Log in
Thyroid UK
93,507 members107,571 posts

Hashi Flares and T4/T3 Combo


I am currently on 62.5 T4 and quarter of a 5mg T3 pill which equals 6.25 of T3, I was previously on 75mg lactose free T4 Only and have been on T4/T3 combo since November time as requested by my Endo who I next see in Feb.

I am still feeling tired on this dose above, the quarter T3 I have found easier to tolerate than half the T3 Pill as I am very sensitive to drugs and don't do well on large doses. However my Endo prescribed me to take 50mg T4 along with the full 5mg T3 Pill which I found I couldn't tolerate. Recent labs from last Friday 26th Jan are as follows (didn't manage to get free T3 tested on the NHS as they usually don't do it):

T4 16 Range (9-21)

T3 1.5 Range (0.9-2.4)

TSH 1.3 Range (0.2-4.3)

I usually feel better on a lower TSH than this, feel better below 1 so for me this TSH reading is high and could be contributing to my Hashi Flares/Readings and current lethargic state in particular in the evenings.

What should I do regarding doses? if I take any more T3 than the quarter of the 5mg pill, I feel Hyper and wired and can't sleep as take T3 in afternoon, if I take T3 in morning I feel it is too strong and I don't tolerate this well. If I put my T4 higher, this also makes me feel ill and wired as I also tried adding another quarter of T4 to the above ratio and felt ill and wired again.

Any suggestions?

Many thanks, I know this sounds complicated!

6 Replies

I'm assuming you mean 1/4 of a 25mcg tablet, as 5 mg would be 5000mcg and 1/4 of it would 1250 mcg (not 6.25mcg) - a stunningly high dose - if it really is 5mg, I'm not surprised you can't tolerate it. You need a free T3 test done as that is really the most meaningful one when on T3. You could increase t3 by another 1/4 tablet as TSH is still well over 1. Not having vitamins in optimal range can make you unable to tolerate T3 well. naturally, your body would make most T3 in the very early am, so if you wake in the night take your t3 then or take it last thing at night - that should help your adrenals too. Then take a second dose at around lunch time. Wired and tired in adrenals usually - trying to compensate for low thyroid. If you stick with it, the increased dose should gradually help - but you still need ferritin at least 70, B12 over 500, folate half way up range and D3 in at least the 90s.

1 like


thanks for your reply, yes I meant 1/4 of a 25mg T3 tablet. If I take the T3 at night though wouldn't I be awake all night as it is an instant hit?

I need to look at getting my vitamins tested I know I also have low Iron and Vitamin D and probably same for B12. It sounds like my adrenals are sluggish too. Going on what I mentioned in the last message do you not think I'd feel worse on more T3 in the afternoon? The increase in T4 didn't work it made me feel worse also. It is tricky to balance!


No, it's not an instant hit - takes a few hours. I find it makes me sleep better, but I take it at about 2 am. Sometimes you have to stick with the nasty symptoms for a while until the T3 helps your adrenals cope. Have you looked at Paul Robinson's Recovering with T3 book or website?

1 like

Essential to have good vitamin levels, for T3, NDT or T4

You need to get these sorted ASAP and if you have Hashimoto's gluten is often underlying issue

T3 makes me sleepy. But it's not the same for everyone

1 like

T3 makes me feel wired if I have too much of it definitely, I always know if I have taken too much.

I am a gluten free and dairy free diet so I am doing all I can for the hashi side already this is why its odd I am feeling so ill...and the drugs do affect me if I take too much of one or the other ....

1 like

Are you on gluten free diet as you have Hashimoto's?

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's gut connection is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ask GP for coeliac blood test first

Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance









You're only on a tiny dose of Levo and T3, would suspect low vitamins

What supplements do you take?

1 like

You may also like...