T3/T4 intake question for those with experience

[MYP9864]

46 y/o male, 6.2" 175lbs, 11% bf.
Currently on TRT (16 years) at 100mg Test C weekly, ED injections and 4iu HGH daily.

SHBG 23.2
TOTAL TEST 1260
FREE TEST 29.6 (6.8-21.5)
ESTRADIOL SENSITIVE 35.5

Thyroid Labs from 12/12/24

TSH 1.050 (0.450-4.500)
T3 78 (71-180) low normal
T3 Free 2.4 (2.0-4.4) low normal
T4 6.1 (4.5-12.0)
T4 Free 1.05 (0.82-1.77)

Thyroid Labs from 12/31/24 after one week on 25mcg Levothyroxine

TSH 0.670 (0.45-4.5) low normal
T4free 1.12 (0.82-1.77)
T3 72 (71-180) very low normal
Reverse T3 20.9 (9.2-24.1) high normal (FIRST TIME HAVING REVERSE T3 TEST DONE)
3.44:1 ratio T3 to rT3 (normal ratio should be 10:1)

After struggling with typical Hypothyroid symptoms such as daytime fatigue/lethargy, brain fog, cold feet, bad sleep for a long time, I have decided to try a thyroid medication. Took 25mcg of T4/Levothyroxine for one week and did labs. See results above from 12/31/24.

Saw improvement in all symptoms since day 1 of T4 supplementation. Currently on 50mcg of T4 for one week and will do bloodwork in three weeks.

My observations:
-TSH decreased upon starting T4, although still within normal range
-minor bump in T4 free
-T3 decreased from 78 to 72 (very low normal)
-Reverse T3 is high and T3 to rT3 ratio is very low

Upon doing an extensive research, it appears that my body doesn’t convert T4 into T3 very well, resulting in high Reverse T3 numbers.

Some online doctors recommend a T3 mono therapy in place of T4. Logic is that T4 in this case is useless as it doesn’t convert to T3 and that T3 should directly increase T3 numbers and alleviate Hypothyroid symptoms. Many patients with high Reverse T3 claim their symptoms have greatly improved after switching to T3 only.

If my assumption is right, my Reverse T3 numbers will be even higher when I do labs in three weeks while on 50mcg of T4 and T3 numbers will not improve.

My plan is to either add low amounts of T3 in combination with T4 or switch to T3 only. Which option would you guys recommend?

T3 Mono therapy plan:
-T3 5mcg three times daily (due to short half life)

OR

-T3 5mcg three times daily with 25-50mcg T4

I still feel minor lethargy midday while on 50mcg T4 but other symptoms are much better.

I am confused though, as to why I am feeling better overall since starting T4, despite having high Reverse T3 numbers and no improvement in T3.

I am also concerned that taking T3 might lower my TSH even more causing Hyperthyroidism.

 

[mochul]

read this.

Metabolic Effects of Liothyronine Therapy in Hypothyroidism: A Randomized, Double-Blind, Crossover Trial of Liothyronine Versus Levothyroxine - PMC

Levothyroxine (l-T4) therapy is based on the assumption that the conversion of T4 into T3 provides adequate amounts of active hormone at target tissues. However, in rodents, l-T4 alone does not restore a euthyroid state in all tissues. Previous ...

pmc.ncbi.nlm.nih.gov

basically, t3 at around 25 to 40 mcg results in normal high free t3 and tsh around 1. You need to do regular blood work to determine your dosage. Timing is important too. First thing in morning and around 6pm looks good according to study and is easier than three times.

 

[sinistral]

I'm in a similar boat bro. You are on the right track according to my research as well.

Basically, the way I see it is to take as much T4 as you can such that you don't increase RT3 beyond 15 ng/dL (excess T4 converts to RT3) then fill in the rest with T3 to get your FT3 in the top 25% of the range. You might in fact end up with T3 monotherapy. You just have to keep adjusting dosages and testing to dial in on your target. Unfortunately the target "moves" a bit every time you apply a treatment e.g. you take T4 and feel great for a week or two then TSH drops from the exogenous T4 and now you are not converting as much FT3 and you start to feel like garbage....

I'm sure you've come across the following in your research but a couple resources I consider credible.

Stop the Thyroid Madness™ - Hypothyroidism and thyroid mistreatment

Thyroid mistreatment using T4 medicine, the TSH lab test, and Hashimoto's or hypothyroidism mismanagement are too common. Find out the truth about this ongoing scandal.

stopthethyroidmadness.com

RecoveringwithT3

Videos on recovering from hypothyroidism by Paul Robinson. Topics will include dealing with thyroid health, hypothyroidism, low cortisol and related issues. This channel content will help those with thyroid issues, adrenal issues, Hashimoto's and thyroidectomy patients. See Paul's website...

www.youtube.com

 

[IronMetal_2]

Not something you want to hear probably but I would believe your thyroid works just fine and your symptoms are unrelated.

If you truly want to see if higher t3 fixes your symptoms, just add some T3. If you don't feel better, it's not your thyroid.

 

[readalot]

With all due respect, I'll keep this short. The internet RT3 fad is utter BS. You don't have hypothyroidism. You are just fine.

The end.

If you want to test your hypothesis, add T3 at 12.5 mcg AM and see if that resolves symptoms after a few weeks. It won't. Not happy with your fT3 and RT3. You could spend the next year spanning the entire reference range of RT3. Won't make a difference to your symptoms. Why?

You don't test blood work after 1 week on T4. Why? Go see an Endo if you have questions as you don't understand what you are doing. No offense. Leave your thyroid alone.

 

[MYP9864]

read this.

Metabolic Effects of Liothyronine Therapy in Hypothyroidism: A Randomized, Double-Blind, Crossover Trial of Liothyronine Versus Levothyroxine - PMC

Levothyroxine (l-T4) therapy is based on the assumption that the conversion of T4 into T3 provides adequate amounts of active hormone at target tissues. However, in rodents, l-T4 alone does not restore a euthyroid state in all tissues. Previous ...

pmc.ncbi.nlm.nih.gov

basically, t3 at around 25 to 40 mcg results in normal high free t3 and tsh around 1. You need to do regular blood work to determine your dosage. Timing is important too. First thing in morning and around 6pm looks good according to study and is easier than three times.

That's a great study. Thanks for posting it. If I do proceed with T3, I will start with 5mcg three times daily at 6am, 12pm and 6pm to asses my tolerance and body's reaction.

 

[MYP9864]

I'm in a similar boat bro. You are on the right track according to my research as well.

Basically, the way I see it is to take as much T4 as you can such that you don't increase RT3 beyond 15 ng/dL (excess T4 converts to RT3) then fill in the rest with T3 to get your FT3 in the top 25% of the range. You might in fact end up with T3 monotherapy. You just have to keep adjusting dosages and testing to dial in on your target. Unfortunately the target "moves" a bit every time you apply a treatment e.g. you take T4 and feel great for a week or two then TSH drops from the exogenous T4 and now you are not converting as much FT3 and you start to feel like garbage....

I'm sure you've come across the following in your research but a couple resources I consider credible.

Stop the Thyroid Madness™ - Hypothyroidism and thyroid mistreatment

Thyroid mistreatment using T4 medicine, the TSH lab test, and Hashimoto's or hypothyroidism mismanagement are too common. Find out the truth about this ongoing scandal.

stopthethyroidmadness.com

RecoveringwithT3

Videos on recovering from hypothyroidism by Paul Robinson. Topics will include dealing with thyroid health, hypothyroidism, low cortisol and related issues. This channel content will help those with thyroid issues, adrenal issues, Hashimoto's and thyroidectomy patients. See Paul's website...

www.youtube.com

Thanks for your reply and your comments.

I will be starting off slowly and making adjustments if necessary.

Yes, I am familiar with Paul Robinson. I have started reading his book “Recovering with T3”.

Lots of great information from a highly credible source.

Feel free to DM me if you would like to share and discuss your situation.

 

[MYP9864]

With all due respect, I'll keep this short. The internet RT3 fad is utter BS. You don't have hypothyroidism. You are just fine.

The end.

If you want to test your hypothesis, add T3 at 12.5 mcg AM and see if that resolves symptoms after a few weeks. It won't. Not happy with your fT3 and RT3. You could spend the next year spanning the entire reference range of RT3. Won't make a difference to your symptoms. Why?

You don't test blood work after 1 week on T4. Why? Go see an Endo if you have questions as you don't understand what you are doing. No offense. Leave your thyroid alone.

Thanks for your response. I welcome your criticism and while I appreciate your contributions to this board, I respectfully disagree with you.

Reverse T3 is not a fad. There is a multitude of medical articles online about RT3 written by experienced practitioners on the subject of RT3 and why having high levels of RT3 can be detrimental to our hormonal health, although not necessarily directly.

https://paulrobinsonthyroid.com/reverse-t3-what-is-it-and-what-it-means-for-thyroid-patients/

Your blank statement that I don’t have Hypothyroidism and that I am just fine is incorrect and not factual.

I had said that I have Hypothyroidism symptoms; I had never claimed to have a true Hypothyroidism and if I was fine and had no symptoms I wouldn’t be posting this thread here to begin with.

I fully understand that testing my T4 levels 1 week after starting therapy was a mistake. It was not something I intended to do.

I was already getting a full bloodwork done and decided to add T4, T3 and rT3 tests at the last minute, without realizing it would be pointless
at 1 week into the treatment.

I am in contact with my Endocrinologist who agrees that perhaps I am not a great responder to T4 due to my body’s inability to properly convert T4 into T3, thus elevating my RT3. It is for this reason I have been prescribed T3 at 5 mcg three times daily, so that I can try an alternate treatment.

But just because I have been given a green light by my Endocrinologist to start T3, it doesn’t mean I am not hesitant to do it.

I wanted to see if some of you experienced guys would chime in with some similar issues and anecdotes.

As I had mentioned before, my Hypo symptoms have greatly diminished since day 1 of T4 treatment. No more freezing cold feet and brain fog, much less lethargy and improved sleep quality.

All other variables such as gear, supplements and diet have been constant, thus it is evident T4 was the sole contributor to these improvements.

Perhaps there is no reason to stop T4 if it’s working but I feel that my rT3 levels will be even higher in three weeks when I do my labs and T3 won’t be improved. If that’s the case, my options will be to either add T3 to the T4 treatment and re-test in 4 weeks or quit T4 and do T3 only.

No worries @readalot, I know you meant well

 

[readalot]

Glad it's working for you Brother. I hope you continue to have success and wish you the best. Short of tissue biopsy you can do the hypothesis testing and find if combination therapy or T4/T3 monotherapy work for you.

Glad your provider is starting you with modest T3 dosing.

 

[MYP9864]

Glad it's working for you Brother. I hope you continue to have success and wish you the best. Short of tissue biopsy you can do the hypothesis testing and find if combination therapy or T4/T3 monotherapy work for you.

Glad your provider is starting you with modest T3 dosing.

Thank you for taking the time to respond to my thread. I appreciate your engagement and your comments Brother.

I will proceed cautiously with testing my hypothesis. I plan on doing bloodwork every 2-4 weeks to assess the numbers vs well being and will stop treatment if any unwelcome side effects arise.

 

[SenorSuperdrol]

Isn’t the half life of t4 6 days? You’re already changing your protocol?

As @sinistral said it’s a moving target to dial the dose in. That goal isn’t a week when something has a 6 day half life. I think his dosing protocol is sounds logical.

In that first week you will still have endogenous production and exogenous supplementation. So it’s not a true test of conversion, or symptom relief for said dose. For the bloods you pulled. As by week 5-6 of the t4 your tsh would be significantly more suppressed as time went on. Changing sll metrics.

Thankfully it’s only a week. Hopefully the mono therapy works for you. 3x a day on an empty stomach doesn't sound ideal.

 

[sinistral]

With all due respect, I'll keep this short. The internet RT3 fad is utter BS. You don't have hypothyroidism. You are just fine.

The end.

@readalot I believe I've seen this general post from you or someone else before. Could you elaborate this position? I'm genuinely interested in what people in this camp have to say.

 

[readalot]

@readalot I believe I've seen this general post from you or someone else before. Could you elaborate this position? I'm genuinely interested in what people in this camp have to say.

Out of respect for OP's thread I'll leave it at the last post. I posted an incredible about of material on this at TNation and ExcelMale under readalot and tareload for the folks who are really interested.

There's a lot we don't know about the individual response to combination therapy so in that respect I should have been less aggressive in my opening post. My apology. Take care everyone.

 

[sinistral]

Out of respect for OP's thread I'll leave it at the last post.

Ok, that's fair. My apologies to OP.

 

[MYP9864]

Isn’t the half life of t4 6 days? You’re already changing your protocol?

As @sinistral said it’s a moving target to dial the dose in. That goal isn’t a week when something has a 6 day half life. I think his dosing protocol is sounds logical.

In that first week you will still have endogenous production and exogenous supplementation. So it’s not a true test of conversion, or symptom relief for said dose. For the bloods you pulled. As by week 5-6 of the t4 your tsh would be significantly more suppressed as time went on. Changing sll metrics.

Thankfully it’s only a week. Hopefully the mono therapy works for you. 3x a day on an empty stomach doesn't sound ideal.

I forgot to mention that prior to taking 50mcg of T4 for one week, I was on 25mcg of T4 for three weeks. So the labs were done after 4 weeks total of T4 administration.

When I said that my symptoms improved after day 1 of treatment, that was on 25mcg of T4.

My endocrinologist said that T3 doesn't have to be taken on an empty stomach. Taking it with food is OK.

Liothyronine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD

Find patient medical information for liothyronine oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.

www.webmd.com

 

[readalot]

I forgot to mention that prior to taking 50mcg of T4 for one week, I was on 25mcg of T4 for three weeks. So the labs were done after 4 weeks total of T4 administration.

When I said that my symptoms improved after day 1 of treatment, that was on 25mcg of T4.

My Endo said that T3 doesn't have to be taken on an empty stomach. Taking it with food is OK.

Thanks for the additional data. Another reason to not stupidly comment on your post like I did. It's difficult to get all the pertinent info in a single post and our dialogue can't replicate the interaction and dialogue between provider and patient.

If you want to supplement with combination therapy while on GH, more power to you. We can agree to disagree on the diagnostic value of RT3 outside the inpatient hospital setting.

Best wishes and hope you continue to enjoy resolution of symptoms.

 

[sinistral]

That's a great study. Thanks for posting it. If I do proceed with T3, I will start with 5mcg three times daily at 6am, 12pm and 6pm to asses my tolerance and body's reaction.

Is the 6/12/6 schedule from your Endo or you? Nothing wrong with it. I'm trying to work out my schedule too. Right now I am doing 25mcg 6am and 12.5mcg 3pm but I'm considering the 3x/day depending on if it affects sleep.

 

[MYP9864]

Thanks for the additional data. Another reason to not stupidly comment on your post like I did. It's difficult to get all the pertinent info in a single post and our dialogue can't replicate the interaction and dialogue between provider and patient.

If you want to supplement with combination therapy while on GH, more power to you. We can agree to disagree on the diagnostic value of RT3 outside the inpatient hospital setting.

Best wishes and hope you continue to enjoy resolution of symptoms.

You're welcome. No worries, it's all good. I appreciate your input and wishes.
I will take a look at your RT3 posts on the other forums you mentioned.

 

[readalot]

Sorry for the dumb email firewall. If I knew they were going to fence all the work I never would have joined up years ago.

What is TRT and What is NOT TRT

There is some more good study material i will find for you. Edit: Good review in this thread:

t-nation.com

More posts below this one.

 

[MYP9864]

Is the 6/12/6 schedule from your Endo or you? Nothing wrong with it. I'm trying to work out my schedule too. Right now I am doing 25mcg 6am and 12.5mcg 3pm but I'm considering the 3x/day depending on if it affects sleep.

That's from my Endo. He said either that or 6am/2pm/10pm is good too.
I take T4 right before sleep and I actually sleep and feel better than when I took it in the morning for the first couple of days. I made that switch on my own as the directions I got was to take it in the morning.

Everyone responds differently to meds. I feel that sometimes you have to be willing to take some risks and make some tweaks if things are not going as desired.

Sometimes doctors have very big egos and are very hard to work with. I am not saying my doctor is like that but it's not easy to find a doctor with an open mind who will listen to your input and allow you to make minor adjustments if warranted.

For example, if your doctor tells you to take your thyroid meds in the morning but you feel better when taking them at night, do you tell them and risk pissing them off or do you take them at night and keep it to yourself, making your doctor feel like they're the boss?

How is your sleep right now on your current schedule?

Hopefully adding T3 or doing T3 only, will not worsen my sleep.