Max. dose of thyroid, Free T4 still too low

My doctor has slowly increased my desiccated thyroid medication up to the max. four pills per day (30mg x 4 = 120 mg) but my Free T4 level never increased into the normal range. I was on the four pills per day for around six months and at the end my TSH was too low (hyperthyroid) so we gradually cut back.

Has anyone increased their medication like this but never seen their FT4 increase? My FT3 level was also slightly high at the end on the 120 mg/day, and my blood pressure increased to 165/110 and pulse around 100 bpm but are now back to normal.

On the four pills per day, I could only sleep soundly around five hours per night and the rest was spent tossing and turning. We tried the min. dosage of Synthroid and equivalent but the side effects were severe anxiety and strange muscle twitching in my facial muscles even taking the lowest dose of 25 mg at once per week intervals.

Endo tests showed no thyroid antibodies.

Your thoughts?

5 Replies

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  • If your t3 is good your t4 doesn't really matter. Generally that is only important if you're actually on levo, but if you're on a regimen which includes t3 your t4 will generally be lower. If your t3 is in or around the upper quarter of the range, your heart rate, temp and gut are normal/working well and you feel well, there is no reason to keep pushing it.

    'We tried the min. dosage of Synthroid and equivalent but the side effects were severe anxiety and strange muscle twitching in my facial muscles even taking the lowest dose of 25 mg at once per week intervals.' Sorry, can you clarify the above? Not sure what you mean. Synthroid + Cytomel?

  • For Levo to work your ferritin, D and folate must be halfway in range, B12 at the upper limit of range. At least these four checked? Coeliac disease? Hypercalcemia? Hypocortisolism?

    Edit: Maximum? A certain written dosing example gave the impression that 3 x 60 mg is typical?

  • Why do you think you are on 'the maximum'? Is it all the doctor will give you? The maximum is where all your symptoms dissapear.

  • You would expect FT4 to be low normal or even below normnal when taking meds contining T3. You'd also expect TSH to be very low (and TSH is irrelevant once you are on meds). Low TSH doesn't mean you are hyper - that's over range FT3. It's your FT3 level that matters. Do you know what it is (with range)?

    I thought most NDT pills were 60 (1 grain), not 30.

  • The only maximum dose when on NDT, is when the patient's symptoms resolve. Usually, if you've already been on levothyroxine, you switch over to the equivalent of NDT and remain on that dose for 2 weeks and then increase by a small dose every two weeks until symptoms resolve. Also before you begin it's a good idea to take your temp/pulse as if they rise too high, you must drop back.

    A TSH below the minimum doesn't mean you are hyperthyroid. If overstimulated it means you've taken too much.

    thyroid-info.com/articles/s...

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