Advice and “moral support” needed with T3/T4 combo - Thyroid UK

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Advice and “moral support” needed with T3/T4 combo

Koola profile image
14 Replies

Hello distant friends,

I’ve been adding T3 for the past three weeks. Background: I tried this a few times in the past years and couldn’t take it. I’d also tried NDT for two days once and no go, felt too awful.

However, trying to raise my T4 intake for three years now hasn’t gotten me anywhere. My TSH is always a little or much too high. FT3 and FT4 too low. More T4 just makes me even more tired. (My vit. & iron levels are good.) After good advice on this site, I decided to try NDT again, starting with half a grain. On the 3rd day I was again in that hyper plus hypo state, exhaustion together with unbearable wired up feeling, plus even worse brain fog.

So, I decided to add 6mcg. T3 to a lesser dose of T4, i.e. first 50 then 62 mcg instead of my previous 88, as I felt I could better control the T3 input this way. And then, after those 3 days on half a grain of NDT and two on this T3/ T4 combo, a miracle happened! For one day, I felt completely fine again for the first time in almost a year… relaxed, energetic, in a great mood. I couldn’t believe it. Well, it was only a one-day miracle but it did give me hope again.

Meanwhile things have been up and down again, not much different from T4 only symptoms, though the up days are slightly more energetic. These last days were bad but maybe also linked with the recent heat (?) My idea is to keep on going till next labs, see results, and mostly how I feel.

Eventually, I plan to try NDT again now that my body is getting used to T3 without flipping out too much (!)

A usual, advice very appreciated. And foremost: has anyone gone through this particular “hell fire” with T3/T4 combo? For how long? And ended up on the bright side?

Thanks for bearing with me in this long account.

14 Replies
pennyannie profile image

Hey there again:

I'm confused by this post Koola as it seems you are taking syntheticc T3 for a few days and then taking NDT for a few days - is that right ?

If so, I don't think you should be switching around too much :

I have found my build up to better health, long and slow :

Please ignore yout TSH result - and concentrate on the T3 and T4 levels :

I've been on 1 + 1/2 grains of NDT for 3 years now and that represents just 57 T4 + 13.50 T3.

When I was dosing myself with synthetic T3 and T4 I don't think I'd have ever found this dose - as I was believing I needed more not less T4 and just a little T3 :

Does that register at all - in what you are trying to do ?

Koola profile image
Koola in reply to pennyannie

Hey Pennyannie,

I must’ve been unclear. It’s not ND/T3/ NDT at all. I switched from 88 mcg T4 and 3 times a week 94 to 1l2 a grain NDT, as you did. I felt too unwell and couldn’t hack it. (I live alone, have cats to feed and a dog, aside from myself (!) plus everything else that I can hardly get done, and my only close friend has heavy health issues of her own these days and stays at home and in bed mostly, so I chickened out after 3 days).

I decided to try T4 / T3 combo instead, so as to be able to monitor things more closely. I reduced Levo to 50 and added 6mcg T3. I had one glorious morning of feeling fine, but for the past 3 weeks it’s been up and down. I upped Levo to 62. At times I do feel more energetic and that’s a progress. It only lasts a few hours though. And then there are still the rough days. I’ll do labs in about 2 weeks.

I figured I would get my body used to T3 and then, whatever the labs say, if my symptoms still don’t get better, I’ll try NDT. Maybe starting with ¼ grain? I’m sure it’s better than synthetics but I’m being cautious, as the last time I tried it two years ago I also felt unwell. Same with T3 back then.

But now absorption seems to be slowly better. (maybe because my vit./ iron levels are good now.)

I would very much like to know what you think of my trials – or maybe errors? Should I up my T3 intake or is this all a mistake?

pennyannie profile image
pennyannie in reply to Koola

Hey there again :

OK - so we need to accept that the ball park numbers for a fully functioning working thyroid to be daily around 10 mcg T3 + 100 mcg T4 - making a total of around 110 mixed T3/T4 hormones.

So, if we work on the assumption that T3 is about 4 times more powerful than T4 we are looking at my overall combination of T3 and T4 thyroid hormones coming in at 111 :

I am on NDT - 1 + 1/2 grains which works out as 57 T4+ 13.50 T3 :

Your 50mcg T4 + 6 mcg T3 would be coming in at an overall combination of T3 and T4 at 74 hormones.

Have you tried adding in another T3 dose later in the day ?

I think the T3 is much faster actioned within the body and slowly you may recognise the need for a second dose within the same 24 hour time frame, - and maybe you can then extend that " glorious morning " into the afternoon.

I've read taking T3 with food, stops that " surge " you might be experiencing.

Most people on here seem to dose T3 twice a day with some taking a little extra when they go to bed.

I think after having had RAI thyroid ablation that T3 is a necessary component of our future medication :

The question remains to dose T3 and T4 independantly or switch to NDT which contains all the same known hormones as that of the thyroid gland, with a fixed T3/T4 ratio of around 1 / 4 T3 to T4 :

To that end I would suggest trying to dose synthetic T3 and T4 at a 1/4 ratio possibly splitting the T3 twice daily.

Does this make any sense at all - I know my thinking sometimes reads cockeyed !!! ??????

Koola profile image
Koola in reply to pennyannie

Yes, Pennyannie, it makes perfect sense!

Actually, if I got it right, you’ve opened up a whole new vista of understanding to me: you put forward the 110 number of T3/T4 hormones, as a fixed aim representing what our thyroid used to do. And that doesn’t change and is true for all of us. Therefore, the aim is to reach that level, by whichever means.

I hadn’t understood this and believed that our ultimate ideal dosage was individual, whereas the aim is to reach that 110 number by individual means, like titrating slowly, or trying out only T4 or T3, or both or NDT, different brands etc. I hope my explanation makes sense. If it does, it’s a “revolution of the mind” to me, lol!

Anyway, I am about to eat and will take another 6mcg T3.

I suppose I still have to take my vit. supplements 2 hours away from T3 as I do with T4? (and iron 4 hours away?)

I still want to try NDT after this round of T3/T4 trial. The “glorious morning” happened 2 days after my three-day NDT trial and maybe it was a foretaste of better things to come. Meanwhile, I’ll see what adding some T3 does.

Thanks for the ray of hope. I hope my muddled hypo brain got yr. advice right! :)

pennyannie profile image
pennyannie in reply to Koola

Well, I only came to this conclusion when I ended up on NDT and much improved as I feel it is " softer " on my body than synthetics.

As on synthetic T3/T4 I felt this " surge " and didn't much like it, but hadn't read about the " taking it with food solution ' at that point in time.

I also held onto the belief that I needed to be taking around 100 synthetic T4 to be well - which didn't work for me.

In hindsight I should of been adjusting down my T4 from 100 mcg as I was increasing up my T3, working on a 1/4 ratio - for every 6.25 T3 I was increasing i should have been dropping 25mcg T4 ;

Maybe it's just a coincidence and maybe it's " just me ' :

I wouldn't aim for any number - just bear in mind what we've lost and try and compensate - it's more important that you feel as well as you can.

It all comes down to how well your conversion of T4 is.

I think my conversion is good, as I maintain my vitamins and minerals at optimal levels. However if conversion is compromised obviously you will be more reliant on the T3 rather than the T4, thereby needing a higher dose than me.

Also bear in mind conversion can also be compromised by physiological or emotional stress, inflammation, depression, ageing and dieting.

So nothing is caste in stone and goal posts can and do move.

And you are right in that everybodies ultimate, ideal dose will be individual to them, at that point in time.

I'm sure there is some leeway in these numbers and we are also comparing synthetic hormones to NDT - so it's a bit like comparing apples to pears and I'm sure there isn't any scientific thought in my reasoning.

If I have to go back on synthetics, which, considering where you are, might be the cheapest option for you, I' d consider to start back at around 62.50 T4 + 12.50 T3 and see how I go from there :

Glad it made some sense - just go low and slow - you can only try.

shaws profile image
shawsAdministrator in reply to Koola

If you have eaten, you must allow a good gap between it and taking thyroid hormones. Foood can interfere with the uptake of thyroid hormones, as I'm sure you are aware of this.

Koola profile image
Koola in reply to shaws

Hi Shaw,Does that apply to T3 as well? Is one hour a good enough gap? Before and /or after?

Do you know if it's okay to take T4 from one brand and T3 from another or if it would be better to take both from the same brand? In this case Unipharma.

On T4 only I switched to Evthyrox a while back, but since I haven't improved, I don't know if it helped at all...

shaws profile image
shawsAdministrator in reply to Koola

I don't think it matters if T4 or T3 are from different pharma companies. It always depends upon how the patient 'feels' on particular doses . If we don't feel very well it could be due to the pharma company changing something within the tablet..

Of course, we'd prefer to take replacement thyroid hormones from the same pharma company

Koola profile image
Koola in reply to shaws

Thank you, Shaws.

Koola profile image

Thank you so much, pennyannie! I will reread your post and think on it with a clearer mind tomorrow, but 62.50 T4 + 12.50 T3, as you said, seems worth a try.

I'm not sticking to synthetics for financial reasons, as both T4 & T3 are so cheap here (less than 2,- euros a piece), that I'm more than willing to spend money on ordering NDT-- health before all. Especially as my brain fog has prevented me from " taking care of business" in a timely way, which has proven expensive... I absolutely need to be able to concentrate and do the stuff that needs to be done, and stop feeling so anxious about this inability to take care of it.

To get out of this downward spiral, like a vicious circle, which obviously affects my health, which -- etc.

Again many thanks for taking the time!!!

pennyannie profile image
pennyannie in reply to Koola

Well yes, I totally get it :

I'm dyslexic and in times of stress my abilty to read and comprehend goes out the window :

I then beat myself up because of my incapacity making everything worse : and it can become a vicious, insidious circle.

There are very many people doing very well on a synthetic T3/T4 and in Greece you are well placed to access both synthetic T3 and T4 .

Please bear in mind that NDT is not as easily sourced and in the few years I've been taking it, the number of suppliers and wholesalers has dropped dramatically whilst the prices for all brands of NDT have at least doubled, with some brands discontinued.

So, try the synthetic, as you have them, and build up confidence in both thyroid hormone replacements, giving yourself as many options as possible.

Koola profile image
Koola in reply to pennyannie

I find I’m getting slightly dyslexic too, and have to doubly concentrate when writing numbers down, and checking them too, as I’m having blurry vision these days.

Re vicious circle, it’s hard to stop beating oneself up... My mantra, that I try to remember (!) is to congratulate myself for every minor accomplishment, however small. To curb my impatience by telling myself that I’m a turtle, no use wanting to be a hare (as when hyper!) or even before all that, when I had energy, often more than many people around me.

Thanks for the advice about synthetics. I do have one more question about brands, though. Hoping I'm not trying yr. patience.

I switched from the Greek Unipharma to Euthyrox by Merck a while ago. However, the only T3 they have here (I’m almost sure) is Unipharma. So I’ve been taking T4 Euthyrox and T3 Greek Unipharma. Should I take T4 Unipharma instead, so that both T3 & T4 are the same brand, with same fillers etc.? Or does it not matter so much?

pennyannie profile image
pennyannie in reply to Koola

Sorry I have no idea :

I'm only jealous you have Unipharma T3 on your doorstep : as this suited me and the replacement brand I ordered, in bulk, didn't suit me at all and I gave it away :

Having already purchased a trial batch of NDT - this was when I moved across around 3 years ago now.

I guess you could look up the breakdown of both tablets - but whether sympatico i wouldn't know.

In the uk brands of T4 are seen as interchangeable but most recently it has been acknowledged that some people need to stay on the same brand and have preference options as to the brands that suit them best.

Koola profile image
Koola in reply to pennyannie

Yes I know it’s absurd that I’ve had T3 on my doorstep, dirt cheap too, and couldn’t or didn’t know how to use it. I realized this when I read how people were ready to give an arm and a leg for it, either because of doctors’ ignorance and / or because it’s so expensive elsewhere – I guess that’s the pharmaceutical lobby or Mafia for you… especially considering that Greece is a poor country, so it can absolutely not be production costs!

Anyway, please pm me if you ever go back on synthetics. I’ll be glad to help out!

I’ll soon do a separate post re different brands. On T4 only I was told not to switch around too often. I’ll stick with different T4 and T3 brands for a while as I’m adjusting to the new dose you recommended and then try Unipharma only. Evthyrox doesn’t list their additives or fillers but even if I search & find out, how will I know which suits me or not etc. I’ll be empirical and just try it out! Slowly…

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