How do you titrate off T3/T4 to T4 only? - Thyroid UK

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How do you titrate off T3/T4 to T4 only?

anniekims profile image

Firstly as I wrote on here last week I don’t want to switch from T3/T4 to T4 only but my GP may give me no choice. If I feel worse I will source T3 privately.

However, so I can check I am getting the right advice about titration from my doctor should it come to that, may I ask how you titrate off T3/T4 to T4 only? Do you literally come off the T3 and swap in the extra T4 to make up for no longer taking T3 or is it advised to reduce the T3 every few weeks until coming completely whilst at the same increasing the T4 accordingly?

Many thanks.

10 Replies

Depends how much T3 you're taking. It would have to be done slowly, though. Like a reduction of 5 mcg T3 and an increase of 25 mcg T4 every six weeks. With testing in between. If your doctor doesn't like that, well, tough! That's the way it needs to be done to give you the best possible chance of adapting. :(

anniekims profile image
anniekims in reply to greygoose

Thank you.

greygoose profile image
greygoose in reply to anniekims

You're welcome. :)

SlowDragon profile image

Plus essential to keep testing vitamin levels every 6 weeks too. They often crash when T3 is stopped

anniekims profile image
anniekims in reply to SlowDragon

Thank you.

I read, only the other day, but can't remember where, that once on T3 in any form then it's not always possible to go back to Levo

I've no idea if that is correct but if anyone else has heard that suggestion then could they help out here?

Could that be connected to what SlowDragon has commented on, the reason being low vits etc.

anniekims profile image
anniekims in reply to silverfox7

Thanks silverfox7, slaydragon’s comment about coming off T3 crashing vitamins sounds like it could be one reason, others on here have explained that after the enzymes that are used in the body to convert T4 to T3 have been suppressed for so long as they haven’t needed to be active as taking oral T3 it could take a very long time if ever for them to kick in again.

Interesting! Keep us posted please and hope it works out for you!

anniekims profile image
anniekims in reply to silverfox7

Will do. I really don’t want to do the switch.

Hi anniekims,

I did the same last year, at my doctors request, due to the cost of T3.

I saw the Endo first, and she just advised me to go straight from T4/T3 to the T4, with an increased dose of T4,125mcg. Well, not the best way to do it!

My heart was racing,my blood pressure was sky high.So I had to reduce the T4.It still wasn't working, so I reduced the T4 again, down to the level of 75mcg which I was previously having with 20mcg of T3.

Of course on it's own the 75mcg of T4 wasn't enough, but I couldn't tolerate anymore T4.

Whether I could have if I had done it gradually, I won't know.

But the result was that I told my Doctor I needed the T3 back again and she put me back on it.

She said she just had to justify giving it to me,and could do that now.

I think the problem was that I had been on the T3 for 20 years,and maybe after that time it's not possible to go back, I don't know.

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