The process of adding T3 to T4

I was diagnosed with underactive thyroid in 1994 and have been taking 100mcg levothyroxine ( I am 70) for the last 3/4 years I have had very low energy levels and each year put on 3/4 lbs

I have recently been prescribed addition of T3 20mcg per day in 2 halves to my T4 medication (reduction from daily 100mcg to alternate 75/100mcg)

I have been following this new regime for almost 2 weeks but feel that as a result I have less energy than I had before. How long does it take to get some sense that I am on the right track. Should I let my endocrinologist know that I am feeling more tired

[Jaydee1507 Administrator]

Welcome to the group.

20mcgs is a lot to add at one time. Usually it's recommended here to go up in 5mcg increments 2-3 weeks apart. That may be why you aren't feeling so great.

What were your last blood results please?

Your post says you are 70 yrs old and in your bio it says you're 28. Which is it pls?

[Hidden in reply to Jaydee1507]

thank you for replying Jaydee

My last blood results were on 21/12/22

And I saw a private endocrinologist on 30/12/22.

My blood results were : TSH 0.11 T4 19.4. T3 4.6

I am 70. Not sure why 28 comes up.

Best Wishes

[Jaydee1507 Administrator in reply to Hidden]

"During this time my weight has steadily increased and at 28 I am 95kilos... " That's from your bio.

It might be an idea to go down the dose a bit if you're not feeing great.

What were your latest vitamin results - ferritin, folate, B12 and D3? getting these optimal helps us tolerate T3.

[arTistapple in reply to Hidden]

I am 70 too (if you are not 28) I could not dream of adding that level of T3 to my regime. I tried a lot less than that and was not well. Jaydee1507 says 5mcg at a time but I would start at 2.5mcg once per day then twice etc. These private endos are great for getting the prescription we need but some of us need a subtle approach building up to 20 mcgs per day. From where I am sitting 20 mcgs is a big change. Maybe it’s an age thing? Take it easier. If it’s too low after a couple of weeks put it up. Much easier than the opposite. The endocrinologist need never know you took it easy but I found my private endo remarkably easy to talk to after my battle with the NHS.

[Hidden in reply to arTistapple]

thank you, for your thoughts, I will reduce my dose from tomorrow and see how that goes.

[SlowDragon Administrator]

Please add thyroid and vitamin results from BEFORE starting on levothyroxine

ALWAYS Test thyroid levels early morning and last dose levothyroxine 24 hours before test

What vitamin supplements are you currently taking

Essential to test vitamin D, folate, ferritin and B12 at least once a year

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we MUST have optimal vitamin levels

Do you have autoimmune thyroid disease, also called Hashimoto’s usually diagnosed by high thyroid antibodies

Starting on T3 must be done incredibly SLOWLY

Cutting T3 into 1/4’s to get 5mcg

Either use sharp craft scalpel or pill cutter

Get weekly pill dispenser for storing spare 1/4’s

Important to have GOOD vitamin levels before starting on T3

Also need to know where in range Ft4 was when on 100mcg

Eg if

Ft4 21.6 (12-22) …..then yes …..reduce levothyroxine small amount 3-4 days BEFORE starting on T3

if

Ft4 16 (12-22) - unlikely to need to reduce levothyroxine

If

Ft4 only 14 (12-22) need dose increase in levothyroxine before considering adding T3

Optimal vitamin levels are

Vitamin D at least over 80nmol and between 100-125nmol may be better

Serum B12 at least over 500

Active B12 over 70

Folate and ferritin at least half way through range

starting T3

Initially add 1/4 tablet in morning waking (with levothyroxine if you take levothyroxine in morning)

After 2-3 weeks……assuming all ok

Add 2nd 1/4 tablet…..mid to late afternoon

Possibly hold at that and retest in 6-8 weeks

Last dose levothyroxine 24 hours before test

Last 5mcg dose T3 approx 8-12 hours before test

Or adding 3rd 5mcg dose

After further 2-3 weeks

Either at bedtime…. So 5mcg approx every 8 hours- waking, mid afternoon and bedtime

or if that keeps you awake

6am, noon and 6pm

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3

plus both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

have you had thyroid antibodies tested

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

Assuming you have Hashimoto’s……you need coeliac blood test