Dose reduction after last blood test. Symptoms coming back?

[Gr8Nica]

Hi guys,

After my last dose increase I've decided to do new blood test and seeing FT3 over the range limit I went on and slightly reduced my dose.

Recent results - fasted, 24hrs after taking 1.5 tablet of Novothyral 75

TSH: 0.001 mU/L (0.55-4.78)

FT3: 6.93 pmol/L (3.53-6.45)

FT4: 15.06 pmol/L (11.45-22.65)

ATG: 193.8 U/ml <60

ATPO: 160 U/ml <60

I must say I felt great (happy, no tiredness, pretty sharp mind, no overactive symptoms) if you not mention occasional pain in my right foot - the only symptom I can't quite get rid of yet. Since the reduction for the past 3 days I've been feeling more tired and very sleepy in the afternoons, small concentration issue too.

Now I'm thinking - was I wrong in reducing my dose?

[SeasideSusie Remembering]

Gr8Nica

Now I'm thinking - was I wrong in reducing my dose?

In my opinion, no, not with those results.

When taking any form of T3 (as in Novothyral T4/T3 combination), as it's the FT3 that's the most important result then to get the level of normal circulating FT3 we should leave a gap of 8-12 hours between last dose and blood draw. You left 24 hours so you have a false low FT3, therefore your normal circulating level is more than the 6.93 indicated.

Maybe Novothyral doesn't have the right balance of T4 and T3 for you at 75mcg T4 and 15mcg T3. Your total dose is 112.5mcg T4 and 22.5mcg T3. Reducing has given you less of both T4 and T3. I can't function when my FT4 is as low as yours in those results above. Personally I need both FT4 and FT3 around 75% of range, although not everyone does.

Maybe you'd do better with less T3 and slightly more T4 which is achieveable with separate T4 and T3 tablets.

I would retest 6-8 weeks after you reduced the dose then see where your levels lie, but only leave 8-12 hours after your last dose and the blood draw.

[Gr8Nica in reply to SeasideSusie]

Do you think it's ok to add 25mcg of T4 at this point as I still have some supply and it hasn't been even a week since my dose reduction? On the previous dose I still haven't felt quite right hence the increase.

Results on 1.25 of Novothyral, fasted, 12 hrs after taking dose (was on a different schedule temporarily):

TSH: 0.03 miu/L (0.3 - 4.2)

FT4: 13.5 pmol/L (9 - 23)

FT3: 5.1 pmol/L (2.5 - 5.7)

[SeasideSusie Remembering in reply to Gr8Nica]

Gr8Nica

It's a bit of a see-saw trying to get the right balance of T4 and T3. Your FT4 is low, which may or may not be fine for you. If you add 25mcg T4 there could very well be some increase in your FT3 due to some natural conversion of T4 to T3. It might be worth adding just 12.5mcg Levo at this point, retesting 6-8 weeks after the dose change. But it's your decision.

[Gr8Nica in reply to SeasideSusie]

I'll try with a 12.5mcg of levo and see how it goes. I was so scared of some symptoms to come back, especially with a new job I started recently and wanting my mind to be quite sharp, I was reluctant to reduce the dose but at the same time didn't want to hurt myself in the long run.

Thanks for that SeasideSusie