In Sept 21 I reduced my T3 from 17mcg a day to 15mcg a day (100mcg x T4 stayed same) and these are my latest test results - see attachment.
At 7am I took my daily 100mcg x T4 together with 10mcg x T3. At 3.30pm - my blood test was done.
I was thinking my T4 looks low - which seems curious. Any thoughts ? Especially as my T3 seems a little high, and at this point in the day I’d be taking another 5mcg. My main reason for checking it out is that I feel constantly tired and unmotivated. And I’m wondering if it’s because of my thyroid levels or because of the menopause.
As docs can be lacking the depth of knowledge in both areas I don’t really know where to go next with this, and I always appreciate your thoughts.
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hobbycat
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When having a blood test for our thyroid hormones, it is usual to get the earliest possible appointment for blood draw and do not take thyroid hormones until after the blood draw and it is also a fasting test (we can drink water).
TSH is highest early a.m. and drops throughout the day,
The aim is a TSH of 1 or lower and Free T4 and Free T3 towards the upper part of the ranges.
Hi Shaws, thank you for your reply. My work pattern made 3.30pm more doable and doesn’t it make it more curious that my T4 is low as I’d taken my levo only 8.5 hrs before ?
Hi SlowDragon, thank you. Yes, I hadn’t contemplated my T4 being under if I’ve left more than 8.5hrs. Interesting. I was thinking that if my active T3 was high that my T4 level might be inconsequential. And I’m not sure why it’s important actually, if my T3 is at a good level. Certainly I’ve reduced my medication overall with a reduction of 2.5mcg of T3. To increase by a small amount of T4 means adding another brand into the mix I guess. I remember a while ago fighting hard for a 12.5mcg tablet. Anyway, I think I’ll push for it.
Re vitamins - I’ve had a few months off supplementing and just getting back on them now. Sometimes it feels like more tablets than food 🤪.
I agree I don’t understand if your t4 is relevant if your T3 is sufficiently high for you. So you reduced your T3 a little and feel tired … I’d be thinking there was a connection there. What prompted you to reduce your T3?
hobbycat , just so you know .....You don't need to get 12.5mcg tablets to increase Levo dose by a little.
1) If you only have 100mcg tablets you could eg;
add one extra 100mcg tablet a week . giving a weekly total of 800mcg which equates to about 114mcg/ day )
cut it in half or quarters and spread the extra evenly over the week . ( mon & thurs take 150mcg . rest of days take 100mcg) or (mon 100, tues 125. wed 100, thurs 125 , fri 100, sat 125 . sun 125)
Or ....for an even smaller increase, add just half a 100mcg (50mcg) tablet each week , equating to about 107mcg /day.
12.5mcg tablets are ludicrously expensive, so there will be a lot of resistance to prescribing them (about £13 a packet , as opposed to about £1 a packet for the other sizes) and they only come in one brand (teva) i think.
2) If you can get 25mcg tablets prescribed in the brand you usually take then that is useful, as you can just take a 25mcg tablet every other day ... or split the tablet in half each day so daily dose is same each day , equating to 112.5mcg/day
There is a section of my Vade Mecum which illustrates fine dose adjustments as you have described. It includes a spreadsheet that can be downloaded to work out the possible doses over a week.
helvella - Vade Mecum for Thyroid
The term vade mecum means:
1. A referential book such as a handbook or manual.
2. A useful object, constantly carried on one’s person.
Please don't get put off by the number of pages!
In particular, it is not intended that you sit and read the document. Just that you download it and know you can look things up.
Not everything is in this one document - my major medicines document is still separate!
What kind of and how much oestrogen dose are you on? As menopause progresses our background oestrogen levels fall even lower and so it's common to need an increase at some point. You might be due a raise.
This web site is excellent for menopause help. If you go to the linked page and scroll down quite a long way you will find a section about the Balance App that you can download for free to your phone and help you to track your feelings and symptoms and gives you access to loads of information. It might help you to pin down a need for more HRT.
The web site is great, but recently remodelled. I wish they had used someone with better experience to do it because it's not a good web site as it is. But the info is the best so it's worth struggling on with it.
Hi FancyPants54, thanks for your response. I’m on 1g x Sandrena and certainly of late I’ve had breakthrough hot flushes early morning waking me up (yup, not helping re tiredness I guess) and always when I’m putting my makeup on about 8am (just weird!).
Now you have me contemplating a self-medicated increase.
Hi. 1mg is not a high dose. And if you are getting some flushes and sweats it's really worth trying an increase. I wouldn't go right up to 2mg in one go. Try an extra half a sachet a day to start with and if it helps hold that for a couple of months, if you feel the whole sachet might be better try that and then go ask your GP for the increase in your prescription. Hold firm. Quote NICE guidelines at them if necessary.
Hi hobbycat I’m no expert but I’ve been up and down and all over on HRT since last Oct and since being on it for the first time in 8 years my dose of thyroxin changed. I’ve read lots that progesterone and estrogen can bind together with thyroxin and prevent good absorption and lots of women have to increase their dose of thyroxin. I’m with newson clinic (who produced the balance app) and they were totally clueless about this bit of information. There are lots of good menopause advice and groups on Facebook etc.
This link tells you a little more on exactly that. HRT does seem to affect absorption. I have read that gel or patch seem to affect this less.
On a personal note I started HRT mid January. I have also been switching to ERFA and thought my dose was ok. About 6 -8 weeks after being on HRT I felt tired and weight was edging up again. Sent off for blood test. T3 seemed ok but my T4 had dropped to 9.2 (usual range 12-22!!)
I had some 25 mg levothyroxine knocking around at home so I have just added in and after 3 weeks feel great. Plan to do blood again in 5 weeks and then just present the evidence to my consultant…..😉
This would fit with needing an increase with HRT, not least because it was only as I seemed to approach menopause (looking back) that my levels had been starting to rise and GP etc kept jumping up and down for me to decrease dose…. A decision which I regret (re weight which I can’t shift and a year of extreme low mood) but ultimately value as it led me to this site and gave me the courage to take control and start NDT (ERFA).
Good luck hobbycat as you work out your best dose!
I’ve toyed with NDT for the last 12 years but I didn’t because of the lack of supply in the uk how did you get started? Sorry not meaning to jump on hobbycats thread.
Long story, which involved an NHS endo telling me to “go and find my own on the internet”. I see a private endo now who prescribes and I am able to source then from a pharmacy who will take his prescription. I think the admin here are able to offer a list of endos who are sympathetic (potentially NHS and private depending I guess on postcode lottery, many work in both). I was signposted via private message on this site (as we are advised not to name/recommend doctors on open thread).
I am sure admin would be able to support you with this if you approach them regarding their list of endos etc.
Yep that was me 10 years ago maybe I’ll look into that it’s all I seem to be doing now is going private for everything but at 55 I’m not waiting years 🤷♀️ Thanks for the reply
Thank you. It’s promising to here you say a little more levo picked you up. My lowness has been like a creeping lion - and with that, my dislike for myself has grown 🙄.
It definitely complicates things doesn’t it when you’re juggling two lots of hormones, thyroid and menopause. It can be difficult to work out which way is up in terms of what to target to help your symptoms. Be kind to yourself, you will get there in the end, hopefully won’t take too long 🤞🏻
I’m on Oestrogel. Been on it about 2 months now, just a low dose. Have noticed a really positive improvement (apart from needing to up my thyroid meds a bit) but as I had read that might be an issue I was prepared and took some proactive action…..
Sandy146, thanks. I’ve been on HRT for a couple of years and my T4/T3 combo for 4 years. 6 months ago my T3 dose needed reducing but it looks like now my T4 may need increasing. It’s all a madness !!
Sure this will have been mentioned before but have you changed brand at all? I went onto teva without realizing it and I felt awful within days no energy but hopefully it’s not and you just need a bit extra 🤞
Sorry if this as already been mentioned I’ve just caught this and not read through replies as off out.
Just wanted to know if you’re on oestrogel and are you aware of the palaver regarding quality and some bottles, it was an oestrodose issue but now they have issued new bottles and one has an orange square 🟧 and others a green square 🟩 on the bottom of bottles, oestrodose has now it seems disappeared but most suspect one of these are the inferior gels.
There’s some who are getting on fine regardless of which colour square they get but some are having a return of menopause symptoms and having to apply more of the inferior one, although Bessins make both bottles it’s the storage of these apparently, it has degraded the efficiency it’s been well reported and MHRA are well aware and menopause specialist and groups are battling with this and to top it all there’s now a shortage of hrt so don’t throw away, possibly get on menopause specialist Instagram and menopause hive see if you can see more up-to date information or chat on this I know a guide was put up if switching brands.
I’d just increase 1/2 or 1 pump more but please make sure you let your GP or Healthcare provider know as I don’t know your health history to advise, it’s just something I’d do knowing that these bottles are different in strength.
I too am on HRT (gel) and progesterone tablets. Then I had my thyroid removed last year and am really struggling to find the right levo dose. I thought my menopause symptoms had returned but my endo said it was hyper symptoms and reduced my levo dose. It’s very confusing when you’re dealing with menopause and taking levothyroxine… I’ve heard oestrogen affects the uptake of levo… the problem is both menopause and hyper/hypo thyroid symptoms are virtually the same 🤨
This is what I’m wondering, if some of my tiredness is actually being slightly over medicated with thyroxine. I’m definitely peri and started patches. Noticed a difference but not sure where I’m at with that.
Hello I am coming through my menopause and have hot flushes on waking too ! But also felt very tired recently so had all blood tests done and found out my ferritin was low. It’s interesting it makes such a difference even though I am not anaemic .The downside is I can’t tolerate iron tablets. But at least I know it was not my thyroid/ B12/ menopause
It seems to run in my family that we can’t store iron very well !! 😩Hope you get some answers.
I can’t tolerate iron tablets but I’ve got my ferritin up well when I’ve followed the instructions very carefully for x 2 spatone sachets with 500mcg vit c. I now also get the ones with vit c in to keep in my coat/ handbag etc so I can take those when I know I’ve not eaten etc.
“Rules” are to keep well away from thyroxine, preferably take an hour after or before eating anything, especially anything containing calcium magnesium or caffeine. So I generally manage to take it around mid afternoon. I’ve also tried simply heme and it seems ok. Both can be taken together as are different types of iron.
Thank you that’s good to know I have tried spatone but one sachet. Think I will try that. Don’t fancy taking these iron tablets! Have enough problems with my stomach!! 😩.
Not in my experience; it’s iron rich water. Highly absorbed but must take carefully with vit c to have best effect.
Simply heme is heme iron and supposed to be better on stomach. Don’t need to worry about vit c or food with that. I’ve started that properly and not noticing any particular issues so far.
My issue (as I was peri menopausal I now know ) was the iron pills gave me loose bowels and then IBS/FODMAPs issue and I lost a lot of weight. Gp suggesting stopping pills and trying FODMAPs diet and test 5 weeks later (so I’d had 2 periods) during this I switched to the spatone and my ferritin had gone up about 30 points, better than on the iron pills. I haven’t needed to use FODMAPs since and got it up again last year. (I think I may need to again now!)
my problem is I don’t keep up with a maintenance dose, drink too many milky/ oatly drinks and have been having heavier periods with hrt.
Thank you for the info. I will keep a note of that in case I need iron in the future. Iron tablets are foul.Having had a forced hysterectomy 12 years ago I’m on HRT patches, but started them before diagnosed with Hashimoto’s and needed to take thyroid meds.
I have been taking levothyroxine for twelve years now and I have never seen an endocrinologist yet. Should I have seen one at the outset or is it alright just to be prescribed medication by your GP and just have follow up blood tests? My dosage started at 50 micrograms and is now 125 micrograms.
Your TSH is incredibly low and this has nothing to do with the osteoporosis theory and endocrinologists freaking out. It's actually not within range. It is all to do with signalling in the body via the brain and how this affects not only the function of the thyroid but what happens at the cellular level.
Taking exogenous thyroid hormone inhibits the natural feedback mechanism production for some people.
When you take exogenous T3, its quite possible for the TSH to plummet to near 0 because the body will recognize that there is already so much T3 in your system, that it has no need
to produce any on its own. This results in significantly lower absorption of iodine, via the sodium iodine symporter expression to pick up iodine from passing blood supply into the thyroid. Thus a low TSH over a period of time results in reduced iodine absorption by the thyroid.
So the thyroid essentially goes to sleep for the duration of time you are “over medicating”.
In some individuals, a very low TSH, can result in the disruption to the HPA-O- axis (hypothalamic, adrenal, ovarian axis).
TSH may not be the direct thyroid hormone. However, your hypothalamus still maintains an intricate communication mechanism that also interacts with those other axes and is involved with thyroid hormone metabolism.
You can find this information in physiology text books and also here in this paper which discusses how thyroid hormones interact with TSH and the Sodium/Iodide Symporter (NIS):
I’m trying to make sense of this:”In some individuals, a very low TSH, can result in the disruption to the HPA-O- axis (hypothalamic, adrenal, ovarian axis).”
If you’re slightly hyperthyroid does it creates a mildly peri menopausal state? Tsh keeps hovering around 0.1-2 and I’m starting to wonder if being on hrt and slightly higher tsh might be helpful.
Well perimenopause is the natural decline in ovarian output and it can happen up to 10 years before menopause. It’s basically the ovaries not functioning as well as they used to. This can result in a host of symptoms. It could be made worse potentially if your thyroid function is off or stress is too much.
The signalling to the ovaries, thyroid and adrenal glands all comes from the brain. If your brain thinks there’s too much thyroid hormone around it’s not going to stimulate the thyroid to make its own hormone. The point is that what happens in the hypothalamic pituitary thyroid axis also affects the adrenals and the ovaries. So if your thyroid function is off it can affect the other organs and also cells across the body.
We know that when we’re under chronic stress this also affects the thyroid and can disrupt the menstrual cycle.
Also, if you take too much thyroid hormone whether that is T4 or T3 and your body thinks for whatever reason it doesn’t need it it will deactivate at it at the cellular level. This is actually a protection mechanism. It’s putting the breaks on. Could be stress, toxins all kinds of things.
HRT - again exogenous hormones, will also affect your thyroid and adrenals in the same way, they are all connected.
Some people do feel better with a higher TSH. See this post:
It does fit with my experiences over the last few years. And with what I’ve read before about fedback loops etc. It’s not hugely suppressed, 0.23 but I can’t help wondering if a little less would hit a sweet spot. Stress has definitely been affecting peri symptoms. Hrt has helped but I don’t feel 100% yet . I suppose it’s whether more hrt would help more first or a dial down slightly of thyroxine.
Hi haggisplant, I think it's always worth trying a slightly lower dose of Levo. if that's what your gut feeling is telling you ..... with the proviso that it's not good to drop by too much .. no more than 12.5mcg /day and possibly less.And also that if you are going to try it, you do need to give it quite a long while to see how things feel once everything has rebalanced itself and adjusted to functioning at the new level .
In my experience the first maybe 4/5 weeks on a lower dose do often feel 'wrong '... i think it sometimes seems as if things swing 'too far the wrong way' then swing back to the middle again after a few weeks, so eg: i wouldn't be concerned about an increase in constipation/feeling undermedicated if it only lasted a few weeks then improved again, but if constipation occurred and continued to worsen after 6 weeks ,and i felt truly awful at that point , i might reconsider.
But if nothing too intolerable was happening, i would wait at least 3/4 months on the lower dose .
I've lowered by 12.5mcg twice.
One time despite feeling pretty naff for the first 5 weeks, it turned out to be a definite improvement in all sorts of areas over about 4 months .
The other time i reduced it was naff for 5 weeks then got much worse ,, so i went back up and i felt gradually better again ... It's very much a case of suck it and see.
My Blood results were not always very helpful at all,... iv'e felt good on 'bad' numbers and bad on 'good' numbers ,and many times my numbers just don't follow any of the rules of logic at all.. so i've stopped paying the too much attention to them be honest.. i'm learning to go more by how i feel, i try small increases or decreases very occasionally and take careful note of subtle changes and i feel like i'm learning to read my body better ... i just see the numbers as 'added extra information, but not gospel'
I think having small kids hasn’t helped for a while as morning routines can be messed up. But that’s settling now. I can’t take it at night, I just forget!
Yep feedback loops are the words I missed out. It’s quite possible that less thyroid hormone may help, and it may also come down to managing your vitamins and minerals better, which I’m not good at, especially in the interim whilst your body adjusts to less thyroid hormone. For some people it’s easier than others.
I hadn’t taken a B complex for a very long time and I was getting terrible aches and pains in my hands and feet. Just started it again and I’ve felt a difference in just two days. B vitamins are vital for the thyroid too so who knows what else that deficiency was affecting.
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16 weeks pregnant, low t4
Should I increase my T4 or stop T3
Advice on blood test results, low TSH, low T4. 
