I was advised by endo to increase T4 by 25mcg as at the 27th September 2024. This was after getting too hot, not sleeping and very sweaty day and night and banging heart rate (too high for me).
Well after 15 weeks I had a piercing headache, massive mood shift, felt depressed, cold, aches and bone cracking (shins).
my results at 16 weeks were as follows:
Ferritin: 137 ug/L (range 30 - 264)
Folate: >45.4 nmol/L (range > 7)
B12 Active: >150 pmol/L (range > 37.5)
Vitamin D: 121 nmol/L (range 50 - 200)
TSH : 1.950 mIU/L (range 0.27 - 4.2)
Free T3: 3.5pmol/L (range 3.1 - 6.8)
Free T4: 18.9 pmol/L (12 - 22)
I came down by 12.5mcg levo 3 weeks ago, I feel dizzy, my hair is really thin, I have water weight (swelling of the ankles especially the left ankle). Tired again, to be honest I have been out of the house for twice in a whole month.
The endo, as I suggested, requested the following tests from my GP Cortisol, testosterone, LH, FSH, Oestradiol and an ESR. The GP has refused. I have run out of options now. I don't think the endo knows what he is doing with the T3, he's just looking at the TSH. I had managed to get my T4 to 75% through range, when I tried to get the Free T3 up by adding a small amount of T3, I lost more weight and then I couldn't walk, then the heart rate goes up, can't sleep and get really hot and sweaty. I don't know what to do now.
Please help.
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AleB
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I had my blood test at 8.30am, fasting, and took meds after the test. My last dose of T3 was 10pm. I split my T4. As I mentioned, I have only really dropped the T4 by 12.5mcg in the last 3 weeks. So I am now feeling the effects of that drop, the T3 was dropped in September from 3.75mcg to 2.5mcg, split into 1.25mcg am, and 1.25mcg at 2pm. I am not taking HRT, I have been prescribed it, though I have not had any blood tests relating to the menopause. I wondered if I should get tests done and also cortisol. When I was on the 3.75 of T3 my adrenals were the best they have been, no balance issues, however I still had poor eyesight and fatigue. I will update my bio to give a bit more background history.
Looking back on previous post you were taking only 50mcgs Levo + small amount of T3, likely far too lower dose of both. Most people on a combi dose need 100mcgs Levo + 5-20mcg T3.
If your Endo is keeping your TSH within range it may be that they never make you well and you might need to look elsewhere for an Endo.
Vitamins look great but have you had an iron panel to ensure that level is good?
I take 3 days at 100mcg levo, split am and pm, and 4 days 87.5mcg levo, again, split am and pm. I take 1.25mcg T3 am with the levo and then 1.25mcg T3 at 2pm, last dose of T4 at 10pm. Prior to this (3 weeks ago), I took 4 days at 100mcg levo and 3 days at 87.5mcg levo but with the reduced T3. My symptons during that increase of T4 was of freezing cold, bone cracking, stiffness, muscle aches. It did however improve my sleep for a few weeks and then back to poor sleep, sweating and then poor mood. I have held off with HRT. Would I need a full iron panel, I take B-Complex. My Ferritin looks ok... for many years it (on T4 only) it was always low. If I increase T4 I will be well over the ideal 75% range or does this not apply? I have tried NDT (WP thyroid) back in 2018/2019, went back to T4 couldn't get back to what I used to take 125mcg, now on T4/T3 combi but have been up and down for the past 2.5 years.
When we change dose, the minimum time to retest levels is 6-8 week, loger is often more accurate as levels can still settle a few months on.
So testing after 3 weeks wont give accurate results.
The last dose before the test should be timed for levo - 24hrs, T3 8-12 hours. Particularly for T3 it has a short half life and leaving too long will give results with a false low. Just delay when you take your dose the day before.
Ferritin can be good or even high when serum iron is low which is why I suggest an iron panel. Also if there is any inflammation that can falsley raise ferritin. Did you have a CRP or ESR test at the same time?
The reason you're still symptomatic through all this is either your FT4 has been too low or your FT3 as well. You now need to increase T3 and leave Levo where it is. Aiming for 70% through range for both FT4 & FT3.
Suggest you change Endo of they will only offer a micro dose of T3.
and increased levo by just 3.57mcg /day (25mcg a week)
8th November 8am: (test done too soon after dose change )
TSH 1.65 (0.27 - 4.2)
fT3: 4.1 (3.1 - 6.8)
fT4: 19.6 (12 - 22)
retested after 16 wks:
TSH 1.95 (0.27 - 4.2)
fT3: 3.5 (3.1 - 6.8)
fT4: 18.9 (12 - 22)
since that test you've reduced levo by 1.78mcg / day (12.5mcg a week). and been on that for 3 weeks now.
3 weeks is too soon to know how that will feel yet.
but looking at the increase in TSH, and the reduction in fT3 since sept .....
i think you should be looking towards adding back the other 1.25mcg of T3
(so i would try 3.75mcg T3 with current dose of levo)
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one thought ... have you ever tried taking T3 dose in one daily dose rather than splitting it ?
i know that sounds counter intuitive when it feels like it's already too much ....but i have found i'm coping better with a single dose of 6.25mcg T3 taken around 11am (levo split am / bedtime)..... i was doing 2x4mcg T3 , but while it didn't initially interfere with sleep , it did after a while , and after a few wks 8mcg had started to feel like too much (again) ..
logically , i like the idea of splitting dose , but twice now i've run into similar problems to you when taking 2 or 3 doses and both times i've felt more stable by taking very slightly less as one dose.
I had wondered about toying with the idea of taking T3 altogether in the morning. Worth a try ... should I wait for the drop in T4 and add back the T3 or do I drop a further 12.5mcg as the previous bloods done on the 8th November 2024 were at 19.6 which is 76%
I've tried this too and my energy levels tank midday if I split my T3 in half, if I take 10mcg at 6am I'm like the duracell bunny, just keep going all day and sleep like a log - its very odd when so many recommend splitting, I keep re-trying but get the same reaction. I'm going to only do it on day before blood tests from now on.
Well for the past two days I haven't had to go to bed at around 2.30pm. That said, I am still hot and restless at night. The first bight I slept from 10.30om until 5.30am. The second night the same, last night, it was gone 11.30pm, too hot and woke at 5.38am this morning. I wonder if theT4 is too high, I noticed since the endo had me increase the T4 by 25mcg (I have reduced by 12.5mcg), I am very short tempered, I also feel a bit wired!
It’s tricky because sometimes these things are short lived and it’s better to see it the rough for the full 6 weeks but yes, if you think FT4 is too high best to reduce it a little.
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Thanks so much for your help. I'll give it a go. 
Am I undermedicated? Confused about where to go next.
T3 and T4 results
I am not wonder woman yet unfortunately !!
Help with bloods, high cholesterol. I am on 50mcg T4
