Hello all,
Test taken as per the advice on here, I have previously posted my vitamin results and nothing stood out.
Currently trying to find a levo dose that works post partum, I am taking 125 5 days a week and 100 2 days a week and not really able to keep on top of tummy problems, bloated, constipated and fatigued.
My TSH has never been this low, why so it so low when I'm not even in the top half of the ranges for t4 and T3?
Thanks!
Looking at previous posts
You have low iron/ferritin
Hypothyroid after RAI for Graves’ disease ....so autoimmune
Autoimmune disease often goes bit haywire after pregnancy
Are you on strictly gluten free diet?
Yes to GF I was taking iron tab whilst pregnant and for a few week pp.
Do you think I am converting okay?
Ft4 only 54% through range Ft3 only 35% through range
So likely under medicated and poor conversion
How do you feel
Pretty rubbish.
So you likely need dose increase in levothyroxine.....or more likely beneficial would be T3 prescribed alongside levothyroxine as 2 or 3 small doses through day
Roughly where in the U.K. are you
Currently many thyroid specialist endocrinologist are doing consultations on zoom
Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private
tukadmin@thyroiduk.org
The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2
When adequately treated, TSH will often be well below one.
Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Okay, thank you. Hmmm a lot to think about. Should I start with the levo increase and see how it goes? My ft3 has never been at 60% since RAI.
I'm in the NW just south of Manchester.
Hey there again :
Your TSH is so low because you have Graves Disease - you can't do anything about it, and this is why the TSH in Graves patients must be ignored as it is known to be very unreliable.
The TSH is known to be a very unreliable measure of anything and this is especially true if you have Graves Disease as you can still have antibodies " sitting on your TSH " driving it down, as this was how you became hyperthyroid in the first place.
You may have had RAI, you may have had a thyroidectomy but this doesn't stop the antibody interaction - but now you haven't a thyroid to stimulate and your feedback loop is broken, and there is no functioning thyroid gland to " rev up " anymore.
You must be dosed and monitored on T3 and T4 blood test results, and both these essential thyroid hormones need to be balanced and we generally feel better when both T3 and T4 are in the upper quadrant of the ranges.
The accepted conversion ratio when on T4- Levothyroxine only is 1 / 3.50 - 4.50 T3/T4 with most people preferring to come at around 4 or under :
So if I divide your T3 into your T4 I get 3 91 - so it looks to be the right side of 4 - and if you are feeling ok - that is all that matters :
However you are only just 50% through the T4 range and would probably feel a lot better near or in the top quadrant and I would suggest you need at least one increase in T4 - Levothyroxine to get you up there, your conversion ratio is balanced so a higher T4 should in turn give you a slightly higher T3 and it is T3 that gives you the symptoms :
Hyperthyroidism and hypothyroidism are the opposite ends of the same stick.
Too high a level of T3 and you may experience hyper type symptoms just as too low a level of T3 and you will have symptoms of hypothyroidism, and it's where your T3 suits you the best kicking in your metabolism and feelings of good health and well being.
P.S. and Congratulations on your new little bundle of joy :
Thank you, this is massively helpful. My feeling is that I need a bit more levo, I haven't been feeling well at this dose although better than I was. I'm going to read through the conversion stuff again as I am not sure I followed but sound reassuring. Obviously I am under pressure from GP to reduced the dose.
And thank you, she is a joy!
You might try looking to the Elaine Moore Graves Disease Foundation website for more information on the unreliability of the TSH in Graves patients and find something to print off : Elaine has Graves and went through RAI and finding no help started researching herself.
There is also a book I purchased by Barbara S Lougheed who explains this well - Tired Thyroid - from hyper to hypo to healing - breaking the TSH rule : another lady with Graves who went through RAI and ended up having to research stuff herself.
The trouble is getting the doctor to understand that the TSH was originally introduced as a diagnostic tool to help diagnose hypothyroidism and was never intended to be used once the patient was on any form of thyroid hormone replacement :
It seems " cutting corners " and not running T3 and T4 blood test as " the norm " and of course thereby not identifying those people unwell through too low T3 levels and blindly prescribing anything other than the appropriate T3 thyroid hormone replacement.
I just got anti depressants and didn't know any better for a good few years and becoming more ill and then I found myself on here and the " penny dropped " after reading a few good books.
You Thyroid and How To keep It Healthy written by a doctor who has hypothyroidism another goto - and Barry Durrant - Peatfield writes in an easy to understand non technical manner and there again, it all makes perfect sense.
My TSH has always been stuck down after RAI, below the range and even when my T3 was just 25% through the range with a T4 at 100% told I was overmedicated and needed a dose decrease. When I queried the imbalance between my T3 and T4 I was told I was very lucky to have ay T3 at all. The doctor was the thyroid lead at the surgery - I just gave up with answers and comments so illogical and demeaning and I threw the anti depressants away.
I'm now self medicating as I was refused both T3 and NDT by my surgery - and fighting the system simply exacerbated my systems : I'm so much better it simply is ridiculous.
Trying extra levothyroxine is first step
Making sure all four vitamins are maintained at optimal levels too
Strictly gluten free diet may help too and is always worth trying
If Ft3 remains low, likely to need addition of small doses of T3 prescribed alongside levothyroxine
My blood test- TSH low
Low/Suppressed TSH
Low TSH & Low T4
Low TSH 
Confused. Why is TSH low but T4/T3 also low?
