I have been trying to find the right balance between T3/T4. I originally started with 150mg of T4 and 12,5mg of T3. All went well, but as some of my old symptoms still persisted, I tried raising my T3 to 18.7mg (basically I had to cut the pill in half) and the T4 went up to 175. Again, for some reason the pharmacy couldn't find T3 alone so this was my only option (Dithyron from Uni-Pharma).
I took this dosage for about a week or so but started noticing I felt panicky and slightly depressed....Is this normal? I went back down to the original dosage about 3 or 4 days ago but I am still feeling the lingering panicky feeling. Again, is this normal and if so, how long would it take for my body to adjust back to the original dosage and have the panicky feelings gone for good!?
Any help would be so greatly appreciated! Feeling quite along with all this!
Thank you in advance for all the support!
Karolina
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babou79
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Sorry, when you say you raised the T3 dose to 18,7 mcg daily, did you raise your T4 dose to 175 mcg at the same time? Usually, when T3 is added, you decrease T4 at the same time.
You may have started on too high a dose of T3. Some start on 6 mcg daily (the quarter of a 25 mcg pill) while decreasing T4 by 25 mcg at the same time (in your case, that would mean going down to 125 mcg when adding T3 to the mix).
You should also not raise T3 too often, but stay on a given dose for a few weeks. If you do indeed lower your T4 dose when adding T3, it will take some time for the levels of T4 in your body to decline as T4 has a half-life of approximately one week. Depending on how well you convert T4 to T3, you could have missed your sweet spot and ended up slightly hyperthyroid.
Also, many need to multi dose T3 or at least split it into two doses (one in the morning, one in the afternoon) in order to avoid peaks in the FT3 levels which can lead to the symptoms you describe.
How long have you been on thyroid medication and what is your diagnosis?
Also, did a doctor prescribe T3 for you (i.e. are you under the supervision of a doctor) or are you self-treting?
Do you have recent labs (with reference ranges) to post here? TSH, FT4, FT3?
If cortisol levels are not optimal, your body could have trouble dealing with T3 which is about four times stronger than T4 and directly affects the body (unlike T4 which needs to be converted to T3).
Not everyone with hypothyroidism needs additional T3, and some only need a low dose, which is why it is important not to increase the dose too often or too fast.
Hi there! Firstly, thank you so very much for your feedback it is greatly appreciated to say the least.
To answer some of your questions: I have been taking T4 alone for hypothyroidism for over 15 years. My endo was the one who prescribed T3 at my urging. He is however, more interested in ensuring that my thyroid cancer remains dormant than worrying about whether I feel well or not. I was diagnosed with Thyca cancer with metastasis 9 years ago, had a radical neck dissection removing both my thyroid and 20 odd lymph nodes. I then did three rounds of radioactive iodine. Found out I was iodine resistant and have never been able to completely "cure" myself of the cancer. We now do regular cat scans, MRI's, blood tests and ultrasounds. My endo is great when it comes to keeping on top of all of this BUT he doesn't pay much attention to the way I am actually feeling. Over the years, I continued to gain weight though I was eating healthy, working out etc, I was continuously losing hair, cold extremities, etc. It took him two years to finally agree for me to try T3. But, he just gave it to me and didn't tell me what to do in terms of blood tests etc. My next appointment with him is in July.
The last blood tests I did were prior to taking T3:
TSH= 9.4 μIU/ml
FT4= 1.070 ng/dL
My endo's goal is to keep my TSH as low as possible obviously.
I was taking the T3/T4 combination as it was prescribed to me (12,5mg/50mg) in one pill and an extra 100mg of T4 in another pill (both from Uni-Pharma). For some reason they didn't have separate T3- which makes things a little hard.
Long story short, I was feeling a little better after two weeks and decided to up the dosage (on my own) of my T3 to 18.7mg (basically I had to cut the pill in half) and the T4 went up to 175. (When I raised the T3 dose to 18,7 mcg daily,I raised T4 dose to 175 mcg at the same time). I took this for a few days and have started feeling panicky, which I am assuming is because as you mentioned I also raised my T4 and the T3 may have been too much. So, I have gone back to my original dosage. I have been on the original dosage now for about 3 days- but the panicky, anxious feelings still persist. Is this normal? And if so, how long can I expect to feel this way?
In hindsight, I shouldn't have increased anything without my endo's supervision but I know how difficult it is for him to agree to any kind of change. Nevertheless, I believe the best thing to do as of now is simply keep this dosage and wait until July (though that seems much too long). Would you recommend I go ahead and take blood tests before then. I've been on the original dosage for nearly 4 weeks now.
I apologize for the very long message- and am so grateful for any feedback you can give me! I hope I've answered all your questions. Thank you again!
No, don't apologise, the purpose of this forum is to ask questions and get answers!
I don't know much about thyroid cancer as I have Hashimoto's myself. I know adrenal fatigue is common in patients having been hypothyroid for years, as is often the case with Hashimoto's patients, but I honestly don't know if ThyCa patients have time to be hypo long enough after treatment to develop adrenal fatigue...hopefully, others with more knowledge will chime in!
Is it a typo, or was your TSH before adding T3 9.4 μIU/ml?!?! That is extremely high and in the hypothyroid range. Your FT4 levels seem suboptimal as well (ranges vary from lab to lab, but I think FT4 levels of around 1.4 is usually considered optimal).
In the package leaflet for my thyroid medication (Euthyrox) it says that TSH suppressive doses in ThyCa patients can be as high as 300 mcg daily.
So yes, you either needed a raise in T4 meds or some T3. Isn't the goal of thyroid hormone replacement in ThyCa patients to suppress the TSH to prevent recurrence? If your endo doesn't know that, I'd find another specialist asap!
From your description, your endo sounds pretty clueless.
However, since you've developed some hyper symptoms since going on T3, it's likely you raised it too quickly or took too much in one dose.
There are many other labs that need to be optimal as well (vitamins, minerals) but I will have to let others comment on that as they know much more about it than I do.
I do, however, recognise the symptoms of overmedication from too much T3 you describe after taking NDT for several years, especially since those symptoms appeared after the addition of T3.
Thank you again for your reply- it is greatly appreciated! I just have mentioned that the rest results I posted were after I was on thyrogen and then had three subsequent blood tests to see what my "real numbers" were off of my medication. My usual TSH is in the normal range! I need a new panel of blood tests done now that I've been taking the T3/T4 combination for 4 weeks or so. I will ask my endo as well but could you give me an idea of what else I should ask for (in terms of the blood test)? Thank you again! You have been so very helpful indeed!
Others will know more about this than me, but vitamins B12 and D are important, as are iron/ferritin, zinc, and selenium. But it’s possible certain labs are required when you’ve had thyroid cancer, so I’m hoping others will chime in!
Great advice . When wanting/needing to raise T3/NDT and one is already on Levothyroxine (T4) meds
1-reducing T4 or omitting for a few days T4 and reinstating T4 at a lower dose is very important prior to making a more successful increase in any T3/NDT meds . T4 is a longer acting hormone and T3 is a shorter acting hormone .
2- Lowering T4 by 25mcg for exchanging/adding 1/4 grain NDT is a more preferred way to go . Or adding half of 5mcg to 5mcg T3 .
3-Changes should be done *low* and *slow*for thyroid meds to work well for us . Giving our body enough time to *acclimate* to any changes so that we don't miss our *Optimal* dose .
Thanks everyone! Unfortunately, I am taking a T3/T4 pill combined plus a T4 pill which makes things a little trickier. I was initially on 175 mg of T4 alone and then we lowered it to 150 mg of T4 and added 12,5 mg of T3. There are days I feel great and days were my heart rate is up....I'm not sure what to do- any thoughts? I'm going to try and reach my doctor as well of course but I'd love to hear your thoughts/advice too. Something tells me my doctor doesn't have as much experience with T3 administering as I'd hoped!
I'm sorry your not feeling well . I think that you might be getting too much T3 . You lowered your T4 by 25 mcg and your raised your T3 by 12.5 mcg . You might want to lower your T4 for a few days before adding low dose T3 . And try to split your T3 dose and see how that improves your symptoms .
Best wishes .
Here is an article about the importance of optimising cortisol levels (often suboptimal in people with hypothyroidism) before adding T3:
The article is fascinating but I am feeling so confused! I don't know what I should be asking for in terms of blood panels or how to read them...I know my doctor checks for quite a few things but I don't know if he checks everything he should be and if he just follows what is considered the "norm"....I was hoping someone here on the forum could give me a list of everything I should ask for in my next blood panel...
It is possible to reduce over high hormone levels quickly when you’re on T3, by just leaving it off for a day. But as you have to keep TSH suppressed this could be risky for you, so you can only reduce by going back to the original dose and giving as long as it takes to balance out. I think in your position it’s best to never increase T3 and T4 at the same time.
Thank you so much for your reply- it gave me a little peace of mind...I was feeling quite panicked! I have gone back to the old dosage and am hoping that within a few days I'll feel a little more like myself!
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Still confused ...should I reduce/ stop T3 and just go back to higher T4 dose? 
has anyone felt not great on T3?
Hashimotos/low tsh but low t4 and t3 help
