TSH levels

[Abirose97]

I was under the impression that TSH levels would be suppressed when on synthroid and liothyronine, t3 and t4 are looking great but TSH is <0.0.1 , some people said that's fine but my doctor has said that's a sign of hyperactive thyroid.

[jimh111]

It depends on the dose. Liothyronine is about 3x as potent as levothyroxine. It's better if your TSH is not low if possible. I find I need to take half my liothyronine just before bedtime to get good quality sleep and awake refreshed. If I have any difficulty getting to sleep I know I need to lower my dose.

It's difficult to measure hormone levels when you are taking T3. The best you can do is to have the blood taken around midway between doses. Having fT3 and fT4 within their reference intervals doesn't tell you much unless both are around their midpoints.

[WildDeer in reply to jimh111]

Hi Jim, please can you explain why it's better for your TSH not to be low when taking liothyronine?

[jimh111 in reply to WildDeer]

Two reasons.

1. TSH usually reflects the combined action of fT3, fT4 for most people. So, for those with a healthy 'axis' TSH is a good indicator of thyroid status, how much hormone you need. However, for some patients the pituitary can fail to secrete adequate TSH and so for these people TSH is a very poor marker. This forum will have a higher proportion of such people than the general population.

2. TSH not only stimulates the thyroid to secrete hormone, it also stimulates T4 to T3 conversion, especially in tissues such as the brain and skeletal muscles. This intracellular T3 is more important than the T3 in the blood. Thus, if your TSH is too low you will miss out on this conversion and consequently need higher than normal T3 levels to compensate. High T3 levels in the blood will be too much for other organs such as the heart. I don't want to overstate this, studies I've seen show that people on combined T3 / T4 therapy live longer than those on levothyroxine monotherapy. My approach is to try and get well on the lowest effective dose of T3 and take it slowly. Many patients have no choice but to take higher doses of T3 than result in a near zero TSH.

An added complication is that if the TSH is suppressed for a long time the 'axis' can be permantly down-regulated. The pituitary always fails to secrete enough TSH. It's preferable to avoid this happening if you can, so take it slow early on.

[SlowDragon Administrator]

Previous post has actual results in

FT4: 17.3 pmol/l (Range 9 - 23) 59.29%

FT3: 5.8 pmol/l (Range 3.5 - 6.5) 76.67%

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Suggest you get vitamin levels tested and consider strictly gluten free diet

[Abirose97 in reply to SlowDragon]

haha hello again! yes I went for a second opinion and he is getting my vit d and iron levels tested BEFORE we do anything with my thyroid doses which I appreciate. but like having a second opinion from my doctor I wanted a second opinion on here. also, I'm following the GF diet and already feeling better within a few days

[SlowDragon Administrator in reply to Abirose97]

It’s ALWAYS Worth trying strictly gluten free diet

So often people are astonished at improvement

[pennyannie]

Hello Abirose :

Once on any form of thyroid hormone replacement the TSH is the least important result and must not be used is isolation.

It's essential to read a TSH, T3 and T4 - and you are only " hyper " if your T3 is well over range :

On a personal level you can monitor your blood pressure, pulse and temperature twice daily just to get a ' feel ' of what makes sense for you and listen to your body - no one enjoys being ' hyper ' and if you experienced symptoms you would be more than happy to adjust you medication to eradicate them.

[McPammy]

I’m very fortunate to be able to keep my T4 and T3 levels within range and therefore my TSH is not suppressed. I’ve had over 20 blood tests since I started combining T3 with my Levothyroxine T4 medications. Only twice in the early days did my TSH go suppressed slightly. I’m full of energy and life. I feel youthful from being housebound for over a year when I got really bad. I’m a very poor converter of Levothyroxine T4 to active T3 and a positive DIO2 gene test result. My private and NHS endocrinologists are really pleased with my recovery. They have no issue in prescribing my Liothyronine T3. I’ve also lost over 4st that I piled on whilst on mono Levothyroxine treatment. Basically keeping my T3 and T4 levels within range has brought me great health and well-being. No one is more amazed than myself.

[jgelliss in reply to McPammy]

Your experience with T4 and T3 is very encouraging. Can you please share what dose T3 and T4 your dosing with ?Thank you for sharing your great experiences.

[Batty1 in reply to jgelliss]

Are you on T3 and T4 ? What dose.

[McPammy in reply to jgelliss]

I take 5mcg T3 twice a day. Or if I’m exercising on a regular basis I will increase to 3 doses T3 all 8 hrs apart. I take 68mcg liquid Levothyroxine a day. I also split my Levothyroxine T4 to half twice a day. It’s a bit of a faff but it really works for me.

[jgelliss in reply to McPammy]

Thank you for your in depth reply. It very helpful for many.

[Batty1 in reply to McPammy]

Im on T3 and T4 and my FT4, T3 and FT3 (which I pay for) is always within range (lower end) and my TSH plummets but Im without a thyroid and always wonder if this is the reason for the numbers.