I’ve been having palpitations for a few weeks now and after my last endo phone appointment two weeks ago because of the following results my T4 was reduced from 100/75 alternate days to 75 every day. This is essentially a drop of 12.5mcg per day. My T3 was left unchanged at 2 x 5mcg/day.
April 2023(100/75 Levo and 2 x 5mcg Lio)
TSH <0.01 mIU/L (0.35 - 5)
Free T4 (fT4) 15.6 pmol/L (9 - 21) 55.0%
Free T3 (fT3) 5.5 pmol/L (3 - 6) 83.3%
I have been on the reduced dose for two weeks now and don’t feel the palpitations have lessened. My fear is that 12.5 reduction isn’t enough and I will wait for 8 weeks without improvement and then need to wait a further 8 weeks for another reduction if I am overmedicated (I am feeling tired but wired, hair is even thinner than when I was on T4 only and I’m feeling a bit shaky and anxious – many of the symptoms of being under medicated before I was given T3 almost a year ago.
My T4 and T3 levels have increased and TSH fallen since my last test on the same dose (100/75 Levo and 2 x 5mcg Lio) 6 months ago, perhaps because my vitamin levels are now optimal.
October 2022(100/75 Levo and 2 x 5mcg Lio)
TSH 0.02 (0.35 - 5)
T4 12.2 (9-21) 27% through range
T3 5.3 (3-6) 77% through range
Thanks for reading.
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Piglet1956
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Thanks for your reply SlowDragon. I have been taking 2 x 5 Roma. I was started on 10 but the dose was too high and I went a bit mental on day four so stepped down to 5.
All tests done as protocol on here. Vitamins tested at last test and all seem optimal.
Piglet1956, I had a massive spike in anxiety when changed to Roma and have now had to have it explicitly written on my prescription’Morningside only’. How long have you been taking Roma?
Thanks for the suggestion and I will give it a try. However I'm sure I was told that it was Roma or nothing by the endo at my first visit. I could still empty out the capsule and mix it with water and take just half if I can't get a change.
I’m aware that several members have had issues with Roma. I am 100% better with Morningside, so I would definitely try to arrange an alternative to see if your symptoms subside.
I suspect your endo reduced your dose due to your low TSH, rather than the palpitations themselves. Your actual thyroid hormone levels would be fine for most people, but palipitations can be a symptom of under-medication as well as over-medication. So, if that were the case, that would explain why they haven't improved since the reduction in dose.
The differences between the test in October 22 and April 23 are so slight as to be negligable. Especieally as you have Hashi's - with Hashi's you can expect levels to jump around a bit even without a change in dose.
And it's highly unlikely that such a small reduction in dose is going to have any effect on your TSH, if that's what your endo is worried about. He should know that taking T3 is going to lower/suppress TSH because that's what it does.
Hello greygoose and thanks for your reply. To be fair, the endo said if I felt fine on that dose I could keep on it but i don't like the palpitations and I felt better when my T3 and T4 levels were lower and I had no palpitations. I'm just not sure which way to jump to change the meds for the best.
and I agree - I wouldn't have thought 12.5 dose change will have much impact.
If you really think you were over-medicated and it was that causing the palps, then it probably would have been better to reduce the T3 slightly, rather than the levo.
That's why most people are put on T3. So, given that T4 is basically a storage hormone that doesn't do much until it is converted into T3, reducing the T4 isn't going to have much effect. Your endo really should know things like that. It's very worrying that he doesn't.
I have plenty of experience of this and I know T3 was at the bottom of it not levo. I was wondering about this throughout Piglet’s post. Of course one can’t help playing this stuff over from one’s own point of view. I know very high T4 is reported to create palpitations but Piglets T4 does not look all that high. However palpitations seem to be a more common issue with T3. I agree a reduction in T3 would have been more useful (maybe). I am very respectful of the power of T3.
Yes its a very powerful hormone and so hard to regulate and predict its effects, particularly when there is so little understanding of it amongst medics.
There's lots to consider SlowDragon. Thanks for taking the time to answer. I am gluten free but not dairy free. I tried DF for a few weeks but felt no difference in symptoms. And good advice to change only one med at a time.
Dairy, I didn’t see any difference at all for 3-4 months. Now, almost 9 months later since last consumed any diary…..I am still seeing increasing improvements month on month
Hi SlowDragon, what improvements do you see with being dairy free?
I went gluten and nightshade free for four years. Never noticed anything. But dairy free? Never tried it because I don't know what adversities are associated with dairy. I am not lactose intolerant. I drink about 250 ml of full fat milk every day and eat some cheese a few times per week. Usually 100% sheep feta. Sometimes cow cheese but usually various types of sheep cheese.
My understanding on protein is there are two kinds. Sheep milk is A2 casein as opposed to most cow milk being A1/2 mix. As far as I'm aware, dairy doesn't give me any adverse symptoms although I've never tried to go dairy free because I'm addicted. Maybe that's my symptom. 😍 I could live on the stuff.
Totally agree with SlowDragon about only changing one thing at once. I got myself in a terrible muddle cutting out too many food groups/ adding numerous supplements…. Now I only make one change at once so I can monitor the affects. Like you, GF made a significant difference to me, but DF made little (noticeable) difference.
I’m feeling tired but wired, hair is even thinner than when I was on T4 only and I’m feeling a bit shaky and anxious.
FT3 levels that high would give me palpitations and make me feel jittery too.
Often optimising nutrients makes thyroid hormone work better, which also has a cumulative effect by improving performance of other functions (such as liver, kidney, adrenals, etc) which makes thyroid hormones work even better.
If this were me I would reduce T3 meds to 2.5mcg twice a day and raise thyroxine. Two med changes at once isn’t usually recommended but you can’t reduce T3 levels without raising low FT4, or resulting ‘under-medication palpitations’ could risk furthering confusion anyway. Therefore, I’d make both changes together.
Many of us only need a tiny bit of T3 which is enough to improve our thyroid physiology on many levels including ‘freeing’ and conversion of hormone. Therefore, we end up with much more T3 than we’re medicating. This is a positive indication that things are working well. You just need to adjust your levels to your own perfect ratio.
Hello radd and thanks for taking the time to reply. My feeling when I first saw the endo last year is I just needed some T3 top up but I know that then messes with T4 levels. At that time I was fairly ok T4 and low T3 and getting palpitations, brain fog, dizziness, not sleeping and the GP saw that as overmedicated but it was likely undermedicated with too little T3 being produced so a wee top up would have been good. So my gut feeling is reduce T3. However I'm not sure which way to turn or what to do for the best.
I will share my experience of having had palpitations on even 12.5 due to having a tendency to heart arrhythmia. On advice of my GP I stayed in that dose till the palpitations and tachycardia stopped. Took 2 weeks to get more stable. And I waited another 2 weeks before- in my.case - increasing the dose. Have remained stable since. I have a breathing exercise that others here have said helps with the palpitations. If you'd like it, message me.
Here you go: 1. Sit or lie comfortably so that your stomach can move easily when you breathe in. If you're lying down, this is easier on your left side.
2. Take a breath in.slowly through your nose. I usually count a slow 2. Let your tummy relax when you do this so it moves out gently.
3. There is a natural pause for most people after the inbreath
Try to tune into it but don't force it.
4. Let the breath out again all in one go - don't worry that you'll be out of breath - there's always air in the lungs right up until our last moments
5. Don't be surprised if you feel like another pause after the outbreath but again - don't force it. Keep tuning in either to the feel of the air moving through your nostrils or the sound.
6. If you need to breathe out through your mouth purse your lips slightly as it helps to feel the breath and know we're in charge of it.
6. Repeat.
Typically your breathing rate will calm and slow down. You may even feel like you're about to drop off to sleep.
This technique is one of many used by breath practitioners to help calm our systems and regulate breathing. I have often got my HR down by 15-20 BPM using this technique and sometimes seen my AF off. Also helps me if I cannot go to sleep
That sounds calming and as if it really works for you. Thank you for sharing. I think any concentrated focus on the breathe and diaphragmatic breathing allows us to re regulate ourselves.
I use a box method involving: in breathe, hold, out breathe, hold, etc, each four seconds long and visualised as going around the sides of a square. You can play around extending the hold or out breathe, and filling the belly, ribs and chest, and then reversing.
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Feeling really weird
How long should it take to see an improvement in symptoms after levothyroxine dose change?
Please help - I don’t know what to think or what I should say to my Dr
