Hi, I haven’t posted in a while. I recently had my bloods checked and gp concerned at my tsh level.
I’m currently taking liothyronine 20 mg morning and lunch and 10mg in the evening.
I took 20mg at 1400hrs and then my 10mg dose at 1800hrs. I Saw my gp that evening who offered me a blood test. It wasn’t until later that I realised what I had done and knew my results would be a concern.
Results are TSH 0.01 (0.27-4.20) has been this low for the past 12 months
Free T4 5 (11-22)
Free T3 10.7 (31-6.8)
GP wanted to discuss bt and I thought it would be to discuss my T3 result and I explained that I had taken my doses too close together but he was more concerned about my tsh. He said T3 result would reflect that I had taken medication but that would not effect my tsh. I thought taking T3 suppressed tsh but he did try to explain what he meant about my thyroid being toxic. He wants me to get in touch with my endo, but I don’t think he’s too clued up on thyroid more specialising in diabetes. Any advice please
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Traceydg
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No, your thyroid isn't toxic. Your thyroid isn't working. Your FT3 is high because you took your T3 before the blood draw. And, he's right, that wouldn't affect your TSH, because the TSH doesn't move that fast. Your TSH is suppressed for two reasons: a) you had the blood draw at the time of day when the TSH is at its lowest, b) because you're taking T3.
Taking 50 mcg is almost certainly going to suppress your TSH. And he should know that. And it's suppressed because you don't need it. That's what he doesn't understand. TSH is a pituitary hormone. When the pituitary senses that there's not enough thyroid hormone in the blood, it secretes TSH to stimulate the thyroid to make more thyroid hormone. The less thyroid hormone in the blood, the higher the TSH. When the pituitary senses that there is enough thyroid hormone in the blood, it reduces the amount of TSH it makes, because it no-longer needs to stimulate the thyroid. This is perfectly natural and normal.
The TSH just has two jobs: a) to stimulate the thyroid - you don't need it to do that because you have enough hormone in your system b) it stimulates conversion - you don't need it to do that because you're taking straight T3. So, why would you need any TSH? It doesn't have any connection with bones and hearts, as most doctors think. It's job is now done, so it disappears. What else would he expect?
He has assessed your dose according to your T3 only, I believe. The TSH is not a thyroid hormone it is from the Pituitary Gland and rises if we need replacement thyroid hormones, yours is low, therefore you don't need an increase but he has jumped to the conclusion you've become hyPERthyrid. Not so. Also as levothyroxine was introduced along with blood tests for it alone, if we take or add another thyroid hormone the results wont correlate.
Give GP a copy of the following:
The facts of the matter are that the current guidelines for LT4 replacement therapy in primary hypothyroidism are not fi t for purpose and the continued reluctance to approve additional treatment with liothyronine denies the patient the precision medicine which we are encouraged to adopt,10 and which many patients crave. In the future, D2 genotyping may play a role in identifying those patients likely to benefi t from treatment with both thyroid hormones.18 In the meantime, I am so concerned about the state of advice on the management of primary hypothyroidism that I am increasingly reluctant to suggest ablative therapy with iodine-131 or surgery in patients with Graves’ disease, irrespective of age or number of recurrences of hyperthyroidism. Treatment with a thionamide, in which the hypothalamic-pituitary-thyroid axis remains intact, making interpretation of thyroid status simpler, is currently a more attractive proposition
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