Feel great, but should I reduce T4?

[Kriticat]

I hope someone can advise me. These are my latest results

TSH 0.01 mIU/L (0.3 - 4.5) -6.9%

Free T4 (fT4) 1.7 pmol/L (0.8 - 1.8) 90.0%

Free T3 (fT3) 6.09 pmol/L (3 - 6.5) 88.3%

T4:T3 Ratio 0.279 

Vitamin B12 545 nmol/L (200 - 1050) 40.6%

Vitamin D 79 nmol/L (30 - 100) 70.0%

Zinc 73.7  (50 - 120) 33.9%

After 2 previous blood tests showing dropping T3 levels (I didn't notice any worsening of symptoms until around the 2nd one when I posted here) Despite being advised to wait, I was getting worse and worse, so I increased my T4 dose from 75 to 88mcg. After a couple of weeks I felt even better than before, and apart from achy joints (which may be a completely separate issue) all my symptoms have cleared up, and I can even sing again! (Not exactly tunefully, but my voice has been croaky for years!)

Anyway, my recent blood test results show thyroid hormones right at the top of the range - TSH still suppressed but that is always the case unless I'm seriously under medicated.

My heart rate is higher than it used to be, about 80, rather than 60, but still within healthy range, and I'm sleeping well, my digestion is good, I've lost weight, my mind feels sharper and I've got reasonably good energy levels. I'm a bit stressed, but that's due to my husband's health issues and it would be strange if I wasn't!

I think I should probably reduce T4 slightly but I feel so good I'm hesitating to do it... what does anyone think? If I carry on with 88mcg will I become over medicated?

Thanks for any input, thr experience and knowledge on here is so invaluable as I'm having to navigate this condition without the help of any professionals.

[SlowDragon Administrator]

You could either

A) stay on current dose and retest again in another 8 weeks

Or

B) try 75mcg twice weekly and 88mcg 5 days week and retest in 8 weeks (so that’s a reduction of 25mcg PER WEEK)

Personally I would try first option, then consider trying 2nd option if Ft4 was over range at next test

[Kriticat in reply to SlowDragon]

Thanks so much, SlowDragon That gives me the confidence to try the first option. I really don't want to go backwards at this stage....I can't believe how much better I am feeling. My vitamin D and Zinc are both improving, so I expect I will need to take less T4 once they are optimal.

[Buddy195 Administrator]

Your increased resting heart rate is likely linked to the stress associated with your husband’s health issues. Mine rises sharply with even a small amount of stress. As SlowDragon suggests I would retest in 6-8 weeks, share results with us and monitor your symptoms.

[Kriticat in reply to Buddy195]

Thanks Buddy195 I will definitely do that, , what are the symptoms I should be looking out for, apart from heart rate?

[SlowDragon Administrator in reply to Kriticat]

Suggest you get a fitness watch that records heart rate, especially resting heart rate at night

Ideally one that does ECG too is useful, but more expensive

Symptoms of over treatment

Loose stools

Tremors

Poor sleep

Hungry

[Kriticat in reply to SlowDragon]

Thanks SlowDragon Ive got a fitbit that does both ECG and heart rate, so far so good, but it keeps telling me I can't rely on it! Bit seems to agree with the oximeter and BP gadget, so feel quite confident. I did have all those symptoms after about 2 months when I originally started on T4, so I'll keep a close eye on things.

[Buddy195 Administrator]

It’s just worth checking how you feel if you think your FT4 is higher- check your heart rate when you are relaxed, maybe check your temperature, notice if your toilet habits change etc.

Ive had instances where I’ve had palpitations, tremor and high anxiety alongside fast resting pulse. When I feel like this, I cut back on my thyroid medication until the symptoms pass and then slowly reintroduce it.

[Kriticat in reply to Buddy195]

That's a good idea, I thought you had to commit to a certain dose for stability, but it makes sense. So basically, if I'm feeling good, with no over medicated symptoms, I am probably fine? Thanks both of you for taking the time to share your experience and reassuring advice

[HealthStarDust]

How long have you been in this dose of 88mcg? If less than 12 weeks, I’d be inclined to give a bit longer.

With that said, if you’re feeling good, I don’t think it’s a good idea to change anything. If your achy joints were present prediagnosis, likely they will improve once on right dose.

As for overmedicated, how this presents in you will will be unique to you. For example, I can consider loose stools as an indicator of over medication due to this being the case prediagnosis.

Just pay close attention to changes (less on tests even the at home gadgets) and more on how you feel. If it feels wrong, you’ll soon know.

[Kriticat in reply to HealthStarDust]

Thanks HealthStarDust , I've only been on 88 for 7 weeks so sticking with it for now... The achy joints weren't a problem prediagnosis, but I have recently developed osteoarthritis, just thankful it's not RA.

[HealthStarDust in reply to Kriticat]

I hope for you that it isn’t overmedicated, as symptoms of over and under overlap. Not easy is it?!

See how you go in the following few weeks I think? I can state for me, some symptoms get better and new ones have developed and some have resolved while optimising dose.

[Kriticat in reply to HealthStarDust]

Too right, it's not easy, that's why I don't want to change anything while I feel so well, it's the first time in years! I know it might not last, but at least I now know that it's possible

[HealthStarDust in reply to Kriticat]

I’m so confused. It’s just a small dose really is 88mcg, so why has it taken 3 years to feel well?

As I mentioned earlier, I have developed new symptoms while optimising dose, and they have resolved. Took a few months and dose increases. Other symptoms still present of course.

When I believe I was over medicated, I didn’t wait or care for tests results (although I did have a test at time due to my suspicion of over medicated). I simply reduced my dose and informed the GP the following week. While overmedicated, my joints felt worse in areas I didn’t experience joint pain prediagnosis and experienced insomnia in a way I hadn’t before. This may have resolved, as it was only 6 weeks on that dose but it wasn’t worth the risk to me. I needed sleep!

So, main thing, just pay close attention to yourself.

Hope that’s helps 🫶🏽

[Johnfishman22]

How you feel is most important. If you have no overmedicated symptoms you are probably fine. Just keep monitoring them and if any come on, then you know what it is, and if none do then you are good. I am currently finding my dosage with my doctor and my levels have been "normal" for 4 different dosages, so he's going based on how I feel. If you are overmedicated you will feel it, I was and it sucked. Fast heart rate, being hot, and unable to sleep are key giveaways

[Kriticat in reply to Johnfishman22]

You're right Johnfishman22 how I feel is the most important thing, quality of life is my aim and having finally achieved it after 3 years of juggling doses, I really don't want to mess it up. Good luck finding your own sweet spot, you are lucky to have a doctor who prioritises how you feel.

[arTistapple in reply to Johnfishman22]

I get what you are saying but I am pretty sure I get these symptoms when I an under dosed - unless of course my thyroid has become more ‘well’.

[DippyDame]

If you feel well I'd suggest you maintain current dose of 88mcg T4....it's not a huge dose.

Never change dose on basis of TSH ...which science proves is not an accurate marker

Listen to your body...it will tell you if something is wrong

Croaky voice is a symptom of undermedication!

You are unlikely to be overmedicated if FT3 remains in ref range.

Some need a fairly high FT4 in order to achieve a therapeutic level of T3....from the body's conversion of T4 to T3.

For good health almost every cell in the body needs to be flooded with T3 by way of an adequate and constant supply.

Keep working on vit D....aim for at least 100

Do you take a good vit B complex?

Stay well

[Kriticat in reply to DippyDame]

Thanks DippyDame yes, that's what I will do, I'm glad everyone is saying what I wanted to hear, and so grateful for the support on this forum... without it I would almost certainly be still extremely poorly. I take yipmai liposomal b complex recommended on here, and a separate b12, D is steadily increasing, I don't get on well with the sublingual drops, but I've got some capsules now, so hopefully I'll be more consistent with them and see greater improvement.