Do I need T3 adding to my levothyroxine - Thyroid UK

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Do I need T3 adding to my levothyroxine



I've been on 125mcg of levothyroxine since July & feel ok but for the last 3 weeks or so my weight is beginning to increase & I have a terrible time trying to get off to sleep & wake off & on through the night. I'm considering trying T3 but really unsure if this is the right route. My diet is good, been gluten free for 3 years. Any suggestions please?

15 Replies

Lio isn't a magic pill. Its great for people (like me) who tolerate it happily and are poor converters. Do you have recent blood results to share that show a conversion problem?

Two years ago SlowDragon advised as follows -

"For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Bloods should be retested 6-8 weeks after any dose change or brand change in Levothyroxine"

Did you follow this advice because I've been unable to see an FT3 result in your posts ( sorry if I've missed it!)

FT3 is the significant result ,beside FT4 , without both we cannot adequately evaluate your thyroid health

3 months ago your FT4 was 14.1 (7 -17) that is 71% through the range so not overmedicated ( certainly not "overactive" as your GP described it) If all things are equal 71% is a good level.

Consequently, I can only guess whether or not you need T3. However, before considering the addition of T3 I would suggest you optimise the above nutrients and test FT4 and FT3 . If the result shows a high FT4 with a low FT3 then poor conversion is indicated and the addition of a little T3 may be advised.

Your GP is wrongly dosing by TSH and since yours appears only slightly suppresed at 0.05% he suspects you are taking too much levo. TSH is a pituitary hormone not a thyroid hormone it responds to the level of available hormones ...too little and it rises, too much and becomes suppressed. Nothing seriously wrong with your result......1 or slightly lower is advised for good health.

Once a patient takes exogenous thyroid hormones ( here, levo) dosing by TSH can be problematic.

This may help -


It's important to work through a sequence of tests in order to point the way forward otherwise you are simply jumping into the deep with no direction.

I suspect you are already aware of this symptom list but add, in case not

I suggest you need to retest as SlowDragon advised and review medication from that point

Just a few thoughts



Can see from previous posts you are on strictly gluten free diet

Presumably you have Hashimoto’s

Absolutely ESSENTIAL to regularly retest vitamin D, folate, ferritin and B12

Can’t see any test results in previous posts....or any Ft3 result either

What vitamin supplements are you currently taking

Getting FULL Thyroid and vitamin testing is first step before even considering adding T3

All four vitamins need to be OPTIMAL first

As DippyDame says.....come back with new post once you get results, members can advise on next step

Thank you to you all for replying

I'm looking at my blood results from July & I'm sure Ft3 hasn't been checked, not sure it ever has been. Don't know if I have hashimoto's or not. If hashi's is detected do the doctors prescribe anything else or do we just plod on?

I take my levo at about 5/6am, well before food or drink. Late morning I take 50mcg vitamin D3, 1000mg sea buckthorn (for dry eyes) & a couple of drops of Canabi hemp oil. Mid afternoon I take a tetralysal tablet (for acne rosacea).

I forgot to say my extremities are always cold so warm socks & leg warmers under my jeans are a must.

I'll book a blood test for all the things that you suggest.


SlowDragonAdministrator in reply to Longinthetooth

NHS almost never tests Ft3 ....even for patients prescribed T3 on NHS

And GP rarely tests vitamins unless really pushed

Vast majority of U.K. patients forced to test privately to make progress

As you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning.

Delay Sunday evening dose levothyroxine until after blood test on Monday morning.

Take Monday nighttime dose levothyroxine as per normal

DIY finger prick test

Blue horizon or Thriva testing includes folate. Medichecks no longer includes folate

I tried the finger prick test with one of the above companies once & it was a disaster. I couldn't squeeze much blood out so I used a razor blade to cut deeper. It was so messy.

I'm sure the doc won't test for all that I ask so I may have to try privately again.

Do we then produce the results to the doc who doesn't like being told? It's so difficult but thank goodness for you lot.

SlowDragonAdministrator in reply to Longinthetooth

So you might want to pay extra for private blood (if you can find clinic open during pandemic )

Alternatively follow these tips on DIY finger prick test

Come back with new post once you get results

Members can advise on next steps

Basically getting all four vitamins optimal by self supplementing (or GP prescription if actually deficient) can significantly improve conversion of Ft4 to Ft3

SlowDragonAdministrator in reply to Longinthetooth

About 90% of primary hypothyroidism is due to autoimmune thyroid disease

It’s important to know, as there’s much you can do to help yourself

Low vitamin levels are especially common with Hashimoto’s. We frequently need to supplement to maintain OPTIMAL levels

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

Presumably as you are on gluten free diet you have Hashimoto’s

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Thanks for all this info.

SlowDragonAdministrator in reply to Longinthetooth

Looking at your forum name .....B12 often drops low the older we get

But Never start supplements without testing first

Yes, I'm 68 next month.

SlowDragonAdministrator in reply to Longinthetooth

Lower vitamins, especially after menopause common reason for poor conversion

Wishing You Happy Birthday in advance. Many Healthy Happy Years Ahead.

Thank you.


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