Finding a balance.

[Daisywhoopsa]

I’ve come up against the old argument about effects of long term suppression of TSH. Been on T4/T3 combo for almost 4 months. My old Levo dose for 20 odd yrs was 200mcg a day. Endo insisted I slowly reduce levo when starting T3. I’m now on 125mcg levo and 27.5mcg T3 split over 3 doses daily. NB I’m prescribed 20mcg (the extra 7.5 is self sourced) My most recent tests results are attached from this dose. Usual protocols about skipping doses pre test.

Endo wanted me to drop levo further to 100mcg to increase the TSH and, although not convinced, have done it for the last week. In just a week the pain, muscle cramps, itching and insomnia have returned. I had felt so much better on the combo- sleeping better, less muscle pain, hair loss improving. Resting heart rate is still low at 50bpm and temp is marginally better than it was. Ferritin and Vit D are in a good place although still room for improvement and I do take supplements to aid this. By chance I had an ecg 4 weeks ago- all good. My query is- Following those most recent results with T4 so low I was thinking I needed to increase back up a little but endo only wants me to reduce it further to get TSH up a bit. Since lowering my levo to 100mcg is causing a returning of symptoms, would I be better off reinstating my 125mcg levo and then later reducing the T3 dose in an attempt to up the TSH a bit? I’m aware and pointed it out to my endo that any thyroid meds will suppress TSH but it’s how low it has suppressed that is the endo’s concern. Advice please.

[diogenes Remembering]

First of all, it's probable that on 200 ug T4 for 20 years, your pituitary has been virtually silenced (TSH either undetectable or <0.01). I would say that nothing you can do now will restore it to anything like normal. The pituitary has had all this time to adjust, as has your body in general, to treatment and will not willingly be reactivated. It isn't like a sleeping tiger, ready to leap up in a moment, more like a dead battery that nothing can reactivate.

[Daisywhoopsa in reply to diogenes]

Thank you Diogenes. I hadn’t acknowledged that could be the case.

[SlowDragon Administrator]

So this test ….last dose levothyroxine was 24 hours before test?

Do you always get same brand levothyroxine at each prescription

Day before test split 27.5mcg into 3 doses and take last 7.5mcg 8-12 hours before test

Many members on levothyroxine plus T3 find that they need BOTH Ft4 and Ft3 at least half way through range

Suggest you increase levothyroxine to 125mcg daily

Retest in 6-8 weeks. You might need to reduce T3 after next test

On almost any dose of T3 TSH is likely to be low or suppressed. As long as Ft3 and Ft4 are within range your not over medicated

If your endocrinologist not happy with low TSH you need new endocrinologist

Essential to regularly retest vitamin D, folate, ferritin and B12….. especially as now your Ft4 is too low

[Daisywhoopsa in reply to SlowDragon]

Thanks SlowDragon. You have summarised what I was thinking, just needed to know I was on the right track. Yes same brand and yes I dosed as you described before testing.

[SlowDragon Administrator in reply to Daisywhoopsa]

Trial and error what suits each person

I take 20mcg T3 split into 3 doses

Personally I have recently discovered it suits me to take higher dose T3 at bedtime (previously took 10mcg waking)

5mcg waking, 5mcg 3pm and 10mcg at bedtime

125mcg levothyroxine 5 x week and 112.5mcg 2 x week (I split this too) - 100mcg at bedtime and 25mcg waking

Essential to maintain optimal vitamin levels

Are you gluten free and soya free?