Hello, I have Hashimoto dx for a year, my tsh is 3.8 with upper limit of normal 4.5. I am only on 50mcg of Synthroid with TSH labs being in the normal range for the past year. Endocriniologist has not seen a need to increase it (TSH was 11 at first dx). I have blood draws every 3 months now.
I feel pretty good except for some slightly achey joints, my morning energy starts out pretty good, but as the day goes on I become more tired, often needing a nap. I do experience anxiety throughout the day - it comes and goes. It can sometimes be hard to focus during conversations. I am just now post menopausal and a lot of these symptoms can coincide with the change. My Endocriniologist wants to start me on 5mcg per day T3 with my Synthroid in the morning. I am having anxiety worrying about if the T3 will give me anxiety. When I first had Hashimoto dx I had hyper symptoms and do not want to relive that again as the anxiety was severe and my blood pressure went to 180 (controlled with meds in low 140/70 now) . I told my doc my concerns and he said this is a low dose, if you don't like how it makes you feel, stop it since it has a short half-life. My question is what should I expect starting this med?
Here are my lab values:
TSH 3.80 range 0.40-4.50miul
T4, Free 1.3 range .0-1.8
Vit D - 50 range 30-100 ng/ml I take 4k IU daily
Ferritin 114 range 16-232 ng/ml
B12 450 pg/ml range 200-1100pg/ml
Yes, I am in the states and my Endocriniologist did his fellowship at the Cleveland Clinic. I do know my next labs he said he will draw a T3.
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Mszippy
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I'm guessing you are in the US .... over here in the UK, it's very tricky to get T3 meds prescribed, and certainly not when only on a "starter" dose of levo and with such a high TSH.
It's more usual here to increase levo by 25 mcg a day until TSH is reliably less than 2 and probably less than 1 and both free T4 and free T3 are nice and high in range, T3 meds are then occasionally prescribed if you are a "poor converter" - ie high in range free T4 but very low free T3.
With no free T4 or free T3 results, it's difficult to know how you will respond to this change in meds. It's not a high dose, so there's no reason to expect it will give you anxiety - but if it doesn't suit I would suggest (a) splitting the 5 mcg tablet in half and taking half with your levo and half several hours apart at the other end of the day; or (b) stopping and getting an increase in levo.
Basically, we all respond differently, so there's always an element of try-it-and-see - but slow steady changes in meds are always best - and that's what you have here ...
Thank you - I posted labs and more information above. I think T3 here is not popular either and the standard of care is increase levo by the Endocriniologist association. He also told me I may lose a little weight - currently 165lbs.
My Endocriniologist wants to start me on 5mcg per day T3 with my Synthroid in the morning.
In my opinion your endo is being hasty.
First of all, just testing TSH doesn't give us a picture of our thyroid status. It's not a thyroid hormone, it's a pituitary hormone which sends a signal (TSH) to the thyroid to make hormone when it detects there's not enough. If the pituitary is satisfied there is enough hormone the TSH will be low, if the pituitary thinks your thyroid needs to make more hormone the TSH will be high - and your TSH will be classed as high (for a treated Hypo patient) as it is close to the top of the range.
The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges. So you can see that your TSH is currently too high but you don't know where your FT4 and FT3 lie (presumably you haven't had these tested).
With your TSH the usual thing to do is increase the levothyroxine until the TSH is low in range then see where the FT4 and FT3 lie. If the FT4 is in the upper part of range and FT3 is low then that's when you consider adding T3, not at the stage you are at currently.
Before you agree to take the T3, I would insist on getting TSH, FT4 and FT3 (not Total T4/T3 but the Free T4/T3) all tested at the same time to see where your actual thyroid hormones (FT4/FT3) lie.
I would imagine you need an increase of 25mcg levothyroxine now then retest in 6-8 weeks to see where all your levels lie, maybe another increase will be necessary.
I would also test your Vit D, B12, Folate and Ferritin. These all need to be at optimal levels (not just "in range" but "optimal") for thyroid hormone to work and good conversion of T4 and T3. As you have Hashi's this tends to cause gut/absorption problems which often results in low nutrient levels or deficiencies so it's really important to get them tested.
You are welcome to put all your new results/ranges on the forum for further comment.
Thank you - I added more information to my post. Perhaps you can elaborate more. Much appreciated. I am not sure why he wants to give me T3 - when we spoke on the televisit he said my TSH was normal, but my OBGYN mentioned 3.8 was too low on my annual checkup. So confusing!
I am not sure why he wants to give me T3 - when we spoke on the televisit he said my TSH was normal, but my OBGYN mentioned 3.8 was too low on my annual checkup.
He shouldn't be considering T3 unless a Free T3 test is done at the same time as the TSH and Free T4. How does he know you don't already have a high FT3 - taking T3 would take it too high in that case. But you also need to know your FT3 level in order that you can monitor how you are doing if you take T3 and how much to increase it by.
Can you just check the range for FT4 - have you missed something off? Is it 0.0 as the low level (that would be very unusual) or something else?
If your OBGYN said your TSH was too low then I'm afraid s/he doesn't know what they're talking about. Anormal healthy person generally has a TSH no higher than 2. As mentioned before, when taking levothyroxine the aim is for TSH to be 1 or below, a high TSH suggests undermedication and yours is near the top of the range. However, your FT4 is also quite close to the top of the range. and that is unusual with a high TSH.
Did you do your test as we always advise to give the most accurate result:
* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH
* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
I'm wondering if you took your levothyroxine before the test which would account for the FT4 being quite high in range.
I really think you should repeat the test, following the advice above and make sure that TSH, FT4 and FT3 are all tested from the same blood draw.
Vit D - 50 range 30-100 ng/ml I take 4k IU daily
That's fine, the Vit D Society and Grassroots Health both recommend a level of 40-60ng/ml.
Do you also take D3's important cofactors - magnesium helps the body convert D3 into it's usable form and because D3 aids the absorption of calcium from food we need Vit K2-MK7 as this directs calcium to bones and teeth and away from soft tissues and arteries where it can be deposited and cause problems such as kidney stones, calcification of arteries, etc.
Ferritin 114 range 16-232 ng/ml
Ferritin is recommended to be half way through range, yours is a pretty good level.
B12 450 pg/ml range 200-1100pg/ml
This is on the low side.
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
If you want to improve your level you could supplement with a good quality, bioavailable B Complex containing methylfolate and methylcobalamin, eg Thorne Basic B. Be aware that if you choose one which contains Vit C this keeps the body from using B12.
When taking B Complex we should leave it off for 7 days before any blood test as it contains Biotin and when Biotin is used in the testing procedure (which most labs do) this causes false results.
am not sure why he wants to give me T3 - when we spoke on the televisit he said my TSH was normal, but my OBGYN mentioned 3.8 was too low on my annual checkup.
Then your OBGYN should either stick to his own medical discipline or take a refresher course on the thyroid.
A TSH of 3.8 is much higher than that of most healthy people. When people are given more thyroid hormones in any form their TSH is lowered. Your TSH is too high for most people to have a hope of feeling well, so you need more thyroid hormones which will lower your TSH.
If you are worried about thyroid hormones you might like this thread - although some of the links might be unavailable to people from outside the UK. But hopefully you can get the gist of what is being said :
In your shoes, if possible, I would make sure I got a test of TSH, Free T4 and Free T3.
Then raise dose to 75mcg Levo (but don't take any T3 - yet).
After 6 weeks test TSH, Free T4, and Free T3 again.
Depending on the results you might end up increasing T4 to 100mcg OR perhaps taking 6.25 mcg T3. And then waiting six weeks and then testing again. But it really depends on the results - we would need to see the numbers.
Honestly I was thinking he should increase my Synthroid 25mcg as well or even 12.5 mcg - I am beginning to think he is using the T3 as a stimulant to get me motivated and lose more weight….I made the mistake of not asking him why he chose T3 over an increase in 25 mcg levo. He kept saying my TSH numbers were good 😔.
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