Need advice- asap please

[Murphysmum]

I posted a couple of days ago regarding my bloods being quite over range. I’m T3 only, was on 60mcg/day split twice.

I’ve recently begun the mini pill and was amazed that within 4 days my bloods had gone from being too but within range to way over.

Since then (Monday) I have dropped my T3 to 55mcg per day but tonight I’m having really dizzy spells and feeling quite over medicated. I hadn’t at all until today.

Should I drop my dose again? Should I skip a dose to drop it down? I’m really unsure how much to drop and how fast. I’m quite worried how high it might be and how long it’ll take me to get it down. Obvs I could do bloods again but not realistically until Monday and then it’s days before you get results back.

Sigh. I hate this disease when it goes wrong!

SlowDragon radd greygoose DippyDame - Can any of you help?

[greygoose]

You have Hashi's, don't you? So, it could be a Hashi's 'hyper' swing. How long have you been on 60 mcg?

[Murphysmum in reply to greygoose]

Yes I do. Though I suspect not. I reckon my thyroid has been pretty gone for a long while.

I asked to be put on the progesterone only pill to even out monthly “dips” I was having where my hormone just didn’t seem to be working.

I didn’t expect it to shoot up so quickly though! So I’m almost certain that’s what’s happened. I just don’t know what to do now, it seems to be working a little too well.

[greygoose in reply to Murphysmum]

All you can do is reduce the T3 a little more, and see what happens.

[Murphysmum in reply to greygoose]

Would you have any advice as to how much is sensible?

Normally I’d have changed in 5mcg increments (though more recently it’s been 2.5) but I’m not sure if that’s enough given how high over range I am?

[greygoose in reply to Murphysmum]

I would go with 5 mcg myself. But you might be more sensitive to changes than I am.

[Murphysmum in reply to greygoose]

Thanks GG. I’ll just stick with that.

I had reduced by 5 already, so tomo I’ll reduce by another 5 and see what happens. At least I know I won’t feel truly terrible on 50mcg, just maybe not optimal.

[greygoose in reply to Murphysmum]

Well, you haven't been feeling too good on 60 mcg, judging by what you've just said. So, the reduction might actually make you feel better.

[shaws]

I'm sorry you are having problems. What I will mention is that 25mcg of T3 is approx equal to 100mcg of T4 in its 'action'. So your dose might be a bit high.

I am fit and well taking between 20 or 25mcg once daily with a glass of water and wait an hour before I eat. Everyone, of course, is different and may have different doses that restores their health.

[Murphysmum in reply to shaws]

Agreed. So I’ve slowly worked up to where I am now over 3 years.

I was a bit rushed earlier and failed to mention that I’ve actually dropped my dose a couple of months ago to 57.5mcg, but yes, this is still a lot. However prior to T3 I couldn’t feel well on a dose of 200mcg levo.

I had been very well for over 18 months now on around 55-60mcg but as I mentioned above, due to cyclical dips in how I was feeling, I’ve experimented a little within that range. My previous bloods will be on my profile and you can see the zigzag up and down where I’ve been trying different doses!

However, my latest bloods (that I did actually as a “let’s see where I am so I can compare in a month or so) after starting the pill are way over range. I was surprised to see this as I genuinely thought a hormone replacement would take at least a few weeks to have any effect.

I guess my question is what do I do to reduce my dose quickly? I’m actually wondering if I should stop my T3 altogether for a few days and restart at a lower dose, but this slightly terrifies me!

Hence any advice being very welcome as at this moment I feel quite unwell.

[Hidden in reply to shaws]

That would be incorrect. Please check this article. It's from Canada, but it is applicable to all of us anywhere in the world. There is also a facebook group you can join as well and they do have sound information that has helped many people. thyroidpatients.ca/2019/09/...

[Murphysmum in reply to Hidden]

Sorry - what’s incorrect?

[shaws]

Just a reminder that 25mcg T3 *in its effect' is equivalent to 100mcg levothyroxine. So it could a bit too much when taking 60mcg.

[jimh111]

This is outside my knowledge but oestrogen increases binding proteins leading to a lower hormone free fraction. If you’ve switched to a pill with less oestrogen it might lead to increased free T3 and so you would need a lower dose. If you are having symptoms off too much hormone I would make a substantial reduction in your dose and work back up to what you need. It’s better to be safe than sorry. I’ll sing off now because I don’t know any more.

[DippyDame]

According to DrugBank...

Re mini pill

The excretion of Liothyronine can be decreased when combined with Progesterone.FT3 now well over range and that should be avoided ...as you know

You are now overmedicated with T3 and need a reduction...as you know

On medic advice I dropped by a huge single dose at one point (212mcg to 50mcg) with no adverse effects...then increased again, slowly.

To explain and hopefully reassure you... I need high dose T3...now 100mcg...I have a form of thyroid hormone resistance

In your shoes I would drop to 50mcg, ( no less) wait for 5 to 7 days and see how you feel

If symptoms of over medication return you can try adding 5mcg T3, otherwise hold the dose meantime until next test.

Listen to your body...

[Hidden]

I'm sorry you're going through this. I'm including a link to many great resources for you and this site has a facebook group, public and private. The people who run this group are well versed in thyroid and aren't doctors (as far as I know) but they have helped many thyroid patients and you don't have to be from Canada to be in their public group and not for their private group I believe. I do hope you get relief soon. thyroidpatients.ca/home/sit...

[Murphysmum in reply to Hidden]

Thanks. I’ll have a look although I’ve managed to return to near consistent full health through the help on this forum alone.

The advice on here is invaluable, and I wouldn’t be here without it 😊

[radd]

Murphysmum,

I agree with Jimh11,

Oestrogen increases TBG but progesterone usually the antagonist will decrease TBG if dominant. Also (according to HypothyroidMom I think 🤔) progesterone promotes better assimilation of thyroid hormone into the cells, so allowing better use of less thyroid hormone.

You need to reduce your dose.

[Murphysmum in reply to radd]

Thanks radd .

Yes, I knew this and this was the intention of using the progesterone only pill, in order to even out cyclical dips that I was having each month.

For clarity for DippyDame , shaws and jimh111 , maybe I wasn’t clear in my above posts - I have been struggling to get consistency in how I feel, mainly because of dropping perimenopausal pg levels, so this was the desired effect but I didn’t expect it to be so pronounced or so quick!

With hindsight, I’d have reduced my dose on starting the hormone replacement, so 10 days ago, had I realised my levels were going to take off quite as much!

Thank you, I have reduced my dose and I’m feeling better, though I suspect another drop may be necessary.

Thanks for your advice 😊

[radd in reply to Murphysmum]

Murphysmum,

Horrid for you feeling over-medicated but at least T3 clears quite quickly, and great you have found your way of making thyroid hormones work better for you 😊

[Murphysmum in reply to radd]

Its been a long time coming.

I originally noticed a cyclical pattern to how I was feeling about 18 months ago. I had tried progesterone cream and while that helped, I found it a bit inconsistent and tricky to use.

So I eventually plucked up the courage to speak to the gp as I had vowed I wasn’t going near them ever again if it relates to thyroid matters!

It had had the desired effect obviously, but wow I don’t expect it to be so much more effective then the transdermal option.

I actually haven’t taken my T3 this morning - I’m not sure what’s the best plan of action as I’m still feeling very over medicated. I feel drunk!

So I thought maybe I’d miss today entirely, then restart tomo at 5mcg less. Given I was very over range a few days ago but felt fine, and now I feel bad, I’m guessing maybe I’m even more over than the bloods showed last week 🤷🏼‍♀️? So I’m keen to clear it as quickly as possible.

[FancyPants54 in reply to Murphysmum]

Are you using Utrogestan progesterone? It's good stuff. And quite strong. Absorption of transdermal progesterone is very poor, hence there isn't an option for HRT that is available through NHS for it. Utrogestan might in itself give you some teething troubles to start with. Feeling dopy or foggy, tired, bloated etc and low mood, but it will settle so I would advise not to do too much at once. You have your own progesterone in the background albeit not a reliable source anymore. But it will be high sometimes and low at others so this might be an anomaly, or it might not. Good advice here to reduce a bit and then wait a while and retest.

[FancyPants54 in reply to FancyPants54]

Oh, silly me, you are using the mini pill not Utrogestan.

[DippyDame in reply to Murphysmum]

Hope you feel better soon!It can be a roller coaster ride but a reduction should help.

[thyr01d]

I do hope you are evening out again now. May I ask, what did you say to your GP to be given the mini pill? Mine steadfastly refuses insisting that it's oestrogen I need, but, as always on oestrogen, I feel no better but gain weight. Your post has helped me because I now realise that the oestrogel I am prescribed could explain why I feel more hypo now, though bloods don't reflect this. Thank-you.

[FancyPants54 in reply to thyr01d]

Oestrogen for me has always required a small dose increase of Levo. I hope your GP suggests you need progesterone as well as oestrogen. If they just want you to have oestrogen and you still have a womb then they don't know what they are talking about. And taking both should stop the weight gain (which is usually fluid).

[thyr01d in reply to FancyPants54]

Thank-you FancyPants, that's very interesting to know that with oestrogen you need an increase of thyroid meds. I have a new GP so there is hope and I'll mention what you've said. :).

[FancyPants54 in reply to thyr01d]

I don't think this happens to everyone. Most people need a dose increase if they take tablet oestrogen. But the experts say transdermal doesn't need it. But for me, I always have needed a bit more if I increase my transdermal HRT.

[Murphysmum in reply to thyr01d]

Hmm, tricky!

I think because I’d already “had a go” with progesterone myself, it made it much easier to tell the gp that this helped and this was therefore what I wanted to try.

It was also a female gp so maybe that helped.

I’ve had an issue with oestrogen dominance for a while now, hence why I had tried the cream myself already. I can recommend Biovea bioidentical pg cream - it definitely helped though as someone has said above, it’s not as effective as tablet form. Maybe you could try this depending on your hormone levels and then talk to your gp?

The whole point of trying the mini pill was to flatten the oestrogen influence and even out the dips in my natural pg…. Which clearly it’s doing to very good effect! 🙈

[thyr01d in reply to Murphysmum]

Thanks Murphysmum that is very helpful. My GP is female and I had already been using progesterone cream and reacted badly in the past with oestrogen, but her viewpoint is absolutely fixed. I have a new GP, also female, so I'm going to try this one, meanwhile I'll look for the cream you recommend, thank-you.