Adding back some levo; how much Levo to T3?

Good morning.

After five years of thyroid turmoil and debility, I'm now stable and energetic on 50 mcg Tiromel, taken in one go on waking. I would like to add some levothyroxine back into the dose. Shaws and Clutter explained the ideal proportions of Levo to T3 last year to me, but I'm afraid I've lost that information. Please could someone post them again?

Many thanks,


12 Replies

  • I'm replying to two magic words you used joeyis7: "stable and energetic". I want to be like that again. What made you change to Tiromel? Why do you want to add Levo? I'm 3 years on levo and I'm constantly unstable and fatigued. I'd like to learn from your transformation.

  • Hello Adam and Radd.

    I want to try adding in T4 again because T3 has raised my cortisol very high. ( I have my cortisol tested every six weeks with Genova labs. ) T3 has caused my fingernails to split and crack and the high cortisol has caused food cravings and weight gain. I take Seriphos for it but maybe if I'm on less T3 I won't have to.

    I didn't have these symptoms before I changed to T3 only; I've been on T3 only ( I mean T3 as my sole medication) for about a year.

    There is no need for most people to be on just T3 for life. It's a strong medication. I needed to do it for a time because Levothyroxine had stopped working after a period of stress and calorie restriction. Also my Reverse T3 was 35/35. I had candida, low vitamin D, very low cortisol and was in a wheelchair for a couple of years on levothyroxine ...long story. I've addressed all these things, as if my health were my full time job. T3 has been a miracle worker for me but I always intended to be on It for a limited time only.

    I will try the T4/T3 mix in proportions as Radd suggests and my other option after that is NDT. Again, I've always had NDT at the back of my mind.

    Thanks for replies!


  • Joeyis

    If you feel well, why are you changing your meds ? ? ..

    T3 is generally thought of as 3x the strength of T4. Therefore if you reduced your T3 to 25mcg, you could introduce 75mcg T4.

    The biological half-life of T4 is approximately seven days and T3 about twenty-four hours so you may be low on thyroid hormone to begin with but it is thought the T3 may help with T4 conversion so you would end up with a little more T3 than you are actually medicating..

    T3 & T4 may be taken together.

    If you post recent blood test results complete with ranges (numbers in brackets) members will comment.

  • Thank you, Radd, I hope you don't mind my mixing your reply with Adam10, above.


  • Joeyis,

    Re your answers to other members - TFT's are only representative of what is within the blood stream and could be misleading when considering actual cellular activity. You would be better assessing thyroid hormone levels by combining blood results with how you are feeling. Some members find taking pulse and temps to be useful tools to see progress .... especially when medicating T3 as it works so quickly.

    I initially medicated T4 mono therapy , eventually adding T3 and then switched to NDT which I feel well on. However NDT appears to only work for some who have addressed any iron//nutrient deficiencies and managed to lower cortisol and thyroid antibodies.

    Hopefully adding T4 will lower your cortisol levels.

    Good luck.

  • Thank you, Radd.


  • What is your reason for adding some T4 into your T3. Are you feeling unwell. I take about the same amount of T3 as you and am fit and well. When on T3 we usually need a lesser amount of hormones, i.e. than T4. I wouldn't even take levo if I were on my death bed.

  • Thank you, Shaws.

    Because my nails are splitting, my facial skin seems to have thinned, my cortisol is through the roof and my heartbeat is strong even after a weak decaf coffee, I suspect T3 might be unsuitable as my sole medicine. T4 never hurt me ( at least Actavis brand didn't; I was allergic to Mercury Pharma) it just didn't work because I stopped converting.

    Aren't a lot of people on a T4/T3 mix?

    The other things I could do are:

    Lower T3 dose slightly

    Go onto NDT, which everyone who takes it seems to love.

    I had a urine T4 T3 test four months ago which showed too high T3 so I halved it to 50 mcg. I'd better get another test, it's no good guessing.

    Thanks so much for the replies!


  • If you were o.k. on T4 before then just add some into your reduced T3. I believe the recommendation is a 3:1 (T4/T3) combination.

  • This is an excerpt about testingl:

    Dr. Lowe: I've never used T3 and T4 urine levels in my clinical practice. To understand thyroid hormone physiology better, however, I’ve studied the published literature on urinary thyroid hormone levels. Because of this, some of my comments about the test are academic. At the same time, though, my criticism of doctors basing their treatment decisions on T3 and T4 levels is not academic; the criticism is based on substantial scientific evidence and extensive clinical experience, and it’s highly pertinent to the practical concerns of patients such as yourself—patients who remain ill despite thyroid hormone therapy based on hormone levels.

    Despite the bravado of many lab test-obsessed endocrinologists, all tests that measure levels of T3, T4, and TSH suffer serious technical shortcomings. For example, a host of environmental, physiological, and disease factors can alter the levels. The level-altering effects of such factors often make diagnostic and treatment decisions based on the levels dubious and debatable. When a doctor isn’t aware that such factors have influenced hormone levels, his treatment decisions for a patient may be wrong and harmful. This is certainly true of the TSH test, which most endocrinologists seem to view as infallible. Kraus, for example, found a lack of correlation between TSH levels week-to-week.[1] If TSH levels naturally vary week-to-week, a doctor’s decisions about a patient’s treatment may also vary, depending on the particular weeks he chooses to measure the patients’ TSH level. His decisions may be based on natural, rhythmical fluctuations in the patient’s TSH levels, and not, as he falsely believes, on a reliable measure of the functional status of the patient’s thyroid gland.

    Urinary T3 and T4 levels may also vary according to factors other than the effectiveness of the patient’s thyroid gland in producing thyroid hormone. I’ll mention a few factors cited in the research literature. You can find abstracts of these studies by going to at PubMed and typing in key words from the references I've placed below.

  • Another link and you'll see nail problems are also a clinical symptom.

  • Wow, Shaws, thank you very much for all this information! I will read it carefully!


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