Should I increase or decrease dose?

[ShonaGreen]

Hi, I’ve been taking 50mg Levothyroxine and 20mg Liothyronine for the last 6 weeks. Just had results back from Medichecks, see pic, with comments that I’m taking too much medication. My Free T3 is the highest it’s ever been but my Free T4 and TSH are at their lowest levels. I’m not sure what to think if it? I took my last T3 dose 12 hours before test and T4 twenty-fours before. Test was done first thing in the morning with fasting.

I had been feeling a lot better but recently a lot more fatigued, but as I was feeling more like normal I thought I’d just been doing too much.

I’m seeing the endocrinologist next week and would like to have a heads-up in case he also thinks I need to decrease medication. Thanks in advance for your help!

[SlowDragon Administrator]

Everyone is an individual...but many of us find we need good levels of Ft4 and Ft3

Your low Ft4 could be causing problems

Suggest you try 25mcg increase in levothyroxine

Retesting 6-8 weeks later

This should increase Ft4 and also raise FT3 a little

[Lalatoot]

I agree with slowdragon. Increase the levo by 25mcg. wait 6 weeks and see what the results are and how you feel.

[ShonaGreen in reply to Lalatoot]

Thanks Lalatoot 😀

[ShonaGreen]

Thanks SlowDragon that makes sense to increase up to 75mg Levo. The endocrinologist said I should stay on 25mg Levo, but I increased up to 50mg following my last post asking for help interpreting results. I had a few months extra supply so thought it would be a good idea to increase Levo.

I expected my T4 to be a lot higher now so was surprised to see it so low. Would this back up the possibility of central hypothyroidism?

[vocalEK in reply to ShonaGreen]

"A low TSH and low T4 suggest secondary hypothyroidism (due to a disease of the pituitary gland or hypothalamus of the brain)."

verywellhealth.com/interpre...

[ShonaGreen in reply to vocalEK]

Thanks vocalEK there's some interesting info on that link! I first posted here last April asking for help with low TSH, Free T4 and Free T3 and secondary hypothyroidism was mentioned then. Only now is the endocrinologist thinking it's a possibility as my levels aren't really improving. I started taking T3 early Dec and have felt a big difference which is great. But I'm not sure now if its the T3 that's causing Free T4 to stay low, or is this caused by secondary hypothyroidism? My endocrinologist doesn't think I need anymore tests looking into this as it would be treated the same way, but I think for peace of mind I'd like to know what's going on!

[Angel_of_the_North in reply to ShonaGreen]

I have central hypo and I sometimes get quite high FT4 (around 50%) for no apparent reason, if anything it tracks TSH instead of going in the opposite direction, so lower TSH, lower FT4. But my FT3 hardly alters even on T3 and my TSH hardly moves either (it was once as high as 0.6 and as low as 0.2). In many ways, once you are on meds it doesn't matter if you have central hypo as long as endo/GP doesn't look at TSH to adjust meds.

[Angel_of_the_North in reply to ShonaGreen]

Impossible to tell really if you have central hypo once you are on meds - the only real sign is a TSH that doesn't rise as expected. Often FT4 drops when you take T3. I do OK with FT4 at bottom of normal range but feel rotten if it drops below (on T3)

[ShonaGreen in reply to Angel_of_the_North]

Thanks Angel_of_the_North , that’s really useful to know. I guess my Free T4 should hopefully increase a bit more in the future with a dose increase. I’m seeing the Endo again next week so hoping he’ll be sensible and not pay any attention to the low TSH 😀