T3 strength compared to T4

[Name4]

Hello, can anyone advise me how much T3 to take if I want to cut out 25mcg of T4?

Many thanks!

[Jaydee1507 Administrator]

The answer is probably noone can tell you in advance, as we are all different as to how we absorb and use T3, plus difference in formulations between brands.

T3 is usually introduced slowly at 5mcgs at maximum every 2 weeks.

What were your latest thyroid blood results, also vitamins? It is very important to have optimal vitamin levels when introducing T3.

[Name4 in reply to Jaydee1507]

Thanks Jaydee, I am already taking T3, in fact, mostly T3, and what to cut out the small amount of T4.

My T3 was in range, and T4 low, as expected on the dose I’ve been taking.

Thanks,? I will look into the vitamins, as I’ve not had them done lately.

[Name4 in reply to Name4]

Ps… the question mark in my reply was added by mistake

[Jaydee1507 Administrator in reply to Name4]

Best go by blood results but 5-10mcgs is my best guess. Only add 5mcgs at a time every 2 weeks.

[Name4]

Thanks for your advice

[jimh111]

LT3 is 3x as potent as LT4.

[greygoose]

Not only does it depend how well you absorb T3, but also how well you convert. If you're a very poor converter then T4 isn't equal to very much T3 at all. All you can do is increase the T3 by a small amout - personally, I wouldn't add more than 5 mcg to begin with - and see how it goes.

[Name4]

Thanks so much jimh111 and grey goose for the information that you have shared, much appreciated, I’ll certainly take it slow

[waveylines in reply to Name4]

Trial and error is really the best way as already suggested. The strength in comparison of T4/T3 is much argued over, some people say 3xs, some 4x & I even read one source 5xs. That level of disagreement means it's not a great guide at all. These arguments are used to argue against the use of NDT in medicine...... But they don't consider the rate of uptake! Liothyronine for example has a much faster uptake than NDT, Peaks far more quickly so it's protocol would be different for many on NDT. But in essence it all come down to how the individuals body respond as there are so many other factors at play.

[Name4 in reply to waveylines]

Thanks so much for your reply, it’s a very good point, especially if I wasn’t converting the T4 well in the first place. I think it certainly is going to be trial and error.

[Fluffysheep]

I can't tell you that this is the right way, but I reduced T4 meds at 25mcg per go, then after a couple of weeks or so increased T3 by 5mcg. This was all done very slowly over a long period of time, and I just kept repeating the cycle until I'd cut levo out completely.

I decided I wanted to cut T4 out completely as I've never done well on it. I started cutting down following my last endo appointment in July (didn't tell him I was going to), at that point in time I was on 100mcg levo and 37.5mcg T3.

I took my last dose of levo at the end of November (at which point I had very slowly cut down to 25mcg of it), and then in January settled on a dose of 50mcg T3 (obviously had been upping it slowly, didn't go straight from 37.5mcg to 50mcg!).

Didn't feel like this was helping, so in March I upped to 55mcg, then in April to 60mcg.

To be honest, I'm now starting to think I may have a problem with thyroid hormone resistance, due to how I'm feeling, and how little effect any kind of thyroid medication seems to have on me. I did do the genetic testing, and have one genetic variant for each of DIO1 and DIO2, so this supports the fact I'm likely to need T3 medication. Levothyroxine did absolutely nothing for me other than leaving me feeling like a zombie, which is why I decided I wanted to stop it completely and try T3 alone (am currently reading Recovering With T3 by Paul Robinson, which is extremely interesting and I can relate to so much of his story).

I probably need to go higher with the T3, but it's a little bit of a scary prospect, as there is less and less research out there about higher doses. I'm sticking at 60mcg for now, as that's what NICE guidelines say for treatment on T3 alone, and I have an endo appointment next month and feel like it's already going to be hard work explaining why I've done what I've done (whilst asking for an increase in my prescription to 6omcg!), but I can at least say honestly that I'm currently sticking to dosing guidelines.

[Name4 in reply to Fluffysheep]

Thanks so much for your reply. It’s so helpful to know your experience!

I do have Paul Robinsons book, but I have been feeling so unwell, that I haven’t been able to do much reading.

Thanks for explaining how you did the cut/exchange, seeing how gradually you have done that, I think I’ve gone too quickly. The trouble was my levels were so low to start with, the T4 was making me feel so unwell, I don’t think I was converting it.

Sorry to hear that you are still having difficulties with absorption. Maybe it will take longer for you to adjust. Do you have an NHS or private Endo? Im thinking your Endo must be fairly open minded, as you had been on T3 and T4.

Do you have to source the T3 yourself?

It’s helpful to know about the info on NICE guidelines, I wasn’t aware of that. It’s good that you have that behind you when you go back for your appointment.

I think I might look into the genetic testing, it would be good to know, though I did take Levo ok for some years, so not sure this would be applicable to me. Levo is definitely not working for me anymore, I have had difficulties for so many years now, I started T3, managed to get down to just 25mcg, and was just about coping with that, and then they changed the ingredients, and that was the last straw. The T4 was giving me so much bone and muscle pain that I just had to drop it,

I am feeling better than I was, even tho it was only 25mcg, it was making me feel so ill, I replaced it with12.5 T3, so double what I should have, I’ll cut back for sure, but hopefully will be able to read a bit more now.

Thanks again for you reply!

[Fluffysheep in reply to Name4]

I have an NHS endo. He wasn't particularly supportive of T3, however by the time I got to see him I had already been taking self-sourced T3 for a while and explained how much it had helped me (it did make a huge difference compared to how I was on levo, but I'm by no means better, and still have a lot of problems, which is why I'm considering whether I might have thyroid hormone resistance).

He did listen to me, and although we had some false starts (initially he told me he couldn't prescribe it but would write to my GP to ask them to prescribe it. I told him that this wouldn't be allowed as NICE states that T3 prescriptions had to be done by an NHS endo for 3 months first, but he ignored that and wrote to my GP. Shock horror, she couldn't prescribe it as not allowed!). Eventually he did mange to pull a prescription out of the bag from the hospital for 3 months, and wrote to my GP. I then had to fight for them to prescribe it, as they refused without additional funding from the CCG/ICB, but I sent in a huge long complaint email to the practice manager (took me hours to write and I was mentally exhausted and burst into tears after doing it). They asked if they could use the email to send directly on to apply for the funding, and a week later it was agreed. I'll admit I was shocked!

I have skim read most of Paul Robinson's book, but I need to go back and read in detail. I suffer hugely with brain fog and fatigue, so like you I struggle to read properly, and also to hold onto information. Even just reading the introduction though with his story rang so many bells for me. I was practically bedbound on levothyroxine, started on 25mcg and went up to 150mcg and didn't make a difference at all. It was only when I started adding in some T3 (very slowly) and got up to about 10mcg that I started noticing a difference. I now function - not particularly well, but compared to that year of hell on levo it's much better.

I have no idea how my endo will react to me having changed my dose so much. That's why I've stuck at 60mcg for now as it's the recommended dose. If I can persuade him to write to the GP to up my prescription to that (and actually, from a purely monetary perspective, it won't cost them any more because they currently have to make up my 37.5mcg prescription with boxes of 20mcg, 10mcg and 5mg, so will just be replacing that with 3 boxes of 20mcg) then I'll take it from there, and gradually adjust upwards in the hope I can find a dose that actually helps me. I still have quite a stash of self-sourced T3 left (we went to Corfu last Easter specifically so I could do the rounds of pharmacies, as you can buy over the counter then for just over 2 euros a box).

The genetic testing I did for the DIO1 and 2 genes was with blue horizon. They had it on a special offer, then thyroid UK had a code to take 20% off (think it was that), so it ended up being just over £100. The way they show results is a little unclear - they've tried to simplify the explanations so much they've actually made it a bit confusing, but with some handy internet sleuthing I got to the bottom of them.

[Name4]

That does surprise me that you have an NHS Endo, a good way forward tho supplying your own T3 to begin with.

So good that you were prepared with info on NICE too, tho why can’t these Drs listen, some do, but I find the majority don’t.

Well done for fighting so much to be able to get the T3 prescribed, that must have been such a relief!

Thanks re the genetic testing, that’s good to know.

The only Endo I’m allowed to see on the NHS wants to take me off the T3 bcos of the CCG wanting to stop my T3 due to costs.

Maybe I need to start writing some letters too. I’ve kept my dose as it was during the spike of price of T3, for fear of losing the T3 that is prescribed, but now I have even more issues with the T4, I need to find a way forward.

I can so understand the brain fog, fatigue, being bed bound on Levo, and not being able to retain information, same here.

Thanks again, the info you have shared has been so helpful.