Best way to reduce Levothyroxine dose?

[Agitator23]

Hi All

As you may remember I was finally diagnosed with central hypothyroidism in June this year after many years of a 'mystery illness'.

I am taking Levothyroxine 112.5 mcg and have changed from oral oestrogen HRT to a patch. I think the oral route was really interfering with other hormones by raising my SHBG levels.

My SHBG was off the scale in previous blood tests and is now within range. I think that reducing the SHBG level has also helped raise my FT4 and testosterone levels. That's my thinking but I may be wrong!

I am also using testosterone gel as I had undetectable levels. I'm sure this lack of testosterone added to my many symptoms.

My latest private blood test results are in photo below this post. (Not shared with GP).

** NB I decided to take my usual dose of Levothyroxine in the morning before the blood test. I know that this is not the advised and usual way. I wanted to find out the highest point of my FT4 spike. So I understand that my FT4 is lower than 23 most of the time.

I feel pretty good on this cocktail of hormones but in the last week I have had slight insomnia (very unusual for me), mild pins and needles and slight headache (also unusual for me). So I have decided to drop the dose of levothyroxine a little.

What is the best way to do this? I'd like to bring down the FT4 as quickly as possible but not too far. Should I not take any Levothyroxine for a couple of days? Or just take 100 mcg per day for a while? At present I'm taking 100 mcg on 4 days and 125 mcg on 3 days. Or is there another way to do this? Maybe 125 mcg just once or twice a week?

I think I'm only slightly over my sweet spot so, although I want to bring the FT4 down, I don't want to drop too far.

Many thanks in advance for your advice!

[Sleepman]

I cannot see the photo. Can you check.

[Agitator23 in reply to Sleepman]

Will do!

[Agitator23 in reply to Agitator23]

Blood test results

Blood test results

[Jazzw]

As Sleepman says, there isn’t a photo of your results?

But I think we may struggle to give much advice because of you taking your levothyroxine just before your test. It means it’s going to be hard to advise on how much (or even whether) to reduce your levothyroxine dosage.

That said, I really wouldn’t reduce it by much (if at all). You could perhaps drop just one of your 125mcg doses to 100mcg? But it sounds like you’ve had a lot of hormone changes in recent months and it might be a little too early to make changes?

[helvella]

Why do you want to bring your FT4 down? 23.2 when top of reference interval is 28.2 isn't high! Especially when taking into account the short time between dose and test.

TSH 0.005 mIU/L (0.4 - 4.05) -10.8%

Free T4 (fT4) 23.2 pmol/L (10 - 28.2) 72.5%

Free T3 (fT3) 7 pmol/L (3.5 - 9.46) 58.7%

T4:T3 Ratio 3.314 

(Both FT4 and FT3 have unusually high top ends!)

I can understand the idea of getting a peak level but it is close to impossible. It only stays at that high level for minutes. And your chance of getting blood drawn at just the right time for you are slight. (Time from ingestion to peak is affected by the tablet, your body, etc.)

And when you accept it might be a little away from the peak, you are into guessing how far, how much higher the peak would have been, etc.

helvella - Scheduling Blood Draws

Factors to consider when choosing time for blood draws. Includes links to several documents/webpages and previous HealthUnlocked posts.

Last updated 12/08/2024

helvella.blogspot.com/p/hel...

[Agitator23 in reply to helvella]

All true. It's really based on how I'm feeling. I really don't like the insomnia. It's not me. I normally sleep like a baby! Feeling a bit wired to be honest. Thinking of reducing to 125 once or twice a week and see how I feel. Not really worried about FT4 at 23. It's that plus my symptoms. My endocrinologist was aiming at 20. I haven't spoken to him yet. I like looking at the results myself first 😊

[helvella in reply to Agitator23]

Do not aim to do anything quickly!

We so often see where that has been tried and caused a mess.

It is so very easy to change a dose and feel OK initially. But when everything stabilises it isn't enough. So need to increase a little. Possibly several times.

I much prefer taking the same dose every day. And I'll even split tablets to achieve that.

But I also take mine at bed-time. And (mostly) sleep very well! However, we are all different and what works for me might not suit you. And I take 125.

I was on 112.5 for quite a long time. But it just didn't quite work and overall I felt slightly under-dosed - my sleep wasn't as good. My heart rate regularly rose. Increased to 125 and have been much better. Blood test shows absolutely fine. And heart rate more stable and slightly lower.

[Tina_Maria]

I know we are all different how we respond and feel, but looking at your thyroid results, many would say that they are quite optimal, however this will be distorted by you taking levothyroxine before the test, so really not an accurate guide. Peak plasma concentrations of levothyroxine occur between 2 and 4h after ingestion, so it depends when you took levo beforehand and also if you have taken your 100mcg or 125mcg dose.

As you had quite a lot of hormonal changes recently, this will influence your overall well-being. For example low and high testosterone can impact your sleep and cause insomnia, and dependent on when you started taking testosterone, this may take a while to settle. I would be inclined to keep your dose of levothyroxine constant for the moment until your other hormones have settled. If you change too many things in a short period of time, it is difficult to know what has had the impact. If the symptoms still persist, then I would take another thyroid test (this time without levothyroxine) in about a month's time perhaps, so you get a accurate plasma hormone levels. This way it is much better to see what your general availability of thyroid hormones are and if your medication needs adjusting.

[greygoose]

Have you not considered that your insomnia might be due to your FT3 being too low? 58.7% would be too low for quite a few people.

I really can't help wondering how you thought that testing your peak level was going to benefit you. What use is that information? Seems to me like a waste of a test. And it's surely going to confuse the hell out of your endo!

[Agitator23 in reply to greygoose]

Thank you for your reply Greygoose.

My FT3 has always been quite a bit lower over the past year without insomnia. So I'm not sure of the reason.

I'm probably not sharing these with my endocrinologist. It was out of interest that I wanted to see the highest the FT4 would be at peak. It's reassuring it's only 23 at peak.

I was really interested in comparing my SHBG to previous results and checking my testosterone level - I actually have some now!

All going in the right direction. Just don't want to overshoot FT4 now the SHBG is much lower and probably dropping more.

[greygoose in reply to Agitator23]

Except, as helvella pointed out, you cannot know if that was the peak, or if the level was still rising, or if it was over the peak and dropping again. But, in any case, it doesn't matter because the peak doesn't last long enough to influence anything. So, I till can't see why that's reassuring. If anything, it would lead me to conclude that I was under-medicated if that was the highest it could get.

[Agitator23 in reply to greygoose]

Seems I have a lot more to learn! 😁

[greygoose in reply to Agitator23]

Don't we all!