Should I add T3 medication : Hi, Would someone... - Thyroid UK

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Should I add T3 medication



Would someone mind giving me their opinion based on my latest results;

TSH: 0.92 (0.35-5)

T3: 3.9 (3.5-6.5)

T4: 15.4 (9-24)

I find I’m totally & utterly drained after Yoga/Pilates etc & have read that T3 could help. I’m not great before the classes but forcing myself to go (with help from my husband & the gym who call me to encourage me when I’ve not been for a bit) in the hope that exercise will help my energy levels, sleep, sex drive, motivation, mood, weight loss etc etc...

Many thanks

27 Replies


Please could I ask what dose you are on and whether you’ve had your adrenals/ vitamins checked yet?

Kind regards

Kateefc in reply to Howard39


Vit D supplemented due to defifficiency diagnosed few years back

B12 deficiency diagnosed last year, loading doses given & only 1 top up since so just ordered everything to self inject.

Folate & Ferritin not done for a while but were good when done last.

Thank you

Assuming you are on Levo then the aim is to get both the FT3 and the FT4 in the top third or even the top quarter of their respective ranges. Your FT4 isn't even half way so you need an increase in meds. Because your levels are so low then your gym sessions could be using up your T3 as well. So get more medication, check that your Vit D, B12, folate and ferritin are optimal as they help your thyroid to function better, helps with conversion issues and can also help with some symptoms you may have and when those are addressed see if you have conversion issues that then may indicated adding T3 but address the basics first.

Kateefc in reply to silverfox7

5 week wait for next docs appointment & as those results were my last in Feb I think I’m going to increase by half a 25mcg or should I do the tests first (see other post) thengo to doctors to ask for increases?


T'here is no thyroid history in your Profile except your name. Can you update it as it does help members to respond if they need a little background about member i.e. when diagnosed, with what, dose of hormones, or on levo/T3/NDT.


To know if your conversion is good, when TSH is around 1 or below then you divide FT4 by FT3, and good conversion takes place when the ratio is 4:1 or 3:1. Your ratio is 3.9:1 so that looks fine.

However, as Silverfox has pointed out, your FT4 and FT3 are too low in their ranges. The aim of a hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges.

You should follow her advice, an increase in Levo to bring the free Ts higher up the range, and check vitamins and minerals and if your levels aren't optimal then you need to supplement to get them there. For us hypos they need to be

Vit D - 100-150nmol

B12 - top of range

Folate - at least half way through range

Ferritin - at least 70, preferably half way through range

Hi Kateefc,

I agree with the advice everyone has given you so far. I think you need an increase in the T4 but do not add T3 until the T4 levels are higher and your bloods are rechecked. Do not increase your medication until you have spoken to your GP and or got new blood tests done.

If you are achy after exercise, it might be that you are lacking Vitamin D, may have anaemia and B12 deficiency which runs hand in hand with thyroid conditions sometimes but not all. So as already advised get your folate and ferritin levels checked as well.

Not everyone needs T3 medication but it depends on the T4 levels and how they are. My current levels indicate that I am under medicated so will be having further blood tests shortly to confirm.

Let us know how you get on.

Take care :)

Kateefc in reply to JOLLYDOLLY

It’s just completed drained of any energy opposed to aching & I just flop on the sofa & is a struggle to move for anything.

I certainly will update when I get the results.

JOLLYDOLLY in reply to Kateefc

It sounds like you are under medicated on the T4 definitely. I have been on medication all my life, but when I was in my 30's my then GP (who was useless), decided that my medication was too high, so she dropped my prescription from 200 mcg which I had been on for at least 20 years to 75 mcg! I could have understood 175 mcg but no "she knew best" - well you can imagine the end result! I was a walking zombie :(

After much a do, I was finally referred by my Gynaecologist to see her colleague who was a thyroid specialist as my results showed my thyroid was completely out of kilter. It was only then that I was not only put back onto my original dose but T3 was added eventually. So much damage had been done and I am still trying to reverse some of it now.

What I am trying to say is, if I had been left alone initially, on my 200 mcg of T4, I might not have needed T3 added and trying to keep on it because of the cut backs. Everyone is different, but I do feel that your T4 needs to be increased by at least 25 mcg but do not self increase until you have medical advise.

It is very depressing when you ache and constantly tired, no one understands until they experience it. The way I describe it is like a toy that has one of those winding keys in the back and gradually gets slower and slower.

Take care :) x

Kateefc in reply to JOLLYDOLLY

😳The brain does baffle with some of these things GP’s do!

JOLLYDOLLY in reply to Kateefc

It certainly does, as most of the time I do not agree with them. At the end of the day they can have all the training and expertise, but unless you have the condition or similar, no one understands what it is like for us. If I had a penny for every time I have seen some one raise their eyebrows or roll their eyes at me, I would be rich by now.

So sad though, as there was a time when you believed every word the GP said but not now. :(

Thank you everyone, your knowledge is appreciated.

I have added some info to my profile.

I am going to use medicheck or blue horizons for tests as my doctor battles with me on what tests they’ll do plus 5 week wait for next appointment (also looking to change docs lol)

T3 might help, but your free T4 is low in range too (not even mid-range), so you probably don't have enough to convert well.


Sorry to jump on OPs post but my levels are similar with the same ranges (Graves Disease and on 5mg Carbimazole) - do these look normal?

TSH: 1.17 (0.35-5)

T3: 4.7 (3.5-6.5)

T4: 14 (9-24)

I'd be wary of increasing T3 when you clearly have problems with Vitamin D and B. Yes, it might help at one level, but doesn't cure anything. So you need them tested along with ferritin and folate. They all need to be optimal for the thyroid to work properly.

Your conversion doesn't look too bad to me, when I was on Levo T4 was at the top of the range and FT3 below the bottom. And that is another reason to hold off on the T3.

My guess is that your underlying problem is with B12, and that alone is enough to wipe you out. And my personal belief is that forcing yourself to exercise is not helpful- unless it makes you feel better when you do it.

Kateefc in reply to Ruthi

Thank you. Yes I’m aiming to get all the basics to optimal levels it has just taken me a long time to research everything & as I have so many rubbish days nothing gets done to progress what I need to, to then get a truer picture of what I need across all the issues.

All my B12 stuff should be here by the end of next week for me to start that then make sure I’m well stocked on Vit D too. I’ll request my GP increases my thyroxin in the meantime then in 6 weeks after everything I’ll do the private thyroid & vitamin test & lead on from those results.

I eat really well mainly (one wrong meal could put 5ib on me & it won’t even be that bad a dish) so I WANT to exercise to help my weight too but I also have a life long knee issue (refused surgery as a teenager but am now ready for it as it’s preventing me doing high impact exercises) but I want to get my other issues all fixed first so I can have a normal daily life - I want my get up & go life back where I hardly ever sat on my bottom & that in turn will help with my weight so I can then go for the knee surgery. I’m not massively overweight just 1stone 10ibs but it’s been impossible to lose.

Gillybean1 in reply to Kateefc

Hi Kateefc,

The putting on 5lb if its the wrong meal resonated with me and Knee problems. Thyroid disease and good gut function go hand in hand. If the guts out of synch slightly we can have absorption problems that give rise to joint problems.

1 tablespoon of Apple cider vinegar (with equivalent of honey if you hate the taste) before a meal helps stimulate H Acid in the stomach bag essential for switching on digestive enzymes, to maximise absorption and therefore energy that follows.Again thyroid disease and low stomach acid HCL are common.

Digestive enzymes also may help, follow directions on pot.

Ask your GP next time for Coeliac screen blood test, to rule out Gluten problems, its not 100% conclusive test in the UK as yet, but it can be useful. You may only get the test agreed if you experience bloating after eating grains. Some people test negative to Coeliac but are 'sensitive' to gluten.

Probiotics increase gut flora, switch on digestive enzymes, help with gut motility. From a health shop, not the sweetened yoghurts in supermarkets.

If we get our guts right we absorb our meds, supps and food better = more energy.

Every best wish, G.

Kateefc in reply to Gillybean1

Thank you Gillybean ,

my knee problems were from birth & diagnosed aged 15 a good 18 years before I became hypothyroid.

I have had that test in the past but it was negative.

I bloat atrociously (look 6 moths pregnant lol) after bread, rice & potatoes & it hurts but I also bloat the same if I’m sat in the car or a waiting room or an aeroplane etc for more than 20 minutes - very odd!

I do have aching small joints (knuckles, wrists, elbows, ankles) & was initially told that was Vit D deficiency then told it was B12 deficiency & it did go when I had my loading doses of B12 & then again when I was having acupuncture (that worked for everything but twice a week for 6 months I couldn’t do financially so had about 9 weeks & amcurrenrly saving again for the full 6 months)

I keep meaning to start good probiotics again as I used them in my twenties.. added to shopping list!

You take care & thank you so much for your advise

jgelliss in reply to Ruthi

Ruthi ,

You make so MUCH SENSE ! I totally agree with you . Most times it's nutrient deficiencies and not thyroid meds . Like Ruthi says correctly Nutrients make our thyroids meds work better for us .

jpar in reply to Ruthi

I agree with Ruthi. I think its extremely important to get your B12, iron and folate levels up before too many thyroid changes. I also have hashimoto's and pernicious anemia and have to supplement with all of these. From what I understand is that b12, iron/ferritin and folate, which make up your red blood cells and oxygenate the body needs to be optimal for thyroid meds to work correctly in the body. Another group on this site called Pernicious Anemia/b12 has a lot of information about this topic that may help.

Just joined and find comments very useful. Does anyone take Magnesium tabs? I find it helps reduce muscle aches.

Just a note from the nit picker out here. It is very important to get measurements and calculate your T4/T3 ratio to establish that your problems are or are not due to conversion before you change your meds. Please note that the units in which your levels are measured are crucial for this calculation.

If you are looking at FreeT4/FreeT3 your FreeT4 should be in ng/dL and your FreeT3 should be in pg/nL to render that 4:1 or 3:1 "ratio". I put ratio in quotes because usually a ratio has to be in the same units. It is a convention that the FreeT4/FreeT3 ratio is quoted in the units in which they are usually measured.

And while we are on this topic, if your doc does total T3 and total T4 (instead of Free) the units should be ng/dL for the TT3 and mcg/dL for the TT4. The ratio is TT3/TT4 - the other way up from FT4/F/T3 - and the answer should lie between 15 and 20 for good conversion.

Kateefc in reply to LAHs

Mine just says T3 & T4?

LAHs in reply to Kateefc

They are probably FreeT3 and FreeT4. Post the units just for curiosity, I would be interested. Also is this a UK measurement or a US? We sometimes do things in different units.

Kateefc in reply to LAHs

UK & I’ll get the measurements on Monday as got a telephone appointment with the dr.

Forgot to ask for measurements as was driving when Dr called.

He initially said my results were normal so I said ‘but my T3 & T4 are not optimum levels according to Thyroid UK - they need to be towards the higher end of the range’ so he said ‘ok so increase your levothyroxine by 25mcg a day, I’ll do you a prescription today for 100mcg a day & book another blood test for in 4 weeks’.

So that was not the battle I was expecting & maybe I should try see this Dr instead of the others until my surgery move is finalised!

I shall update again after next bloods.


Just had my 6 weeks after increase of 25mcg a day & results as follows;

TSH - 0.03 (0.35-5)

FT3 - 4.8 (3.5-6.5)

FT4 - 20.5 (9-24)

On top of the increase in Levothyroxine to 100mcg from 75mcg I’ve also been self injecting B12, taking folate & my ailments have all gone (though my memory hasn’t returned) . I get tired if I do too much over a few days & am exhausted after a short excersise session but on the whole I’m pretty much back to myself.

Doctors want me in to see them and appointment is 2.5 weeks away.

Shall I go ahead and get the private tests for thyroid & vitamins? What do people think of the latest blood results?

Many thanks from a scared kate who thinks her doctors going to reduce her thyroxine & I’ll be fully rubbish again!

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