Lowered dose of T4 after overmedication and now fatigued, low mood and constipated

[Zazbag]

Hello,

I posted a few days ago as I had some blood tests that showed my FT4 was 22.0 (top of the range) and FT3 was 8.0 (over range – range goes up to 6.8). I was on 175mcg levo and 25mcg T3.

I lowered my dose of levo to 162.5mcg and kept my T3 at 25mcg, but I feel a huge reduction in my energy levels and mood since making this change. Also, I have suddenly developed constipation.

Was it a mistake to lower my levo or will I adjust to the reduction over time? This doesn't feel very good. For context, I've been overmedicated since April this year as I've tried to adjust my dose as I had hypo symptoms for a few months before then.

On the positive side, I've noticed a definite improvement in my sleep quality and felt less hungry than usual so I guess those are good signs.

[Buddy195 Administrator]

I need to adjust medication (upwards or downwards) very slowly, eg 12.5mcg Levothyroxine reduction alternate days at first, then daily, then build to a 25mcg reduction. Maybe, like me, you are more of a tortoise than a hare when altering thyroid medication.

[Zazbag in reply to Buddy195]

Thanks so much for your fast reply!

I didn't realise this might be necessary. I will try to alternate the reduction like you suggested and see if that helps. How long should I do that for? And does this mean it's normal to experience temporary hypo-like symptoms after a dose reduction? Will my body adjust?

[GlowCoach Administrator in reply to Zazbag]

For me if I’ve gone over range yes I would get symptoms on a reduction. Hang in there and a week to 2 weeks you should be good.

[Buddy195 Administrator in reply to Zazbag]

I get adverse symptoms if my thyroid levels are either over or under my ‘optimal’ ; it’s a fine balancing act! I would try an alternate day reduction in medication for a few days at least, but longer if needed, before trying a small daily reduction.

[Zazbag in reply to Buddy195]

Thanks a lot for your help!

[Zazbag]

GlowCoach

Buddy195

SlowDragon

Hey everyone, I'm feeling so fatigued and brain foggy and have very little motivation and my mood is low and I'm so irritable since lowering my levo last Thursday. It's not getting any better. I decided to white knuckle it and not taper down the dose reduction as I thought I might be able to adjust to it after a few days but it's not working. I had plans for this evening and I have decided to stay home. I feel like I want to be alone. This is how I was before I added liothyronine two years ago. Not sure how a 12.5mcg reduction in levo when I was at the very top of the range can have such an effect. Do you guys have any thoughts at all? I'm starting to think I should increase it back to 175mcg and maybe lower my T3 instead to bring it below 6.8...?

[tattybogle in reply to Zazbag]

mu twopenneth based on my last 4 experiences of 12.5mcg dose changes ...allow a few weeks for any dose change to settle in , even a 'small' one like 12.5mcg Levo . In my experience 12.5mcg Levo dose reduction can feel like it's "a reduction too far" initially , but then after a couple of weeks things can start to balance out again. Don't judge any Levo dose change, however small , by how it feels during the first 5 weeks . If you're going to tweak your dose , stick with it until at least 6 wks have gone by ..... that's my rule for myself nowadays .

[Zazbag in reply to tattybogle]

Thanks so much for replying tattybogle. I will try to hold on. I'm just struggling to motivate myself to do much right now and don't feel like myself. Any tips for how I can make it through the next few weeks while feeling this way? I'm worried I'll fall into bad lifestyle habits that will become hard to get out of, like isolating myself and eating badly and not sleeping at proper times etc. I can feel it starting to happen.

[tattybogle in reply to Zazbag]

Have faith that you are being methodical....accept that every so often in life you will have to adjust your thyroid dose to your changing needs , and that when you do it will usually involve having a few weeks of crap because you are having to adjust it 'manually' now that your thyroid can't do it automatically .... lighten up on yourself and embrace the crap , call it hibernation, enjoy the seclusion for what it offers and eat chocolate eclairs for dinner if you want to, and just keep reminding yourself that trying something properly is the only way to have confidence in what you are doing. Chop and change too soon.. and you will just get lost. Stick with it till you know for sure if your chosen tweak is an improvement or not .. and either way ,, your reward will be more confidence about which direction to go next.

Don't be afraid of the bad habits.. when you feel well again they'll sort themselves out .

[Zazbag in reply to tattybogle]

I don't know why, but reading this made me cry. Thank you so much for your comforting words ❤️

[Buddy195 Administrator in reply to tattybogle]

totally agree with tattybogle ’s advice 👍

[GlowCoach Administrator in reply to Zazbag]

Right now you’re just levelling of and experiencing turbulence. You need to give it another couple of weeks to come out the other side. Hang in there.

[Zazbag in reply to GlowCoach]

Thank you. I decided to increase my levo to 175mcg and taper it down more gradually like SlowDragon suggested. Hopefully it helps.

[SlowDragon Administrator]

personally I can only just tolerate reducing levothyroxine by maximum of 25mcg PER WEEK

and reducing by just 12.5mcg PER WEEK I still find noticeable but slightly more manageable

Waiting 6-8 weeks before reducing again

Since going dairy free I have recently needed to reduce T3.

I know from past experiences I can’t tolerate reducing by 5mcg T3

So I am reducing in 3 smaller steps. Initially reduced by 2.5mcg per day ……after 8 weeks….retested….

Next step reduced by 1.25mcg - 1/4 of 5mcg T3 tablet per day

and also trying reducing levothyroxine by 12.5mcg per WEEK

(Probably shouldn’t have done both together)

Due to retest soon ….

before reducing by final 1/4 tablet of 5mcg T3 ….

then will hopefully settle on 3 x 5mcg T3 per day

[Zazbag in reply to SlowDragon]

Thanks so much for replying SlowDragon!

When you say you can tolerate reducing by 12.5mcg per week do you mean you will only lower your dose of levo by 12.5mcg on one day for the first 6–8 weeks, then you will reduce on two days for the second 6–8 weeks until you eventually take 12.5mcg less levo on every day of the week?

[SlowDragon Administrator in reply to Zazbag]

No I mean reduce by 12.5mcg one day per week and continue to only reduce by 12.5mcg once a week for next 6-8 weeks …..and ideally waiting 10-12 weeks before it settles

Taken me about 8 months to get use to reducing from 125mcg every day down to 125mcg 5 days week and 112.5mcg 2 days week

Now currently try to get use to 125mcg 4 days week and 112.5mcg 3 days week. Currently on week 7 of this reduction.

As I said…..I probably shouldn’t have reduced levothyroxine at same time as (tiny) 1.25mcg per day reduction in T3

[Zazbag in reply to SlowDragon]

Ooooh okay I understand now. You can tell the levo reduction has given me brain fog, can't you?

I will try that instead – can't continue the way I am now. The past week has been tough, especially going into the darker, colder months when you need every shred of motivation you can get!

When it takes months to make small dose changes I don't blame you for changing both at the same time. This disease is like a straitjacket.

[Zazbag in reply to SlowDragon]

Good luck with your dose adjustments! It's so tedious isn't it? How are you finding being dairy free?

[SlowDragon Administrator in reply to Zazbag]

Dairy free has been astonishing (annoyingly) …..so it looks like dairy will be gone for good

Thank goodness for lots of new dairy free products

And usually can find a dairy free & gluten free something eating out (just got to not consider what might be missing!)

[Zazbag in reply to SlowDragon]

Yeah, I can't do dairy either (or gluten, or egg). There are a lot of brilliant dairy free products now so it's very manageable. Glad it has helped you!

[Zazbag]

I took 175mcg last night (12.5mcg more) and my mood/motivation/energy level/concentration is noticeably better this morning. I will try the slow taper like you described SlowDragon . Thanks again!