I'll try to keep this brief, but I'm looking for a bit of an explanation for my blood tests and advice for what to do next....
Diagnosed with Hashimotos 25yrs ago, and ever had an issue. Then two years ago, my TSH fell below reference, then 6months later was fully suppressed (I'd not changed weight or my thyroxine dose from 125mg). Obviously the advice was to drop my dose, which I did but I had ALL the hypo symptoms with no change in TSH.....it seems to always stay at 0.01.
Since then I've basically continued to feel ill....now I'm on 150mg and 20mg T3 which has helped with some symptoms but not all....I still feel hypo, and my T4 and T3 are both bottom of in-range, and TSH is still unrecordable.
My GP has basically refused to see me again for 6months to see if symptoms just resolve of their own accord. Any ideas what's going on with TSH and what I can do?
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rmjbreb
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Hey! Thanks for replying. I started T3 in 2017, after my TSH was suppressed. I'll check later what my values are, but FT3 is just in range and FT4 is mid range. If T3 suppresses TSH how do people usually know if the dose is right?
If T3 suppresses TSH how do people usually know if the dose is right?
TSH is not an indicator of correct dose. It's wrong to dose by TSH result. The important tests/results are FT4 and FT3 which are the thyroid hormones (TSH is not a thyroid hormone, it's a signal from the pituitary to tell the thyroid to make hormone if it detects there's not enough). When taking T3 then it tends to lower TSH and FT4 so FT3 becomes the important result. And, of course, how you feel.
Extremely common with Hashimoto's to have suppressed TsH, even on just Levothyroxine. But on almost any dose of T3 it's almost inevitable
Suppressed TSH doesn't necessarily mean you are on high enough dose, most important results are FT3 and FT4
Can you add most recent blood test results and ranges
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.
Have you had vitamin levels tested recently?
Add results and ranges if you have them
As you have Hashimoto's Are you on strictly gluten free diet?
Good article about why suppressed TSH may not mean you are over treated by Canadian Thyroid association
Vitamin D is verging on too high. Suggest you reduce dose vitamin D
Ferritin is likely far too low
Eating liver or liver pate once a week, plus other iron rich foods like black pudding, prawns, spinach, pumpkin seeds and dark chocolate, plus daily vitamin C can help improve iron absorption
Try splitting levothyroxine dose into 2 or even 3 helpings and reduce liothyronine to less than 10 maybe even 5, slowly! There comes a point where levothyroxine dose increases actually reduce the rate of t3 conversion in tissue cells and we can get hypothyroid symptoms despite having suppressed tsh and ok looking plasma levels of ft3 and ft4. Sometimes our symptoms get so confusing the best strategy is to manipulate our free hormone levels and tsh to peer group normal e.g. tsh 1-2 ft4 15-18 ft3 4-5. Then wait and see how you feel after several weeks. Suppressed tsh is not normal and only necessary in specific medical circumstances. TSH also has a wider role beyond direct thyroid gland signalling and may be necessary at normal levels even if there is no thyroid gland response to its presence. If nothing else it is an indication that your system is calling for or is overdosed with free t3 & free t4. How you can manage your replacement without assessing a dynamic (ie not suppressed) tsh alongside ft3 and ft4 seems impossible to me, unless you have a perfect grasp of the relationship between the subtleties of physiological symptoms and signs of thyroid hormone status and your day to day replacement tactics (eg making small changes in liothyronine according to fluctuating need and finding a stable levothyroxine core dose).
Also - do you have a paper for your sentence about where levothyroxine dose increases actually reduce the rate of t3 conversion in tissue cells? I would love to read more.
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