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Levothyroxine and Hair Loss

Hi everyone! I am totally new to this group and excited to get input from everyone! I'll try and give you a quick synopsis of the past year and a half for me when I gave birth to my first child....

Initially I felt fine, until about 4 months after I gave birth.  I had initially lost all the baby weight and then I started gaining again, had major brain fog, dry skin, cold, crazy water retention and bloated face, unmotivated, etc.  all the usual symptoms.  In February I was diagnosed with Hashimotos by my regular doctor and here are my levothyroxine dosages and blood results since...

Feb 2015    Tsh 269.    T4. <0.11.  T3. <20.      (No meds yet...initial blood work)
Apr 2015.    Tsh 156.    T4.   0.45.  T3.  42.       (25 mcg)
May 2015.   Tsh 6.69.   T4.  1.83.   T3.  96.       (75 mcg)
Sept 2015.   Tsh 2.89.   T4.  1.59.                      (100 mcg)
Oct 2015.     Tsh 8.61.                                         (75 mcg)
Nov 2015.    Tsh 1.21.                                         (100 mcg)
Feb 2016.     Tsh 2.36.                                         (100 mcg)

So my original Doctor began my levothyroxine regimen at 25 mcg for 6 weeks. I immediately felt much better even though my numbers were still going crazy.  He upped my dosage twice then sent me to an endocrinologist.  Both agreed that my numbers were so bad it could not be postpartum hypothyroidism and I had probably had this for a long time undiagnosed and the pregnancy made it officially just turn off.  In October we lowered the dosage to double check this theory and I felt terrible and my numbers changed right away so my endo put my meds right back up.

Now, hair loss was actually never one of my initial symptoms and I am convinced that it began when i started my medication, but both doctors insist that it's my body getting used to the meds and my levels getting better and better. My endo thought perhaps it's was especially bad because I was also experiencing postpartum hair loss.  But at this point it is now a full year since I have been diagnosed and on medication.  Coupled with the hair loss I also started getting serious joint pain, but again my endo said I was adjusting and this was a common symptom of hypothyroidism.  

So basically, I am wondering how after a year of medication I would still be experiencing symptoms with levels that are now perfectly fine? Unless it was related to the medication??....I feel very guilty bringing it up all the time to my doctor because I know I should be glad that the huge issues of brain fog, concentration and mood are generally good (I still say I am not exactly myself yet).  I feel silly bringing up something cosmetic but it is so depressing to look in the mirror.  I hate doing my hair, washing it, sometimes just running my fingers through my hair I get five more.  Even though now I can say it's less, it's definitely still happening and I don't see any new growth.  But, on the flip side, hair loss is associated with adjusting to armour and I am terrified to lose any more :(

So...advice?! Am I Crazy? Should I try to switch meds? Has anyone else experienced this on levothyroxine? My endo insists that hair loss is not a side effect...
3 Responses
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Avatar universal
It is a good sign that your doctor was willing to prescribe some T3 med.  You are correct that your total effective dosage is actually being reduced by the med change.  You can tell the doctor that on page 1002 of the 2012 Guidelines for Hypothyroidism, published by the AACE and the ATA, it says that the ratio for T4 to T3 is 1:3.  So our new dosages add to only the equivalent of 50 + (2 times 5 times 3) = 80 mcg of T4.    That is probably why a lot of his experience was most patients noted no change.  If your 100 mcg dosage was insufficient, this new dosage will be worse.  Although you may feel some benefit for the first week or so, from the effect of the fast acting T3 med, as the old higher dose of T4 dissipates.

The drop in your T4 med should be no more than down to 75 mcg based on your Free T4 test results.  I think you should discuss that dosage with the doctor for the reason I outlined above.  Then with the 2 times 5mcg dosage of T3 you should be ready to go back and get tested for both Free T4 and Free T3, and make sure it is done each time they test.  Scientific evidence shows that Free T3 correlates best with hypothyroid symptoms, while Free T4 and TSH do not.  TSH tests are a wast of time when already taking thyroid med.  

Even though your doctor said, incorrectly, that Free T4 and free T3 tests were not necessary, there may be a possibility that he will work with you if you give him enough scientific evidence to refute some of what he has been doing.  I a going to send you some info by PM.  To access, just click on your name and then from your personal page, click on messages.  
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Avatar universal
Ok I had my appointment today and it went well-ish.  My doctor was very open to trying to add t3 to my drug regimen although said he only sees between 20-25% of patients who feel better with the adjustment. He said that most notice no change.  I asked all the question about testing free t3 and free t4 and he said it was not necessary??... He added b12 and iron to my bloodwork which I'll ha e done in 6 weeks so he can also check my levels after this prescription switch.  Ian terrified of dropping the levothyroxine dosage but hopefully his calculations are correct...I am going from 100 mcg of levothyroxine to 50 mcg and now the added liothyronine 5mcg twice a day.  By my calculations that only adds up to the equivalent of 90 mcg of the original levothyroxine?...

Sigh...I think I'll do my research, see how I feel and my results from the bloodwork in 6 weeks and perhaps start seeing someone new...I don't know :(
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Avatar universal
I would agree that the hair loss is not a side effect but inadequate levels of the biologically active thyroid hormones, Free T4 and Free T3, along with likely low levels of ferritin, which is a form of iron.  

It appears that your doctor tested for Free T4, but Total T3.  Total T3 is not very useful compared to Free T3.  Scientific studies have shown that hypo symptoms correlate best with Free T3, and not Free T4 or TSH.  When already taking thyroid med, TSH is basically a useless test because it is so often suppressed below range when taking adequate med.  Symptom relief usually required Free T4 at the middle of its range, at minimum, and Free T3 in the upper half of its range, as needed to relieve symptoms.  Your Free T4 appears to be on the high end of the range, but if your Total T3 is an indication of your Free T3 level, then I expect that your body is not adequately converting the T4 to T3, resulting in low Free T3.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free T3 as needed to relieve symptoms, without being constrained by resultant TSH levels.   Symptom relief should be all important, not just test results, and especially not TSH results.  You can get some good insight from this link written by a good thyroid doctor.  

http://www.hormonerestoration.com/Thyroid.html  

So you need to use this information to get your doctor to add a source of T3 to your meds and then gradually increase as needed to relieve symptoms.  Also I suggest that you get tested for your Free T3 level and also Reverse T3.  Revere T3 is a mirror image of T3, but biologically inactive.  RT3 is a normal product of conversion of T4, but in excess it blocks the effect of Free T3 and can cause hypo symptoms also.  It would also be a good idea to test for Vitamin D, B12 and ferritin.

If you can get all that done, then post results and reference ranges shown on the lab report and we will be glad to help interpret and advise further.  



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