Dose increase on Levo: FT3 & 4 same, TSH reduced? Now increase Levo or back to NDT?

[FoggyThinker]

Afternoon all,

After switching to Levo, as I increased doses, my FT3 has stayed about the same, FT4 increased once then stayed the same the last two increases, and TSH has gone down each time... Is this as you would expect?

Please note, the dates in the graph above are most recent on the left, to make it easier to read on a small screen I hope!

Tests were all done as advised here except when I was on Armour/NDT, I found that taking the NDT at 8pm (12 hours before test) kept me awake so, as it was just for my reference, I took it as usual about 3pm and skipped my morning dose.

I know that TSH is not a good guide as it's dependent on pituitary functioning well, but why would it decrease when the FT3 and FT4 stayed the same?

I feel better at 175g than at 150 or 125, though still not as mentally sharp as I was. Physically, joint pain and muscle weakness is worse, sweats/flushes about the same, sleep definitely worse than on NDT. Wondering if I should switch back to NDT, or try to find someone who will prescribe some T3 (I felt I should try T4 only as I did things a bit backwards and started straight on NDT, and my Adrenals were suffering which I'm now addressing) and would appreciate any general advice please?

Thanks very much for any answers!

[Regenallotment Ambassador]

hey Foggy

Good work it’s all going in the right direction. Good to see the slow and steady drop in TSH. It looks like your body is using up more and more of the hormone as you increase. How many weeks on 175mcg is it now?

It looks to me like your absorption is poor, are you gluten and dairy free? Do you struggle with gut health at all? Sweats for me is low FT3 so that could be a logical step when Levo is settled.

Which brand Levo have you been trying?

FT3: 4.3 pmol/l (Range 3.1 - 6.8) 32.43%

FT4: 16.7 pmol/l (Range 12 - 22) 47.00%

If you weren’t on such a whopping dose I’d suggest a raise but will defer to someone like  SlowDragon for that advice.

[FoggyThinker in reply to Regenallotment]

Thanks Regenallotment helpful thoughts as always Re:gut health I have had some symptoms, got a lot better when I went low GI and gluten free. Never tested for anything but I wouldn't be surprised.

I don't have a lot of dairy (none for 4 weeks on the adrenal plan) and am gluten free though could be stricter... I gained weight on the lower dose of levo to just over 14 stone which is heavy but you're right it's still a big dose.

I'm on compounded, just with rice flour... And have been on 175 for maybe 4 months? I'm on holiday at the moment so don't have my notes to hand, but I think that's right.

[Insomania]

Why did you switch from NDT to Levo?

I would’ve stayed at 2 grain in Aug 23 when you felt good! I do longer gaps between dose changes though, 6-8 weeks minimum.

[FoggyThinker in reply to Insomania]

Thanks for replying Insomania Aug 23 I felt very over replaced, started getting palpitations and anxiety - my suspicion is that I was advised to raise too quickly and my adrenals couldn't keep up. There is a thread somewhere where we discussed possible options, was also concerned about joint pain that seemed to have got worse since starting NDT. It just seemed worth a try on levo only as many people do seem to do fine on it, it's a bit cheaper and simpler, and if I didn't need the T3 then that could've been causing some of my problems... I don't think it's working out but maybe I just need more?

The gaps were 6 weeks min I think? Maybe a bit wicket at 125 to 150 as I felt dreadful, much longer this time though as I'm still on 175 and not sure whether to raise or not..

[Insomania in reply to FoggyThinker]

That makes sense, it is a high dose 2 grain. I got adrenals issues in the mix too. Are you doing an adrenal programme? I’m planning to when I’ve had an iron infusion plus this next NDT dose increase kicks in. Feel soooo fatigued I’m just getting by day by day atm. Good luck with levo and T3!

[FoggyThinker in reply to Insomania]

Adrenals and thyroid issues do seem to go alongside each other! Yes, I recently bought Izabella Wentz' book "Adrenal transformation programme" and it seems helpful, I think I need to pay some extra attention to gut health, now, too...

I'm sorry to hear you're feeling rough and hope things improve with the NDT dose increase

[Insomania in reply to FoggyThinker]

That’s the book I’ve got too.

[SlowDragon Administrator]

Guidelines suggest Levo dose is typically approximately 1.6mcg per kilo of your weight per day

If you’re taking more than this….and still have low Ft4 and Ft3 …this suggests poor gut function/poor absorption issues

which brand of levothyroxine are you taking

Are you taking on empty stomach and then nothing but water for at least an hour after

No vitamin supplements or other medications within 2 hours

Some like magnesium, vitamin D tablets, iron at least 4 hours away

Are you gluten free/dairy free

Have you had testing for H Pylori or SIBO

Your antibodies are significantly reduced now on levothyroxine compared to NDT

NDT increases antibodies in some Hashimoto’s patients

I would try further increase in Levo first……before considering adding T3

[FoggyThinker in reply to SlowDragon]

Thanks SlowDragon - that would suggest more like 140mcg. I've never tested but wouldn't be surprised if I had some gut issues. Next thing to tackle I think.

I take my T4 as suggested, am gluten free but not fully dairy free, and my Levo is compounded, just with rice flour.

Will try a small increase and see how it goes. Thanks again

[SlowDragon Administrator in reply to FoggyThinker]

Personally I was very surprised to find dairy free was as much of an improvement as gluten free

Worth considering trying

Is your levothyroxine lactose free

Why are you taking a compounded levothyroxine?

[FoggyThinker in reply to SlowDragon]

Yes, it just has rice flour - I went with the pharmacy's compounded one as I have to get it on private prescription, there were few choices of brand available and I wasn't sure the branded option was mannitol free...

I've just done 4 weeks of exclusion diet; all I really missed was milk in my coffee, porridge, and strong cheddar cheese. Maybe I should continue it. Thanks again as ever SlowDragon

[SlowDragon Administrator in reply to FoggyThinker]

Oat milk brilliant in coffee

Cathedral city do a plant based “cheeese” ….ok as an extra……probably not up to replacing cheese in cheese sarnie

[TiggerMe Ambassador in reply to FoggyThinker]

Any improvements with the small increase?

[FoggyThinker in reply to TiggerMe]

Thanks for checking in my brain feels better but body feels worse, more aches and pains and less energy. The dratted sweats are about the same or a bit worse. I think I need to stick with it for a bit and retest about 3 months from the increase?