I expected to required T3 and T4 at this stage, but not only do I only seem to require T4, but also lower doses now than 20 years ago when I was diagnosed. Back then, an ultrasound showed my thyroid gland was of normal size, but that there was already extensive damage to the hormone-producing cells. An ultrasound in November 2020 showed an undetectable thyroid gland so the radiologist concluded end-stage Hashitmoto´s (the ultrasound was ordered by my new doctor who questioned the original diagnosis as my anti-TPO and anti-TG levels have been in range for the past couple of years).
I recently switched from Euthyrox (which I did not feel optimal on) to L-Thyroxine by Takeda, and the difference is enormous. The Takeda brand seems to much more potent and also much more stable. On as little as 15 mg of Erfa, however, I had terrible hyper symptoms such as racing heart, profuse sweating, insomnia, and restlessness.
The doctor said this is due to low cortisol and that the symptoms are caused by high adrenaline/low cortisol and not by high FT3. However, every time I go off anything containing T3 and take levo only, I feel so much better.
I have a colleague who after a total thyroidectomy 13 years ago has been stable and feeling well on levo only, so not sure how much credence to put in all that talk aboout people needing T3 in addition to T4 if you no longer have a thyroid (my doctor said an ultrasound showing an undetectable thyroid gland puts me in the same category as someone who´s had a TT).
Adrenal fatigue is a controversial diagnosis so not sure I want to go down that road...my doctor wants me on 2 mg of Medrol daily to support rather than suppress my adrenal glands.
But, the problem with unconventional doctors is that they seem to think nobody can do well on levo only...!
One thing that bothers me about studies on the efficacy of combined T3+T4 treatment is that they were performed on mice and rats that are much smaller than humans, produce T3 and T4 in a different ratio and also have a much faster metabolism. I believe to have read the reason NDT fell out of flavour in the 1970s was because reasearch showed that humans almost exclusively produce T3 from extra-thyroidal conversion....whereas rodents´ thyroid glands produce much more direct T3. The same seems to be true for pigs and cows, BTW.
Anyway, I´d be interested in finding out if others have noticed their hormone needs changing/decreasing with end-stage Hashimoto´s. I really cannot expect why my body suddenly seems happy with levo only, but it´s hard to accept taking T3 and feeling horrible while being told by doctor that this is due to adrenal fatigue.
Only on T4, but I want T3 medication after full thyroidectomy 
Explanation of why levo & NDT don't work?
New paper showing TSH is controlled by both T4 and T3
Confused Delux
