Hi everyone me again,my mum's lab test:
Tsh- 0,37 (0.25-5.00)
FT4-13,26 (9.0-20.0 pmol/l)
FT 3- 4.24 (4.0-8.3 pmol
She's on levo 100,but how much t3 does she needs? Endo says she doesn't need t3 because t4 is good? In our country doesn't exist t3 (Cytomel) so i have to look abroad,any advice!
fT4 is not good it is only 39% up its interval. For patients on levothyroxine only therapy it is generally recommended fT4 is towards the upper quartile, this tends to bring fT3 towards mid-interval. I would try an increase in levothyroxine first to see how she does.
You don't give any indication of how she is doing, is she feeling fine or does she have symptoms and if so what symptoms?
Although I believe it's better to try more levothyroxine first I suspect she will need some liothyronine because her TSH is low with low normal fT3 and fT4. It looks like her TSH is lower than it should be, this can happen and suggests her pituitary is under-performing but not so much as to be central hypothyroidism. Since the TSH is low for her fT3, fT4 levels it doesn't make sense to use TSH as a marker for thyroid status.
Thank you jimh111 , well she's 74 years old,i don't get why TSH is low? If she raises the levo,what gonna happen with TSH (0.37) could be lower much more?? Does levo decreases the TSH?? Something else that i want to point is my mum's TSH always was 3, 2.45 but never 0.37, is that because she is on b12 injections??
Yes she has a lot of symptoms,diabet mellitus type 2,insomnia feet and toes neuropathy,swelled and ache on feet,chronic constipation more than 20 years always using laxatives,if not ,it goes a week and she doesn't have sensation of pooping .
( since 2015 she has been diagnosed with hipothyroidism) itching arms and back usually after bathing (better now while on b12 injections) ,memory issue's,confused,excessive sweating on face, dry eyes and mouth.
What country are you in?
Doctors and Endos only seem to look at a TSH result and make a decision that everything's fine. With a FT4 and FT3 at the bottom of the ranges when they should be nearer the top you need a rise in your dose.
That's why most on this forum DIY themselves as at least they are in control of their hormone intake and recover.y You cannot feel good with both frees near the bottom of the range when they should be in the upper part.
There is also the original thyroid hormone replacements in use since 1892 in different forms that members find helpful. It is called natural thyroid hormones and they may be easier to source as they are made from pigs' thyroid glands and are still in use today and members source their own. 1 grain (they are measured in grains) is around 100mcg of levo but you increase dose gradually every 2 weeks by 1/4 tablet taking note of symptoms when relieved and if temp/pulse rise drop to previous dose.
You'd have to put up a post asking for a private message to be sent to you with info of where to source. The post will then be closed so that information willonly be sent privately.
Thank you Shaws,you think to raise the levo? What about TSH, could it lower much more if she raises the levo?
She's 74 is TSH age related??
I'm surprised how much Tsh lowered since last time 2.48. Could it be from b12 injections? I see improvement such on her feet and toes (warmer than before,less aches ,improvement on tounge and less itchy arms).
This is from an expert in Hormones:-
What is more important than the TSH is the very low FT4 and FT3. There's no possibility (and I not medically qualified) that she can feel well due to the Frees being so low, We cannot feel well unless these are near the top of the range. Does she convert levo into sufficient T3? It doesn't look like it does. I think she needs some T3 added to a reduced T4 on a trial basis.
Doctors do not seem to realise that it is T3 which is the active thyroid hormone and is needed in our millions of T3 receptor cells and brain and heart need the most.
Several research departments state that a T3/T4 combination is required for many.
Myself, I could not improve on either T4/T3 or NDT but I did on T3, but I was fortunate enough to source it as it is practically impossible to source find any at present.
Unless a doctor has hypo himself or has someone in the family who isnt recovering will have no understanding how patients feel if either levo or the dose isn't improving their health.
Once-upon-a-time we were all diagnosed upon our clinical symptoms and given NDT which was slowly increased until syptom-free. No blood tests but expertise of the doctors. This very important knowledge has been lost as they are told to only acknowledge a TSH when it reaches 10 (in the UK but 3+ in other countries).
Thank you Shaws, low TSH could it be from liqiud iron supplement,and b12 injections?
I've read somewhere that iron could low tsh,also t3 and t4.
This is a previous post that may be helpful:
Firstly, how is your Mum feeling? I echo the suggestion that she could first increase her dose of T4 before considering adding in T3. Her FT4 isn't currently even at mid-range, and is likely to drop lower with the addition of T3 when there will be less call on the body to produce it. This isn't necessarily a problem per se, for those people who do well on mono-T3, but is for others. It seems to make sense to first try and optimise FT4 with Levo and see what happens to FT3 as a result, before deciding on adding in T3 to the Levo.
Thank you MaisieGray, she's constipated more than 20 years,always using laxatives if not she never feels movement. She's diabetic type 2, high cholesterol and triglyceride.
Swallowed feet,feet neuropathy, ache on feet and toes,itchy arms and back usually after bathing.She had 3 fractures for 25 year,osteoporosis,sweating all over the face like flushes.
She's on b12 injections and I'm confused and surprised how TSH lowered from 2.48 last time, and now 0.37, is it from b12 injections??
Her FT4 is too low
Suggest she tries 25mcg increase in Levothyroxine
Retesting in 6-8 weeks
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)
Also test vitamin D, folate, B12 and ferritin
Plus thyroid antibodies
Thank you Slowdragon. Antibodies 0.8
I'm not sceptic as I'm afraid to raise the levo,becaise of low TSH.
Last time TSH was 2.47.
Do you think TSH lowered from b12 injections? Is she at any risk from such low TSH?? She's 74,is TSH Age related?
It's strange that her TSH has gone down. Yes levothyroxine will lower her TSH further, all thyroid hormone reduces TSH. TSH is usually higher in old age, your moms TSH is rather low for her low-normal fT3 and fT4. I would increase her levothyroxine by 25 mcg and retest in a couple of months. This will put her TSH lower but her TSH is not consistent with her fT3 and fT4 and cosequently isn't a reliable marker of thyroid status. Her endo is wrong in saying her fT3/4 are good although I wouldn't let her fT4 go above 20.
It's possible some other illness is making the TSH low so if it is still low after the next blood test it would be worthwhile her having a general check up.
Thank you jimh111,low TSH could it be from liqiud iron supplements or b12 injectoins?
I've read somewhere,that high iron causes low TSH and low ft3 and ft4.
She's never had low tsh like 0.37.
Last time ,two months ago TSH was 2.37
It doesn't make sense,I'm confused to raise the levo or not? What do you think?
I'm hypothyroid with lowing B12. How much B12 should I take?
How much T3 to increase by?
How much t3 should I take- I’m on 75mg Levothyroxine 
Low T3 Low T4 and very Low TSH
How much is T3 in Turkey?
