Advice please on T4/T3 dose

[Ukie]

Hi. I would appreciate your thoughts on my current situation.

A couple of years ago I was on 100mcg Levo and I felt wonderful for 5 months. Then I started to get rapid heartbeat with night sweats. It frightened me, so I began reducing, testing, increasing etc. (over a long period, leaving time before testing) to try to find the sweet spot. Even with tiny adjustments I seemed to have either symptoms or heart issues.

Sept. 2024

After persuading my lovely GP to refer me, I had an appointment with an NHS endocrinologist in September 2024 whilst my dose was a stable 87.5mcg Levo. She advised combination therapy of 50mcg Levo + 10mcg T3 (🎉), so in preparation I immediately reduced my T4 dose to 75mcg. My joy was short-lived unfortunately because the endo was from a different area, and my surgery was unable to prescribe it because local endos did not agree.

Nov. 2024

I had an appointment with Roseway Labs, who agreed to prescribe 10mcg T3 (introduced gradually )and advised reducing Levo to 62.5mcg, which I did.

Dec. 2024

I was still experiencing nighttime heart symptoms, so I tried having my 10mcg T3 all in one dose in the morning. When I was still getting heart symptoms 22 hours after my T3 dose, I thought that the problem must be T4, so in late December I reduced Levo to 50mcg.

February 2025

I have a follow-up appointment with Roseway Labs next week. I now only get heart issues if I drink alcohol (even if only a little) so I’m not drinking at the moment. I feel about the same as before I started on T3, BUT since November I have gained almost a stone in weight, after it being completely stable for several years. Here are my Medichecks results from 2 weeks ago, on 10mcg T3 and 50mcg T4:

TSH 1.78 (0.27-4.2) 38.42%

FT4 13.6 (12-22) 16%

FT3 4.3 (3.1-6.8) 32.43%

What would you advise me to do now? I think I’m undermedicated, but unsure whether to increase Levo and risk heart problems returning, or increase T3. Obviously I will listen to the Roseway prescriber, but we may have a conversation on my thoughts. I know that my T4 is a lower percentage than my T3, but to be honest I get scared when I have nighttime heart problems, so I think I would favour trying a T3 increase first.

Thank you very much for your thoughts. Ukie.

[SlowDragon Administrator]

You also need to test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

What were last vitamin results and when were they

Which brand of Levo are you taking

[Ukie in reply to SlowDragon]

Thanks for response.

Folate 45.4 (>7)

B12 112 (>37.5)

D 110 (50-250)

Ferritin 191 (30-332)

In August 2024

Levo is Teva, which I have been on for ages with no problems.

Supplements: Thorne Basic B Complex, D3 2000iu, K2 200mcg, C 500mg, Omega 3 1000mg. + Magnesium 375mg (only since blood test)

[SlowDragon Administrator in reply to Ukie]

Well it could be the Teva causing issues

Teva upsets many people

See if you can get Vencamil Levo instead

Ideally only change one thing at a time

Your results suggest you are on inadequate dose overall

Palpitations can be caused by being hypo

Perhaps initially try 5mcg increase in T3 as 3 x 5mcg doses spread across the day

Retest in 6-8 weeks

[Ukie in reply to SlowDragon]

Thanks 🙂

[goingholiday in reply to Ukie]

Levo is Teva, which I have been on for ages with no problems.

My thoughts exactly a while back. I did change to vencamil eventually in a desperate attempt to feel better. And feel better I did ! Felt marvellous for a few weeks though that did wear off gradually. However, overall I am better on vencamil and wouldn’t go back to teva. It could be worth swapping. Good luck.

[Ukie in reply to goingholiday]

Thanks 🙂