Following on from the below thread by diogenes, I'm wondering how if at all I can get my TSH back into the normal range. It's been in the 0.03-0.08 range for some time now. I switched from Metavive to Levothyroxine in October 2021 but TSH is still sitting well below normal range. It used to be in the normal range on 75mcg-100mcg of Levo but dipped well below when I started Metavive around 2018. Going back to Levo I actually feel better in may ways. I'm not as hungry/thirsty or suddenly tired as I used to be but I do still have lots of other symptoms.
tattybogle provided an interesting account of her experience also on the thread below but wondering if anybody else has any experience of this?
I'm currently on 87.5mcg, wanted to reduce slightly to see if there's any effect and I wasn't ready to go down to 75mcg again in one go. I'm splitting a 25mcg and taking with a 25mcg and 50mcg to achieve this.
Taking exogenous thyroid hormone/glandulars can inhibit the natural feedback mechanism production, for some people, not all, this means their TSH goes well below the reference range.
When you take exogenous T3, your TSH can plummet to near 0, because your body will recognize that there is already so much T3 in your system, that it has no need to produce any on its own.
This results in significantly lower absorption of iodine, via the sodium iodine symporter expression to pick up iodine from passing blood supply. Thus a low TSH over a period of time results in reduced iodine absorption by the thyroid.
So your thyroid essentially goes to sleep for the duration of time you are “over medicating”.
The HPT axis has an intricate connection to the HPA and HPO axis (hypothalamic, adrenal, thyroid & ovarian), which can result in depleted metabolic reserve and physiological resilience.
Replace hormones if your own gland does not produce enough. However, your hypothalamus still maintains an intricate communication mechanism that also interacts with other axes and is involved with thyroid hormone metabolism.
You can find this information in physiology text books and also here in this paper which discusses how thyroid hormones interact with TSH and the Sodium/Iodide Symporter (NIS):
Hi, you say you are feeling better on Levo. Your FT3 level is rather low, I’d be really struggling on that. Your TSH moves up and down, my endo would be happy with that. He’s certainly not worried if the TSH is 0.02 or more.So I’d say the same as meme, why do you want your TSH to rise?
And also, do you feel really good with your FT3 so low?
I actually dont feel much worse compared to when I was taking Metavive. In some ways I feel better. Other things haven't changed and still aren't good.
My TSH is essentially stuck at a very low point. It has stopped fluctuating like it used to. Explained above to meme why it's so important for TSH to not be so close to 0.
Thank you for your reply and the info.My TSH has been low since I added a small amount of T3. But on Levo alone I did not do well. Far too much struggling to function, needing to sit around etc which won’t do me much good either.
You might be interested in Dr Eric Balcavage’s account. He explains thyroid hormone physiology with quite easy to follow short videos and posts. Endorsed by Dr Carrie Jones.
I'm also trying to get my TSH up from 0.02. I take 75mcg levo per day, I split it so I take half just before I go to sleep and half the moment I wake up. I take 10mcg of lio per day, split into 5mcg about an hour after the morning T4 and then again 12 hours later.
I used to be on 200mcg of T4 and have been on between 20 and 120mcg of T3 over the last year. I slowly dropped the T4 and after a couple of weeks for the TSH and deiodinase 3 enzyme to re-adjust I would drop the T3 a bit.
The most important thing I did to drop the doses was to split the T4 and T3. For me taking the medicine in one go was too big a hormone dump and my TSH dropped to undetectable. I drip feed it now. Dropping the T3 from 15mcg, dosed 5mcg three times per day down to 5mcg twice per day was hard for the first near two weeks as I waited out for the deiodinase 3 to lower, but after that I felt fine. I also take magnesium, vit D, A, and K and collagen and that makes me feel energetic enough to actually exercise.
I've tried multiple amounts of T4 and found anything over 50mcg of T4 in one go would negatively affect my TSH and make me feel hypo. The low TSH increases the deiodinase 3 enzyme which converts T4 and T3 to useless rT3 and T2 hormones at a faster rate than I could handle. Splitting the dose and keeping it lower than 50mcg of T4 per dose made me feel much better.
I split my 112.5mcg Levo now, 50mcg before breakfast /62.5mcg bedtime. After 6 months i was astonished to find TSH was 1.9 ... up from my usual 0.05-0.5 for previous 20 yrs.....
Of course , its only one result so could be something else going on , but i don't feel undermedicated, , and when i previously tried a lower dose of 100mcg i became constipated and TSH rose , but only to 0.5
..... So i don't think the higher TSH of 1.9 is due to absorbing less Levo... i don't eat after about 8 pm anyway. 'empty stomach for bedtime dose' is quite handy actually ... stops me being tempted to eat maltesers all evening.
( Well i say it's only one result .. my most recent one a year later was 2.7 , but i fiddled that one on purpose so a GP who'd become too 'interested' in my low TSH /high fT4 results would bugger off and leave me alone to experiment by myself for a few years)
This sounds really encouraging and I like the idea of keeping the same dose but splitting it throughout the day, who would have thought! I swear in the past Levo has helped me get to sleep so might be a win win.
So what did you do to fiddle your TSH for your GP? Not take your meds for a few days? My GP has given up on me, just tests me when needed and lets me get on with it.
you have to not take anything at all for 'x' days before the test ... but knowing what 'x' is .... that's the problem .... 4/5 days ... a week ....10 days ?
**WARNING** it's rather like Russian Roulette ....
~ you've no way of knowing how quick it will go up ,( we're all very ,very ,different) .... too few days for you and it wont move at all .. too many days for you and it might go so unfeasibly high that GP gets more involved than you bargained for ....and then decide they want to test it again in 6 weeks .
~ it will definitely make you feel very very unwell ,
~ you certainly shouldn't drive the car , and you might well become so useless you get the sack if you don't have a convenient holiday to do it in ...
~ and it will then take at least a week and a half (if you're lucky ) to feel better once you start taking the levo again.
~ and it's a bad, bad, thing to do to your HPT axis .. it might not forgive you at all.
Not recommended . and i'm off to report myself for giving unsafe advice.
I definitely wont be doing this, it was bad enough dropping Metavive right down and then starting at 25mcg of Levo and building up. I was all over the place, never again but good to know.
So I’ve started split dosing since yesterday. Head was very tired yesterday morning couldn’t think straight then it all clicked. Feeling very tired right now too.
Did you notice an increase in TSH anytime before 6 months? It’s a very long time. Are you still split dosing? If not why not? Did your FT4 and FT3 get affected or did they remain the same?
Not much private testing going on here .. can't afford it. Yes . still doing it . ( got used to taking it AM/PM now .. it's no hassle, it quite usefully stops me eating maltesers all evening ) and since i don't know for sure what made my TSH go up a bit , and i feel well .... i'm not changing anything.
So ..did TSH rise earlier than 6 mths ?.. don't know .
Any affect on fT4 .... it was lower at 6 mths (down from 19 [7.9-14] to 16.6 )... BUT for the previous 19 i was taking a LOWER dose ( 100mcg ) for the 16.6 was taking 112.5mcg split into 2 .
my fT4 routinely goes up and down all over the place even on the same dose / same way of taking it... so no proof one way or the other .
Similarly ....no information for fT3 (NHS testing only ).
#Flying by the set of my pants.
In case that's confusing :
Date............ Dose ............. TSH ......... fT4................. (all tests same time of day / last dose)
(GP now not looking too closely anymore... presumably 'happy', as TSH well within range , and probably doesn't want another argument like last one about my fT4 level )
I’ve been a bit of a daze since I started split dosing. Sorry for not acknowledging your reply earlier, appreciate your response. I’ve abandoned it for now and gone back to one dose. I’m on too low a dose of Levothyroxine to be splitting it.
I’m going to get a thyroid panel done tomorrow. Feeling rather low on energy and will hopefully reveal if reducing from 100 to 87.5mcg has had any effect on TSH. Might need to start back on the beef liver capsules as I might be low on B Vitamins, iron etc and then might have to go back to 100mcg ☹️
Raising a TSH can be as challenging as raising the Titantic :
The question is why should you need to :
Once on any form of thyroid hormone replacement you should be being dosed and monitored on where your T3 and T4 sit, hopefully in the ranges, at around a 1/4 ratio T3/T4 and high enough in the ranges t be acceptable to the patient.
The TSH was originally introduced as a diagnostic tool to help confirm a diagnosis of hypothyroidism and was never intended to be used once the patient was on any form of thyroid hormone replacement as then you go by the T3 and T4 ;
Sadly I am all too aware of the treatment in primary care with a yearly thyroid function test that, in reality, without looking at the T3 and T4 is pointless.
Thanks for your response. I take it you’ve not seen my first response to “meme”.
Unfortunately, TSH is treated simply as a diagnostic tool as you’ve said whereas it is a vital parameter of thyroid and brain communication. I am looking at this all from a functional medicine perspective.
So it’s really not just a matter of making the numbers look good.
It might not be the case with everyone but, despite lowering my thyroxine my TSH is still showing very 'under' - 0.03. My T4 and T3 are okay though so I don't worry. The doctor would have reduced my thyroxine further but, fortunately, I managed to persuade him not to.
Yes, I was trying to bring it down (well, my doctor was) but I had been on T3 in the past so I think this also affected my TSH level. I'm only on T4 now but all seems okay. I wouldn't worry too much about TSH, just get your T4 and T3 levels.
So let me get this clear. You were on T4 and T3 for sometime. You switched to T4 only and despite reducing T4 it still took years to increase TSH? How long were you taking T3? Did you take the decision to stop taking it because of a very low TSH or something else?
Sorry lots of questions. What are your results like now?
My FT3 is very low too. I’ve tried T3 with T4 and it just caused insomnia and nausea. Metavive caused a very low TSH and better FT3 but I was still symptomatic.
I was left on 50mcg T4 for far too long when I was first diagnosed so paid to see an endocrinologist privately who started me on T3 as well as advising me to increase my T4 slowly. I took both for about 10 years before my surgery said they would no longer fund it. I came off the T3 but stayed on 150/175 mcg and fortunately was okay but I've since gone through the menopause and could tell that I was becoming over-medicated so agreed to reduce my thyroxine. I'm not on 75/100mcg of thyroxine but my TSH is still showing very low but my T4 and T3 are in range.
Maybe you aren't converting well? I suppose you have checked B12, D, folate and ferritin? Take your thyroxine away from other food and drink?
Sorry completely missed your questions. Yes B12, D, folate and ferritin are all at good levels. Just tested them on 12th February.
I think there's a number of reasons for this. One being reduced conversion at the cellular level for a number of reasons, such as cell danger response and the other relates to how much hormone the pituitary gland is sensing. This is all functional medicine and your doctor won't discuss this with you because they can only lower or increase thyroid meds and these factors do not matter.
What is your FT4 and FT3 now? I wonder if (FT3) is as bad as mine?
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