probably the cause of my suffering. Tablets are impossible to take because I get upset stomach and IBS or diverticulosis symptoms because I seem to be allergic to the fillers in the tablets and so a chronic high blood pressure problem has to be medicated by patches and hopefully, next week, my GP will hopefully, medicate my Hashimotos (autoimmune illness!!!!) with a liquid or other method that will not cause an allergic reaction. It's ridiculous to medicate an autoimmune problem with tablets that have fillers that you are likely to be, guess what, allergic too!!!!!!
Hi Tracie, you've already had 61 replies so i don't know if my experience will add anything, but.... I was prescribed T3 here at 2.5mcg twice daily and the GP was instructed to reduce my Levothyroxine/T4 to 50mcg from 75. To cut a long story short, the GP refused to do it and I was stuck for a long time until I sourced my own. I got Tiromel from Cyprus and the only dose available was 25mcg tablets. I went through quite an elaborate process of cutting and powdering pills and diluting the powder with water to get around a 3mcg dosage twice a day. I felt a lot better really very quickly. However that didn't last more than a few weeks. I increased my dosage to 6.25 twice a day and am still on that though I feel I could do with another increase: all my hypo symptoms returning. However, I am now getting a private blood test before proceeding because I know that a lot of factors can influence my symptoms, including stress etc and especially adrenal fatigue. I also agree that making sure you take plenty of selenium is important for anyone with this condition. With your test results, I can see the doctor's point about you maybe being overmedicated with T4. When i saw the endocrinologist, she advised that my T4 be reduced for two weeks before introducing T3. I think it's worth the experiment, as long as you are very cautious, make sure your selenium, B12, vit D and iron levels are good, and stay patient.
Thanks so much for your reply DandyThyro, and the story about your experience - great to hear that you're on Tiromel as well. I have read good things about it. I started 6.25mcg two days ago and so far so good, feeling a bit improved already - a few headaches, but I read this can be normal when your body is adjusting to the T3. I will be cautious about raising any further, I will drop my T4 slightly to compensate. It's a slow process hey, but one that's definitely worth it - I have an end goal in mind, and it's to FEEL GOOD!!!! Good luck if you decide to raise again, hope all goes well for you - thanks for the advice, great hearing another story
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Tracie
I’m going Carnivore with some added T3 need some advice please. 
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Adding T3 to perscribed Levothyroxine
Update since adding T3
Is it time to try adding T3
