Thyroid UK
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Very Low TSH but higher T4 + how to add in T3:

Hey friends...

Just a question... so last time I had posted I was on a reduced dose of T4 being at 150 of Synthroid. I saw a new PCP that said per my labs (0.03 TSH & Top of the range FT4) that she said traditionally she would reduce my T4. However, after being on a reduced amount, I was feeling all the more hypo. So, since she said I wasn't experiencing traditional hyper symptoms, she agreed to raise me up but I'm going at baby steps and agreed to do 163. Now, here's my question... I do feel that I have more energy since then and it has only been two weeks. My TSH has been mostly suppressed since my TT, minus when I had swapped back to synthetic from NDT and it was in the 2.0 for a few months, even when on T4 doses of 125 - 150 + 5 mcg of T3.

So, my question, I still can't sleep, no matter what my dosage or form of thyroid hormone is. My hair is still falling out like it is meant to be a sweater and that has instilled more than enough sadness in me. I do know Synthroid suppresses me more than any other brand (minus NDT but just by a bit) but I still wonder if I'm too hyper, if TSH does play a part or if it's not accurate for me, but I wonder if I just need a shove of T3 or what. However, I know many claim to reduce their T4 when doing so. If even on 150 with T3 from my experience, I felt the crash after T3 dosing and wonder if anyone here is on a higher amount of T4 with some T3? Anything less than 150 and I just feel so miserable, more than I do now, but I still have cold intolerance, still constipated, lethargic, dry mouth, and of course, my symptoms are always much, much worse around that monthly female time. My appetite has been a bit more ravenous since raising but I had none when reducing my dose but waking up shivering.

Anyway, I digress. I'm trying to accrue explanations. I still think about NDT a lot but my coworkers remind me how often I made mention that I "didnt feel right" when on it and my low FT4 made me feel physically weak. Now I'm wondering if I'm some freak that needs some insane amount as the only time I felt well was

a) on Cytomel only right afte my TT (possibly due to still having natural hormones in my body)

b) when switching to NDT from T4 for the first week (also possibly due to the high mix of T4 with the surge of high T3 in the system)

I just want to feel like me again, or to feel like seeing my friends, or being a 30-something and laugh and not be exhausted, sleep deprived, and to smile. That's all. I feel so devoid of emotion now and trying to get opinions on what people find normal or in this situation sans thyroid. I just don't know about this TSH lab or maybe it's been right all along, eeeks.

Thank you all!

11 Replies

Well, you don't give your actual results, but it sounds to me as if you're not converting very well, and you need your FT4 to be very high, to get enough T3 to feel well. But, it's difficult to give any advice without seeing the actual numbers. So, if you could post your results, with the ranges, I'm sure people will help. :)


thank you as always for responding, goose! i'm due for labs in the next week so i should have some proper ones asap...


OK, :)


endos are the worst, i swear! however, i found the T3 ratio in NDT is what ultimately was causing me a lot of issues as well... wish i could juatraise that t4 in there and lower that t3 a bit or otherwise i would have stayed on it.


It is common for conventional doctors to overdose patients on T4. How does your T4 dose of 150mcg or 163mcg compare to the T4-only full-replacement dose of 1.5-1.7mcg/kg body weight?

I can't recommend anything without seeing your FT3 and FT4 labs, which I gather you don't have. TSH is really irrelevant, but I guess your doc doesn't know that. Were I in your position, and unable to get a full TSH/FT3/FT4/rT3/TPOAb/TGAb panel, I would reduce my T4 dose, based on weight, to within the full-replacement range, then add in T3 (2.5mcg every few days) in the hope of eventually feeling better. The problem some of us have with NDT is that pigs have a higher percentage of T3 than humans. T3:T4 of 1:4 is for pigs; a human in good health is on the order of 1:13. I am currently at 1:9, and expect I will end up at 1:12 when FT3 and FT4 are both in their sweet spots. I've run into a number of patients who use NDT, then add in T4.

All this is dependent on other things. You said nothing about your nutritionals, or whether you have actually been diagnosed with Hashimoto's.


Hey there! Yeah, on T4 only I feel like virtual death if under 150 mcg... horrible chills, aches, fatigue... i still feel like that now but still exhausted... if it is by KG, then i'm roughly around 119 mcg but i can't imagine doing that solo... I feel like i'm one of the freaks that needs a mid-mid huh FT4 and a FT3 around 3.0... The only time i tested positive for Hashi's was when I was on NDT and that was part of the reason I stopped... and adding T4 was hell...

I should be getting labs this upcoming week so i'll gladly post the results once I accrue those... you all are so helpful!! Thank you!


If your future labs include FT3 and FT4, then I will be interested! It sounds like NDT isn't your cup of tea, so the next best thing to try is synthetic T3+T4.


@eddie also, how did you figure out your ratio? just curious!


I had been on T3+T4=15+75 (1:5) up until recently. That dosage resulted in my FT4 low in range. Had not had testing in a long time, and my biochemistry had changed (for the better) in the meantime. So when I finally tested, I had FT3=6.06 pg/ml (range 2.77-5.27), i.e. TOO HIGH! So I am now on T3+T4=10+88 (1:9) and definitely feeling better than I was, when FT3 was too high. So depending on testing after another 5 weeks, when FT4 has increased, I'm guessing that I may be able to do well on T3+T4=10+100 or even 7.5+100.


so interesting. i have a friend that was on 150 and then on 137 of T4. she was lowered to 88 + 10 and feels great. sleeps well. i can't imagine going that low but i'm curious if maybe that's like a magic combo number because it would make sense and a lot of people feel good on that.

i think i'm getting labs today so if so, i'll post info accordingly. i haven't taken meds since yesterday morning just to be safe, yay!


Ok, so my *doctor* is of no help. She didn't send in a lab order for FT3, which she always does, but my TSH:

TSH: .09 (ranges .35 -5.0)

FT4: 1.3 (.80 - 1.8)

Ironically, my TSH hasn't really budged at all going from 175-150 and slightly back up. I've spent SOOO much time wondering if my TSH was ever the problem or not but as noted, it's only gone up when on Levoxyl and when having swapped back to synthetic. Like I've said, no matter what I do, if I go under 150 then I start to feel uber hyper symptoms.

I also waited 24 hours since my last dose for these. Last labs were four weeks ago and with a seven hour time frame and my FT4 was at top of the range, TSH was .03. GO FIGURE.

I've increased my dosage just 13 mcg since then but still can't sleep nor can i shake this fatigue. I feel slightly more energetic than being on the 150 but only slight. I also have this weird side effect where about 8 hours following my dose that I get sever nasal congestion along with feeling sleepy and my heart starts to race a bit. But only hours later. Like my body is coming out of a fog of sort. So, not sure what to say. Not sure if I should cut my dose down drastically or maybe I'm a freak that needs a lot more. Considering I was uber active, I'm not much now and I've been uber cranky. and Tired. I'm considering armour but I, too, had this nasal like thing after the burnout and didn't feel as steady but desperate.

Hope this helps and more so, hope someone can help. xo.


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