Hi All, I would be grateful for some expert advice. I have had hypothyroidism for many years. I did well on levothyroxine up until about 2 years ago. My t3 was at the lower end of the range. So in my wisdom (or stupidity) I decided to try t3 only. I weaned down the t4 and added in the t3 slowly until I reached 75mcg. I take this in 2 split doses. I feel great,the best I have ever felt. The swelling and oedema I had is less,my memory is getting better, I have more energy etc. But my gp is worried because my blood test are abnormal. They are tsh 0.01 (0.3 to 4.9) t3 9.0 (4.00-7.2) t4 1.2 (12 to 22)
Do I need to lower my t3? Do I need to do anything with the t4?
Thanks in advance ☺️
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An excess (or inadequate) amount of T3 is subjective for each person. And the amount each requires is of no less importance, ie I require a little but without that essential ‘little’ I simply can not convert enough T4 meds to retain well-being.
This is because for many people the way their conversion enzymes work is in the presence of a little exogenous T3 the enzymes action becomes up-regulated so conversion abilities increase. This means we end up with a lot more T3 in our body’s than the amount we medicate (or additionally make if we still have some thyroid gland working).
For others that extra T3 amount will make little difference to their conversion enzymes due to further impaired de-iodination and so requiring larger T3 doses, maybe even whole replacement (T3-only meds). The T4:T3 ratio is different in every person and it is only finding that ratio that brings & retains our well being.
T3 will only drive insulin resistance if the amount is too high for own individual needs as its abilities in potentiating insulin signalling, cell sensitivity and improved storage & synthesis may actually contribute towards reversing insulin resistance as happened in my own case.
Therefore, having insulin resistance is not a reason to not take T3 if you need it, but only if you do actually need it, evidenced by labs & symptoms when every other avenue to increase T4’s performance has been explored, as many add T3 much too early in there recovery regime which then muddys the waters later when recovery isn’t achieved, and conditions such as insulin resistance have appeared.
My consultant considers over 40 mcg a high amount. That said, he prescribes according to my symptoms and asks my GP to do regular heart and bone checks.
Talking t3 can impair glucose metabolism. I think it is even said in the package. That's why if you take t3 you have to often check your sugar levels. Google "t3 and insuline resistance" and You Will find many papers on this subject.
T3 is the active hormone that increases metabolism. Everyones required amount varies and those who medicate T3-only (so a substantial amount) are more at risk of blood glucose issues by increasing gluconeogenesis in the liver (glucose synthesised from noncarb sources, ie amino acids, glycerol, etc) . This continued high glucose output then leads to cell insensitivity and classic insulin resistance that then exacerbates the condition further.
All research refers to insulin resistance in the state of hyperthyroidism as the result of mainly heptic influence because of the exact same driving mechanisms.
The insulin resistance may then become further compounded by high levels of cortisol which is also a driver for gluconegenesis (along with glucagon, growth hormone, adrenaline, etc), and leptin resistance. Leptin (known as the hunger hormone) puts our body into starvation-mode when high glucose levels remain constant in the blood stream that can not be used efficiently, and will hang onto fat stores (same mechanisms as when we follow a calorie deficient diet).
Leptin is made in our fat stores so the more fat we accumulate, the higher our leptin levels become. When leptin resistance occurs (similar to insulin resistance), we may remain hungry after eating as the brain-tummy connection is lost, so are more likely to overeat.
We need balanced glucose levels, insulin & leptin to be able to utilise thyroid hormone meds effectively, or meds can start working against us. I have read research showing as soon as leptin levels reduce the up-regulated D3 enzyme that will be converting T3 to an inactive form will stop, and T3 meds become more effective again.
This whole catalogue of events means recovery becomes further distanced and why once over-weight it can be difficult to lose. It also exemplifies how just ‘upping the old thyroid meds’ in an effort to boost metabolism to shift some weight can dramatically back fire.
My test results are similar to yours and I've been on T3 only for several years. An endocrinologist thought I must be causing some sort of damage although every test she did in the office I passed. I asked what damage. She said it would take more testing to find out. She was very hostile at the start and maybe I should have asked her to do them but I doubt she would. If you have no hyper symptoms I wouldn't worry. T3 only may be a new paradigm for them.
Hang in there. The Canadian website that Dippy posted is all about T3 or have you seen it already because they claim 75 mcgs T3 is the proper dose for many people.
That's good, shaws. I don't think they meant EVERYONE needs 75 mcgs. but weren't you on a higher dose previously? It's on that Canadian site that DippyDame posted.
Sometimes the phrase thyroid hormone resistance is used to identify cases where patients with autoimmune thyroid disorders respond poorly to normal doses of replacement thyroid hormone, this is thought to occur where patients have developed antibodies to thyroid hormones. Antibodies to thyroid hormones quite commonly occur in such disorders, and may interfere with the normal clinical assays used in monitoring such disorders, and in unusual cases may have further independent clinical significance.
Thank you, shaws. That website will take a while to peruse and lots of food for thought. I've been looking at sarcoidosis lately and this statement caught my eye. Dr. Marshall has invented a protocol for Sarcoidosis and autoimmune disease that is proving to free many thyroid hormone resistant patients from their symptoms and their large doses of medication.
The entire immune reaction seems wide open for good reason due to the complexities and mutations involved.
My dose was higher but have found that a lower dose of T3 is now needed. I can adjust T3 'according to how I feel'. At present I have no symptoms and feel well.
Thanks, shaws. I will keep that in mind. I had a small crisis during mail lapses from the Covid and delivery problems. I thought I might run out so I was taking doses every other day and it didn't seem to make a difference so maybe I don't need as much either.
In countries that have 25 microgram liothyronine tablets, 75 micrograms is usually the amount regarded as a full dose.
In countries that have 20 microgram liothyronine tablets, 60 micrograms is usually the amount regarded as a full dose.
The difference appears almost entirely down to the convenience of prescribing three tablets a day. 15 micrograms of liothyronine is a significant difference. 75 is 25% greater than 60.
I know. I think you can still get 5 mcg. tablets but cutting tablets is ridiculously difficult if you break up your dosing. And then there is a potency issue. thyroidrt3.com/which.htm
I still consider it somewhat useful. Cynomel and Tryotex are still sold online and I agree with their opinions on both. Actually the Viatris link is pretty interesting although I just took a glance. Cynomel is going out of supply again, haha, so right up to date.
The Viatris link only works because the Mylan site redirects you to Viatris!
But what it doesn't tell you is that Viatris was formed by a merger of Mylan and Upjohn (a subsidiary of Pfizer). And that Greenstone is a brand owned by Viatris. And Greenstone Liothyronine has absolutely identical ingredients to Pfizer Cytomel and is made by the same company in Europe (Peptido GmBH).
And it confuses by implying that Generic T3 by Goldshield is different to Tertroxin. Which has never been the case.
And the UK has several additional liothyronine products from Morningside, Teva, Roma and (possibly) Accord and Colonis.
I suspect that you find some utility in the site because you know what is what. A newcomer would, I am pretty sure, be confused and misled.
Perhaps YOU should have a website, Rod. (I'll be embarrassed if you do It's probably hard to keep up with all the changes in the industry.
Right now I would take any of the above! It would be good if we could count on reliable, affordable liothyronine. My son said he could get it in bulk if I were willing
to make my own tablet. Actually I think he could do that as well. hmmmm
I have thought about it, but I decided that producing documents was a better approach. Partly because I don't wish to compete, or even be thought to compete, with existing websites.
helvella - Thyroid Hormone Medicines
I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.
That represents well over a thousand pages. Which anyone can download and read however they wish. Phones. Laptops. Tablets. Desktops. No need to have internet access once you have downloaded what you want.
That is an amazing compilation, Rod! Of course I had to look up the famous people with thyroid disease, haha. It will be interesting to look at thyroid hormone in a more global way....or were you just deciding which country to visit. I doubt anyone is going to make corrections any time soon. It really must have been an enormous project and have to congratulate you for doing it! Are you also recommending pasta siringa
I like DippyDame’s response. I have struggled with GP knowledge issues for 50 years. Over time, I developed my own protocol that works well for me. I reduced my Synthroid (275-175 mcg) to as low a level as comfortable, slowly, while increasing T3, both day and night doses of 5 mcg each. My GP seems to go along with me but it has been a slow learning process for him. Most Docs are reluctant to admit that they don’t understand the issues very well. But the advice to monitor HR and body temp, as well as how do you feel, is the best advice, but keep an 👁 on the numbers as a guide. Also refer your GP to the Doc that developed the TSH test, Dr, Robert Utiger. He warns Docs not to use TSH for therapy, it is a diagnosis tool. I could write a book of my experiences but why bother, they don’t listen to patients.
It’s difficult to say how you might need to monitor your metrics. I am male, 82 , so my experience may not correlate. I use temporal thermometer and pulse oximeter to monitor myself. I am very low HR, 50 BPM or less if I don’t keep my T3 up to a minimum. My goal is consistency. I discovered many years ago that my HR dropped to a very low number <35, during my sleep. I would awaken gasping for breath on many nights. After getting dressed and heading to the ER, my breathing was normal. My GP (who was also hypo) suggested T3 and that did the trick. Additionally, my short-term memory problems were solved. There is much more to the story but this limited forum is not equipped for attachments.
As an afterthought, I use fasting, 3 days per week. That technique yields excellent results in many ways, both in terms of chemistry and how one feels. For those fighting glucose issues, it works wonders.
I’ve been on extended release T3 for over 20 years. I wear a Fitbit so I am always aware of my pulse, which stays around 62-72 bpm. If I were to have trouble with my GP, I would take my temperature before getting up and document it for additional proof that I’m doing well.
My TSH is almost non existent. I still have trouble losing weight but I continue to feel really well. I’m almost 69, do circuit training twice a week and recently added burlesque dancing to the mix.
Another GP rang me abd he seemed a lot calmer about it all. He said as long as I'm feeling well he would not be concerned, but he would speak to my endocrinologist. My endocrinologist does not know much about t3 though.
I haven’t set up my patient access request yet as this is a relatively new GP - we moved a year or so ago. I seem to remember that my T4 is non existent.
Dr John Lowe, scientist, did not split doses as he stated that one dose should saturate all of our T3 receptor cells and they, in turn, sent out waves for the next few days. The following is what helvella copied.
Like Shaws, I no longer need as much T3 as I did, I feel as if my body now needs just a maintenance dose where at first it needed sort of replenishing - no medical evidence, just personal opinion, but maybe you too will be able to reduce gradually?
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It's probably hard to keep up with all the changes in the industry. 
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