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Why Is T3T4 Low Again When It Was Rising Before?

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Posted on 2 days ago
Question: Hi there, I attached my latest labwork. I'm on 50 mcg Levothyroxine for 11 weeks, and my labwork is horrible. My story started with 5.66 TSH in April, 2020. T3T4 was within normal range back then, and I had vidamin D insufficiency. Doctor prescribed me vitamin D and 75 mcg Levothyroxine. At the 6 weeks checkup on 05/28/20, TSH down to 0.421, vitamin D back to normal, T3T4 not checked. Doctor told me to continue to take the 75 mcg. After taking 75 mcg Levothyroxine for 3 months, I had hyperthyroidism (on 07/31/20 TSH 0.01, Free T4 2.0). So doctor reduced the dosage to 25 mcg. Next blood test on 9/9/20 shows hypothyroidism with TSH 11.61, Free T4 low. Changed dosage to 50 mcg Levothyroxine. 10/05/20 TSH 58.51, Free T4 back to low-end average. 10/20/20 test, TSH goes down to 36.3, Free.T4,.Free.T3 goes back to normal. Continued 50 mcg dosage,.TSH continues to go down TSH 13.69, but Free T4 below normal again,.vitamin D deficiency again,.TPO antibody (checked.for the first time) crazy high. What is going on? Is vitamin D deficiency a factor? Do I have cancer or problem with my pituitary gland or is this just the good old Hashimoto? Is it Hashimoto for sure? Vitamin D deficiency couldn't cause this havoc? If 75 mcg too high, 25 too low, why 50 mcg doesn't work either? Should I start taking 75 mcg again? Or just keep taking 50 mcg for the time being as my TSH keeps going down and Free T4 is low because my body is trying to figure out how much hormone I really do need? What's happening with the free T4 level? Why is it low again when it was rising before? Is it vitamin D deficiency or tpo antibody? Thanks for your reply in advance.
doctor
Answered by Dr. Mirjeta Guni (1 hour later)
Brief Answer:
About levothyroxine dose;

Detailed Answer:
Hello and thank you for asking!
I have gone carefully throigh your concern.
it is not a pituitary pathology, it is Hashimoto thyroiditis. It is confirmed by high antibodies and there is no relation to Vit D.
I would suggest to increase the dose again 75 mcg.
Hashimoto thyroiditis means that your body produces the antibodies that destroy the thyroid gland progressively and it does not produce hormones. You have to take the hormone orally and the dose needs to be increased with the passing of time as more thyroid tissue will be destroyed.
In April you needed 50 mcg, now you need 75 mcg. There is nothing to get worried.
Increase the dose and check TSH after 6 weeks.
Best wishes,
Dr.Mirjeta Guni
Above answer was peer-reviewed by : Dr. Kampana
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Follow up: Dr. Mirjeta Guni (2 hours later)
But then why did I have hyperthyroidism after taking 75 mcg the first time? In July my TSH was 0.01 and Free T4 2.0. Is it not possible that because of the overdosing, my body stopped producing the hormone and then we should have gradually reduce the dose,, not dramatically and suddenly to 25 mcg? I mean after receiving too much supplemented hormone then not.recei ing basically any didn't just caused further damage b/c my body doesn't know how to react? With Hashimoto, rapid decline is common? I mean for 39 years nothing and then 1/2 year ago 75 mcg too much but now, that's the right dosage? Also, can anything else influence the TPO antibody count or it's Hashimoto only? Like allergy, Covid19, etc... Thanks.
doctor
Answered by Dr. Mirjeta Guni (26 hours later)
Brief Answer:
About levothyroxine dose;

Detailed Answer:
Hi again,
No it is not caused by the high levothyroxine dose taken at that time,,this rapid decline is not common ( usually happens post partum or after a very stressful situation), regarding to covid, it's effects aren't studied yet.
All you have to do is to adjust the doses depending on TSH result.
The dose of levothyeoxine needed can go up to 300 mcg/ day, so do not worry, 75 mcg is not considered a high dose.
Hope the information will help.
Best wishes,
Dr.Mirjeta Guni
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Nagamani Ng
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Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2413 Questions

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Why Is T3T4 Low Again When It Was Rising Before?

Brief Answer: About levothyroxine dose; Detailed Answer: Hello and thank you for asking! I have gone carefully throigh your concern. it is not a pituitary pathology, it is Hashimoto thyroiditis. It is confirmed by high antibodies and there is no relation to Vit D. I would suggest to increase the dose again 75 mcg. Hashimoto thyroiditis means that your body produces the antibodies that destroy the thyroid gland progressively and it does not produce hormones. You have to take the hormone orally and the dose needs to be increased with the passing of time as more thyroid tissue will be destroyed. In April you needed 50 mcg, now you need 75 mcg. There is nothing to get worried. Increase the dose and check TSH after 6 weeks. Best wishes, Dr.Mirjeta Guni