Disrupted sleep with increased T4

[sweetgrapefruit]

Hello dear Thyroid UK,

I had thyroid cancer in August 2021 with part of my thyroid and a parathyroid removed. Since then, I've been trying to get an ideal dose of Levothyroxine T4. I did take a very low dose of T3 (Cytomel) briefly. I felt great alert-wise but experienced headaches, nausea and anxiety.

My endocrinologist would like my TSH below 2 (currently at 3.3, see below with additional blood work) and feels this is ideal so that the cancer won't return. In the past, I went from 75mcg to 88mcg of Levothyroxine and felt it was too big of a jump. More recently, I've titrated up from 4 days of 75mcg Levo and 3 days of 88mcg and then test at 6–8weeks. Then, 5 days of 75mcg and 2 days of 88mcg and then test at 6–8weeks and then most recently 6 days 75mcg Levo and 1 day of 88mcg Levo.

My endocrinologist suggested I now take 88mcg of Levothyroxine very day. I experience disrupted sleep and mild heart racing at night. Should I continue taking this dose? I'm open to doing this if my sleep and heart racing will improve. Or should I go back to my previous dose of 6 days of 75mcg Levo and 1 day of 88mcg where I felt better? These symptoms of waking up at night, insomnia and heart racing have always occurred when I take 88 mcg of Levo. Otherwise, I sleep very well.

I took the TSH test early morning with no food & last dose of 88mcg was approximately at 7am the previous morning.

Thank you for your insight. I appreciate the comments and community here.

Date // Component // Your value // Standard range

6/24/23 // TSH // 3.3 uIU/mL // 0.4 - 4.5 uIU/mL

6/24/23 // Free T4 // 1.2 ng/dL // 0.8 - 1.7 ng/dL

6/24/23 // VITAMIN D, 25-HYDROXY // 39 ng/mL // 20 - 79 ng/mL

6/24/23 // Calcium // 9.3 mg/dL // 8.8 - 10.5 mg/dL

6/24/23 // Iron // 150 ug/dL // 50 - 212 ug/dL

6/24/23 // Iron binding capacity, unsaturated // 138 ug/dL // 110 - 370 ug/dL

6/24/23 // Total iron binding capacity //288 ug/dL // 228 - 428 ug/dL

6/24/23 // Transferrin % saturation // 52 % // 14 - 57 %

6/24/23 // Ferritin // 64 ng/mL // 22 - 291 ng/mL

6/24/23 // Hgb A1c % // 5.3 % // <=5.6 %

6/24/23 // ESTIMATED AVERAGE GLUCOSE // 105 mg/dL // 85 - 126 mg/dL

5/7/21 // Folate // 12.7 ng/mL // >=4.0 ng/mL

6/24/23 // WBC COUNT // 6.6 K/uL // 3.7 - 11.1 K/uL

6/24/23 // Red blood cells count // 4.59 M/uL // 3.60 - 5.70 M/uL

6/24/23 // Hgb // 14.4 g/dL // 11.5 - 15.0 g/dL

6/24/23 // Hematocrit // 43.6 % // 34.0 - 46.0 %

6/24/23 // MCV // 95 fL // 80 - 100 fL

6/24/23 // RDW, RBC // 13.3 % // 12.0 - 16.5 %

6/24/23 // Platelets count // 219 K/uL // 140 - 400 K/uL

6/24/23 // RBC's, nucleated // 0 /100WC // <=0 /100WC

4/18/23 // MAGNESIUM // 1.9 mg/dL // 1.7 - 2.3 mg/dL

4/18/23 // Parathyroid hormone intact // 50 pg/mL // 23 - 110 pg/mL

2/24/23 // Vitamin B12 // >2,000 pg/mL // >=200 pg/mL

2/24/23 // Pyridoxine // 68.8 nmol/L // 20.0 - 125.0 nmol/L

2/24/23 // Cholesterol // 171 mg/dL // <=239 mg/dL

2/24/23 //Triglyceride // 36 mg/dL // <=499 mg/dL

2/24/23 // HDL // 78 mg/dL // >=50 mg/dL

2/24/23 // Low density lipoprotein calculated // 86 mg/dL // <=159 mg/dL

1/6/23 // Potassium // 4.5 mEq/L // 3.5 - 5.3 mEq/L

11/5/22 Thiamine, whole blood // 117 nmol/L // 70 - 180 nmol/L

[Lalatoot]

Have you tried splitting your dose. I couldn't tolerate a dose of more than 50mcg in one go as it made me feel ill so my endo suggest adding a second dose.2lower doses don't lead to such a high spike in levels and are gentler on the body.

I take mine first thing and bedtime. I did also try taking 3 doses morning afternoon and bedtime ....you can try anything you think might work .

[sweetgrapefruit in reply to Lalatoot]

Thank you Lalatoot. That is something I could try. I also take iron and calcium and would just have to make sure they don't interfere time-wise.

[Wa_mo_jo_67]

I have taken levothyroxine for over 12 years increasing/decreasing dosage. I still have same symptoms when I started now including high ferritin levels and cholesterol. GP no help. I am weaning myself off them as I have started natural remedy. I realise this is not for everyone so I would speak to your GP if he/she is open to this.