Thyroid UK
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Lower T4,T3,FT3,FT4,TSH after taking Levo

Hi all! I am really desperate and clueless about a solution. My physchology is getting worse as I cannot get to a better place. I hope you can advise me something new. I appreciate you all in advance.

I finally founs a doctor to prescribe me Levo and he luckily accepted my complaints (irregular period,weight gain,hair loss, swinging mood, muscle weakness) may be a result of my low thyroid hormones - even if he cannot classify me as hypo,central hypo, or any orger known hypo type.

My latest results before any medication on 28.12.2017;

T3: 1.28 (range 0.80-2.00)

T4: 6.64 (range 5.10-14.10)

FT3: 4.50 (range 3.10-6.80)

FT4: 14.80 (range 12.00-22.00)

TSH: 1.35 (range 0.30-4.00)

(My T3,T4,FT3 and FT4 were even lower on the tests I had done prior to this one)

So the doctor prescribed me 25mcg Levo and wanted see how it goes for 6 weeks.

19.02.2018 (aprx 6 weeks later);

T3: 0.82 (range 0.80-2.00)

T4: 6.53 (range 5.10-14.10)

FT3: 3.70 (range 3.10-6.80)

FT4: 16.00 (range 12.00-22.00)

TSH: 1.45 (range 0.30-4.00)

As you can see, my FT3 and T3 got even lower, I guess we can say the others didn’t chane significantly. We were aiming to take my FT3 and FT4 to the upper 1/4 of their ranges. So he increased the those to 50 mcg.

The results from today, 26.03.2018 (aprx 5 weeks later);

T3: 0.69 (range 0.80-2.00)

T4: 5.84 (range 5.10-14.10)

FT3: 2.90 (range 3.10-6.80)

FT4: 13.70 (range 12.00-22.00)

TSH: 0.51 (range 0.30-4.00)

My T3,T4,FT3 and FT4 descreased. Somehow my TSH decreased too! My doctor checked and confirmed that I don’t have a central (secondary) hypo, and my pituitary gland is workşng normally. My symptoms got worse, I am so depressed, I exercise regularly for last 4 years but I have sore muscles after every workout. My hairloss increased and it became harder to control my weight. Is that even possible!? The more I take medication, the worse my symptoms and results get.

Please help me:(

22 Replies
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My hairloss increased and it became harder to control my weight. Is that even possible!?

Yes, it is possible, because it takes a lot of T3 to exercise. You should hold off the exercise until your FT3 is higher.

And, it's possible to lower your thyroid hormone by adding in 25 mcg levo, because it's enough to stop your thyroid producing hormone, but not enough to replace it. On the higher dose, your levels should rise - especially if you restrict your exercise to gentle walking and swimming.

And, remember, conversion takes calories. If you are using up your calories exercising, you will lower your conversion.

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Oh it’s like a nightmare! But I increased 25 to 50 mcg, how come it became lower? My exercise routine is more or leas the same since before I had started levo.

And how come my TSH doesn’t go higher while my FT3, FT4, T3 and T4 going lower?

Would you recommend me to increase to 75 or 100 mcg? I am afraid my TSH might go lower with an higher dose...

Thank you very much Greygoose.

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Your TSH would go lower with a higher dose. That's what it does, that's the system. But, it doesn't matter once you're on thyroid hormone replacement, how low it goes. Could be several reasons why the TSH doesn't rise. Were all the tests done at the same time and fasting? Could be that your pituitary isn't reacting very fast.

I would only ever recommend an increase of 25 mcg every six weeks. With hormones you have to go slowly.

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Oh I didn’t know a low TSH level is not important during medication. Thank you for the acknowledgement.

My tests have always been done during the day, after the breakfast or lunch. All the doctors and the lab nurses I get my tests done said it doesn’t matter a lot. That’s why I thought it was not important and didn’t even care about it.

So I guess I should go for 75 mcg in a week time.

Ahh.. I was doing weightlifting (not hardcore), and it has been the only way of stress-management and keeping my mood a little bit more stable... and actually I read some articles saying it is good to do resistance/weight training if you are hypo. It freaks me out when I even think about stopping it. But I see you say it is a must and I have to do a MUCH lighter exercise version. Arghh:(

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It's just for a while, give your FT3 levels time to rise. The fact that you're experiencing sore muscles shows that you're over-doing it.

TSH is highest early in the morning, and drops throughout the day. It also drops after eating. The medical profession doesn't seem to understand this, so, it's a patient-to-patient tip to get the highest TSH possible, as doctors only seem to take notice of that.

But, no, it doesn't matter if the TSH goes low when you are on thyroid hormone replacement. It drops because you don't need it anymore. It stimulates the thyroid when levels are low, but if you're taking exogenous hormone, the thyroid doesn't need to make it. So, the pituitary doesn't make TSH anymore.

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Thank you so much for all these informations and tips Greygoose!

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You're welcome. :)

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Not read your previous posts but it is essential to have optimum ferritin,folate,D3 and B12. See ?seaside Susies posts for detail.

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Thank you Treepie! My B12, vit D and ferritin (I haven’t checked folate before) decreases all the time, so I take these supplements for a period of time every once in a while as per docs advise.

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It's important that once you have your vitamins and minerals up to optimal levels that you maintain those levels. It would seem as though you get yours up, stop taking supplements, your level else fall again so you start supplementing again. If your doctor is aware of this then it shows that they know nothing about nutrition. Once your levels are optimal then you need a maintenance dose to keep them there.

What are your current levels and what supplements are you taking and the dose.

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Hi SeasideSusie, Cofy mentioned some vitamin results to me, below:

[[And my ferritin is 6.60 (range 5-204). I started using Ferritin too. I asked him to advice me on a dose to maintain good levels thanks to your advice. He said he will once it reaches to a good level. And my vit D is on the lowesr barrage. I started ysing vit D supplement too, and I will keep using a maintaining dose for this as well. My B12 on the other side is very well as I have been using Biotin (it has B12).]]

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I would not have a ton of confidence in your doctors, because they are making some strange decisions. Best to do your own research and double check what they tell you to do.

I agree with Greygoose that 50mcg and below are often disruptive rather than helpful.

Your blood tests were right on the borderline of normal when you started on hormone replacement. Most doctors would want to see your TSH outside the range. As a patient even I would tend to see a TSH of around 2 or 2.5 as when it starts to get unusual. Your freeT3 is only just below halfway - freeT3 is the more important of the numbers. But I'm less sure exactly how to diagnose with it. Many people on medication have worse numbers than you did.

So I'd try to keep an open mind about whether you have a thyroid problem at core, and keep an eye out for vitamin deficiencies or other explanations for your symptoms.

Have you had an anti body test? If this came back positive it would give you concrete evidence.

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Here is a very useful report showing distribution of TSH in the population. I don't feel fully comfortable offering diagnostic comments on TSH alone, freeT3 would be much better. But unfortunately there is very little information on things like distribution of freeT3 in the population.

web.archive.org/web/2004060...

Now, according this chart the most common TSH in the population was 1.25, and the median was 1.5. This means 50% of the population had a TSH lower than 1.5. So your TSH was a shade higher than the most common TSH in the population, but over 50% of people had a TSH higher than you did.

You have got a low freeT4, which suggests your thyroid is starting to struggle. But I'd still feel a bit worried this is caused by overall illness rather than a cause of it. Also, we have no idea how common it is to have a freeT4 like that and feel well.

I think it's still a good idea to continue with the trial you're doing. But as I say, keep an overall open mind, and don't be surprised if the trial is unsuccessful, and you have to go on and try the next thing on the list.

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Ah thank you so much for this link.

Neither me nor my doctor are very sure about what we are doing! He said he is giving Levo treatment a tey without being 100% sure, and because I want to try it and he feels like I will do it myself if he doesn’t help me:)

Like you said, I will hold on to this for a longer while - even if 6 weeks before getting any benefit and before a new test feels sooo so long with these symptoms, I don’t have any other choice. And unfotunatelly I don’t have any other plan after this-which makes me feel even more depressed and hopeless.

Thank you very much again!

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I think looking again at vitamins is definitely worth it. As both B12 and vit D deficiencies are very similar to Hypothyroid, and iron problems has a whole nother set of things to look into.

If you've got general fatigue there Are a few other avenues, although I'm not too sure myself.

Also, I think its worth giving T3 a try if you don't have success with Levo. T3 is what I would recommend to anyone who doesn't have hypothyroid blood tests, but suspects thyroid. Just because Levo requires quite a lot of your body to be working correctly to get into your system. Whereas T3 gets straight to the point.

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Thank you for your reply SilverAvocado!

I agree that I am not a regular hypothyroid patient. But I had been suffering from common hypo symptoms (and I have 3 thyroid patients in my family). I waited for 2 years to see if it was something about the session, about my mood that time, about the stress or the exercise type I was doing those days. I tried changing everything and looked for a positive change in my symptoms - literally for 2 years... I tried to get benefit from only ferritin, vit D and B12 supplements. I couldn’t see any good change with them as well. It was then I got more into thyroid, and realized my levels are mostly around the lower edge, which may cause symptoms on some people-even if the TSH is normal. I have read many many researchs about it and found many patients like me. I cannot classify myself as a hypothyroid patient, but my hormones are obviously lower than optimal.Otherwise the idea of taking a hormone replacement was scary for me to be honest. It was like a last choice for me.

I got my antibodies tested before, it was postivive but not very high as far as I remember. But I haven’t got it checked after I started Levo. My doc didn’t ask me to do this actually. Maybe I should test them too. But is that important at this stage as I am already using Levo?

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A positive antibody test is gold dust. This proves that you have Hashimoto's disease. This is an illness that will slowly attack your thyroid, which means you'll become more and more hypothyroid over time.

I think this is very important, because actually it's not clear your results are sub-obtimal. They are actually very close to average, which means a large proportion, maybe 50% or more, would have results worse than yours.

Unfortunately we know a lot about what optimal results are for medicated people, but we don't know as much about what 'optimal' would be for healthy people. Certainly medicated people aim for much higher thyroid hormones than healthy people. So for example a medicated person would want freeT4 in the top quarter, but a healthy person will have it closer to the halfway point than that.

But if you have Hashimotos disease, then your thyroid is definitely an issue.

In terms of supplementing vitamins, it's not enough just to take the supplements, you must confirm that the numbers are raising. Often people who have vitamin deficiencies can not raise their levels by taking any old supplements, because the deficiencies are caused by their digestive system not absorbing vitamins properly. If your numbers aren't raising, you can adjust your treatment to more and more effective and easily absorbed forms.

It's a good idea to get hold of: ferritin, folate, vitamin D, vitamin B12. If you can, get your older results, too, so you can see if the supplements helped.

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Dear SilverAvocado, I am sorry gor the kate reply. Actually I wanted to re-test my thyroid hormones as that was what my doctor advised. And additionally I wanted to test my vitamins as per your advice.

My thyroid hormones are still ‘just’ on the lower end. These are the same results with the ones before I started Levothyroxine at all. But as my TSH is lower, my doc thinks I may have conversion problems. Just like what you said, he wanted to give T3 a go. Now I am on T3 for 3 days, but he cut off Levo. I hope this doesn’t cause a problem.

And my ferritin is 6.60 (range 5-204). I started using Ferritin too. I asked him to advice me on a dose to maintain good levels thanks to your advice. He said he will once it reaches to a good level. And my vit D is on the lowesr barrage. I started ysing vit D supplement too, and I will keep using a maintaining dose for this as well. My B12 on the other side is very well as I have been using Biotin (it has B12).

My ANTI-TPO (ECLIA) is 18.40 (range is <34). What do you think about it. This is the result when I was still on Levo. And it was lower than this before Levo as far as what I remember. I guess this may mean my body tranformed T4 to reverse T3. Would you have any recommendation or warning on that?

Thank you ver much again.

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Cofy, I think it's good news you've swapped over to T3, as I think it suits more people who have more complex thyroid situations!

It should be fine cutting off the Levo, as T3 and Levo are equivalent to each other. T3 is about 4x as powerful, so 50mcg of T4 is equivalent to about 12mcg of T3. Hopefully you will carry on testing and adjusting dose every 6 weeks.

Sounds like you have some very bad vitamin results. The rule of thumb is that these should be at least halfway up the range, and Vit D should be at least 100. Bad vitamins can be good news, because it means you have room for improvement. You must make sure to take good quality supplements. I'll copy and paste what you've said to Seaside Susie above. She gives very good advice on vitamins.

Anti TPO stands for thyroid peroxidase antibody, and is one of the 2 antibodies to the thyroid, that indicate Hashimotos. You're result is under 34, so this is a negative result, meaning you don't have these antibodies.

You mentioned you tested positive for Hashimotos? Did you have another antibody test showing positive for antibodies? Or is this the one you were thinking of and there may be a mistake?

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Thank you so much for this quick reply! My vit D is 68.75. As you said, it is promising to see that there will be improvement from this side of the picture once I increase my vitamins:)

Yes definatelly, I made a mistake on this hashimotos test, excuse my nescience. I thought this ANTI TPO should be zero for it’s best, but above 34 is extremely bad. But my father has hashimotos, so I guess I should be aware of genetic factors in future.

Thank you for involving Seaside Susie too for help! :)

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You're very welcome Cofy, I hope you find useful things in it that will help you :)

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Ferritin is 6.60 (range 5-204). I started using Ferritin too. I asked him to advice me on a dose to maintain good levels thanks to your advice. He said he will once it reaches to a good level.

A ferritin level as low as yours can suggest iron deficiency anaemia. If not already done you should ask for a full blood count and an iron panel.

I would have hoped for an iron infusion with your level but f you have been prescribed iron tablets then you should take each one with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

Once you have reached the recommended level then eating liver regularly should maintain that level.

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And my vit D is on the lowesr barrage. I started ysing vit D supplement too, and I will keep using a maintaining dose for this as well.

What is your actual result? What dose of D3 supplement are you using?

The recommended level, according to the Vit D Council is

40-60 NG/ML

OR

100-150 NMOL/L

depending on what unit of measurement is used.

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

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My B12 on the other side is very well as I have been using Biotin (it has B12).

Biotin doesn't contain B12. Biotin is a B vitamin - B7. Often included in a B Complex along with all the other B vitamins.

If you take Biotin, either as a standalone supplement or as part of a B Complex, then when having thyroid tests you should leave it off for about 5 days beforehand as it can skew the test results.

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