I am currently on a trial 3 months with an NHS endocrinologist. I started a regime of 75 levo and 20 liothyronine on June 4th. I was given a follow up appointment for July 1st which I have amended to August 1st as no one had sorted out how I could get blood tests done in time. As I am in Devon I will be given no more than 10 mcg liothyronoine if I am allowed any at all. But I was curious to see what this dosage is doing for me before I have to argue my case on August 1st. Results are as follows:
TSH 0.04 ( 0.27 to 4.2 mU/L)
fT4 11.4 (12 to 22 pmol/L)
fT3 5.3 (3.1 to 6.8 pmol/L)
Why would the TSH be so low when the hormones are not hugely high? Does the TSH respond more to what the fT3 is doing than the fT4? If the results in 4 weeks time are similar I am wondering how the discussion with the endo is going to go. To my intense relief the constipation has gone but still swollen left ankle so my shoe does not fit, heavy eyelids, itchy dry skin, terrible memory. Otherwise I feel fine. How could I adjust dosage to raise all 3 results a bit?
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I've had a hectic week and my brain might be turning to mush but I'm having difficulty in understanding this:
I started a regime of 75 levo and 20 liothyronine on June 4th.
As I am in Devon I will be given no more than 10 mcg liothyronoine if I am allowed any at all.
So what exactly are you taking - 20mcg or 10mcg liothyronine and if 20mcg how come if Devon doesn't allow more than 10mcg?
TSH 0.04 ( 0.27 to 4.2 mU/L)
fT4 11.4 (12 to 22 pmol/L)
fT3 5.3 (3.1 to 6.8 pmol/L)
Why would the TSH be so low when the hormones are not hugely high?
Because you're (presumably) taking liothyronine, it lowers and often suppresses TSH, it's just what it does. Your FT3 is 59.46% through range so a pretty reasonable result.
Does the TSH respond more to what the fT3 is doing than the fT4?
If you're taking liothyronine it will be low due to taking exogenous T3.
To my intense relief the constipation has gone but still swollen left ankle so my shoe does not fit, heavy eyelids, itchy dry skin, terrible memory.
That could be due to the low FT4. When on combination thyroid hormone replacement some of us are fine with low FT4 as long as FT3 is in the upper part of it's range, some of us need it in balance with FT3, it's so very individual that we have to experiment and find out what we need as an individual.
How could I adjust dosage to raise all 3 results a bit?
You can add some Levo which will raise your FT4 and may raise your FT3 depending on how much natural conversion you have. As long as you continue taking liothyronine there's not much chance of your TSH rising (whether your endo likes it or not).
Sorry to have not explained properly. My endo is not in the Devon CCG and I am trying to get T3 prescribed as I do not convert T4 very well to T3. I think my GP will agree to prescribe 10 mcg daily (the maximum Devon CCG allows) if the endo agrees that I need liothyronine. I am trying to find my sweet spot and will top up the T3 if necessary. But I have heard that when on combination therapy the TSH should not be suppressed. Is that correct?
But I have heard that when on combination therapy the TSH should not be suppressed. Is that correct?
I don't know, and I doubt if any endo does either. If TSH is suppressed and FT3 over range in a hypERthyroid patient that's very different, but you are hypo and so am I. I take Levo plus T3, my TSH was suppressed on Levo only, it's still suppressed on Levo plus T3 and it's over 20 years that my TSH has been suppressed, my GP doesn't like it but I'm not dead yet, nor do I have osteoporosis or atrial fibrilation.
Many thanks to both you and Pennyannie. This is the reassurance I needed. I have now read so much that my thinking goes in circles. I have just watched a video on the Thyroid Trust website (not a recent one) by a lovely GP who is herself hypothyroid and takes T3 plus levo. She says her TSH is suppressed and she has had to talk to her GP colleagues about allowing her to do this. In another Thyroid Trust video talk by Dr Toft he seemed to say that if on just levo then the TSH could be suppressed without danger so long as T3 is not too high, but on combination therapy the TSH should not be suppressed. I feel that I would know if I was over medicated and would adjust accordingly. It seems to be a matter of learning to trust and listen to one’s body, plus a healthy dose of advice and reassurance from here. Many, many thanks.
The TSH was originally introduced as a diagnostic tool to help identify a patient dealing with hypothyroidism and was never intended to be used once the patient was on any form of thyroid hormone replacement as then you must be dosed and monitored on your T3 and T4 readings.
When taking any form of T3 this tends to lower, suppress the TSH :
If you want your T3 or T4 higher in the range it is likely that your TSH will go lower.
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