Hello all. I have been on a t3/t4 regime for 3 months now. Doses are 125mcgs (t4) & 25 mcgs (t3). I'm a 30 yr old male, very active physically and weigh around 200lbs with a muscular frame.
This is a long post about a situation that isn't common. If you want a quick summary of this post, please go to the end of the post.
I have Hashimoto and before going on my current thyroid regime, my lab work was "fine" except for high antibodies. In these three months of my thyroid regime, I've had 3 (yep, THREE) superficial vein thrombosis (blood clots), although I suspect one was a deep one (DVT). Scary stuff.
LAB WORK:
My TSH is undetectable with my current thyroid regime; it's 0.005 (lowest I've read in this forum).
T4 is middle of the range.
T3 was middle of the range one month after starting this regime (surprised by this; thought it'd be higher). Last lab work two months later (i.e. 4 weeks ago) didn't test T3 (silly health care system).
The goal with this thyroid regime is to suppress TSH so antibodies go down. Indeed, they've gone down and down. Good stuff. I feel absolutely fine.
THE PROBLEM: (?)
I have Factor V Leiden (hetero), which means that I am slightly more prone to clotting than people without this. I've been doing a lot of research and there's some suspicion that a "hyperthyroid" state may increasing blood clotting. The research is muddy as there isn't much and there's some that points to a hyperthyroid state leading to hemophilia (increased bleeding) and NOT thrombophilia.
I was diagnosed Hashimoto over a decade ago and I've been on a couple of long-term thyroid regimes similar to my current one.
I have had two DVTs in the past and both were when I was on my thyroid regime with similar lab work (including undetectable TSH). Before starting my current thyroid regime three months ago, I was 6 years off any thyroid medication and I didn't have any clots whatsoever. But, as soon as I started my thyroid regime three months ago, I started having clots.
What scares me is the extremely low TSH, which could be causing hyper coagulability (just a thought). Yet my t3 was in range when tested as so was t4.
OPTIONS:
1) Go off the thyroid medication and continue to watch my Hashimoto. My last lab work detected an extremely low level of vitamin D (15.2 ng/ml, when range is 20nm/ml and above). I'm currently treating this deficiency to get my levels top of the range. Vitamin D deficiency is associated with auto-immune disease, so the idea is to go off the thyroid medication, continue with high-dose vitamin D to get levels up and watch antibodies.
How would I go off my current thyroid regime? I'm very active physically, so really need my thyroid to bounce back smoothly.
2) The second option is to alter the dose (i.e. lower t3), but I may still get more clots as I find a threshold dose. This would involve more lab work and the hope of not developing more clots until I find such threshold.
I'm currently on low-dose heparin for my last clot. I'll be off it in a couple of weeks, so I have to decide what to do.
Stop my thyroid meds and continue with high-dose vitamin D while keeping a watchful eye via further lab work?
Or try to find a threshold dose?
Many thanks for any help offered.
SUMMARY:
- I'm a 30 yr old male on 25mcgs (t3) & 125 mcgs (t4) since 3 months ago. Lab work is fine except TSH is 0.005 (extremely low).
- I have Factor V Leiden and I've had 3 blood clots since starting thyroid regime (last 3 months).
- I have had 2 major blood clots in the past when I was on a similar thyroid regime. I've been on and off thyroid meds and never had a clot when OFF thyroid meds.
- Suspicion is that current thyroid regime may be putting me in a hyper-coagulating state. There's research hinting that pharmaceutically-induced "hyperthyroidism" may lead to increased clotting.
- Options are to go OFF thyroid meds OR to try to find a threshold dose that keeps lab work in check and which also doesn't cause clots.
Written by
Mike0
To view profiles and participate in discussions please or .
I honestly think TSH is a red herring in this scenario. TSH isn’t a thyroid hormone and if you’re taking T3 it will be suppressed because your pituitary doesn’t need to send a signal to your thyroid to make thyroid hormones.
The research will be really unreliable and probably not relatable to your situation because the link will be between hyperthyroidism and throwing off clots, which is more likely to be due to what happens when someone has a condition like Graves - rapid heartbeat, tremor, metabolism going at a million miles an hour etc. But you don’t have Graves and you don’t appear to be over medicated, so that’s unlikely to be the reason for the clots in your case.
As you’ve identified, you urgently need an FT3 result. “Mid range” implies you are actually under medicated. I think reducing your dose is likely to make things better rather than worse.
But given the uniqueness of your situation and the additional complexity of having another condition, I doubt whether anyone here can properly advise. We’re not doctors here, just thyroid disorder sufferers. I think you need to work together with your healthcare provider to work out what to do.
I agree with Jazzw , Just having a suppressed TSH in no way indicates a hyperthyroid state if your FT3 is in-range.
But, I also think that antibodies are a red herring, too. There's no direct link between TSH and antibodies. Antibodies fluctuate, but they are highest just after an immune system attack on the thyroid, when they come in to clean up the traces of TPO/Tg that have leaked into the blood stream during the attack. But, they don't do the attacking. So, even if you entirely got rid of them - should such a thing be possible (but is it even desirable?) - you will still have Hashi's. So, not much point in deliberately setting out to reduce your antibodies in the hope that you will get rid of your Hashi's. You won't.
What could happen, is that suppressing your TSH reduces immune system attacks on the thyroid, because when the TSH stimulates the thyroid, it also stimulates the immune system to attack. But, the odds are it will still attack. Not enough is known about this to say anything with certainty.
Are you gluten-free? That is supposed to be the main trigger, and getting rid of that could also reduce immune system attacks. But, there again, nothing is certain.
What is certain is that suppressing the TSH does not make you hyper. It doesn't work that way. Thyroid Stimulating Hormone only stimulates the thyroid to make more hormone when it is present, not when it is absent. Don't confuse optimal thyroid hormone replacement with Grave's.
Hi I am on 100 mcgs T4 and 30 mgsT3 I have a suppressed TSH 0,004
My TSH was 0.004 when on T4 mono and my endo did nor seem that bothered about my TSH being that low
My T4 is only 11 at bottom end of range and T3 4,9 the very top of the range...
I think T3 does suppress the TSH in many people when they take T3,,
The point is do you feel good ?
, you would know if you was over medicated
if you feel over medicated and have signs of hyperthyroid . Tremor in hands, feel hot, your Temperature would be raised , fast pulse rate have high BP, maybe get pains in the chest and arms and feel Anxious and irritable and also quite tired, Hyper thyroid doesn't really give you much energy as you would think it would it is quite the oppisite it makes you feel quite tired tbh I know I had hyperthyroid years ago
if you have any symptoms of the above then maybe reduce meds I personally would reduce some of the the T4 if i had symptoms but thats up to your Dr or yourself to decide.
I am not a DR so cant tell you what to do,
Did a GP or Endo prescribe the T4 and T3 ? or have you self medicated.... ?
if you are seeing a Dr on this I would ask them what to do.!
Ask your Dr for another blood test and tell him he must write "ON T3" on the blood form and they should test it at the lab then,
or you could get private testing for thyroid panel from Medichecks ,
If you wait till Thursday they do thyroid Thursdays and get a discount other wise it is 39 UK pounds for TSH,T4,T3 or they do a test with TSH T3, T4 & anti bodies for 59 UK pounds..
... Sorry i have a americium keyboard and i don't have a pound signs on it which is a pain in the bum !, I am in the uk
Most people in the uk are Magnesium deficient or border line because our soils our food grows in now is deficient in magnesium so we are all suffering with that one, so maybe get Magnesium checked as well plus other vitamins B12 , folate, Ferritin, Vit D . and selenium if they will do it I think it is expensive so may not do the selenium, I never got Selenium or magnesium tested ( as my ex is a consultant he told me to take it as all uk are deficient or borderline ! but both made me feel much better
I take 100mgd selenium( Bio care) in the form of L-Selenomethione , this can lower anti bodies.
I also take Zinc Picolinate , 22mgs ( Solgar)
Magnesium Glycinate , This absorbs well do not use citrate as can cause other problems Methyl, B12 2500mg , ( by Jarrows ) but you can get 5000mgs
l have Factor Five Lieden ( DVT ,s and multiple Pulmonories x2 ) resulting permanant use of Riveroxiban , you dont mention that you have been prescribed blood thinners ? If you havent l would suggest that is the underlying cause of continued clots My TSH is suppressed and t4 just within range but free t3 is in upper range
On NDT and very well ,not worried about TSH at all and no clotting episodes .
I don’t understand why you’re not on blood thinners. Also don’t understand how you can go off thyroid meds for years at a time.
Suppressed TSH can be helpful in Hashimotos, by reducing stimulation of thyroid gland. A lot of people have suppressed tsh. It doesn’t sound as though your tsh is undetectable so not really suppressed anyway.
Have you been taking NSAD such as Ibuprophen at all, as there are some indications that these can cause clots.
Currently on a low dose of heparin but stopping soon? I had a PE many years ago now and put on Warfarin and told I would be on it probably for 6 months whilst they ran further tests. I'd recently had a hip replacement and within three months the medics had proved that was the reason for the clot so I was taken off the Warfarin but had they not proved that the operation was the cause then I would have been kept on the medication for life. So I'm thinking you should be kept on anti-coagulants as well, not just when the clot appears. Having said that I know nothing about your cause for clotting but something that is the reason for many and this condition is permanent I would have thought the treatment would be permanent as well. Please check with your doctor/consultant and get a second opinion if you have to stop and start as to me this doesn't sound right.
Welcome to our forum. Sorry to hear about your blood clots. I don’t know about Factor V Leiden but others have given their advice.
Many aren’t diagnosed with Hashimotos until the insidious destruction of the thyroid gland & more has been allowed, and thyroid hormone replacement becomes a necessity. As you appear to function well in between Hashimoto attacks, you are fortunate to have received a diagnosis before too much destruction of your thyroid gland has occurred.
Medicating 25mcgs T3 & 125 mcgs T4 is quite a high dose for someone who previous thyroid labs “were fine”. You say you are medicating thyroid hormone to reduce antibodies but these may be reduced in a variety of other ways. What were your thyroid hormone levels before you started medicating additional ?
TSH is released from the pituitary in response to the body requiring more thyroid hormone. As you are medicating T3, this will reduce TSH levels as the body detects you have enough thyroid hormone.
You mentioned low Vit D levels but thyroid & other hormones require optimal levels of all nutrients and iron to work well. Have you had Vit B12, folate and ferritin tested ?
Also thyroid hormone replacement should not be frequently stopped and started.
You may find The Root Cause by Izabella Wentz an interesting read.
Is my dosing really that high, though? I've seen some monstrous doses being used in this forum with no ill effects. My dose equates to about 200-220 mcgs of T4, which is high, but not skyrocket high considering that I weigh 200lbs and I carry quite a lot of muscle. I also engage in very intense exercise.
A full replacement dose of levothyroxine (only) for me would be around 160-180 mcgs according to the guidelines I've seen that aim for a TSH of 0.4 or just below.
I don't mind dropping the t3 to 18 mcgs, but I'm wary of this since the last test result of free t3 (one month after starting treatment) came out with barely mid-range free t3 at 25mcgs of t3 with 125 mcgs of t4.
No dose is too high or low if it is the correct amount to replace missing thyroid hormones.
Your TSH lowers and FT3 & FT4 stay about mid range after medicating but you feel physically the same whether you medicate extra thyroid hormone or not ?
The amount of thyroid hormone replacement we take can be estimated by our weight but it is usually the blood test results and how we feel that are the real indicators.
Be aware there are different feed back loops between the thyroid, pituitary, hypothalamus & adrenal glands and by suppressing the TSH level for some time, your pituitary/thyroid axis can become down-regulated, even when more is required. Thus, if you then decided to reduce/stop thyroid hormone replacement you may risk becoming hypothyroid.
Since my FT3 came back barely mid-range when tested after a month of 25mcgs t3 & 125 mcgs t4, I decided to test a higher dose by upping the dosing of t3 to 37.5mcgs while keeping t4 the same (125mcgs). The result was hellish and went back to 25 mcgs after 10 days.
In your opinion and considering the downregulation that you mention, what would be a good TSH to shoot for to avoid said downregulation? (and assuming FT3 and FT4 are kept in range - upper end of the range ideally).
If I were to be functioning well with test results within range whilst not medicating thyroid hormone replacement, I would not start medicating for the sole intention of reducing antibodies.
Especially after suspecting that said meds could be encouraging blood-clots.
In my capacity of only another Hashimoto sufferer, I would assume any level of thyroid hormone replacement meds taken that aren’t actually required could do possible damage. Remember all hormones (and their carriers) work together and count on balance to synergise successfully.
As advised above antibodies may be successfully reduced in a variety of other ways.
I expect that others on this forum have very low tsh readings when on T3; mine has been <0.001, as I recall. I certainly don’t pay any attention to it as I’m on T3 only.
I recommend getting your T3 checked as the supressed Tsh does not indicate hyperthyroidism to me in the absence of symptoms. However, if it turns out that you have lower T3 than you should, it may indicate an adrenal or pituitary issue or a deficiency. Personally I don't recommend getting serum Magnesium tested, as it is a wasted test (Magnesium is always kept in circulation even when cells are deficient). Your low vitamin D (It is a hormone) is very telling as it shows how unwilling your body is to take on too much Calcium. Calcium is responsible for clotting. Magnesium does not thin the blood, but it prevents Calcium build up that triggers clotting. If you want to check Magnesium levels an RBC test is recommended by the Doctors who are known to understand the many and varied problems that deficiency can bring. I cannot help any more than that, as you have a very unusual problem, but in your position I'd be trying to check things like inflammation markers and kidney function because Calcium deposits can wreck an otherwise healthy body.
Thanks. I'm pretty certain that I was NOT Vitamin D deficient in the two instances that I had the two big blood clots many years ago. My recent 3 clots in 3 months were whilst Vitamin D deficient though.
Kidney function was tested and it's great, although my phosphate excretion (measured via 24-hour collection of urine) is thrice the upper-most range (i.e. it's a huge amount). Calcium was measured and was good though, which is surprising given how much phosphate I excrete.
Maybe my vigorous physical activity is encouraging the retention of calcium despite the deficiency in Vitamin D. I do not want to get this thread off topic (blood clotting and TSH), but in vitamin D deficiency, it's both calcium and phosphate that are excreted in huge amounts.
I am sorry you have problems at present but thought I'd give you some reassurance about the TSH as most doctors do not have sufficient knowledge about it at all. This is from an expert in Hormones:-
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.
Sorry about your clots, last year when I was on NDT my TSH reading was the same as yours 0.005 but I have never had clots or any other health problems I hope you get the answers to sort out your problems.
Am I right in thinking that you've spent some time with no thyroid hormone replacement at all, felt completely fine and active in that state. But have recently gone up to a pretty high dose all in one go, and also feel fine on this dose?
This is a very very strange report. It may be that you're experiencing problems from starting on the high dose so quickly - people would usually start on 50mcg of T4 or 10 or 20mcg of T3, and increase doses every few weeks at the fastest. Ideally testing after 6 weeks and then changing.
But its also strange that you've felt fine on no hormone at all, and have had several periods of taking it and not taking it in the past 10 years? My suggestion would be that if you're coping completely fine with no hormone replacement then there is no need to start it. If you do have some symptoms, start with a lower dose and work your way up slowly to find your ideal dose.
This a very stressful situation you've put your body under could be a reason for the issues. Particularly some people struggle to introduce T3.
No one seems to have mentioned that Vitamin D should be taken with Vitamin K, this touches on blood clotting issues, so is important for you. Those who know a lot about this have written a lot on the forum but Vitamin D has several cofactors that help it to work, there is also magnesium and may be others. You should look into these and make sure you're taking it in the most effective way.
Yes. With no thyroid meds, I was the same as I am with my current dosing.
Before I started the thyroid meds three months ago, I did a thyroid panel test. This is what I remember as I don't have the test results at hand (I do have a copy of them stored, just not here). Remember, off thyroid meds three months ago:
- TSH was 3.80
- T3 and T4 about mid range. Unfortunately, the t3 tested was Total and not Free (clinic didn't have it available). T4 was free, though.
- TPO was off-the-charts high (something like 5,000, I recall?) and TGA was positive but not very high.
Basically, I've tested very similar in all these years when not on thyroid meds. The idea was to now be on thyroid meds again for life in order to preserve the thyroid by dropping antibody count through a replacement dose of thyroid meds (hence my super-low TSH). Antibodies have dropped substantially at three months, but usually it has taken me at least 6 months of a full replacement dose to get them to come back negative.
That is a strange situation. It sounds like your original thyroid blood tests are not terribly bad freeT3 is the most important one, although no one seems to know what diagnosis threshold are for anything besides TSH.
3.8 is not very high. In the UK 4 is often the cut off for diagnosis, or for the unlucky 10.
Although I consider symptoms are more important, and a TSH of even 2.5 is a bit abnormal, so if symptoms go with it a person should still try thyroid replacement.
The same applies to you, really. Just in reverse, and it seems less common. If you don't have symptoms, then there isn't really a reason to be on replacement
I follow the argument of keeping antibodies down. But I've never heard it before. Generally in the NHS (I didn't catch whether you're in the UK and having NHS treatment) antibodies are completely ignored, because there's no available treatment. Althought things like being gluten or less commonly lactose free can reduce them. Eventually, left to their course, antibodies will nibble away the thyroid so it's function decreases, as your own has decreased a little. But people don't really talk about slowing or reducing the nibbles. Once you're on thyroid replacement you might as well have reduced thyroid function anyway, because hormone replacement is just to top up for failing thyroid function.
Your plan is to wait for antibodies to reduce and then go back off the thyroid replacement and wait till they increase again?
This may be one of those strange ideas doctors get into their head about how Hashimotos work, making logical leaps from the small amount they know. Or your doctor may be a thyroid researcher who has found a completely new technique to slow the progress of the illness.
It makes me a bit suspicious, because starting and stopping substantial doses of thyroid hormone once or twice a year will be putting tremendous strain on your body. You may find that one day you start or stop the hormone and have very negative symptoms. Especially as you have another condition, which you'd expect to play up as a result. It might also be contributing to the vitamin D deficiency.
Many thanks for the replies. I realized how long the post was when I posted it, so didn't expect to see many replies. So thanks!
I'm well acquainted with TSH and should have worded the "hyperthyroidism" part better. I know it's the actual free t3 & t4 levels that matter when medicated and they're mid range in my case. I actually want TSH suppression as I feel fine on it and it drops my antibodies to zero. Where I live it is almost impossible to get t3 tested and I had to really push my doctor for the free t3 test one month after starting treatment.
The free t3 test revealed barely mid-range free t3 on my 25mcgs t3/125 mcgs t4 regime. Very surprised to say the least (last t3 dose before blood test was some 18 hours earlier). I actually increased to the t3 to 37.5 mcgs (while keeping t4 to 125mcgs) for a couple of weeks and I can now say that I know what being seriously hyperthyroid feels like. Went back to 25 mcgs.
The TSH is a red herring indeed, but I've been reading of its purported isolated effects on bones, for example. TSH alone "could" have effects on other systems in the body when undetected as is my case. Factor V Leiden slightly increases chances of clotting given the "right" circumstances; suppressed TSH perhaps pushing me into a hyper-coagulating state REGARDLESS of free t3 and free t4 being mid-range?
According to research, hyperthyroidism is believed to increase clotting. Unfortunately, most I've read only looked at elevated t4 levels and/or extremely-low TSH. The higher the free t4 level, the higher the chances of clotting. Most research has been on biologically hyperthyroid patients, not those on thyroid medication who have become hyperthyroid.
There's a researcher at the University of Amsterdam who has been researching blood coagulation under different disorders, including thyroid disorders. He's opinion is that hyperthyroidism, whether biologically induced (e.g. Graves) or pharmacologically induced will increase clotting. I'm tempted to contact him.
Here's a case study of a woman who overdosed on 25 mgs of levothyroxine. Clotting factors increased substantially, but this is an isolated case with a crazy dose . It's the actual discussion material that's very interesting (same Dutch researcher):
"In conclusion, our findings suggest that thyroid hormone excess shifts the hemostatic balance towards a hypercoagulable and hypofibrinolytic state, and is therefore likely to reflect an increased risk of venous thrombosis. Further prospective studies should focus on the influence of hyperthyroidism on the risk of venous thrombosis, and subsequently on the mechanisms behind this presumed relationship."
I have a lot of research on blood coagulation and its effects on thyroid saved in another hard drive, so I'm only posting some research I have at hand. I'm going by memory but, as an example, I remember reading how checking thyroid status is recommended for those with a first-time DVT with no reasonable cause for this.
I do not smoke, do not take drugs and I'm very active physically. All clots I've had have been on t3/t4 thyroid regime with undetectable TSH.
Likewise, in the last 6 years I was off thyroid meds and had no blood clots. I start my thyroid regime and, bang!, 3 clots in 3 months. Naturally, I'm now suspicious of what the thyroid regime could be affecting in my body's clotting system.
QUESTION:
Any recommendations on how to wean off my current thyroid regime? Stop the t4 and then start dropping the t3? Since I'm considering this option, I'm trying to read as much on it as possible.
Many thanks again.
OFF TOPIC:
To answer other questions:
- Yes, I'm self medicating with t3 (one many of you know). T3 isn't a treatment option here and saying I'm using t3 on my own to my doctor is a no go. The t4 is prescribed and Hashimoto is confirmed. My doctor's eyes almost popped out when he saw the TSH and endocrinologists here only accept t4-only treatment. It's a struggle as many of you know.
- Yes, I know Hashimoto is for life. I've been on and off meds for reasons unrelated to this post (don't want to side track it). Yes, I know thyroid medication should be for life, but given my case, I'm considering stopping it and keep a watchful eye on my thyroid status.
- My idea was/is to continue with this treatment for life as my antibodies always disappear on such a regime. Part of the rationale is to preserve the thyroid from attack; highly-suppressed TSH seems to be the only way to do this, although I'm willing to give other doses a try (i.e. higher TSH).
I think you have possibly conflated a number of issues and arrived at an incurate conclusion. As I understand it, Factor V Leiden is an inherited genetic disorder variant of human factor V which causes an increase in blood clotting. With this mutation, protein C, an anticoagulant protein which normally inhibits the pro-clotting activity of factor V, is not able to bind normally to Factor V, leading to a hypercoagulable state. Separately, the hyper/hypo clotting associated with clinically overt hypothyroidism and hyperthyroidism modifies the hemostatic balance in opposite directions, supporting the assumption that thyroid hormone excess and deficit are the main mechanisms of a hypercoagulable and hypocoagulable state, respectively. As far as I can see, there is no evidence that either one process/fault triggers or exacerbates the other in hypothyroid patients; so it's unclear why, with the genetic diagnosis that you already have, you were looking beyond this as a cause for your intermittent hyper-coagulation. Others have explained why having a low or suppressed TSH arising from being medicated for low thyroid function is not the same as that originating in hyperthyroidism. But in any case, where there is a thyroid-associated clotting disorder, patients with overt hypothyroidism and overt hyperthyroidism appear to have an increased risk of bleeding and of thrombosis, respectively ie as you are hypothyroid you might be at risk of bleeding and not clotting. Separately, I too am wondering why you have been on and off thyroid hormone replacement for long periods, and echo the advice that if you need to supplement or replace absent endogenous hormones, then that's what you need to do, and consistently.
Actually, the more I read, the more I see a correlation between hyperthyroidism and the impacting of the body's clotting mechanism. Being Factor V Leiden gives me the impression that one would increase the risk of developing a blood clot if one were to become hyperthyroid.
In my case, free t3 and free t4 are mid range, while TSH is 0.005. I know that people here advocate looking at free t3 and free t4 and discarding a low TSH result when medicated with thyroid meds that include t3. But such an extremely low TSH could have knock-on effects on other bodily functions? I've read that TSH affects bone formation directly, for example.
I've been reading this forum for quite a while and a TSH as low as mine is very uncommon. Factor V Leiden is present in about 10% of those of European descent (most do not develop blood clots in their lifetime). Ergo, there are probably not a lot of Caucasians like yours truly walking around with Factor V Leiden and such extremely-low TSH; thus the lack of any anecdotal reports online.
I'm also wondering if my twice daily dosing of t3 (12.5 mcgs per dose) could be spiking t3 to a temporary hyperthyroid state (above range free t3), thus temporarily increasing clotting chances (as per the findings above). I've seen published data on t3 spiking to supraphysiological levels for hours with once-a-day dosing.
Last but not least, I'm surprised that my free t3 and free t4 are mid range while my TSH is so low. The reports in this forum that I read usually have above-the-range free t3 (or t4) when TSH is this low (or even higher).
Part of the reason people are saying having overreplacement of thyroid hormone is very different from being hyperthyroid is because the numbers are very different. A person with Graves will have a freeT3 well over the top of the range, double or more the top of the range. If yours is mid way through the range this is not what would be called over replaced - most people on thyroid replacement will want their freeT3 quite a bit higher, into the top third of the range.
Part of the reason you haven't seen such low TSH is because most labs only go down to 0.05. So people with a suppressed TSH will just have a value of <0.05. I do agree that yours is maybe a bit low given your mid range freeT3 and freeT4, but everyone is a bit different, and TSH can have different levels of responsiveness.
To answer your question about reducing the dose. Generally you'd make a change of 10 mcg of T3, or 25 mcg of T4. In a perfect world you'd drop 1 of these units and then wait 6 weeks and retest. When increasing the old fashioned way, people will wait a few weeks for a raise, maybe as little as 2 weeks. When reducing by a large amount, what's in your blood will change more slowly than when increasing, because you will be waiting for it to wash out, and the 6 week guide is for how long T4 takes to fully wash out.
I'd say you want to wait at least 2 weeks, and as long as you can stand, between each decrease. Particularly if you're staying very physically active at the same time, as this will be demanding on your body. Keep an eye out for hypothyroid symptoms, to make sure you really do feel just as well on the low dose. Low mood can be a symptom as well as physical things.
Thanks for the advice. I think there's some literature around showing how fast thyroid recovers after stopping thyroid meds.
Last I recall it recovers very fast, even when thyroid meds are stopped (assuming the thyroid was fine prior to thyroid meds). Will be reading a lot about this in the coming days. Lots of anecdotes on this on underground bodybuilding forums, go figure (since they do cycles of t3 only with huge doses).
When I have some good links, I'll let you know. A typical daily dose is 100 mgcs of T3 (and even higher). To counter muscle catabolism, T3 is always used with AAS so that muscles are spared and fat loss is enhanced.
Also, too much T3 causes insulin resistance, increased blood glucose and muscle strength loss, which are counteractive to fat loss, hence the use of AAS.
Maisie, any chances that you could weigh in on my reply to you showing research evidence that hyperthyroidism decreases Protein C and Factor V, and how my twice daily dosing of T3 (12.5 mcgs each dose) could be putting me temporarily in a hyperthyroid state and thus an increase in clotting during such time?
When you have a fast metabolic rate and are physically active, as you say, you're using up Magnesium and electrolytes like a F1 car uses up lubricating oil. For that is what Magnesium does, it prevents spasms, cramps and lowers inflammation. It is readily excreted in urine and sweat. Taking high dose Vit D is going to pull more Calcium into your system which will only increase clotting factors and make the body more tense and reactive. You should be careful not to drastically speed up or slow your metabolic rate down though as this can encourage clotting too - there is evidence of this happening to cyclists who suffer heart attacks on their rest days. I really don't know your specific condition but I do know a bit about the dangers of inflammation and that Magnesium is not just helpful, but essential in most inflammatory conditions, provided you introduce it slowly, take the right sort and in sensible spaced out rather than megadoses. Zinc and B6 are also useful cofactors in many processes involving Magnesium.
Thanks. Yes, I'm getting magnesium citrate soon. My lab results showed normal calcium excretion in a 24-hour urine collection, but my phosphate excretion is off the charts (thrice the highest range). Serum levels of calcium and phosphate are good, but the urine collection is more indicative of what's going on.
I got a lot of stuff tested and it was all perfect, except for the vitamin D status and urine phosphate excretion.
Thanks. Yes, I'm working on the vitamin D (I'm actually shooting for high levels), but I'm wary of taking Vitamin K2 as it is involved in clotting and not just bone formation.
Sorry, I was thinking of K1. Thanks for the suggestion as Vitamin K2 is something I've come across in my recent researching of vitamin D supplementation.
I would definitely consider K2 as you seem a bit obsessed with having high range Vit D for some reason yet with all that phosphorous in your blood it will rob your bones of Calcium and readily bind with it and create crystals that could clog up your arteries and kidneys. Look up kidney damage re: phosphorous also look up parathyroid. Phosphorous also blocks Magnesium absorption, so you really need to prioritise getting those phosphorous levels down.
My serum (i.e. blood) phosphate is good I.e. in range, as is serum calcium); it's that I'm excreting huge amounts of phosphate via the urine (off the chart). Seems a side effect of vitamin D is high excretion of phosphate (and calcium, the latter was fine surprisingly).
What would you suggest leads to off-the-chart phosphate urine excretion while calcium urine excretion is in range?
Not sure, as I don't have your clotting problem that may be a factor, but kidney function must be checked. Hopefully, you have caught the problem early. High phosphorous in urine is linked to badly functioning kidneys.
I spoke with my doctor and he mentioned that the only markers that were a bit off were due to very strenuous exercise, carrying more muscle mass than average and a high-protein diet. The most important tests for kidney function are GFR, Album/creat. coefficient and albuminuria, which are all great, especially considering the high creatinine that I excrete in my urine.
I do suffer from nocturia, which is why I got a lot of kidney function tests. Vitamin D (prescribed dose and sunbathing) is really helping with the nocturia. The nocturia could be psychosomatic in part.
I have more tests results like 24-hour urine glucose (0.01g/24h, perfect result). Still waiting on a nephrologist's response though, but kidneys seem to be good.
Hi. Were you diagnosed factor v leidon after your first clot? May be worth getting a haematology referral. My TSH low, also on t3/4 and factor v but heterozygous. Never had a clot though.
First test didn't test positive for anything (including other any other clotting disorders). Second test (by another hospital) some months later came back positive as heterozygous.
Hi. You have to look at your red blood values in complete blood count - Hct, RBC. Are they in range? T3 can and will easily raise your erythrocytes via erythropoietin stimulation and if your RBCs are high your blood will get thick and you will get clots. So this is an additional risk pathway.
High creatinine and high phosphorous is going to be a problem eventually - Vitamin D is not the answer unless you understand the cofactors involved. High protein diet depletes Magnesium, vitamin D depletes Magnesium, Phosphorous blocks Magnesium. Symptoms of Magnesium deficiency include inflammation, osteoporosis, insomnia, pre-diabetes symptoms including nighttime urination, obsessive personality, cramps, anxiety, blood clotting, arrythmia, migraine...
Vitamin K2 prevents osteoporosis and artherosclerosis as it directs Calcium to bones... Phosphorous pulls Calcium out of bones. Vitamin D increases absorption of Calcium from foods, which may upset the balance with Magnesium unless Magnesium is supplemented as well, or you opt for a low protein /Vegan diet! Vegan diet can work for people with overactive parathyroid, probably because it gets the ratio between Calcium and Magnesium right.
Thanks. I'm actually making it a priority to get magnesium citrate. I've supplemented with it in the past and could tell the difference at good enough doses. My calcium intake per day could easily be 3 grams due to my diet; I do not take any supplements (not even calcium supplements), except for vitamin C and the couple of vitamin D doses I was prescribed (15,000 IU each per week).
Considering my high calcium intake, high protein intake and vigorous exercise, I absolutely agree with the need for magnesium (going to need at least 600-800 mgs/day. Going to get expensive). What I found in stores here is expensive low-dose magnesium oxide, so it's off to the internet to buy a big quantity of Mg. citrate.
The high creatinine excreted (24-hour urine collection) isn't worry some (by itself) as it's common in males like me with above-average muscle mass doing heavy, strenuous frequent exercising. My blood serum creatinine is in range (upper range, as expected in someone like me). The high phosphate excreted, however, is a problem pointing to somewhere up in the chain of events (rather than at any kidney malfunctioning given my perfect kidney test results; I could be wrong though in my assumption).
How would you fix the high phosphate excreted in the urine and what is it indicative of? Blood serum phosphate came back in range (mid range, actually, and the range is very narrow, so good). Also, from my researching, high phosphate levels excreted in the urine are correlated with high calcium levels being excreted too, yet, in my case, excreted calcium is in range (good too).
No vegan diet for me, even though I love animals. I do respect others' choices.
May be worth reading 'The Calcium Lie' - it is on my list of books to read myself. Owing to previously low iron / B12 I would not go Vegan. However, it seems a good option for some (men especially). Amino acids are important too, so I make broths, which should have all the essential Minerals for bones as well, but may be quite Calcium rich (I don't have Dairy). Your intention to be healthy is good, just make sure you don't overdo it..given the potential problems that may occur later. I have seen fit young men in my family in intensive care due to cardiac arrest.
Thanks. My ferritin levels and Vitamin B12 are in the upper range. All the vitamins/minerals that are recommended to look at when someone is hypothyroid (as per this board) came up all in great shape, except the Vitamin D.
I have to say that I'm noticing the mood-enhancing effects of the Vitamin D as of the last 3 weeks. Especially since I've been sunbathing almost every day (no sunscreen, while avoiding burning). I seem to have lost fat in these 3 weeks, even though I eat like a horse and my strength has gone up. I sleep better too.
The prescribed Vitamin D (from the doctor for my Vitamin D deficiency) is a measly 15,000 IU per WEEK (very low). Only taken two gel caps in 3 weeks; most of my Vitamin D has come from daily sunbathing as my location allows for it at this time of the year. Really feel the health effect of the increase in Vitamin D and I'm probably making anywhere from 10,000 to 20,000 IU per day from the way I sunbathe and my location.
I'll be testing Vitamin D in two months. Plan is to continue sunbathing daily, start taking 5,000 IU daily of Vitamin D (10,000 IU on non sunbathing days) and take magnesium citrate at 800 mgs/day or so. I may also get Vitamin K2 while at it.
Lots of new research coming out on revising Vitamin D daily intake and how it is too low. Also revision of acceptable Vitamin D blood levels.
whats absolutely crucial is that they test you for any autoimmune issues that could cause increased clotting. Ie anti phospholipid antibodies aka hughes syndrome, there are other conditions like lupus/sjogrens that can also cause increased clotting. I think you need to see a specialist. I hope they have you on blood thinners?
I didnt read the whole thread but caught that you may have increased secreted phosphate in urine. Have they checked your parathyroid? Pth should be tested I think when vit d is low. Because after supplementing it can change results. Still worth looking into though.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
What to do next? suppressed TSH but not enough T4 and T3 
Endocrinologist has reduced Thyroid meds *again* due to suppressed TSH from T3. Argh!
Timing of taking T4/T3 prior to TSH Lab Work
No thyroid gland TSH level too low, T3, T4 ok
Blood tests TSH T4 T3 
