TSH undetectable

[Toadie444]

I'm taking 100 micrograms thyroxine and 37.5mg liothyronine spaced out through the day. I had a sub-total thyroidectomy many years ago. I'm feeling better for the first time in years but doctor has just told me my TSH is undectable. Do I need to worry or do anything about this?

[SeasideSusie Remembering]

Toadie444

doctor has just told me my TSH is undectable

That's what taking any form of T3 can do, it can lower or even suppress TSH. If your doctor is on board with you taking T3 then he really ought to know how it works.

What are your FT4 and FT3 results? Can you post them with reference ranges.

I take Levo plus T3 and my TSH always comes back <0.01, and even when I was on Levo only it was well below range regardless of the dose I took.

[Toadie444 in reply to SeasideSusie]

Hi thank you for your reply. Currently I get the T3 from a private GP and NHS doctor not really clued up on it. Sorry I'm afraid I don't have the details from the test results at the moment - I was just told this morning that TSH was undetectable, T4 was 'fine, in the normal ranges, and my GP doesn't test T3 routinely... I just wondered if it was ok for TSH to be completely suppressed?

[shaws Administrator in reply to Toadie444]

This is an answer from the link below:-

"Dear Thyroid Patients: If you have thyroid gland failure--primary hypothyroidism--your doctor is giving you a dose of,levothyroxine that normalizes your thyroid stimulating hormone (TSH) level. Abundant research shows that this practice usually does not restore euthyroidism--sufficient T3 effect in all tissues of the body. It fails particularly badly in persons who have had their thyroid gland removed. IF you continue to suffer from the symptoms of hypothyroidism, you have the right to demand that,your physician instead give you T4/T3 (inactive/active) thyroid replacement therapy. Your physician can either add sufficient T3 (10 to 20mcg) to your T4 dose, or lower your T4 dose while adding the T3. The most convenient form of T4/T3 therapy, with a 4:1 ratio, is natural desiccated thyroid (NDT-- Armour, NP Thyroid, Nature-Throid). If you have persistent symptoms, you can demand that your physician change you to NDT and adjust the dose to keep the TSH at the bottom of its range-- when you have the blood drawn in the morning prior to your daily dose. This may be sufficient treatment, but IF you continue to have hypothyroid symptoms, and no hyperthyroid symptoms, demand that your physician to increase the dose to see if your symptoms will improve, even if the TSH becomes low or suppressed. You can prove to your physician that you're not hyperthyroid by the facts that you have no symptoms of hyperthyroidism and your free T4 and free T3 levels are normal in the morning, prior to your daily dose.

They may even be below the middle of their ranges. Your free T3 will be high for several hours after your morning T4/T3 dose, but this is normal with this therapy and produces no problems. You should insist that testing be done prior to your daily dose, as recommended by professional guidelines. It's simple common sense. TSH is not a thyroid hormone and is not an appropriate guide to thyroid replacement therapy. The hypothalamic-pituitary secretion of TSH did not evolve to tell physicians what dose of levothyroxine a person should swallow every day. A low or suppressed TSH on replacement therapy is not the same thing as a low TSH in primary hyperthyroidism. If you have central hypothyroidism, the TSH will necessarily be low or completely suppressed on T4/T3 therapy; your physician must treat you according to symptoms and the free T4/free T3 levels.

hormonerestoration.com/

[SlowDragon Administrator]

You do really need to test FT3 and FT4 when taking T3

As long as FT4 and FT3 are within range TSH is largely irrelevant on Thyroid replacement hormones

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take in the 24 hours prior to test, and if on T3 don't take in 12 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Also make sure that vitamin D, folate, B12 and ferritin are at good levels as this helps Thyroid hormones work well

Vitamin D around 100nmol

B12 and folate near top,of range

Ferritin half way in range