History of tsh suppressed with Graves’ disease for 15 years. TSH wasn’t measurable until 8 months post thyroidectomy. Now 2+ years post thyroidectomy still sooo symptomatic. TSH <1, but swollen, breathless, muscle aches, blurry vision, puffy watery eyes.
Had DHEA unconjugated tested and it’s extremely low… can this test result lead to explain false low tsh levels?
I’m trying to figure out if my symptoms are due to being undermedicated on T4, not enough T3, or if TSH is fluctuating. We all know tsh doesn’t make you feel anything but it does tell you if we have enough hormone…. Riiiiiiight….?
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Meanbeannyc
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The TSH was originally introduced as a diagnostic tool to help confirm diagnosis of hypothyroidism and was never intended to be used to treat or monitor a patient once on any form of thyroid hormone replacement.
You haven't a thyroid :
Your HPT axis - your Hypothalamus-Pituitary- Thyroid feedback loop is broken as your " T " - the thyroid isn't there any longer as you have had a thyroidectomy.
You must be dosed and monitored on your T3 and T4 blood test results and we generally feel at our best when our T4 is in the top quadrant of its range as this should, logically, result in a higher T3 level, working on the basis of a 1/4 ratio - T3/T4 :
How does a TSH identify whether you are low in T3 or T4 ?
How does a TSH identify a T3/T4 conversion problem ?
A fully function working thyroid would be supporting you daily with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.
When you haven't a thyroid you have " lost " the management of the thyroid gland regulating your thyroid hormones throughout the day, and if you do not replace your own " lost " T3 production you have, in effect, been down regulated by around 20% of your overall wellbeing.
Juggling synthetic T3 - Liothyronine alongside synthetic T4 - Levothyroxine can be challenging :
I found taking Natural Desiccated Thyroid softer on my body, and now almost 4 years in on NDT believe this to be the best option for me.
P.S. No thyroid hormone replacement works well until your ferritin, folate, B12 and vitamin D are up and maintained at optimal levels - having had a quick look back I see there's some work to do there and read ferritin needs to be at least at 70 for T4 to work.
I now aim to maintain my ferritin at around 100: folate at around 20: active B12 at 75+ and vitamin D at 100:
There are many supplements available, though what's where you live I don't know:
Since your endo has switched you to liquid vitamin D - I suspect you may have absorption issues so suggest you look at liquid iron supplements.
I couldn't tolerate the iron supplements so forced myself to eat liver and now having built myself up I need to maintain myself with eating a small quantity of liver each week.
She switched me to the liquid because it was low IU and the only D I could tolerate thus far without puking. She has suggested trying different types and brands of meds, she stressed vitamin D as most important, although she doesn’t believe in different preparations of T4.
I will check out some ferritin supplements in low doses.
TSH can be an unreliable guide for assessing thyroid hormone levels at the best of times but when you don’t have a thyroid gland it must become redundant.
However, low DHEA could be causative in making you feel 'swollen, breathless, muscle aches, blurry vision, puffy watery eyes' as will be inhibiting thyroid meds to work effectively. Have you had cortisol measured also?
DHEA & cortisol are our body's long-acting stress hormones and should be kept in balance with each other. Ongoing stress (ie inadequate or ineffective thyroid hormone levels) raise cortisol levels that reduce DHEA before eventually decreasing itself.
Remember all hormones work together and you can not look at one in isolation (ie T3) in the hope of gaining wellbeing if there are other hormonal imbalances that you aren’t addressing. Are you supporting your adrenals glands?
I don't know your iron levels but in your convo with pa above if you are indicating serum iron is adequate but ferritin is low then supplementing risks raising serum iron levels further. Iron has many safety mechanisms that go askew with low thyroid hormone.
You could try adrenal glandulars. I don't get on with them but many do and Dr P was a huge advocate. Look at Nutri as a start.
I prefer adaptogens but if you have Hashi then it's a case of seeing which suits as they work with/against the immune system as well as influencing the HPA axis. I love ashwagandha, and use curcumin for inflammation.
Other than that the usual, ie optimise nutrients, eat clean foods, ensure consistent blood sugars, adequate sleep (which we aren't atm as its 4am 😄), managing stress & giving yourself time out. I love yoga, walking my dog, take 2-3g buffered Vit C. I have used salt in the past but stopped due to elevated BP atm.
Your aim would be to lower cortisol and raise DHEA so they balance. It would be advisable to avoid adaptogens that specifically raise cortisol and choose others that are known to balance as these will encourage all hormone levelling out within the HPA system.
But Graves is autoimmune too so be careful. Your thyroid has gone but the remnants of autoimmune disease may still remain. I think glandulars are ok as won't directly influence the immune system but some adaptogens are extremely powerful.
Discussing with your naturopath is an excellent idea 😊.
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TSH at 0.02 is this too low?
TSH low the rest normal
