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.

 

[Anonymous35]

You had not optimal hormones levels thats sure
You should probably increase your levothyroxine to 50mcg
Then wait a month mesured again

Yes rt3 can be great but very expensive
At labs
And i don’t think the problem came from here because your t4 lvl are very low too

T3 from my experience cause a lot of fatigue on the long terme

 

[MYP9864]

As stated in my thread, I have been on 50mcg of Levothyroxine for a week now and will be doing bloodwork in three weeks.

Yes, my thyroid levels were not optimal, especially T3.

Although I feel much better, I must admit I am somewhat hesitant to continue my treatment. In my opinion, thyroid issues and thyroid plasma level ranges are much more complicated and unpredictable than the Testosterone Replacement Therapy. Consequences of screwing up also seem to be more dire.

I have learned so much over the long years about TRT, Test levels, SHBG, E2, Prolactin and other variables through regular bloodwork and observations, that at present I feel I am perfectly dialed in and can manipulate variables with confidence in order to achieve a desired goal.

It seems that dealing with thyroid issues and variables is a completely different animal. Lab ranges differ vastly and sought after results seem to be much more unpredictable.

For example, after almost a month of Levothyroxine treatment (three weeks on 25mcg, one week on 50mcg), my TSH levels decreased from 1.050 to 0.670, while my T3 decreased from 78 to 72.
T4 free increased from 1.05 to 1.12. All while my symptoms improved.

What do I do if my bloodwork in three weeks shows my TSH decreased even more to Hyperthyroidism levels and my T3 decreased even more?
Certainly it would make no sense to continue Levothyroxine treatment.
Perhaps then add T3 and re-test in 4 weeks and if that doesn't help then switch to T3 mono therapy and re-test in another 4 weeks.

I guess time will show.

 

[readalot]

Aways pull

TSH
FT4
FT3

for comparisons.

Best info you can get from serum data. T3 is clouded by TBG just like TT is a f(SHBG, HSA, fT). That's an issue (measuring T3 and hence TBG indirectly) when you are using exogenous androgens that can influence TBG.

 

[IronMetal_2]

As stated in my thread, I have been on 50mcg of Levothyroxine for a week now and will be doing bloodwork in three weeks.

Yes, my thyroid levels were not optimal, especially T3.

Although I feel much better, I must admit I am somewhat hesitant to continue my treatment. In my opinion, thyroid issues and thyroid plasma level ranges are much more complicated and unpredictable than the Testosterone Replacement Therapy. Consequences of screwing up also seem to be more dire.

I have learned so much over the long years about TRT, Test levels, SHBG, E2, Prolactin and other variables through regular bloodwork and observations, that at present I feel I am perfectly dialed in and can manipulate variables with confidence in order to achieve a desired goal.

It seems that dealing with thyroid issues and variables is a completely different animal. Lab ranges differ vastly and sought after results seem to be much more unpredictable.

For example, after almost a month of Levothyroxine treatment (three weeks on 25mcg, one week on 50mcg), my TSH levels decreased from 1.050 to 0.670, while my T3 decreased from 78 to 72.
T4 free increased from 1.05 to 1.12. All while my symptoms improved.

What do I do if my bloodwork in three weeks shows my TSH decreased even more to Hyperthyroidism levels and my T3 decreased even more?
Certainly it would make no sense to continue Levothyroxine treatment.
Perhaps then add T3 and re-test in 4 weeks and if that doesn't help then switch to T3 mono therapy and re-test in another 4 weeks.

I guess time will show.

How ablut not obsessing with blood tests?

You understand serum thyroif levels do not necessarly reflect tissue level?

Low free t3 in blood doesnt have to be an issje if your body is converting t4 to t3 well in tissue.

 

[readalot]

Post in thread 'HGH sleep issues'

Sep 17, 2024

You should probably use more T3 than T4 UNLESS you are already on GH. Clearly you do not have high enough T3 levels and that is why your TSH could be so high.

Was on 150 mcg T4 / 50 mcg of T3 per day when I had AFIB issue. My fT3 was very high and TSH was above 10. So that's not it. Very complex subject matter. Adding more T3 won't always titrate your TSH, especially in deranged patients like me.

Always use at least physiologic ratio of T4 to T3 for treatment unless you know what you are doing.

I advise not to F with high dose T3. Recipe for disaster if you have arrythmia...

• readalot

Post in thread 'Irregular heartbeat'

Feb 21, 2024

Can you expand on running t3 without t4? I currently take t3 year round, 25-50 mics without t4.

Realistic TRT Recomp Progress

Wow, that is a massive difference, brother. Thanks so much for taking the time to explain all of this – super helpful to see it visualized! You are the man. I was thinking of doing injections EOD. From what I know, high SHBG guys tend to do better with more frequent injections. What do you...

forums.t-nation.com

Thyroid Advice with TRT?

Take this schematic to an Endo and ask him to review the various potential outcomes when a euthyroid patient does combination therapy or ends up going too high on the exogenous T3. I have tried my best to explain difficult concepts on here but this one I won’t expound on here (opportunity cost...

forums.t-nation.com

T3 Supplementation

Thanks for sharing these points and good to read your points and the discussion of the paper above multiple times. Running clen (by itself for vanity reasons) and combining it with T3 (and then adding in AAS, tren no less) is really bad news. It’s amazing how much punishment the body can take...

forums.t-nation.com

Sorry for member firewall. Quick sign up and where a lot of my posts are buried.

Careful with the T3 mono. Watch your serum TSH, fT3, fT4. My fT4 sunk below range and TSH continued to climb. Pretty sure it contributed to my AFIB. If your thyroid and heart are fine then...

• readalot

• 

Post in thread 'US Domestic T3'

Mar 21, 2024

So 250 t4 and 25 t3. Do you take all the t4 at the same time in the morning empty stomach with 12.5 t3 and 12 hours later take the other 12.5 t3?

I dose all the T4 early AM at least 2 hours before any food.

T3 gets taken with AM meal.

I have special case that requires over 300 mcg/day of T4 to titrate TSH to reasonable level and I do 12.5 mcg of T3 in AM currently. I monitor TSH, fT4, fT3 frequently.

Years ago I was doing 25 mcg T3 twice daily with no T4. Ended up with AFIB and the asinine thyroid med use may have contributed. I really thought I knew better than my board...

• readalot

• 

Post in thread 'Irregular heartbeat'

Feb 21, 2024

@PaintDrinker a summary post with many links. I ended up spending about a year on SSRI to reset my brain to not panic with arrythmia. In all the AFIB ended up costing me about 2.5 years to really mentally recover. Good news is I am good now knock on wood. Disclaimer: I have Hashimotos so my experience may not be applicable at all to you. Just want to help someone avoid all the crap I went through if I can. Currently I take a much more physiologic ratio of T4 to T3.
Best wishes.

Edit: whoops here's the link...

• readalot

• 

 

[MYP9864]

Post in thread 'HGH sleep issues'

Sep 17, 2024

You should probably use more T3 than T4 UNLESS you are already on GH. Clearly you do not have high enough T3 levels and that is why your TSH could be so high.

Was on 150 mcg T4 / 50 mcg of T3 per day when I had AFIB issue. My fT3 was very high and TSH was above 10. So that's not it. Very complex subject matter. Adding more T3 won't always titrate your TSH, especially in deranged patients like me.

Always use at least physiologic ratio of T4 to T3 for treatment unless you know what you are doing.

I advise not to F with high dose T3. Recipe for disaster if you have arrythmia...

• readalot

Post in thread 'Irregular heartbeat'

Feb 21, 2024

Can you expand on running t3 without t4? I currently take t3 year round, 25-50 mics without t4.

Realistic TRT Recomp Progress

Wow, that is a massive difference, brother. Thanks so much for taking the time to explain all of this – super helpful to see it visualized! You are the man. I was thinking of doing injections EOD. From what I know, high SHBG guys tend to do better with more frequent injections. What do you...

forums.t-nation.com

Thyroid Advice with TRT?

Take this schematic to an Endo and ask him to review the various potential outcomes when a euthyroid patient does combination therapy or ends up going too high on the exogenous T3. I have tried my best to explain difficult concepts on here but this one I won’t expound on here (opportunity cost...

forums.t-nation.com

T3 Supplementation

Thanks for sharing these points and good to read your points and the discussion of the paper above multiple times. Running clen (by itself for vanity reasons) and combining it with T3 (and then adding in AAS, tren no less) is really bad news. It’s amazing how much punishment the body can take...

forums.t-nation.com

Sorry for member firewall. Quick sign up and where a lot of my posts are buried.

Careful with the T3 mono. Watch your serum TSH, fT3, fT4. My fT4 sunk below range and TSH continued to climb. Pretty sure it contributed to my AFIB. If your thyroid and heart are fine then...

• readalot

• 

Post in thread 'US Domestic T3'

Mar 21, 2024

So 250 t4 and 25 t3. Do you take all the t4 at the same time in the morning empty stomach with 12.5 t3 and 12 hours later take the other 12.5 t3?

I dose all the T4 early AM at least 2 hours before any food.

T3 gets taken with AM meal.

I have special case that requires over 300 mcg/day of T4 to titrate TSH to reasonable level and I do 12.5 mcg of T3 in AM currently. I monitor TSH, fT4, fT3 frequently.

Years ago I was doing 25 mcg T3 twice daily with no T4. Ended up with AFIB and the asinine thyroid med use may have contributed. I really thought I knew better than my board...

• readalot

• 

Post in thread 'Irregular heartbeat'

Feb 21, 2024

@PaintDrinker a summary post with many links. I ended up spending about a year on SSRI to reset my brain to not panic with arrythmia. In all the AFIB ended up costing me about 2.5 years to really mentally recover. Good news is I am good now knock on wood. Disclaimer: I have Hashimotos so my experience may not be applicable at all to you. Just want to help someone avoid all the crap I went through if I can. Currently I take a much more physiologic ratio of T4 to T3.
Best wishes.

Edit: whoops here's the link...

• readalot

• 

Thank you for your help. Lots of solid info. It's gonna take me some time to absorb it all

 

[readalot]

Thank you for your help. Lots of solid info. It's gonna take me some time to absorb it all

Not sure if it is helpful. But at least you have the info.

Best advice I never listened to initially...if you want to try T3 then combo therapy with physiologic ratio of T4/T3. Careful if you tread higher than physiologic ratios of T3/T4. Of course you may be less sensitive than me since you are euthyroid (at least clinically). Caution if your FT4 dips below range. Treating with T3 mono can paradoxically (from a superficial knowledge standpoint) cause TSH to rise in some.

Treating/chasing thyroid is a humbling experience. And of course you don't have tissue level data as @IronMetal_2 stated. The heart has T4 receptors as well IIRC.

 

[Anonymous35]

As stated in my thread, I have been on 50mcg of Levothyroxine for a week now and will be doing bloodwork in three weeks.

Yes, my thyroid levels were not optimal, especially T3.

Although I feel much better, I must admit I am somewhat hesitant to continue my treatment. In my opinion, thyroid issues and thyroid plasma level ranges are much more complicated and unpredictable than the Testosterone Replacement Therapy. Consequences of screwing up also seem to be more dire.

I have learned so much over the long years about TRT, Test levels, SHBG, E2, Prolactin and other variables through regular bloodwork and observations, that at present I feel I am perfectly dialed in and can manipulate variables with confidence in order to achieve a desired goal.

It seems that dealing with thyroid issues and variables is a completely different animal. Lab ranges differ vastly and sought after results seem to be much more unpredictable.

For example, after almost a month of Levothyroxine treatment (three weeks on 25mcg, one week on 50mcg), my TSH levels decreased from 1.050 to 0.670, while my T3 decreased from 78 to 72.
T4 free increased from 1.05 to 1.12. All while my symptoms improved.

What do I do if my bloodwork in three weeks shows my TSH decreased even more to Hyperthyroidism levels and my T3 decreased even more?
Certainly it would make no sense to continue Levothyroxine treatment.
Perhaps then add T3 and re-test in 4 weeks and if that doesn't help then switch to T3 mono therapy and re-test in another 4 weeks.

I guess time will show.

Tsh to be honest is useless focus about your t4 and t3 lvls
Do be diagnosed with hyperthyroidism you need your t3 or and t4 out of the reference range
You’re not

 

[MYP9864]

How ablut not obsessing with blood tests?

You understand serum thyroif levels do not necessarly reflect tissue level?

Low free t3 in blood doesnt have to be an issje if your body is converting t4 to t3 well in tissue.

How ablut not obsessing with blood tests?

You understand serum thyroif levels do not necessarly reflect tissue level?

Low free t3 in blood doesnt have to be an issje if your body is converting t4 to t3 well in tissue.

Thanks for your reply.

I agree with you, although not being able to see and know if T4 converts well into T3 in tissue leaves us in a limbo.

My Endo said that given that my RT3 levels were measured for the first time this past bloodwork and came back high while I was already on T4 for a month, doesn't necessarily mean they were high prior to starting the treatment, although it's a possibility. He said if my RT3 levels go up on the next labs while T3 stays low, it will be indicative of poor T4 to T3 conversion.

 

[MYP9864]

Not sure if it is helpful. But at least you have the info.

Best advice I never listened to initially...if you want to try T3 then combo therapy with physiologic ratio of T4/T3. Careful if you tread higher than physiologic ratios of T3/T4. Of course you may be less sensitive than me since you are euthyroid (at least clinically). Caution if your FT4 dips below range. Treating with T3 mono can paradoxically (from a superficial knowledge standpoint) cause TSH to rise in some.

Treating/chasing thyroid is a humbling experience. And of course you don't have tissue level data as @IronMetal_2 stated. The heart has T4 receptors as well IIRC.

What do you consider physiologic ratio of T4/T3?

I will asses my thyroid levels after the next labs. If my TSH keeps further decreasing on T4 toward the Hyperthyroidism territory, then perhaps it would be good for TSH go up slightly on T3 mono.

 

[sinistral]

Thank you @readalot. I knew we could have a productive conversation even though there is a fundamental difference of stance on the subject. You are a gentleman and a scholar

 

[MYP9864]

I will be doing a DIO1 and DIO2 genetic testing some time in the near future.
That will show if my T4 to T3 conversion is impaired.

DIO1 and DIO2 Gene Defects and Testing Them for Thyroid Patients with Suspected T4 to T3 Conversion Issues - Paul Robinson Thyroid

The D1 and D2 deiodinase enzymes are produced in our cells to enable the conversion of FT4 to FT3 to occur within our cells. Both D1 and D2 enzymes are seleno-proteins, i.e. they have selenium as part of their structure. Hence, if someone has low levels of selenium this can hamper conversion...

paulrobinsonthyroid.com

 

[sinistral]

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.

Agreed. That's why many of us TRT guys are here. The doctor's ego and lack of understanding of recent data on the subject is a big hurdle for many.

How is your sleep right now on your current schedule?

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

Right now my sleep is shit because I have a cold and only just recently started T3. I chose 3pm as the last dose b/c Paul Robinson said that was his last dose in a podcast. No other reason.

 

[Anonymous35]

i dont think it’a problem with conversion
Our body produced also some t3

When you take only levothyroxine you only now have t4 in the blood because your thyroid is shut down (very low tsh)
Mono therapy of levothyroxine often time lead to this high lvl of t4 and low lvl of t3