Starting T3(Tiromel) on top of existing levothy... - Thyroid UK

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Starting T3(Tiromel) on top of existing levothyroxin: suggested doses/daily timings


After recent Medichecks results and helpful discussion/advice on the forum, I am going down the route of adding T3 due to poor conversion rates of T4 to T3. I am on the very top of the T4 range blood test at a levothyroxin dose of 125mcg. I can get hold of Tiromel in 25 mag tablets, which I believe might be equivalent of 75-125 mcg of Levothyroxin. What do you suggest I take to phase in T3: eg 100 levothyroxin and a quarter (6. 25 mcg) of the Tiromel, or any other combination? If feeling ok ( not expecting good yet) would i swop more 2-3 weeks later eg 12.5 mcg Tiromel to 50 mcg Levothyroxin? I know some of you are on all T3, others need a bit of T4 medication to feel good.....

I take my present levothyroxin 3-4 am at night, away from other drugs, vitamins, food, etc. Does taking Tiromel have similar restrictions about taking it with/ without such things to aid absorption? So when would be the best time to take it, especially if to start it would only be 6.25 mcg? I could shift the taking of the levothyroxin and get into the habit of not having my morning coffee etc so early if it is easier to have them together. If I then add another 6.25 mcg would this be at the same time or staggered say 6 hours later?

I need to feel I will limit any damage of going too fast/far, so need some sound advice from the forum. Many thanks in advance.

10 Replies

I take my Levo at bedtime, and didn't want to change that, which is why I was keen to add T3 not try NDT

My endo reduced my Levo from 125mcg to 100mcg. And advised I start on 1/4 tablet waking and 1/4 tablet mid afternoon (that was Uni Pharma 25mcg)

But actually I did 1/8th tablet am and pm for first few days, (even that was noticeable) then increased to 1/4 tablet. Retesting after 6-8 weeks.

I take T3 on waking about 6am and most supplements after breakfast (about 9.30ish)

Thanks for that SlowDragon - even more cautious, but understandable, than I thought. Out of curiosity how easy is it to cut these various T3 tablets? I have a pill cutter and tried chopping my 100 levothyroxin pill up and I just got lumps and bits - it was easier to bite bits off , not very accurate but with long half life it didn't matter so much if a 100 was consumed unequally over 4 days.

SlowDragonAdministrator in reply to Judithdalston

I use a craft scalpel. Very sharp.

Like this - replaceable surgical knife blades in a handle. Available in most art shops

Some brands cut better than others

I now take 3 x 1/4 daily 20mcg NHS Liothyronine. Slightly trickier to cut than Uni Pharma

Tricky to get equal 1/4's, but it's usually a rough 1/4 each. I try to even it out per day (3 pills does 4 days)

I haven’t tried Tyromel but I’ve found that other T3 tablets cut best if at room temperature, not straight from the fridge. Staggering dose at least six hours apart would be my suggestion. I understand that absorption of T3 is unaffected by food and drink. Not sure about other medication though, don’t think I’d risk that, or vitamins and minerals.

shawsAdministrator in reply to Aurealis

Why stagger doses? This doctor was an expert on T3 and he himself took 150mcg T3 in the middle of the night. All his patients took one daily dose of NDT or T3.


Dr. Lowe: As a rule, our patients take thyroid hormone only once per day. An advantage of this one-per-day schedule is that it’s easier to find a window for good intestinal absorption—when the stomach or small intestine doesn’t contain food.

Most of our patients wait at least one hour after taking thyroid hormone before they eat. Or they wait at least two hours after eating before they take thyroid hormone. The two hour wait is a rough estimate of the time it takes for food to pass through the stomach and small intestine. It’s worth noting, however, that several factors can increase the time a patient should wait before taking thyroid hormone.

One factor is being female. Researchers report that on average, the woman’s stomach empties more slowly than the man’s. In a 1998 study, for example, researchers tested how long it took for half of a solid meal to empty from the stomachs of healthy women and men. The average time for women was 86 minutes and for men was 52 minutes.[1] This result is consistent with those of other studies; it suggests that women may benefit by waiting a while longer than men after eating to take thyroid hormone.

Another factor is the slower movement of food and stool through the gastro-intestinal (GI) tract of many patients who have hypothyroidism or thyroid hormone resistance. Doctors often diagnose the sluggish GI function as "constipation-type irritable bowel syndrome."[2,pp.681-687] Until the patient finds a thyroid hormone dose that relieves her constipation, it may be prudent for her to allow more than two hours—maybe three—for food to clear from her stomach and small intestine before taking the hormone. etc etc etc.

Aurealis in reply to shaws

I am very sensitive to thyroid hormone so get a spike if I take a lot of T3 in one dose, followed by a later slump. Spreading it out removes this problem.

Just realised you now take the T3 3 times a day, when twice it was 6.30am and mid afternoon. So where does the third quarter pill go?

SlowDragonAdministrator in reply to Judithdalston

I take at bedtime, improves my sleep. A lot find similar that T3 is good for sleep. But a few find it keeps them awake

Originally I was advised to take on waking, noon and 6pm when dose was increased. But I found, through trial and error, waking, mid afternoon and bedtime suits me best

Don't increase dose beyond 2 x 1/4 tablet without testing after 6-8 weeks on constant dose.

Get your Vit D, B12, folate and ferritin tested. They help you thyroid to work better but they must be optimal, not just in range. They also help with conversion problems, solved mine though takes time, and can help with some symptoms as well. Well worth a try as you may not need so much T3 or even any at all.

Yes, they were tested by Medichecks this week, see earlier post: fine tuning is needed! Also doing. The acid stomach test.

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