Both T 4 & T3 reduced after taking more Thyroxine Feel dreadful Advice what to do please

[Otto11]

Hi

I'm sorry to post again but I feel so unwell I just don't know what to do. I'm currently trying to increase my T4 level which had reduced since starting T3. When I started T3 15 months ago my T3 was 3.3 (3.1-6.8) & T 40 was 20 (11-22). I reduced my thyroxine form 112.5mcgs daily to 75mcgs daily when 10mcgs x 2 daily was introduced. Whilst my T3 has been slowly increasing my T4 reduced slowly to 16 then 14 then 13 last October at which point my T3 was 5.4.

In an attempt to raise my T4 levels my consultant suggested increasing my Thyroxine to 100mcgs which worked & my T4 increased to 18 in December but my T3 dropped to 4.9. I felt shaky & had palpitations on the higher dose of thyroxine so my Consultant suggested I try 87.5mcgs daily which has been my dose for the past 8 weeks. The last 3 weeks or so I felt awful again totally exhausted by afternoon needing to sleep. I could feel I needed more T3 so have added 3mcgs some evenings just to get me through. Today was 8 weeks since my last dose change so had my bloods done this morning. My T4 has dropped to 14 again & my T3 has also dropped again to 4.3 I can't get through the day due to exhaustion can anyone suggest what I should do. I called the Endocrine Nurse last week but she wasn't interested. My next Consultant appointment isn't till the end of March so need to try to sort this myself. Do I try to increase my Thyroxine again or do I increase my T3. My brain fog is dire so can't work out what to do.

[greygoose]

First I have to ask: did you really need your FT4 increased? Even though your FT3 was good? Some people do, I know, they need quite high levels of T4 even with high levels of FT3. But not everybody does, so it's not obligatory, and trying to raise it can really mess things up!

Secondly, did you really start T3 on 20 mcg a day? Or did you mean 5 mcg x 2 daily? Because if you started on 20 that probably got you off to a bad start.

have added 3mcgs some evenings just to get me through.

That is never going to work, and could make things worse. If T3 is going to do what it's supposed to do, you need to take the same dose every single day. Why not take the extra 3 mcg every evening?

Besides, it's not aspirin, it doesn't work the instant you swallow it. First of all, it has to get into the blood, and you'll probably be in bed by the time it does that! Then, it has to find a receptor to attach to. That can take a while. T3 in the blood is inactive. It doesn't do anything. It only becomes active when it gets into the cells.

I can't work out from your post exactly how much T3 you're taking at the moment, but it's obviously not enough. In your shoes, I would ignore the T4 and get my T3 back to where I need it. The FT4 is probably not that important. And if it is, you can see to it later, when things are stable. But for the moment, trying to increase it just doesn't sound like a good idea to me.

[Otto11 in reply to greygoose]

Thank you so much. I thought my T4 was supposed to be about 70% through range so I mentioned it to the Consultant who said yes it was a bit on the low side hence the increase in Thyroxine. I was initially prescribed 10mcgs of T3 twice daily so yes 20 mcg. I did start very slowly though over several months. The consultant reduced my Thyroxine dose from 112.5mcgs to 75mcgs & added the T3. That was December 2023. I think it would have been at least 3 months possibly more till I got to the full dose of T3.

I felt I needed more T3 recently since last dose change 8 weeks ago. I don’t have much spare as they are really tight with all my meds from GP’s not just T3. I doubt I have enough to increase to 23mcgs daily.

After your response I will call my Endocrine Nurse tomorrow to see if I can increase my dose but it’s highly unlikely. I certainly can’t carry on like this for another month till my appointment. I’m currently taking the same dose of T3 that I started on which is 20 mags daily. I have capsules so sometimes open them up & tip the contents into some water then split it into 3 giving me that little bit more ( 3 mcgs roughly). I will do as you suggest & revert back to 75 mcgs Thyroxine daily which is what I have taken prior to the last few increases. I honestly feel like I’ve gone back where I was 12 months ago & so annoyed with myself. Thank you very much for your help it’s really appreciated.

[greygoose in reply to Otto11]

When you're on T4 mono-therapy, maybe, but not when you're on NDT or T4+T3, it needs to be where it makes you feel good. I know some people on here say that about being 70% throught the range, but they are wrong and doing a great disservice to the people they're supposed to be helping.

How much T4 one needs when taking T3 is a very personal thing. Everyone has different needs, and ranges are only a very rough guide, anyway. So don't aim for any particular number, aim to feel well.

[Otto11 in reply to greygoose]

Thank you so much. I thought I needed to increase my T4 blood results. I'm not sure why the consultant said yes but it's quite obviously been a bad move. I have managed to speak to one of the good Endocrine Nurses this morning & she has suggested to go back to 75mcgs daily & retest again just before my next appointment with the consultant in 4 weeks. I hope things will start to improve a bit by then. I have a lot of important hospital appointments coming up so need my brain to function. Thanks again you have been so helpful.

[greygoose in reply to Otto11]

You're very welcome.

Sounds like the nurse gave you good advice - it's a start, anyway. Except that if you change your dose now, and retest in four weeks, the results are not going to be reliable because the new dose won't have had long enough to settle. But, cross that bridge when you come to it.

[TiggerMe Ambassador]

Are you still splitting your T3 dose? I'd suggest it might be worth trying taking as a single dose to see if that suits you

I'm one of those who takes a single dose of 15mcg T3 (better than splitting a larger dose) along with T4 and I've been down the road of reduced fT4 and it makes me feel tragic! I need to keep it above 50%

fT3 results will fluctuate unless you keep the test/dose timings the same

[Otto11]

Thanks that's something I could look at trying. My blood tests have all been at the same time first thing in the morning following the protocol suggested here. But yes I have taken the extra bit of T3 here & there but not in the 5 days prior to the test. I guess it's back to the drawing board.