This has been on my mind for some days now and I've been trying to figure it out. When I managed to get T3 from my surgery about one and a half months ago, it didn't take me long to feel and look so much better. My blood test results at the time were;

TSH 1.8 (0.2 -4.5)

FREE T4 14 (9-21)

FREE T3 3.3 (2.6 - 6.2)

I also argued the case to keep my current dose of 100mcg of thyroxine (initially the Doc had wanted to reduce it to 75mcg but after taking my pulse and saying either you're very fit (not) or you have a very low pulse due to being hypo., he agreed to leave the dose. So, at the moment, I'm taking;

10mcg of T3 & 100mcg of T4 every morning

Over the last week, I feel I'm failing again, not sleeping well (worse than usual) and getting more stiffness in the hands and sore neck/shoulders (falling apart)! Could this be due to too much thyroxine? According to the Doctor, my thyroid doesn't produce any hormone now. My appointment with the Doc is in January so would welcome any help and advice now xx

ps also thought my weight would come down but it hasn't!

23 Replies

  • Hi birdie - I suspect that you need an increase in T3 as 10mcg is a fairly small dose. Is it possible to get some more blood tests done sooner than January? It may be that you could get away with a slightly lower dose of T4 if you took more T3, but seeing up to date blood tests would really help with advising you on this. If you do get a blood test it is probably best to get it done early in the morning and to not take any T3 that day until afterwards. xx

  • I wonder if perhaps you would benefit from replacing 50mcg of your levo with another 10mcg of T3. You might want to either split the dose of T3 or take your T3 in the morning and your levo at night. It may be that you just do better on T3. Some people do.

    Has your pulse increased at all? If not then it looks like more T3 might be the answer, perhaps with a reduction in the T4. You may not actually need the reduction of T4 but it is something to bear in mind if you start getting symptoms of being hyper.

    Can you call your GP and ask if it is ok to add 10mcg of T3 to see if it helps and reduce the T4 if needs be (you may not need to)? Sometimes the effect of the initial dose of T3 wears off as your body realises it actually needs some more. It's not unusual to need an increase in dose after a few weeks.

    I hope that was helpful

    Carolyn x

  • Oh, thanks v much Clarebear and Carolyn for your answers. I'll take my pulse in the morning and see what shows up and also arrange more blood tests. I think my pulse will have increased, mind you. I have a feeling that to increase T3 and reduce T4 would help (especially because of the increasing numbness in my hands). Ideally I'd like to try NDT but I know I've got to give this new regime a try.

    What would I do without this support group? I've got you all to thank for giving me the 'get up and go' to make my case for T3 in the first place. Love to all xx

  • I hope it helps.

    Regarding the numbness in your hands; have you had your vitamin B12 and folate tested? Lack of B12 in particular can cause nerve problems. I now have two permanently numb patches on my big toes which I believe is down to prolonged B12 deficiency that I didn't know about until recently. It might just be worth getting these tested along with ferritin, serum iron and vitamin D if you can. B12 deficiency can also cause insomnia. Just a thought...

    Carolyn x

  • I used to take Biocare's B complex but when I started feeling good on T3 in Oct., I stopped and now take a good all round multi (iron free because iron makes my constipation worse). I also take krill oil, Ubiquinol, Vit D and am taking 5HTP at night. Maybe I've just got to keep Vit B handy. Haven't had B12 checked in a long time

  • I'll try out T3 in the morning and levo at night. Should this be before dinner or before bedtime?

  • Ideally you should take your Levo last thing at night and try to avoid eating anything for at least 2 hours previous to that. Hope you feel better soon. :-)

  • Thanks, Zephyrbear - I'll make sure of that x

  • Very nice tip here. Thanks for sharing this.

  • I took my thyroxine (reduced it from 100 to 75mcg) last night instead of yesterday morning and I don't know if it was just coincidence but I had a terrible night! Anxiety, painful joints - utterly exhausting. Lately I've been having one decent night's sleep (about 6 hours) and the next night bad but it's not been as bad as this in a long time. Should I keep going with night time thyroxine or go back to taking it with my T3?

  • I tried this after reading some 'advice'. Never again! My understanding now is that Levothyroixine before bed is a terrible idea. It's a stimulant that is designed to get your system going because you need the T4 to be converted to T3 which is an active energy medium. T3 has a shelf life in your body of about 4 hours but T4 is much longer 24 - 36 - although in my experience you can gauge when this falls off if you are aware of your symptoms. What this means is that you are trying to ramp up your body and trying to lower it into restful sleep at the same time. Taking Adrenal supplements before bed can be helpful as adrenal function peaks during the night but not thyroid meds.

    But I like you was struggling with the management of it and found this other advice - which worked like a charm. You have the meds beside your bed and set the alarm for about two hours before you normally wake. Take the T4 then and go back to sleep. This should be just long enough for this to start kicking in when you get up and should not disturb your sleep - play it by ear - it may be 90 mins or 2.5 hours. You know yourself best. By doing this regularly you can train yourself to go back to sleep quickly. When you get up take your (first) dose of T3. It requires some discipline to get into the routine!

  • The same thing happened with me, felt wonderful for a few weeks then started to feel not quite so well. Keep going with it though, I felt really terrible for a couple of weeks, pains worse than ever, could hardly walk, then started to pick up again, and now feel so much better all the time. I have been on T3 for 3 - 4 months. I know it sounds odd, and perhaps rather far fetched, but during those weeks of feeling very poorly it felt as if nasty things were being eradicated and everything was being reset in a new and better way. It was so worth going through, I hope you will feel the improvements soon. x

  • Hi thedoghouse, thanks for your reply. Do you take thyroxine too and if so, how much? Also, how much T3 are you taking? x

  • I take 75 mcg of Eltroxin and 10 mcg of T3. Before starting the T3 I was on 100mcg of Eltroxin but the consultant suggested lowering the dose to 75. I have sometimes been tempted to up the Eltroxin but have decided to give the T3 a proper chance. After so many years of being starved of T3 I think it will take some time before all the benefits become apparent.

  • Well I hope it doesn't take too long for you. I'm feeling more confident after receiving your replies that things are heading in the right direction. I think I've been doing too much navel gazing and needed to get my question out! x

  • The more I increased T3 and reduced T4 the better I felt till I was on T3 alone, but some doctors wouldn't prescribe T3 alone.

  • Shaws, do you take T3 only now?

  • Hi birdie I take t3 only 60mcg at bedtime and am really quite good on that dose. Last December I stopped my t4 and upped my t3 and in February plucked up the courage to tell my doc and he was alright about it as I was so well.

    Jo xx

  • Well done, Jo. Having been on Levo only, for so long (11years) I've just got to trust T3 and gain the knowledge. After all, I was the one who insisted on getting the tests and pushing for the treatment! I used to adjust the Levo myself when I thought I needed to. I think the surgery wondered what I was going to do next! Anne x

  • After a while I switched to NDT plus 10mcg T3 and I feel very well.

  • Worth a technical note here for newbies: NDT (natural dessicated thyroid) contains T3 and this is proportionate to the T4 (depending on brand and tab size). For example in Naturethroid (which is from pigs not cattle and is the one I use): 1 grain = 9mcg of T3 to 36 mcg of T4.

    So Shaws is getting T3 in her NDT already and is topping this up with a further 10mcg of T3 which by itself would be a low dose. NDT also contains tiny doses of T2, and T1 and calcitonin and no one knows what these last three do however they must have some value. Some people with chronic thyroid problems and poor long term treatment programmes find an inverse T4 /T3 helpful so a little T4 and much more T3. So an extra 10mcg is inverting the ratio a little.

    To note though, it's impossible to find a definitive human T4 / T3 ratio which is why this ratio figure is never mentioned because despite all doctor's protestations they do not know what this is nor do they know if it varies widely in the population naturally. However it is always assumed T4 is a much higher figure than T3 which in chronic hypo patients can be the opposite in terms of treatment.

    By the way Shaws, I'm very glad glad you're feeling very well :))

  • Thanks. I get annoyed that there are alternatives which can improve sufferers ill health but it is denied so we have to source outside the NHS

  • Hypothyroid patients have been called borderline with a test result of TSH at 10 and often treatment was denied until you had this marker. I am one such person. Your treatment seems fine but if you are feeling ill it is possible that your T3 is too low to be effective for you. According to the clinical pharmacology data provided by Armour the following is true: "The mechanisms by which thyroid hormones exert their physiologic action is not well understood... The normal thyroid gland contains approximately 200mcg of levothyroxine per gram of gland and 15mcg of T3 per gram of gland. The ratio of these hormones in circulation does not represent the ratio of the thyroid gland."

    For Armour the ratio is 37 mcg of T4 to 9 mcg of T3 in a 1 grain size. But you should be aware that traditionally 180mcg or 3 grains was considered a standard dose or higher and without this level many doctors failed to see improvements and that was assuming some thyroid function. Now I'm quoting you NDTs but converting these to Synthroid is not simply a number swap. In fact two grains or just 120mcg/130mcg at tablet weight (depending on brand) is considered as 200mcg of Synthroid and this is without any of the benefits of T3.

    T4 is absorbed in the gut and depends on a variety of things including gut speed, wellness (e.g. candida or gluten intolerance etc). The average NDT absorption is 48% to 79% and fasting increases absorption. New research has found synthetic tablets do not have protective coatings on the molecules like natural thyroid supplements do which means they are also more likely to be damaged in the absorption process reducing effectiveness over their natural counterparts which are protected until the point of gut digestion. The same issue does not apply for synthetic T3 as it is quickly absorbed at about 99% without degradation and this holds for synthetic or natural.

    So all in all I would want to know your T3, RT3, Total T3. T4 and Total T4 to check the ratios and I would want to compare these results to previous tests. I would also want to understand your gut health situation and bowel speeds. Hypo produces chronic constipation reducing absorption as the speed is slow but also the lining is damaged affecting absorption. It seems clear your thyroid is producing hormone - 100mcg is not a full replacement dosage in what I understand of this and this dosage is affecting your results into normal limits but without reducing illness - what you report are HYPO symptoms. However you could be struggling with T4 to T3 conversion. A good rule is to change only one thing at a time. Drop your T4. Raise your T3 but if you do it simultaneously you will not know what is causing your symptoms - keep a tracker journal. Personally I would do it the other way around raising T3 and stabilizing before dropping any dose of the T4 (which is only just the equivalent of 1 grain of NDT). Just my two pennies. Good luck xx

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