Thyroid UK
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I've upped my thyroid meds - so why do I feel more exhausted than ever !!???

Hi All

after much deliberation, and with some great insights gained from this forum, I decided to up my T4 by 25mcg.

So I now take 150 mg of T4 and 20mcg of T3 early morning. I take another 20mcg of T3 at bedtime.

So total of 150 of T4 and 40 mg of T3. I also take DHEA, Vit B12, Vit D3 and EPO.

Since upping my T4 though by 25mcg I feel more exhausted and demotivated than ever!?? I wake up like I am coming out of a coma!! I am at a loss to think why? I thought the worst thing that would happen if I upped T4 would be that I could end up hyper. Instead I feel achy and hypo and exhausted - like 2 steps backwards

I introduced the change about a week ago so not long enough to build up a lot of T4 in my system. Latest results done just before I introduced the change are below.

My results were:

TSH 0.07 (0.3 to 4.5)

T3 free 3.64 (2.1 to 4.2)

T4 free 0.86 (0.7 to 1.8)

Testosterone 85 (150 to 600)

DHEA 41 (65 to 280)

Urine tests

T3 1770 (800 to 2500)

T4 2120 (550 to 3160)

Total 17 OH steroids 2.81 (3.17 to 8.63)

Many thanks


7 Replies

That's exactly how I feel when I take too much T4. I never get the hyper feeling. I think I have a problem converting T4 to T3 and am converting to reverse T3 instead, which actually blocks the T3 receptors in the cells. Perhaps the same thing is happening to you.

You might find that you are better raising your T3 slightly rather than your T4.

It might also be that you need to see what state your adrenals are in. If you have low cortisol, you will likely feel tired.

I hope that helps a little.

Carolyn x


Hi Carolyn

Thanks for replying - that's interesting - I never realised that it could be reverse T3 problem. I started to up my T4 as I thought I would feel better with it higher in range. I am also trying out CT3M to help heal adrenals and get rid of any reverse T3 problems- LOL !!

I had a saliva test done recently and the results are below. So I know I definitely have a problem with adrenals although they are marginally better than they were a few years ago.

Saliva Test

These are my adrenal/cortisol/DHEA levels and the time the test was done. The overall comment was that I was at Resistance Stage 3 - Maladaption

1 (after waking at 7am)

results 17.6. Results on the normal range. The range was 12-22

2 (4.5 hours later)

results 4.8. Results low and outside the range. The range was 5-9

3 (another 4.5 hours later)

results 2.6. Results low and outside the range. The range was 3-7

4 (just before bed time)

results 1.4. Results in normal range. The range was 1-3

total daily cortisol 26.4 (range 21 to 41).

DHEA levels

0.08 (results were low) range 0.30 to 1.00

0.10 (results were low) range 0.30 to 1.00

DHEA:Cortisol Ration 0.34 (results were low) range 1.0 to 4.0h

Back to the drawing board I think for me!




Your testosterone level looks really low. Are you on any medication for this? I was feeling crappy and then had Oestrogel and Testogel prescribed and have felt so much better since x


Yes I know my testost. is really bad, I am on DHEA which the private doctor I see said should help improve adrenal and dhea and testost. levels and that was the best way to approach this.

Its exhausting all this stuff isn't it!


By taking 150 mcgs T4 plus 40 mcgs T3 you are in total taking the equivalent of 310mcgs of T4 which is a large dose (T3 is 4x stronger than T4).Maybe you don't need that much or you may have a conversion problem. Have you thought of reducing T4 and increasing T3? For every 10mcgs of increased T3 you take you should reduce T4 by 40mcgs. Hope this helps - you can check the info out on thyroid info sites.


Hi Barbara

Thank you for this information - I didn't realise T3 was 4 times stronger - yikes!

Basically because I am trying to get my hair back and get rid of joint stiffness and exhaustion I have been trying to see what I may be doing wrong. I thought I may need to increase T4 having looked at my latest results.

As I have adrenal weakness (proved by urine and saliva tests) I am pretty sure I must have reverse T3/conversion issues too. That is why I am trailing CT3M and playing around with the doses.

So if I was to go back to the drawing board and reduce T4 and increase T3 I may try and do 50mg of T3 and 80mcg of T4 (assuming my maths is correct?!?!).



Hi Lizanne - your blood results indicate that your TSH is suppressed which technically means that you were more than adequately replaced on the dose you were on at the time they were taken. This doesn't mean though, that you are converting adequately or that you don't have a reverse T3 problem which could explain your ongoing symptoms. The dose you suggest you may take would be the equivalent of 280mcgs T4 (probably 275 as T4 is only available in 25 mcgs stages)

I am not medically qualified so I am unable to advise what actual dose to take. Maybe you could see an endocrinologist who is recommended on this site to investigate the cause of your symptoms? I hope things get better - please let me know. Barbaraj


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