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Is this a sign of too much levoxyl?
Hello and thank you for taking the time to answer my question.
I have had Hashimoto's autoimmune thyroiditis with elevated antibodies for over 5 years. I've been on levoxyl all this time and my current dose is at 112mg. I recently (September) had my TSH and free T3 and T3 tested, results were as follows:
TSH 1.3
Free T4 1.3
Free T3 2.3
Here's my question. I am feeling hyper again...insomnia, fatigue, anxiety and occasional diarrhea (every other day). My doctor claims that my numbers are perfect and he doesn't want to lower my dose at all. Do my symptoms and numbers sound consistent with too much levoxyl? Thank you again for the service you provide here on this forum!
I have had Hashimoto's autoimmune thyroiditis with elevated antibodies for over 5 years. I've been on levoxyl all this time and my current dose is at 112mg. I recently (September) had my TSH and free T3 and T3 tested, results were as follows:
TSH 1.3
Free T4 1.3
Free T3 2.3
Here's my question. I am feeling hyper again...insomnia, fatigue, anxiety and occasional diarrhea (every other day). My doctor claims that my numbers are perfect and he doesn't want to lower my dose at all. Do my symptoms and numbers sound consistent with too much levoxyl? Thank you again for the service you provide here on this forum!
You are so very helpful :) Thank you! I swear, I've learned more from these posts than my stupid dr. He never, ever once mentioned anything about my FT3, because the lab range said it was normal, even if it is low-normal.
I do think you're right, that I might need to add in a little T3 at some point since I don't convert it well. My FT4 has always been at the higher end of the range and my dr. always said that's great. But I hope that by cutting back on the Levoxyl and adding in a little selenium will tip the scales back to normal for me. I kept telling him that I felt hyper...extremely light periods, insomnia, tacychardia, heat intolerance, wired feeling and diarrhea. He just poo pooed everything I was saying because he thought my TSH was perfect at .9 Anyhow, thanks again for your insight (:
I do think you're right, that I might need to add in a little T3 at some point since I don't convert it well. My FT4 has always been at the higher end of the range and my dr. always said that's great. But I hope that by cutting back on the Levoxyl and adding in a little selenium will tip the scales back to normal for me. I kept telling him that I felt hyper...extremely light periods, insomnia, tacychardia, heat intolerance, wired feeling and diarrhea. He just poo pooed everything I was saying because he thought my TSH was perfect at .9 Anyhow, thanks again for your insight (:
I just realized the first sentence in my last post should read, "Rule of thumb for FT4 is 50% of range, and you're at 54%."
The balance of FT3 to FT4 is very important. When you don't convert well, your FT4 level often goes up higher than it should be, causing some hyper-like symptoms, while FT3 stays low. Typically, FT3 should be higher in its range than FT4 is in its.
Added selenium will only help conversion if you were deficient in it in the first place. More is not better, especially since selenium can be toxic in high doses.
I hope the selenium works for you, but do keep in the back of your mind that I'd be really surprised if you don't eventually have to add some T3 to your meds.
The balance of FT3 to FT4 is very important. When you don't convert well, your FT4 level often goes up higher than it should be, causing some hyper-like symptoms, while FT3 stays low. Typically, FT3 should be higher in its range than FT4 is in its.
Added selenium will only help conversion if you were deficient in it in the first place. More is not better, especially since selenium can be toxic in high doses.
I hope the selenium works for you, but do keep in the back of your mind that I'd be really surprised if you don't eventually have to add some T3 to your meds.
Thank you! From what you say, it does appear I convert slowly. However, the symptoms I've been having are hyper, go figure. So I convinced my dr. to lower my levoxyl by 10 mcg and I'm taking selenium which is supposed to help with the conversion proccess. You are right, my T4 was getting high so hopefully by lowering the levoxyl and adding the selenium will help me convert quicker! I appreciate all of your insight, it was extremely helpful and you're the first one to mention my conversion rate (:
Your FT4 looks good, perhaps just a little high. Rule of thumb for FT4 is 50% of range, and you're at 5%.
However, your FT3 is very low. It's way down in the bottom of the range, and it's lower in its range than FT4 is in its. That indicates that you convert slowly. Do you have hypo symptoms?
Cells cannot use T4 until it is converted to T3. It looks like you might need to add some T3 (Cytomel and generics or desiccated, which contains both) to your meds. You'd probably feel better with a better balance of FT3 to FT4. Often, when adding T3, it's best to decrease T4 meds at the same time to maintain an overall equal dose of meds. T3 is around 4 times more potent than T4, so T4 should be lowered 20-25 mcg for each 5 mcg T3 added.
Is your doctor agreeable to using T3 meds? If so, you might ask him if you could try 5 mcg of T3 while decreasing T4 to 88 mcg to see if you feel better at that balance.
However, your FT3 is very low. It's way down in the bottom of the range, and it's lower in its range than FT4 is in its. That indicates that you convert slowly. Do you have hypo symptoms?
Cells cannot use T4 until it is converted to T3. It looks like you might need to add some T3 (Cytomel and generics or desiccated, which contains both) to your meds. You'd probably feel better with a better balance of FT3 to FT4. Often, when adding T3, it's best to decrease T4 meds at the same time to maintain an overall equal dose of meds. T3 is around 4 times more potent than T4, so T4 should be lowered 20-25 mcg for each 5 mcg T3 added.
Is your doctor agreeable to using T3 meds? If so, you might ask him if you could try 5 mcg of T3 while decreasing T4 to 88 mcg to see if you feel better at that balance.
Sorry! Ok, here are the tests and ranges:
TSH .9 (ref. range .4 - 4.4)
FT4 1.3 (ref. range .7 - 1.8)
FT3 2.4 (ref. range 2.2 - 4.2)
TSH .9 (ref. range .4 - 4.4)
FT4 1.3 (ref. range .7 - 1.8)
FT3 2.4 (ref. range 2.2 - 4.2)
Please post your actual FT3 and FT4 results along with reference ranges (ranges vary lab to lab, so have to come from your own lab report). With those, we'll be in a better position to advise you.
Just reposting here. I'm still having these strange side effects...light periods, diarrhea only in the morning 2 hours after I take my levoxyl, nervousness and extreme heat intolerance.
Does this sound like too much levoxyl? I've been to a gastro. dr. and everything she tested for came back normal. My latest labs was from April with a TSH .9 and normal range FT3 and FT4. I'm at my wits end and my dr. won't consider lowering my current dosage of 112mcg ):
Does this sound like too much levoxyl? I've been to a gastro. dr. and everything she tested for came back normal. My latest labs was from April with a TSH .9 and normal range FT3 and FT4. I'm at my wits end and my dr. won't consider lowering my current dosage of 112mcg ):
Meds with T3 in them (both synthetic and dessicated) are often contraindicated with heart arrhythmias. Be sure to run this by your cardio if you decide to try T3.
I also have tachycardia that I thought was unrelated to thyroid...and it was to some extent since I have a congenital heart defect. However, my tachycardia has been controlled the best of my life since my throid meds were properly adjusted and I got on a stable dose. I'm becoming convinced that a correct thyroid balance...neither hypo nor hyper...is the best thing you can do for arrhythmias.
Once again, be sure to get your cardio's approval before starting T3.
I also have tachycardia that I thought was unrelated to thyroid...and it was to some extent since I have a congenital heart defect. However, my tachycardia has been controlled the best of my life since my throid meds were properly adjusted and I got on a stable dose. I'm becoming convinced that a correct thyroid balance...neither hypo nor hyper...is the best thing you can do for arrhythmias.
Once again, be sure to get your cardio's approval before starting T3.
Some say as much as 50 to 60% of people that are Hypo have some problems with conversion. Which makes sense really that people who are feeling bad go to the Dr and they may very well feel bad to begin with since they have conversion issues.
It is not surprising at all that your Dr. does not realize this. In fact you are pretty darn lucky to have a Dr that is not 100% reliant upon TSH alone. You are further lucky that your Dr even tests for FT3. My wife's Dr refuses to even order the test. We had to go to a private lab and pay out of pocket to even get a FT3 test.
Knowing what I know now if I were to be 18 again, I'd to to be a Dr. and concentrate on Thyroid issues. Just reading and learning here and other places I believe most people on this site know more about thyroid and thyroid treatment than the vast majority of Dr's.
It is amazing to me that they teach that the body only uses the Free T3 hormone. Yet they do not understand or correlate that to realize that they need to therefore ACTUALLY test for FT3. This seems so obvious to me a 3 year old could figure it out!
You do not determine a car's oil level by looking at the temperature gauge! By the time it shows you are running hot, it is too late and the engine is ruined. Yet that is exactly what Dr's do by relying on TSH. Using the oil pressure gauge is about equivalent to using FT4. It would show if low pressure that the oil may be low a bit before the engine overheats and is ruined but still a lagging indicator. ACTUALLY checking the oil dipstick is the equivalent of testing for FT3 and making sure it is at the proper level.
Would anyone pay a mechanic to determine if you have proper oil level by starting the engine and watching the temperature gauge or even oil pressure gauge? Heck no! Then why would we pay a Dr to do the same with your Thyroid function?????
just blows my mind!
Sissafus: Thank you. I'm glad you find my posts useful.
I think it is a tragedy what is going on with the medical community as it is associated with Thyroid function!
It is not surprising at all that your Dr. does not realize this. In fact you are pretty darn lucky to have a Dr that is not 100% reliant upon TSH alone. You are further lucky that your Dr even tests for FT3. My wife's Dr refuses to even order the test. We had to go to a private lab and pay out of pocket to even get a FT3 test.
Knowing what I know now if I were to be 18 again, I'd to to be a Dr. and concentrate on Thyroid issues. Just reading and learning here and other places I believe most people on this site know more about thyroid and thyroid treatment than the vast majority of Dr's.
It is amazing to me that they teach that the body only uses the Free T3 hormone. Yet they do not understand or correlate that to realize that they need to therefore ACTUALLY test for FT3. This seems so obvious to me a 3 year old could figure it out!
You do not determine a car's oil level by looking at the temperature gauge! By the time it shows you are running hot, it is too late and the engine is ruined. Yet that is exactly what Dr's do by relying on TSH. Using the oil pressure gauge is about equivalent to using FT4. It would show if low pressure that the oil may be low a bit before the engine overheats and is ruined but still a lagging indicator. ACTUALLY checking the oil dipstick is the equivalent of testing for FT3 and making sure it is at the proper level.
Would anyone pay a mechanic to determine if you have proper oil level by starting the engine and watching the temperature gauge or even oil pressure gauge? Heck no! Then why would we pay a Dr to do the same with your Thyroid function?????
just blows my mind!
Sissafus: Thank you. I'm glad you find my posts useful.
I think it is a tragedy what is going on with the medical community as it is associated with Thyroid function!
Wow, your post was very insightful. Thank you. Hmm, so I don't convert my T4 to T3 properly then? My doctor has never mentioned anything of the sort to me. He's always concerned with my TSH and free T4.
Cytomel sounds a tad scary though. I already have tachycardia issues unrelated to my thyroid and it sounds as if taking in too much T3 can cause that, right?
Is it normal to be a poor converter of T3 when you have Hashimoto's?
Cytomel sounds a tad scary though. I already have tachycardia issues unrelated to my thyroid and it sounds as if taking in too much T3 can cause that, right?
Is it normal to be a poor converter of T3 when you have Hashimoto's?
I'm so glad you commented as I learn a lot from your posts.
"However because you already have proven to be a poor converter, they may not reduce your T4 med at all."
I've recently been a little weary of the addition of 10 mcg Cytomel given without a decrease of 100mcg Tirosint (formaly 100 mcg Levoxyl). I feel better having read your reply.
"And even that should be split for half in the morning, half in the early afternoon. (not past 3PM or you may have trouble getting to sleep)."
I have trouble staying a sleep, but not getting to sleep. So a relief to read this too.
I hope the above isn't considered hijacking. If it is - I'm sorry.
I found it difficult to split 5 evenly when I was taking 2.5 a day and think that splitting it again from there would leave you with dust?
"However because you already have proven to be a poor converter, they may not reduce your T4 med at all."
I've recently been a little weary of the addition of 10 mcg Cytomel given without a decrease of 100mcg Tirosint (formaly 100 mcg Levoxyl). I feel better having read your reply.
"And even that should be split for half in the morning, half in the early afternoon. (not past 3PM or you may have trouble getting to sleep)."
I have trouble staying a sleep, but not getting to sleep. So a relief to read this too.
I hope the above isn't considered hijacking. If it is - I'm sorry.
I found it difficult to split 5 evenly when I was taking 2.5 a day and think that splitting it again from there would leave you with dust?
Fatigue, anxiety and insomnia can and are also associated with being Hypo. These are 3 symptoms which are associated with BOTH Hypo & Hyper.
Your test results tell me that your body does NOT convert T4 into T3 that well. This is determined by the significant difference in your levels or FT4 & FT3. Proper conversion would have both in similar parts of the range if not the FT3 range a bit higher than FT4. How low your FT3 is indicates that you are most likely Hypo. In fact most people with that low of FT3 are indeed VERY hypo. How your Dr says that your labs are perfect are COMPLETELY beyond me!
Symptoms correlate most closely with Free T3 as that is the ONLY what the body's cells use. So it should be no mystery that in fact symptoms correlate to what your body uses. However most Dr's don't seem to realize or understand this fundamental basic fact!!!! As a result many people are left unmedicated or under medicated and feeling like crap.
Your FT4 is exactly at mid range. Most people seem to find symptom relief when their FT4 is mid range AND the FT3 is in the UPPER 1/3 of the range. You are at the VERY BOTTOM of the range. No where near the UPPER 1/3 of the range. Clearly you are not converting well and need to add T3 medication.
Typically the rule of thumb is that T3 med is 4 times more effective than T4 because it is available for immediate use by the body and does not need to be converted over like T4. So the general rule of thumb is that they will lower your T4 med about 4 times as much as they add T3 med. Put another way, for each 5 mcg of Cytomel (T3) they add,they will reduce your Levo by 20 mcg.
However because you already have proven to be a poor converter, they may not reduce your T4 med at all.
Be aware that T3 meds can be a bit hard to adjust to if too large an initial dose. You do not generally want to start with anything more than 5 mcg per day. And even that should be split for half in the morning, half in the early afternoon. (not past 3PM or you may have trouble getting to sleep).
Patience is always recommended and starting out with a split dose of 2.5 mcg a day (1.25 mcg AM and 1.25 mcg PM) may not be all bad way to start. Then after about 2-3 weeks or so you can get a blood test again. Since T3 is available immediately you do not need to wait 6 weeks like you do for a T4 med for blood labs to be completed. They can then adjust as necessary.
The goal is symptom relief. Actual levels are different for every person. The rule of thumb of mid range FT4 and upper 1/3 range FT3 is just that. A rule of thumb or average. Every person will vary. The trick is to adjust your dosages of T4 & T3 until YOU feel well.
Understand that with Hashi's, you will continually have to get tested and adjustments made as Hashi's takes its toll on slowly killing your natural Thyroid output. So don't be surprised that small increases are necessary once or more per year. And to get blood drawn at least every 6 months if not more until you've become stabilized.
Your test results tell me that your body does NOT convert T4 into T3 that well. This is determined by the significant difference in your levels or FT4 & FT3. Proper conversion would have both in similar parts of the range if not the FT3 range a bit higher than FT4. How low your FT3 is indicates that you are most likely Hypo. In fact most people with that low of FT3 are indeed VERY hypo. How your Dr says that your labs are perfect are COMPLETELY beyond me!
Symptoms correlate most closely with Free T3 as that is the ONLY what the body's cells use. So it should be no mystery that in fact symptoms correlate to what your body uses. However most Dr's don't seem to realize or understand this fundamental basic fact!!!! As a result many people are left unmedicated or under medicated and feeling like crap.
Your FT4 is exactly at mid range. Most people seem to find symptom relief when their FT4 is mid range AND the FT3 is in the UPPER 1/3 of the range. You are at the VERY BOTTOM of the range. No where near the UPPER 1/3 of the range. Clearly you are not converting well and need to add T3 medication.
Typically the rule of thumb is that T3 med is 4 times more effective than T4 because it is available for immediate use by the body and does not need to be converted over like T4. So the general rule of thumb is that they will lower your T4 med about 4 times as much as they add T3 med. Put another way, for each 5 mcg of Cytomel (T3) they add,they will reduce your Levo by 20 mcg.
However because you already have proven to be a poor converter, they may not reduce your T4 med at all.
Be aware that T3 meds can be a bit hard to adjust to if too large an initial dose. You do not generally want to start with anything more than 5 mcg per day. And even that should be split for half in the morning, half in the early afternoon. (not past 3PM or you may have trouble getting to sleep).
Patience is always recommended and starting out with a split dose of 2.5 mcg a day (1.25 mcg AM and 1.25 mcg PM) may not be all bad way to start. Then after about 2-3 weeks or so you can get a blood test again. Since T3 is available immediately you do not need to wait 6 weeks like you do for a T4 med for blood labs to be completed. They can then adjust as necessary.
The goal is symptom relief. Actual levels are different for every person. The rule of thumb of mid range FT4 and upper 1/3 range FT3 is just that. A rule of thumb or average. Every person will vary. The trick is to adjust your dosages of T4 & T3 until YOU feel well.
Understand that with Hashi's, you will continually have to get tested and adjustments made as Hashi's takes its toll on slowly killing your natural Thyroid output. So don't be surprised that small increases are necessary once or more per year. And to get blood drawn at least every 6 months if not more until you've become stabilized.
Forgot to add that typically your T4 medication should be decreased when T3 is added. My doctor didn't do this because he thinks I could go either way and that we'll see in six weeks. The downside is continued symptoms if we didn't get it right.
Cytomel and Tirosint were also more expensive for me than Levoxyl (brand) that my insurance seemed to cover more of. But, maybe that won't be the case with your insurance and there is a generic for Cytomel.
Cytomel and Tirosint were also more expensive for me than Levoxyl (brand) that my insurance seemed to cover more of. But, maybe that won't be the case with your insurance and there is a generic for Cytomel.
I think you'll be told that your Free T3 is low and that's what's primarily responsible for your symptoms. I've recently started Cytomel and some of my fatigue and depression has improved. I also didn't realize how much hair I was losing until I recently started losing less. I'm taking 10 mcg total in a divided dose in addition to Tirosint 100. I haven't had blood work done on this new dose yet. But from what I understand you don't have to wait as long for bloodwork if T3 is added with no other thyroid med changes.
Ack! Sorry.
TSH 1.3 (ref. range .4 - 4.5)
Free T4 1.3 (ref. range .8 - 1.8)]
Free T3 2.3 (ref. range 2.3 - 4.2)
TSH 1.3 (ref. range .4 - 4.5)
Free T4 1.3 (ref. range .8 - 1.8)]
Free T3 2.3 (ref. range 2.3 - 4.2)
I think you're going to be asked to include the reference ranges for your labs
Also you mentioned T3 and Free T3, but you listed T3 and Free T4.
I recently had all those symptoms - insomnia, fatigue, but anxiety alternated with depressed (mostly) and diarrhea alternated with constipation (mostly). I had a few more including a fifteen pound weight gain, sore joints and muscles, brain fog, forgetfulness, dyslexic writing etc. Despite this, I was afraid that I was on too much medication because of the insomnia especially. So, I called my (now former) doctor who told me not to take any medication for a week and then go back down to 100. I regret doing that without testing and now very much doubt I was hyper since my T3 has been consistently low since the start of treatment almost two years ago. Don't know if this will help you much or at all, but I hope it does.
Also you mentioned T3 and Free T3, but you listed T3 and Free T4.
I recently had all those symptoms - insomnia, fatigue, but anxiety alternated with depressed (mostly) and diarrhea alternated with constipation (mostly). I had a few more including a fifteen pound weight gain, sore joints and muscles, brain fog, forgetfulness, dyslexic writing etc. Despite this, I was afraid that I was on too much medication because of the insomnia especially. So, I called my (now former) doctor who told me not to take any medication for a week and then go back down to 100. I regret doing that without testing and now very much doubt I was hyper since my T3 has been consistently low since the start of treatment almost two years ago. Don't know if this will help you much or at all, but I hope it does.
Forgot to mention that my periods have been lighter and shorter than normal the last few months too. That is not normal for me. Thanks.
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