TSH Normal, T4 Low--What do you do to level your T4?

[ilovecruises]

I don't have a thyroid anymore. I currently take Armour and my TSH ( 1.360 uU/mL) is normal and my T4 (0.8 ng/dL) is low.

Those that have had this issue what have you done, taken to get a normal T4?

[Jazzw]

Those of us who take NDT often find we feel better taking a dosage which takes TSH below 1.0. At a guess, you need more Armour. How much are you taking? Do you know your FT3 levels?

[ilovecruises in reply to Jazzw]

I haven't had my T3 checked since March of last year. However, prior to my TSH being normal, it as well as T4 and T3 were always either too high or too low.

In April of this year, my TSH finally became stable on the current dose of Armour and I've been on various hormone therapy since 2019.

[Jazzw in reply to ilovecruises]

OK. But TSH isn’t a reliable indicator of whether you’re on a high enough dosage of Armour. You need an FT3 test to know whether you’re really on enough.

But then again, if you feel ok, there’s no need to change anything.

I’ve recently added a small amount of levothyroxine to my NDT dosage (12.5mcg a day) as my FT4 and TT4 were under range but my FT3 was well up its range. It’s too soon to say if it’s going to help me but others here do the same.

[ilovecruises in reply to Jazzw]

Levo and Syn were horrible and my body did not like it at all. I do feel fine but I figured at some point before my thyroid went wacko all of the numbers were level and I wanted to see if I could get them all leveled and if anyone else has been able to get all of their numbers leveled.

[greygoose in reply to ilovecruises]

If you are taking NDT, your FT4 is always going to be low. Doubtful you could ever get it 'leveled' - and I'm not convinced that's even a good thing to be aiming for.

I imagine you mean you want all three results at a euthyroid level? Well, that's not going to work. It's doubtful you ever would because euthyroid is a TSH of around 1, FT4 around mid-range, and FT3 slightly lower - allowing for individual differences. But, you can never replecate levels from endogenously produced hormone (from your thyroid) by taking exogenous hormone - you cannot control your absorption in the gut, for one thing, and that could vary from day to day.

Plus if you take T3 to get your FT3 to a level that makes you well - hypos tend to need higher levels than euthyroid people to make them well - your FT4 and TSH are more than likely going to be low.

There's nothing you can do about the level of your TSH except take less hormone in general, which could leave you hypo again.

You could try adding levo to your NDT, as Jazzw suggested, but how many years are you prepared to mess around with dosing to try and get your FT4 exactly where you want it? You might never succeed. And if you ever did get those levels back to where they were, there's no guarantee it would suit you now. Your bodily needs will have changed. So, why upset the applecart?

If you feel well with your present levels, leave well alone, that's my advice. And, if you don't feel well, alter your dose with the aim of feeling well, not in order to chase round in circles after phantom figures from the past.

[pennyannie]

Hey there again ;

I'm now over 3 years into self medicating and taking Natural Desiccated Thyroid ;

I too do not have a fully functioning working thyroid having had RAI thyroid ablation in 2005.

On NDT when optimally medicated it's likely that your TSH will be low suppressed :

Your T3 higher in range with your T4 likely lower in range than when on synthetic T4 :

T4 needs to convert to T3 in your body and I take a low T4 when on NDT to mean optimum conversion.

On synthetics my TSH was usually low suppressed at 0.01 and my T3 was generally around 25% - 40% with my T4 coming in at around 90% - 120% through the ranges :

Increasing T4 up and over range helped a little but the small benefit experienced by having a higher T3 fell away and wasn't sustainable.

On NDT my TSH is 0.01 but my T3 and T4 have swopped % through the ranges :

Depending on timing of the blood test and last dose my T3 can be 90 - 110% through and my T4 sits at around 25 - 30% through the ranges.

The ranges and guidelines were introduced to be used with synthetic thyroid hormone replacement when Big Pharma launched their alternative to Natural Desiccated Thyroid.

The TSH was originally introduced as a diagnostic tool to help confirm a diagnosis of hypothyroidism and was never intended to be used as a reliable measure of anything once the patient was on any form of thyroid hormone replacement.

NDT was the treatment of choice and successfully used for over 100 years, prior to the science of blood test, and you simply dosed up to relieve symptoms of hypothyroidism.

[SlowDragon Administrator]

Also test vitamin D, folate, ferritin and B12 at least annually

[greygoose]

I'm interested in your comment that FT4 should be low in range if your are on NDT.

Not what I said. I said it 'is', not 'should be'. It's a well-known fact that taking T3 lowers T4 levels.

but why was my wife's FT4 more over range than her FT3? If this is unusual, what action would you suggest?

There are always exceptions. And, it really doesn't matter what her actual levels are, as long as they make her well.

I wouldn't worry about her morning pulse, either. If she feels otherwise well on 3.25, then she is best off staying on it.

[greygoose]

I'm glad. And, you're very welcome.