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Mary Shomon

Study Shows that the Addition of T3 is Superior to Levothyroxine/T4-Only Thyroid Treatment for Hypothyroidism

By May 17, 2010

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Positive news for thyroid patients: a study published in a highly respected and reputable endocrinology journal says that the combination of T4/T3 is superior to T4 only/levothyroxine treatment for hypothyroidism! Here are the details.

The groundbreaking study, reported on in the European Journal of Endocrinology, looked at the controversial issue of treatment with synthetic T3 as a supplement to T4-only (levothyroxine) therapy for hypothyroidism.

Some studies going back more than a decade have shown the superiority of the combination therapy. Other studies, however, found no difference. The inconsistency of these research findings on T3 has led some experts -- in particular, those who are biased in favor of levothyroxine-only therapy -- to conclude that there is no benefit to the addition of T3. (Some of those same "experts" even made a major logical leap, and erroneously concluded that levothyroxine/T4-only therapy is superior to T4/T3 combination therapy.)

In any case, in the new research, Danish researchers conducted a double-blind, randomized cross-over study -- which is considered the gold standard format for research -- of 59 patients. In the patient group, 50 micrograms of the usual T4 dose was replaced with either 20 mcg of T3 or 50 mcg of T4 for 12 weeks. The patients then did the "cross-over," doing the opposite for another 12 weeks. The T4 dose was regulated if needed to keep the TSH levels stable.

Tests for quality of life (QOL) and depression were performed at the start, and after both of the 12-week treatment periods. The quality of life and psychological factors evaluated included, among other factors: general health, social functioning, mental health, vitality, sensitivity, depression, and anxiety.

What the researchers found was that among the patients -- 55 of whom were women -- there were significant differences in 7 out of 11 of the QOL and depression scores, showing a positive effect related to combination T4/T3 therapy.

A total of 49% of the patients preferred the combination treatment, and only 15% preferred levothyroxine-only treatment.

The researchers concluded that, in a study where TSH levels were kept consistent, the T4/T3 combination therapy that included 20 mcg of T3 daily was superior to levothyroxine-only treatment, when evaluating for a number of quality of life measurements, depression and anxiety scales, and patient preference.

Doctors often point to the risk of side effects with T3 therapy as a reason not to use T3, but this study showed that there was no difference with regard to side effects. According to the authors, during the T4/T3 combination therapy, five people experienced side effects including palpitations, excessive sweating, and psychological instability. During the T4-only therapy, nine people reported the same side effects.

Interestingly, the Danish researchers pointed out problems with some of the previous studies of T4/T3 therapies that had not found any benefit to T3 treatment, saying: "the studies included in the meta-analysis were a mixture of different patient groups, including patients with previous thyroid cancer, autoimmune hypothyroidism, and subclinical as well as overt hypothyroidism."

And, according to the Danish researchers, in one of the key studies, "...[the] authors were unable to keep serum TSH levels at a similar level in the two treatment groups, mean serum TSH being 3 in the combination group and 1.5 mU/l in the monotherapy group.

The researchers have said that their study suggests that a subgroup of patients appear to benefit from the combined T4/T3 therapy. In particular, they suggest that there may be physiologic reasons why the subgroup responds to -- or needs -- the T3, specifically, that:

...a recently identified polymorphism in the gene coding for the type two deiodinase, the enzyme responsible for the regulation of T3 availability to the tissues, has been proposed in order to help identifying subgroups more likely to benefit from T4/T3 combination therapy. Another polymorphism, located in OATP1C1, a thyroid hormone transporter expressed at the blood-brain barrier, has been associated with fatigue and depression.
Famed Dutch Endocrinologist Wilmar Wiersinga Says Sustained Release T3 May be Best, Some People May Have Genetic Propensity to Do Better on T3

Dutch endocrinologist Wilmar Wiersinga wrote an accompanying editorial, titled "Do we need still more trials on T4 and T3 combination therapy in hypothyroidism?"

According to Dr. Wiersinga, some previous studies had concluded that there is no benefit to adding T3. Yet, the fact that, according to Wiersinga, as many as 10% of hypothyroid patients are dissatisfied with how they feel on what doctors would call an "adequate dose" of levothyroxine replacement led to the publication of the Danish study.

The editorial, which is published in full-online, points to flaws in the previous studies and analyses of T4/T3 combination therapy. Dr. Wiersinga concludes that there are two strong reasons to conduct additional randomized controlled trials comparing levothyroxine/T4 only treatment monotherapy, to T4/T3 combination therapy:

First, trials so far have been largely unsuccessful in mimicking physiological serum FT4-FT3 ratios throughout 24 h. The development of sustained-release T3 preparations might be essential for reaching the goal of 'physiological' thyroid hormone replacement. Secondly, an increasing number of polymorphisms in deiodinases and thyroid hormone transporters are associated with psychological well-being, depression, fatigue, and preference for combination therapy. Could it be that subjects not satisfied with monotherapy are frequent carriers of these polymorphisms, and will have a better response to combination therapy?
According to Dr. Wiersinga, development of a sustained-release T3 preparation, given as a single nighttime dose (together with levothyroxine once daily) might best maintain physiological ratios of Free T4 and Free T3 in in some thyroid patients over a 24-hour period.

Note: So let's just recap this again. Half the patients preferred the T4/T3 combination -- only 15% preferred levothyroxine-only, AND, quality of life and other factors were improved. AND, the T4/T3 therapy had no more side effects than the T4-alone. (In fact, in this study, the T4-only therapy caused MORE side effects.) I anticipate that some of the same so-called thyroid experts -- who frequently are also on the payroll for the levothyroxine manufacturers -- are probably going to fall all over themselves trying to explain away the findings, and it's going to be fun watching them try!

The actual journal article in its entirety is fascinating reading, but unfortunately, it's not posted on the Internet in full. You can, however, purchase a copy online for $25 at the European Journal of Endocrinology website. This is definitely one that you want your doctor to read as well, so be sure to let him or her know to get a copy as well. Frankly, it might even be worth it to buy a copy to GIVE to your doctor, if he/she isn't willing to learn about new thyroid developments.

More Information on T4-Only Vs. T4/T3 Combination Treatment for Hypothyroidism


Birte Nygaard, Ebbe Winther Jensen, Jan Kvetny, Anne Jarløv and Jens Faber. "Effect of combination therapy with thyroxine (T4) and 3,5,3'-triiodothyronine versus T4 monotherapy in patients with hypothyroidism, a double-blind, randomised cross-over study," European Journal of Endocrinology, Vol 161, Issue 6, 895-902, December 2009 Abstract, (Full text ($25))

Wiersinga, Wilmar "Do we need still more trials on T4 and T3 combination therapy in hypothyroidism?" European Journal of Endocrinology, Vol 161, Issue 6, 955-959. Full text (free)

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May 18, 2010 at 10:41 am
(1) Saffron says:

This is heart-stopping news. (There IS a God!)

Mary, I’m confused about timing. Your post is brand new (May 17, 2010) but the study is from last year. Why is it only coming to light now?

May 18, 2010 at 12:40 pm
(2) Mary Shomon / Thyroid Guide says:

Study was published late December 09 — and, no surprise, was totally ignored by the media and doctors, and endocrinology establishment.

It’s been on my to do list. But I’m a one-woman research/writing/advocacy operation, and have about 4000 unread emails and an 8 foot mountain of studies, books, etc. to read/review.

So I get to things as soon as I possibly can! Sometimes it takes a bit of time, as you can see. :-)

February 2, 2011 at 1:12 pm
(3) Martha Forsyth says:

This study, being more than 12 months old now, actually IS online: http://www.eje-online.org/cgi/reprint/161/6/895

2 Feb. 2011

August 30, 2011 at 6:41 am
(4) Christine Kavanagh says:

You are fantastic Mary. I would be lost without your research. Lost 21lbs last year and put it all back on and feel soooo tired and sluggish. Only on elthroxin here in Ireland. So hard to get doctors to move from what they believe to be normal !!! So frustrating.

Keep up the good work, you are a light at the end of a very dark tunnel xxx


August 30, 2011 at 7:55 am
(5) marion says:

anyone on Thyrolar? If so how do you find it works?
Somehow I just don’t feel I want to use dessicated pig thyroid [armour] – am not Jewish or Muslim but am concerned about it..so would opt for the synthetic combination of Thyrolar, which, I think, is available here in the U.K.

August 30, 2011 at 11:07 am
(6) Andrea says:

First of all Mary S. is fantastic!! I am a 31 year old female diagnosed with hypothyroidism at age 6. Since then I have lived in 3 countries, I find that a lot of doctors think females are unhappy about thyroid treatments because we want to lose weight only. They dont seem to get that our qaulity of life is suffering, I am sure I need not name the the endless list of systems here. I find that as long as my results are in the “avarages” doctors seem to feel their job is done. So I want to say to Christine Kavanagh, lets talk about this here in Ireland and see if we can find a doctor that understands/cares, maybe even listens…?

May 18, 2010 at 12:58 pm
(7) Saffron says:

You’re amazing! Thanks so much. (I’m thinking we might need to reforest for all the printouts being made by patients today for their endocrinologists.)

May 21, 2010 at 3:49 am
(8) Joanna Scott says:

This is great news.
My NHS endocrynologist would not accept the T3/T4 combination and told me I was ok just on T4 Levothyroxine as my blood test said so. Even though I was suffering depression and anxiety and still sleeping six hours a day. He didnt feel depression had any link to thyroid disease!!! All complete rubbish of course. Thank God I was lead by my insinct and sought help from another practitioner. Now happily on Armour thyroid.
This study hopefully will go some way to changing minds in the medical establishment.

July 18, 2011 at 2:45 am
(9) Extenze says:

I never heard about any of this stuff before reading this article. Only T3 I know of was the movie Terminator 3 (T3). Great informational article.

August 12, 2011 at 4:06 am
(10) Helen says:

I am having exactly the same problem with the NHS. April appointment cancelled till August. Took one look at my results and told me that I was normal and that it was “nothing physiological” I was furious – my symptoms are classic hypo! I can tell you that if I hadn’t been depressed before I went in, I certainly was by the time I left!!!

I would be interested to find how you managed to get armour if you are in the UK, was it very difficult and which county are you in? I would also be interested to know how many people have actually succeeded to get T3 in the UK


May 21, 2010 at 4:23 am
(11) Mette says:

Hi Mary
Just wantet to let you know that I participated in the Danish study as a patient. Transitioning from monotherapy to the combo made a world of difference to me. Luckily I was in the combo group and was offered to continue on the combo after the study ended. In Denmark T3 is not marketed but can be obtained on a named-patient basis if prescribed by an endocrinologist.

September 5, 2010 at 4:17 pm
(12) Anna Nederdal says:

Dear Mette

Can You recommend a endocrinologist that prescribes T3 in Denmark?

I live in Sweden.


May 21, 2010 at 5:00 am
(13) Inga says:

Does the T3 improve general wellbeing even if the doctor claims the T3 level is normal in the tests?

I am on 75mcg of thyroxine and still feel exhausted!!

May 21, 2010 at 5:30 am
(14) Mahmoud says:

what is the % fot T3 toT4

May 21, 2010 at 5:54 am
(15) Rich says:

Im on eltroxin 150mg, Can someone advise on what dosage of T3/T4 combo I could go on, My doctor is open to the idea of combo treatment , 150mg Eltroxin will keep my bloods looking ok but I still feel peed off and tired

May 21, 2010 at 7:35 am
(16) Carol says:

Can you tell me if this info also applies to those who have had total thyroidectomy/ablation of thyroid for cancer?

August 31, 2011 at 11:07 am
(17) TexasThyroid says:

THYCA patients need the T3 even more than others, because part of your T3 is made in the thyroid gland itself.

I am a thyroid cancer survivor.

After ten years in $ynthroid h*!!, I blackmailed my internist, wrestled him to the ground and got him to write me a script for Armour Thyroid. It has T3, T4 and trace amounts of all naturally occurring thyroid hormones.

May 21, 2010 at 7:59 am
(18) Mette says:

Hi Rick (comment 8)
I was on 150 microgram Eltroxin when I entered the study and it was changed to 100 mcg Eltroxin plus 20 mcg T4. I stayed on this dosing regimen after the study ended. I don’t know if that would be appropriate for you though; that’s for your doctor to assess. Good luck.

May 21, 2010 at 10:30 am
(19) Nella says:

Mary, you are an Angel! I can’t tell you how many times I have been wondering about something and then I get your emails right on point. My Endo is awesome (my 3rd one after a full thyrodectomy-no cancer a year ago) and this last time I sat down with him and told him flat. “I’m not a 5 min. patient and I’m very informed. This is not only an appt. but an interview, at the end I HAVE to like you HAVE to like me, otherwise this lifetime relationship will not work” Well, he liked me, or at least tried. He has been always open about my suggestions. In fact, I had read about T4/T3 combination during the winter months where I was miserable. I suggested to him to try Cytomel and he agreed right away told me about the side effects and so on. We are still on a trial phase and I ran out of Cytomel and decided to go with Mail in order that took to long (my fault not the company). So I had been feeling bad again and did not know why, UNTIL I just read your emai. It does make sense.

So, listen to your bodies, do what is best for you and don’t settle for less than 100% good quality caring physicians! They are out there and it is your job to find them!


May 21, 2010 at 10:38 am
(20) Nella says:

Carol, yes the combination works for full thyrodectomy, I had one on March last year. I didn’t have cancer so you might want to double check with your Dr. As for the dosage, it depends on what your body needs, it is not a one-fit-all formula. I was on 150mg T4 and was put on 5mcg Cytomel (T3) for 3 months. My TSH at the time was 2.1 but my pre-surgery TSH was 0.2 so that is our goal. After 3 months my TSH was -0.4 (which is hyper) but I did my blood test a few hours after taking the T3 and that affects the results. My Dr. lower the T4 to 137mg and continue with the T3 at 5mcg. My next appt. is in June so we’ll see. Just remember that when you do your blood work you have to have several hours from your T3 so it doesnt’ affect the TSH result. T3 is a fast-release type of hormone and this why it may give you an accurate TSH result.

Hope this helps!

May 21, 2010 at 11:00 am
(21) KAL says:

This study used functional and subjective instruments to measure outcome. There is nothing wrong with this, but without physiological measures being used to measure tangible and objective changes such studies only provide part of the picture.

Fatigue for example is a vague and highly subjective term – in other words your “fatigue” may not match that of the patients in the study.

Unless the measurement includes both duration and severity, the results don’t mean much.

If T3/T4 were shown for example to affect weight loss and all other variables were controlled for, that would be good objective evidence.

Once again, public health and preventative health studies do not measure symptoms the same way medical science does. Undifferentiated, fatigue could be construed as depression or anxiety when that may not be the case at all.

In other words – still room for improvement in the research world.

The bottom line of course has always been to use the treatment your body says is best for you.

May 21, 2010 at 11:03 am
(22) Paul R. says:


This is interesting news, and seems to corroborate what Dr. Ken Blanchard and others claim when speaking about T3.

I have 2 questions:

1.) It appears to be that the patients were given both T4 and timed-released T3 at night, prior to bedtime. Is this further proof that the earlier study demonstrating improved TSH, lowered symptoms, and improved overall well-being from nighttime dosing is becoming more the norm?

2.) 20 mcg of T3 was used in the place of 50 mcg of T4, correct? If that is the case, how is that considered combo dosing? Don’t they need to be taken together to represent a true combination?

I had been on Armour as high as 1 grain, and was suffering from chest tightness, frequent waking during the night, and general tiredness/ tenseness. My Free T4 was also in the basement (.98) on this dosage, and my Free T3 was off the charts (4.9 with 4.2 being the ceiling). As I have lowered my Armour, I have noticed myself less tense, sleeping through the night, and having less chest discomfort.

My current dose of 1/2 grain Armour with 25 mcg Levothyroxine seems to be close to perfect, but I have a blood test scheduled in June to see where I am at. I still feel as though I could raise my Free T4 to 37.5 mcg, but I am not sure if I need to lower or keep my Armour where it’s currently at.

I do feel better with some T3, but for me it seems to be somewhere in the 2-4.5 mcg range. 20 mcg of T3 as used in this study seems like an awful lot.

May 21, 2010 at 11:05 am
(23) Jenny says:

oh, it all sounds so confusing to me, I`m trying to understand my underactive thyriod problem, maybe I just need the time. All I know how tired and overweight I`ve become.

May 21, 2010 at 11:25 am
(24) Mary says:

I’m one of those fortunate autoimmune patients (with both Graves & Hashi’s antibodies)who does well on synthetics. Over a year ago, I developed a severe iron and vit D deficiency causing my hypo symptoms to return in full force, so my doc and I added a 20% ratio of T3 to my T4 , based on the premise that I was not converting the T4 due to the iron deficiency. My doc thought that clearing up the effects of the iron deficiency would take a few months because it takes that long for poorly formed and under-functioning blood cells to cycle out of the system. It’s a year later and I’m still working on building up my ferritin levels, but all things considered, the addition of T3 has made a huge difference in my daily well-being and symptom relief. Although my story is anectdotal, I believe the T3 has had much more than a placebo effect. I am also very lucky that my endo sees thyroid disorders as a complex puzzle that she is challenged to solve and that the solution varies from person to person. (How could it not when it’s about hormones!).She is willing to juggle all the puzzle pieces around until she finds the right mix for the individual, and she’s aware that the mix may change over time. She has also recognized that I have a thyroid that is still partially functioning, and can therefore fluctuate based on antibodies and other autoimmune factors. One thing I find amazing, based on the typical personality profile of endocrynologists, is that they are not more drawn to and fired-up by the challenge of solving individual ‘patient puzzles’. Why would any condition related to hormones ever justify a ‘one-size-fits-all’ cookie-cutter approach?

May 21, 2010 at 11:42 am
(25) Pam says:

Thank you!! ANYTHING to help us!! I have felt so lousy for so long, and I KNEW something was wrong!
Thank you!

May 21, 2010 at 11:46 am
(26) Celia says:

“According to Dr. Wiersinga, development of a sustained-release T3 preparation, given as a single nighttime dose (together with levothyroxine once daily) might best maintain physiological ratios of Free T4 and Free T3 in in some thyroid patients over a 24-hour period.”

Does this mean that time-released T3 should be taken at night? My physician has instructed me to take both levothyroxine and compounded time-release T3 together early in the morning before breakfast. To my understanding, this is how it is conventionally done.

Mary, could you address this issue further? I’m very interested in knowing if changing the timing of T3 dosage could be of benefit. Thank you for your great work!

May 21, 2010 at 12:58 pm
(27) Ursula says:

Thanks Mary for this article! I am fortunate to work for a medical school, and could download the full publication. It was very interesting to read, and confirmed why I am feeling so much better with adding some cytomel (additionally to Armour). As the study says, the T4/T3 ratio is something to experiment with, for a significant number of patients 3:1 or 4:1 being the best (Armour: 4.22:1, I think).

About the comments about the timing of taking the medication (just to add my experience): Purely by trial and error, I find it best to take one dose at night, right before going to bed, and the second half during the day, in the afternoon (after lunch has been digested). The medication taken before bed-time makes me sleep much more quietly and deeply. I am taking Armour with cytomel, non-time-released. I haven’t discussed this effect with my doctor, yet, but he did suggest dividing the dose.

Thanks again, Mary, for this invaluable resource!

August 30, 2011 at 10:37 am
(28) Margot says:

I found your comment interesting. I have been adding Cytomel 5mcg, to my Levoxyl .112. My TSH level is quite low which I have been ignoring but my FT3 is finally adequate. My sleep has been chronically problematic and variable, generally not reflecting my daily life which is quite positive. I wonder if changing my dosing time of either the T3 or T4, could improve my sleep. Currently I take both pills as soon as awake in the morning. Could you say more about splitting doses for clarification?
Thanks a lot.

May 21, 2010 at 1:06 pm
(29) Teresa says:

I took Synthroid for 15 years but still suffered from depression. My internalist kept prescribing different antidepressants for me which would sometimes help but not completely. After finding a new physician who uses holistic as well as traditonal medicine, I was precribed Cytomel to take with my synthroid. After a month, it was the best I had felt in years. My depression was gone, more energy and just a greater feeling of well-being. We’re still working on regulating the dosages (levels became too low)but I can truly say the combination works well for me.

May 23, 2010 at 8:03 pm
(30) Sara says:

I took Armour for almost 3 years and felt ok but not 100% of what I use to be. Late last year, I all of sudden grew immune to the Armour. My doctor put me on a T3/T4 treatment. I am now taking 75mg of Synthroid and 15mg of Cytomel. I feel pretty great but I was still having to take late afternoon naps. My doctor told me that the Cytomel only last 6-8 hrs in your system. So, he had me start taking 10mg of Cytomel in the am with the Synthoid and then 5mg of the Cytomel at my lunch (12:30-1:00pm). It is doing wonders!

May 24, 2010 at 6:25 pm
(31) Norma says:

I would like to know if there are hypothyroid patients out there that suffer with what I call ‘icy-feeling-painful’ feelings in their extremities, especially upper legs and buttocks and sometimes arms. It is sooo wierd !!! I am assuming that it is a symtom of hypothyroidism which I was diagnosed with nearly a yr ago. Could this be what they refer to as ‘intolerance to the cold’ ? I set my thermostat at 75 degrees F, and it doesn’t help most of the time. I am on .5 mg of synthyroid. Please help!!!

September 22, 2010 at 3:22 pm
(32) marci says:

hello Norma.
absolutely, positively yes. the discomfort of the cold and painful extremities is very very real. the addition of cytomel to my levo (synthroid) helped quite a bit. you likely need to add T3. this has helped me a lot! good luck

May 24, 2010 at 10:04 pm
(33) C. Smith says:

Begged my doctor to try me on Cytomel. He agreed and it safed my life. This happened only because of my own research on the internet and because I felt it was my only hope. I was diagnosed with Hashimotos in 1995 and put on Cytomel 5 years later! I give God the glory and also a Doctor that would listen to his patient. This news will make a tremendous difference for so many thyroid suffers.

May 26, 2010 at 1:14 am
(34) Lisa says:

Hi Norma,
I have the feeling that I am sitting on ice and the top of my thighs feel like someone has put snow on them. I also have very cold hands and feet. I also get the opposite – painful burning patches on my skin like I have been poked with a burning hot iron poker straight from the fire. Had my thyroid ablated 14 years ago and have been diagnosed with severe Vit d def 2 yrs ago.

June 10, 2010 at 11:19 am
(35) Pamela says:

I agree completely. I was on a compounded T3-T4 combination about 10 yrs ago. Somehow, over the years (and a new doctor) I was on T4 only. Recently, having read “What Your Doctor Won’t Tell You About Hypothyroidism” – sorry, don’t have the Doctor’s name at hand that wrote this – I spent a long time discussing this will my Doctor. Almost 4 weeks ago he added only 5mcg of T3 to my compounded T4 and I could tell a difference the next day. I can definitely say now that it does make a difference for me. More energy, clearer headed, easier to exercise and feel better afterwards, seems easier to eat less and make better choices with my food. I’m sleeping better too.
Thanks goodness!

October 3, 2010 at 5:20 pm
(36) Pat says:

Hi have just started on T3 only….my open-minded new doctor had not broblem prescribing Tertroxin. The doctor knew nothing about T3 until I showed him a print-out of Mary’s blog with people suffering the same symptoms as I do.
Your discussions mention side effects of T3….what are they please. My doctor obviously knew nothing about them. I am taking 5mcg T3 at night but can get a bit panicky and anxious during the day. I increased my anti-depressant (Cylift) just before starting T3 as I was extremely depressed. Could this cause a confilct?

August 30, 2011 at 9:40 am
(37) JP says:

I”m on T3 only. I take 1/2 (25mcg) my daily dose right at bedtime and it has improved my sleep tremendously.

My other 25 mcg is split into two doses, morning and early afternoon.

If I start feeling anxious, it usually means I’m late for my dose!

I am now off of antidepressants altogether.

October 22, 2010 at 4:49 pm
(38) LauraC says:

I have been on a combination of T4/T3 for about 10 years. The T3 saved my sanity. I take more T3 than T4 –I take the T4 in the morning, and I take the T3 three times a day (morning, noon, early evening). I found several years ago that it works much better for me to spread it out over the day. It is expensive, as it means I either have to split pills, or take 5 mcg pills enough to reach the right quantity (25 mcg of T3 at one time is way too much for me). But for the quality of life, it is well worth it. Thank you for posting this article–I know I will have to fight in the future, as my endo is retiring and no one else in his group will prescribe T3. The fact that I’ve done so well on it for so many years doesn’t seem to matter to them.

October 25, 2010 at 8:35 am
(39) SteveH says:

Mary wrote I anticipate that some of the same so-called thyroid experts — who frequently are also on the payroll for the levothyroxine manufacturers — are probably going to fall all over themselves trying to explain away the findings, and it’s going to be fun watching them try!

This sort of comment does worry me. Can you substiantiate it?

In my experience doctors are donkeys, they are not in the main crooks (in Europe anyway).

November 18, 2010 at 12:03 pm
(40) debbie says:

Can anyone recommend an endo in massachusetts(northshore area)I’m desperate,they just don’t want 2 listen 2 me about other options as suggested here, n I deserve more than 3minutes!!!thank u

January 10, 2011 at 3:21 pm
(41) Joan says:

Interesting to see a study verify what I’ve been doing for years! Using T3 did things for me like taking away leg pain. Also, I began using time-release T3 about 6 years ago. It helped give me a good energy level all day long.
I take my meds early in the morning, about 5:30, then sleep another 2 hours, usually. I take time release compounded Armour, (75mcg of T4& T3) and a supplemental levothyroxin of 125mcg. Works well for me.
Recently, I had to use some synthetic progesterone, and found that it blocked my thyroid uptake. T4&T3 moved from upper range to lower range, and TSH moved from just below range to way above, at 5.36, higher than when I finally got diagnosed! So really watch your meds, foods, supplements, etc., as they really CAN affect your thyroid levels.

August 31, 2011 at 4:38 am
(42) marion says:

Hi Joan
I use *natural* progesterone cream [it works through the skin, so the liver does not have to deal with it], and studies show that it actually works to *help* thyroid uptake, [and I feel it is making mine work better], whereas too much oestrogen [oestrogen dominance], actually is the culprit that can work against thyroxine uptake.
It must be natural though [bio-identical].

(I am on 175 mcg of levothyroxine, also, and have been on thyroxine since 1991 – as my post above says I am wondering about the t3/t4 combo of Thyrolar])

January 12, 2011 at 3:46 pm
(43) Anita says:

The full-text of the article is available free if you access it using PubMed. From PubMed (http://www.ncbi.nlm.nih.gov/pubmed), search for the PMID of the article (19666698) or the title.

January 17, 2011 at 6:25 am
(44) Alan Roughley says:

I’ve been on 150mgs levothyroxine plus 20mgs of liothyronine for 10 years – shortly after the first article on the benefits of T3 came out. At the time I was being reassessed by my NHS consultant after being on T4 only for best part of 20 years.
He thought it worth a try and replaced 50mgs of the 200mgs of T4 I was on with the 20mgs of T3. Both he and my GP think that the patient is in a better position to judge effective treatment than measurements such as TSH alone. My TSH is close to zero and has been for many years no matter what dosage of T4 or T4+T3 I have been on! It is thought that I am not producing any T’s at all after all this time.
I have never tried slow release but have messed about a bit with timing and splitting the daily dosage – but honestly I cannot see or feel much difference!
Psst! T4+T3 does act as a happiness agent! More laid back and less irritable than before!
Alan R

February 2, 2011 at 1:10 pm
(45) Martha Forsyth says:

This study, as referenced in the “Note”, actually is now available online in pdf form, at:

March 10, 2011 at 11:51 am
(46) J W says:

I think the reason that levothyroxine monotherapy works for some and not others is a polymorphism that results in reduced conversion of t4 to t3. There has to be a balance 1:15 of these to have adequate body function. There is a study that some of you may find beneficial. It is not just T3 or just T4, it is the balance of these in your body. There are people that lack the gene that converts this to some degree. If you are on combination therapy (levothyroxine-triiodothyronine) you may not suffer from specific neurological side effects that are not being addressed with levo monotherapy. (My appologies if this was previously posted.)

Acosta BM, Bianco AC. New insights into thyroid hormone replacement therapy.

F1000 Med Rep. 2010 May 11;2. pii: 34.

PMID: 20948851

August 8, 2011 at 6:00 am
(47) Addy says:

Transitioning from monotherapy to the combo made a world of difference to me. Luckily I was in the combo group and was offered to continue on the combo after the study ended. In Denmark T3 is not marketed but can be obtained on a named-patient basis if prescribed by an endocrinologist.

August 12, 2011 at 5:55 am
(48) Mark Johnson says:

The Nygaard study was done in a group of subjects with a high baseline psychological morbidity, meaning people who were severely depressed. It is not fair to say these results would be the same for people without a high baseline psychological morbidity. The type of subjects in the study were very specific which accounts for the differences seen in other studies that do not show a benefit of T3.

August 26, 2011 at 11:33 am
(49) Lorraine Williams says:

I agree with you, Mark. As much as we (with hypothyroidism) want to believe that adding T3 to the T4 we are already on will make us feel better psychologically it has been shown that taking T3 replacement leeches bone. There are many more studies showing there is no benefit of T3.Read them on PUB Med. It distresses me to hear so many blame their doctors’ refusal to prescribe it as being ignorance or greed. Is it possible they don’t want to harm you? Diabetic patients often feel better when their glucose levels are higher than they should be, but that extra glucose is damaging their blood vessels, eventually leading to blindness and kidney failure. It’s a good idea to get a 2nd or 3rd opinion, but Pam, I would be running away from a doctor who prescribed a medication based on no knowledge whatsoever of the side effects or the disease.

August 30, 2011 at 1:09 pm
(50) meg says:

I was on Levothyroxin & Cytomel (T3) for a while, but developed heart palpitations. They started out very mild, infrequent, but increased dramatically to the point where they would last for several minutes. I almost cancelled a vacation because I was afraid I might have a heart attack.

I complained to my doctor & she said I was drinking too much coffee. I cut out the coffee and the palpitations continued. I went for my regular thyroid blood tests, and my TSH was 0.08, way too low. I called the doctor, who was not avaiable so I talked to the nurse practioner. She took me off the Cytomel completely and lowered my dose of Levothyroxin from 125 mcg to 100 mcg. After a couple of weeks the palpitations stopped completely, and I’m back to drinking coffee with no problem.

Personally, I’d rather stay off the Cytomel than risk my heart. I’ve also started losing weight again, which was not happening while I was on the Cytomel.

August 30, 2011 at 4:24 pm
(51) Naomi says:

I recently was told I was thyroid hormone replacement resistant and that my meds are at the max dose.I had the ablation done 11 years ago my levels run high every time.
Has anyone one else ever heard of being resistant to the replacement theropy? I think I have been given up on by my doctors becouse a few years ago my insurance was not covering my meds therefore i had to cut my meds back to less of a daily dose becouse i could not afford it and i have for 2 years now been back on them regularly.

August 30, 2011 at 4:37 pm
(52) Lynn says:

My question is the same as someone else’s: i.e. does this study and the T3/T4 combo apply to people who have had a thyroidectomy? (mine due to papillary thyroid micro-cancer). BTW, I switched to Armour from levothyroxine about 1 yr ago, have gone thru several blood tests and dosage adjustments with it & STILL do not feel good (low energy, mild depression). My TSH continues to be way too low (.01). Now my new endocrinologist is recommending I go back on levothyroxine. She says that some of T4 is naturally converted in the blood to T3, that it’s not necessary to have the T4 + T3 combo, that T3 is very powerful & may be resulting in my low TSH as well as osteopenia (bone loss, which Lorraine mentioned). What about this? FYI, she also said a thyroid supplement should never be taken within 4 hrs of calcium supplement, b/c they bind together, creating too large a molecule to be absorbed easily by the digestive tract. This was news to me! She also said any generic (like levothyroxine) can have some variation in effect b/c different producers formulate differently, whereas a brand name product is always formulated consistently. Any comments on this? I would love to feel better in my daily life, I don’t care which supplement, combo/non-combo, brand/generic, as long as it works!

August 30, 2011 at 9:20 pm
(53) sylvia says:

I’m 52yrs old i have been on levothyroxine only for the last 7yrs my Dr wont listen to me I’m still feeling tired and overweight. I am on 75mcg of thyroxine and still feel exhausted! Hair is still falling out. My Dr states test show I’m at proper levels, WHY don’t I FEEL NORMAL! Where in the state of Illinois (Saint Charles )can i find a DR that will try me on the combo of Levothyroxin & Cytomel (T3). I want the Old me back the one that had the energy,hair, & normal temperature back! I want to play with my Grandkids Please help.

September 9, 2011 at 11:27 pm
(54) Julie says:

Hi Sylvia,
Can you get to Chicago? I used to live there and went to Dr. David Edelberg at WholeHealth Chicago. He’s great and really takes the time to listen. You will probably have to pay cash and hope your insurance will reimburse, but it is completely worth it.
I’ve always found natural thyroid to work much better for me and have currently added T3 in with it, even though the natural does contain T3. Wow, what a huge difference. I felt like I was just getting by before, felt good but never great.
Good luck in your search and keep on going until you find what works for you.

September 27, 2011 at 2:09 pm
(55) leanne says:

have felt poorly for a while on 100 mcg of thyroxine just got blood test result back and my tsh level is 0.01 but because my T4 level is 17.0 the doctor said normal no change. But i feel so tired and have lived off anti-depressants and tranquilizers since i was 17. Then i found your page on the web and have never heard of T3 before. Do you think my doctor would help me if i mentioned this? Is it available in the UK? Desperate to get better and feel on track especially for my children i just don`t have the energy to run after them. hoping someone can help or advise me. thanx leanne

October 8, 2011 at 12:45 pm
(56) thyca2010 says:


I have always been on a t3/t4 treatment and also have a .01 tsh due to thyroid cancer. If I do not have my cytomel I am useless. Push your doctor – they can lower the t4 to add the t3 to maintain your tsh. Also, not all of us do well with such a low tsh.

Good luck

October 8, 2011 at 1:18 pm
(57) Lori Ratcliff says:

I heard about T3 from you about a year ago (not from this article, must have been another one) and because of it I asked my endocrinologist about it.

She agreed to prescribe it IF my T3 level was low–which I knew it would be because it always had been whenever they checked it. So when I got the results of my blood work back with no new prescription attached, I called her office and asked for the prescription. Her Assistant argued with me about it for a while, insisting she’d never heard of it and the doctor had never prescribed it–even though I told her I’d already talked to the doctor about it and the doctor had agreed. !!!

Anyway, a short time later I got a phone call saying the prescription had been called into my pharamacy. It makes a HUGE difference in how I feel. Without it I have no energy. To the rest of you, it is definitely worth the battle with your doctor to get a prescription for it.

So thank you, Mary, for keeping us informed!

October 8, 2011 at 1:32 pm
(58) Lori Ratcliff says:

Before the T3 supplement was added, I was on .88 of Levothyroxine. The endo added .5 of the Cytomel without reducing the Levo, which I thought was odd, but took it anyway.

At that time i was taking the Levo at night before bed so I took the Cytomel at the same time. But I noticed I was having trouble sleeping when I took the T3 at night, so I switched it to morning and now I sleep ok and I’ve noticed a difference in my energy level. I think I would do even better if she’d increase the T3, but there is definitely a difference with it.

December 10, 2011 at 12:28 pm
(59) Holly says:

any generic (like levothyroxine) can have some variation in effect b/c different producers formulate differently, whereas a brand name product is always formulated consistently.

Each drug manufacturer formulates differently – different raw material sources, excipients (inactive ingredients), etc. So yes, the brand name is always the same because its the same manufacturer. When you go onto a generic drug be sure you stick to the same company so the formulation will be consistent from batch to batch.

I love being on T3/T4 combo because my Dr found my body does not convert T4 into T3 as it should. She tested for T3 levels and found they were off scale in the beginning. Other Drs I went to would only test for T4 and refused to do any T3 testing because the body ‘takes care of it’. But I have autoimmune problems (hashimotos and MS) and can never take it for granted that my body ‘does what it should.’

December 27, 2011 at 7:59 am
(60) DESMOND says:

Tell me. What is the purpose of TSH if you have no thyroid? TSH is thyroid stimulation hormone. If you have no thyroid/ and pituitary sends TSH to a thyroid that is not there to tell it to release t-4 t-3. Knock Knock no one home. For what other use is it? ‘It’s Thyroid stimulation hormone’ hence the name TSH. No thyroid no purpose.

December 27, 2011 at 8:15 am
(61) DESMOND says:

I should add that I am on 5mcg Cytomel and 125mcg Synthroid with border line TSH. Below normal t-3 and very low free t-4. Dr. won’t increase t-4 because it will drive my TSH even lower. T-4 to low hypo?

December 27, 2011 at 9:07 am
(62) AlexisB says:

After reading the comment saying that T3 therapy is bad for the bones I’m wondering if you think that applies to Armour thyroid. From what I’ve read since armour contains calcitonin it actually helps bones. I’m on Armour at a fairly high dose and my bones are fine. If people are miserable and something makes them feel better I don’t think that should just be discounted on account of one factor – they sure don’t care what all the horrible side effects of pharmaceutical drugs do to people when the focus on one thing and ignore the rest. Where are these studies showing T3 leaches bone? How MUCH effect does it have! Isn’t it also possible other things can be done to counter the effects on bone. If someone is tired and depressed and don’t exercise, for instance, doesn’t that also harm bone as well as other body systems? I guess I don’t like broad generalizations that don’t take the entire person into consideration. What about quality of life? As to TSH – if one’s pituatary doesn’t function well you can have a low TSH and still be hypo and miserable – that was the case with myself – it was 1.5 and I felt horrible and was gaining weight when I didn’t even have an appetite. On an Armour dose that makes me feel normal I have practically no TSH and I’m sure not going back to the way it was before just because of that one hormone! Might as well kill me now!

December 27, 2011 at 9:15 am
(63) AlexisB says:

Desmond – you need to find another doctor – below normal T3 and low T4 and he wants you to stay that way because of stupid TSH? I get so sick of hearing about TSH ruling if someone is allowed to feel decent or not! TSH is a pituatary hormone – if the pituatary doesn’t respond correctly it won’t go UP when one is hypo. Before I got on armour I had to point out to my doctor that the three tests I had had over a little over a year of TSH, Free T3 and Free T4 had a pattern – each time the Free T3 was going lower, T4 was staying about the same and the TSH was goind DOWN (when it should have been going up! So was my body doing what they assume it is supposed to do? No – it was not – and that shows how inacurate TSH can be as an indicator of thyroid function.

December 27, 2011 at 2:38 pm
(64) Steve says:

I have been on t3 liothyronine + thyroxine for 10 yrs.

Recently I have had to double my thyroxine dose as my endo specified that His patients normally feel much better with free serum t4 at the upper end of normal. Here in the uk that is 11-21. Took me to double my thyroxine dose to get me up from 11to 18.9. I now have loads of energy can cycle 60-80 miles. No longer feel the need to eat all the time & can actually feel hungry. My memory & mental agility has improved. I have also lost weight.

My free serum t3 has stayed closetot 6 with TSH suppressed to 0.03.

December 27, 2011 at 2:47 pm
(65) Steve says:

Yes in the uk you can get T3 but your gp will not prescribe it unless you first get a endocrinologist to say you need it . Best to get referred by your gp to see endo .

Also for those in the uk all your thyroid meds are free on the nhs. But you have to apply for a medical exception card. This is great as anything prescribed by your doctor for you is also free!

December 28, 2011 at 9:38 am
(66) DESMOND says:

Thanks AlexisB. Reformation helps. It took me a year and a half just to have her agree to test T-3. With her saying this is only a test. When my test came back and my T-3 was so low/ Pretty much had no T-3.Then she started me on T-3 with me calmly suggesting. Mind you this is a very large and prominent Hospital in Boston. And as you may very well know Dr.’s don’t like to be told anything even when they can’t even agree among themselves. This is my 4th. Endro. and not the last. Moved on after she would not answer my question in regard to TSH! It’s always been. balance Free T-4 and TSH. Dr’s are scarfed to death to test and or prescribe T-3. Their still learning/ Well some are.

December 28, 2011 at 2:59 pm
(67) J Franklin says:

all the talk or post about not wonting to take pigs pills. is rather silly. to be well is the key. the pigs are dead so come on folks get real.if you take the parts of humans and transplant then nobody turns an eye but ask some one to take pigs thyroid and every one go`s mad. if vegetarian
it can be a problem but if it were life of death then i would
be inclined to take the pills and be done. has anyone died
from getting better,. i don`t thing so.

January 24, 2012 at 9:34 am
(68) Hayam says:


I have been suffering from Hypo for few years now and was suicidal due to depression. My GP would only perscribe T4 and nothing else. I managed to get hold of T3 cytomel and used it for 6 weeks and i have to say that it was the best 6 weeks of my life. All my symptoms began to clear away and i just felt so good. My GP wont perscribe this medication as he thinks i am ok.

All my symptoms are now back and I am thinking of just starting on a low dosage myself :( i know i shouldnt but its not like the NHS helps :(

April 9, 2012 at 1:17 pm
(69) Debbie says:

I have been bracing myself yet again for a return trip to the GP next wk, yet again with the same but worsening symtoms!! Fatique, constipation, aches & pains, forgetfulness, I can’t even seem to spell anymore! my family all have noticed that I HAVE CHANGED, it is awful and the worst symptom I think is being totally exhausted all of the time, I can’t even to bothered to socialise anymore, all i want to do is put my pj’s on when I get home from work and go to bed. I was finally diagnosed last year with Hypothyroidism and put on thyroxin 50 mcg and later put up to 100mcg. I never thought for a moment that I would continue to get worse, I have been back to my GP with all the symptoms and how I have no quality of life anymore, I’m just going through the motions everyday. Oh yes and as expected the GP said “oh your depressed” which is what they say everytime I go there, only I refuse to go onto antidepressants. I was delighted when I found this write up so as so many I will be going to the gp with a print out. I have also read (The Thyroid Solution) by Arem Ridha, fantastic reading. I take 5htp 100mg at night before going to bed, this definetly helps with the dark moments.
It is great to find other people with the same thing as me and to know i am not going totally MAD! I really need to get the combination T4/T3 or get the T3 seperate, I’m sure I could get it on the internet but I would rather go through the GP so I can be monitored, I’m not holding my breath thou, the GP will probably send me to a shrink. wish me luck, Deb

April 15, 2012 at 2:36 pm
(70) Patricia Hanson says:

I am 66 yes old started taking thyroid hormone at age 13 had thyroidectomy at 20. For years on 150 synthroid and doctor lowered it to 112 a few years ago. My weigh has been increasing, osteoporosis bad , headaches . Cold feet, pains in legs . I feel slow , don’t feel like myself .’Tired , memory problems . Was supposed to have knee replacement on April 12 the anestesiogost cancelled my surgery because my TSH was 0.03. Went to my family doctor he lowered my synthroid to 88 . He said no reason to cancel surgery or to see a thyroid specialist because he can look after it. PLEASE HELP ME I need to feel like my old self . The added weight doesn’t help because I had a car accident with a train in 1976. My right foot is still broken in half and also had a patelectomy and now I have wrecked my good knee. they scoped my knee twice now will have my knee replacement on April 24 2012. No matter what I do I can’t seem to loose weight and my other big concern is that all of a sudden my body gets hot and I just drip sweat. I can actually feel a drip coming out of the pores then I’m in a cold sweat and my hair is like I took a shower, I live near Edmonton Alberta and I need help ASAP I am very scared about the TSH numbers and the fact he lowered my thyroid meds to 88 I hope to hear from you soon thanks Patricia

April 21, 2012 at 4:45 pm
(71) Korby says:

Dear Patricia, you’re very lucky that you live in Canada! You have access there to the best Natural Dessicated Thyroid medicine that’s made. It’s Thyroid manufactured by Erfa. All the other Nat. Dessicated Meds: Nature Throid, Armour, NPThyroid have this terrible cellulose filler now that makes people sick, somehow interferes with the medicine working, and is generally very bad for you. But this cellulose that they use now is cheaper, so they use it. I’ve studied all the NDT meds and their side effects from many, many internet posts people have added. The conclusion I’ve come to is that the NDT thyroid meds are definitely better than the synthetics, but only if its Thyroid, by Erfa – they have no fillers that will make you sick. Please talk to your doctor about it to see if he agrees, the Erfa brand is reasonably priced as well.

June 19, 2012 at 5:20 am
(72) claire says:

Many thanks for this update. I have been taking Levothyroxine (T4) for last 12 months. Whilst my energy has increased, there are other outstanding issues; memory, bloating, cold hands/feet, anxiety as a result of not feeling well.

My endocrinologist has suggested a trial for me on T3 with T4, or just upping my T4. I’ll give the combination approach a go as I don’t like the look of the long term side effects of over prescribing with T4. It is useful to be able to access info that has been digested by you and summed up in language that can be more readily understood. Fingers crossed. If there are any more studies on the long term effects of T3 I’d be grateful. Your book has been a big help, thanks again!

July 18, 2012 at 7:50 pm
(73) Yiruma says:

A very interesting article. But I do object to the unnecessarily aggressive tone of your comments. Surely the majority of prescribers is not “on the payroll for the levothyroxine manufacturers” but are simply practicing medicine as best they know how. The thyroid “experts” did not become experts by ignoring or covering up evidence but by evaluating it in fair and rational ways. Your assumption that the profession is somehow against new evidence or the best outcomes for patients is simply untenable and rather cynical. I think that we can safely assume that when the evidence is convincing that any changes that need to be made for best patient outcomes will be made willingly and gratefully by the profession. Physicians are by and large good people who want the best for their patients and loved ones, just like you.

July 19, 2012 at 1:43 pm
(74) Stefanie says:

After reading this and researching T3 a little more, I asked my endo last night for T3. He agreed that it was worth a try since the T4 isn’t doing it for me. Praying it works for me because I’m so tired, anxious and depressed.

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September 4, 2012 at 9:30 am
(76) Tina says:

I was on Synthroid and felt like I was going to die-no energy, brain fog, emotional basket case, etc. I have been on Armour Thyroid for over a year and I feel normal again!!! I could feel the life return to me after only 3 or 4 days. These doctors who won’t prescribe natural thyroid are in the pockets of the drug companies. If you are no feeling well, my advice to you is to find a doctor who will prescribe the medication to make you feel better.

October 14, 2012 at 12:15 pm
(77) Anne says:

My wonderful new endocrinologist prescribed T3 added to T4 based on this study (I took him a copy of the article). Started 4 days ago and I cannot believe the difference—nothing much first day, then somewhere id-day two, wow. (Can this be a placebo effect? I don’t think so…I didn’t have much hope for this, frankly.) I feel stronger in the morning, more clearheaded—I am thinking of trying the divided dose regimen to keep feeling like this all day! It is worth a try, folks. Unbelievable. Good luck to all!

January 16, 2013 at 12:39 pm
(78) Cathy says:

I switched from Levoxyl to Armour just two days ago. I read all the forums and research before I asked my doctor (general pract.) . He denied me. I went to my endo doctor and explained that I researched Armour and want to try it. I was very direct and clear when making the appointment what I wanted. He gave me the prescription with no issues. I live in the US bay area.

I started looking into the switch because I had anxiety. I do not think my issues were as severe as some of the folks I have been reading on. I did start to loose hair, which along with the anxiety, I thought I should look at alternate options. I was not able to handle stress very well and I had the brain fog to some extent.

I have no thyroid, had a complete thyroidectomy and had been on Levoxyl since 2006

February 26, 2013 at 8:05 am
(79) Barbara says:

I too have problems with hair loss since taking just T4 after complete removal of thyroid in 2009. No other symptoms are not bad as a lot of people but the hair issue is huge to a woman. I am 63 and wondering after reading the posts if I should switch. Just don’t want to upset the AppleCart and end up with more problems than I started with. How are you doing since your change to adding T3?

March 4, 2013 at 4:35 pm
(80) Wm. Beckman, RPh says:

The ratio of T4:T3 in porcine thyroid is not ideal for humans. This contains a ratio of about 4.2:1, versus a human ratio which is closer to 11:1.
As a pharmacist, I make special slow-released T3 capsules to go with the required T4 dose. This gives day-long coverage in the right ratio, and provides a better metabolic match for most of my patients.
Many thanks to Mary Shomon for keeping her readers informed.

March 24, 2013 at 12:25 pm
(81) Sheila Re: Negative T3 says:

After three decades of being tested regularly for what all of my doctors felt had to be an abnormal thyroid. And after giving up on my “brilliant” endocrinologist at UNC. And after thirty years of being told that my T4 and T3 were normal, while the infertility, grossly, heavy periods, ovarian cysts, uterine fibroid tumors, breasts full of fibroid cysts, extreme fatigue, unexplained weight gain, memory problems, brittle nails and hair – all of it continued to get worse. My local GYN, who is also a nutritionist, called me with what she said was exciting news. She had checked something in the latest round of thyroid tests called a NEGATIVE T-3. I had never heard of it and didn’t really understand how it worked, but she was excited about it. So I took the prescription to my compounding pharmacist and started taking Compounded T3 SR 5ucg twice a day. Within 2 weeks, I had a normal level of energy again. I could think clearly again. My memory improved; my nails look much better; my face was no longer swollen. I’ve lost five pounds. She’s checking me again in 4 weeks to see if this is the right dosage. Soon, I’m starting a Thyroid multi vitamin that is on back order. If your doctor will not work with you / is not open to your concerns, find another doctor. I would suggest trying a nutritionist.

March 28, 2013 at 7:52 pm
(82) jason says:

There are so many ways to control your thyriods through your own personal feelings.

my thyriods levls are usually on the high side of the safety scale that doctors needs to follow.

Doctors have the tedency to follow the thyriods chart vs using the patients input.

best way to figure out what levels of thyriods works for you is to have your doctor test your blood levels every week as you thyriods level are changing. during this period, as soon you feel good, regardless of the last time you had your blood drawn, even it was yesterday, do it again…now, when the results come back, those are your numbers to go by…if you are at 3.75, tell your doctor to adjust your medication to that number. the kicker is, your thyriods are different in the winter and summer months, so test your self in the winter, once summer comes, ask you doctor to drop you doses down one level.

April 6, 2013 at 3:09 pm
(83) penny says:

I have been on a combo t3 and t4 and feel great

July 9, 2013 at 2:57 am
(84) ThyroidAbyss says:

Well, after 25 years of telling doctors that my thyroid was still messed up and being told that I can’t blame everything on hypothyroidism. I can now blame everything on hypothyroidism. When the body cannot convert T-3 from T-4 that is a problem. After the start of liothyronine or T-3 and a bumpy few weeks after first taking the medicine. I can say it is working for me. My TSH kept going up and up and so did the dose keep going up and up. A brilliant endo and his partner gave me T-3. I am eating again and doing things again. I am still in the adjustment phase but I did my own adjustments as I know my body and the TSH was in range, Free T3 was in range, Free T-4 was in range. For me this has been dramatic. Obviously I needed this for a long time. Thanks to all the endo’s who screwed around with my life until I could no longer function. Instead it was so much easier to say I was depressed. Knowledge is power!

July 17, 2013 at 6:37 am
(85) valentina kioko says:

Mary has been my guru for 10 years now, since i had the total thyroidectomy procedure performed. Needless to say that T4 and T3 combined therapy has done it for me. i had to print out a whole lot of research articles posted on different website for my doctor to start believing in it and treat me. i live in Nairobi, Kenya and the t3 has been available only for 3 years and never again. I had to reslove to regularly travel to Italy to stock up on it but it is worth it! Thank you Mary!

August 25, 2013 at 9:00 pm
(86) GardenDiva says:

Looking back at my labs, I believe I have had subclinical hypothyroidism for 8 years.

I went to my GP about 8 years ago complaining of fatigue and weight gain even though I ran a mile every day and no diet changes. She ordered a TSH test; results “normal”. This continued with a 2nd GP & 6 more years.

About 1 1/2 years ago, I had a crisis with severe fatigue, a visibly swollen thyroid gland, and a huge amount of discomfort in the outer portion of my throat and in my joints. I felt like I had suddenly developed ADD because I couldn’t concentrate on anything! I couldn’t sing due to the discomfort. Not good when that is your profession!

Thyroid ultrasound-normal. ENT said “reflux, overuse, post-nasal drip”. Blood work -”normal” again but I finally did my own research. I wrote a letter to my GP detailing my findings and asked for a trial of some sort (any sort!) of thyroid hormone. She agreed. I immediately started feeling better. I left her practice later due to other issues combined with her ignorance of thyroid issues.

So now, I am 50 pounds overweight and insulin resistant. My new doctor, an int med specialist, consults with the endos in the practice. She ordered an antibody test (which apparently the last doctor didn’t know anything about!). I have Hashimoto’s.

How long does Hashimoto’s progress? I am constantly playing catch-up because of the changing hormone levels. My dosage of Synthroid wasn’t increased after the last test and the one done last week showed a DECREASE in TSH of about 50 micro IUs. I’m trying to figure out how that could even be possible. I think that the discrepancy is due to the last test being done in-house whereas all of the others have been sent off to the lab of my insurance’s choice. I am pretty careful to have the blood draw at the same time of day (mid-morning) to limit differences in the results.

November 20, 2013 at 1:00 pm
(87) Jeanette says:

I believe if doctors treated thyroid patients base on their FT3, FT4, rT3 etc. and symptoms, they would clearly see which patients do not convert T4 and so need supplemental T4 and which patients are converting T4 to rT4. T3 treatment is not one size fits all any more than T4 alone is. Every body is an individual and should be treated as such by their doctors.

December 4, 2013 at 6:08 pm
(88) luna says:

I am on staggering 2.50 mg of T4, have been for years! I switched to T3 and it made me feel strange, I want to try the combo, as I am tired, weak, lethargic thereby depressed all of the time! My dr. is an idiot! He will not know what dose, unless I tell him! Could someone please tell me what would be the adequate dose of T4 and T3 combo for me to try! Thank you and God Bless, this illness has been negatively affecting my life since I was 14 (even then had no energy) I want my life back!

January 16, 2014 at 10:55 pm
(89) Bev says:

I have been on both T3 and T4 meds since 1998. When I was diagnosed with hypothyroidism in 1997 and put on synthroid only, my doctor would not believe me when I told him I still felt bad because my TSH levels were good. I finally changed doctors and she tested the T3/T4 separately and found them to be each enough out of wack to make the TSH appear normal. She prescribed the separate meds and I have been fine. Thank God for doctors who actually listen to their patients!!

February 16, 2014 at 8:14 am
(90) Sam says:

Meh Doctors are retarded, there are studies showing that people prefer desicated pig thyroid 2-1 over synthetic T-4. Somehow T-4 managed to absolutely replace Desicated and become the 2nd most prescribed Drug without evidence showing its superiority. Just alot of marketing and money. Dessicated had been around for 100 years where doctors prescribed and adjusted dosages based on symptoms alone (the barbarian!s).

March 4, 2014 at 10:23 pm
(91) Jess says:


So I’ve been diagnosed with Graves Disease in 2010 – then the drs prescribed me onto the Radioactive Iodine in 2012. Now my thyroid is underactive and I’ve been classed to having hypothyroidism.. sigh. So Im on thyroxine but I’ve put on a whopping 20kg! and want to lose the weight.. I’ve been on diets and exercise regularly.. I’ve researched that T3 is what I’m lacking. So I’m asking if I take thyroxine and T3 together is that a good or bad combination? I just want a boost in my metabolism..


April 9, 2014 at 4:15 am
(92) Pippa says:

I am so confused. After relatively low doses of T4 & T3 replacing my 150mcg of thyroxine, my doc told me I could go to T3 only & increase the doses until I had a good result. I stopped thyroxine as I have a heart murmur & it upset it more. But I was my right weight & awake on thyroxine.
The initial low combines T’s didn’t have the good weight & wakefulness result. But I am nearing 60, suffering genetic primary immunodeficiency & HIES & not that well or able to exercise as much as it progresses.
My adrenal function is severely lacking. I have bioidentical HRT & it is great! But I am still so tired & wake every night at 3am without fail! Grrrrr.
My 150mg T3 dose each day needs to be increased again. I must be T3 resistant….& now my doc is ill & not working & no other medico knows about T3 in Aussie!
I could really do with some suggestions please….even adding 50mcg thyroxine makes my heart wobble!

April 22, 2014 at 10:13 pm
(93) Meggie ann says:

I’m 66 years old and have suffered for many years.I have not felt good on T4 alone. I now take T3 and T4 and feel a lot better and some times i have to take less on weekends to keep it from building up in my system. I was getting palpatations and hot flashes. I have Hashimotos hypothyroidism since 1996 after breast cancer surgery and ovaries were removed. I am trying to get rid of all inflammation totally out of my system and build my immune system. Its not easy. As I do I don’t seem to need as much thyroid meds. I also have tried thyroid helper. it sort of works as do other vitamins. focusing on the immune system seems to be the answer. it helps if i am careful what i eat and get the right amount of nutrients to let the body heal itself. Sugar and white flour products, and all fake-food foods are the worst for me. Caffeine and stress, overwork, undersleep is bad also. I also had sinus problems chronic fatigue, fibromyalgia , IBS and Candida. At least now i am making headway but ,I still feel like my hormones are not balanced as I have PMS feelings every month at the same time I use to have my cycle. I have seen so many doctors over the years that was not able to help me. I have been helping myself by reading a lot and telling my doctors. Some work with me and some not. I stay open to any new info i find. So if anyone has any suggestions I’m all ears.

May 5, 2014 at 9:42 pm
(94) Mona says:

I have been searching to find more about the T4/T3 for Hypothyroidism. I know Levothyroxine is T4. Been taking this since 2005 but I do not know any name of a T3 to ask a doctor to give me. Can anyone tell me what the drug is called?

May 6, 2014 at 10:54 pm
(95) Joan says:

Some of you have commented on needing to find out names of T3 meds, and doses of T3 and T4, etc. I highly recommend finding a good compounding pharmacy, and asking one of the pharmacists there. They are familiar with all the different brands/companies in your area, and also with managing the right ratios of T3/T4 for the combo therapy. They can also make time-release compounds, which I use, as it keeps the T3 from “spiking” and makes it available all day long.
I like using desiccated pig thyroid, because it is closest to the human ratios, and will also include all the same hormones humans make, like T2, T1, T0, and calcitonin. Calcitonin is needed to absorb all that calcium that you take to avoid osteoporosis. I’ve seen where docs are hesitant to give too much thyroxine as they believe it causes osteoporosis. Actually, it is the lack of calcitonin, as synthetic thyroxins only contain T4. Then I add in extra T4, as humans make more of this hormone than pigs, and correct the ratio for humans.

May 6, 2014 at 10:57 pm
(96) Joan says:

It also depends on how you are hypothyroid. Do you still have some gland function? You might then be still making some of all these hormones, and will have less of a problem. If you have little or none, such as after surgery to remove the thyroid gland, then you will likely have more need to replace the full range of thyroid gland hormones, and using desiccated pig thyroid will do that. You could probably compound these as all synthetic, but it would be more costly, and trickier to provide a correct ratio.
Fortunately, synthetic thyroid hormones are bio-identical, so don’t present side effects. The “side effects” often spoken of by doctors when giving thyroid replacement meds are actually due to being under, or over, supplemented, or from not addressing other hormones that are out of balance.
By definition, side effects occur when using a substance that is not totally natural to the human body, and the body objects to the part of the substance that is foreign to the human body. This includes meds like Premarin, and other man-made estrogens and progesterones. If you check the chemical diagram of the bio-identical and non-bio-identical meds, you can see that there are extra things in the non-bio-identical items that the body doesn’t know what to do with, and this creates a side effect.
Thanks, if you’ve managed to read this far, and I hope I’ve kept this clear enough to provide some insight for you. This has taken me lots of years to learn, so I hope it’ll save you some time.

May 8, 2014 at 4:49 pm
(97) Beth says:

Dr. Wiersinga has a new study out that further supports the use of T3: http://www.nature.com/nrendo/journal/v10/n3/full/nrendo.2013.258.html.

Unfortunately, I cannot access the entire study, just the abstract (unless I pay).

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