Hi,
I am hoping to benefit from the experience of others before me.
I am currently on 125 mcg Levothyroxine. I will be starting a trial of t3 and t4 combined next week. The consultant is prescribing 75mcg Levo and 10 mcg Liothyronine. She said it would be fine to start on new doses straight away.
It makes me feel a bit nervous. Is it okay to do a straight swap? Have others done it smoothly? I really can’t afford to be having absences from work.
I’d appreciate any advice please.
Sigh. They just have no idea, do they!
Best to reduce the levo by 25 mcg first for about a week - if it needs reducing at all! It often doesn't. Then, add in 5 mcg for a couple of weeks. If all goes well, then add in the second 5 mcg daily - either at the same time, or in a split dose.
Far, far better to do things slowly and gently rather than come at it with a sledge hammer, which often back-fires, making you feel worse rather than better. 
What is your FT4 level?
Thanks for your reply. I will be cautious and take your approach. I don’t want to risk feeling worse. FT4 in October was 17.2 (12-22).
OK, so your levo didn't really need reducing at all. It wasn't that high in range. And taking T3 will lower the level, anyway.
GG your on top of your game. Best Advice Ever.
Thank you.
GG you are very Sensible. I can't wrap my head around that this day and age Dr's still don't know much about thyroid meds dosing. It's a shame.
I did the same and feel really good. Have done this for about 15 years now.
Thank you for responding. That is so reassuring to hear. I am excited to be given a trial (obviously I can’t wait to feel really good too) but you just don’t know if the doses you are given will be right for you. I’ll have to cross that bridge later. Did you swap the doses in one go?
Rosie. No don't swap doses overnight. Too much of a shock to the body..Reduce levo by 25mcg daily. Wait a week for levels to drop.
If you are given t3 tablets and can split them add 5mcg t3 to your levo dose. Wait 2 weeks. If you are given capsules you can't split you'll need to start on the 10mcg unfortunately.
Reduce levo by 25mcg. Wait a week.
Add in the second dose of 5mcg t3. Either take it altogether or take it as a separate dose. Wait 6 weeks do bloods.
To keep your t3 prescription and to show the doctor you are following their protocol you need to try their prescribed dose. However, often folks find that 50mcg drop in levo is too much and they need to increase their levo dose again. It is trial and error as to what doses of levo and t3 suit you. I spent 2 years slowly adjusting doses until I found what suited me
Thank you so much. Luckily I’ll be getting 5mcg tablets so I can take them in separate doses. I will follow the slow and steady approach you have suggested and make notes in my diary with instructions for the coming weeks.
I’m keeping everything crossed that the doses work but will prepare myself that it might not be the end of the road for me.
Hi Rosie, I see you had your thyroid removed, like me! I went through exactly what you describe more than 10 years ago. When I was prescribed T3 my consultant didn’t ask me to reduce my Levo when I started taking T3. Instead he looked at my FT4 result and decided it would be better to keep it higher within its range. So it’s tricky to know what to advise as another person has also asked what your FT4 result was, and at 17 with an upper range going up to 22 you can be sure that it will drop if you reduce the dose to 75mcg a day. In theory the aim should be to get FT4 and FT3 up to hear the top of their ranges. Unlike a lot of people, my view is that if you have no thyroid at all, it’s even more important to look at the FT4 & FT3 results and treat accordingly. That might well not entail a reduction in Levo but an increase.
The way that I have seen most success with people like you ( no thyroid, horrendous fatigue), FT4 not over range) is to ADD the T3 dose to the Levo whilst keeping Levo the same. ThecT3 dose can be started on 5mcg (my own experience avd that of others feeling desperate fatigue & no thyroid) is that you will barely notice any beneficial change from such a tiny dose. At 10mcg you might feel very slightly better, but chances are that you are going to need more than 10mcg, but you find that out weeks/months along the line. I have seen it where pole like you are told to drop the Levo dose and that in itself makes them feel worse, the addition of a tiny T3 dose not compensating for that feeling worse and therefore overall the dose you’ve been told to take may not help. Sorry, but you need to know what to expect.
On Facebook I run a group that you might like to join called UK without a thyroid. Please join.
Out of interest. Have you managed to get your T3 prescription on the NHS ?
Thanks for responding. I have read that most people feel best when their ft3 and ft4 are in the upper quadrant of the range. I am aware that my ft4 is going to drop and it is not even high right now.
It is an important milestone to have been prescribed t3 via the NHS. It blew me away - I had been preparing to go private. It is a six month trial. I need to get started, see it through and be hopeful. If I need an increase in levo, I’ll cross that bridge next.
"...is to ADD the T3 dose to the Levo whilst keeping Levo the same."
I would agree with this as well. You'll know if there's going to be any improvement within several weeks by doing this.
Great Advice. From someone that had TT as well. Been there and done that.
My question to you is if you feel well and your FT4 range is good too and you just need a bit of T3 to add to your T4 why lower the T4 ? In addition to lower your T4 by a tremendous amount and adding a large dose T3 all in one shot leads me to believe that your Dr/Endo does not understand to thyroid dosing and or is setting you up for failure. With thyroid journey I learned that slow and steady wins the race. In addition labs should be done with vitamin D, B-12/Folate,Iron/Ferritin. These vitamin markers help our thyroid meds work more efficiently.
Best wishes sorting it out.
hi Rosie,
I followed the advice from Greygoose and others on this site. I wasn’t feeling great on T4 alone unless it was over range. Adding T3 has definitely helped me. I was on 125mcg levo for years (constantly being told all was normal) then I’m convinced menopause sent things into a free fall. Unfortunately I’m not getting T3 on prescription but the endo has said he’s happy for me to continue as is.
Endo had increased the 125 to 150 which seemed to work but then TSH dropped and T4 were went a slightly out of range. GP nearly had a buckle lol wanted to reduce to 50mcg! Anyway, I reduced down to 125 and added a quarter tablet (25mcg) for a few weeks. Then increased up to half a tablet. When I tested my bloods, the T4 was a bit high so now I alternate 100/125 T4 each day.
The advice from here will be better than the GP or endo. I agree with what others have said - that reducing your levo by such a huge amount will not help.
Good luck
Advice re combination T4 &T3
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T4 Monotherapy Versus T4/T3 Combination Therapy
