Which days for reduced dose?

[WestElf]

I have been on 75mcg levothyroxine for over ten weeks with tiny improvements in some symptoms but a big increase in others. I am now suffering badly with anxiety, low mood, tearfulness, aversion to food, depletion of appetite. However my thyroid blood results are now ‘optimum’ - T4 21 T3 5.3 (more info and blood results in Bio)

At my review appointment last week my thyroid specialist suggested I reduce my dose of levothyroxine by 10% by taking 75mcg on weekdays and 50mcg at weekends. I am wondering if it is important to take the 50mcg on two consecutive days or if she suggested weekends for convenience. I would actually prefer to take the reduced dose on Wednesdays and Saturdays as that would fit better with my routine but obviously I want to do what is therapeutically correct. I should have queried this with my specialist but the appointments are so short and I didn’t think of it.

My doctor also increased my oestrogen and wants me to add in testosterone in 5 weeks.

I held off on reducing the levothyroxine dose last week because I increased the oestrogen and my mood improved for a few days but that has now worn off so I’m thinking I should reduce the dose this week. I am feeling so dreadful and desperate to feel better.

I wonder does anyone know if it advisable to do the Sat and Sun or is Wed/Sat ok?

[TiggerMe]

I use Sat and Wed for my change of dose and it works well, so whatever suits you but I'd also suggest that these symptoms are very likely tied in with your low sex hormones and if you can battle on you will likely find that the testosterone will put that spring back in your step as it will also back up you obviously low oestrogen levels

[WestElf in reply to TiggerMe]

Thank you so much for saying that. When the anxiety drops a little, and I can think rationally, this is what I think too - that I just need to hang in there and work on the sex hormones. I’ve put in a lot of hard work to get my thyroid levels optimum, what a shame to reduce them now! But when the anxiety peaks it is so hard to be logical. I question the whole treatment plan and whether I should even be on levothyroxine at all.

It is helpful to hear an objective viewpoint.

Perhaps I’ll hold off on reducing the dose a while longer…

[TiggerMe in reply to WestElf]

Low oestrogen turn me into an anxious, self doubting loon, with horrible nightmares more like PTSD.

The chances are when you get your sex hormones up a bit you might have to add this little T4 decrease back in as all hormones interact, balance is the key and it takes a little experimenting to find what works for you

[TiggerMe in reply to TiggerMe]

Have you managed to optimize all your vits and mins as these also help greatly?

I see you are using patches, it wasn't till I stuck 3 x 50's on as an experiment that I realised I just wasn't absorbing them well and switched over to Lenzetto spray

[WestElf in reply to TiggerMe]

I think I am doing ok with nutrients. I’m supplementing D, B12 and folate as per recommendations from this forum. I’m doing my best with increasing ferritin in my diet but my many difficulties with eating make it hard. My result isn’t terrible though…

[TiggerMe in reply to WestElf]

I’m out walking the dogs now so can’t refer to your excellent bio, have you tried skipping dairy as it’s common to become intolerant and often the tiny amount of lactose in T4 can give you the ick

[WestElf in reply to TiggerMe]

Realistically I can’t experiment with excluding any food groups currently as I struggle to get anything at all in as it is so cannot restrict calories further. However I’ve had allergy tests over the years and dairy has never come up as potential for me so I think I’m ok there.

I’ve tried Evorel, Estradot, Sandrena and Estrogel. Blood tests didn’t show any big differences in absorption from any of them. I think I am just a poor absorber of them all! I’m happy to stay on patches as I do absorb something from them and they are less time consuming in terms of application than the gel. They were also the first estrogen I tried back in March 2022 and made me feel normal for a couple of weeks for the first time in years.

[TiggerMe in reply to WestElf]

Just a heads up in that swallowing hormones can for some seem to be the cause of the intolerances as obviously it isn't the standard route, I didn't have issues before starting on Levo and now have several intolerances and find lactose free T3 & 4 makes a big difference. I found a difference within 3 days whereas going gluten free is much longer term, thankfully I found it's only barley I need to avoid 😅

I'm with you that the gels are yucky but I do find the spray works well, is quick drying, easy to adjust dose as well as being a body identical form of estradiol

[WestElf in reply to TiggerMe]

Oh I see - thank you - something to consider…

Yes, Lenzetto still an option for me if needed 😊

[Buddy195 Administrator]

Personally I would only make one change at once- either adjusting the Levothyroxine slightly or the HRT, as otherwise it’s hard to work out which change is beneficial.

I also make adjustments super slowly- eg in increments of 12.5mcg (alternate days at first).

[WestElf in reply to Buddy195]

Yes thank you I wondered this too. I think I’m probably best sticking with the current Levo dose if I can. I’m just worried that my T4 of 21 (12-22) is high and that may be causing the anxiety.

[Buddy195 Administrator in reply to WestElf]

Having FT4 at the top of the range makes my anxiety spike, although I seem fine with FT3 high in the range. Ive found it best to make adjustments very slowly so you don’t miss your ‘sweet spot’ where you feel most well.

[SlowDragon Administrator]

Free T4 (fT4) 21 pmol/L (12 - 22) 90.0%

Free T3 (fT3) 5.3 pmol/L (3.1 - 6.8) 59.5%

Assuming test done as recommended?

tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[WestElf in reply to SlowDragon]

Yes test done as per protocol.

[SlowDragon Administrator in reply to WestElf]

So shows poor conversion

Likely to benefit from addition of SMALL dose of T3 alongside slightly reduced levothyroxine

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

thyroiduk.org/contact-us/ge...

[WestElf in reply to SlowDragon]

Thank you. So do you think it’s possible the high-ish T4 is causing the anxiety and that reducing T4 to the suggested 50mcg for 2 days is a good idea? And then maybe seeing if the Dr will add in T3 later to address symptoms?

I’m already seeing a recommended thyroid specialist (don’t want to name names) so I’m ok there thankfully.

[SlowDragon Administrator in reply to WestElf]

Yes …..high Ft4 can make you feel anxious/difficult sleeping etc

Adding small doses of T3 …..often calming and more relaxed and more energy

Typically starting on 2 x 2.5mcg T3 per day or 5mcg single dose

Then probably increase to 2 x 5mcg after 1-2 weeks

Hold at that dose then retest 6-8 weeks later

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

[WestElf in reply to SlowDragon]

Thank you for sharing your knowledge with this. I feel reassured to go ahead with what my doctor said last week - reduce T4, increase oestrogen and add in testosterone in six weeks. I will then speak to her about T3 at my next appointment.

Thank you 🙏