I've been on thyroxine for more than 15 years and always has problems with tiredness and mood.
Recently I realised that the days where I felt great over the last few months (and probably for years but I didn't notice the pattern) was when I accidentally skipped my thyroxine dose. And I mean really great, like the best I've felt in 15 years or more. I realised afterwards that I had skipped the dose so it can't be placebo.
To be more specific, I had more energy, was in a much better mood, and could think more clearly, more productive (I was happily working all day in a software project without getting tired) and needed less sleep. I did think that maybe it's possible I'm bipolar because I could imagine that's what hypomania feels like, but for now I'm assuming I'm not because of the timing with not taking thyroxine.
And even my allergic rhinitis was less and I could smell things more easily when walking through the city (I normally can't smell anything and antihistamines don't seem to help much). I've since read that there is a strong link between hypothyroidism and allergic rhinitis (a study said that the incidence of hypothyroidism in the general population is 1.5%; in contrast, it was observed in 16.3% of the patients with allergic rhinitis).
I think what could be happening is that when I take a thyroid dose, this disturbs the ratio of FT3/FT4 over that day (because the dose is not mimicking the natural ratio of hormones produced by the thyroid) causing me to feel a bit shit, and this ratio is important.
I have some evidence to back this up as a possibility:
"Free thyroxine was increased by 12.7 ± 2.6% (p = 0.0003) and 14.5 ± 2.3% (p = 0.0001), respectively, compared with trough samples. Thyrotropin levels were 18.9 ± 6.8% (p = 0.003) lower in patients receiving replacement and triiodothyronine levels showed small or no changes."
This means that the FT3/FT4 ratio will change by 14.5% too after thyroxine dose is taken.
Presumably taking the right amount of T3 with thyroxine would cause the ratio to stay the same.
2) Similarly, there is evidence that me skipping a dose improves this ratio
Short-term withdrawal of levothyroxine, induced increase of thyroid-stimulating hormone and an increase ratio of triiodothyronine to thyroxine (scholar.google.com/scholar?...
3)
The ratio seems important as indicated in the following study:
Health-related quality of life is reduced in treated primary hypothyroidism and with lower fT3/fT4-ratio (endocrine-abstracts.org/ea/...
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CraftyAsparagus
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This is possible. You don't give your dose or TSH, fT3, fT4. I'm always arguing that it's not the blood levels of fT3 that matter but where the T3 has come from. i.e. wether it has come from the thyroid / tablets or from converting T4 to T3, especially type-2 diodinase (D2) which takes place within organs such as the brain and regulates local T3 levels.
TSH has a role in promoting D2 activity and of course blood T4 (and T3) lower TSH. It's possible that on the day you skip your L-T4 that TSH is hihger and this promotes D2 which provides T3 within the tissues that rely on D2 for local T3 regulation. Thus, tissues reliant on D2 such as the brain and skeletal muscles will have higher T3 levels. This is very important for those of us who use a lot of sustained brain function, such as working as a computer programmer or software engineer.
When on L-T4 monotherapy we need a higher fT4 level to achieve a normal fT3. This results in a lower TSH and so less D2 activity. We may end up with the same fT3 but the lower TSH means more of the T3 comes from type-1 deiodinase (D1) which although providing blood T3 does not have a role in local T3 regulation. D1 also creates reverse T3 which is a D2 antagonist.
In summary, a higher TSH will lead to more of the T3 being produced in organs such as the brain, this T3 finds its way into the blood but importantly has contributed to the regulation of local T3 levels. You may find taking a little L-T3 and reducing your L-T4 beneficial.
Oh yes, skipping a dose and feeling great is definitely a thing. I noticed by accident too, and we are not the only ones. I only skipped Levo on purpose on a couple of occasions years ago. Quite a few on here stopped taking Levo completely, until they subsequently crashed.
I'm 13yrs post dx. Wow, does it still work after 15yrs? I've had a couple of recent illnesses, but if it still works for you, I might try that soon when things should be more stable.....it would be bloody fantastic to have the odd really excellent day now and again.
I have read that some people take weekly doses. I'm not sure that I'd want to do that, but maybe the good days outweigh the bad? 😀
I find I get instantly drowsy after most thyroid meds and I’ve tried lots of combinations over the years Have you tried taking meds at night before bed?
The ones I take early evening or at bedtime don’t seem to affect me negatively like the morning ones do.
Yes I have and I think it was slightly better, but missing a dose still made me feel great. I think it might be due to the spike in T4 (but not T3) which occurs in the hours after a dose, thereby disturbing the ratio. So I will try taking T3 medication too too see if they helps
Yeah it's possible, but I do have a dust allergy so I was thinking the hypothyroidism was just making me more sensitive to it.
I could try a different brand, but I've been on it 15 years and been on many different brands incidentally just from living in different areas and using different pharmacies, but I've always had a problem with tiredness and mood.
Saying that though, my tiredness seems to have got worse since I moved country and am using a different levothyroxine so I'll try so l changing
Wishing you good luck if you do change brands 🤞 It would be great if the answer was so simple …. I have to take Teva brand myself as it’s lactose free but know that many others have issues with the acacia in it … so much to be aware of!!
But many times we have read of someone observing this effect and assuming that means they don't need it at all. And coming back later realising that it is a brief interlude which very often deteriorates all too quickly.
One suggestion was that the body reacts to reduced T4 by increasing conversion to T3 - hence a slight increase in available T3. But only for a short time.
Wow, you nailed it! That's exactly why we feel so bad on T4 alone! I ALWAYS feel better when I miss my T4 only dose because my body is busy creating T3 from my stored T4 since it didn't get a T4 dose that day! I could never figure out why, now I know!
I started taking T3 2 1/2 years ago, I am currently on 75mcg T4 and 5.5mcg T3. Trying to find the perfect T3 dose, was on 6mcg and recently reduced to 5.5mcg. Might move to 5.75mcg depending on my bloods at the end of July. I sometimes feel like 6mcg may be a bit too high so tweaking things, glad I have a doctor that allows me to do that.
I get my T3 compounded in a slow release formula. I couldn't handle straight-up T3 as I would crash every afternoon. I live in Canada, and thank God everyday that I do, because I don't know if I would be able to get compounded drugs in other countries.
I got my life back when I started on T3, I feel normal and healthy for the first time in years. Also when taking the right amount of T3 your TSH does not go too low. My TSH floats between 1 and 1.5. When I was on T4 only my TSH was between 2 and 2.5 and my T3 was usually below the bottom of the range.
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