I tried lowering T4 dose but now feeling under medicated

[Sailing14]

Could the helpful members greygoose McPammy and TiggerMe offer further advice on this please? And anyone else if they can.

I am definitely feeling the symptoms of too low t4 and I don’t know what to do now. I have raised it back up again as I couldn’t cope with the symptoms.

I am on a ppi and take it away from the thyroxine but I don’t know if a conversion issue (if it is that) is causing the acid reflux or the reflux is causing the poor conversion.

Thank you for any advice possible.

[SlowDragon Administrator]

What are your most recent vitamin D, folate, B12 and ferritin results

Your previous posts show you have poor conversion rate

And last test high, over range Ft4

How much did you reduce dose levothyroxine by?

How long did you stay on lower dose

Once vitamin levels are all optimal if Ft3 remains low …..look at getting T3 prescribed alongside slightly reduced dose Levo

Have you tried gluten free and/or dairy free diet

[Sailing14 in reply to SlowDragon]

Thanks a lot for your reply and advice.

My vitamin D was 65 in June and B12 420.

I have to wait for the results of a caeliac test to see if I am gluten intolerant so will see what to do then.

I reduced by 100 to 100/75 and within days I felt very under medicated so I really don’t know the best thing to do.

If it is my conversion, why would it be now or is it with increasing age (late 50s).

[SlowDragon Administrator in reply to Sailing14]

Very common post menopause/as we get older to find conversion gets worse

Aim to maintain vitamin D over 100nmol, B12 over 500 , ferritin at least over 70 and folate at top of range

[TiggerMe]

We talked in the past about your likely need for some T3, dose change often takes a little getting used to and doesn't mean its the wrong thing to do.

Did you do the burp test?

The issue we have is that your testing has been erratic which makes it harder to really see what is going on

[greygoose]

I am on a ppi and take it away from the thyroxine but I don’t know if a conversion issue (if it is that) is causing the acid reflux or the reflux is causing the poor conversion.

Well, neither. They are two separate issues.

And, it doesn't matter how far away from levo you take the PPI because the result is always the same: low stomach acid. That's what PPIs do, they lower the level of stomach acid because doctors always think that digestion problems have to be caused by high stomach acid. But when you are hypo, your stomach acid is far more likely to be low already, and a PPI just makes things worse. The symptoms are the same for high and low.

So, you're probably not absorbing your levo very well, and are now under-medicated. Does your doctor test the FT4, or just the TSH? What were your latest results?

To know if you have a conversion problem, you need to get your FT3 tested at the same time as your FT4, can compare the results in percentages. But I expect you'd have to get private testing to get that done.

h

[TiggerMe in reply to greygoose]

With T4 taken 2 hours before

[greygoose in reply to TiggerMe]

How much levo?

[TiggerMe in reply to greygoose]

100mcg

[greygoose in reply to TiggerMe]

OK, so the OP seems to be absorbing well, but could still be under-medicated. Impossible to tell when levo is taken 2 hours before the blood draw.

[TiggerMe in reply to greygoose]

Previous results were also 2.5hours after dose but only 4 weeks after a brand change so it's really hard to tell what is going on as we don't have any reliable result to go from 🤷‍♀️

Not sure if this was 75 or 100mcg?

[Sailing14 in reply to TiggerMe]

Thanks a lot for your reply. This was on 100 mcg and an NHS test early June.

NHS has shown this year twice T4 as normal range but two monitor my health (Feb and August have shown over range, especially this one.

My symptoms feel like under medicated as I was very under medicated on 75 mcg back in 2022 and increased but the symptoms got a lot better (following the increase).

[TiggerMe in reply to Sailing14]

Which if any where done pre 9am without levo for 24 hours, water only before and on the same dose/brand for 8+ weeks? Might be the better way to look at it and discard the others

[Sailing14 in reply to TiggerMe]

This test was early June a few hours after taking 100 mcg thyroxine. Could this be showing under medicated on this test considering tablet was taken and MMH in August this year false high?

I will go through the GP surgery website for previous results this year after fasting and allowing 24 hours. I haven’t been saving them as I can access their site, but I know now it is better to store them somewhere to go back to.

Thanks

Thyroid results

[TiggerMe in reply to Sailing14]

This one shows one of your best results, good conversion but you'd only been on that dose for 4 weeks so hasn't had a chance to settle properly but if I remember rightly your vits and mins weren't optimized then either?

[Sailing14 in reply to TiggerMe]

I had been on 100 mcg since last November before this test early June. I changed to Mercury Pharma just after this test but after around 8 weeks I returned to accord (GP refused a blood test at this stage).

 greygoose commeted I may be undereducated here (the 100 mcg thyroxine was taken 2 hours before in error this time) but I couldn’t delay test due to another health issue.

Could it be if T4 was at 15.9 allowing for having taken T4 before test, that this T4 could have been a lot lower?

Sorry this is all a bit of a mess when trying to explain.

[TiggerMe in reply to Sailing14]

No idea it all depends how well/ quickly a person absorbs and your mid August result came in at 27.8... 2 hours after taking your 100mcg dose 🤷‍♀️

[Buddy195 Administrator]

How much did you reduce Levo by? I like to go ‘low and slow’ when making adjustments- ie 12.5mcg reduction alternate days at first, then daily until well tolerated.

[Sailing14 in reply to Buddy195]

Yes I agree but this reduction turned within a few days to undermedicated so it is all confusing still.

Thanks for your reply and advice.

[Catseyes235]

Why are you taking a PPI? A small change of diet meant I hardly ever take them after years of taking.

[Sailing14 in reply to Catseyes235]

Thanks but do I need to get this flare up under control first?

GP said at least a month and when I stop it for a few days at the moment all symptoms return.