Very low TSH!

[tp104]

Hey guys I'm new and I don't know where to start.... Total Thyroidectomy 2007.

I had my thyroid removed due to a large goiter. I have Rheumatoid Arthritis and have been told the goiter was related. Honest answer is I don't know what my journey has been cause I've never had a stable history with my thyroid testing. I live in the US and most doctors don't give you much info other than we need to add or reduce your dosage. I'm hopeful that I will learn more here on this site.

I've been unbalanced for years I've taken levothyroxine, synthroid, Armour, and now Tirosint.

Here are my latest labs with 120 Armour

TSH 0.007 (range 0.5 to 2.0 milliunits per liter (mU/L))

T3 229 ng/dl (range 80-180 ng/dl)

Free T4 1.13 ng/dl (range 0.7–2.0 ng/dL)

I'm now on 200 Tirosint next labs this Friday.

What does this all mean? I love how I feel on Armour but Dr. wants to keep lowering dose which makes me feel sluggish and automatically tired. I just turned 52 is it because I'm just getting older?

Any suggestions?

[fuchsia-pink]

Welcome to the forum

Please add the reference ranges to your lab results [you can edit using the "more" button on the right] as these vary from lab to lab. Are the T4 and T3 results free T4 and free T4 or total T4 and T3?

[tp104 in reply to fuchsia-pink]

Thank you I've updated that information.

[fuchsia-pink in reply to tp104]

Ok so on Armour your T3 result was quite a lot over range (still not sure if that's total T3 or free T3), which is a bit of a worry. And yet your T4 was only 46% through range. Personally I'm not fussed when TSH goes very low - once you're on thyroid meds it's your actual thyroid hormones that matter much more. I'd expect these result to move bit since you moved to T4 meds ... but just Tirosint may bring your T3 down too far. I suspect the best blend for you may be a bit of T4 meds and a bit of armour (at a lower level than before) so you can bring your free T4 and free T3 results into the top third of their respective ranges. All trial and error though and tiny tweaks to medication until you find your personal "sweet spot".

Also worth testing key nutrients - ferritin, folate, vit D and B12.

And PLEASE don't allow your doc to bully you into thinking that as a peri or menopausal woman you should settle for anything less than feeling FABULOUS!

[pennyannie in reply to tp104]

Hey there :

I didn't see the above when I last posted to you :

So on Armour 2 grains these are the results - ok - how long after taking the NDT did you have the blood draw and do you have any symptoms of over medication ?

My understanding of dosing with NDT is that you dose to the relief of symptoms and not a blood test range and certainly not a TSH number:

The TSH will become low/suppressed because you are taking T3 :

The T3 will be proportionally higher in its range than the T4 will be in its range :

After about 10 hour gap between dose and blood draw my T3 comes in at just tipping the top of the T3 range and my T4 comes in low at about 20% through : and this is ok for me :

I have no signs of over medication and think if I was to wait 24 hours between dose and blood draw as you do for Levothyroxine I would sit well in range and sail through a medical appointment, and be able to keep my dose where it is, if that's the objective.

If anything I'm still a little hypo and wish for a bit more stamina in the afternoons, but it is what it is, and I don't seem able to take a smidgeon more, but it's ok, I'm 73 with my share of wear and tear, and much improved than I was on T4 only thyroid hormone.

No thyroid hormone replacement works well if vitamins and not maintained at optimal levels so this might be an area to look at but would suggest that you ask to stay on the Armour and keep this T3/T4 combo as it suits you best.

Can you ask to stay on the Armour by suggesting, if you must, you drop the dose by a little, like 1/4 grain ?

In this way, you stay on your preferred choice of thyroid hormone replacement, you acknowledge the medical guidelines you find yourself having to work within and take back a bit of control yourself and then adjust back as you see fit, and next time just extend the time gap between dose and blood draw ?

[pennyannie]

Hello Tp and welcome to the forum :

It would help us to help you if we had more information about your thyroid and more probably your thyroid-less journey -

A TSH blood test result seen in isolation is of little value and I remember when I first started looking for answers on this website, that was all I knew of my condition.

I have Graves Disease and had RAI thyroid ablation in 2005 and became extremely unwell about 8 years later which was when I found myself on the forum looking for advice.

I am now so much better through the support I have found here and you too can turn things around for yourself if you give us more information to work with.

[tp104 in reply to pennyannie]

Ok I had my thyroid removed due to a large goiter. I have Rheumatoid Arthritis and have been told the goiter was related. Honest answer is I don't know what my journey has been cause I've never had a stable history with my thyroid testing. I live in the US and most doctors don't give you much info other than we need to add or reduce your dosage. I'm hopeful that I will learn more here on this site.

[pennyannie in reply to tp104]

Hey there

OK then - well we need to see some blood test results :

If you have been dosed and monitored on just a TSH blood test result you have probably been under medicated throughout this period, and the symptoms of hypothyroidism are insidious and disabling, and you can find a detailed list of these on the Thyroid uk website, who are the charity who support this forum and it's members.

To help you sort out your situation we need a TSH, T3 and T4 thyroid hormones plus ideally, ferritin, folate, B12 and vitamin D along with the ranges for each.

A fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3 :

T4 is branded as Levothyroxine / Tirosint / Synthroid - and is a storage hormone which your body needs to be able to convert into T3 which is the active hormone that the body runs on. Generally speaking most people feel more well when their T4 is in the upper quadrant of its range.

T3 - is Liothyronine and branded as Cytomel in the US. and is said to be about 4 times more powerful than T4 : Generally speaking most people feel more well when their T3 is in the upper quadrant of its range.

Armour is Natural Desiccated Thyroid ( NDT ) contains both T3 and T4 thyroid hormones in a fixed ratio of approximately 4/1 T4 to T3.

Your ability to convert T4 into T3 can be compromised if your core strength vitamins and minerals, namely ferritin, folate, B12 and vitamin D are not maintained at optimal levels. Conversion can also be reduced because of any physiological stress ( emotional or physical ) inflammation, ageing, dieting, and or depression.

If you felt more well on Armour I would suggest that is because it contains both T3 and T4 and was successfully used to treat hypothyroidism for over 100 years prior to the introduction of synthetic T3 and T4 and the blood tests, ranges and TSH that were to be used alongside this new synthetic thyroid hormone replacement.

With NDT you dose to the relief of symptoms and not a blood test result, and as it contains T3 you TSH will be suppressed but is of no importance, and this doesn't mean you need a dose reduction.

It is T3 that causes symptoms and at too high a level of T3 you experience symptoms of hyperactivity whilst at too low a level of T3 causes symptoms of hypothyroid, and sadly some symptoms can to overlap at either end of this spectrum, so causing possible confusion.

I hope that helps explain a bit, can I ask why was your thyroid removed ?

I'm 73 and without a thyroid gland and found T4 stopped working for me about 6 years ago:

I added in some T3 along with my T4 and felt better -

I then tried NDT and am currently taking this form of thyroid hormone replacement.