I had RAI treatment for hyperthyroidism ( graves) in April of this year. Then after 2 months I was diagnosed with hypothyroidism with a tsh of 60. I was put on 50mg of Levo for 2 weeks, then I ended up In ambulatory care because I felt so anxious, with bad headache, thirsty, and cold sweats. They moved me to 100mg for 4 weeks, and 150mg onwards. My doctors had no idea what they were doing because I ended up being over treated, and ended up with a tsh of 0.20 and T4 of 35.6. They didn’t even test my levels and just put me on setrenaline for the anxiety and panic. My doctors didn’t take any of my symptoms seriously ( really bad brain fog, no concentration, ocd symptoms, really bad anxiety, depressive symptoms, hair loss and acne plus a lot more!). I went privately to see an endocrinologist and he suggested we stop Levo for 2 weeks as I was being over medicated. My results as of this week are:
TSH: 35.03 (range 0.27- 4.2)
FT4: 7.8 (range 11-26)
FT3: 2.5 (range 3.9/6.8)
It’s now been a week on 50mg of Levo and 3 days on 20mg a day of t3. I take 10 mg in the morning and 10mg in the afternoon. I’ve had all of these symptoms for nearly 3 months and nothing is working. I’m constantly so tired, feel almost tipsy/ drugged from the brain fog ( a sense of unreality) depressed, and just feel so hopeless and scared. I’ve been on the t3 for 3 days and I’ve been more tired and foggy I think. I was really hoping that it could help my brain fog and this sense of unreality because I cannot function properly. I’m scared I will lose my job, I’ve been off for 2 months! I’m looking for advise from you. I don’t know what to do!
Also I tried teva and accord Levo and I’ve stuck to the accord.
So just to recap, since April, my tsh has gone from 60 to 0.20 to 35.06.
I have a b12 deficiency but I’ve had 6 injections last month.
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Angie10116
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T3 is not an instant fix. It can take months to feel any benefit. And, 20 mcg is far too high a dose to start on. You should have been started on 5 mcg, and increased by 5 mcg every two weeks until you reached 20 - if indeed you need 20, you may not. But starting on too high a dose can cause all sorts of problems, and that could be what's wrong with you now.
After having RAI you should have had very regular testing as hypothyroidism is expected. You should been given medicated long before you reach a TSH of 60.
Is your B12 back in range? Also important to test Vitamin D, folate and ferritin. Low ferritin can cause hair loss.
“tsh of 0.20 and T4 of 35.6.” Levo should not have been stopped completely. Perhaps reduced slightly. The low TSH is unreliable and your FT3 wasn’t tested but it may have been low. Were you hyper for a long time before diagnosed? As being hyper can make the TSH especially unreliable. Were you on anti thyroid medication before treatment?
Usually levo doses are increases by 25mcg and retested after 6 weeks. If increases are tolerated at a faster rate than that can be appropriate but Im not sure the sudden increasing & ceasing and starting high dose of T3 will be helping you. Are you dealing with GP or specialist?
Taking T3 will show a low TSH so if your doctors is judging your doses by TSH then reaching the correct dose is going to be difficult.
Do you take your doses away from food, drinks and other medication & supplements?
When you test, do you test early in morning after fasting except water? This give highest TSH & lowest FT4. Doctor often think this is not relevant and don’t advise about this. Supplements containing high levels of Biotin (B7) can skew test results. Check labels & avoid 1 week before draw
Teva contains mannitol which many react adversely to, sticking to a preferred brand is good idea.
I’ve no idea about b12, I have a blood test in 4 weeks to see how the injections helped. My vitamin D and ferritin levels were all good.
Yeah I agree. Looking back it shouldn’t have been stopped. I was experiencing a lot of hyper symptoms though so my endo decided to stop for a week. Ive been hyper since around 12 years of age. I’m now 19.
I’ve messaged my endo today and said that I’ve not felt any better on the t3 and that I was at my best when I was on 100mg of levothyroxine. He said to stop t3 and start up my dose from 50mg to 100mg starting tomorrow.
I take my dose every morning, before food or drink. I only take it with water and don’t eat for at least an hour after.
Yes I test early in the morning. Thank you for your reply. Do you think it’s a good idea to stop t3 and up my dose to 100mg? My doctors were stupid and only had me on 100mg for 4 weeks and then upped my dose to 150mg, which was significantly too high for me. I felt my best at 100mg to be honest. But again, I was only on it for 4 weeks
Generally it’s best to alter 1 dose at a time but you seem to already had so much chop and change its making it more difficult at this stage. Sorry you have had this, Hyper from 12 years old must must have been very hard for you.
Do you think the high dose of T3 has resulted in symptoms or the low T4? I think a low dose of 5mcg would be better and you can see if you can tolerate it better be in a position to increase in the future.
50mcg levo, doubling to 100mcg tomorrow, although you felt better on it before the quick & larger alterations causes shifting levels which can cause symptoms you wouldn’t notice if applied more gradually. I think try 75 mcg at first especially if you keep taking T3. I take low dose of carbimazole so I have never had to juggle levo & lio. Others with more experience & knowledge may offer a different opinion.
Yeah it’s been a pain! I’ve been so anxious since a child because of it. But I’ve never felt as bad as I do now! It’s so horrible. I think that the lio isn’t really helping at all. I’ve not felt any positive changes yet, and even though I know it’s only been a few days, I felt better on 100mg of Levo alone. So I think what I’ll do it just leave t3 for now and stick to Levo. It’s so difficult! I hate this so much! I could deal with the physical symptoms, but I can’t work or drive because of this brain fog! I just feel like tipsy almost all the time and it’s making me feel depressed.
I think I shouldn’t have stopped Levo as it made me hypo again, even though it was only stopped for a week.
would it be worth trying another brand of Levothyroxine - other members of the forum, myself included, experienced a range of worsening symptoms following the rebranding of Activis to Accord - symptoms ranged from racing heart, palpitations, worse brain fog, excessive hair shedding, hives, tingling, headaches, fatigue, anxiety. On stopping Accord Levothyroxine, these symptoms subsided. I have since filled in a Yellow Card Report. Oral solution Levothyroxine has fewer excipients than tablets, which my GP now prescribes. Hope you feel better soon.
I just wanted to say to hang in there as it will get better.
Being persistent in getting the right (probably functional) doctor that will help you look at the whole picture, getting the right dosage of meds, having a positive mindset, making good lifestyle choices and eating nutritious food seems to be what the best specialists advise.
I’ve found these three books really helpful;
Be your own thyroid advocate
It’s not my head, it’s my hormones
Hashimotos protocol
Your hair will grow back, your mind and mojo will come back and you will feel yourself again.
Thank you so much, bless you! I really needed that to be honest. The worst symptom is the brain fog.. I feel so disconnected from the world and I don’t worry about things that normal healthy people worry about. I’m just numb and bleh.
Since July, my tsh has gone from 60 to 15 to 1.5 to 0.20 and back to 35.06. All due to doctors medicating me too fast and also over medicating me.
Could you share your story with me briefly? What symptoms did you go through and are you doing better? I just need a positive story to keep me going ❤️ Thank you so much again x
Hey A!I’m sorry I didn’t see your post until now. I had long covid from Feb this year, and after tests I found out I was anaemic (iron level 10), sub clinic hypothyroidism, adrenal fatigue and high blood pressure.
I’ve been okay and getting by, but the hair loss picture you shared reminded me of a similar picture I took, which was the tipping point when I knew something really wasn’t right.
Hair loss, heart palpitations, high blood pressure, really dry skin, low mood, back pain, loss of mojo etc meant docs screened for everything. Thankfully all other tests came back clear.
But GP wouldn’t treat thyroid.
So, I went private for iron infusion treatment and a functional doctor to get the right meds straight away.
The thyroid and adrenal meds are starting to work and I’m gradually feeling better. But I know I need to be patient too.
I’m normally an avid reader and I only started reading again in the last month or so, reading about four books in September. It was about two years since I’d last read a book!
Consultant thinks I’ve probably been anaemic for six years (as I had a miscarriage and needed a blood transfusion back in 2015).
I had a lot of stress at work and never connected the dots that my health was slowly deteriorating!
So, as well as meds, I’ve made some changes to my diet and lifestyle, and I also write in my journal daily to help me process what’s going on and work on keeping a positive mindset.
A fully functioning working thyroid would be supporting you daily with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.
As I understand it, RAI is a slow burn, and it can take time before your thyroid is fully disabled, dormant and dead.
RAI induced primary hypothyroidism is more difficult to treat.
RAI induced primary hypothyroidism can trash your vitamins and minerals.
I mention just the above two facts, as the list of potential symptoms following RAI is long and depressing, especially when you have taken this treatment route, and in fact, do not apply to everybody as much as these top two.
It is essential that you dosed and monitored on your T3 and T4 blood test results and not a TSH - though in primary care this may well be all that is offered.
Your feedback loop, the Hypothalamus/Pituitary/ Thyroid - HPT axis broken, as your thyroid is now longer there in the true sense of the word.
No thyroid hormone replacement works effectively until your vitamins and minerals, especially ferritin, folate, B12 and vitamin D are at, and maintained at optimal levels, so this is another area that needs to be regularly monitored.
T4 is a pro-hormone and needs to be converted by your body into the active hormone T3 - which is said to be about 4 times more powerful than T4 - with the average person needing to be able to convert and utilise around 50 T3 daily, just to function.
Some people can get by on T4 only, some people find that T4 seems to stop working at some point in time and need the addition of a little T3 with their T4 making a T3/T4 synthetic combo, some people can't tolerate T4 and need to take T3 only and some people find they feel better on Natural Desiccated Thyroid.
NDT is made from pig thyroid dried and ground down into tablets referred to as grains and contains all the same known hormones as that of the human gland namely trace elements of T1. T2 and calcitonin, plus a measure of T3 and T4 in each grain. NDT was successfully used to treat hypothyroidism for over 100 years and you simply dosed to the relief of symptoms, prior to Big Pharma launching synthetic thyroid hormones and introducing blood tests, ranges and guidelines in the middle of the last century that current doctors seem wedded to.
I have Graves, and had RAI back in 2005, and was immediately put on 100 mcg T4.
I was relatively well for around 8 years and then it was as though the insidious symptoms of hypothyroidism started rubbing me out with a severe cognitive decline and my whole body seeming to dry out - details on my profile page.
Over 2 years of various O/P appointments, instigated initially by my dentist, I was no further forward and referred to as a conundrum by my doctor, and offered anti depressants.
I was refused both T3 and NDT by my doctor and hospital and now I self medicate and buy my own full spectrum thyroid hormone replacement.
Both a synthetic T3/T4 combo and Natural Desiccated Thyroid worked for me, it was like a light bulb coming on in my brain, and I found NDT softer on my body and am now 3+ years into this thyroid hormone, much improved and have my life back.
It's not a question of being better - I now manage lingering Graves, thyroid eye disease caused by the RAI and hypothyroidism and am as good as I can be at this point in time.
I too was told nothing back in 2005 and only learnt what I now know some 6-7 years ago ;
I'm a bit like a Humpty Dumpty and have put myself back together again.
Graves is an auto immune disease and as such it is for life though without a thyroid the symptoms you may now experience are not considered life threatening, and you will manage and get through this.
We can live without a thyroid but just need to think a bit more about what we do.
You might like to read around Graves Disease and I found the Elaine Moore Graves Disease Foundation website very interesting regarding why and who may be affected with a diagnosis of Graves so to get a better understanding of your situation and what may trigger your immune system response as Graves does tend to be a stress and anxiety driven AI disease.
Elaine also had RAI and finding no help with her continued symptoms decided to research this poorly understood and badly treated AI disease herself around 20 odd years ago.
I purchased Elaine's first book in 2015 thinking maybe that Graves has come back and what was making me ill - only to read - Graves is an AI disease and the thyroid the victim in all this, and not the cause - as the cause is your immune system attacking your thyroid.
Another book that helped me is written by doctor who has hypothyroidism and is a relatively easy read by Barry Durrant - Peatfield and entitled Your Thyroid and How To Keep It Healthy.
Thyroid UK who are the charity who support this forum have a Library section within their website where, I think, I saw the above 2 books listed and where you can start reading up on all things " thyroid " so to equip yourself better and be able to become your own best advocate.
Thank you. I’ve had graves since 11 years of age, and it’s never made me feel this poorly.
I appreciate the book recommendations but to be completely honest, I can’t read for pleasure. I feel like a zombie and can barely do the bare minimum right now. I think it’s because my doctors have medicated me so inappropriately!
Well, I'm dyslexic and when poorly medicated this became a bigger challenge for me - but you will get there, just read up bits and pieces, and like a jigsaw, bits start joining up and corner pieces and building blocks established and relied upon.
We are here to help and support you, so lean of the forum members as there are people here who have been where you are, as we all wear the same T shirt in trying to improve thyroid health and understanding for everybody.
I’m sorry that it made it worse for you. I had no idea that it plays a part with dyslexia! I’m so thankful for you, I appreciate your help so much and thank you. Please stay safe and the best of luck to you.
The brain needs an awful lot of T3 to function properly - no worries :
And the thyroid controls all your bodily parts including your mental, physical, psychological, emotional and spiritual wellbeing, your inner central heating system and your metabolism so, loosing my thyroid simply compounded many issues and it all takes time to settle and rebalance, with the help of optimal thyroid hormone replacement.
Yes brain fog is a very common problem experienced by most hypothyroid patients when not optimally medicated.
Mental issues are well documented as well - it all comes down to being on the correct dose of thyroid hormone replacement and getting your T3 where it needs to be for you to be a well as you can be with as few a symptoms as possible.
If you go back into Thyroid UK website there is a list of symptoms of both hypothyroidism and hyperthyroidism - sadly, some symptoms cross over but it gives you an idea of just how many symptoms can be attributed to hypothyroidism and I'm sure there are some not even on the list.
Just take one step at a time, you'll get there.
You're already asking questions and building your confidence - this is a safe place - just ask and forum members will pick you up and support you as most of us have been there already and got through it and then we come back on here to help others in a similar situation.
You’re so knowledgeable and empathetic, thank you SO much for the kind words. I will stick to 75mg and just give my body a break from the crazy changes in tsh and T4.
I will go on there now and remind myself of everything. Some symptoms are so scary, it’s crazy to think that they are associated with the thyroid.
This forum is amazing, the amount of support and info I’ve gathered over the last few months have been incredibly helpful. Once again, thank you so much pennyannie, you’re a wonderful person. Thank you
I’m taking 1000 I.U (25ug) Of vitamin D. Is that Enough?
I have a vitamin b complex but I didn’t think I could take it because it contains biotin. Also that only has 1.0ug of b12, whilst the one I take now has 1000ug. I think I should stick to the pure b12 1000ug?
Also today I started folic acid 5mg. Should I substitute that with folate?
When finish prescription folic acid, look at taking vitamin B complex to maintain vitamin levels
supplementing a good quality daily vitamin B complex, one with folate in may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels too
B vitamins best taken after breakfast
Thorne Basic B is a recommended option that contains folate, but is large capsule. You can tip powder out if can’t swallow capsule
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
Yes the folic acid was prescribed ages ago but I didn’t understand the importance of taking it so I didn’t. Silly me! I haven’t actually done a full iron panel. I will have to chase that up with the doctors!
Thank you for all of that information. Do you know if the b12 sublingual lozenges are better than a b12 capsule or tablet? I will add the b complex to the b12 one as recommended, thank you so so much. You’re extremely helpful.
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normal TSH and T3 but Low T4
Can I have some help with results please?
Struggling with symptoms I presume are from Levothyroxine 
I really need some help and advice please. 
