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Hi All. I need some help, please, as I think I am in a bit of a pickle.

Like so many of the people who post here Levo wasn't the complete answer for me. After a 40 year 'thyroid journey' I was really overweight, poor sleep pattern, weak, bad headaches, etc. but only on 75mcg per day. My GP put this up to 100mcg because the blood results showed I was under medicated but the only results were bladder problems and infections! My GP referred me to a private GP who worked with me to change over to Erfa and I have written posts regarding this fairly recently. However from the point that I was on 60mcgs Erfa per day alone a number of the previous problems were put right (apart from weight gain!) but I started to feel quite hyper so with the agreement of the private GP I reduced to 45mcgs per day.

Even though some of the problems have been resolved I am now lactose intolerant (which I wasn't before) and I have bright white visual disturbances a lot of the time which are quite frightening so I have reverted back to 75mcgs Levo per day knowing I am under medicated but not knowing what to do next.

My latest blood tests results (at which point I had been on 45mcgs Erfa for 3 days and 60mcgs Erfa for a week before that) are

Free T3 5.5 (3.5-6.5) Free T4 11.5 (11.00-23.00) Serum TSH 12.0 (0.35-4.5).

My instinct is that perhaps Erfa just doesn't suit me but I need some T3 just not in the ratio that it exists in Erfa but I would really appreciate any comment that anyone can provide. I am due to go back to my private GP 2 weeks today.

Many thanks to anyone who can help me

8 Replies

Abby, there's no lactose in Erfa but there is in UK Levothyroxine and UK Liothyronine (T3). Armour doesn't have lactose so you might try it as an alternative to Erfa. If you can get lactose-free Levothyroxine prescribed you can add a small amount of Erfa or Armour, say 15mg, which would give you 2.25mcg T3.

Cytomel T3 is lactose free but it is very expensive. There are links to lactose free Levothyroxine in your previous thread below.


Thank you, Clutter, for responding so promptly.

I find being lactose intolerant a bit of a pain but my main concern were the visual disturbances. My vision was very bright with varying patches where I had no vision at all. Is this something that is indicative of a problem with Erfa or with my medication levels.

This may not be a query that you can answer, but thank you anyway


Abby, I misread your TSH as 1.2, not 12. You are terribly undermedicated and I think this will be responsible for your symptoms, not Erfa, or lactose intolerance.

You said you reduced from 60mg Erfa because you felt hyper. What were the symptoms? There is considerable crossover between hyper and hypo symptoms.


Hi Clutter

I agree that over the years I have not always known whether my symptoms are hyper or hypo. On my 40 year thyroid journey I have swung between both, as well as under and over medicated. The symptoms that made me feel I was overmedicated on 60mcg were that I was feeling increasingly 'wired' and jumpy as each day progressed. These feelings quickly disappeared when the dosage was lowered to 45mcg which seemed to support my theory.

The visual disturbances also started on 60mcg and I have had experience of these before when I was suffering bad migraines at a point I was hypo or overmedicated. They haven't developed into a migraine in the few weeks since the visual disturbances have restarted. These visual disturbances have been less severe in the last few days but have not totally gone away.

From my 40 years of experience of this condition and the really useful advice I pick up from this site my instinct is that I need more T4 and only a small amount of T3 and that Efra alone has too high a proportion of T4:T3 to suit me.

I am not feeling too bad on just 75mcg of T4 but I know that in the next few weeks I will start to go down hill so I still don't think it is enough and I was planning to order a blood test kit from Blue Horizon next week and send the results to you for comment and discuss them with my private GP when I meet with him on 26th to see if 100mcg levo + 15mcg Erfa would suit me or just add the 15mcg Erfa to the 75 mcg levo I am currently taking.

I'm sorry that this has been such a long reply. Do you think I am on the right track. Please let me know if I should re-think.

Thank you very much.


Abby, At the moment FT3 5.5 is very good, but it is possibly due to your high TSH which will be stimulating conversion. When TSH is lower FT3 may drop and you may need T3 added to Levothyroxine then.

FT3 5.5 is very unlikely to be making you feel wired but having low ferritin or iron can make it difficult to raise dose without feeling wired and tired. May be worth having ferritin tested.


Clutter, thank you.

I will move forward as intended and get bloods tested again next week, to include ferritin and iron, and report back.

Thank you


A TSH of 12 is too high. You are undermedicated.

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Hi eeng. I had sort of suspected this, thank you, and had felt it was T4 I needed rather than more T3. I think this is the direction I shall go in, and then have bloods re tested. Many thanks


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