It’s been a little bit since I updated you, but my new endo finally got me on block and replace and my free t3 is finally coming down. My levels are in normal range and I was feeling so good with lots of energy but now I feel super tired and brain fog again. My current dosage is 40 mg of methimizole and 159mg of levo. My vitamin D supplement has also brought my levels into normal range as well. B12 is fine as well as all other levels. Here is what thyroid levels are at now. I’m curious your thoughts on if I should decrease methimizole or increase levo to love these levels up into the upper range of normal? It seems in on a pretty high dose of levo, so I’m not sure if it’s safe to increase it anymore.

3/15
40 mg methimizole
I can’t remember what level my levo was at, but it was maybe around 140mg?
TSH <0.005
FREE T4 1.13 (0.93-1.70)
FREE T3 4.53 (2.00-4.40)

3/31
40mg methimizole
150mg levo
TSH <0.005
FREE T4 1.18 (0.93-1.70)
FREE T3 3.56 (2.00-4.40)


4/24
40mg methimizole
159mg levo (one 150 tablet and 1/8 of 75mg tablet)
TSH <0.010 (0.380-5.330) TSH is rising!
FREE T4 1.29 (0.93-1.70)
FREE T3 3.31 (2.00-4.40)

This is the first time my levels are “normal”. I just need to find the optimal range. I’m really clueless with block and replace so I was hoping to get some guidance with what to increase/decrease. I’m confused why all the sudden I feel fatigue when just a few weeks ago it felt like I was running on rocket fuel with so much mental focus and confidence. It’s crazy how fast it changes. I have another appointment with my endo on May 15th, but wanted to gather your thoughts since you’re the one that really guided me to this point. I can’t thank you enough. By the way, my goiter has also shrank which is so nice, but I still have bags under my eyes. I was hoping that once I get my levels at the upper range, it should help with reducing the bags. Thanks Elaine

Hi D,
Glad your doctor finally agreed to block and replace. Your thyroid hormone levels are in range but too low for your body's needs, causing your symptoms.
It would be good to lower MMI to 30 mg and just keep levothyroxine at 150 mg. No real purpose in getting it to 159. There often needs to be some mild adjustments when first starting block and replace so you might want to call and ask if these changes meet with your doc's approval. mention your symptoms too. Best, Elaine