Am I overmedicated? How best to manage these results?

[Chasing-rainbows]

Hi, I posted my latest results this morning but think the post must have been missed as I've had no replies. Can anyone have a look at these results for me please and help me work out how best to manage my medication, levothyroxine 75mcg.

[Jaydee1507 Administrator]

How did you take this test? Time of day? When was last dose of Levo before the test?

Vitamins all look optimal. Well done.

How do you feel?

If you allowed 24hrs from last dose of Levo before thtest you may be marginally over replaced.

FT3 is only 62% of range though so really it depends how you feel and how you took the test.

[Chasing-rainbows in reply to Jaydee1507]

Test was taken at 07.45am and I had left 24hrs since last dose. Symptoms wise just tired and brain foggy which is the same as I feel when I'm hypo so I was a bit surprised at these results.

[Jaydee1507 Administrator in reply to Chasing-rainbows]

You're really only a tiny amount over replaced so dropping Levo by 25mcgs once a week should be enough to bring your FT4 back into range.

Your FT3 could possibly use a boost with a small amount of T3. You can email [e-mail] for a list of T3 friendly Endo's.

Have you tried a strictly gluten free diet? Some Hashi people also need to remove dairy from their diet to feel well.

[Chasing-rainbows in reply to Jaydee1507]

That's interesting thank you. I did try 6 months of gluten and dairy free but it didn't seem to improve anything for me unfortunately.

[Buddy195 Administrator]

I personally would not want my FT4 at the top of the range, due to potential risks to heart health. I’ve experienced palpitations, tremor and fast heart rate when FT4 has gone over range.

What are your current symptoms or do you feel well?

We all have different ‘sweet spots’ where we feel most well.

[Chasing-rainbows in reply to Buddy195]

I feel OK apart from fatigue and brain fog which I'm quite used to feeling to be honest!

[FallingInReverse in reply to Buddy195]

Hi Buddy - a quick question on a complicated topic… do you have a link that talks about the heart risks of high t4 due to excess exogenous Levo… or is it high t4 from actual hyper that is the concern, or… ???

edit: I’m also remembering the same logic with suppressed tsh… how studies show its not the suppressed tsh from exogenous hormones that’s a problem, but suppressed tsh from actual hyper that is.

[Buddy195 Administrator in reply to FallingInReverse]

 jimh111 may be able to offer links re heart health

This one relates to cancer healthunlocked.com/redirect...

I suggest posting this question in a new post, so not to detract from original post.

[jimh111 in reply to FallingInReverse]

Hyperthyroidism carries bone and cardiac risks resulting from too much hormone activity. There are also risks from an fT4 in the upper part of the reference interval, from above average normal fT4 levels. See healthunlocked.com/thyroidu... .

[FallingInReverse in reply to jimh111]

There’s my weekend reading! Huge thanks for the link Jim,l.

Buddy - agree I shouldn’t hijack a post but I do think it’s directly relevant to OPs decision. Which is … what to do with a ~100% in range T4. And what level to aim for while we consider that in combination with how we feel.

It s a minefield isn’t it!

[pennyannie]

Hello Chasing-rainbows:

Do you feel over medicated as these blood tests do not show that you are :

However a blood tests is just a snapshot in time and tends to run a couple of weeks behind symptoms being tolerated.

Once on thyroid hormone replacement the TSH is the least important reading and can go very low and when under 1 not a reliable measure of anything.

Your T3 is in range and your T4 a fraction over rage which isn't really worth talking about -

How long did you leave from your last dose to your fasting blood draw ?

You have over range and positive antibody readings for TPO and TgAB antibodies which is a positive for Hashimoto's - a thyroid Auto Immune disease where the immune system systematically attacks and disables your thyroid with you becoming hypothyroid and needing the support of thyroid hormone replacement medication.

With Hashimoto's you are liable to erratic own thyroid hormone production and to experiencing ' swings in symptoms from hypo to hyper to hypo ' when your thyroid comes under attack from your immune system - and if suffering symptoms could this be an immune system flare - rather than over medication.

Many forum members follow the research and suggestions of Dr Izabella Wentz who writes under - thyroidpharmacist.com

[Chasing-rainbows in reply to pennyannie]

This definitely sounds like I'm experiencing those hypo to hyper swings. I've never picked it up on a blood test before but this seems to confirm it?

[pennyannie in reply to Chasing-rainbows]

Well both sets of thyroid antibodies are over range so this shows that there have been further AI attacks and likely your symptoms the consequences :

How do these T3 and T4 readings compare to previous readings ?

Are you still taking the Propranolol as this tends to ' slow ' the conversion of T4 into T3 - maybe a different beta blocker might be worth considering - that doesn't effect this thyroid process ?

We do not recommend multi vitamins as these generally do not use ' A ' grade supplements and if containing iron this mineral will negate the other contents within -

Best to supplement core strength as needed, track and adjust, as likely a long term plan - in order to keep maintained ferritin, folate, B12 and vitamin D at optimal levels.

I now aim to maintain ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500++ ) and vitamin D at around 125.

Everywhere I researched suggested that no thyroid hormone works well until feritin is at least over 70 ?

[pennyannie in reply to Chasing-rainbows]

If you ' think this a swing ' - some people stop taking their thyroid hormone replacement for a few days to try and offset the worst of the symptoms being tolerated - ??

[Chasing-rainbows in reply to pennyannie]

Oh I never started the propranolol in the end, I am on sertraline now and not experiencing the palpitations anymore so think it was anxiety causing them.

[FallingInReverse]

Curious looking back at your posts, I see the post from 7 months ago, where you had already been on 75 Levo for a couple months.

Is this the first blood test you’ve had in 7 months, and has nothing changed in 9 months with your dosing and vitamin supplements?

[Chasing-rainbows in reply to FallingInReverse]

Yes, my last medichecks test was in December and these were my results then. I did post a few months back thinking I may have been having a hyper swing at the time but then those symptoms settled so I held off of getting any further tests done until now. I take a multivitamin with iron as advised by my gp which seems to have improved my ferritin which I have previously struggled with low ferritin levels.

Results

[Den_And]

Looks very much like my results from several years ago. Your TSH is very low indicating the body does not need any more Thyroxine & this is confirmed by your free T4 being high and just outside range. Your Autoimmunity test results would indicate Hashimoto’s or Graves. Don’t know how long you have been treated but have you been diagnosed with a thyroid goiter?

[Chasing-rainbows in reply to Den_And]

Never been diagnosed with a goiter, initially treated with levo maybe 8/9 years ago. Stopped due to various reasons and restarted I think about 2 years ago now.

[Den_And in reply to Chasing-rainbows]

Worth trying a reduced levothyroxine to 50 mcg and get TSH & T4 retested again in 6-weeks.

Your autoimmune conditions however will still prevail and need confirming through GP & possible referral to endocrinologist.

It’s a tough condition to diagnose and manage. Symptoms can cover :

Fatigue and sluggishness

Increased sensitivity to cold

Increased sleepiness

Dry skin

Constipation

Muscle weakness

Muscle aches, tenderness and stiffness

Joint pain and stiffness

Irregular or excessive menstrual bleeding

Depression

Problems with memory or concentration

Swelling of the thyroid (goiter)

A puffy face

Brittle nails

Hair loss

Enlargement of the tongue

Anti inflammatory diet, de-stressing yourself and getting the right medications & vitamin supplements are some of the main management options.

[McPammy]

To me your T4 is too high especially if you left 24hrs since you last took any t4 meds before the blood draw. Your TSH is too low also indicating you have too much thyroxine in your body. Your symptoms of brain fog and fatigue are over medication. Over or under medication can feel very much alike. If it was me with those blood levels on 75mcg a day, I would change your daily dose to 75 one day and 50 the next to reduce the T4. Alternate 75 and 50 doses. It’ll take about a week to feel better. Then after two/three weeks get your bloods done again if your symptoms have subsided. You need to reduce T4.

[Chasing-rainbows]

Thank you all for your thoughts and advice. I've reduced my dose this morning to 50mcg. I'll have to have a think about whether to do alternate days of 50 and 75 or just once a week at 50 or everyday at 50. Lots of different opinions to consider there but I'll definitely get more frequent bloods to try and keep a closer eye on the levels. I agree it's a complicated condition to manage with the hypo to hyper swings. I can't complain too much I suppose as I am otherwise fit and well.

[HealthStarDust]

In my experience, it took a few months of being overmedicated before it affected my heart. That is to say, heart symptoms are not a reliable marker of over medication.

[Chasing-rainbows in reply to HealthStarDust]

I've just been reading some of your posts HealthStarDust and we sound similar, both had tpo above 1300 and miscarriages too. How are you getting on now? What happened to you when you were overmedicated in terms of your heart etc?

[HealthStarDust in reply to Chasing-rainbows]

We do have similar histories. I didn’t have just have TPO over range but an elevated TSH of 8? What was your TSH at diagnosis?

I haven’t achieved wellness with levothyroxine after a year+ of trailing different doses and brands, so I’m currently taking a break from levothyroxine and any vitamin supplements partly to get a measure of what my thyroid is doing on its own.

[Chasing-rainbows in reply to HealthStarDust]

My tsh was only ever just above range, somewhere between 4 and 5. Sorry to hear of your struggles, it isnt an easy journey at all. I have used Monitor My Health for thyroid tests and Medichecks for the advanced thyroid test which includes vitamins and antibodies. Hope you find the answers you need soon.

[HealthStarDust in reply to Chasing-rainbows]

Thank you.

[FallingInReverse]

Yes, lots of opinions here… here’s one more lol!

I have been pondering that your FT4 was only 40% through range after a couple months on a stable dose of 75, and now it shows slightly over, and it’s SEVEN whole long months later where you’ve changed nothing else. That’s a long time with no changes.

Although your vitamins are admirable : ) and perhaps could be improving your absorption…

And we are certainly all different. But, generally, 50 is a starter dose and more often that not, it’s not enough on our way to the broad-stroke guideline of 1.6 mcg per 1 kg body weight.

I’m just marveling at this jump in ft4 in the last 7 months where no dosing has changed. And personally I lean towards the responses above that say - for example, maybe one day a week drop to 25. Or drop for a few days. Or alternate days.

Even when I increased from 50 to 75 I did it with +12.5 for 6 weeks, then another 12.5 for another 6 weeks.

More frequent testing going forward is absolutely necessary… but I’m just one voice here calling out the trued & true “low and slow” of any change.

[Chasing-rainbows in reply to FallingInReverse]

Sounds like I have some trial and error ahead! I'm pleased with my vitamins especially as my ferritin was 20 for quite a while. I'll monitor tsh, ft3 and ft4 much more regularly and recheck vitamins at least once per year.