Lowering Levothyroxine

Hello Diane, you do seem to be going through the mill at the moment. My thoughts when I read your post are: its complicated and the person best placed to work this out us you given the right pointers of where to go for guidance. First things first though, the figures you quote must be for TSH (range 0.4-4.9 in my lab in the UK) whereas T4 range is 4.9-19. Secondly, the worst possible time to go without thyroid meds is when your body is under stress, in this case internal stress from the infection. The suggest to skip a dose of Armour demonstrates a lack of understanding of how it, or any NDT, works. As NDT contains both T4 and T3 it is important to take it every day, split into two doses so that you even out the T3 you are getting. This is because T3 has a half life of 6-8 hours, which means half of it will be absorbed in this time. So by skipping a dose you will be getting no T3 for that day. Most people (80-85%) are able to convert T4 to T3 efficiently. As you didn't get on well with synthroid, this suggests you aren't converting as well as you should be, hence the reason you need NDT (which already contains some T3). So your suggestion of splitting the Armour tablet and taking less (instead of skipping a dose) is a good one. Personally I would say dropping by a quarter (I.e. 30mg) is tii bug a jump in one go. Try taking 7/8 (seven eighths). This would be a half, quarter and eighth of a 100mg tablet. Stay on this for a week or two then drop by an eighth if you need to. Some reading up on his to dose with NDT would help, for which I would recommend the ThyroGold website, which at the top if the Question and Answer section provides 3 free chapters of a book that explains it well. Also read through all the Question and Answers provided. In there you will find a link to an 'overstimulation form', which is a good way to objectively document your symptoms (which you have done an excellent job of describing).

Does your lab ever test your T3 as well as T4? This is a useful additional method to help understand what is going on. To give you an example, I'll use what is currently going on with me.

Uk Doctors put a high emphasis on keeping TSH in range. So this winter (2017/8) I did an experiment to see if I could get my TSH in range, note (there is a delay of about 3 months before TSH will react). My T4 and T3 was in range so I tried to keep at the same dose for 3 months to see if my TSH would react. This was a mistake because in that time, I got under-stimulation symptoms (i.e. hypothyroid symptoms) but didn't increase my dose of NDT (in my case ThyroGold). The result was my TSH didn't change, my T4 went up (suggesting I was taking too much NDT), but at the same time I was getting hypothyroid symptoms (suggesting that I was taking too little NDT). See what I mean about complicated? To understand what was going on, it was necessary to look at my T4 and T3 results over time. This showed that although my T4 had gone up, my T3 had gone down. In other words, I wasn't converting T4 to T3 as efficiently, hence the hypothyroid symptoms. Counter-intuitively, the answer was to increase my dose of NDT.

Note, I find it best to make dose changes in small increments every one or two weeks to give my cells chance to adapt and absorb the increased dose.

Whilst I was waiting for my body to adapt to the increased dose I did, on occasions, get pounding in my head/an awareness of my heart beating quicker. For me these hyperthyroid symptoms are merely because my body hasn't yet adapted to absorb the increase dose and they go away after a few weeks.

Are you aware that to minimise these effects, and to get the most out of thyroid medications you need to take it on an empty stomach and then wait an hour before eating? This is because food impairs the body's ability to absorb the thyroid meds). It is tricky to combine splitting doses of NDT with doing this. The way I do it, is to take my 1st dose of ThyroGold upon waking at 9am, eat 1 hour later at 10:30 (brunch). Take my 2nd dose of NDT at 15:00, eat at 16:00 (dinner). If I'm hungry I'll then have a light snack at 19:00. This works for me because I'm not getting up early. If I was, it would be easier to fit in eating at more normal times.

By the way, I think I remember reading that high blood pressure can be an effect of being under-stimulated with thyroid hormone (e.g. not taking enough). So get your thyroid sorted and see if it goes away.

I hope you will find some of this of use.

Sorry for typos, it should have said...

Personally I would say dropping by a quarter (I.e. 30mg) is still a big a jump in one go.

A further comment, it nay even be that in a few weeks your body will have adjusted back to coping with your current dose of 120mg Armour.

Barbara, those are great points. I would add on the high bp, that meds can cause bp to go up, hypothyroid can cause it to be either high or low. If you were on Levo, that can cause liver lesions, which can slow blood flow and result in a myriad of complications including high bp and heart problems.

The high T3 in Armour can actually result in increased (high) levels of rT3. When your T3 is too high, your body converts excess T3 to rT3, which binds up T3, resulting in low T3. But this won’t show in blood tests unless you do the right tests and know how to read them, which most docs don’t. 

Finally... if you drink diet sodas, this contains artificual sweetener aspartame, made of aspartic acid and phenylalanine. If you change your diet soda intake, this will be problematic for dosing.

Barbara, Here's the breakdown by days:

Before hospital stay was on 120mg/day for 1 year +

4 days without meds, under high stress and infection (out Hosp Feb14th)

4 days on 120 mg/day on antibiotics until Feb 18th  (saw Dr. and lowered it)

6 more days on antibiotics and 100mg/day (Feb 18 to Feb 24th)

37 day on 100mg/day (Feb 24th to March 31st)

 42 days or 6 weeks at 100mg/day)  

-----------------------------------------------------------------------------------------

4 days 90mg/day (Apr 1st to Apr. 5th)

All these symptoms started in the hospital Feb.12th where I litterally thought I was going to die and was mentally prepared for it and then continued after my release and  up till today.  I was attributing all these symptoms to the infection and extreme stress I went through until I was through the antibiotics and actually felt like myself for a few days in a row.  Then the downward spiral started of spasms, tremors, palpitations, panic attacks.

So if I decreased dosage and I felt hyperthyroidic, what does that mean?   I get confused with a high level TSH reading means low production of thyroid hormone ? and we are taking meds to increase production?  So if my meds are working and increasing hormone I shoiuld have lower level numbers  TSH?  Is that correct?

So if my adrenals are increasing blood level hormone by leaking and I am taking hormone to increase as well, wouldnt that mean I am adding to the increase and over medicating?   And if I am over medicating, what does that mean for my symptoms?  Would it be in a hyPER state now?

Or is this all because she lowered it to 100 mg/day because I told her about the tremors and fatigue, heart papitations, muscle weakness, spasms, high BP.  Maybe I should have stayed at 120 mg/day instead?

I just don't know.

Hi Catherine, to add to the discussion on T3, there are research articles that indicate that under times of stress the body converts T3 to rT3 which blocks the T3 receptors. This means that the body doesn't get the T3 it needs. Do a Google Scholar search on 'rT3' or 'Reverse T3' for more info. I haven't heard the bit about too much T3 being converted to rT3. The research I've read indicates that to fix the excess rT3 one needs to take more T3. This might be why you felt better when you did higher doses of NDT for a couple of weeks - it takes several weeks for our cells to adapt to be able to use the extra T3 and in the meantime we get hyperthyroid symptoms.

Diane, the doctor on the ThyroGold site explains all of this much better than I can. Look under the menu option 'question and answer' and at the top you will find links to 3 PDF files, that explain this and however to dose with NDT.

Thanks Barbara, I will do that.

Diane, for me I find the TSH results meaningless. My TSH is always suppressed even when T4 and T3 are both in range. It takes over 3 months for the TSH to react and stabilise (think if it as being 3 months out of date) and in that time your T4 and T3 levels can change significantly. I use Basal pulse measurements and the overstimulation form to monitor my levels in between having T4 and T3 blood tests done. So sorry, I can't really advise on your TSH results.

To be honest with you, I really think these blood tests and over reliance of blood tests is crap. Yes they are a guide but we are all different, totally unique and what's the right level for one person won't be right for another. It's far better to think about how you, as an individual feel, do you feel well? Have you good levels of energy for you? Are you experiencing any side effects? This is far more reliable than blood tests which are different in different countries anyway. If you feel OK and the blood test isn't ott stop worrying

I completely agree. I use the T3 and T4 blood tests as extra information in conjunction with the other methods. Which is why this time, when my T4 went up despite me having hypothyroid symptoms, I looked more deeply as I knew that couldn't be the whole story. That is when I realised that my T3 had gone down over the same period. So T4 up, T3 down, hypothyroid symptoms, basal pulse = 60 bpm - means I am hypothyroid, so instead of reducing my dose of ThyroGold, I increased it. Hypothyroid symptoms have gone away.

We're now getting into Spring, so I will need to watch out for when I need to reduce my dose, as I always need less in the warmer months April to September. Is this the sane for anyone else?

Totally agree that reliance on blood tests can be a dangerous way to treat. If they actually work to indicate treatment, it’s accidental. I don’t even bother with them anymore. Don’t bother wasting my time with the doc here. The medical care here has become so bad that going to the doctor is a waste of time and generally worsens your condition. Better to solve it on your own. By the time they sort out the system of socialized medicine many people will have died unnecessarily. The problem of lack of diagnosis and treatment isn’t isolated to thyroid disease is all I’m saying. 

To all who are responding,

Thank you so much for your comments and insight.  I am now charting all my vitals and basal temps.  This morning I had tremors in my arms and basal was 97.3 (it's almost as if I m going into hypothermia symptoms, but not that low)  My temp goes from 97.7 usually to 98.2, up and down all dya.  I have never been at 98.6 unless I feel like I have a fever.  97.3 is low for me.

How are you getting on?

Well had my general check up, was at the time, feeling like hell but this has gotten better.  At first I was showing a hyper state with TSH in middle of range and my T4 was low and T3 high.  I think some of this was an attack on my thyroid glands by the infection that sent me into a huge imbalance.  After about two to three weeks of being on 100 down from 120, I decided to go back up to 120 because the lower dosage made me still have skipped heart beats, a body temp below 96.0 that would give me hyperthermic chills or shaking (different from tremors caused by a nuerological problem), hair falling out and weight gain.  I thnk in the midst of all this, my body switched back to hypo and the lower thyroid dose was causing some of those problems, like being in hyperstate (some of the symptoms are the same) .  Now that I have gone back to 120, I am starting to feel like my self again after a month on.120 mg/day.   I am also going back into ketosis (keto diet) so I can start losing weight again (lost 3 lbs already in a week)  Unfortunately, my doctor could not give me a download of my test results for comparison.

Also found that my Vitamin D level was very low and that helps with muscle spasms, so those have gone away mostly.