Decreasing TSH while on T4/T3 combo: Hi guys, I’m... - Thyroid UK

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Decreasing TSH while on T4/T3 combo

Sveistre profile image
8 Replies

Hi guys, I’m still on the same 100mg T4 + 20mg T3 combo, what I’ve noticed from my last 3 blood tests that TSH is decreasing every time, is there any particular reason for that? I’m not feeling very well past 6months I would say and the last time endo he said I might be overmedicated, which is absolute crap since my numbers are not even in the middle of the range - I almost burst in tears after his idea.

Thanks for your thoughts

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SlowDragon profile image
SlowDragonAdministrator

This is the tricky thing with taking T3

On almost any dose of T3 TSH becomes suppressed.......even if on inadequate dose

Many endocrinologists remain TSH obsessed ....which is obviously then a disaster

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

If/when also on T3, make sure to take last 1/2 or 1/3rd of daily 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?

Latest results

Ft4 is only 31% through range

Ft3 only 44% through range

If you did test as advised...these results suggest under medicated

When were vitamin D, folate, ferritin and vitamin D last tested?

What vitamin supplements are you currently taking?

Sveistre profile image
Sveistre

Yes I always do my bloods exactly the way you wrote.

These were done in January:

Serum vitamin B12 level 798 ng/L [180.0 - 914.0]

Serum folate level 8.6 ug/L [3.0 - 20.0]

Serum ferritin level 89 ug/L [10.0 - 307.0]

vitamin D level 92.4 nmol/L

Supplementing magnesium, vit D, B complex, selenium, zinc

Sveistre profile image
Sveistre

The last time I saw endo I told him I was not feeling well and horrible cold intolerance especially in this weather, and he was like not listening to me and just looking to the numbers and keep trying to convince me I was fine😤😟

thyroidnodules profile image
thyroidnodules

hi there. i am on exactly the same dose of combo t4/t3 as you. before starting combo my readings were similar to yourse. This is my third week on it. i was put on levo when i was made hypo with RAI 8 years ago but levo alone made my weight balloon up and swollen leg etc. i then went on thiroyd and felt good and managed to lose a stone of the weight i put on. i had been on NDT for four years. It is now not possible to obtain thiroyd plus my financial circumstances have changed. The endo reluctantly agreed to put me on combo trial t4/43 for three months but has told my gp to only test tsh and t4 only at the end of the three months, as she considers t3 is not important and that they would hope to reduce my dosage as my tsh is suppressed. So i can foresee the same problem as you on my next visit. She is so entrenched in the idea that if tsh is suppressed there is a chance of a stroke or osteoporosis, even though not once have they taken my blood pressure or checked my bone density so they are psychics now as well

Sveistre profile image
Sveistre in reply tothyroidnodules

I’m more than a year on the same dose, the same that I started and they don’t see the point to increase it I guess despite me saying I’m not feeling well anymore, their answer but you was feeling good 3 or 6 months ago, so you should be fine now too..🤯

thyroidnodules profile image
thyroidnodules in reply toSveistre

i have only just started combo so dont know how i will be feeling in the next few months. i feel bloated already - i wasonly feeling good before that because i was on ndt but cannot now obtain it. i dont have any optimism for this combo especially as my endo is hoping to reduce when i go back in two months

SlowDragon profile image
SlowDragonAdministrator

Personally I think you need to increase levothyroxine up....perhaps 12,5mcg per day and retest in 6-8 weeks

Sveistre profile image
Sveistre in reply toSlowDragon

We changed to 75mcg T4 + 3x10mcg T3 to see if that helps with my tiredness from early in the evening. As of today, it seems to be working

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