Thyroid UK
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TSH advice and Thyroid Testing Trough Method

Have gone to so many Drs, a few best endos in my area, and trying to figure out how to medicate myself properly to reduce this decade-long fatigue (other issues possibly, including adrenal fatigue from stress and a long time in t4 only meds). Finally seeing a good dr tomorrow to go over recent test results. All Drs have told me to lower my WP Thyroud that I take sublingually and incrementally throughout the day (approx 2.5 grains total). This Dr M, I'll call her who is also testing me for suspected Lyme disease, advised me to test using the trough method. No meds morning of and you test your thyroid hormones in the am right when you are supposed to take your meds.

My issue is that many Drs are always saying to lower my meds because my TSH is too low. Like .001, but that was not using the trough method. With the trough method, my tsh was better at .01 and with a 1/4 grain less meds from the prior test take. Finally my a TSH at .01 really not good? This supposedly good endo told me that with Hashimotos and with a non-functional thyroid at this point in time, that my TSH range goal should be .045-.25. I feel like I need more thyroid meds or hopefully Dr M will prescribe hydrocortisone for me tomorrow. I drink very watered down coffee all day that seems to help, and recently I started to take ibuprofen throughout the day. I'm up to three ibuprofen now and that is what helps when I really start to slide. I think that it is helping me retain fluid and increase my blood pressure.

Last question is re the trough method. My free t3 and free t4 could have been raised slightly per those results, however, if it's close to optimal w/o meds in the morning when the test was taken, does that mean that I'm actually over medicated once I do take my first grain in the am and my free t3 and free t4 then increase? Or are the results exactly reporting my status? If it shows a free t4 at 1.17 and a free t3 at 3.9 (TSH at .01) can I increase my WO Thyroid? Any advice is appreciated!! 😊🌸😊

6 Replies

No, it doesn't mean you're over-medicated. I've never heard it called the 'trough method' before, but we always advise people to leave a gap of 12 hours between their last dose of NDT, and the blood draw. Have the blood draw as early in the morning as possible, and fast over-night. That way, you get the highest TSH - because doctors only tend to look at the TSH, although, in actual fact, when you are on thyroid hormone replacement, the TSH is totally irrelevant. It can go as low as it likes. And it doesn't mean you're over-medicated, it just means that the pituitary senses there is enough thyroid hormone in the blood, so you don't need TSH anymore. It's only there to stimulate the thyroid.

When taking T3 in any form, the FT4 is bound to be low, because the body only hangs on to what it needs, and you don't need as much. The important number is the FT3, and although you haven't given a range for your FT3 - please, please, always give ranges - it looks low. So, plenty of room for an increase in dose.

Why do you want hydrocortisone? It's not something to be under-taken lightly.


Thank you. My Free t3 is 3.9


As you have Hashimotos are you on gluten free diet?

Any obvious gut issues? Hashimotos is strongly linked to leaky gut & food intolerance - usually gluten but sometimes May be dairy and/or soya too

Any recent tests for Vitamin D, folate, B12 & ferritin

These all need to be at good levels for thyroid hormones to work

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Yes, gluten free for a long time and now dairy free except goat milk in am w coffee (yuck). Checking vitamin levels w/ dr M today. Thank you!

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See Isabella Wentz The Thyroid pharmacist website for more

Also Chris Kresser & Amy Myers

Also look at gut infections- e.g. Candida


Thyroid hormone molecules are too large to be absorbed sublingually through the tongue. You may not be actually taking the dose you believe.

This is an excderpt from RLC labs who make WP Thyroid and NatureThroid:-

Take WP Thyroid or Nature-Throid in the morning on an empty stomach 30-60 minutes prior to food or caffeine with an 8oz glass of water; unless otherwise instructed by your physician. These medications can also be taken two hours after eating with an 8oz glass of water, then waiting 30-60 minutes before consuming food or caffeine. Some medications and supplements may lower the effectiveness of WP Thyroid and Nature-Throid when taken simultaneously, so it is important to take WP Thyroid or Nature-Throid at least one hour before any other medication. Calcium supplements, iron products, or antacids need to be taken four hours apart. Some foods may cause your body to absorb less WP Thyroid or Nature-Throid, including walnuts, infant soy formula, cottonseed meal and high-fiber foods. Talk to your doctor about adjusting your dose if you consume these foods. Keep out of reach of pets and children.

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