I have hypothyroidism from Hashimoto’s and Sjögren’s syndrome. I have have been on 3 grains on NDT for a few years now but recently have gotten my hypo symptoms back and hen I had my levels check my T4 was rock bottom. Endo has now put me on 50Mcg Levothyroxine. Does anyone know why my T4 might have plummeted? Is it lifestyle related; I don’t get enough sleep, drink alcohol, do weights and some cardio at the gym and have recently lost 3 stone? Or is it’s to do with reverse T3 or maybe some bad batches of ERFA? Would be great to know the cause so I can fix it and know if this is the right course of action! Many thanks in advance.
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Bushbaby83
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Are you saying that your endo has added 50 mcg levo to your 3 grains of NDT? Or that he has taken you off NDT and put you on 50 mcg levo?
Bit difficult to make any suggestions without seeing the actual numbers: results and ranges. What is your FT3 like? T3 is the active, and most important hormone, the one that causes symptoms when it's too high or too low.
Very doubtful that your reduced T4 has anything to do with rT3, that's not the way it works. But could possibly be that you're over-exercising. Although FT4 is bound to be low on three grains of NDT, but are you saying that it has dropped since the last time it was checked when on the same dose of NDT? As I said, we need the numbers to understand.
So I have been supplemented with Levothyroxine and am still on 3 grains of NDT. My T4 has dropped since last time and my T3 is fine. I don’t have the exact numbers but this what my endocrinologist has told me that my T4 is rock bottom and my T3 is optimal.
Completely normal that T4 drops on NDT. If you’ve been pushing it at the gym then you’ll use more T3. I know when I’m on not quite enough as a regular weight lifter I will start to get disturbed sleep and sore joints. If you’ve added 50 Levo it may just be that little tweak that’s needed. See how you go
Hi I do weights with little break in between and things like chin ups and walking lunges which in effect is cardio. Separately I’ll do either hill sprints or 30-60 minutes interval hill walking once a week
I would ask for the exact numbers and ranges or you dont know what you’re dealing with. Free T3 will be the most important to indicate correct optimisation
The range is usually 6.8 at the top end so that’s not too bad. Check the range though because they can vary. It’s best not to be above the range. It could be that the remaining thyroid is still doing something but erratically. I used to take 1.25 grains felt well for years then suddenly felt hypo again I had to jiggle the dose for ages before I felt ok again at 1.75 grains. No idea why that happened as my thyroid had long shrivelled to a useless crisp.
Have FT4 levels suddenly plummeted? Were they actually higher in-range previously?
Hashi can be quite intolerant and it's easy to become complacent and blame the meds when the underlying reasons could be life style choices, such as not enough sleep, maybe inadequate carbs/protein for amount of exercise? Is iron, Vit B12, folate and Vit D optimal? Are you gluten free?
Yes, agree if you previously had higher levels of T4 on 3 grains NDT, then RT3 could be the reason for its reduction if conditions for meds to work effectively weren't being met over a steady duration. In which case adding more meds isn't going to fix it.
An example might be low iron coupled with elevated inflammation from thyroid antibodies and strenuous exercise could be enough to put a spanner in the works. First steps would be to provide recent test recents for thyroid, iron and nutrients including the ranges (numbers in brackets) for members to comment.
Thanks for the info. Unfortunately I don’t have test results as they went straight to the endo but I was told that my iron, vit D, B12 and female hormones were just fine. Was a recent drop in T4 but I don’t think it was super high before. Lifestylewise, my workouts had gotten slightly longer in duration. However, never hugely strenuous and I get between 100-150g protein per day all tracked and between 1600-1800 cals whilst trying to lose weight. I must admit I have been eating gluten and dairy for the past year so am cutting them out going forwards.
Yes, something like gluten inflammation can create issues for our meds, and T4 is known to be lower when we medicate T3 anyway.
Maybe you lost your weight too quickly, 3 stones is a lot to lose but hopefully you can rein your fitness back again. I personally wouldn’t be adding the extra meds until I had addressed all possible issues that could have impaired NDT from working so effectively, such as being strictly gluten free, better sleep, etc because if extra meds aren't actually needed you risk further RT3 and a longer return journey.
You can ask for your results as are legally allowed them. Members like to keep a record to keep an eye of what our doctors/endos are doing for us.
Thanks for the info. I lost the weight between October 2020 and December 2021 so 14 months. I do normally ask for a print out of my results when they go to my gp but they went to my endo and I’ve not had time to get them. My endocrinologist is quite far from where I live, I work full time and my appointment was only last week.
Hey Bushbaby83 how are you getting on now? I wanted to let you know that I'm also on Efra and since starting my new batch at the beginning of the year the hypo symptoms I always have and never go away like fatigue worsened and the ones that had previously gone like air hunger, feeling cold all the time, depression, body aches and brain fog have all come back. My dose hasn't changed and when I compare my test results in Feb 2022 to Aug 2021 my FT4 has dropped by about 5 and is now under range, my tsh was suppressed and is now in range again and my T3 is in range but has dropped by 2 and is on the lower side - not good at all! I feel completely debilitated again. I knew something was up as soon as I started this batch, I get really itchy skin when my levels are off and I have an area on my wrist that itches like crazy when this happens too and it started not long after being on this batch. Not sure what to do but when I tried upping my dose I felt worse somehow!
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