Low TSH, low T4, T3 top of scale. Do my meds need adjusting?

[Busbod]

Hi there,

I am hoping for some advice on my latest blood tests. I have a diagnosis of Hashimoto disease. I take 150 Levo T4 and 75 of Tiromel T3. My GP would like to reduce my Levo as my TSH is too suppressed. However, my T4 count is at the bottom of the range. See below.

I have been feeling really fatigued lately so I down want to reduce meds as I know I will feel worse. Can anyone help me decide how I go forward.

Many thanks in advance you kind people.

Serum vitamin B12 - (GA7967) - Normal - no action

682 ng/L 180.00 - 900.00ng/L

B12 stores normal, adequate for at least 2 years.

! Thyroid function test - (GA7967) - for routine monitoring

If patient is on levothyroxine for the treatment of primary

hypothyroidism, then consider reducing the dose, aiming for a TSH

that is within the reference range.

! Serum TSH level. 0.01< mU/L 0.27 - 4.20mU/L

Serum free T4 level 11.5 pmol/L 11.00 - 25.00pmol/L

Serum free T3 level - (GA7967) - Normal - no action

6.4 pmol/L 3.10 - 6.8

[Marz]

As you are taking T3 your TSH will be suppressed - and the T4 will be low in range. Does your Doc know you are taking T3 ? As your FT3 is in range you are not over- medicated.

[Busbod in reply to Marz]

Thanks Marz. Yes GP knows i'm taking T3 purchased privately but is concerned about the damage of suppressed TSH on my long term health.

[FancyPants54 in reply to Busbod]

And what damage does he suppose this to be? I bet he'll mutter something about bone health. Why they think a pituitary hormone affects bone health I will never understand.

[Zazbag in reply to Busbod]

How do you feel?

[Busbod in reply to Zazbag]

Hi there, I feel very fatigued which has only come on in the last month or so, before that with the same meds I felt good.

[Marz in reply to Busbod]

There are many posts here about suppressed TSH and the relevant research showing it is not an issue ... check out posts by SlowDragon ..

healthunlocked.com/api/redi...

The above link posted by diogenes - a member who is an Analyst involved in Thyroid research.

[fuchsia-pink]

You're on quite a lot of medication overall - so it's possible you have gone past your particular "sweet spot" and that's why you're still fatigued and not feeling great. Don't worry about low TSH - that's just what happens when you take T3 meds. Personally, I like free T4 and free T3 both to be quite high in range - but others just focus on the T3 level. It may be that reducing T3 meds a bit and increasing T4 meds (not both at the same time) will increase free T4 and keep free T3 at the current level and make you feel better ...

At the end of the day, it's all trial and error and slow small changes to dose until you get to where you feel best x

[Busbod in reply to fuchsia-pink]

Thank you that was really helpful

[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 half or third 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?

Important to regularly retest vitamin D, folate and ferritin too

What vitamin supplements are you currently taking?

Are you on strictly gluten free diet?

[Busbod in reply to SlowDragon]

Hi SlowDragon I always follow your advice on getting the most accurate reading. Thank you