Can anyone enlighten me please. Had thyroid gland removed 12 years ago. Have been on Levothyroxine. Just gone onto T3 5mcg twice a day plus T4 75mcg.
My blood tests have come back, T3 and T4 in range, normal, but TSH dropped to 0.01. Consultant, who I have little faith in, due to past mistakes, says this is showing over medication, but will review in 2 months. I really don't understand if T3 and T4 ( 13, range 9 - 19), are in range, how is the TSH so low. Does it matter???
In a word...,no it doesn't....but sadly endo is unlikely to agree ....Most are TSH obsessed
When taking T3 our TSH is almost always suppressed
Essential thing is that FT3 and FT4 are within range
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
If also on T3, make sure to take last dose 12 hours prior to test
Is this how you do your tests ?
Yes, blood test done early in the morning, fasting and before meds. Will have to wait and see what happens at next blood test.
And last dose of T3 twelve hours before blood test?
Yes
I have no thyroid either and mine TSH is lower than yours. When I had mine removed my surgeon wrote to my GP requesting that she kept mine suppressed i.e. low.
I have good bones and heart so this in my opinion is just the Endo making too much over nothing. If you don't feel over medicated then you are not, simple.
Interesting, as she is an Endrocrinologist, you hope she knows what she is doing. I know that if you have it removed because of cancer, then they keep the TSH low, mine wasn't. I just don't get how the T3 and T4 levels are in range yet TSH so low. Good to hear your bones and heart are ok, this is what they scare you about.
Suggest you get vitamin D, folate, B12 and ferritin tested. Often one or more of these are low, and can be reason TSH goes very low
Or some of us just need TSH suppressed in order to have high enough FT3
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne at
tukadmin@thyroiduk.org
Professor Toft recent article saying, T3 may be necessary for many, otherwise we need high FT4 and suppressed TSH in order to have high enough FT3
rcpe.ac.uk/sites/default/fi...
Professor Toft
President of British Thyroid Association 1996-2009
Past President of the Royal College of Physicians of Edinburgh
Physician to the Queen in Scotland
I am still confused, as having read the study by Dr Toft, I see that at the very end, he still says in his summing up of choices for doctors that a combination of T4/3 could be prescribed but TSH should be normal. Mine is always suppressed on the combination treatment, even when T3 is low in its reference range. Surely everything that he says earlier in the paper indicates that TSH will be suppressed if taking T3? Whenever my GP squawks that TSH is suppressed, I tel her it is because I am taking T3 and she drops the subject but one day I know a difficult GP will stir up trouble for me. What is your view, please?
I agree. My TSH is also suppressed on Levo or on T4 plus T3. I have DIO2 gene variation.
But I don't know anyone on adequate level of replacement thyroid hormone who doesn't have suppressed TSH
Many thanks for your response. So why, when he appears to be on our side re the necessity of T3, does he still think TSH must not be suppressed? I was about to print the paper as evidence to a GP should one ever become difficult, but the last paragraph makes it no help at all if one is on the combo...
I did email him a few months ago and he very kindly replied that my suppressed TSH was fine as long as T3 was in range, so I am very puzzled about this paper.
I have no idea whether I have the D102 gene variation but I have had thyroidectomy, which he specifically mentions as a problem for T4 only patients.
More studies are needed, obviously...round and round we go...
That’s interesting his reply ....as long as FT3 is in range
diogenes May have some research you could give GP
There is a problem of perception here. There are supposedly valid clinical trials indicating increased frequency of osteoporosis and atrial fibrillation with suppressed TSH on therapy. Then there are others that say no such thing. The complete intellectual mess in this area is the result of poorly designed trials, nearly all of which only look at TSH and FT4, and which can confuse truly overdosed patients with properly dosed ones (because they don't measure FT3, the only useful determinant of over treatment). The medical profession seems to favour the "result" trials over the "no result" ones for reasons I can only suppose are purely subjective. There is no logic here, only prejudice.
Hmm! Sorry but I have just tracked down my reply from Dr Toft last December and re-read it to make sure I had my facts right. He says that as long as T3 and T4 are both LOW in range, I should not reduce my dose of T4/3, even though my TSH is suppressed. That is the crux of it - low in range. So my earlier post is not absolutely correct when I said they should be “in range”. Hope this clarifies it for all.
well that doesn't fit my results....both high (top 1/3rd) and suppressed TSH
I did try lower dose ....Felt dreadful and TSH never moved
I would definitely be taking more T3 if I had not suffered one attack of atrial fibrillation, whilst recovering after being in hospital for an appendix abscess. It was frightening and made me more wary of being too cavalier with thyroid hormones. When tested, both T4 and T3 were slightly over range, which was never my intention but I believe it happened because I had been very ill, had no sleep the whole time I was in hospital and had lost a great deal of weight, hence I probably did not need my usual level of thyroid dose.
Blood tests TSH T4 T3 
Low T3 Low T4 and very Low TSH
Mega low TSH normal T4 & T3
normal TSH and T3 but Low T4
