# Experiences going on T3, especially with low ferritin?



## Sabrina (Aug 30, 2016)

My labs are low, both FT4 and FT3, and I am supposed to start supplementing with T3. My ferritin was tested in January at 13 (range 10-291), and re-tested this week now that I've started taking iron supplements it's at 22. Not bad for three weeks!

There is some great info at TiredThyroid and one of the things mentioned is that it may cause anxiety to take T3 with low ferritin. I feel like I need the thyroid hormone, it's 5mcg once daily to start, but of course I'm worried what my experience will be, especially that I feel so tired all the time.

Anyone have experiences taking T3 that definitely knows they had low ferritin at one point while taking it?

*January 9, 2017*
*100mcg Levothyroxine since September 2016
Free T4 1.3 (range .8-1.8)
Free T3 2.5 (range 2.3-4.2)
TSH 2.51 (.55-4.78)*

*March 6, 2017*
*100mcg Levothyroxine since September 2016
Free T4 1.1 (range .8-1.8)
Free T3 2.3 (range 2.3-4.2)
TSH 1.99 (.55-4.78)*

*Edited to add May 1, 2017*
*75mcg Levothyroxine / 22.5mcg liothyronine daily 
Free T4 .8 (range .8-1.8)
Free T3 3.4 (range 2.3-4.2)
TSH .10 (.55-4.78)* *** See post below***

Article: http://www.tiredthyroid.com/feeling-hyper-when-hypo.html


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## Sabrina (Aug 30, 2016)

I think, based on what I understand so far, is that T3 is so fast acting that if I do have a reaction, hopefully it will be gone in a day or so?


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## Lovlkn (Dec 20, 2009)

My first try I did have low Ferritin although I did not know it. I had horrible anxiety and stopped taking it for several years.

After addressing my low ferritin - the addition of T3 hormone seemed to go more easy. I never put those two together until I saw it in your post. Very interesting.

Today I take 2 1/2 5mcg lilothyronine pills over the day in 3 doses without issues. I want to point out that I also now take calcium 3x a day and feel there is quite alot of interaction because if miss doses of calcium I definitely feel more hyper,

Ease into the T3 hormone, going as slow as 1/4 a pill if needed. Break the pill and keep all the pieces in 1 spot to assure you get the full 5mcg dose. Also if you are only taing 1 pill a day I think it's a good idea to split doses. Taking a dose after 3P.M. seems to keep alot of people awake at night - that's what is posted here and I have personal experience. I've also come to find out that T3 is a cortisol booster so that may explain it and I am already high night cortisol.

Good luck and be sure to keep good notes of your experience


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> My first try I did have low Ferritin although I did not know it. I had horrible anxiety and stopped taking it for several years.
> 
> After addressing my low ferritin - the addition of T3 hormone seemed to go more easy. I never put those two together until I saw it in your post. Very interesting.
> 
> ...


Thanks for the input! Do you happen to know if your ferritin at that time was as low as mine is now (22)? If it happens, I am hoping the anxiety runs it's course in a day and is gone after that.

The article (and I think maybe you were the one who provided it on another thread?) indicates cortisol and ferritin are required for metabolism of T3. So in my own little non-Dr head, that makes me think if I don't have adequate amounts of one or the other, my body won't be able to use the T3 to provide proper resources to my body, and won't know what to do with it - which would cause the side effects I assume.

I definitely need it so am hoping the ferritin continues to go up. In the meantime, if I can't take it I'm kind of stuck.


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## Lovlkn (Dec 20, 2009)

I started at 33 and got as low as 18 post monthly cycle.

I struggled on iron supplements - it caused much discomfort, especially with GI and eventually had ablation to stop my cycles.

Aug '11 140 (13-150)

Jan '09 78 (10-120)

May'08 66 (10-120)

Dec '07 18 - It took a few months for the mild periods to stop but eventually they did. I think after this lab I probably began taking my whole foods multi with iron.It was an extremely low dose but eventually got me to top of range. My doc refuses to run Ferritin, I believe because I was over range in '14 when I had it last run. I ask but he ignores me - irritating.

Ablation late Sept. 2007

Sept'07 48

Jul '07 all iron stopped

Jun '07 64

Apr '07 44

Jan '07 47

Nov'06 33

Sept'06 start 18

I tried adding the Cytomel in 2005 with complete failure and tons of anxiety with even the lowest dose.

In June 2008 I tried again and had much better success.

How interesting that I never figured out it was the low ferritin - thank you for sharing - that's what this forum is for.


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## Sabrina (Aug 30, 2016)

So it looks like you were at about 66 when you were finally able to tolerate T3. You were at 18 in 2006, the year after you were not able to take it. I may have a ways to go then.

Thank you so much for this information! It is very helpful. I will use a great deal of caution in proceeding on T3.


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## Sabrina (Aug 30, 2016)

Day 1:

I started taking liothyronine today. It is supplementing 100mcg daily of Levothyroxine, with all labs to date post sugery indicating inadequate conversion (or conversion to rT3 - I only have one recent lab for that and it is high).

My prescription is for 2x daily of 5mcg. I am instead cutting them in half and taking one in the morning until I feel comfortable with my reaction to it.

I am anxious about taking it and that might be cause for a slight increase in heart rate already, but it's not bad. My understanding is that it has a 6 hour half life so within the next few hours I will have maxed out on today's dose.

My ferritin is low, 22. I know there can be problems tolerating T3 meds with low ferritin, it can cause something the STTM website calls "pooling." So I am taking this very slowly, dumping a bunch of T3 into my system when I am not able to work with it means I could have some really bad side effects that I prefer to avoid.

When I was hyper for a few weeks from overmedication, I remember feeling my blood flowing all through my body. I felt alive and aware of my systems. This morning I am having a small similar feeling, like a slight reinvigoration.

I know it's really early to tell what it will be like and if it will help but I thought I would share for others who are potentially going to start taking it. I was worried I would have anxiety day 1. I was nervous taking it and had a few concentration issues earlier but it seems a bit better now.


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## hypocrazy (Jun 30, 2013)

Sabrina, how is it going today? I am interested to know...i am still having anxiety effects of the nature throid and i stopped it 2 days ago...


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## Sabrina (Aug 30, 2016)

Hi hypocrazy! It is going ok. I ended up taking a nap, I haven't been sleeping well for months and felt great to be able to nap. Did my heart rate it's really good right now.

I am starting the T3 very conservatively to be careful about that. My next dr appointment is later this week.


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## Sabrina (Aug 30, 2016)

Update - almost a week on 2.5mcg T3 once in the mornings (being careful so as not to cause issues) and it feels like it's going okay. I actually am starting to feel better, like this is the thing that has been missing from my life kind of feeling, although it really is too early to tell.

I need to increase soon, really my dose is supposed to be 5mcg 2x daily. But I know there can be bad experiences going on T3 so I approached it in moderation.

Generally I feel like I am a bit less tired, I am not having anxiety as easily as I was before (which I believe was an adrenal response due to low thyroid hormone), and this may sound weird, but it's like my body feels like all of it is starting to get attention. Like my body is waking up or something. In my head I am thinking I did not have enough thyroid hormone to address all of my metabolic needs, and now with more I am able to do that, so it's starting to happen again. And I think I'm starting to sleep better too!

I hope this post helps someone who is nervous about taking T3. I was terrified, to be honest. Now I am really glad I'm doing it, even having such low ferritin. I am working hard to raise that too, eating a lot of heme iron (mostly red meat, ugh), non heme (greens) and also supplementing.


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## Sabrina (Aug 30, 2016)

Update!

The liothyronine/T3 appears to be making a huge, positive difference! I am finally seeing lowered blood pressure numbers that are almost back to my normal.

I started so cautiously - 2.5 once a day. Then I went to 2.5 twice a day. Finally, I took the plunge and did 5mcg twice daily and it went ok. Slept better, felt more rested, had more energy.

After a week and a half I had an unusual rise in my heart rate, while at the same time my blood pressure numbers were going lower and getting better. I ended up ADDING a third 5mcg dose during the day and my heart rate is not totally back to normal, but better.

My Levothyroxine was lowered as I have a reverse T3 issue, and after two weeks I was DRAGGING. So now I've added another 2.5 to each dose of T3 I take daily, meaning 7.5mcg three times daily, 22.5mcg total.

I truly feel I am on the right track and although I have a ways to go, I am very happy to be making progress!!


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## Sabrina (Aug 30, 2016)

Had my labs done yesterday and some good news!! See edited original post for results.

First, the journey to start talking T3/liothyronine was really scary for me, it's basically taking the active thyroid hormone and adding directly to your system. This sometimes does not go well for a variety of reasons, sometimes low iron (which I have) or low cortisol.

I started small and built up - I think my dose changed twice after the initial script. My current dose, 7.5mcg 3x daily, didn't go great the first attempt but I waited a week or two and tried again with success.

My Levothyroxine was lowered a little because my body was creating reverse T3 with it. I have these labs still out and will update later, but want to mention the low T4 is ok because for the first time since my thyroidectomy, I have good free T3!!

Also, learned at STTM that liothyronine (T3 meds like cytomel) suppress TSH, so the fact it's super low is not indicative (to me) of any concerns about being overmedicated. I was overmedicated on Levothyroxine alone and had TSH of .19, and that was an experience that put me hyperthyroid, it was awful. I feel nothing like that right now. I almost feel normal, although I can barely remember what that's supposed to be like.

So for me, not being great at converting enough T4 and also trying to get rid of some reverse T3, adding the liothyronine has changed how I feel, really in only a couple of months.

I really hope this helps anyone else who needs to start taking T3 and is as worried as I was. Start small and build up carefully. I monitor my heart rate and blood pressure, my weight and am doing some other work too. My blood pressure is actually LOWER AND ALMOST NORMAL NOW now that I'm taking T3! My previous doctor refused to give it to me due to elevated BP, turns out T3 is what helped lower it.


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## jenny v (May 6, 2012)

It's crazy how well T3 can work for some people, isn't it?

I had a high heart rate and crazy palpitations before I started T3 and now it's all back to normal. I did like you and verrrry slowly built up my T3 meds.


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## FLhorserider (Apr 12, 2017)

Thank you for posting all the details!

I just started taking liothyronine and wanted to read others' experiences.


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## Lovlkn (Dec 20, 2009)

YEA!!! Went much better for you than me - glad to hear it.

Thank you for sharing -


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## Sabrina (Aug 30, 2016)

Sorry I missed the responses here! I am grateful if I am able to help anyone who might be starting T3. It was really scary for me and some great people here, especially lovlkn, helped me immensely. 

My latest update is that I have been given the green light to start exercise, I just cannot do it on consecutive days, in order to evaluate my body's response to the stress of it on the rest days. I am doing resistance training and cardio, and am thrilled to be honest to finally be active again without feeling like I'm hurting myself in doing so. I monitor my heart rate almost every morning to make sure it's ok and my blood pressure in occasion to see that it's not changing significantly.


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## Sabrina (Aug 30, 2016)

Update.

Things had been going so well I felt like life can be great after thyroidectomy! But at the same time I realize it's a process and what might work at one time might not later.

My Fitbit Alta HR monitor, which does a great job of tracking my resting heart rate, showed a steady increase over a two week period about a month ago, that ended up being a total of 10bpm increase. I had labs done again but they changed the ranges, so it's like starting over again ugh! But when I felt good, I was at 50% of FT3 range, and the new labs with new range showed me at 65%. I lowered my cytomel dose and within a week it was back to normal.

At the same time my other labs showed a marked improvement in iron and ferritin, and my understanding is that iron is integral in making use of thyroid hormone and may also be important in the T4 to T3 conversion process. So....if my FT3 went up, it could be the improving iron?

Anyway, I'm learning the signs of when I am getting a little low and when I'm getting a little high in range. My heart rate and blood pressure are good indicators.

And great news, my blood pressure is normal again! Note that my previous doctor refused to give me cytomel despite low FT3 because my blood pressure was high. Being optimally dosed brought my blood pressure back to normal.


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## Sabrina (Aug 30, 2016)

It’s interesting to go back next read this. I’m currently in the process of increasing my levothyroxine to get to a better free T4 number and adjusting liothyronine accordingly, Its been a learning experience all over again, I’ll come back and post some notes when I have more information and updated labs. I’m almost five weeks into 88mcg levothyroxine and currently down to about 10mcg daily of the liothyronine. 

cytomel/lliothyronine can be really scary to work with, but I’ll probably have to take it my whole life because I don’t covert enough from T4 on my own. And taking it is what truly gave me my life back, the ability to train for and do half marathons again, be active in my life and take care of my household.


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## Sabrina (Aug 30, 2016)

Officially five weeks into new levothyroxine dose. I believe I’ve been over medicated about a week on the liothyronine, so I’ve temporarily cut back a bit more. Truthfully I’m shocked I’ve dropped from 30mcg daily to 7.5, but that was my goal - be less dependent on the liothyronine.

Note that if I take too little, I convert more of my T4 to T3 and my T4 number drops. The reverse is true as well, if I take more liothyronine than I really need, my body seems to stop converting as much and my free T4 numbers rise. I got a little worried if I was taking a bit too much T3 that with the new levothyroxine dose my T4 could go up too high. Today was the first day I felt like I desperately needed the doses, I felt pretty exhausted and had a hard time warming up until after my second dose. I have labs in a couple of weeks, very interested to see where everything lands.

Something interesting to note - from my own experience, cardio burns up free T3 nicely. That’s how I crashed on levothyroxine meds only, I couldn’t convert enough on my own and I was using it up. Ran the number down low and from the stress started cranking out reverse T3. Earlier this year when I was struggling with low numbers I went for a 30 minute walk and that was overdoing it. Also, longer distance running required more liothyronine daily, on both running days and rest days. When this all settles, I’d like to start running again.


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## Sabrina (Aug 30, 2016)

Past couple of days have been very difficult, heart racing and my blood pressure up. Been getting a lot of nosebleeds the past few weeks and had two just a couple of days ago. That night it was hard to sleep, my heart was racing. I’ve noticed my vision getting a little blurry, which I attributed to eye strain. I think these are all high blood pressure symptoms. I finally got my labs at six weeks from dose change, minus three days, because I had to know what’s going on. I’ll come back and post the official lab results later, but T4 is good. My T3 was at the top of the range and my problem. Worked out with my doctor to cut back another 2.5 so now I’m at 5mcg of liothyronine daily, cut in half. I also skipped my third dose yesterday so I went from 10 am yesterday to 5am today.


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## Lovlkn (Dec 20, 2009)

Thanks for sharing your story. I find that I have to adjust the T3 hormone seasonally - I seem to go hyper every March. I reduce a whopping 1/4 of a 5mcg pill a few days a week and it makes the difference.

Also - I have noticed since going on generic T3 Lilothyronine I have more FT-3 fluxuations and have had several uncontrollable rapid heart rate events - even with not over 3/4 range FT-3. Never ever had this on brand Cytomel but die to excessive Brand Cytomel cost I deal with it


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## Sabrina (Aug 30, 2016)

Thanks for your post! I am sharing as much of my experiences, even the miserable ones like this one, in hopes of potentially helping others with the information.

may I ask….how are you cutting these into quarters? I took a half this morning and needed about a quarter at 1:30, I had to bite into a half.

interesting info about seasons, I noticed that on the higher dose as well and I think it equated to 5mcg.

Can I ask what your dosing schedule looks like, and if anything else has set off a need for more or less, like workouts?

thank you!


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## Sabrina (Aug 30, 2016)

Figuring out my new dose of T3 is really hard. When my T4 was low, it wasn't really an issue to add or subtract a half of a 5mcg pill. Right now I'm taking a half in the morning with my levothryoxine and it almost feels too much, then I do a second dose of about a quarter of a pill later in the day. Low doses of liothyronine is really, really challenging.

So I have a big question....if I only seem to be needing 3.75mcg-7.5mcg daily of liothyronine (with the 7.5 sending me hyper), and the tiny doses seem to really have an impact, do I need to lower my levothroxine so I can still take a small amount of T3 without such an impact? It seems like the higher the dose of T4, the less T3 I need but the stronger it feels when taking it. Then, any changes, like physical activity, how I cut the pill into half/quarters, timing of the doses, all seems to have a bigger impact.


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## Lovlkn (Dec 20, 2009)

Are your Ferritin and D levels optimal? I had alot of issues adding T3 hormone when my Ferritin and D levels were low.

After addressing these I had no issue


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## Sabrina (Aug 30, 2016)

Labs indicate I’ve overmedicated on T3 because my T4 number came up so quickly and I didn’t decrease liothyronine fast enough. Right now I’m supposed to just take the levothyroxine only and take up to 5mcg in a day of liothyronine as needed, but I’m having a hard time knowing how to dose that. Urgent care wouldn’t do blood work for me today but did an EKG and all is ok there. 5mcg of liothyronine yesterday pushed me hyper, it was awful.


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## Sabrina (Aug 30, 2016)

Just a quick update that I’ve had to stay off T3 since Friday because I was overmedicated on it too long. I’m taking it very easy this weekend so as not to burn through too much thyroid hormone, I have some appointments next week and hope for labs to see where I’m at. My free T4 is definitely better on 88mcg, now I just need to figure out how to get the liothyronine dialed in safely. Its been an awful process and confusing because it’s been difficult to get in touch with providers and get labs ordered, I feel pretty alone in this. I am thinking about adding .25 of a 5mcg pill in the mornings to see how I tolerate it if labs show I need it. If I can’t get labs and feel terribly hypo, I may try it but Hope I don’t have to without support from labs data.

My reason for upping the T4 was because my free T4 was usually .7-.8, meaning if I had any issues or missed a dose, it would be easy to crash quickly.


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## Sabrina (Aug 30, 2016)

Here I am, reading my own post for help getting back onto T3. Being overmedicated last week made me scared to take this medication I need.

I increased my levothyroxine so that number would be a bit better than the usual .7-.9 I usually get (.8-2.2), going from 75mcg daily to 88mcg. I worked down from 25mcg daily of liothyronine, but didn’t monitor my signs and symptoms very well. Truth is, feeling optimal for so long I haven’t had to remember all those little details. Now, after this experience, I have a binder of everything I’ve documented.

At urgent care Saturday (five days ago), i was in with over medication symptoms, and the endo they consulted with suggested I stop the liothyronine. I do need it, but I felt it was good advice to clear what I believe was excess in my system. Liothyronine is 95% absorbed within four hours, but what I just learned is that it has a half life of 2.5 days! This means that amount of T3 taken is reduced by half by that point and tapering down. I’m no doctor, but it seems to me that means everything I had taken for 2-3 days was still having an impact on me.

I stopped liothyronine for three days exactly, and got labs.

10/13/21
FT4 1.2 (.8-2.2)
FT3 2.7 (2.8-5.3)

Yup, my Free T3 crashed, and I was feeling pretty yukky. Problem was, I am now anxious about taking it because I felt so awful the week before. I took 2.5mcg that afternoon and all I wanted to do was sleep. I got guidance from my doctor to take 2.5 2x per day, but that made me nervous so I went into research mode.

I know my hypo and hyper symptoms, and some of them kind of cross over which is why this can be hard. But I think watching my heart rate has been really helpful, my FitBit tracks it so well I can go back and see what it was doing a week or even a year ago. For me, it seems important I not start to go over 63bpm for the day. I’m at 58bpm today, feeling cold, tired and brain foggy, and my adrenals kick in when I exert myself. So my HR may spike for a bit but unless I’m really nervous about it, it settles quickly back down to 60s. Also, GREAT site for info, I am looking at BP a bit differently now, this is true that my systolic was high but diastolic normal Saturday when overmedicated (159/74).


http://www.tiredthyroid.com/blog/2014/10/08/high-blood-pressure-hypertension-is-a-symptom-of-both-hypothyroidism-and-hyperthyroidism/



After my doctor visit today I’m hypo enough she wants me to add another 2.5mcg dose during the day. I did so by testing my reaction to half of it, all seemed ok, so I took the other half within about 20 minutes. I’m keeping an eye on my heart rate and symptoms, and just trying to take it one day at a time. Feeling better every day!


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## Sabrina (Aug 30, 2016)

Another day, this one hasn’t felt as good as yesterday. I had to do some house chores this morning and it was probably too much, I should at least wait about 3 hours after my liothyronine dose to be a bit more active, and otherwise rest a lot.

Currently on 88mcg levothyroxine daily, and at 2.5mcg liothyronine 3x a day. I have some hypo anxiety kicking in which increases my heart rate and makes me worry about taking my next dose. I ran a bunch of numbers before dose 2 today - 60bpm for the day per FitBit. Feeling cold, tired and have air hunger (where I kind of forget to take breaths, it’s weird but it’s one of my signs). Helpful metric for me today was understanding my BP and “pulse pressure” as described at the Tired Thyroid website. A widened pulse pressure may indicate hyper, as does a higher systolic (top) number. An increased diastolic (bottom) number may indicate anxiety. So I calculated my pulse pressure, when hyper (159/74) it was 85. Tuesday and Wednesday it was 69. Today it has varied from 50-66, so even though my seated heart rate was high 70s/low 80s at the time I was supposed to take the second dose, I took it and started to feel more relaxed, within an hour or so it was back in the 60s/70s. I still feel tired physically but better mentally at least.


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## Lovlkn (Dec 20, 2009)

Have you ever had your adrenals tested with 4 point saliva testing?


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> Have you ever had your adrenals tested with 4 point saliva testing?


i haven’t yet, when I get my free T3 up a bit and am feeling a bit better I will work on that. I was optimal before I started this and have regretted doing this quite a few times. But my free T4 was low and I didn’t like taking 7 thyroid pills a day. I’m hoping to land at maybe 2-3 pills of liothyronine plus the one levothyroxine per day,


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## Sabrina (Aug 30, 2016)

Lovlkn said:


> Thanks for sharing your story. I find that I have to adjust the T3 hormone seasonally - I seem to go hyper every March. I reduce a whopping 1/4 of a 5mcg pill a few days a week and it makes the difference.


@Lovlkn just curious what your symptoms are when going hyper, and if that happens each spring, what are the hypo symptoms you get in the fall that let you know you can stop reducing? I think I read you’re on 2 1/2 pills (12.5mcg) liothyronine daily, correct? Thanks for any insights you’re willing to share!


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## Lovlkn (Dec 20, 2009)

Alot more energy, heart palps and anxiety


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