How to increase T3 and T4 without suppressing TSH too much

[crmavb]

I think it was in July that I changed from NDT 2 grains and 12.5 mcg T3 back to Levothyroxine 75mcg and T3 12.5 mcg

My previous 2 blood tests showed my T4 level at 12 . Something, bottom of the normal range. One test showed my T3 level also at the bottom of the normal range. T3 only appears if one of the ranges is abnormal. Earlier this year I had a TSH of 14. Something, when I tried going without medication.

I think I will need to pay for private testing that includes folate, B12, vitamin D perhaps, and ferritin. As although my T4 has increased, I would like more increase. The dr has asked me to keep a symptom diary.

[Lalatoot]

Why are you concerned about tsh? Once we are diagnosed and on meds the pituitary /thyroid feedback loop is broken so tsh tells us very little. The important result is Ft3 particularly when you are dosing with some t3.

[crmavb]

Hello

But there is still a range for the TSH and because mine is below range, the doctor isn’t happy to increase the levothyroxine. I am purchasing my own T3 so I can increase that from 12.5 to 25mcg.

I suspect my vitamin taking could be improved and would be useful to check the ranges. And trying not to overdo things. I ran out of cbd in August and I was reluctant to buy more as the price has increased from £45 to £54 for a month’s supply. However taking some at night, helps me to sleep soundly and lessons the aches and pains I can feel.

[greygoose]

I think it was in July that I changed from NDT 2 grains and 12.5 mcg T3 back to Levothyroxine 75mcg and T3 12.5 mcg

Well, you gave yourself quite a hefty reduction in dose, there, didn't you. Not surprising your Frees have dropped. You should be on at least 30 mcg T3. Unless you feel well like that.

Forget the TSH. It's going to be very low if you're taking T3, because you don't need it any more. TSH has two jobs: a) stimulate the thyroid to make thyroid hormone - you don't need that. b) stimulate conversion of T4 to T3 - if you're taking T3, you don't need it for that, either. So, why would you want your TSH to be higher?

[crmavb]

Thank you, earlier in January I was taking 4 grains of ndt and 50 mcg of T3 and felt well!

[Lalatoot]

There's your answer then. Go back to what you were doing that made you feel well.

[Hashihouseman]

Unlike others on here I would be quite wary of overly reducing, even suppressing, TSH. TSH along with free T3 and free T4 are the three most basic vital direct indicators for thyroid function test. You can use the relativity in their test levels to get a better idea of thyroid function along with a long term symptoms diary and other indirect indicators like prolactin and cholesterol. Furthermore TSH does more than just signal the thyroid gland in its role as a thyroid system hormone and it can also have side effects of and in itself on things like cranial tension headaches. Everybody’s balance or optimal stable relationship between these three indicators is unique to them and laboratory reference ranges are quite crude guidelines about what may or may not be appropriate for you for each hormone. Over the years I have experimented with many different replacement regimes for both T4 and T3. It is clear to me that even with a dysfunction in converting T4 to T3 many people still struggling despite apparently appropriate TSH and levothyroxine doses could well emulate what your natural healthy thyroid gland would secrete, that is to say something equivalent to between 100 and 125 µg of T4 with possibly as little as 5 µg of T3 if levothyroxine alone does not deliver appropriate free t3 levels or ameliorated symptoms. Because everybody is different individuals may need to find their optimums, of both replacement hormone doses and blood test levels, by trial and error, initially aiming somewhere in the middle of the lab ranges and then experimenting with dose and timing of doses in relation to symptoms and periodic triple thyroid function tests (ft3 ft4 tsh) to find an optimal regime. As for timing of doses the subtlety to consider is that the natural normal healthy thyroid system does not secrete amounts of free T4 anything near the size of standard T4 levothyroxine medication regimes. For me, splitting 125 µg into 5 x 25 µg doses, as inconvenient as that may be, produces less side-effects and better free T3 levels then taking it all in one dose on waking - No healthy thyroid gland ever does that! Replacement thyroid hormones may never produce perfect results but with a bit of effort we could do much better than simply aiming at lab range indicators and standard levothyroxine replacement doses and also better than simply overdosing because that seems better than being under medicated but which causes suppression of TSH to orders of magnitude below normal levels (0.1 or even 0.01 when 1.0 is more normal). Some conditions and some individuals may absolutely need to suppress TSH to feel well or prevent specific complications and some people may not feel well unless they push free t3 or free t4, or both, abnormally high thus suppressing TSH but perhaps this should be a last resort for personal choice or only if a clinician Specifically directs it should be suppressed.