My blood test- TSH low

[Suzi_]

My blood test done after lunch as requested by dr. Took my levothyroxine 30 mcg and cytomel 5 mcg at 7 am, blood test at 2:30 pm.

My triglycerides little high, slight anemic. Tsh is very low 0.12 range- 0.40-4.50. Dr suggest cutting back on cytomel to half. I plan to take cytomel 5 mcg for days only and skip 3 days a week.

Any suggestions please.

[fuchsia-pink]

If you take T3 meds, your TSH will be suppressed - it's how it works. Do you have results for key nutrients - ferritin, folate, vit D and B12 - and for your free T4 and free T3 - they are what matter!

Do you feel well on your current dose? - it's not very much, but it's how you feel that matters. If you feel fine, I wouldn't reduce dose. Also, taking T3 less than every day isn't a great idea because of it's very short life. If your free T3 and free T4 are say less than half-way through range and you don't feel great, I would actually increase meds rather than reduce them - most of us need these to be in the top third and often the top quartile of the range.

Good luck x

[SeasideSusie Remembering]

Suzi_

I plan to take cytomel 5 mcg for days only and skip 3 days a week.

That wont work. T3 (Cytomel) needs to be taken every day. It has a short half life of 24 hours so you need a regularly, daily supply not take for a few days, miss a few days, or even alternate days.

Is your doctor basing the reduction on your low TSH? If so that is completely wrong. When taking T3 then TSH is going to be low, even suppressed, because that's just what T3 does. It's not possible to base doses on a pituitary hormone (which is what TSH), you need to measure the thyroid hormones (Free T4 and Free T3) and base dose on that plus your symptoms.

[Suzi_ in reply to SeasideSusie]

Yes the dr is basing the reduced dose on low tsh. T4 free was 1.2, range0.8-1.8. t3 free 3.7, range 2.3-4.2. Both normal range.

I feel ok.

[SeasideSusie Remembering in reply to Suzi_]

Then it doesn't look like you need your dose changing. Both Ft4 and FT3 are in range, that's all that matters.

[Suzi_ in reply to SeasideSusie]

Thanks

[Suzi_ in reply to SeasideSusie]

I have been having regular heartburns since starting this med, does it have anything to do with the meds?

[SeasideSusie Remembering in reply to Suzi_]

Sorry I can't answer that. It could be. Why not miss a day and see what happens, if no heartburn then it's likely to be the brand .

[Suzi_ in reply to SeasideSusie]

Thanks so much for everyone’s quick and helpful replies. My dr has agreed to leave me at the current dose if I am feeling alright!

I skipped the cytomel dose this morning as i was planning to start the new routine!

Thanks a lot SeasideSusie!

[SlowDragon Administrator]

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 third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

So a test after lunch and after taking thyroid medication is useless

You also need vitamin D, folate , ferritin and B12 testec

When taking T3 you MUST take same dose every day

[Suzi_ in reply to SlowDragon]

Vitamins D normal 56, range 30-100

Ferritin normal 41. Range 16-288.

[SlowDragon Administrator in reply to Suzi_]

Ferritin is rather low

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

[SlowDragon Administrator in reply to Suzi_]

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

[tattybogle]

It is quite possible , though not certain , that had your blood been taken at 8/9am rather than at 2.30pm, your tsh may have been within range. In some people the diurnal range is quite large, it's highest middle of night then falls through day till about 5pm ish (i've forgotten the exact times , there is a graph somewhere )

Did they not do a FT3 test?

[Suzi_ in reply to tattybogle]

Yes. T3 total normal 163, range 76-181. T3 free normal 3.7, range 2.3-4.2.

I tried to space my blood test about 8 hours after taking my thyroid med dose.

[tattybogle in reply to Suzi_]

I cant see any need to reduce dose based on these tests if you feel good. If it were me i'd make sure 'you' are in charge of this decision ,not GP. Once you agree to a reduction in prescription there is no guarantee they will raise it again if you then feel less good. At least get an assurance you can go back up again if you dont like it.

Edit: and get an explanation of why / what he thinks the risks are, so you can check them out for yourself, dont take his word for it.

[Suzi_ in reply to tattybogle]

Thanks. Dr is very compromising

He agreed to leave me on the current dose!

[Angel_of_the_North]

If you are taking T3, you must take it regularly at least once a day if not multiple time a day. You will cause your body a lot of stress and make yourself more ill if you stop it for half a week. And it will probably make no difference to your TSH (which is not a thyroid hormone and doesn't really matter).