I was wondering if anyone had any medical knowledge or experience based on their dosages on how much thyroid medication (roughly) it takes to reduce TSH by a certain amount?
I understand everyone responds somewhat differently, but I'm sure there is a baseline average somewhere that says that taking X amount of Levo or Armour etc will reduce TSH by X?
This is the only information I could find was some doctor saying that a very low amount of Levo ( 15mcg ) will lower TSH by 2 digits.
The reason I ask is because I am self medicating under supervision to try and increase my low T3 and T4, but my body is simply lowering TSH but keeping t3 and t4 the same. I want to try and increase my t3 and t4 but want to have an idea on how much I should take based on peoples own experience.
I have attached the thyroid dose conversion chart for reference.
Thanks so much xx
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krizzobizzle
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Your TSH is still too high to resolve symptoms. We aim for 1.0 from any lab as the ranges seem similar, however for FT3 and FT4 the labs have different ranges so I can't tell how good or bad yours are without seeing the range for that particular lab.
Your antibodies are still high so your thyroid gland is still at risk. Do you take selenium and if you have diet issues like gluten, dairy you should try to exclude them as those two seem to be involved in autoimmune conditions. You do have an autoimmune issue when you have antibodies.
The link I gave you shows the pathway for thyroid hormones and it is a long and variable one so you can't really form a rigid cause and effect. Once you take either NDT or Levo, it begins to convert in the stomach, then it does through more conversions in the liver and kidneys (IF it converts since it need cofactors for that) then if you have free T3 trying to attach to receptors, the condition of the receptors come into play. Cortisol can block receptors and your antibodies are a problem.
That's why you need many approaches to your condition although the simplest is to keep taking enough hormone and hopefully get to some degree of utilization. In the meantime your nutrition is affected so supplementing is almost always necessary.
I think it's best if you ignore TSH and test FT3 and FT4 - I am not medically qualified. I will give you a link and you can see the reason why both should be taken into account when trying to recover.
To specifically answer your question, in my experience the higher your TSH is the larger effect a specific dose will have. For example when my TSH was 100 I added a quarter grain and it went down to 50. The next quarter grain took it to about 20, the next to about 6 (this is from memory, but I've studied my numbers a lot!).
When you're self medicating the most important number is freeT3. This is the number that relates most closely to symptoms as it's the active hormone. In my experience, TSH always correlates with the dosage - every time I have increased my dose the TSH has always reduced. Whereas my freeT3 and freeT4 waver a lot more. Sometimes with an increased dose the freeT3 is lower than it was on the previous dose.
MY ferritin and vitamin levels seem fine when checked on last test. The problem I have is, what if i take thyroid medication but my body lowers TSH and keeps t3 and t4 in the same place?
I believe this is a relatively common issue, but have not seen many threads explicitly discussing it. I think you may get more responses about this if you start a new thread only asking this one question.
At the momen, btw, your TSH is far too high, and freeT3 looks low-ish. The rule of thumb is you want the TSH at 1 or below (although the exact number isn't really important, it's more important not to hang about with it well over 1), and more importantly freeT3 in the top third of the range. You haven't given the range for yours, but I suspect your is about a quarter up?
This is actually not a terrible freeT3 in relation to that TSH, so you might find the freeT3 will rise of you have a few more increases. It doesn't necessarily rise every single time. Or maybe not even half the time, it just generally rises. As long as that number isn't over range you're safe to keep increasing.
Sry I only just saw I had this message. Thank you so much for this useful information, this really helps.
I'm thinking a low dose of t3 (cytomel) may be useful? I have 25mcg tablets and thinking a month or 2 trial may be of benefit to see if it can drive TSH down and t3/t4 up. Although I am unsure what dose may be of benefit. I can maybe get a blood test after 1.5/2 months and see what ranges I get it to .
You are right. I think the TSH number is irrelevant, whats more important is enough thyroid hormone to get my t3 and t4 slightly higher.
Are there any issues with blood tests? Should you not dose on the day of the blood test to make sure its accurate?
Ideally you want to stay on a given dose for 6 weeks and then have another test. You have room for an increase, so add a small amount, 10mcg of T3 or 25mcg of T4 to your daily dose. Round up or down to what you can get with tablet sizes. Get a pill cutter to make halves of you need to.
Then stick to that dose for the 6 weeks. Some ppl find T3 hard going, so you might have to add a very small amount at first and build up to the full amount you want to increase.
On the day of the test get the earliest timeslot you can, go in fasting (water only). Leave a 24hr gap between taking your medicines and the test.
Yes, 25mcg is an extremely large increase. T3 is much stronger than T4, so that is the equivalent of about 100mcg. It's the best part of a complete replacement dose, so too large to increase in one go. But you can repeatedly test and increase to eventually get up to that size dose.
In terms of dosing thyroid replacement, T4 and T3 are roughly equivalent to each other. If everything is working well, any T4 you take will be converted into T3 by your body. So you can either take T4 and let your body do the conversion and end up with T3 downstream, or take the T3 itself. Theoretically there are a few benefits to taking it as T4. It allows your body to make the T3 as it needs it, and also it lasts in your body a long time, so you only need to dose once a day, or can even take different doses on different days to tune your dose. With T3, your body only gets exactly what you give it that day, and the half life is very short, so you will likely need to dose at least twice a day. I take mine 3 times a day.
The argument for T3 is that some people are bad at conversion. Some people also have problems getting the T3 into their cells and other kinds of issues. T3 can therefore work for people who don't do well on T4. There's an argument that everyone could benefit from a tiny addition of T3, as it may help to kickstart the conversion process.
So anyway, whether to raise T4 or raise T3 is a choice. I think the simplest path is to try out T4 only first of all, and only start experimenting with T3 after you've found T4 doesn't work well. One of the biggest arguments for this is pragmatic - the NHS give T4 but don't really use anything else. I'd go through 2 or 3 cycles of adjusting your dose by a small increment, and then getting a blood test to have a good trial. The blood tests should be every 6 weeks.
You've mentiomed that your freeT3 and freeT4 haven't been raising, but you haven't said how many increases and what kind you've had, so I can't tell whether this is a big problem yet. But definitely get hold of 3 or so examples of raising your dose and looking at the blood tests to confirm whether things are raising. When you've got those make a new post and people will have more material to advise you about.
Hi S.A, I think you are right and T4 lowish at 50mcg may be safer at this time? and then test after six weeks? I'll post my before and afters in six weeks.
Hi, sorry I've got a bit confused. Are you not already taking thyroid hormone? What dose where you on when this blood test was taken?
Whatever you're already on, I tend to prefer giving that a thoroughly testing - taking it for 3 plus months, having several dose increases and ideally getting your blood into a good range. Only then can you decide whether that treatment is working well for you. Don't chop and change between T4, T4+T3, and NDT. Ideally you want to give something like T4 a full testing, so that if you choose to move on to a different format of thyroid replacement, you're doing it because you're absolutely sure whether T4 works well for you. You don't want to be several years down the path and wondering whether you need to trial T4 again because it might be the only thing that works for you.
Oh let me clarify. Currently I am on NO thyroid medication. Does this change anything? These are my levels. I am simply trying to get my tsh down and my t3 and t4 slightly higher so I can feel better.
Oh, this is much better with the ranges, and the anti body test is also important. This anti body test shows that you have Hashimoto's, sometimes just called autoimmune thyroid disease. You will have this illness for life, and it will slowly attack your thyroid. Which means your thyroid function will get worse and worse over time.
Yes, the fact that you're not on thyroid medication makes a difference. It's because the numbers a healthy person will have are a bit different from the ideal that you'll aim to achieve with thyroid meds. So two people could have identical blood tests, one of them having a perfectly healthy thyroid and feeling fine, and the other person having no thyroid and being dependent on meds, who may need a much higher dose in order to feel well.
As it is, you have blood test results that a well person could have. But it's a shade higher than the average. So you're right on the borderline. If you have symptoms, and as you definitely have Hashimotos, those are reasons to perhaps medicate. You will probably have worse blood tests in a few years time.
So for you taking thyroid replacement is an experiment, rather than a case of turning the treatment you definitely need. It might make you feel better, but it might not and you might decide you're better off without. Pretty much all doctors will advise you not to medicate, and so will a lot of patient advocates. Personally I think it's always worth an experiment, I know a lot of people with CFS, and I certainly advise them to try it, as it's better to have a small chance of improvement than none.
So it's a judgement call first of all of how bad things are. You may feel worse on medication than you do now. I also think records are VERY important. Take very detailed notes before you start, particularly record the things you find hard to do, and your symptoms. Research how to measure and record your basal temperature, pulse, and record these for several weeks where you are now - you may not be able to tell whether your symptoms have improved just from memory. Overall read up a lot. This is a decision you're making, and not necessarily something you're forced into, so make sure you're going in with your eyes open.
I think it depends where you are. NDT is probably the most likely form of thyroid to work for everyone, even if you're very ill and have other complications. But it's just about never available on the NHS, so you're committing yourself to a lifetime of self medication, and no conventional doctor will be able to give you any advice.
I'm now confused about whether you've already started on something, or that this blood tests might be with no medication at all. If you're not taking anything, the interpretation is quite a bit different, as actually you don't meet the requirements to be diagnosed as hypothyroid, even by the much more generous definition patients would use.
So in that case you're just doing an experiment with thyroid replacement to see if it helps you out. In that case I do tend to recommend either NDT or T3, because these are the more powerful kinds of formats. But this is really a philosophical issue rather than a medical one
Also I think you need to go super super slow. NDT can be good because very small sized tablets are available. You can buy quarter grains, which are the equivalent to very roughly 5mcg of T3. Also for NDT armour is VERY expensive. If you're in the UK all the prices have raised since the Brexit decision, and Armour is about double the mid-priced brands.
I'm just rambling, now, as these are complicated decisions! You've got to do plenty of research to work out what you want to do.
Also the reduction of TSH after taking exogenous hormone is rather meaningless. It doesn't see the need to rise if you have plenty of hormone in your bloodstream however you want T3 to enter cells (every cell of the body in fact needs thyroid hormone). They used to use body temperature as a guide as it is difficult to know whether this is happening.
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