I have been prescribed T3 by private endocrinologist in combination with T4. The doctor has asked me to reduce T4 from 100 mcg to 50 mcg and change to nighttime dosing, and add in T3 5mcg at breakfast and 5mcg at Lunch. I am not sure he wants to increase this to three times a day eventually.
I haven’t been able to start this at the moment due to not finding the right T4 for me (I have been switching between brands and I know this isn’t right but I need to know what one suits before I trial T3).
I’m not sure dropping to 50 mcg will be too much but he said T3 is potent and T4 needs reducing by half.
Previously, my T4 has been over range with finger prick test, and a most recent private blood test that showed it still over range but not as high.
Thank you for any advice greygoose TiggerMe or anyone else who could possibly help.
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Sailing14
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I personally would reduce Levo to 75mcg as a first step, as I found making increases/ decreases in larger steps had an adverse reaction. I also started with 5mcg Liothyronine and introduced a second dose once well tolerated. It is key to retest levels 6-8 weeks after making a change. Personally, I like to wait 8 weeks as it can take this long for me to ‘feel the difference’.
Hope you don’t mind me messaging but could you advise when you take your T4 and T3 as the endocrinologist wanted me to take the T4 at night and I know I will find this difficult.
It’s very much trial and error to find a regime that works best for you. Personally, I take my Levothyroxine on waking, alongside 2/3 my Liothyronine dose. I try to leave an hour before breakfast. I take the last 1/3 of my Liothyronine in the afternoon, as I found this evens up my energy levels.
Thank you. If I have already started by reducing T4 by half and changing to evening and adding in T3 at breakfast and lunchtime for two days, how would I dose tomorrow morning?
I wanted to at least see if the endocrinologists advice would work but realise this is making me unwell this evening.
Steer well clear of making big changes, as already advised drop to 75t4 and then add in some t3 and see how it goes. I would agree with you finding a T4 brand that suits you should a priority before combination T3/T4. Adding more unknown variables into the mix on combo therapy will only confuse the picture even more.
Thank you for your reply and advice on the T3 and doing this gradually. I can very much understand what you are saying regarding confusing the picture with T4 also.
I think 50mcg sounds like a big drop, we have plenty of members on 100mcg of Levo and 10-15mcg of Lio. T3 suppresses FT4 levels anyway and we are always told not to drop Levo by more than 25mcg.
When I started I was on 200mcg Levo daily. I dropped Levo down gradually over a few days to 150mcg, started off on 6.25mcg Lio and then after 2 weeks added another 6.25mcg and I've stayed on the same dose. I did try adding a third dose in for experiments sake but found it too much.
My bloods are good and I feel this is about right for me. Endos always seem to want to drop Levo by too much when adding T3.
Thank you for your helpful reply. I can understand what you mean about the big drop with Endocrinologists and I am nervous of dropping by 50 mcg in one go even if T3 is being added.
It’s good that you were able to work out what was suitable for you in the end and gives an insight into how to work this all out.
I would not be prepared initially to drop my T4 dose!
T3 naturally lowers both TSH and FT4!
he said T3 is potent and T4 needs reducing by half.
T3 is more potent than T4 but dropping from 100mcg to 50mcg is likely to be a shock to the system....particularly if you are introducing T3 at the same time
Only change one thing at a time otherwise you have no idea what is affecting what
I don't think this private endo has much idea about T3...being private doesn't mean they are better educated. Maybe just more quickly accessible!
T3 needs to be added low and slow so I would start by adding 2.5mcg in the early morning....at least an hour away from food and drinks/breakfast
I don't agree with the endo's advice to take the hormone at breakfast and at lunch....food affects absorption!!
After a week I'd introduce 2.5mcg in the evening.
Wait another week and increase morning dose to 5mcg then after another week raise evening dose to 5mcg
There is no quick fix and rushing increases is a retrograde step!
Once you are on 5mcg twice a day see how you feel. I'd be inclined to test after 6 weeks on 100mcg T4 + the 10mcg T3. Only then would I consider reducing T4 if FT4 is still high.
From then on dose changes need to be slower.....T3 every 2 weeks and T4 every 6 weeks.
I would want to avoid more than 2 doses daily (morning and evening)....the body doesn't normally need multiple dosing. T3 stays in the serum for about 12 hours but once on a stable dose it remains in the cells ( and so available) once cellular level has built up.
T3 doesn’t stay stable for more than about12 hours in the blood….though it stays in cells, and is available, for a few days.
Too many changes confuses the system.
I base my comments on my own experience of using T3... from T4/T3 in various combos eventually to high dose T3-only.
Listen to your body, keep a diary noting all dose changes and any symptoms or improvement.
Expect to experience bumps along the way as the hormone level settles....it doesn't mean T3 isn't working, just that the dose still needs tweaking. That can take many months, so be patient!
how does it increase their income? Mine put me on T3 only of 10mcg split through day and NEVER with food, so normally food one hour later. This was early 2019. But he also said that I’d have to source privately, because NHS reluctant to do so, because so expensive. Also British Thyroid association doesn’t think T3 is good and keep rabbiting on about TSH. Mine’s around 0.01 and my T4 is low and GPs can get very upset about this, because they don’t really know enough!. But because I go straight to the T3 that the body needs, I don’t need lots of TSH to make thyroid release T4, which then has to change to T3. My body is not doing this, so, as I say, I cut out the middle man.
So, until Brexit, I sourced from German company, with British prescription, and sometimes in France and Belgium. Since, I have have bought online from abroad without prescription. A box of 100 x 25mcg costs me around £11.50. I usually buy 3 boxes at a time and post is usually the same - also around £11.50. It’s just as well that it’s so cheap because I have now increased to 75mcg a day!
Because every time they write a private prescription they charge, so if they increase the dose, decrease the dose, change the number of tablets, or the manufacturer they charge.
Or if you dont feel well and have to ask questions or for guidance they charge. Private medicine isnt cheap. And they need us to keep coming back for more. You pay handsomely for their time, so called expertise and prescription pad.
Thank you very much. This is really helpful advice and I will take all your suggestions into consideration when I do commence on the T3 which I hope is very soon.
I know this is a delayed reply, but I have reduced my T4 by half and changed to evening and taken T3 5 mcg at breakfast and lunchtime (at endocrinologists advice as I wanted to at least see if it would work), but I now feel unwell.
I have read over your suggestions, do you mean take the T3 with my T4 in the morning? This was my normal time for T4 and I have really struggled to take at night due to my eating patterns and gaps needed.
Also, how would I dose this morning, as I have already reduced T4 by half and put in T3 breakfast and lunchtime Saturday and Sunday.
The thought of taking T4 and T3 together worries me and I also put trust in my Endocrinologist like we do, so am finding I’m getting very mixed up again leading to anxiety and stress.
Thank you for your reply and helpful advice. I have got on the wrong track but have received some helpful advice here so I am going to start afresh and hope for a better outcome.
The endocrinologist said take T4 at night and 5 mcg with breakfast and lunch but I just can’t manage nighttime dosing and the timings away from food so this really set me back if only for a few days.
I am worried about taking T3 with T4 and also whether to reduce T3 to 2.5 at first.
Do you have any advice on this from your perspective and experience.
No reason why you shouldn't take T4 and T3 at the same time....you have already been advised about this.
It looks as if you are going round in circles....suggest you write a time plan for taking medications....and it might also help to re-read the replies you received
Thank you for your reply. It’s just other opinions and then putting them together to come up with the best option when embarking on this journey, and also your own make up and how we all respond differently to different doses, medication and timings.
I have been helped quite a lot by all on here especially TiggerMe for which I am most grateful.
I think a diary is a very good idea and I do keep one but need to be more strict with it.
I've played the "game" and got the T-shirts...boxes of them!!
Glad you find the forum helpful....it's the best source of thyroid advice. TM definitley adds to that and is working hard to help everyone in her new role.
Thanks a lot. Yes she is and it helps to know that other members have been there and gives people like me who lack confidence and find it quite scary, the security that if it works for some people there is hope for us too.
I'm not exactly sure how much more potent T3 is in relation to Levo, I've seen anything from 2.5 times to 5.
If its around say 3 times then 5mcg only equivalent to 15mcg Levo. Obviously T3 is much more quick acting whereas Levo is just a storage hormone so they act very differently. I still think dropping to 50mcg is a mistake though.
I agree with everyone above! Low and slow changes, you might find you tolerate the T4 better once you have a better level of fT3 🤗
The strength of T3 compared to T4 is kinda irrelevant, you need what you need as we all have different absorption and cell uptake to take into consideration
Yes I can see what you are saying there. As I tried to drop 25 mcg not long ago due to high T4 and I very much knew I had, so quickly increased again but it is taking weeks to recover from this trial.
I have forgotten how the endocrinologist compared the T3 to T4 in potency but I’m sure he said 5 mcg is equivalent to 20 mcg.
Thanks. I have a lot to consider and didn’t realise just how much but it is good to know how many others have been through this already, and have come through the other side.
Sorry to message but could I ask if I did what you have advised, what dose of T3 would I add in and also do I need to change from morning to evening dosing of T4 once I start T3 as the endocrinologist is saying to do this?
Ask away... you can happily take T4 and T3 at the same time so entirely up to what works best for you, most important is to remember to take it!
The less things you change at once the easier it is to monitor the effects, I'd suggest adding 5mcg T3 with your morning dose or if you are able to split it to 2.5mcg you could split morning and 12hours after... truth is it's going to take a little experimenting but I'd always say try adjusting dose timings and single or multi dosing before adding more, that way you are more likely to find your sweet spot
Thank you for your helpful advice. I have for two days reduced T4 by half and taken in evening (I normally take first things) and took T3 at breakfast and lunchtime as I wanted to see if I could get on with the Endocrinologist’s advice on how to dose, but as I explained to buddy, I now feel unwell and under medicated. Although, when I took the T3 Sat and Sun, I noticed I had but it was short lived.
I have 20 mcg tablets so 2.5 would be difficult. Do you suggest splitting them though and if so, could you explain the 12 hour gap between the morning one with T4?
Just to check also, you suggest not reducing T4 at the moment and adding in T3. Is that still your advice with 2.5 or 5 mcg of T3?
I still recommend taking your 100mcg T4 in the morning along with your first dose of T3, now you have tried it (assume 5mcg dose) and haven't had any strong reaction I'd stick with that dose, my slight concern is you say after 2 days you feel 'undermedicated' which could also be your body reacting to the T3 as symptoms of over-replacement feel much the same, taking the doses that close together gives a double whammy!.... perhaps just take 5mcg am for a week to give your body chance to adjust before adding the second dose as T3 is potent stuff
I have no idea what the logic is with your Endo's dosing guidance 😬 suggesting way to many changes at once! If I followed my Endo's instructions I'd still be feeling awful 😅 they have never walked in our shoes
The 12 hour gap is between your T3 doses, so if you take one dose at 8am the second dose at 8pm and see how that feels, if you don't get along with that then I'd suggest trying as a single dose in the morning so 100mcg + 10mcg T3
Thank you very much. I think the feeling unwell is mainly to do with the underactive symptoms as I noticed a lift when taking T3 over the weekend, although, as I said before, it was short lived. I am not sure though, that two 5 mcg doses was too much at first and will have to consider the 5mcg for a week first like you advised.
I do have acid reflux and take lansoprazole when it flares up (it seems there are certain foods that cause it but I struggle to find which one) but I also don’t know if all the underactive symptoms are contributing to the reflux or my increasing age or the T4 being a lactose tablet, as I couldn’t tolerate vencamil or liquid. I try to keep lactose free from my diet to allow for this but I’m not sure you can advise further on this? The T3 is lactose free and I seemed to tolerate it as you said.
I get into a situation where I think the acid reflux is causing poor absorption and then think it is my poor conversion and low T3 that is be causing ill health. I really don’t know.
I have taken 100 mcg Mercury Pharma this morning. Do I give it a few days to try and settle down before I start the T3 again?
Also, could you explain why my T4 will drop when on T3 as you advised before and also, when you said that I should be able to tolerate T4 more when T3 is raised and the reasons for this.
Sorry, yes I did take 5 mcg breakfast and lunchtime but could I ask your opinion on taking T3 with food as my endocrinologist said to take it with breakfast and lunch.
I know lansoprazole can effect uptake of thyroid hormones so need to keep that well away from them, most of us suffer with low stomach acid which has improved for me now on an optimal dose.
Ideally with T3 keep the dose the same at the same time of the day, 2 days of half dose T4wouldn't have had a big impact as you were above range and it is slow to react and you replaced the missing T4 with quite a hefty whack of T3 which is far more potent so quite a shock to the system.
This is my simplified take on it, I can probably find you a science paper if you'd rather?
Crikey your Endo is a right one! T3 isn't as fussy about being taken with food and if you do that every dose then that's fine, ideally I'd say give it at least half an hour alone in your stomach but continuity is key
Thanks a lot for this. I have had a return of reflux this morning and this is where I blame the t4 when actually it could be like you said being underactive symptoms. There are other symptoms too but this one is so troublesome for me.
I haven’t taken T3 today as I was unsure with the changes I made but thank you for advising it will be okay to add in again.
Could I put in the T3 at teatime as suggested as I may keep T4 at the same dose (100 mcg) but only take one lot of T3 for now and not the two (2x5 mcg as prescribed) ) or should I restart in the morning with my T4 dose?
Could I ask a quick question. I am going to introduce T3 with T4, but I am unsure if I should start on 2.5 mcg instead and continue for a week at one dose a day as advised, but I have a 20 mcg tablet. Is it too much to try and split this into 8?
I've never seen a TH tablet so I don't know how doable it is, I think I remember others have managed it, often a craft knife is involved, it would be the best place to start to see how you react... lets put a shout out to Regenallotment
Thanks Tigs, Sailing14 They are so easy to split you can do it with your finger nails, snaps along the groove and then each half snaps in half. Super brittle and a little crumbly 👍
This is another option to try. I have a pill cutter and it has cut cleanly (the quarter part) but the other half crumbled a bit, but it is late and I will try again in the morning as I do have a scalpel in a drawer somewhere.
I’m sure the crumbled part is not advisable to take I imagine?
Also, if I manage it, would it be okay if the 8 parts are not quite even over the days I take them? Regenallotment
It's far from perfect but if just doing it for the initial introduction phase to give your body chance to get used to the change there is every chance you'll be able to take 5mcg within a week or two so then it should be more even.
The thing is the active content in a pill is miniscule and not necessarily evenly spread so getting and accurate split is impossible... crumbs can be mopped up with a damp finger... no sense in wasting it 😏
I’m sorry to message again but I have taken 2.5 T3 with 100 T4 this morning with no ill effect, but did you suggest I could take two doses of this for a week or was it best to take the one dose and then increase to two after the week?
I am going to leave the 12 hour gap today as advised if so.
Any improvement? I'd be inclined to say give it 3 days minimum as it is gradually building up in your system, T3 has a 1 day (ish) half life so by tomorrow morning when you take your 2.5mcg you actually still have half of the previous days dose circulating so in effect you are building up just by staying on the same dose
I regularly split Thybon Henning into 8ths. You need a scalpel blade for the Final Cut but can use your finger nails or a pill cutter for the halves and quarters. It's not dead accurate, but it will do. Don't waste the crumbs.
adding another voice in support of "don't drop your levo by that much" .
since mid july I've added 6 then 9mcg T3 , and because my fT4 had been 91% and sometimes much higher , i decided to lower levo from 87.5mcg to 75mcg at same time as adding T3 .....first blood test showed ft4 had reduced significantly from 91% to 56% ,,, i felt mostly hypo ,pretty wobbly and weak , with some hyper bits... well frankly 'a bit all over the place' ... i put levo back up to 87.5mcg 4 weeks ago and i now feel more solid/ stable .
I'm still playing around with timings of T3 doses , and i'm nowhere near sorted yet, but lowering levo by 12.5mcg really didn't feel like it was helping things, so i certainly wouldn't recommend anyone lower it by 50mcg .
.. also re. how much T3 / how fast....... 6 mcg T3 (3 +3) felt like 'more than enough' for several weeks ... i had initially tried 6mcg in one dose, but packed that in after a couple of weeks and split it to 2x 3mcg ...... then after another 3 wks went to 9mcg (3+3+3) but after 6 wks of that i realised the morning dose was making me feel naff and not up for doing anything , and i felt better if i missed an odd dose of T3 , so am now trying 4mcg mid afternoon and 4mcg bedtime., which seems to be suiting me better. i've actually got some jobs done this last week.
also a warning ... as you can tell from the above 'randomness' .....i usually find it easy to be patient/ methodical / calm and wait several weeks for any dose changes to settle in, but something about adding T3 has turned me into a headless chicken.... one day my mind says 'i must stop this at once' ... the next day , (or even the same day!) , it's saying 'this is great' .... i think i've been trying something for 'weeks' then look at the calendar and it's only a matter of days ... so i recommend keeping a calendar/ notepad handy and writing notes as you go.
Combi therapy is much harder to get right than just taking Levo or NDT. And it will take time to hit your sweet spot. I think I've been quite fortunate that I havent had to fiddle about too much.
It is interesting when the T3 hits the brain cells that it throws up all kinds of random thoughts and actions! Like you say improvements do tend to bounce around for a good few months even without changes dosage as different things start to fire up 😆
25mcg tablets and craft knife (like scalpel) cut on upside down coaster with a cork base ...do it on on grannies old dinner tray to catch any bits that attempt to escape....
Tiromel ~with a score line... quarters , then eights , to get 3.125mcg (ish)... bit of a faff but do-able
or cut in half , cut each half into 3rds , gives 4.16mcg ( ish) .... easier
I think you're right to be cautious about dropping so much levo. So when I was first given 10mg T3, I was told to drop from 75 to 50 levo. I dropped it by 10mg levo and I became really ill. I ended up getting my levo increased to 87.5 while on the 10mg T3 and I was still hypothyroid and unwell so changed to NDT. Can I ask what your t3, T4 and tsh levels are? Depending on your levels and how well you are, I would drop nothing and try 5mg T3 or drop 10mg levo and see how it goes. It will take a bit time to feel the effect of the T4 decrease.
Liothyronin T3 is great and good for the heart. However if you start with 2x5mg you'll probably get some symptoms like anxiety, palpitations & bad dreams as it's an active hormone so its a bit of a shock to the system. I recommend starting with 5mg for 7-10 days and then start the remaining 5mg, so that there will be less of these symptoms. It takes about 2 weeks for your body to adjust to T3 and remember it's quick acting unlike Levothyroxine. My thyroid doctor says we get an increase in cortisol in the first 2 weeks of taking T3.
Some people find it helpful to split the doses but this didn't help me, I just took all my T3 in the morning when I woke and my levo last thing at night. So it's just about finding what is best for you, everybody is different. I hope it goes well.
Thank you for your reply and helpful advice. It is good to hear other people’s experiences as you can then try and make the right choices.
I have got a plan at the moment (after kind advice on here) of keeping T4 at full dose and taking it in the morning like I normally do and adding in 2.5 mcg T3 for a few days and then taking another 2.5 mcg in the evening and see how this goes.
I am hoping for an improvement as I have been very unwell thyroid wise for a long time.
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New results and I need help
Thybon Henning 
New results - could you please help?
Shocking blood test result variation: NHS Vs Private UKAS laboratory 😳
