Difficulty finding right T4 dose.

[Modest]

Helll everyone, I am new here but have found this forum extremely helpful with loads of info on Thyroid issues especially symptoms, dose medication, and 'thyroid terms'.

Please, has anyone found it difficult to get the right T4 dose? After my Sub-total Thyroidectomy in 2009 I have been on 200 mcgs of Levothyroxine.

But in March this year, it started causing me chest pain with a burning sensation, so my endo reduced the dose. Only problem is my body seems to be hooked on 200 mcgs! I tried reducing it to 150 mcg, but somewhere during the day I begin to feel weak and have to increase the dose. I also tried 175 mcg as well as 187.5mcg ( just trying to stay below 200mcg).

The chest pain and burning feeling have gone since I reduced the dose. But the body still wants 200 mcgs, and I cant go there again. Now I experience tired eyes but no more weakness.

Do I alternate between 175 mcg and 178 mcg within a week? I weigh 72 kg. Please any advice, ideas or shared experience will help. Thanks.

[Clutter]

Welcome to the forum, Modest.

If 200mcg is too much but 187.5mcg not enough split the difference and try 187.5mcg/200mcg alternate days. You'll need to allow 3 or 4 weeks on the dose to see whether it helps. Small tweaks can make a satisfactory difference but don't work within a week.

If you post your last thyroid results with the ranges and say what dose you were taking members will advise whether you were optimally medicated.

Have your eyes checked. Hypothyroidism affects our eyes and you may need glasses or a stronger prescription.

[Modest in reply to Clutter]

Thanks so much Clutter. The following was my last thyroid function test. Unfortunately the hospital lab dosent have facilities to test for Ft3, Ft4, antibodies, Rt3 or any other thyroid related test other than T3, T4,& TSH:

TSH- 13.300 (0.39-6.16)

T4- 8.035 (4.8-11.6 )

T3- 0.785 (0.52-1.85)

I also have to titrate my doses through each day, as I tend to feel the slight chest pain if I try to take a whole dose. For example, if I'm taking say, 100 mcg daily, I have to take 25 mcg at intervals, like say, every hour ( thats in 4 hours), because if I take a 100 mcg tablet, I'll start feeling a slight chest pain.

Is it ok if I take my meds like that? or will it affect my thyroid levels in a bad way? And I have been too afraid to take 200 mcgs, So, I have been alternating between 150, 175 & 187 mcgs fo almost a week. Is that advisable, or am I doing it wrong? Thanks.

[Clutter in reply to Modest]

Modest, You should see your GP to investigate chest pain and to see why your TSH is so high. TSH 13.3 indicates you are very undermedicated and this is probably the cause of your chest pain, not Levothyroxine (T4). Ask GP to check ferritin and iron as low levels can cause chest pain. I'm afraid I can't interpret Total T4 and T3, I'm only familiar with FT4 and FT3.

I don't understand why you are taking different doses each day. You need more than 200mcg and should take 187.5mcg if that's the most you can tolerate. Splitting the doses the way you are is probably reducing absorption. Levothyroxine needs to be taken 1 hour before, or two hours after, food and drink. Taking Levothyroxine with coffee can reduce absorption by up to 40%.

It's possible you are sensitive to some of the fillers in Levothyroxine but I don't understand why multi dosing would make it more tolerable. Try an antihistamine an hour before Levothyroxine. If you don't get the chest pain it is an allergic reaction and you should change your brand.

It's also possible that you can't tolerate high dose Levothyroxine, I know I felt poisoned on 200mcg. Reduced dose T4 + T3 (Cytomel) might be better. I couldn't tolerate T4 only but T4+T3 is good as the T3 calms the adverse effects T4 caused me.

[Modest in reply to Clutter]

Thank you Clutter. The reason why I thought its the T4 that was causing the chest pain, was because when I reduced the dose, the chest pain went away.

My Endo and GP had me take series of ECG tests, checked my pulse rate, BP, and all were normal. I did previously have sinus tachycardia just briefly. But when the dose was reduced, the chest pain went away.

My Endo has suggested I try a new brand as this one may no longer be effective for me, and as you said, I may be allergic to it now. So I have ordered for a new brand.

As for my thyroid function test results, my endo said it is indeed abnormal. And there is no need to worry as the tsh level will go down with time because it is usually slow and gradual.

However, my GP said the results are okay since my T4 is within range. But I know all is not well coz I dont know my Ft3 & Ft4, they may be low.

As for the doses I'm alternating, to be honest dear Clutter, I am totally scared and confused. I'm just trying to find a dose that wont cause me chest pain. If only I could find a way to calm my fears.

But hopefully when I get the new brand and try it, it'll work better. I'll keep you posted. Thanks so much, I really really appreciate your comments and help.

[Modest]

Hey Clutter how've you been? I've been fine since then. My thyroid levels normalized eventually, while being on 200mcg thyroxine.

I realized something strange: my symptoms dont correspond with my lab results. What I mean is, I remember when I had my thyroid surgery back in 2009, to find the right t4 dose, I was started on I think 25mcg and was gradually increased till I felt normal at 200mcg.

That has, and still is my ideal dose where I feel normal. However, whenever the dose is slightly reduced in any way or amount, due to my lab results showing high t3 & t4 & low tsh, I immediately start feeling horrible hypo symtoms: weakness, eye-tickling achey feeling, hoarse voice, slow and sluggish movements.

Then, when the dose is brought back to 200mcg, I feel perfectly fine and happy, although the lab results are showing high t3 & t4.

My doctor cant understand why my body is hooked on 200mcg, and wont allow it to be reduced without me feeling severe hypo symptoms. Any ideas? Thanks.