Could someone maybe explain the reason why my T4 dropped from 16.9 (12-22) which is 53% of range on 100 Levo only to 12.6 (12-22) which is 6% with taking 12.5 mcg of T3?
Adding the T3 improved my T3 from 3.4 (3.10-6.8) to 5 but I don't understand why my T4 dropped to 12.6 while I am still taking the same dose of 100mcg Levo. I have read on the site that T3 can drop ones T4 if one is only using T3.
I'm not sure why this happens but my FT4 dropped dramatically to barely register a few months after starting T3 treatment added to 25mgs of Levothyroxine. It would appear to be a common pattern. I felt dreadful although some folk do well on T3 only treatment. Someone may be able to offer you a reason.
The blood test while you were on Levo only, measured the free T4 in your blood (that is, the T4 from the Levo you were taking plus the T4 made by your thyroid gland). Probably, following the introduction of T3 your thyroid made less or no T4, so the overall measured levels of T4 are lower at the time of the next test. This doesn’t matter as long as you feel well.
Thank u for ur reply.
Is there any point in me taking 100 mcg Levo when my level was so low?
Your Levo is still in range isn’t it? Although some people like T3 only, it isn’t for everyone. I for instance feel quite poorly on T3 only. I seem to need both T3 and T4 to feel anything like normal. Low in the range is fine for me for T4 as long as T3 is towards the top of the range. It’s very individual. I think you should be guided by how you feel, it’s the only reliable guide. Good luck
Yes, that makes a lot of sense.
Many of my initial symptoms have improved greatly but I’m still fatigued and wonder should I increase the T3 or the T4?
Thanks
That is the difficulty....
There’s trial and error, but it may make you feel poorly. Perhaps try another quarter of a tablet of T3?
Personally I found I need high levels of both FT4 and FT3.
As my energy and mobility improved with addition of T3, I found I needed to increase Levo back up.
It's very individual what we all need
Also NDT seems to give very different results and needs
Trying different thyroid doses and meds and seeing what works and feels best and eliminates your symptoms . Having a Dr that is very supportive and willing to work with you . A Dr that *GETS IT*. Will help you get there . I find keeping a journal of your symptoms with each change of thyroid hormone and doses will help you determine your Optimal . Monitor your blood pressure ,pulse , you have enough energy , mind works well , constipation , aches and pain , moods , sleep , weight , skin . Go Slow and Low with changes . Let your body acclimate to changes . It takes patience and perseverance .
Best Wishes On Your Next Steps .
Can I ask a dumb question? How are you calculating the percentage of the range?
Not a dumb question at all!
Take the points in the range e.g. 9-24 has 15 points- I was at 16.9 which is 7.9 from the lower end (9) so its 7.9 over 15 x 100 over 1 =53%
Hope that explains it for you
T4 is a storage hormone, which the body normally changes to the active form, T3, as and when needed.
Imagine if all you have to eat is a freezer full of ready meals (T4) and when you are hungry you take one out, (or two if you are extra hungry) defrost and use (T4 is changed to T3 and used to help give your body energy).
But if your freezer is full and someone keeps delivering fresh meals for you to use you don't need to get so many out of the freezer. (T4 decreases if there is enough T3)
But maybe the delivery man is sick and can't bring the meals, or there is a problem at the factory...
Our bodies are far more complicated than that of course but that may help get the general idea.
I enjoyed making up the story anyway, lol!
Perhaps try taking your T3 in the morning first thing and the Levo at night. Try a smaller dose of T3 for a few weeks and then retest. How did you take you blood test fasting leaving off T3 for 12 hours and Levo for 24 hours before the test?
Yes, the blood draw was 24 hrs after taking both
Only 12 hours before for T3 .....24 hours for Levothyroxine
If you need to take T3 in the morning it’s impossible to have the test 12 hours later. As long as you avoid taking either T3 or T4 for many hours before a test, at least you are measuring a constant pattern at your early morning test.
If normally take in one dose, The day before test, you can take split dose, for just that day
But why? Where does this rule come from? And would that make measured T3 higher or lower than normal?
Graph showing why to take T3 approx 12 hours before blood test
healthunlocked.com/api/redi...
Research Paper data comes from
ncbi.nlm.nih.gov/pmc/articl...
Many Endocrinologists would want test sooner than twelve hours.
Thank you Slowdragon. This looks really interesting though it’s a bit late today to look in detail and I’ll have a proper look tomorrow after some sleep / work etc.
I find this facinating. Figure 2b suggests that levels don’t drop significantly after the first 12 hours. So I don’t think it looks as if it makes much difference if you take it in two doses, or one, as long as you don’t have a test in the first 12 hours. How large the last dose is would also make a difference to test result.
Personally I’d prefer to standardise to my normal dosing schedule if possible and this doesn’t look like it’ll make much difference unless you need Free t3 right at the top of a range. I’m surprised how little variation in tsh there is. Thank you for the links x
Ah! Had a closer look - the insert graph with figure 2 does show still quite an elevation in T3 at 12 hours, though it is following a massive 50mcg dose which I probably couldn’t tolerate in one dose, although I know that some can and do. It’s all very complicated this!
125mcg Levothyroxine, always Mercury Pharma taken at 11pm (much more effective than taking in morning)
Plus 20mcg T3, must be Morningside Healthcare.
After much experimentation, essential for me to take T3 in 3 divided doses - 10mcg waking, 5mcg 3pm and 11pm
So dose is every 8 hours. As recommended by my own endo, and also by Professor Colin Dayan in Cardiff
Recently tried just 2 doses per day 2 x 10mcg....very badly upset adrenals.
Just one dose per day.....rapid and severe adrenal upset
I find it fascinating that many people on here do take T3 in one dose.....absolutely impossible for me
Hashimoto's, gluten intolerant, Heterozygous DIO2
More info on my profile
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
If also on T3, make sure to take last dose exactly 12 hours prior to test
Hi Slowdragon, do you have reference for recommendations of Professor Colin Dayan please x
Can't find at moment the specific one that states this clearly
But this is similar
ncbi.nlm.nih.gov/pmc/articl...
See page 5
pad.res360.net/Content/Docu...
Also this
wvrtaal.files.wordpress.com...
I would love to just take T3 twice a day, but have through extensive experimentation found I must take it every 8 hours
Fortunately I find T3 improves sleep, so taking at bedtime is great
Many thanks for these links Slowdragon. Interesting reading.
I think we have some common experiences - needing split doses, T3 improving sleep, extensive experimentation (!), impossibility of taking T3 in one dose.
Wasn’t aware of 8 hourly recommendation though. I think I may try adopting this in the hope I can eliminate some minor irritations, as I have perhaps become a bit complacent over timings over time.
Do you take your bedtime dose early on day before blood tests?
I don’t mind taking split doses as it has truly transformed my life.
Yes, that's how I discovered taking nearer bedtime was better
My endo originally said take waking, 2pm and 6pm
I think they assume T3 keeps you awake.
Personally I find I sleep deeply after taking at bedtime and often in morning too
Normal day now I do waking 7am, 3pm and 11pm
Day before blood test, just adjust slightly- 6am, 1.30pm and 9pm
T3 dose 10mcg, 5mcg, 5mcg
Levothyroxine 125mcg at bedtime
Thank you. Do you have your blood test at 9 or later?
I get Medichecks blood drawn at local private hospital, usually 9am, sometimes 9.15
Take my delayed Levo and T3 immediately after blood draw.
Drop test kit at post office and head home for late breakfast 10.30 ish
Also meant to say Levo I normally take at bedtime.
Before a test, typically on a Monday, Saturday evening dose Levothyroxine delay taking until Sunday morning, Sunday evening dose Levothyroxine delay until after blood draw. Take Monday evening dose Levo as per usual
This gives 24 hour gap for Levothyroxine between last dose and blood draw.
Yes I remember slipping doses forward like that when I was on Levo, but it’s not so easy with NDT because of the T3 content. On T3 and NDT.
Aurealis
Do you have DIO2 gene variation? Or not been tested?
I find it fascinating than many people on here can take T3 all in one go, yet many like you and me need smaller regular doses.
I haven’t been tested. Do you? I think I do have it - suspect my mum did too though her thyroid wasn’t underactive when I asked for it to be tested, she had T4 above top of range but signs of hypo. I didn’t know much about T3 back then. To be honest I’m appalled by the research giving 50mcg of T3 in one dose, think it would have finished me off, but maybe I wouldn’t have passed the pre-tests 
Yes I am heterozygous DIO2, so inherited from one parent.
Helped in my argument for NHS funding
I was very immobile on just Levothyroxine.
Severe gluten intolerance, diagnosed by endoscopy. No gut symptoms and negative coeliac blood tests, probably negative for coeliac on DNA test. More details on my profile
My endo tried me on T3 about 18 years ago. Obviously knowledge of gut and vitamin connection to Hashimoto's was in its infancy then. They did do coeliac test though. Which I was very confused about.
But all those years ago I couldn't tolerate T3, I assume because all my vitamins were dire, especially vitamin D, due to undiagnosed severe (but silent) gluten intolerance
Pretty sure my mum was undiagnosed gluten intolerant, possibly Hashimoto's, but she died a few years ago....so will never know
I may have it one day
Very interesting research paper which makes a good case for splitting the dose of T3 to maximise effect,
Thank you
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