Help/advice urgently needed please...dosage increase or not

[DizzyD]

Hi all would really appreciate some help and advice re: dose increase of thyroid medication. I am hypothyroid.....had a thyroidectomy due to cancer 1992.For reasons, too complicated to go into (mentioned in previous posts) NHS endocrinologist reduced levo dose to 50mcg alternate days in August 2023 because T4 was over range despite a prior decrease of levo. Incidentally, I was also taking half grain (30mcg) of Efra in addition to the levo reduction. Private retest via Medichecks in October after reduction to 50 levo alternate days was:

TSH 11.9 0.27 - 4.2

FT4 12. 12 - 22

FT3 3.5 3.1 - 6.8

Given these results, along with my usual dose of 30 mcg EFRA I made the decision to increase levo to 50mcg daily. Retest after levo increase November 2023:

TSH 1.53 0.27 - 4.2

FT4 17.3 12 - 22

FT3 3.9 3.1 - 6.8

Given these drastic results I did not increase daily dose 50 mcg levo or 30 mcg efra. Recent retest results January 2024:

TSH 3.47 0.27 - 4.2

FT4 15.9 12 - 22

FT3 4.1 3.1 - 6.8

Given these awful results I really would appreciate some advice as to increase of levo I could take. TSH of 3.47 indicates the need for levo increase. What do you guys think?

Brief explanation as to why I did not increase levo after November drastic results. Was prescribed Amiodarone April 2023 to treat afib. Came off this drug August gone. Despite coming off the drug the half life is very long. Consequently, a very high iodine content remains in the body for up to 6months or beyond and can push thyroid numbers up or down via conversion process so I had to be cautious with levo increase. Just hope iodine level has dropped to a level whereby it will not make much of on impact re: conversion issue when I increase levo dose.

Thank you for taking the time to read this post

Have a rewarding evening

[Jaydee1507 Administrator]

Free T4 (fT4) 15.9 pmol/L (12 - 22) 39.0%

Free T3 (fT3) 4.1 pmol/L (2.4 - 6) 47.2%

Obviously you need an increase now. Are you aiming for mainly Levo with an NDT top up or mainly NDT?

As you have mentioned Levo then 12.5 to 25mcgs Levo looks reasonable.

Hopefully you are almost through getting the awful Amiodarone out of your system.

[DizzyD in reply to Jaydee1507]

Thank you so much Jaydee. Yes I really do need an increase asap so decided to increase levo 25mcg alternate days to play it safe, as you so kindly suggested. Also going to do a small increase of NDT, 15mcg daily. Cannot tolerate hypo symptoms for much longer. Weight gain and brain fog driving me crazy. Never mind....it's time to live in the solution not the problem.Sincere thanks lovely

[Brightness14]

I really don't know how you manage on that low dose, especially with no thyroid. The only time I had afib was when my FT3 was too low. When increased the afib stopped completely.

When the body has too little T3 it increases the flight or fight mode i.e. Adrenaline mainly.

This causes afib. You need an increase in meds.

[DizzyD in reply to Brightness14]

Totally understand where you are coming from. I really worried about low T3 triggering AFib but I am in a position (post Amiodarone medication) where I have to take it very slowly with increase of thyroid meds. I have excess iodine in my body which interfere with conversion of thyroid hormones, so even at such a low dose, thyroid hormones could go too high or even too low. Either way AFib could kick in. Unfortunately, that's the nature of the Amiodarone beast.

More than likely I am running on adrenaline...dread to see state of my adrenal function.

Sincere thank you

[Brightness14]

Ok good luck to you.