Suppresed TSH 0.13, Low T4 10.5 and Middle T3 4.6 (3.5-6.5)

I have Hashi's and introduced T3 to my T4 about 2 months ago. Originally on 112.5mcg T4, now on 50mcg T4 and 15mcg of T3. Doctor just phoned with the above so don't have all the ranges yet but will pick up and post tomorrow.

My question is, why is my TSH suppressed when my T4 is low and T3 in the middle? I know that TSH is suppressed when taking T3, but the T3 level isn't that high either, so wondered why the pituitary wasn't busier.

6 months ago my TSH was up as high as 44 so the pituitary seems to be working okay but i did have high antibodies a year before that up to 1100.

If the thyroid is now defunct, does that mean TSH will always be low. Does the pituitary know the thyroid is dead?

I know life with Hashi's isn't simple, but does anyone know what is going on.

Thanks, Jan

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17 Replies

  • Wish I did! My results similar but always with much lower TSH, usually < .02. I'm hypo but they've never detected any antibodies on testing.

    Drs nervous of what I'm taking because of the low TSH. My TSH originally very high and reduced quickly but my T4 level never rose! So still low on thyroid hormone and taking tabs for life? Really feels there's something rather idiotic in that when you think about it......

  • Thanks Sandi, it seems an all too familiar story with Hashi's but I fear my understanding of the biology of it all is woefully lacking. Good luck

  • If you cursor to the question dated July 15, 2006.

    If you email for a copy of an article in Pulse Online and question 6 states we can have a low or suppressed TSH if it makes us feel well.

  • Thank you Shaws I will read the links as suggested. The problem is I don't feel fully well even with a suppressed TSH - just trying to understand, as much as you can with these things, what it all pointed to, if anything.

  • I only finally felt and got better when I stopped levo altogether.

  • Hi Jan - looking at my results, your TSH isn't particularly low, mine's 0.03 mu/L and although below the normal range for the testing lab (their range is 0.10-5.00) the doctor has said to have another test in six months. My T4 is 16 pmo/L which isn't really high enough for me to function efficiently. I'm hypo following RAI so I dont know if that makes a difference. I'm on T4 only (100 mcg) and have been unable to persuade doc to test T3, he says lab will only test if other thyroid results are abnormal. I'm seriously thinking about getting a private thyroid test to give me some ammunition!

  • Thank you for your reply. I can see what you mean about your TSH but my labs reference ranges are 0.35 - 5.5, so I am under on mine and okay on yours. The only reason I got the T3 test was that my endo had asked for it, otherwise, like you, they wouldn't do it. I understand TSH fluctuates during the day and read somewhere, I think, that its higher in the mornings and tapers off during the day (someone else may be able to clarify this). Having said that how doctors think they can see the full picture without a Free T3 test I don't know. It could be that your T4 is not converting efficiently and your T3 is low, which is the one that provides the energy. If your budget will run to it, I think I would be tempted to get a private test too.

  • I put up a post on T4, T3 and TSH rhythms about two years ago, here:


  • Thank you Rod, a very useful piece of kit and I can easily see why you could end of up with several different TSH readings on the same day.

  • There has been research to show that, once you have hypothyroidism, TSH is no longer a reliable indicator of thyroid function and thus hypothyroidism should be treated as a different entity when treating. TSH is not the test to use. The feedback mechanism is broken because the thyroid isn't working properly and you are getting your thyroid hormones through different means (tablets). Nobody really understands why the TSH test doesn't follow the usual curves for hypothyroid patients. It seems to be a very complex business! We just know that it doesn't.

    Low TSH is nothing to worry about if your T3 is normal. Actually your T3 is still rather low. To be middle of the range it would need to be around 5. You could probably do with either an increase of T3 or T4 depending on what makes you feel better. Your doctor would be better trying to get your symptoms controlled whilst keeping your T3 within range to get best results.

    My TSH is always low but I think I may have some form of secondary hypothyroidism because, when I was pregnant, my TSH was 0.2 and my T4 was low. I don't think it was always this way as I was diagnosed quite easily when I finally got a diagnosis! I was 'definitely' hypothyroid and it was clear from my tests. I don't have the results so I don't know what my TSH was, but I do know that my excellent GP at the time tested T4 and T3 and decided t3 only would be the best treatment for me. It was and I was very well until the 'Powers that Be' decided we all had to take levothyroxine instead. I would be interested to find out what my TSH was at the time...

    Carolyn x

  • Thank you Carolyn, I appreciate your comments. I am less concerned about my TSH than my endo, he has already said he doesn't want it suppressed. So here lies the problem. I will be going back to see him next month so was trying to anticipate the reaction and what might happen. As my T3 is not far off mid-range, just 0.4 (not sure what that represents in terms of T3 meds but from what Rod was saying above if I had had bloods taken at a different time time in the day it might be higher), and my T4 was right at the bottom end I thought I just might increase my T4 a bit and leave the T3 where it is.

    To be honest I am not taking the amount of T4/T3 which was prescribed, just couldn't tolerate it to begin with so have been starting low and building up to prescribed dose.

    I am in an old body so I think the shock of the full dose sent me into a spin.

    jan x

  • Hello. I'm new to your site, and very interested in the new research you have mentioned. Could you please send me a link to it, or at least point to where I can find it and read it's full text. Your help would be greatly appreciated. Thanks.

  • Hi Fannie, welcome to the site. I'm not sure which paper Carolyn was referring to when she wrote that, but it may be this one from 2010:

    Is it safe for patients taking thyroxine to have a low but not suppressed serum TSH concentration?

    There are a couple more on the same page that you might find interesting.

  • Thanks for the link. It will be very helpful in my negotiations with my endo.

  • ive been on 100mg levo for 2months bloods came back normal i feel so tired so depressed to a point where i get suicide thoughts i have asked my doctor to put them up as i still dont feel right and he offered me antidess i am already on diazapam for the past 12 years and slowly coming off them,i no my own body but he is having none my bloods were 0.3

  • I assume you mean your TSH was 0.3? Mine is lower than that and I don't feel too bad, although I am taking T3. Thats the problem with doctors relying on TSH, how do they know what is going on. Could you persuade him to do FT4 and FT3. With a TSH like mine of 0.13 you would expect that T4 and T3 would be at the high end, but its not, in fact the T4 is only just in at the bottom - so how do they think they can tell by just looking at TSH.

    If you have been unwell for a long time, it will take a while for things to start working again. Have you had tests for Vit D, B12, folate, ferritin etc. Do you think you are getting a bad reaction from coming off the diazapan?

  • TSH is a total rubbish test that should never be relied on once on thyroid meds but doctors are too stupid to remember its the pituarity feedback loop satisfy the body with adequate thyroid hormone and theirs no need for the pituarity to try to kick a dead thyroid with TSH ........simple really

    your free t4 or free t3 are more important and need to be at top of the range or even over depending on which meds you are on

    Be sure to get ferritjn level checked needs to be at least 70 and pref 90. (13 -150) to absorb and convert thyroxine into t3

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