T4 dose too high?

[Pinkpetite]

Hello everyone,

I just got the results of my recent blood test back after doing gluten-free strictly for 8 weeks and taking the thyroxine an hour before food or drink. My T3 is the highest it's ever been. I also got my iron and vit D up (from last test) and had started recently supplementing selenium. The GP wants me to lower my dose, I'm on 150mcg, but I said I would email the private Endo I saw and ask him - really I'm asking you guys!

T3 5.9 (2.5 - 5.7

T4 20.7 (9.0 - 23.0)

TSH Less than 0.01 (0.3 - 4.2)

What do you think?

[fuchsia-pink]

How do you feel?

Yes, you are slightly over-range, and being lots over-range for a long time isn't a good idea ... DId you leave 24 hours from taking your previous dose of levo? - if less than that you will have a slight "false high".

If it were me I might drop a little - say go to 125 mcg for 2 days a week and see what that does both to the results and how you feel after 8 weeks.

[Pinkpetite in reply to fuchsia-pink]

Yes I took my last dose 24hrs before the test and did it before food or coffee at 9am.

I feel ok however am wondering if the dose is causing me anxiety which I've always suffered from or whether that is just me. I'm very impatient too! May just be my personality.

The private Endo I saw from Dionne's list did think I was probably on too high a dose and that's when my blood results weren't so high. I am petite and weigh about 47kg.

The anxiety is worse in the morning. I just have 2 cups of coffee then, no more rest of the day. Anyone find they can't tolerate coffee?

I will think about lowering for 2 days a week. Bit anxious about that though!

[fuchsia-pink in reply to Pinkpetite]

No point in making yourself anxious about it - it's only a teeny bit over-range. But if you think too much T3 increases the anxiety, a small drop may improve things. What I wouldn't do is get the prescription changed (if at all possible) - then you can go back up if a small reduction doesn't suit. And if you are happier with a small reduciton, you will build up a little stash of "extra" levo - which is always a good idea anyway! x

[greygoose]

Do you have Hashi's?

If you feel well, I wouldn't change a thing! Ranges are arbitary, not rigid barriers that you mustn't cross. A lot of people need their FT3 slightly over-range, and yours is so slight it's really not worth mentioning. I expect your doctor is only looking at the TSH, anyway, and has no understanding of how it all works. What is important is how you feel, despite what he might say.

[Pinkpetite in reply to greygoose]

Yes I have Hashi's. I could leave things as they are and test again in 8 weeks.

I am a bit anxious as in my reply to Fucshia-pink but no idea if this is related to the thyroxine dose. I did get badly anxious when adding T3 - just for 10days - a few months ago so maybe I am sensitive to my T3 being too high?

[greygoose in reply to Pinkpetite]

Maybe you are. But, as you have Hashi's, those results might not be your average results. There could be some minor sort of 'hyper' swing due to your Hashi's, and nothing to do with your dose. Do you have any other labs done on the same dose? Your dose isn't all that high, so I would be very wary, if I were you.

[Pinkpetite in reply to greygoose]

All my other labs were on the same dose but I never took it an hour before food and drink and didn't fast before any blood test as wasn't told to. I always took it with coffee and milk, for the last 38 years!!!

And all the other results were never like this, T3 was a bit up at times but not this high and T4 was a lot lower mostly. In my last blood test my T3 was higher in range than my T4 in its range.

[greygoose in reply to Pinkpetite]

OK, so when did you stop taking it will milk and coffee? Was it long before this blood test?

[Pinkpetite in reply to greygoose]

Yes over 2 months.

I only learned that through this forum. The old leaflets never said this and I stopped reading them anyway. No Gp ever said this to me either. My newly diagnosed sister-in-law told me initially, just before I read it on this forum.

[greygoose in reply to Pinkpetite]

The majority of doctor have no idea. I've even heard of doctors telling patients that it's fine to take your levo with your birth control pill and your calcium! It won't affect absorption at all. Frankly, they have no idea.

OK, so if you started taking your levo correctly two months before that test, then it does look like 150 might be a little to much for you, then.

Of course, we can't discount the Hashi's having an effect, so several blood tests would be a good idea to understand the levels further. So, if you try reducing just a tiny bit, as fuschia-pink says, do it by yourself, don't involve your doctor and get your prescription change, because you might need to go back to 150 mcg at some point. Just conduct your own little experiment to see how you feel. But, remember, you need labs done six weeks after any changes in dose.

[Pinkpetite in reply to greygoose]

Ok so I can either keep things the same and test in 6 weeks or slightly reduce the dose, by 25mcg or 12.5mcg?, and test in 6 weeks

[Zazbag in reply to greygoose]

greygoose based on the OP's FT4 and FT3, is she an example of someone who is a "good converter"?

[greygoose in reply to Zazbag]

I don't think we can make any sort of judgement on that, because not enough information. Could be that those high results are due to the Hashi's, not the dose.

[Zazbag in reply to greygoose]

Oh yeah that's right, because you can have periods of hyperthyroidism with Hashimoto's.

[greygoose in reply to Zazbag]

Not true hyperthyroidism, no. But, raised FT4/3 levels due to the dying cells dumping their store of hormone into the blood.

[Zazbag in reply to greygoose]

Transient hyperthyroidism though as a result of that process? I definitely had periods like that over the years before my diagnosis, when I look back. I never had blood test results to show it, but I had periods of weight loss, feeling hyper and extreme insomnia.

[greygoose in reply to Zazbag]

Yes, same here. I rather enjoyed them because I lost weight, my hair grew and I had bags of energy. No hyper symptoms, just a welcome relief from dragging myself around, fat and sluggish.

But, I don't like calling it 'hyperthyroidism', because that implies that the thyroid is over-active. Which is not the case at all.

[Hidden in reply to greygoose]

This is really interesting. How long would a hyper swing last? As long as 8+ weeks? In April and May this year, I was feeling great, running up to 6k every other day and I achieved a personal best! My periods were 'normal' as well instead of barely there and then it all went away again and now I mostly sit on the sofa wishing I could run again! 😣

[greygoose in reply to Hidden]

Difficult to say, but 8+ weeks doesn't seem impossible to me. And, then, on the way down from 'hyper' to hypo, you can have a period of euthyroidism, that can last quite a long time, too.

I've never been able to run - think I've always had some degree of neuropathy, even as a child, and I really would love to run, but always feel as if I'm going to fall on my nose! I feel very insecure. But, I can relate to what you're saying about being fit and active one moment, and then couch-bound the next. Sigh.

[Hidden in reply to greygoose]

Thank you. Perhaps it wasn't a hyper swing then. My diet was useless then AND I wasn't supplementing because it was before I was medicated with levo.

My thyroid results were the worst they've been at the end of June so perhaps it was more like 6 weeks.

Heaven only knows what caused it then! I shall remember it fondly and hope to get back there soon... 🤞🏼

That must be rotten for you, not feeling safe if you move too fast! What about on a treadmill? Does that make a difference if you can hold on to the side bars?

[greygoose in reply to Hidden]

lol You are funny! A treadmill? I would never dare get on one of those. I'd probably slide off the end and break my neck!

Perhaps it wasn't a hyper swing then.

Don't understand why you're saying that. Why wouldn't it have been?

[Hidden in reply to greygoose]

I don't like them either. There's a weird moment when you get off the treadmill where you adjust to the floor not moving... It's a bit like finding your sea legs. 😂

Sorry - I think because you said it 'wasn't impossible' I assumed it was unlikely. I don't recall any let up in any other symptoms. Do hashi swings happen once medicated? I'm assuming not?

[greygoose in reply to Hidden]

Hashi's swings can happen any time. I had them throughout my life and I wasn't medicated until I was 55.

I said it wasn't impossible because I just don't know. I don't think anyone dose.

I will not be trying a teadmill any time soon - probably never! lol

[Hidden in reply to greygoose]

Oh I see! Apologies, I must be less literal! 😂 Very much appreciate your time. Thank you. 🙂

[greygoose in reply to Hidden]

You're welcome.

[Pinkpetite in reply to greygoose]

I didn't know that!

I can see then why it's best to get a few blood tests in leaving things the same so you get a better picture.

So I should probably stay gluten free for the next 7 or 8 weeks. Am getting a bit fed up of it really now!

My fluctuations, quite severe, over the years could be attributed to being on and off gluten free, eating before the blood test, having coffee too and poor ferritin and iron levels etc etc

[greygoose in reply to Pinkpetite]

I'm pretty sure that being gluten-free is not going to have any effect on your blood test results. However, eating and drinking coffee before the blood draw can affect your TSH levels.

What you want is a clear 6 to 8 weeks taking your levo on an empty stomach and leaving at least one hour before eating or drinking anything other than water, and at least two hours before taking any other medication/supplements.

Then, get your blood draw early morning - when the TSH is highest - having fasted over-night, and leaving a 24 hour gap between your last dose of levo and the blood draw.

Then, we'll have a better idea of where exactly you are.

Gluten-free is something that a lot of people find help with their symptoms - probably symptoms caused by the gluten itself. It's not going to have any effect on thyroid production, conversion, antibody levels or anything else. So, if you don't find it is making you feel better, then there's no point in continuing with it.

[Pinkpetite in reply to greygoose]

I did exactly as you said for this blood test, no food or drink, took last dose 24hrs before, early morning test 8.50am, and supplements were always 4 hrs after.

[greygoose in reply to Pinkpetite]

Good. So, looks like we're getting somewhere, now.

[Nanaedake]

If it were me, I would stay on same dose and retest in 8 weeks and then adjust slightly if still overrange. Unless in the meantime you get more anxiety or other symptoms related to overmedication in which case I would drop 12.5mcgs daily and still retest to see what's happening. In my case being overmedicated is worse than slightly under in terms of symptoms but we're all different.

[Pinkpetite in reply to Nanaedake]

Yes thanks for this. Another blood test in 8 weeks, keeping everything the same, should tell. It's hard re the anxiety symptom as I don't know whether this is just me and I can understand how you might feel a bit better slightly undermedicated - if this turns out to be my case.