I think I might be over medicating....?

[TiredMummy]

Hello everyone, I’m beginning to think I’m over medicated on Levothyroxine due to trying to solve a low T3 conversion issue. If someone could cast some light on my blood test results and sense check my thoughts on my next plan, it would be hugely appreciated. I’ve been scrabbling around for years now trying to get stability as I’m perimenopausal and only recently found a stable form of HRT.

Here are my bloods when I’d been on 100mcg dose of Levothyroxine for about one year:

TSH - 0.01 (0.27 - 4.20) - LOW

T4 total - 121.0 (66 - 181)

Free T4 - 31.10 (12.0 - 22.0) - HIGH

Free T3 - 4.59 (3.1 - 6.8)

Thé lovely people on this forum pointed me in the direction of some research which showed a need for higher doses of Levothyroxine to be enable enough T3 conversion. Due to this research & an approachable GP my dose was increased to 125mcg.

Initially I felt much better felt but found after a while I discovered I was yo-yoing from being hyper, to feeling ok for a bit and then crashing after I took my thyroid meds. This was a monthly pattern and to do with when I was taking oestrogen only or progesterone and oestrogen but neither hypo or crashing state was good. Anyway, I’m now on a continuous HRT regime which seems to suit me better as it gives me more stability on a monthly rhythm. I’m now turning my attention back to my thyroid medication because it feels too much. I’m only on day 2 of reducing from 125mcg to 100mcg but already the effect has been positive. I don’t feel ‘great’ of course not and I appreciate it will take weeks to settle down to the reduced dose but the severity of the awful pressure headaches have eased already and I’m less hot etc.

Here are my historical bloods after being on the 125mcg dose for 6 weeks:

Free T4 - 19.5 (0.30 - 4.20)

T3 - 4 (2.6 - 5.7)

I don’t have my TSH for this test but it will be similar I would think to the TSH in my next set of bloods below which were taken around 4 weeks later:

TSH - 0.02 (0.30 - 4.20)

Free T4 - 17.1 (9-19)

I can’t help thinking these results might show the ‘put more T4 in to get enough T3 out’ approach isn’t working for me? It looks like the T4 is just going up and the T3 ratio is largely staying the same? This could explain why I currently feel worse after taking my Levothyroxine- nausea, debilitating headache, exhaustion, frowning, just feel stomach wrenching awful.

I was thinking I need to reduce my Levothyroxine back to 100mcg for a while & then consider adding in T3? Perhaps even consider if that doesn’t work, try dropping Levothyroxine to 75mcg with T3. I’d really appreciate people’s thoughts on this and how long you think I should stay on 100mcg before I do anything but as I was on this amount for over a year, I presume my results will probably be the same:

TSH - 0.01 (0.27 - 4.20) - LOW

T4 total - 121.0 (66 - 181)

Free T4 - 31.10 (12.0 - 22.0) - HIGH

Free T3 - 4.59 (3.1 - 6.8)

Should I just reduce my Levothyroxine from 125 to 100mcg for 6 weeks or try going down to 75mcg after a week or so? To me, these bloods look like I might need to be on 75mcg Levo (not 125) possibly with T3 if I still can’t convert enough of it on my own?

Apologies for the marathon post but one last thing, this isn’t a food issue, the crashing etc is the thyroid meds, been there done that with food. I’ve done GAPS, done elimination diet, now on Low FODMAP autoimmune diet for some time which helps.

Thank you so much in advance for any thoughts xxx

[tattybogle]

I was going to say your FT4 had gone down even though you increased to 125. But i've just looked at your old posts and it seems that high 31.1 [12-22]FT4 was taken 1 1/2 hrs after taking 100mcg Levo, and the (19.5) was taken 26 hrs after taking 125mcg Levo.

(i assume the range after the 19.5 result is a typo? was it done by the same lab as the 31.1? in which case it's probably the same [12-22 range].

You can't really compare dose using these tests because of the time difference in taking Levo, and also you cant assume the results on 100 Levo from 2 yrs ago will equate to what 100 Levo will do now. Especially with estrogen and HRT.

Is this result for 125mcg taken recently ?

FT4 17.1 [9-19]

TSH 0.02 [0.3-4.2]

If so then it doesn't show overmedication. But it could be more than you feel ok on.

personally ,I find adjustments of 12.5 are effective. maybe try that if you feel you are on a bit too much T4 for you.

[TiredMummy in reply to tattybogle]

Thanks Tattybogle and Seaside Suzie. You are quite right about the timing issue and also the typo! So yes, I see what you mean....looking at those results, I don’t look over medicated. Whether or not I’d feel better on 100mcg Vs 125mcg however remains to be seen. I’m wondering if I need to reduce my oestrogen as much as possible (rather than Levo) without getting meno symptoms in the hope that the Levo utilises better,

I think I will try night time Levo dosing and tweaking my HRT so I’m taking slightly less oestrogen and the bulk of it the morning, as far away from Levo dosing as possible.

It’s interesting Susie that you think I should just do one change (drop Levothyroxine if that’s what I want to do) as the endo I saw about a year ago wanted me to drop to 100 and start 3x5 T3 straight away. I didn’t get on with this approach but then I was on a HRT Sequi regime so might work better now I’m on Conti.

I’m also interested to see some folk on here alternate their dosing, say 100mcg one day and 125mcg the next which also might be a viable option for me in the future.

I think my plan is to firstly try night time dosing and move some oestrogen dosing to the morning. I won’t move it all in one go, I will take time to do this. I haven’t decided yet whether to stick at 100mcg or 125mcg & will have to decide that over the next few days and then stick at it.

Then I can get bloods done and hopefully see where I am but in the meantime I just need to find the most comfortable ledge to be on whilst I navigate through this,

Thanks again for all your advice and thoughts, hugely appreciated xxx

[SeasideSusie Remembering]

TiredMummy

Here are my bloods when I’d been on 100mcg dose of Levothyroxine for about one year:

TSH - 0.01 (0.27 - 4.20) - LOW

T4 total - 121.0 (66 - 181)

Free T4 - 31.10 (12.0 - 22.0) - HIGH

Free T3 - 4.59 (3.1 - 6.8)

It came to light that you took your Levo about 1 and 1/2 hours before that test so you had a false high FT4, so we can discount that result. Your FT4 would still have been high, but not to that extent.

I’m now turning my attention back to my thyroid medication because it feels too much. I’m only on day 2 of reducing from 125mcg to 100mcg but already the effect has been positive. I don’t feel ‘great’ of course not and I appreciate it will take weeks to settle down to the reduced dose but the severity of the awful pressure headaches have eased already and I’m less hot etc.

I was thinking I need to reduce my Levothyroxine back to 100mcg for a while & then consider adding in T3? Perhaps even consider if that doesn’t work, try dropping Levothyroxine to 75mcg with T3. I’d really appreciate people’s thoughts on this and how long you think I should stay on 100mcg before I do anything but as I was on this amount for over a year, I presume my results will probably be the same:

TSH - 0.01 (0.27 - 4.20) - LOW

T4 total - 121.0 (66 - 181)

Free T4 - 31.10 (12.0 - 22.0) - HIGH

Free T3 - 4.59 (3.1 - 6.8)

Should I just reduce my Levothyroxine from 125 to 100mcg for 6 weeks or try going down to 75mcg after a week or so? To me, these bloods look like I might need to be on 75mcg Levo (not 125) possibly with T3 if I still can’t convert enough of it on my own?

Reading through this post, you don't seem to have given us any current results, only historical ones. For us to offer you any sensible suggestionss we really need to see your current test results.

It would seem that you reduced your dose of Levo 2 days ago without testing, so it would be best to now stay on your 100mcg for 6-8 weeks then retest - don't make any further changes without testing, let your levels stabilise after the dose change and see where they lie. That is your starting point.

As you have Hashi's, I'd also check your vitamins because these need to be optimal for thyroid hormone to work properly and good conversion. So the test you need should include

TSH

FT4

FT3

Vit D

B12

Folate

Ferritin

You don't need thyroid antibodies testing but they come with the test bundle anyway, so the cheapest way to do the test is either

Blue Horizon Thyroid PREMIUM GOLD bluehorizonbloodtests.co.uk...

Check this page for discount code (currently 30% for "Premium" tests) thyroiduk.org/getting-a-dia...

This test can be done by fingerprick or venous blood draw.

Or

Medichecks Thyroid Check ULTRAVIT WITH FOLATE medichecks.com/products/thy...

You can use code THYROIDUK for a 10% discount on any test not on special offer

This test has to be done by venous blood draw at extra cost.

Medichecks does an Ultravit test by fingerprick but it doesn't contain Folate and it's considered important to include all the nutrient tests.

[wanttobenormalnow]

When I tried using bio identical hormones for menopause, they caused problems for my Levothyroxine. I believe estrogen blocks conversion to T3 or simply blocks T4. I read about this 9 years ago but I believe one of the articles was, "Estrogen Therapy May Increase Thyroid Dosage Needs "Hypothyroid Women Starting Estrogen Therapy Need Monitoring and Potential Dosage Adjustments by Mary J. Shomon

All I remember is that no doctor could/would help me with getting both hormone replacements working together. They insisted they had no effect on each other, so I finally gave up on the estrogen and progesterone, as of course I can't live with out my levothyroxine! Good Luck to you!

[TiredMummy in reply to wanttobenormalnow]

Thanks want to be normal now! Yes, I know what it feels like to be stuck in the middle of the HRT support camp & thyroid med support camp. They basically conflict each other, well they seem to in my body, so it’s no fun when you’re a patient on both is it! To be honest I think I’m going to try and reduce my HRT as much as possible and longer term try and head to perhaps being off it altogether. It’s so exhausting trying to work out which is a low/high oestrogen/progesterone/T4/T3 symptom!

Do you feel better now you’re off HRT?

xx

[wanttobenormalnow in reply to TiredMummy]

That's exactly what I felt like it's too hard to know which hormone is affecting which. Off HRT, I could then focus on my thyroid hormones. Which needed to be done. The hot flashes went away eventually. I missed the good feeling of taking estrogen, but didnt miss the progesterone, it was giving me migraines. Overall I am happy to not deal with the com plication, since no doctor was willing to help me and I don't have an exhausted supply of funds to go check out every doctor in the world until I find one that can!