Anyone taking levo and T3 ? : Hey folks, seeking... - Thyroid UK

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Anyone taking levo and T3 ?

Mobilepirate profile image
35 Replies

Hey folks, seeking some guidance, aprecciate any help, im wanting to get on a proper dose of t3 to feel better

I had a full TT, now just on levothyroxine, 100mcg

Im hypo with TSH of 5,64 µUI/mL

Lab REF being 0,40 a 4,30 µUI/mL

--

FT4 1,61 ng/dL

Lab REF 0,70 a 1,90 ng/dL

--

I will ask tomorrow for a FT3 and rT3 test and will update here

Should i lower my dose of levothyroxine prior from starting T3, If so, how much should i drop?

What would be a resonable dose of t3 to start with, 7,5 mg twice a day?

Thank you for your time

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greygoose profile image
greygoose

Are you in the UK? If so, no way will you get an rT3 test. It isn't even necessary because it won't give you any useful information that you can't get from testing FT4 and FT3 at the same time. And, with your levels of FT4 - FT4: 1.61 pmol/l (Range 0.7 - 1.9) 75.83% - even if your rT3 is high, it will have nothing to do with your thyroid because your FT4 isn't high enough. There are many, many causes of high rT3, and only one of them has anything to do with thyroid.

FT3, on the other hand, is essential to know how well you convert. :)

Mobilepirate profile image
Mobilepirate in reply togreygoose

Hello there,

Thanks for reaching out, in not in the UK, brazil here. got me :)

-even if your rT3 is high, it will have nothing to do with your thyroid because your FT4 isn't high enough

What thyroid mate? I mean, i had to remove it , due to health issues(ptc)... But you're saying that my FT4 is low anyway, that what you're saying Isnt It?

-FT4 and FT3 at the same time.

I Will do that then, today i will ask the doc for these to be measured, i will get the rT3 Just to base myself om how its going in general

I will update here once i get It, do you think that i should lower my t4 dose to start with T3? Im hypo on that dose already, what do you think?

Thanks for your time mate.

greygoose profile image
greygoose in reply toMobilepirate

Yes, ok, you've had your thyroid removed, but when we use the word 'thyroid' on here, we mean 'thyroid status' - i.e. FT3/4 levels. Not necessarily the gland itself.

No, I didn't say your FT4 was low, it isn't. It's 75.83% through the range, which is a good level for most hypos. But, it isn't high enough to cause high rT3. Which is good.

will get the rT3 Just to base myself om how its going in general

Doesn't matter how it's going in general, it's totally irrelevant. rT3 is inert - it doesn't do anything - it's just a step in the recuperation of iodine, which is recycled in the body.

And suppose it was high? What would you do about it?

do you think that i should lower my t4 dose to start with T3? Im hypo on that dose already, what do you think?

I don't think it's necessary. Your FT4 will drop anyway when you start T3, because that's the way it works.

But, the reason you're still hypo on that dose is probably because you aren't converting it to T3 very well. So, get the test and let's see the results. ;)

Mobilepirate profile image
Mobilepirate

No, I didn't say your FT4 was low, it isn't. It's 75.83% through the range, which is a good level for most hypos. But, it isn't high enough to cause high rT3. Which is good.

But, the reason you're still hypo on that dose is probably because you aren't converting it to T3 very well. So, get the test and let's see the results. ;)

Really appreciate your time and help :)

greygoose profile image
greygoose in reply toMobilepirate

You're welcome. :)

pennyannie profile image
pennyannie

Hello Mobilepirate and welcome to the forum :

a fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg - with T3 said to be around 4 x more powerful than T4.

When on T4 only we generally feel best when the T4 is up in the top quadrant at around 80% through the range with the T3 tracking just behind at around 60/70% through its range and at around a 1/4 ratio T3/T4.

No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal levels - and these are ferritin, folate, B12 and vitamin D.

Some people can get by on T4 only.

Others find T4 seems to stop working as well as it once did and that by adding in a little T3 - at around a similar level to that they had when they had a thyroid - restores T3/T4 hormonal balance and they feel better.

Some can't tolerate T4 and need to take T3 only - as you can live without T4 but you can't live without T3.

Whilst others find their health restored better taking Natural Desiccated Thyroid which contains all same hormones as the human thyroid gland and derived from pig thyroids, dried and ground down into tablets referred to as grains.

In order to help you better we need a blood test showing :-

TSH, Free T3 + Free T4, inflammation, antibodies and ferritin, folate, B12 and vitamin D -

This needs to be a fasting, early morning blood draw -

just take in water until after the blood draw -

and having left a 24 hour window from your last dose of T4 -

and having been of all supplements being tested and anything containing biotin for around 7 days - so we measure what your body is holding rather than that just recently ingested.

What is ptc - ?

Mobilepirate profile image
Mobilepirate in reply topennyannie

Hello pennyane

My antibodies are down, thyoglobulin and anti tpo, former is at 0'5, and anti tpo less than 12ng/dl i think its the measurment, will confirm.

In order to help you better we need a blood test showing :-

TSH, Free T3 + Free T4, inflammation, antibodies and ferritin, folate, B12 and vitamin D -

TSH is high- Its 5,64 µUI/mL

FT4 is at 75.83% through the range, based in what user greygoose explained to me,

FT4 was: 1.61 pmol/l (Range 0.7 - 1.9)

I measured again today, FT3 and FT4 and TSH, will update once i get the results

Regarding b12, i take b12 once or twice a week Just in case due to other reasons.

Regarding vitamin D i take calcitiriol If not daily just cycling day yes day no, its the active form of vitamin D.

Still while taking It my vitamin D wasnt high, It was 37ng/ml maybe the measurment for the Active form of D in the blood is diffrent

Ferritin and folate i gotta measure, but often take some rice bran few days a week, It has folate.

What is ptc - ?

Thyroid cancer,

I will update as soon as i get the results

Thanks for you time

pennyannie profile image
pennyannie in reply toMobilepirate

OK - we can all read what is being written by you - this is an open patient to patient forum but sometimes questions get repeated simply because of timing issues - so there is no need for you to keep repeating information.

Go easy on the cycling until your medication is optimal - going that extra mile - and pushing yourself not a good idea at the moment - your thyroid was your gear change mechanism - and your body needs time to recuperate and reset itself.

The thyroid is a major gland responsible for the full synchronisation of your body from your physical ability and stamina, through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

SlowDragon profile image
SlowDragonAdministrator

Get vitamin D, folate, ferritin and B12 levels tested as next step

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we need good vitamin levels

Many patients on replacement thyroid hormones need to supplement vitamin D, magnesium and vitamin B complex continuously to maintain good levels

Some people also initially need separate B12

Some need to work on improving low iron/ferritin

How much levothyroxine are you taking

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

is this how you did your test

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

Mobilepirate profile image
Mobilepirate in reply toSlowDragon

Hey slow dragon

Get vitamin D, folate, ferritin and B12 levels tested as next step

I take b12 ocasionally, Rice bran also, It hás b vitamins and other stuff as iron, folate, others vitamins, i use caciltriol, active form of D, day on day off, i measured my D levels again today. Last time It was 37ng/ml despite calcitiriol

How much levothyroxine are you taking

100mcg

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

Ate an Orange and bread some several hours before testing, around 7 hours before. Tested around 12pm, took the dose of levothyroxine at 5 am.

I will update here on the thread as soon as i get the new results

Thanks for y'all time. Appreciate It.

SlowDragon profile image
SlowDragonAdministrator in reply toMobilepirate

Next time test before 9am and last dose levothyroxine 24 hours before test

Mobilepirate profile image
Mobilepirate

Hey folks.

End of the day, the doc ended not asking for fT3 levels, but t3 count in the blood.I will go to the lab and pay out of pocket for the FT3.

since the day i got the former updated results, i upped my dose from 100 mcg to 125mcg.13 days or so on that dose.

my TSH lowered from 5,64 µUI/mL a bit to 3,21 µUI/mL,

FT4 is 2,2ng/dl

(not fasted when i measured, not 24h from the last dose)

T3 in blood (not free T3) is 104 ng/dl

Despite this i got back to my 100mcg, felt that It didnt changed anything , fatigue still high, maybe worst even, as i wasnt feeling well with it i got back to 100mcg

Will update once i test fT3, and i will get the TSH again and FT4 again , this time i will get it done properly as you folks advised

Going to update here when its done

Thank you for your time.

Mobilepirate profile image
Mobilepirate

Hey guys and gals

I had major diffrences in my results,

As i went back and forth with the doses, or because of getting back to using TUDCA/UDCA

how can i do the transition to T3 safely,?

The way that t3 affects my nerves (i have nerve damages) its much diffrent than levothyroxine, i got to change, but concerned in how to do this. Need some insight

My levels fasted, 24h from the last dose of levothyroxine, 100mcg (a week in) after backing down from 125mcg that i took for 14 days.

TSH 1,96 uUI/ml - lab REF ( 0,40-4,30)

fT3 -3,01 pg/ml - lab REF (2,00- 4,40)

fT4 - 1,75 pg/ml - lab REF ( 0,70-1,90)

--

Need help to get by on just T3, How should i go with this? I backed down to 75mcg levo and added 2.5 mcg t3 at morning, is that too little t3 to replace 25mcg ?

im calculating based on what i saw here that 2.5 mcg = around 10mcg t4 , is that correct?

how long should i wait to cut another 25 mcg and How much t3 should i add ?

Thank folks

Jaydee1507 profile image
Jaydee1507Administrator in reply toMobilepirate

Are you testing at 9am or earlier?

Are you leaving 24hrs between last dose of Levo & blood test?

You still have a small amount of room for a Levo dose increase.

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

Don't start on any more than a total of 5mcgs T3 a day. More than that can cause issues.

Mobilepirate profile image
Mobilepirate

I dont understand this major changes in my levels (i changed labs for this last blood work) but formerly when taking 100mcg levo my TSH was 5,64 uUI/ml..

took 125 for 14 days, tested- TSH 2,61 - didnt felt well with It, backed down to 100mcg, 5 days and tested again, TSH -1,96 ... Seems that this 25mcg did major changes in my levels, but didnt felt well at all ...

Now im on 75 mcg levo, want to get down on levo and adjust with t3, any insight on how should i go with this?

I backed down to 75mcg levo and added 2.5 mcg t3 at morning. will take more 2.5 mcg at evenning today. is that too little t3 to replace 25mcg levo ?

How long should i keep with this dose to test again?

Thank you folks

Jaydee1507 profile image
Jaydee1507Administrator in reply toMobilepirate

Its important to note that people often report feeling worse with an increase before they turn the corner and feel better. Changing your dose every few weeks and expecting to feel well isn't going to work.

It takes 6-8 weeks for blood levels to stabilise enough for results to be accurate. The results you have after 14 days and 5 days aren't worth the paper they are written on.

How do you know you need T3? What was your latest result to include an FT3 result?

Expectations need to be lowered about feeling well on any particular dose after a few weeks.

The way treatment for hypo works is to take a dose for 6-8 weeks then do a blood test. Assess the results and adjust from there.

Following an increase in dose you may feel a bit worse before you feel an improvement. It can take many, many months to actually feel well.

Mobilepirate profile image
Mobilepirate

How do you know you need T3? What was your latest result to include an FT3 result

My last blood work

TSH 1,96 uUI/ml - lab REF ( 0,40-4,30)

fT3 -3,01 pg/ml - lab REF (2,00- 4,40)

fT4 - 1,75 pg/ml - lab REF ( 0,70-1,90)

--

T3 feels diffrent on my nerves , there are reasons for that, when i ingest levo i feel It hitting the nerves in a way, and T3 in another, ( i have nerve damages) Then, i'm just wanting to make sure im safe with this dose and that im doing this properly, as i already kinda messed things up a bit by going back and forth with the levo

The goal being partially replace levo for t3 ...

Dropped 25 mcg from 100, and added 2.5 mcg twice a day (8 hours apart)

tattybogle profile image
tattybogle in reply toMobilepirate

hi , when replying to someone on your post , you need to use the the reply box directly beneath their comment. That sends them an 'Alert' that you have replied to their comment .

i assume you were replying to Jaydee1507 , but she won't know about it unless she comes across it by chance. (she will see it now as i have 'tagged' her, which also sends an alert)

to tag someone , you put an @ before typing their name( no space), a drop down list will appear, click on the name you want , and it will go blue)

Mobilepirate profile image
Mobilepirate in reply totattybogle

Thank you mate,

..

Mobilepirate profile image
Mobilepirate

Hey folks

User tattybogle gave me a heads up, then im marking you guys/gals to see this message greygoose Jaydee1507 SlowDragon

Idk If im taking too little T3, 2.5mcg twice a day or if its too soon to tell, i tend to respond very quickly to stuff, but im noticing heart effects, idk If Its due to hypo or hyperthyroidism, or just due to changes in hormone levels itself, but Its a bit concerning, only symptom im getting from this change of dose is that occurance with the heart, less fatigue , a bit of strange feeling on the neck but not major anything blood pressure stuff . But i wasnt getting these at 100mcg and with my TSH being 5,61

I found a lab which is cheaper, (10 € for the Full pannel, planning to check this tomorrow, i might bê over reacting and too soon changing doses, but im a bit concerned...

What do you guys think, too little t3 given that i lowered 25mcg of levo, from 100> to 75mcg +2.5 mcg t3 twice a day?

My last blood work

TSH 1,96 uUI/ml - lab REF ( 0,40-4,30)

fT3 -3,01 pg/ml - lab REF (2,00- 4,40)

fT4 - 1,75 pg/ml - lab REF ( 0,70-1,90)

--

I will measure again tomorrow being fasted around 24 h from the levo dose, and around 16 hours from the t3 dose, i might be overeacting but a bit concerned.

Please let me know what you guys think.

Thanks

greygoose profile image
greygoose in reply toMobilepirate

You don't say how long you've been on this dose but with those last labs you're hardly likely to have jumped to over-medicated on just 5 mcg T3 a day - especially as you reduced your levo (I wouldn't have done that).

Palps are a major hypo symptom, so it's far more likely that you're still under-medicated rather than over-medicated. Don't worry about it. Even if your levels are a bit over-the-top, it's not the end of the world. :)

Mobilepirate profile image
Mobilepirate in reply togreygoose

You don't say how long you've been on this dose but with those last labs you're hardly likely to have jumped to over-medicated on just 5 mcg T3 a day - especially as you reduced your levo (I wouldn't have done that).

When i measured i was taking 100mcg back again for 6 days or so, too little time to test...

i tend to respond very quickly to anything that i take or change in regimen, not just t3, rápid respond to whatever drug or supplement

I did 3 tests, former i was on 100mcg levo, TSH was 5,61 and i was hypo, then i took 125mcg for 15 days, TSH went to 2,8uUI/ml (0.40-4,40) or so, didnt felt better so i backed down to 100mcg, TSH went to around 1,96 uUI/ml, then i dropped 25mcg (75mcg/t4) and added 5mcg T3, might be hypo

Palps are a major hypo symptom, so it's far more likely that you're still under-medicated rather than over-medicated. Don't worry about it. Even if your levels are a bit over-the-top, it's not the end of the world. :)

Its not really palpitations, more like trepidations, you might be right, likely that im hypo due to lowering t4 even more.

Im thinking about adding another 2.5 mcg or 1.25mcg, or i am better testing first to make sure?

i should wait at least 6 weeks for a proper measurement, im deciding If i just add 2.5 mcg > 7.5 mcg t3 /d and see If It improoves

Is testing tomorrow a bit too much? I found a cheap lab (=9€) for a full test, at least i would make sure what step to take ... Guess i will do It, thx bro.

greygoose profile image
greygoose in reply toMobilepirate

"i tend to respond very quickly to anything that i take or change in regimen, not just t3, rápid respond to whatever drug or supplement"

Responding to drugs and building up enough T3 in the blood to get into the cells to make you over-medicated are not the same thing. Even if you were taking enough to do that - which you weren't. You cannot compare reacting to hormones to reacting to drugs and supplements because the pathways are not the same.

"I did 3 tests, former i was on 100mcg levo, TSH was 5,61 and i was hypo, then i took 125mcg for 15 days, TSH went to 2,8uUI/ml (0.40-4,40) or so, didnt felt better so i backed down to 100mcg, TSH went to around 1,96 uUI/ml, then i dropped 25mcg (75mcg/t4) and added 5mcg T3, might be hypo"

You cannot compare dose levels to TSH like that because the TSH tends to be too erratic - there are too many variables that affect is. And, anywya, it's not about the TSH. The TSH doesn't make you feel anything, good or bad. It's the Free levels you should be looking at - especially FT3. And, anyway, with those levels, it's a million to one chance that you're over-medicated, even on an individual level. So, I would stop worrying about that, if I were you.

Seems like there's been a lot of chopping and changing going on, but we still don't have a time-line, so difficult to comment. And we still don't know if you're a poor converter so don't know if you actually needed that T3.

I think what you need now is to stay on the same dose until you reach six weeks on it, with no further changes - give your body time to settle down - and then retest. Then you'll know what to do next. :)

Jaydee1507 profile image
Jaydee1507Administrator in reply toMobilepirate

Many people struggle totolerate T3 if they have low vitamin levels. Have you tested ferritin, folate, B12 & D3 and have now raised them to optimal?

Palps can also be a hypo symptom which wouldnt be surprising as yourTSH was almost 2 previously and it can take time for any new dose to work well.

How long have you been taking this dose? You need a minimum of 6-8 weeks to get an accurate result.

16hrs is too long a space for T3 before blood test. Delay your last dose the day before to allow maximum 8-12 hrs, otherwise you will get a false low result.

Mobilepirate profile image
Mobilepirate in reply toJaydee1507

Hey jaydee, while i dont have pannels in regards of vitamins, i guess that i have my levels covered due to supplements, b12 and D included, i need to test folate but i consume some organic Rice bran that hás folate and iron.

Palps can also be a hypo symptom which wouldnt be surprising as yourTSH was almost 2 previously and it can take time for any new dose to work well.

It might be that, i found a cheap lab, i might test to make sure tomorrow, If hypo im upping my T3, then i test again in 6 weeks

How long have you been taking this dose? You need a minimum of 6-8 weeks to get an accurate result.

I messed things up a bit, i was in 100mcg levo, upped to 125mcg, didnt felt well, backed down to 100, tested again, TSH even lower at almost 2 but lower than when i was taking 125mcg, didnt took enough time tho and tested(6 days taking 100mcg) then i dropped 25mcg and got 5mcg t3 a day to cover, ending on 75mcg levo and 5mcg t3 (2-3 days now) im likely hypo, i will make sure tomorrow, If thats the case i will up the t3

Im having strange stuff in my neck might be BP and trepidations in the heart, a bit not bad boatiness.. . These mentioned are not severe but bothersome

Based on my results i will up the dose, If i mantain my dose sheudle, i would then be taking 2.5 mcg prior from testing

Wonder If i should take It now 8 hours before testing, or take my doses only after testing, took my dose today at 6PM, hence test will bê around 14h later.. what do you suggest? Take now or Skip and take It after testing?

SlowDragon profile image
SlowDragonAdministrator in reply toMobilepirate

vitamins, i guess that i have my levels covered due to supplements, b12 and D included

You can’t assume your vitamin levels are ok

You need to test

Exactly what vitamin supplements are you taking

Stop any supplements that contain biotin 5-7 days before any blood test

As others have said absolutely no point doing any blood test until been on constant unchanging dose and brand levothyroxine and T3 for minimum 6-8 weeks

all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

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

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Mobilepirate profile image
Mobilepirate

Hey everyone, greygoose , SlowDragon ,Jaydee1507 , tattybogle ,pennyannie good evenning everyone

I waited some time and tested again, fasted and 10h after last dose of t3

Im feeling a bit better with this ongoing sheudle of 75mcg levo and 7.5 mcg of t3, willing to updose to 10 mg a day in 3 doses

My TSH came back high , is that normal? Its at 17,12 uUI/ml REF being 0.38-5,33

fT4 at 0.76ng/dl REF being 0,54 -1,24

fT3 at 2,89 pg/ml REF being 1,81- 4,59

Is concerning that my tsh is that high? It was much lower when only on levo, but was feeling worst, now its that high but feeling a bit better

Will my TSH Go down If augmenting the t3 ?

Thanks everyone

Jaydee1507 profile image
Jaydee1507Administrator in reply toMobilepirate

How long have you been on the same dose that you took this test on?

How are you taking your Levo?

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

Mobilepirate profile image
Mobilepirate in reply toJaydee1507

more than two weeks, around 20 days.

I take Levo 75 mcg first thing in the morning paired with 2.5 mcg of t3, empty stomach, i dropped from 100 to 75mcg prior from starting t3

At the time of this test, i was fasted, didnt took levo not t3, and my last t3 dose was 10h prior.

Thx

Jaydee1507 profile image
Jaydee1507Administrator in reply toMobilepirate

Your levels will only settle and be an accurate reading after 6-8 weeks. There is no rushing this process, otherwise you risk finding your dose taking a lot longer and making yourself unwell in the process.

Retest once you've been on the same dose for a minimum of 6 weeks, preferably a little longer.

Mobilepirate profile image
Mobilepirate in reply toJaydee1507

Thanks mate, will do that, appreciate your help.

pennyannie profile image
pennyannie in reply toMobilepirate

Hey there -

Two weeks is too soon to test - you need to be testing 6-8 weeks after any dose increase and only change T3 or T4 at any given time.

You have had surgery that has massive implications throughout the whole of your body and I'm afraid thyroid hormones take time to settle with the body adjusting and resetting itself after a thyroidectomy and it's a slow build back to a full recovery.

Your T4 is much too low at around 31% and your Free T3 too low at around 39% :

We generally feel best with Free T4 up at around 70/80 %

with T3 tracking behind at around 67/70 % :

Your TSH is not a reliable measure of anything when without a thyroid and taking thyroid hormone replacement - yes it's too high - stop tracking it - and build up your T3 and T4 -

As a rough guide as detailed previously, a fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1, T2 and calcitonin + a measure of T3 at around 10 mcg + measure of T4 at around 100 mcg.

Do you have some current readings for ferritin, folate, B12 and vitamin D ?

If you are out riding your bike, you need to stop until your thyroid hormones are high and stable in the ranges and you have the necessary reserves of T3 and T4 to pull on - and not leave you exhausted with nothing ' in the tank ' :

greygoose profile image
greygoose in reply toMobilepirate

I don't think it's concerning because TSH doesn't make you feel anything, it doesn't cause symptoms, but it's rather strange.

FT4: 0.76 pmol/l (Range 0.54 - 1.24) 31.43%

FT3: 2.89 pmol/l (Range 1.81 - 4.59) 38.85%

As you can see, your Frees are still rather low, but I wouldn't have thought they were low enough to cause a TSH that high. Could be a pituitary malfunction, could be laboratory error or something interfering with the assay. But I wouldn't worry about it. Try and get your Frees higher and see what happens at the next blood test.

Mobilepirate profile image
Mobilepirate in reply togreygoose

Hey, thx, should i just updose the t3 and let the t4 the way It is? updosing t3 affects t4 ?

Thanks mate

greygoose profile image
greygoose in reply toMobilepirate

Increasing T3 lowers T4. But, try an increase in T3 first.

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