I'm on 150mcg levo and 37.5mcg (12.5mcg x3 per day) T3 at the moment. I've known for some time this isn't the right dose of either but haven't known how to change it for the better. I'm fatigued a lot, excessively hungry (have gained weight) and I keep losing my temper over things that I'd usually be able to stay calm about. I'm also having joint pain (mostly feet). My blood pressure has also been higher than usual and I've noticed a racing heart/heart palpitations on the odd occasion.
Back in July I tried cutting levo to 125mcg and keeping T3 at 37.5mcg (endo's advice) for a few days but it made me feel worse, (suicidally depressed, fatigued, brain fog) so I increased it back to 150mcg after a few days.
I had a blood test last week. 9am, fasted, last dose of levo 24 hours before, last dose of T3 (12.5mcg) 12 hours before. Here are my results:
TSH <0.01 (0.30 – 4.20)
T4 15.8 (12.00–22.00)
T3 8.1 (3.10 – 6.80)
Ferritin 65 (13 – 150)
Folate 9 (2.99 – 26.80)
Vitamin B12 576 (197 – 771)
Vitamin D 100 (50 – 250)
So clearly my T4 could be higher, my T3 needs to be lower and I need to increase my folate. My thinking is that I should increase my levo to 175mcg and reduce my T3 to 25mcg. I currently only have 50mcg T3 tablets so I can't reduce my dose by increments smaller than 12.5mcg (a quarter of a 50mcg tablet) unless I buy more tablets in a different strength. It'll take a few weeks for them to arrive if I do this. I am already supplementing folate. The last time I felt well was about 1–2 years ago – I was on 150mcg levo and 25mcg T3, and at that time, this put my T4 at around 19–20 and my T3 around 6.8.
Would really appreciate any advice.
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Zazbag
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Zazbag, Only change one thing at a time otherwise you won't know what is causing the benefit or the worsening symptoms.I would decrease your T3 wait 6 - 8 weeks minimum and then bloods to see where you are and also how you feel. That will put you back on the dose you last felt well on. Your ft4 will rise slightly as you have decreased your T3 and your ft3 should fall. Changes in T3 are ideally in 5mcg but you may be stuck with the larger decrease because of your tablet size.
Thereafter if you still wish to alter things then I would raise your levo maybe only by 12.5mcg but you know your body best .
I know you are by nature impatient for things to happen but please only change 1 thing at a time otherwise you risk not knowing what is doing what.
Hey, thanks so much for your reply and it made me smile that you know I'm an impatient type of person lol.
From September 2020 I was on 150mcg levo / 25 mcg T3 (I was on levo only before this). I felt really well on this dose until the end of last year. At the end of April this year, I had a blood test that showed my T4 was 15.9 and my T3 was 5.1. I know for some people those numbers might be okay but they were worse than the numbers I had before I added the T3 in the first place and I was feeling really bad back then and in April this year with hypo symptoms. That's why I increased my dose. If I go back to the same dose I will feel hypo again.
Because if you feel rotten after you change both you won't know if it's the reduction in t3 or the increase in levo that has made symptoms worse. So you won't know which to undo.
Also if you do 1 at a time you get a better idea for future changes. For example I know that reducing my lio by 5mcg usually raises my ft4 level by 0.5 as well as reducing my FT3.
The last time I felt well was 2 years – 9 months ago, when my FT4 was about 19–20 and my FT3 was 6.8 so both quite high in the range. Dose of levo was 150mcg, dose of T3 was about 20–25mcg. In April this year I had a blood test and it showed my FT4 had dropped to 15.9 and my T3 had dropped to 5.1. I was having hypo symptoms and feeling bad. I increased my dose of levo and T3 to 175mcg and 37.5mcg respectively but had overmedication symptoms. I reduced levo back to 150mcg but endo told me to keep my T3 at 37.5mcg and told me to reduce my levo further to 100mcg. Within a few days of this change I felt really hypo and couldn't function so I increased my levo again to 150mcg. I've been on 150mcg levo 37.5mcg T3 for the last few months. Latest blood test (as above) show FT4 15.8 (same as in April pretty much) and FT3 8.1. I've been having symptoms of overmedication this entire time. I've now decided to increase my levo to 175mcg and reduce my T3 to 50mcg. My rationale for this is that the last time I felt well, my FT4 and FT3 were both high in the range, I've been on 125mcg levo only, 150mcg levo only, 125mcg + 20mcg T3, 150mcg + 20–25mcg T3, 175mcg levo + 37.5mcg, 150mcg levo + 37.5mcg, 150mcg + 50mcg. I know how all of these dose levels feel and they either make me feel hypo or over-medicated. Lalatoot has been very kind to reply and give me very sensible advice about only making one change at a time. As above she said to reduce my T3 back to 25mcg (as it was in April when my FT3 was 5.1, FT4 was 15.9 and I was feeling hypo) and keep my levo at 150mcg (again, as it was in April).
I completely understand the rationale for this and it makes sense, but when I was on this dose level in April I felt very hypo and my FT4 and FT3 levels were worse than they had been 2 years previously which was when I felt so bad that I had to try the T3 (and it made me feel almost 100% better within a few short weeks). I don't feel I can risk feeling hypo for an indefinite period of time. Being over-medicated is preferable for me as at least I am able to think clearly and do my work and get things done in my life without wanting to commit suicide. My thinking is that 175mcg levo will bring my FT4 level closer to where it was the last time I felt well (raise it from 15.8 to 19-ish) and lowering my T3 will bring my FT3 level down from 8.1 to 6.8 or below. I know there is a relationship between your FT4 level and the dose of T3 which makes things more complex. I am not trying to be impatient or disagreeable, or ignore sensible advice, but as I say I find it really hard to function when I am hypo particularly because it makes my mood so low and gives me brain fog that makes it hard to even think straight. Would appreciate your thoughts. Thanks in advance.
I've now decided to increase my levo to 175mcg and reduce my T3 to 50mcg
I assume you meant reduce T3 to 20mcg (or 25mcg)
Oh yes haha, sorry for confusing things with my mistake there. I meant to say reduce to 25mcg of T3 (this is purely for cost-effectiveness as 50mcg tablets cost only slightly more than 5mcg ones. I might be better off on 20 or 22.5mcg but it costs 3–4x as much).
I would agree….you likely need more Ft4 and (definitely) less FT3
Plus all vitamins optimal
Yes my folate is on the lower end of the range but I am supplementing that. The others look pretty much optimal. I had two B12 injections (privately) which helped bumped my B12 up a bit.
Are you gluten or dairy free
Strictly gluten free, I was also dairy free for 5 years, then tried reintroducing it for a few months this year as I was travelling but I noticed fatigue, bloating and really bad joint pain (especially in my feet) so I have cut it out for good now. I'm also egg free as I can't tolerate eggs either sadly.
Always get same brand levothyroxine at each prescription?
Yes always Teva levothyroxine (as it's lactose free, and doesn't seem to cause me issues) and Sigma T3.
Like you I feel best with Ft4 and Ft3 approx 80% through range…but pretty rough if Ft3 is right at top of range
What happens to you when your T3 is top of range? And what happens when your T4 is less than 80%? Do you also feel hypo?
I have found significant improvement splitting levothyroxine into half daily dose waking and half at bedtime. T3 as 3 smaller doses spread through the day ….waking, mid afternoon and bedtime.
I always take my levo at night before I go to sleep and on 37.5mcg have been taking T3 3x per day same timings as you. Now I'm reducing it back to 25mcg it'll have to be in two doses because I'm splitting 50mcg tablets.
I've never thought about splitting the dose of levo. How would you suggest I split 175mcg of levo? One dose of 100mcg first thing in morning with 12.5mcg T3, second dose of T3 around 5pm and then 75mcg levo before bed?
I struggle to tolerate reducing T3 ….having to reduce very SLOWLY…..just by 2.5mcg ….then waiting 8 weeks
I will see how I manage reducing from 37.5mcg to 25mcg. I fear I might have the same experience. If I do I will order some 5mcg tablets and titrate down slowly.
I think you take to much t3 and levo. Maybe you coud reduce the levo with 12,5 mcg and t3 with 12,5mcg. So, Your dose could be 137levo and 12,5 t3 +6+6t3.
Hello, I’m no expert but I do know that any change in (thyroid) medication can make you feel really bad, fatigued mentally unstable etc… so don’t mistake that with the new dosage being wrong it takes a while to settle before you can know how you really feel x
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