Log in
Thyroid UK
91,706 members106,008 posts

Reverse t3 . Depression . Liothyronine what to do ? Psychoneuroendocrineology

My question is..... i have no thyroid due to cancer and if I am given 60mcg of liothyronine (a treatment for my treatment resistant depression ) on top of 150mlg of thyroxine designed to give me normal thyroid function and I get a lot of reverse t3 on a similiar (175mlg dose of levothyroxine ) will that stop the antidepressant properties of the liothyronine dose because of reverse t3 build up? To put it another way.... is the antidepressant properties of t3 by raising t3? And there for it won't work because of reverse t3 because of the levothyroxine dose? If so can I just reduce the t4 so reverse t3 isn't made or do I need to go purely on t3 to clear the reverse t3? Say to take the 60mcg liothyronine for depression and 50mcg liothyronine for normal thyroid function? Or if I take levothyroxine at a reduced rate (say 100mcg ) will my body metabolise that preferentially and not make any reverse t3 when having it with large doses of t3? Please? This is the crux of my problem if you understand it and of you follow me you'll realise this is why I need am psychoneuroendocrineologist..... any one know of one, please message me! This question has been burning in me for a long time but the brain fog had got to me!

Thanks to everyone who reads this and replies! After this. I think I am run out of questions. This site is the best in the world! Thankyou all, Michael.

17 Replies

after thyroid cancer i suspect just t3 is the whole answer for you

or maybe NDT plus t3 my husband and daughter were on 120mcg t3 without overactive symptoms but they suffered horrendous joint pains just the same as on levo

yet both are fine on NDT


That's really interesting to know reallyfedup123 I've been doing great on T3 only but changed to a more physical job in Oct. I've found that joint and muscle pain takes forever to ease and just a short drive home from work causes me to cease up to the point that I have to hobble from car to house.

Maybe it is the t4 in it but do you have any thoughts on why the ndt is better than the T3 only.

1 like

NDT is the very original replacement, since 1892 (before that we died) and in the 60's Big Pharma introduced its 'new replacement' i.e. levothyroxine (T4 only to convert to T3).

NDT is made from pigs' thyroid glands and contains T4, T3, T2 and T1 (latter ones in very small amounts). Many find it beneficial as it contains all hormones it is 'natural' from an animal but obviously it is processed so it is palatable for us to take. Levothyroxine is synthetic and thousands do well on it but I'm one who doesn't.


Thanks shaws I don't want to hijack this post so will post my own question later about changing from T3 only to ndt


I agree with reallyedup123, I did just great on the T3 only they gave me for 2-3 months after a total thyroidectomy. I was lucky to get a good brand after that but after 5 years they discontinued that brand. I never did find another brand of Levo that suited me so I changed to NDT (Armour).

If you have a high rT3 you are probably overmedicated. My dose on Levo was 137mcg and my present dose on NDT is 1 1/4 grains.

I think I would try T3 only for a while until your rT3 has dropped. The key is to alter your dose and keep taking blood tests until you get it right. That's a bit expensive at first but after you have got it sorted out you only need a blood test every year.


T3 only seems like a better option, then there'll be nothing to convert to rT3.

1 like

Last year I had the same op for the same reason as you. I was on Levo for 5 months and feet really bad pain and was getting worse each month so I put myself onto NDT and now I feel OK. When I was on 3 grains per day my FT3 was over the limit. I reduced to 2.5 grains per day and that is working. I am feel more like my old self again. It's a huge shock to the body and it takes time to sort out. Good Luck


I have read about RT3 on the following link and I think you will be reassured. Go to the date March 24, 1999 on the following link.



There is a book called Recovering with T3 that explains why for some people they need to be on T3 only with no T4

Look on amazon


Paul Robinson also has a website rwt3.com

He is also a member of this forum so you could send him a PM zebady .....

1 like

Hi Mikepassword, Are you being prescribed this dose by a psychiatrist? Did they have anything to say about this issue? Also I'm curious as this seems a very high dose. I also have no thyroid, and have been offered 60mcg as a complete replacement. Whatever you do is taper up slowly.

I'm not sure anyone has really addressed your question. I don't know much about psychiatric use of T3, but I'd share your concern about it stimulating rT3.

The obvious suggestion is to switch your usual thyroid treatment over to T3. You don't say whether you otherwise feel fine on this current dose? But I suspect that this depression is about undermedication or imperfect medication. Although a lot of people are said to do well on Levothyroxine, actually as a population they do poorly on measures of well-being and depression.

So if you switch over to T3 you may find that the symptoms reduce anyway, without needing the extra 60mcg boost. And you'll still have the option to add that in on top. Downside is that this would take several weeks or even months to switch. Do you have the support of this psychiatrist, or will they be expecting you to come in and show progress very shortly?


Thankyou. And yes it is from the psychiatrist but they don't know about my reverse t3 problem at 175 levothyroxine.


If your psychiatrist is any good, I would discuss this issue with them. They must realise Levothyroxine is very similar to the T3 they are prescribing. If they don't, I'd take that as an indication they don't understand what they're doing, and proceed with great caution.

1 like


While getting your thyroid hormone dosage right is extremely important, it's critical to look elsewhere in solving treatment resistant depression.

One of the best books on finding solutions for depression is "New Optimum Nutrition for the Mind" by Patrick Holford. It is easy to read, is well organised, and has good diagrams. Understanding what's in it is the key to beating depression.

Key areas that may be contributing to your depression for you to investigate are:

- diet - low carb, high healthy fat, nutrient dense Paleo Diet

- gut health - intestinal malabsorption, food intolerances/allergies (especially gluten and milk) candida, parasites

- methylation nutrient deficiencies - B12, folate, magnesium, B2, B6, B3

- fatty acid deficiencies - fish oil, evening primrose oil, flax seeds, coconut oil

- zinc/copper imbalance

- need for amino acids like tyrosine, tryptophan, methionine, cysteine, glycine, etc.

The above can make a profound difference in how you feel, even with serious psychiatric issues.

Don't go off any prescription abruptly, but work the issues above, and then it's possible to get off psychiatric meds, all if which can compromise long term health.

Hope you find some good answers soon.


Thankyou. Diet seems key in a lot of things. And thankyou for taking the care abs effort to reply. Xx


You are quite welcome!



Your dose of medication is very high and its the most likely cause of your high RT3. I agree with SilverAvocado that taking T3-only for few months in order to clear RT3 from your system might be the best idea. People from the recoveringwithT3 facebook group may be able to support you: recoveringwitht3.com/ go to "contact us" and "RWT3 on facebook".

Once you feel a bit better you could then decide whether you stay on T3-only or whether you want to try T3/T4 combo (most likely at lower dose).

I don't think there is anything special about the use of T3 in psychiatric care. All of us here would be in the depths of depression and anxiety if we stopped our thyroid meds. Nutrients, vitamins etc are also very important but you need to get your thyroid medication sorted first.

Do you have a good endocrinologist in your area who would be competent in the use of T3-only or T3/T4 combination? I'm sure your psychiatrist would be happy to refer you to somebody who has more experience in the use of thyroid meds and is T3-friendly (many endos aren't).

Take care x


You may also like...