I developed Hashimoto’s thyroiditis (an autoimmune thyroid disease) around thirty years ago. I suffered during the early years as is so common for thyroid patients.
I was given the standard T4 (Levothyroxine/Synthroid) thyroid treatment. However, when I was told my endocrinologists and doctors, “You are cured!’, I asked them, “Why do I still have all the symptoms of hypothyroidism?”
The answers to the question were varied depending on the doctor I spoke to:
- I was told I had some unknown disease that appeared to have symptoms reminiscent of hypothyroidism.
- I was told that I had a psychological problem – possibly depression.
- I was consistently told I could no longer have any problems with thyroid hormones because my thyroid hormone levels were ‘normal’ as determined by laboratory testing.
- I was asked to join a growing number of patients in an ME/CFS support group by one endocrinologist. I believed that since these were thyroid patients with symptoms of hypothyroidism (or ME/CFS), this simply meant that my endocrinologist was happy to stick a label on me and push me into a room to commiserate on my bad luck and lack of a future with others that he had failed to help.
- I was refused any more blood tests or referrals by one GP unless I took Prozac (antidepressants) for some time.
The quality of the treatment I received from some of these ‘doctors’ seemed to border on abuse.
Far too many thyroid patients who do not feel well on just T4 thyroid hormone medication have encountered these ridiculous attempts to justify poor diagnostic work and even poorer treatment.
So, I did my own research. I read endocrinology books – real ones that are used during medical training. I bought books that I could not find or borrow. I used the emerging Internet resources.
I concluded that a trial of T3 (Liothyronine) was necessary because my hypothyroidism was not fixed by using Levothyroxine (T4).
This was needed at the very least to see if I could learn more about what was ‘broken’ inside of me. I knew something was broken because such a wide range of T4 dosages had been tried and had all failed. I also knew that this had all occurred after the advent of my autoimmune thyroid problem – Hashimoto’s thyroiditis. I was totally healthy prior to this point.
Eventually, I found a doctor who allowed me to try natural desiccated thyroid (NDT) and then T4/T3. We also used hydrocortisone and prednisolone. None of these treatments made a bit of difference. Then eventually I got the T3 trial that I had wanted for so long.
With T3, the lights went on. Within a week I could get up the stairs at home more easily. My digestive problems all vanished within days. I began to be able to think clearly and function once again. Within a few weeks I felt like I was a different person – not the shambling wreck of a human being, old before his time. T3 on its own was the answer and the clue. I still had a lot of fatigue issues and these arose from my continuing low cortisol, which I still had to resolve.
My problems had definitely been occurring at a cellular level and beyond the ability of any blood test to see them.
I now know that there are many causes for this. Although at the time I was not really able to pin down any one specific reason.
It took me nearly three years to completely finalise my dosage and understand how to use T3 correctly. I had to apply all my background in science and applied research to understand everything I needed to know to get to grips with T3. I had to raise my cortisol levels a lot to really be able to properly recover. However, It was worth it.
I have now been using T3 (Liothyronine) for around 20 years and am fit and well. I have no weight issues or any other symptoms of hypothyroidism or low cortisol.
So, why have I chosen the title for this blog post? It is simply that T3 is more difficult to find the correct dosage for than other treatments, and that doctors are far less keen to prescribe it.
When I first began to discuss T3-Only use on forums many years ago, I frequently met ignorance, defensiveness, incredulity, and even abusive and rude comments from other thyroid patients. There was so little discussion about T3 and so few people who had good experiences of using it that I found the Internet forums to be quite difficult places to inhabit. The situation is somewhat different today. More and more thyroid patients in the UK and the USA are using T3 to get well.
Over the years I have now spoken to thousands of thyroid patients who have managed to recover their health using T3-Only.
Many patients are now hungry for information about this under-prescribed thyroid medication.
However, increasingly I get questions from people who want to know if they might be able to get well by taking T3-Only instead of T4. Some people even consider switching directly from their current T4 medication to T3. This increasing trend has provided me with the title of this short article.
T3 is not an easy drug to use and any patient or doctor who begins to introduce T3, whether on its own or in combination with T4 or NDT, must know quite a lot about it before commencing its use.
Some of these thyroid medications are more difficult to use than others. I believe that the order goes like this (with increasing difficulty):
- T4 (levothyroxine) – easiest to use.
- T4 / T3 in combination.
- Natural desiccated thyroid (NDT).
- NDT / T3.
- T3-Only (T3 on its own or pure T3) – hardest to use.
I am prepared to debate where 2 and 3 are relative to each other and possibly even 4. What is clear to me is that 1 (T4) is definitely easier to use than 2-4 (combos of T4 and T3). Number 5 (T3-Only) is harder to use than the others.
Why should I say this last statement?
Once the nature of the T3 hormone is understood and the reasons why people resort to it are also taken into account, it should become clear why T3 is a medication that should be not be seen as a simple panacea.
In the human body, the biological half-life of T4 is approximately seven days, which means a patient can take their entire daily dosage of synthetic T4 in one go, without any issues, because it is used up relatively slowly.
In contrast, the biological half-life of T3 is believed to be twenty-four hours. However, a single dose of T3 is rapidly absorbed and reaches peak circulating concentration in just two to three hours (2.5 hours is typical), after ingestion.
Blood serum concentrations of T3 may remain somewhat elevated for six to eight hours. After this, blood serum concentrations decline again, unless another dose of T3 is ingested.
So, for most thyroid patients T3 has to be taken several times a day. Taking it all in one go, once a day, is far to potent in one dose for most thyroid patients.
The other interesting fact about T3 is that it arrives in the body extremely quickly and it has the effect of rapidly suppressing the TSH. Therefore, patients who are receiving only T3 replacement therapy should expect unusual laboratory tests of thyroid hormone levels. This makes it impossible to use thyroid lab tests to manage the T3 dosage. Many doctors are still very uncomfortable with this as they mistakenly think that the lab ranges developed for people on T4 meds can be used for ALL the thyroid medications.
Low FT4 levels should be expected. FT3 results could be low, normal or elevated above the top of the reference range, depending on how much T3 is being prescribed and the exact time of the thyroid blood test, in relation to the time that the last dose of T3 was taken. TSH could be highly suppressed or at the very least TSH is likely to fluctuate far more with the use of T3 medication than with T4.
The above information, on the rapidity with which T3 achieves peak serum concentrations and then declines again and the potential for unusual TSH, FT4, and FT3 results, is very important. This means that laboratory tests cannot assess the adequacy of replacement with T3.
Endocrinologists, doctors and thyroid patients may wish to use thyroid blood test results to check the T3 dosage – but this simply will not work!
Patients that are using T3 on its own will certainly struggle to get any value at all from thyroid blood test results. Those that are using T3 in combination with T4 may also see some distortion of their thyroid blood test results depending on how much T3 is being used. This means that other methods need to be used to manage the T3 treatment and set the correct level of T3 medication. Symptoms and signs must be used but this is not as easy as the conventional way of looking at thyroid labs.
In particular, it is critical to be aware that people who use T3 are taking it because something in their normal processing of thyroid hormone has broken.
All we can see is that T4 or T4/T3 does not make someone well but that T3 does. It is crucial to realise that in this case the T3 is being taken to overcome whatever the problems are and that all that is important is that the patient feels well and that normal symptoms and signs are returned (including key measures like blood pressure and heart rate).
In order to achieve this, the right amount of T3 needs to be effective within someone’s cells. When this occurs, the levels of hormones within the bloodstream are likely to be completely unrepresentative of the cellular activity of the T3. So, TSH, FT4, FT3, or reverse T3 in the bloodstream (which is the only place they can be measured currently) are very likely to be unrepresentative of actual cellular activities of these hormones.
Attempting to manage the dosage of T3 for someone who can only get well by using T3-Only can only currently be done effectively and safely by using indirect measures of thyroid hormones, as described in my books.
Attempting to do this by using thyroid hormone blood test results could even be dangerous, as all of these thyroid hormone test results may have no bearing on cellular activity. This point is highly relevant for those patients using T3 only and this is a major reason why using T3 is harder than the other hormones.
Unfortunately, many doctors appear to be unaware of any of this and still cling on to the idea that they can use thyroid blood test results to monitor T3 replacement and manage their patient’s T3 level. This is not only going to fail but it could make the patient very ill.
Someone new to T3 replacement therapy may believe that the medication can be taken in a single daily dose, just like synthetic T4. This may work for a few people but for others, the daily dosage of T3 will need to be split up and taken in smaller doses, known as divided doses. This divided dose approach enables T3 to be taken at various intervals throughout the day, in order to provide a steady supply of T3 to the body.
The use of divided doses also ensures that no single dose of T3 creates an exceptionally high peak level of T3 in the tissues of the body. The majority of patients successfully using T3 use between three and four divided doses of T3 per day.
Using divided doses of T3 clearly adds a lot of complexity to the life of thyroid patients. A further complication of the use of T3-Only is due to the suppressive effect that it can have on TSH. The level of TSH influences the conversion of T4 to T3. A high TSH results in the maximum level of conversion of T4 to T3. A fully suppressed TSH will result in the conversion rate of T4 to T3 being reduced to the minimum level.
For the patient on combined therapy with T4 and T3, this is very significant indeed. Some doctors attempt to perform simple mathematical calculations when they add T3 to their patient’s T4. They reduce their patient’s T4 dosage when T3 is added. Often there is no understanding that the added T3 is likely to have a suppressive effect on TSH and this is likely to downgrade any T4 to T3 conversion rate. So, finding the right balance of T4 and T3 can be an extremely challenging task.
In summary, the use of T3 has a number of difficulties:
- The half-life of T3 is short and the drug is very potent. T3 usually needs to be taken in three to four divided doses per day. A few patients find that they can cope with only two divided doses.
- T3 acts quickly and powerfully and will distort thyroid blood test results of TSH, FT4, FT3, and rT3. For someone using T3-Only, these thyroid blood test results are not reliable measures to be employed for managing the treatment.
- Doctors may wish to try to manage the patient’s T3 dosage using thyroid blood tests and the standard lab ranges – this will not work.
- T3 used in combination with T4 can also prove difficult. Blood test results can be distorted, divided doses of T3 need to be used and the conversion rate of T4 can deteriorate.
All of the above difficulties mean that using T3-Only is not something that anyone should want to do unless everything else has been tried and failed.
Using T3 in combination with T4 is simpler but has its own issues.
As well as bearing the above in mind, investigations into deficient nutrients or low cortisol levels should be thoroughly performed and ruled out before ever considering the use of T3. T3 is harder to use, so other treatments should be explored first.
I have been known to refer to T3 as the thyroid hormone treatment of last resort – I believe it should be viewed like that.
However, if all the necessary investigations have been performed, and all the thyroid hormone therapies have all been tried and shown to fail, then T3-Only can be a wonderful way of recovering your health. I know – I have done it, and so have thousands of other patients.
However, a safe and effective protocol needs to be used – this is why I wrote Recovering with T3.
I hope you found this helpful and informative.
Best wishes,
Paul
(Updated in May 2021)
My brother and I had radiation treatment, on our Thymus Gland, as infants. Neither of us convert T4 to T3. My brother had cancer in his Thyroid and had many surgeries to save his life (age 16). I had a tumor on my Thyroid, at age 29. Had surgery to remove my gland. My Dr. turned my surgery over to an intern and he removed the tumor but failed to remove my gland. We have both been under treated ever since. Since TSH has come out life has been hard. I have found a Dr. that gives me T3 and I had been wondering about T3 only but not sure how to go about this. What are your thoughts on this? I would be interested. Also, I wondered if T4 does anything else other than convert to T3.
Thanks…
Hi Gabbe,
That’s a very sad story. T4 does very little indeed and nothing that the T3 cannot do alone. I wrote my Recovering with T3 book for people like you. I would not decide to use T3 only without reading it. It has enough background information on T3 and a protocol for using T3 only. I would definitely read and digest the Recovering with T3 book before making changes. See my homepage on the website too as I do a few coaching sessions (I won’t do these indefinitely but I still do small numbers of these).
Best wishes,
Paul
Hi,
I have had low T4, low T3 and low to middle range of TSH for the last 20 years. I was initially treated with Levothyroxine, then it was stopped as the doctor was going on my TSH results and not my symptoms. After a break of a couple of years where my T4 levels plummeted further I was prescribed Levothyroxine again. I have spent the following 15 plus years still suffering from UAT symptoms. I felt better when my T4 was raised but as this dropped my TSH below range I remained poorly medicated. 3 years ago I switched to NDT and added T3. My endocrinologist wants me to do NDT only but since going down this route I am struggling and find that I am better with adding T3. I have one copy of the DI01 and DI02 genes and have had low cortisol levels for 15 plus years. The Endo also said I either have central hypothyroidism or a pituitary gland that is not functioning properly but as the treatment is the same it was irrelevant which was the cause. 3 years later I am still struggling to find my correct dose of medication.
Hi Bella,
It does sound like your situation requires a mix of T4 and T3 that suit you. This might mean NDT with T3 or T4/T3. Whichever it is the dosage of the T4 medication might need to be lowered and the T3 increased until your symptoms resolve. Note: TSH level should not restrict this as long as you are not hyper, i.e. a very low TSH is not an issue as it is not an indicator of hyperthyroidism when a patient is on thyroid meds. In addition, if cortisol remains low you might be a candidate for my CT3M protocol to attempt to raise cortisol. It is very common for people with low FT3 levels to have various pituitary issues, as the pituitary needs a lot of T3 to work properly.
My books cover a lot of this. The Thyroid Patient’s Manual is a great starting place.
Best wishes,
Paul
20 years of thyroid replacement. My preferred dose is 40mcgs of t3 and 50mcgs of t4. Can’t take T3 and T4 together. I like half the T3 first thing in the morning, then hours late sneak in the t4, then evening the other half of the T3. T3 is great stuff. T4 is nasty debilitating stuff–but for some reason, I don’t know why, I need some it, otherwise I feel loopy.
Why this combination? Simple, because I feel better. Nothing more than that. Does it screw up my blood tests? You bet. Do doctors argue with me? You bet. They keep telling me I need twice the T4 and a lot less T3 and every time I try, I get the same result–debilitation. So, I’ll stick with feeling good over lab test results that come back inside the norms.
Proof is in the puddin, not the lab test result or the book that a Med student reads.
Hi Eddie, thanks for the comment.
I agree with you. At the end of the day, it is far more important to feel well and have a life than have a set of laboratory test results that please a doctor or endocrinologist. Unfortunately, most of them do not work tirelessly to fix the symptoms of the thyroid patients that they deal with. If a thyroid patient’s lab test results are in range, the doctors feel they have done their job.
I’m sorry it took you 20 years to get there. It took me 10 to get the thyroid medication solution I needed and then another 5 or so to recover from the damage that the T4 had done.
Thanks again for your comment! Stay well!
Best wishes, Paul
Hi
Sluggish hypothalamus, hypopituitary secondary AI-hypothyroid non t4 converter for years with no help looking at labs. Obvious culprits like ferritin, progesterone, b22 addressed, Weigh gain is now a problem after lowering T3 only dose when f/t T were 2-3x normal bone loss deeply concerning. Went off fully to use up excess-holding my own ready to give up trying to get the right dose. Went up to 150mcg, down to 37.5 everything in-between. Feel unwell, not sure where to go from here. Though I had clear hypo symptoms, lethargy afternoon, only to be double normal labs 4-5 hours after last dose as I was told peel took that long. Point being- lab’s not helpful, if you peek in a few hours, how do you calculate the half-life of the previous doses, and how they overlap? WHAT are the definitive clinical symptoms to use if labs are not useful? No TSH/T4 for years since Mayo Clinic diagnosed me.
65 year old frustrated female working this disorder out with a nurse who will try anything we can to keep me going.
Thank you.
Linda,
I would read the Recovering with T3 book. I explain fully how to use signs and symptoms to manage T3 doses. T3 also helps to build bone. The biggest culprits of bone loss are low estradiol and then hypothyroidism. So, cutting the T3 because of bone loss would not have been something that I would have suggested.
A minor aside low B12 is best deal with via injections – regular injections. Simply getting B12 blood levels up by supplements doesn’t necessarily fix the cellular issue: https://paulrobinsonthyroid.com/b12-critically-important/
Have you tested and address cortisol (saliva cortisol test and 9:00am morning blood cortisol)? The book covers dealing with cortisol issues too.
You can’t use the half life of T3 to assess dosage – it has to be based mainly on signs and with symptoms backing it up.
https://paulrobinsonthyroid.com/tracking-thyroid-symptoms-and-signs-vitals/
The book explains this fully.
Best wishes, Paul
i was wondering what is considered to be high t-3? i see some ranges are higher than others. MY tsh is 5.5. which trying to get it lower but my t-3 is 180,
any suggestions?
It is really hard for me to discuss specific patient situations via this website. I would need a lot more information.
Labs always vary with the type of assay that they do when they test thyroid hormones. So in some countries and labs an FT3 range might be 3.3 – 6.7 and in others, it can be completely different. So, what is considered to be high will be dependent on the actual lab and the type of assay that they do.
Also, T3 can be measured as Free T3 (FT3) or Total T3. FT3 is the bioavailable T3 and is much more useful. Usually, the Total T3 is a lot higher with a much higher range.
Best wishes, Paul
Reading this piece a question immediately rose to my mind… after reading your response that T3 can be measured as Free T3 or Total T3, it kind of cements my original theory– it looks like your providers were not aware that you can test *Reverse* T3, which is pretty critical information when diagnosing thyroid or thyroid-based problems. Conventional medicine doesn’t seem to understand the need to know reverse t3 numbers & what that means for understanding what the individual’s body is doing with t4 (or indicating other issues *leading* to the thyroid condition, which is almost always secondary).
…and, in addition, this is why standard exogenous T4 based protocol often doesn’t help– and in the case of someone struggling to convert t4 to t3, it just compounds the problem by giving more t4 to be dysfunctionally converted.
Hi again Jessica,
If a doctor has a patient with high FT4 and low FT3 there would be little or no point increasing the T4 meds to address symptoms. Also, someone can have poor conversion to FT3 without rT3 looking especially high.
Competent doctors should be looking at the overall picture with clinical presentation being the most important and labs backing that up.
Best wishes, Paul
If you were addressing me Jessica, when I was having my own issues with thyroid meds the Reverse T3 test wasn’t even available in any country. This was over 30 years ago.
RT3 can be very helpful yes. However, often the conversion issue is so apparent from low FT3 and high FT4 and symptoms that it actually isn’t going to do more than confirm that conversion is awful. Some countries still don’t have rT3 as an available test also. Some of the European countries don’t do it. Even in the UK rT3 is never tested in the NHS and doctors often disregard it.
But yes, it can be helpful sometimes.
Best wishes, Paul
My daughter has recently been prescribed T3 (after begging for it- the doctor wasn’t keen. She was diagnosed with Hashimoto’s 13 years ago. At times her blood tests said she was hyperthyroid instead of hypo. She is going to cut her T4 (been on it for 13 years) from 150 to 100 and takes T4 recently in three daily doses. She has also been diagnosed with atrophic thyroiditis. All these diagnoses are confusing and I can’t find sufficient easy-to-understand info on these. Does your book touch on these aspects?
Hi Sharon,
1. At times her blood tests said she was hyperthyroid – do you mean that her TSH on thyroid treatment was low? Or that at times FT4 or FT3 were high? With atrophic thyroiditis (AT), you can get variation in the conversion rate of T4 to T3 and at times the TSH signal into the thyroid and other cells is blocked. This makes dosing of T4 meds extremely difficult.
2. With AT the person is often better off with no T4, or very small amounts T4. So, even 100 mcg of T4 may be too much to cope with. See:https://paulrobinsonthyroid.com/could-atrophic-thyroiditis-be-your-problem-it-is-not-always-about-hashimotos-thyroiditis/
3. For someone using mostly T3 (which is usually better for AT), I would definitely recommend reading Recovering with T3. T3 use necessitates a different model for dosage management. Blood tests are no longer very much use and signs and symptoms need to be used instead. The book explains this. My The Thyroid Patient’s Manual book is a more general book on thyroid diagnosis and treatment. It also covers all the other tests and elements that ought to be examined and addressed to be sure that the thyroid treatment has the best chance of success.
Best wishes, Paul
Thank you for this most informative article. I have been taking T3 only for 5 yrs but have been recently experiencing aFib episodes. Now I have. Cardiologist involved and am prescribed Metoprolol25 and Xarelto 25 . My Endo is suggesting that I split my Liothyronine 45 in 2 doses which I’m ok with doing. What are your thoughts?
I always recommend T3 be taken in multi-doses to limit the peaks of FT3 in the cells (not so much the blood).
I recommend 3 doses usually. In your case that would look something like 20, 15, 10 or equivalent taken first thing in the morning, late morning nd then late afternoon. You could try two but it still is not as physiological as 3 doses.
See:
https://paulrobinsonthyroid.com/why-t3-or-liothyronine-is-usually-taken-in-multi-doses-per-day/
Best wishes,
Paul
I just ordered your book.. can’t wait to devour it!
I hope you enjoy whichever of the three books you have purchased.
Best wishes, Paul
What an informative article, thanks. Quick question:
On T3 alone medication, how does one figure out how many mcg one needs daily?
Is it realtive to body weight like the T4 medication is usually calculated 1.5 x weight in kg. So a 60kg indiviual would need 90mcg of T4 daily.
If the ratio of T4:T3 is 3:1 in a T4/T3 combo therapy, does that mean in mono T3 therapy we just divide T4 dosing by 3 ie a 60kg indiviual would need 90/3 = 30mcg T3?? Wondering 🤔
Hi Saman,
I wrote my Recovering with T3 book to explain how to use T3. You can’t even use T4 meds by body weight with any accuracy as everyone with thyroid disease has different amounts of conversion ability. All thyroid hormones have to be titrated. My book explains how – and blood tests can’t be used to do it. In general, though, signs and symptoms have to be used. Three doses per day are typical and it is started low. The book has the full protocol and may not be obvious, so if you intend to try this, please read it.
Best wishes, Paul
As a psychiatrist who is treating numerous patients with T3, I agree with much of what you are saying and salute you for doing your best to get the word out. However, you are mistaken when you say that T3 levels cannot be used to guide treatment. The rule is that the blood for T3 levels must be drawn 5-6 hours after the morning dose, i.e. half-way between doses if the patient is taking it twice daily. If it is three times daily, then the blood should be drawn half-way between two doses, usually at 4 hours. Most people who have T4 levels and TSH within the reference range, but who continue to have hypothyroid symptoms, will have T3 levels at the bottom of the reference range or below. When the free T3 levels gets around the middle of the reference range, most symptoms resolve. That is, guide treatment by testing T3 levels half-way through each dose, then the average level throughout the day is about where we need it.
The dosing can be fine tuned for even better results by also following Reverse T3, which mainstream doctors ignore completely because they believe it is inert. RT3 is actually a thyroid-receptor blocker, so when it is high people will be hypothyroid even if the T3 levels are in the appropriate range. By following the ratio of total T3 to reverse T3, we get much better results. There are only a small number of doctors who follow this protocol, but we get very reliable results. If you look in the Townsend Letter, an integrative journal, for articles by Dr. Alan McDaniel, I believe you will find detailed explanations of all this.
Hi Dr Goderez,
My comments on the Value of FT3 is mostly for people who are on higher amounts of T3 and far less T4. Those with severe conversion issues often require a mostly T3 or only T3 treatment.
For small amounts of T3 added to Levothyroxine treatment I agree that FT3 is much more reliable – more like it is when on Levothyroxine only.
Good luck with your work. I am pleased that you are getting results with your patients.
Best wishes, Paul
p.s. the simplest example I could offer is that of myself. I had Hashimoto’s and Atrophic Thyroiditis. My conversion from T4 to T3 was terrible when on Levothyroxine and on a T4/T3 combination. I only got well on T3-Only. Having been on 60 mcg of T3 per day in 3 doses of 20 mcg, for 25 years I know a lot about how this feels and how it affects blood test results. I am not hyperthyroid at all and function normally. But I have a low TSH, no FT4 and would have an over-the range FT3 if tested so close to the T3 dose as you suggest. Even when only 10 mcg of T4 is added to my treatment (with or without a drop in the T3 dosage) I become very hypothyroid within 1 week.
My work with T3 is mainly aimed at people with severe issues that cannot get well on Levothyroxine or a Levo with a small amount of T3 dosage.
Anyway, once again, I wish you continued success with your patents.
Best wishes, Paul
p.p.s. I forget to mention that the blog post you have commented on was really referring to T3 Only therapy. I mention the other treatments like Levothyroxine, T4/T3 and NDT treatments and that they ought to be tried first. My views on blood tests being quite unhelpful in managing dosage is mainly confined to T3-only or T3-mostly treatment. I think that is clear within the post itself. I wanted to clarify this for any other reader.
Anyway, thank you for your comment.
Best wishes, Paul
Hi, I am from the UK and have taken t3 for several years, 80mcg spilt in 4 doses. T3 has made a huge difference to my well-being, sleep and functioning. Originally sourced the T3 myself from the internet before it was prescribed by an understanding Endo. Previously took levothyroxine, never felt any beneficial effect from taking it, titrated myself gradually off T4 and introduced the T3 over several weeks until I completely stopped the T4. However, I have a new GP and my previous Endo has retired. I am 53 years old, and been having disturbed sleep from night sweats caused by perimenopause symptoms. Not had this problem before, always slept really well, no other symptoms of being over medicated. Requested HRT from GP who felt my symptoms were from me being over medicated on T3. My TSH was suppressed and my T3 results elevated over normal range, my T4 range was practically none existent. Anyway my daily dose to has been reduced 60mcg split into 3 dose, I have been seen by a new Endo who wants me to remain on 60mcg as he was concerned about me developing atrial fibrillation and brittle bones. I myself and my partner have noticed a massive difference in my well-being. I am very tired and fatigued, have reduced concentration, massively reduced function, seem to be covered in bruises and a lot of my hypo symptoms have returned.
You mentioned in your article that you still had a lot of fatigue issues and these arose from continuing low cortisol. I was wondering how you manage to resolve this?
Many thanks
Suzanne
Hi Suzanne,
I had remaining fatigue issues but that was in the first few years of using T3. I then created an additional and optional part of my protocol which is described in the Recovering with T3 book (CT3M) and it resolved the issue which was low cortisol. I’ve been on T3 for well over 25 years now and have no fatigue issues.
In your case it could easily be menopausal issues. I suggest joining a group which has been recommended many times to me:Bio-identical Hormone Replacement Therapy group:
facebook.com/groups/329681332452
It may be closed at the weekend – I don’t know.
For cortisol testing and sex hormone testing I recommend my The Thyroid Patient’s Manual book.
By the way T3 when dosed correctly does NOT cause heart issues or bone loss – it actually prevents them.
Best wishes, Paul
Hello Paul,
I just came accross your website and found the information very informative. I take 100 mcg of T4 and 5mcg of T3. The T3 revs me up in the morning, raising my blood pressure and then fatigue by end of day. Tomorrow I will split my T3 in half. My question is how far from food does the second dose need to be? I find it challenging to find the right time for the second dose and do not want it to upset my sleep. Thank you for your response.
Hi Linda,
Do you know what your TSH, FT4, FT3 and Reverse T3 are prior to using the T3?
Sometimes, poor conversion and high rT3 can cause major issues when adding any T3.
Also, if your cortisol, iron, B12, folate are low then this can also cause issues.
It isn’t always about dividing the T3 or assuming that a tiny amount of T3 (which 5 mcg is) is the issue.
I’d test extensively to understand the situation. Apart from full thyroid labs as above I’d test:
– 9:00am morning cortisol
– a 4 point saliva cortisol test
– serum iron
– ferritin
– B12 (if not on any B12 supplements at all for 4 months)
– folate
T3 can be taken with food. T4 cannot.
I think something is off – either with the thyroid labs or something else. Testing a lot of things may seem like too much work. But thyroid issues can drag on for many years if not deal with properly – so in this case it is worth the effort.
I discuss all things related to this in my The Thyroid Patient’s Manual book.
I also still do some 1-1 coaching online via Zoom.
Best wishes, Paul
Hi!
Im have been on liothyronine for two months now. I am overweight 27 year old girl and I have been on levothyroxine in the past but stopped taking it in 2019 because I felt like it didn’t help. Now I seeked help from a good endrogrinologist and I got liothyronine, I also bought your book and the dr has advised me to slowly increase my dose. I have slowly increased my dose by 5 mg eeekly up to 40 mg (20 mg twise a day now. I feel good but I havent started to lose any weight yet..
My starting labs were T4 15 fT3 5,3 and TSH 1.0
I do have insuline resistance littlebit but should I continue to trust T3 or can it be I dont have issue there..
I think I will still benefit because I have highly stresfull past events and I have been compeating in swimming in my teenage years and I deffinetly have some stress trapped in my nervoussystem.
Excuse my english skills my mother language is finnish.
Best Nea Uusivuori
Hello Nea,
You don’t say if you are taking the Lio on its own or with the T4 medication.
40 mcg of T3 is not a full replacement dose for most people. If you are using the Recovering with T3 book then you’ll read that 40-80 mcg is typically needed. 40 mcg is often not enough for people and some need more than 80mcg.
Insulin resistance often improves as the T3 dose is raised.
You may need to use 3 doses of T3 as the T3 is increased.
Check other things too: cortisol, B12, folate, iron, ferritin, vitamin D.
Your English skills are excellent and better than my Finnish 🙂
Best wishes, Paul
Hi,
thank you for answering. So Im taking T3 only now. I had had 4 years between 2019 and this year that I dodnt take any medication. I have had 24h urine cortisol and vitamin D test done and they vere normal. My vitamin D is in the lower end of the norman range bc it has been on uv here in winter and very dark days also 😁 but usually my vitamin D levels rise in summertime.
I do feel great and I have had no side efects at all. I think I should try to up the dose to 60 mg taken three times a day (3x20mg).
Im interested how insuline resistance improves when the t3 dose is raised? I also do strenght training 2-3 times a weeks and try to eat fiberous and protein rich foods, as well as good fats, no pufa’s ect. But I feel like sometimes my only obstacle when trying to limit sugar is that I have so intense sugar gravings that it makes the restriction almost impossible. My bloodsugar levels are normal in sugar test but my insuline are toi high ”after eating” feel like my insuline levels make that so I feel excess gravings.
Best Nea
Hi again Nea,
Yes, insulin resistance often improves with better T3 levels:
https://paulrobinsonthyroid.com/t3-improves-insulin-sensitivity-insulin-resistance-for-some-thyroid-patients-research/
Good luck! Sounds like you have a plan.
Best wishes, Paul