side affect with starting T3

[Dobby]

Hi I just wondered if anyone has experienced a problem with starting Liothyronine T3? I was taking 125mg of Levothyroxine. My endocrinologist, suggested I reduce down to 100mg, for a period. Then when she introduced the T3, (5mcg twice daily) she asked me to reduce it to 50mg a day. Not sure if it is coincidence or not, but I have now an extremely bloated abdomen, which is also very painful, this has been for about two weeks now. Any advice would be greatly received. Many thanks

[jimh111]

If your bloated stomach came on straight after starting T3 it may be due to a reaction to some of the fillers in the tablets.

If it came on after a week or two it is because the idiot has reduced your levothyroxine far too much.

[Dobby in reply to jimh111]

II did wonder if this was the case!

[Larai in reply to jimh111]

Hi Jimh111,

Since 2016, Docs started freaking out about my levothyroxine dose, steadily lowering it from .150 mcg in 2016.. to my current .75 mcg as of 2024.. I've been complaining since 2016 about them just lowering it, w/out listening to me.. I'm in the US, All I've gotten from my 3 endo's and two pcp's is that they've been getting levo wrong, and backwards, I'm still a bit dubious on that.. In this past 2 years I've gone from 105lbs at 5 ft tall, to 145.6 lbs.. I'm not a happy camper about this.. but new pcp, she listens, and we are working on it. Also, I feel bloated and tender to touch my belly.. which is painful for other chronic issues with my low back.. I'm praying that the Liothyronine will help.

[Kowbie in reply to Larai]

I’m sorry to here that I’m so anti drs really they don’t realise what it does when they meddle hope you get sorted soon

[SlowDragon Administrator]

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

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

is this how you do your tests

what were Ft4 and Ft3 results and ranges when on 125mcg daily

Which brand of levothyroxine are you taking

Is it always same brand

What brand is T3

We frequently see endocrinologists reduce levothyroxine dose far too much when T3 is added

Also extremely important to test and maintain GOOD vitamin D, folate, ferritin and B12

Please add most recent vitamin results and ranges

What vitamin supplements are you taking

[Dobby in reply to SlowDragon]

Hi sorry, I think I replied to myself! Not sure you and the other kind folk will be able to view my response. I think this problem is also frying my brain, can't think straight! 🤦‍♀️😂

[JCRiver in reply to SlowDragon]

what if I take my meds at night? I normally skip the night that I have a test in the early morning so it's about 34 hours in between. How would I go about taking them so there isn't that much time in between? Thank you so much!

[SlowDragon Administrator in reply to JCRiver]

JCRiver

As you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[JCRiver in reply to SlowDragon]

So helpful! Thank you so much 🙏❤️

[helvella Administrator]

Your endo appears to think that T3 is five times as potent as T4. (or 7.5 times if the initial reduction was meant to be part of the changeover process.)

My blog (hopefully) gives my opinion on that:

helvella - How much more potent is T3?

A discussion about the relative potency of T4 and T3.

helvella.blogspot.com/p/hel...

[jimh111 in reply to helvella]

I would go with Celi's pragmatic approach, determine how much liothyronine is needed to have the same effect on TSH as a dose of levothyroxine. This gives a 3:1 ratio. pmc.ncbi.nlm.nih.gov/articl...

This should be reliable in terms of achieving the equitable levels of thyroid hormone in the blood. If someone has problems converting T4 to T3 or resistance to thyroid hormone the issue gets a hell of a lot more complicated.

There are so many factors involved that I think the numerical approach is doomed to failure. Going from 125 mcg to 50 mcg levothyroxine would need 25 mcg liothyronine. I would start with 2 x 5 mcg liothyronine and reduce the levothyroxine from 125 to 100 mcg.

[helvella Administrator in reply to jimh111]

Completely agree that a pragmatic approach is the only viable way of tackling this.

[Buddy195 Administrator]

Do share your thyroid blood test results…. 125 to 50mcg drop in Levo dosage is quite a considerable reduction!

Also important to state brand of Levo (is this consistent with brand before reduction?) and the brand of Liothyronine

[Jazzw]

What were your blood test results BEFORE you started T3, that is, what were they on 125mcg levothyroxine?

[Dobby]

I can't thank you all enough for replying to my post.

I do not have blood test results since starting the T3. and reducing the T4 to 50 mcg The endo wanted me to be on it for 5 weeks then do a blood test.

When I reduced the Levo to 100mcg my last results were TSH 0.05 (range 0.35-4.94) T4 was 10.8 T3 was 3.5.

The Liothyronine I have been given is 10mcg which I cut in two as directed by the consultant) the brand is Morningside. The Levothyroxine is always different depends on what the Pharmacy has in stock even though on the prescriptions it request the Mercury brand. The current one I am taking is Accord.

Really sorry I seem to be having a problem accessing my medical records through my GP surgery so can't check previous test results.

Would the filler in such a tiny pills cause such horrendous bloating/stomach pain?

I think I will have to see my GP tomorrow and or try and contact the consultant because I am in a lot of discomfort and need to find out if it is the change in meds causing this problem.

[helvella Administrator in reply to Dobby]

 Jazzw  Buddy195  jimh111  SlowDragon

Calling out to all previous contributors.

helvella - How to "mention" or "callout"

Having read a post or reply, I've noticed that you might wish to alert other members to your post or reply. For example, you might have said so, or asked how to do so, or tried but it has not worked.

This is an explanation and screen recording showing how to callout members in posts and/or replies so they get alerted.

This is not to say you have done anything wrong. This is meant to help you by pointing out this option, and help to do so, not to criticise.

There is no need to reply! If it was helpful, ticking the "Like" button lets me know.

Last updated 03/01/2025

Link to blog:

helvella.blogspot.com/p/hel...

[tattybogle in reply to Dobby]

just tagging jimh111 helvella Jazzw Buddy195 for you so they will be notified of your reply above ( you replied 'to yourself' )

[Dobby in reply to tattybogle]

So sorry just wasn't sure at the time how to do a generally reply! 🤦‍♀️😁

[tattybogle in reply to Dobby]

but you're a house elf, surely you can do anything lol sorry couldn't resist

[Dobby in reply to tattybogle]

I wish! 🤣

[Jazzw in reply to Dobby]

When I reduced the Levo to 100mcg my last results were TSH 0.05 (range 0.35-4.94) T4 was 10.8 T3 was 3.5

Do you have the lab ref ranges for FT4 and FT3? It’s looking rather as though you were very undermedicated on 100mcg. Intrigued also to know what your results were on 125mcg levothyroxine—do you have any?

Re the bloating, are you constipated? Being undermedicated could definitely lead to issues in that department…

[Dobby in reply to Jazzw]

Well the GP and Endo keep on about my TSH was always showing I was over medicating! 🤷‍♀️

Don’t have any other blood test results at the moment can’t seem to get them from the login facility at my GP’s surgery.

Definitely not constipated , I thought that so have taken some colon cleanse which have worked! 😁

[Jazzw in reply to Dobby]

Well the GP and Endo keep on about my TSH was always showing I was over medicating!

Of course they do. 😬 It’s like they can’t engage their brains.

My money is still on this being a side effect of being undermedicated.

As you’re going to speak to your surgery anyway, maybe you could ask for the results over the phone?

[Dobby in reply to Jazzw]

Unfortunately because the results were requested and then sent straight to the endo, my GP surgery doesn’t have the records!

Not sure how I would argue the fact of being under medicated if my TSH is low? X

[Caradoc1a in reply to Dobby]

Email consultant secretary and ask for your results by email. That's what I do and it works. Maybe it's dependent in who the secretary is??

[Dobby in reply to Jazzw]

Also forgot to mention they are saying my Osteoporosis may be caused by high dose of Levo?! 🤷‍♀️

[TVOReason in reply to Dobby]

Hi Dobby I had severe stomach problems for 9 months taking the Accord brand and before that the Teva brand I only take Wockhardt now and although I still have bloating I haven’t the pain anymore

[SlowDragon Administrator]

When I reduced the Levo to 100mcg my last results were TSH 0.05 (range 0.35-4.94) T4 was 10.8 T3 was 3.5

As per Jazzw asked

We need to know ranges on Ft4 and Ft3

You look like Ft4 was already too low

How long before test was last dose Levo

[Dobby in reply to SlowDragon]

Unfortunately she never gave me the range for both T4 or T3. All she said was they were in normal range! 🤷‍♀️

I always stop taking Levo two days before test. My TSH they always say it suppressed.

[SlowDragon Administrator in reply to Dobby]

So Ft4 result is false low as last dose should be maximum of 24 hours before test

Has your TSH always been low

What are your most recent vitamin D, folate, B12 and ferritin levels

What other medications or supplements are you taking

Suggest you get FULL thyroid and vitamin testing

How long have you been on 50mcg Levo and 2 x 5mcg T3

Ideally test 6 weeks after any dose change

Ensure you test correctly

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

So on current 10mcg dose

The Liothyronine I have been given is 10mcg which I cut in two as directed by the consultant) the brand is Morningside.

Take 5mcg waking, 2.5mcg mid afternoon and 2.5mcg at 8-9pm

Test 8-9am following morning

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

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Get hold of actual ranges from Endo secretary

You are legally entitled to results and ranges

The Levothyroxine is always different depends on what the Pharmacy has in stock even though on the prescriptions it request the Mercury brand.

Take your prescription to different pharmacy if you can’t get brand you need

[Larai]

Hi Dobby.. I guess it depends on the issues.. I've learned some things that I didn't realize just recently.. I was born w/out a thyroid gland so I've never actually been normal.. I've been complaining about my doc lowering my levothyroxine.. I thought that was the right thing, NOW I realize that for all the Levo I was taking, it was NOT converting to T3.. Currently taking .75mcg Levo, and 5mcg Liothyronine, I'm cautiously optimistic.. Maybe, when my next blood work is done.. may lower the Levo a bit more and raise the T3.. The last time, I was put on the Liothyronine name brand Cytomel.. I was taking .125mcg Levo, and it kinda made me anxious and a bit heart racey.. I've been suffering with bloat & yes it's painful to the touch, my belly, but it started before the adjustments were done with the liothyronine.. I can't speak to anyone else's results.. My pcp are going through a process of elimination.. we are also going to be looking at SIBO (Small intestine bacterial overgrowth) which seems to be common with Hypothyroidism. Since I have a new pcp we are exploring, she's actually the first doc in a LONG time that is actually listening to me, and she seems to have done some research on this issue. The way she explained it to me, and which I had already ascertained, is that while Levothyroxine is Supposed to convert to T3.. it doesn't always do so. I hope you find the answers you are looking for.

[arTistapple in reply to Larai]

I too am looking at SIBO. Always had bowel problems but since reducing Levo substantially, it’s all gone completely haywire. These large scale reductions in Levo are not to be recommended. Anything like that should be done gently.

[SlowDragon Administrator in reply to Larai]

Larai

That’s a substantial reduction in Levo and only 5mcg T3

Ft4 May now have dropped too low

Many on Levo plus small doses of T3 find they need BOTH Ft4 and Ft3 at least 50-60% through range

Being hypo causes bloating and gut issues

Get Ft4 and Ft3 levels tested 6-8 weeks after being on constant unchanging dose and brand Levo and T3

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

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

[Stickybiscuit]

Hi, If you're taking calcium supplements, they can dry your guts out and make you constipated and bloated too. This'll make me sound so wiered but I find Spinach helps.

[Hectorsmum2]

hi Dobby. The stomach problems could well be this reduction in levo but stomach pain could be all sorts of other things as well. Worth getting it checked out with GP.

[arTistapple]

I was stupid enough to do similar when my (well researched) endo offered a similar regime.

I have had nothing but bother since lowering my Levo and never even got the T3 prescription at all. My own fault for being so optimistic. I see all this dreadful advice/stories patients experience from the medical profession right here on the Forum and I still trusted.

Endlessly optimistic with dreadful episodes of pessimism to deal with.

I have now been back on my 100mcgs Levo for 116 days and counting and my bloating and constipation (using mag citrate) has never been worse. All sorts of symptoms but a pretty awful six months with a Candida infection I am not sure I have got rid of yet!

No, I no longer trust them.

I would love to know where they get their ‘evidence’ for treating patients in this manner.

Or is it (I know this is a mad thought) a conspiracy? Do no harm? Pah!

[Venicefan]

I had my trial of t4/t3 combination with a private doctor. I had my levothyroxine prescription from the GP and had to source my own t3.

He did very similar to your endo, telling me to drop 25mcg of levo for each 5mcg of t3 increase.

I started on 5mcg of t3 just in the morning for 2 weeks and reduced my levo from 125mcg to 100mcg. When I introduced the 5mcg in the afternoon he told me to reduce levo to 75mcg, which I did and I became very symptomatic. I had a test after 6 weeks from the start of the trial and my t4 was rock bottom and t3 still low.

We agreed that I should increase my levo back to 100mcg, and I continued to increase the t3 without reducing the levo.

I ended up on 100mcg levo and 30mcg t3. On that, my t4 was just below mid-range and t3 was near the top of the lab range.

Endos regularly set their patients up to fail with t3 because they don’t have a clue what they’re doing. TSH is not a thyroid hormone. It shouldn’t even be looked at when you’re taking t3.

I was fortunate because my private doctor was open minded and was prepared to experiment to find the best combination for me.

[arTistapple in reply to Venicefan]

Unfortunately I had already tried a private endo (on the ThyroidUK list - not really a recommendation list I know, but again high hopes) and had issues that she was unprepared to deal with. Wonderful. The same training as NHS endos, let’s be honest and equally clueless. No back up when going privately. Things don’t go to plan they just ditch you; after off course taking a whack of money. “Stop the T3 immediately”. End of.

Oh to be a doctor. Great pay and no fear of comeback. Leave the patient alone and protect your own back. On the surface it all looks like responsible behaviour - NOT.

It’s so much easier just to leave us rotting. As long as their jobs are secure - never mind the patients!

Indeed a number of eminent endocrinologists have declared war on us, so confident are they in their ‘world’. It’s the patients fault!

[Venicefan in reply to arTistapple]

Yes, I was really lucky to find a good private doctor. Though he retired about 6 months after I signed up with him, but it was long enough to have my t3 trial, and get the tests I needed to prove I wasn’t converting the levothyroxine to t3.

I provided all of the test results to the MHS endo and she agreed to take me on and monitor me. She was a good one. Of course, she moved on after 12 months and I’ve never seen the same doctor twice since then. Nominally the NHS are monitoring me but it’s a joke because they haven’t got a clue.

The point of my comment though, is that it’s not necessary to reduce the levothyroxine dose so much.