Do I need to reduce T4? Latest results

[tinkerbell22]

Hi everyone, as SlowDragon is aware from our conversation yesterday I have had another blood test done. And now I have my new test results.

I am on 150mcg T4 Synthroid daily and 7.5mcg T3 split into 2 doses daily.

I think I need to reduce my T4. I increased it from 100mcg to 150mcg after my last test results 6 weeks ago. Initially I felt great on the higher dose but then breathlessness crept back in (which I usually find vitamin B fixes but not this time).

hs-CRP H 19.17 <5.0 mg/L

Ferritin 67.4 13 - 150 ug/L

Thyroid Function

TSH L <0.005 0.27 - 4.20 mIU/L

T4 Total 128.0 66 - 181 nmol/L

Free T4 H 23.50 12.0 - 22.0 pmol/L

Free T3 6.46 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs <9.0 <34 kIU/L

Anti-Thyroglobulin Abs H 255 <115 kU/L

Vitamins

Vitamin D (25 OH) 56 Deficient <30 nmol/L

Insufficient 30 - 50

Consider reducing dose >175

Vitamin B12 206 Deficient <145 pmol/L

Insufficient 145 - 250

Consider reducing dose >569

Serum Folate 9.05 8.83 - 60.8 nmol/L

My vitamins are all better than 6 weeks ago. I'm continuing to build these.

CRP is up on 6 weeks ago slightly (it was slightly raised then too)

My TSH has fallen lower due to extra T4 these last 6 weeks. It is so low since I started T3 which is ok.

My T3 is a tiny bit higher than 6 weeks ago.

My free T4 has gone higher and is now out of range. This might be ok If I felt well but I definitely don't! Still so exhausted, and as I say, increased breathlessness. I actually went back over my test results and notes over the last couple of years and this has made me wonder if Synthroid causes the breathlessness and that I may need to replace it with something else. I found in my notes that increased exhaustion and breathlessness started for me on starting Synthroid! I switched from UK levothyroxine to Synthroid because of debilitating side effects of UK levothyroxine. These vanished when I swapped to Synthroid but I felt more exhausted and started having breathlessness. Maybe I'll never feel right on Synthroid...

I'm considering reducing to 125mcg Synthroid and see if this resolves the breathlessness. If it doesn't help, I may go back to 100mcg Synthroid. Then I may try increasing T3 instead.

Any thoughts or help much appreciated xx

[SlowDragon Administrator]

Going from 100mcg to 150mcg was a very large jump

You probably need to try 125mcg daily.

T4 needs very fine tuning. Suggest you retest after 8-10 weeks on 125mcg (takes much longer to settle after reducing dose)

Your vitamin D, folate and B12 are still too low

I would agree you may need 100mcg plus 3 doses of T3 at 8 hour intervals

But one step at a time. Slowly and gently.

[tinkerbell22 in reply to SlowDragon]

Oops! I usually did 25mcg jumps or even 12.5mcg originally. This is the first time I went up by 50mcg. I'd read of others doing 50mcg increases and thought that was normal. I must have got that wrong. Silly brain!

Thank you for all your advice again. Very much appreciated

[MaisieGray in reply to tinkerbell22]

We are each individual in our response to dose adjustments, I have moved up and down by 50 mcg increments of T4, 20 mcg increments of T3, and half grains of NDT, without any discernible problem; and even taking all my T3 from me at the same as reducing my Levo by 50 mcg had a noticeable effect only gradually over time. If it were de facto, dangerous or ill-advised to make 50 mcg adjustments, it wouldn't be included, for specific instances, in the NICE guidance nor in the manufacturers' Patient Information Leaflets. In 40 yrs I've been able to notice change only by looking back over a period, with no immediate effects. On the other hand, some people are far more sensitive to change than I, so as we become more experienced about our condition and our body's individual responses, in general it makes sense to do what works best for us individually, rather than following a fixed rule.

[tinkerbell22 in reply to MaisieGray]

Thanks so much MaisieGray!

[greygoose]

Your low ferritin might have something to do with your breathlessness, too.

[tinkerbell22 in reply to greygoose]

Hi greygoose Yes I agree. I'm pleased all my vitamins are up and will continue to work on them I know I've got a fair way to go.

[tinkerbell22 in reply to tinkerbell22]

Just a thought, I don't Feel hyper... I don't feel as though my T4 is too high? I've had breathlessness on and off all the way through from 25mcg to 150mcg of synthroid, just it's been more pronounced lately.

I do wonder if for me breathlessness is a side effect of Synthroid that increases the higher my dose. I also get exhaustion as a side effect of Synthroid I think... so perhaps that is masking what would be a hyper state otherwise on this high dose?