Switching from T3 only to T4+T3 Combo advice - Thyroid UK

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Switching from T3 only to T4+T3 Combo advice

Hi all,

I made a few posts here months ago 8 in fact about my dreadful situation in how Iam feeling along with my thyroid levels and such. healthunlocked.com/thyroidu...

I have recently seen a new endo and he is suggesting I go onto a T4 + T3 combo I currently take 35 mcg T3 and still not feeling any good really but when I was on 40mcg i feel over replaced with heart palpation sweating and so on.

My latest bloods while taking 35mcg for about a month showing:

Free T4 <3.0L pmol/L (12.0-22.0)

Free T3 15.5 H pmol/L (3.1-6.8)

TSH 0.09 L mU/L (0.27-4.20)

(T3 might be this high due to taking it few hours before test i didnt know i was getting one)

The combination he wants to try with me is Levothyoxine T4 100 mcg and T3 10mcg

So I guess my question is do you have any thoughts on this advice and so on because I used to be perfectly fine on T3 only (40 mcg one day 60mcg the next) for years until one of my DRS swapped me to a T4 only and that was when things went bad for me so put me back on the T3 but its still not been right.

(I dont have a thyroid due to Cancer)

Im also waiting for various scans to be done.


17 Replies

Do you have labs from when you were on T4 only? If they've done the right tests, that would tell us how well you convert. It's important to know that, to know how well you would do on the new regime.

Personally, I think it's a bit drastic to go from T3 only, to 100 mcg T4 and only 10 mcg T3, and I can't see the necessity. Myself, I've been on 75 mcg T3 only for years, and recently decided to try adding in some T4, just to see how I felt. But, I only added in 25 mcg levo. And, so far, it seems to be a good combination. I might try going up by 25 mcg levo at some time in the future, but no way would I lower my T3 so drastically. Some doctors just love to play around with our doses, just for the sake of it, to justify their existence, I believe!


greygoose when you say you added 25 mcg of levo are you saying per day to go with the T3 you already take?





How did this work out for you?

I'm currently on 75 mcg of T3 and when I tried adding Levo ( 12.5 mcg ) to that dose, I ended up in A&E because my normally low blood pressure went through the roof and I went hyper.


It didn't have any effect whatsoever. I didn't feel any better and I didn't feel any worse.

But, although it could have affected your blood pressure, you cannot have 'gone hyper' because you are hypo - the thyroid cannot switch from one to the other like that. You may have been over-medicated, but that seems rather unlikely on such a small dose. Did you get copies of your blood test results at that point?


Hyper, as in hyper symptoms. It was last night, I'm waiting for the results. Most people are on a larger dose of T4 and a smaller dose of T3. So surely it would be better that way round. Just need to know the right way to do it.


The right way to do it is the way that suits you best. How long were you taking 12.5 mcg levo before these hyper symptoms started?

What other symptoms did you have? Because high blood pressure can also be due to under-medication.


I took 75 mcg of T3 along with 12.5 mcg of Levo last night at 10pm, by 12.30 my heart rate was 119, my BP 136/67. I was shaking all over. I seriously thought i was gonna die.


Well, it was unlikely to have been the T4 that caused it then. It wouldn't have had time to do anything in 2.5 hours. It would be at least a week before you felt anything. Unless it was the fillers in the tablet that affected you. Was it a brand you'd never taken before? Which brand was it?


I haven't taken it before, it's called ALMUS, a prescription levothyroxine that the doctor provided last year, which I never took till now because I decided to try T3 after being on NDT.


OK, I don't know that brand. But, it could have been the fillers. Although the reaction does seem to be a little fast.

So, how were you on NDT? Why did you decide to change for T3 only?


I wasn't doing well on NDT which was Metavive, no matter what the dose. I followed Paul Robinsons book about T3 and decided to give it a go. Ive been on T3 only for 9 months, I'm ready to go back on combo now, which would help a lot with the expense of buying T3 from Greece.


I didn't know you still could buy from Greece.

But, before trying a combo, it might be a good idea to try T4 only to find out how well you convert. You can't know that when taking NDT or T3 only.

Did you try any other brand of NDT? They're all different in the way they affect you, and whilst Metavive might not suit you, it's possible that a different brand would.

1 like

Alumus is the same as Northstar and one other that I don’t recall the name of. I use Almus. I think it’s regularly dispensed by Boots. I’ve not had a problem with it.

But I can tell I’ve taken it. Within half an hour. I have always felt my T4 in that time. I feel calmer and more able to do things. It could be that I’ve never been optimally dosed and that’s why. I don’t know.


Update. I tried a really tiny bit of T4 on its own this morning and it gave me a terrible panic attack feeling of a racing heart and sweating, with in a very short period of taking it. I'm going to go back to NDT, to combine with T3 and see how that goes.

thank you greygoose for your advice on NDT and taking the time to answer my questions. I guess pharma T4 just doesn't agree with me.


Or, maybe, T4 just doesn't agree with you. Because you said you weren't doing well on NDT.

So, how are you going to dose on NDT - which one, anyway? - plus T3? Knowing how to dose is essential. But, for that, you need FT4 and FT3 tested.

Oh, and by the way, I only saw this by chance. If you don't reply to someone by clicking on the blue 'Reply' button under their comment, they won't be notified. Or, you could tag them. @ followed by their name brings up a menu of names, and you click on the name you're replying to - PaulaV66


I think I'd request a new blood test before you change your regime. Especially as the previous ones are skewed through taking T3 before your unexpected blood test.

I think you are aware that all blood tests have to be at the earliest and allow a gap of 24 hours between last dose and test and take afterwards. Also don't take food before test but afterwards. I think it would be worthwhile getting a new test.


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