What next: should I reduce Levo and increase T3? - Thyroid UK

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What next: should I reduce Levo and increase T3?

DizzyD profile image
18 Replies

Hi all, I finally managed to get a thyroid blood test via NHS endo, follow up appointment, to discuss results and any potential med changes is in March 22. Spoke with endo nurse, she claims that my results are fine. But are they?

Endo thinks the results are based on my dosage of levo being 75mcg levo. I DID NOT TELL HIM THAT I AM ALSO DOSING WITH SMALL ADDITION OF NDT along with the 75 levo.

Here are my results. I really would appreciate some feedback based on these results. With my limited knowledge, I suspect FT4 is too high and improvement could be made with FT3. What do you knowledgeable people think? Should I reduce levo dose?

I have no thyroid due to thyroidectomy and poor conversion issue with levo only.

RESULTS:

TSH 0.49...............0.27 - 4.2

FT4 19.3...............12.0 - 22

FT3 5.1................3.1 - 6.8

Fasting blood test done 8 30am. Last dose of levo 7am previous day. Last dose of NDT 7pm night before test. No supplements with biotin traces taken ten days prior to test.

sincere thanks to anyone who takes the time to read this post. Have a rewarding day.

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18 Replies
greygoose profile image
greygoose

I think, in your place, I would increase NDT by 1/4 grain, on the understanding that this will probably take my TSH below range, which might freak out any doctor that sees it! But, I wouldn't reduce my levo straight away. Increase your intake of T3 will probably lower the FT4 anyway, but wait and see what it is on the next test before lowering your dose of levo. :)

DizzyD profile image
DizzyD in reply to greygoose

Thank you Greygoose will consider your suggestion as an option. However, March this year I was on 75mcg levo along with 15mcg NDT (only taking 7.5 NDT now) and test results were FT4 top of range FT3 over range hence bit wary of going down that path again as you so kindly suggested. Having said that at end of day I may not have any other option.

greygoose profile image
greygoose in reply to DizzyD

sorry but what is '15 mcg' NDT? NDT is measured in grains, and contains both T4 and T3, so I don't know how you get to 15 mcg NDT.

But you don't tell us anything about how you feel. Did you feel well on the last dose? How do you feel now?

DizzyD profile image
DizzyD in reply to greygoose

EFRA 30mcg split into 4 = 7.5 and so on.

I feel like my get up and go has gone. No energy no motivation during the day but energy levels better during evening. Brain fog is awful, feel like my brain is all mushy....can't grasp onto my thoughts or conversations, as off their is a brick wall in my head. At times I suspect the start of dementia. I am 70. Worse of all all for first time in my life I have gained over a stone in weight despite a very healthy diet and exercise which I force myself to do. Sore gritty eyes, dry brittle hair with hair loss, nails rigid and brittle. Joint pain and muscle aches. Constipation with periods of loose bowels.

Can't recall if I felt better on the last dose but have to say considering the above I felt much more functional both mentally and physically.

greygoose profile image
greygoose in reply to DizzyD

EFRA 30mcg split into 4 = 7.5 and so on.

Ahhhhhhhh That's 30 mg - not mcg. Huge difference!

If you're splitting it into four doses, do you always manage to take it on an empty stomach and what at least and hour before food/coffee, or two hours after? Do you take it at least two hours away from other supplements/medication - four hours for some of them?

Have you ever tried taking it all in one go as it's such a small dose?

No energy no motivation during the day but energy levels better during evening.

That sounds more like an adrenal problem than a thyroid problem. Have you ever done a 24 hour cortisol saliva test? It might be a good idea.

At times I suspect the start of dementia.

Yes, that is typical of hypo, a lot of patients think that. Sadly, so do a lot of doctors! I'm certain a lot of Alzheimer's patients are misdiagnosed.

Worse of all all for first time in my life I have gained over a stone in weight despite a very healthy diet and exercise which I force myself to do.

My advice would be to stop forcing yourself! If you have to force yourself it means you're not ready to do it yet. And you will only harm yourself by forcing.

Hypo weight-gain is not about unhealthy eating or lack of exercise. It's probably water weight, anyway, and no amount of dieting and exercising will shift that. On the other hand, not getting enough calories can make you more hypo. You need calories to convert. I'm not a fan of calorie counting, but approx. how many calories do you think you get per day?

Sore gritty eyes, dry brittle hair with hair loss, nails rigid and brittle. Joint pain and muscle aches. Constipation with periods of loose bowels.

All typical hypo symptoms. But you could be low on zinc. Have you had that tested?

Can't recall if I felt better on the last dose but have to say considering the above I felt much more functional both mentally and physically.

Then maybe you should go back to that dose. It doesn't matter if your FT3 is a bit over-range. The ranges are only a rough guide, and some people just need higher levels than that. I know I do! :)

DizzyD profile image
DizzyD in reply to greygoose

Whow greygoose your reply has blown me away and given me room for thought perhaps breaking through a crack in the wall within my brain. Sincere, heart felt thank to you.

Whoops, I have been taking NDT an hour after food and eating two hours after. Wrong way round!!

Magnesium taken well away (4 hours) from any thyroid meds.

Think I confused you re: dosage of NDT. I am only taking 1/4 of 30mg of efra in the evening (8pm). Will increase dose to 1/2 of 30mg this evening.

Yes I have had a saliva cortisol test (regenerus) which revealed high cortisol evening lower levels during the day. Plan to get another saliva test in six weeks time, in addition to thyroid test after increase of NDT.

It,s so reassuring to hear that lots of folk on this site think they have onset of dementia re: brain dysfunction due to hypothyroidism. Once again thank you so much.

I totally accept you advice regarding forcing myself to exercise. Won't do that again. Considering lowish cortisol during day I know I was doing the wrong thing but I was disgusted with my weight gain. As for consumption of calories daily, I have no idea as to the amount I get daily. Another blunder on my part, yesterday I ate nothing, a sort of fasting, never knowing that lack of calories can make hypo symptoms worse. Thank you for informing me that calories are a must to keep hypo symptoms at bay.

Not sure if my weight gain is due to water retention because I drink a lot of water and I do pee a lot even during the night. But still, it's kind of refreshing to be told that I have hypo weight gain. Phew what a relief!

When I increase NDT (given time) is it possible that I may drop a few pounds?

Stopped taking zinc supplement a while back but I will use them again to remedy gritty eyes. Where would I get my zinc levels tested?

Greygoose, the dose you suggested I go back too is 75 levo and 1\2 30mg NDT (same dose as I plan to take this evening) Only trouble is when I was on this dose ,March this year, FT4 went out of range and FT3 was at top of range. It's FT4 going over range again that concerns me not too of range FT3. What are the chances of history repeating itself?

The difference this time is that I will take the 1\2 of 30mg NDT in one go rather than split dose.

Thanks a million greygoose. Sorry for causing any confusion.

greygoose profile image
greygoose in reply to DizzyD

Think I confused you re: dosage of NDT. I am only taking 1/4 of 30mg of efra in the evening (8pm). Will increase dose to 1/2 of 30mg this evening.

Yes, I did get a bit confused there. lol Got it now!

Yes I have had a saliva cortisol test (regenerus) which revealed high cortisol evening lower levels during the day.

That's what I thought. But, the cortisol is probably only high in the evening because it is low during the day.

Cortisol should be highest in the morning, to get you up, out of bed and started on your day. If your adrenals are struggling, they won't be able to make their morning quota, but keep on trying throughout the day until they finally manage it in the evening, when you really need low cortisol to be able to sleep.

So, what you need to do is help your adrenals raise that early morning level. Adrenals need plenty of B vits and vit C, and good levels of all the rest. They also need salt, so no low-salt diets! And, they need early morning protein. So, a high protein breakfast as soon as you wake is a good idea, even if it means you have to take your levo at some other time - like the evening, when you take your NDT.

It,s so reassuring to hear that lots of folk on this site think they have onset of dementia re: brain dysfunction due to hypothyroidism.

I've thought that since I was a teenager! The brain needs lots of T3. Without it you can have a hell of a lot of 'brain' symptoms, like depression, anxiety, paranoia, claustrophobia/aggerophobia, dyslexia - and even things like poor ability to spell correctly. And many more. But, I doubt if many doctors have a clue about all that.

Not sure if my weight gain is due to water retention because I drink a lot of water and I do pee a lot even during the night.

Here's a video that will help you decide if you have fat or water! :)

Peeing a lot during the night could be an adrenal problem.

When I increase NDT (given time) is it possible that I may drop a few pounds?

Anything is possible, but no guarantees.

Where would I get my zinc levels tested?

Details of private testing:

thyroiduk.org/help-and-supp...

I'm sure you'll find something in there. I'm not an expert on private testing because I don't live in the UK.

Only trouble is when I was on this dose ,March this year, FT4 went out of range and FT3 was at top of range. It's FT4 going over range again that concerns me not too of range FT3. What are the chances of history repeating itself?

There's every chance, because NDT contains T4 as well as T3. But, if that happens, just reduce your levo slightly.

Thanks a million greygoose. Sorry for causing any confusion.

You're very welcome. :) Please don't apologise - the whole subject is confusing!

SlowDragon profile image
SlowDragonAdministrator

When were vitamin D, folate, ferritin and B12 last tested

How do you feel?

Do you always get same brand levothyroxine at each prescription

DizzyD profile image
DizzyD in reply to SlowDragon

Hi SlowDragon vit D, folate, ferritin B12 last tested March....they are all ok.I always get the same brand of levo.

I don't have much energy, lack of motivation, foggy brain very forgetfull, sore gritty dry eyes, insomnia at times. Never really feel hungry during the day but I do at night time. Hair dry and brittle falling out. The best of conditioners does not make hair any better. Worse of all I have gained stone in weight first time ever in my life. At mine months pregnant (long time ago) I weighed 9stone 3 now over past couple of months I am 9 6. Grrr. My temperature averages 35.9 (take it 3 times daily when I remember to do so)

Hope that helps. Thank you for your reply.

SlowDragon profile image
SlowDragonAdministrator in reply to DizzyD

Exactly what were vitamin results

Being within range is not optimal

DizzyD profile image
DizzyD in reply to SlowDragon

I will hunt them out and post later.

Thank you

DizzyD profile image
DizzyD in reply to SlowDragon

Hi SlowDragon here are my results for March 21 FERRITIN. 154..........13.150

FOLATE. 9.46.........3.89 - 19.45

BIT B12 ACTIVE 150.......37.5 - 187.5

VIT D 102.......50 - 175

SlowDragon profile image
SlowDragonAdministrator in reply to DizzyD

So pretty good

Presumably you supplement to maintain these levels

DizzyD profile image
DizzyD in reply to SlowDragon

Yes I supplement to maintain levels but also incorporated a more healthier nutritional diet so I assume vit levels have improved greatly.

greygoose profile image
greygoose in reply to DizzyD

You cannot assume that. One of the symptoms of hypothyroidism is low stomach acid. Given the number of symptoms you still have, your stomach acid could still be low, meaning that you do not digest your food properly, and therefore do not absorb the right amount of nutrients.

You are not what you eat, you are what you absorb. Always good to remember that. :)

DizzyD profile image
DizzyD in reply to greygoose

Greygoose, is there any way to improve stomach acid? What about cider vinegar? I do take a pro-biotic. Love it: YOU ARE WHAT YOU ABSORB.

greygoose profile image
greygoose in reply to DizzyD

ACV is good for a lot of people, yes. Can't really comment because it's never been my problem, funnily enough.

Have a read of this article, they discuss raising stomach acid at the end:

healthygut.com/3-tests-for-...

DippyDame profile image
DippyDame

Bottom line....how do you feel on this dose?If well I wouldn't change dose.

If not, as I suspect from your comments, then I'd follow Greygoose's advice and increase.

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