T3/T4 ratio dosing query : Hi folks hope everyone... - Thyroid UK

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T3/T4 ratio dosing query

jacobite33 profile image

Hi folks hope everyone had a lovely xmas!

for the last week I have now upped my T3 dose to one and a half Tiromel 25mcg tablets whilst also taking 50mcg Levo

I take half a tablet of tiromel in the morning along with 50mcg of Levo then roughly every eight hours take another half tiromel twice after

Thing is I starting feeling better until yesterday then I started feeling like before and although still not sleeping

Wondering if anyone has taken T3 up higher than this whilst taking levo?

Since upping the dose I noticed my blood pressure had reduced (although up again since yesterday) but my temperature is around 34/35.5 and heartbeat has went up slightly from 50/55 when resting to around the 60's to 70 after dosing eventually going back down

Still feel fatigued and wondering if it's safe to up my dose in a week being on both Levo and T3?

Have a lovely new year and take care!

19 Replies

Ratios are for healthy people. They have nothing to do with people on thyroid hormone replacement. You need what you need, both in T4 and T3. I for example, need 75 mcg T3 and zero T4. Other people have varying needs. You need to experiment to find out what's right for you.

Do you have any lab results to share with us? That plus how you feel will tell us if it's ok to increase your T3. But, from what you've said, it does sound like it's time for an increase in dose. It happens all the time that you feel wonderful on a dose for a while, and then the hypo symptoms start creeping back in again. And all that means is that you're ready for the next increase, and to hell with the ratios. :)

jacobite33 profile image
jacobite33 in reply to greygoose

Thank you or replying greygoose!You make me smile as I love your straight to the point no nonsense approach and advice!

I had blood done about 8/10 weeks ago and been using T3 since roughly then

Wondering wether to just up my levo in case that's what I need but if not it takes a while to reduce it again if it's more T3 I need

I dropped from 100/112.5mcg to 50mcg in about three weeks as I started T3 so thought I would feel better by

Majority of my latest problems started when they reduced me from 125mcg to 100mcg then to 75mcg and back up To 75/100mcg within a few months

Tried taking more Levo again on my own up to the 100/112.5mcg but it never really helped

I was initially on 125mcg for years but all of a sudden had an awful time (been thinking I might now have issues with levo)

I feel as if I want to discard the Levo altogether and use T3 only

As Dr Dr.John C Lowe (although I haven't read any of his stuff) said according to Paul Robinson about T4 and canned beans

If I don't convert very well why take it I'm thinking?

But then others are saying only as a last resort?

Just footering about trying to reach a combo dose that might not work seems pointless

But then if T3 is dosed properly it's perfectly safe and far more beneficial they say

Greygoose thank you so much for your reply and have a lovely new year!

greygoose profile image
greygoose in reply to jacobite33

If I don't convert very well why take it I'm thinking?

Yeah, but it's not just about converting, is it. Some people who don't convert well still need quite high levels of FT4. I used to convert perfectly well, yet still couldn't tolerate T4. Beware of people full of absolutes!

As to this 'last resort' thing, what does that even mean? If it means that you should try levo first, then T4+T3, then NDT only to finally end up on T3 only - as I did - well, yes, it was a last desperate resort. But, the question is: how long to do you give these other combinations - how much of your precisous life do you waste - before deciding to give in to that last resort. I feel I wasted far too much time - won't go into details here, but you can read all about it on my profile. If you really feel that T4 isn't for you, and you have all your other ducks in a row - nutrients, cortisol - then give T3 only a try. You can always go back to taking levo if T3 only doesn't suit.

But, one of the worst things you can do is change your dose too often, by too much, too soon. Which it sounds like your doctors were doing. But, what do they know!

jacobite33 profile image
jacobite33 in reply to greygoose

Thank you Greygoose Thyroid dosing conundrums indeed!

June25 profile image
June25 in reply to jacobite33

I think it would be worth it to stick with your 50mcg Levo for a while to see if you can make it work while varying your T3. The reasons are :

- At 50 your FT4 will likely be under range. The D2 enzyme is much more efficient at converting T4 to T3 when T4 is more scarce. You could even bring your FT4 up to just inside low end of range and this would still be true.

- FT4, FT3 and TSH all work together in your metabolic ecosystem. So the lower your FT4 is, the higher your FT3 needs to be to compensate. It is more difficult to dose T3 'properly', therefore having some T4 provides a bit of stability, sort of smoothes out the ups and downs of T3 peaks and troughs.

Having said that, we are all different and some people are best on T3 monotherapy, but I think you'd be better off giving combo a good try first. Keep your T4 low and raise your T3 cautiously in line with protocols till you get relief of all symptoms. Be patient, it could take a while.

jacobite33 profile image
jacobite33 in reply to June25

June25 I’m on the June 24th but many years ago 😊 ( probably not your birthday)Thanks very much for replying

So if I interpret that correctly,I’m probably converting better to T3 with a lower dose of T4?

Will add another 1/4 of Tiromel tonight with my half 25mcg dose to f that’s the case

When I was on 75mcg Levo my heart palpitations and shivers eased a fair bit,that’s why I reduced to 50mcg when taking T3

Reading Paul Robinson’s recovering with T3 but struggling to concentrate and take it in hence why i’m back asking questions

Thanks again junr25

June25 profile image
June25 in reply to jacobite33

Hi Jacobite,

Yes that's right, to maximize your conversion of T4 to T3 your T4 should be low which upregulates (increases) your D2 enzymes. In addition, your T3 should be high but not too high, which upregulates your D1 enzymes. Both D2 and D1 convert T4 to T3.

I'm on 50mcg T4 myself. As Paul R. says, it would be unusual not to get issues along the way and I've had issues with raising T3 too quicky / too much at once, which have set me back. Slow and small is the way to go, at least for me.

Another tricky thing I've found is that it can be hard to tell if you have gone a bit hypo or a bit hyper as they can feel much the same, so don't just assume that it's hypo and you need another T3 raise. Use a range of indicators, like body temp, pulse, resting heart rate, BP, etc to confirm which way it is. Nothing worse than thinking you've gone hypo and raising your T3 and getting an overdose. Been there, done that.

Good luck and I hope this helps.

jacobite33 profile image
jacobite33 in reply to June25

Thanks again June25!I have been checking all the vitals since I raised to one and a quarter tablets and everything’s been ok so far

Initially when starting I had felt buzzy and edgy but that settled a fair bit

Its just this fatigue that hit again yesterday

in reply to greygoose

" feel as if I want to discard the Levo altogether and use T3 only"

Ha! welcome to the club! I have similar thread here today titled Why take T4 at all?

jacobite33 profile image
jacobite33 in reply to

That’s what I have been thinking HikinTina and thanks very much for replying!It’s the big question isn’t it!?

greygoose profile image
greygoose in reply to jacobite33

Wasn't a big question for me. I'd tried everything else, so why not? Don't over-think things. It's all trial and error. I made about 15 years worth of error until I found what suited me.

Sus64 profile image
Sus64 in reply to greygoose

Hi Greygoose, do you take your 75 mcg T3 all at once, what time of day?

greygoose profile image
greygoose in reply to Sus64

Yes, I take it all at once, when I get up - whenever that might be. :)

Sus64 profile image
Sus64 in reply to greygoose

Thanks

We're riding' the same jenny donk! Hope we don't get bucked off!

Hanna
jacobite33 profile image
jacobite33 in reply to

ha ha ha ha I’m in total knots of laughter here!Jenny donks made my day!

Brunettes have all the fun on the promenade!

in reply to jacobite33

A face only a cowboy could love... :)

jacobite33 profile image
jacobite33 in reply to

My shrek like protruding lugs would go well with that donkey

I’d wait another three weeks then test to see where your levels are before making any further tweaks. You could still see improvement in symptoms as your body acclimatises.

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