TSH way below but T4 low, advice needed

[monkeybird]

I was taking 20 t3 and 75 t4 until my last blood test, results:

My t3 was 3.5 (2.63-5.7)

T4 8.2 (9.01-19.05)

TSH 0.06 (0.35-4.94)

After consulting here, I increased my t3 by 5mg and repeated bloods after 8 weeks

Ranges as above, new results

T3 4.1

T4 7.9

TSH 0.03

So my GPcalled me and suggested I was overtreated. Pointing out that my t4 was still below range, she rang the endocrinologist for advice. Endocrinologist suggested that, in view of my osteoporosis, and that my TSH has been below range for 2 years, I should reduce t3. I explained to her that I come onto this site to learn and she was happy for me to stay as I am and re-test in 8 weeks.

Please help, are there any articles I can read on this and share with my GP? Am I causing myself harm? Why is my TSH so low when my t4 is below range? Am I worsening my osteoporosis as the endocrinologist suggested?

My tests were done in the morning, I hadn’t had any meds for 24 hours. Other tests were normal, I take D3 to keep it that way.

[T3sortedme]

You look well treated. T3 is the active form of thyroid hormone. T4 is the storage version. You are taking T3 and it will push back the T4 because it is not needed, so the more T3 you take the more the T4 level will drop.

For most of us to be well using T3 our TSH is below 1.0, often below 0.5 and can be under 0.1 but not below 0.05 as that can indicate a likelihood of being over medicated. T4 will often be under target (always in my case). It’s seems the increase in T3 could be doing that and you were fine before that. Increasing T3 won’t increase T4 as it will stop the body producing T4, sending it down (exactly as your results show)

The key is how you feel. That is what really tells you if you are on the right level. Are you jittery or other signs of over medication?

I hope others will comment. I am on T3 only, not T4/T3 combo and others can guide you better. Just don’t worry about T4 being under if T3 is in range and you are feeling well.

Hope that’s helpful

[SlowDragon Administrator]

Blood test should be early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

But day before test ALWAYS split T3 into 2 or 3 smaller doses spread through the day, with last dose 8-12 hours before test

eg

10mcg waking, 10mcg mid afternoon and 5mcg at 8-12 hours before test

Last dose T3 at 24 hours before test is incorrect and gives false low Ft3 result

Many people on levothyroxine plus T3 find they need BOTH Ft4 and Ft3 at least 50% through range

It’s trial and error what suits each person

Suggest you try reducing T3 back to 20mcg ….and increasing levothyroxine to 100mcg this should bring Ft4 back into range and will increase Ft3 as well

How much levothyroxine were you taking BEFORE adding T3

Also essential to regularly test vitamin D, folate, ferritin and B12 at least once a year.

What vitamin supplements are you currently taking

Do you always get same brand levothyroxine at each prescription

Many people find they end up on 5mcg T3 at 3 doses spread through the day….plus high enough dose levothyroxine to bring Ft4 around 50% through range

[monkeybird in reply to SlowDragon]

before I ever took T3 I was on 125 mcg thyroxine. I split my doses and refrain from taking prior to testing, I took my last dose of t3 probably 24 hours before testing rather than 12, otherwise all as you said.

Can you advise on my extreme TSH please?

[SlowDragon Administrator in reply to monkeybird]

Taking almost any dose of T3 will significantly reduce or suppress TSH that’s just what happens for majority of patients taking T3

Your low, below range Ft4 likely causing issues

We see this frequently, that dose levothyroxine is reduced too much when T3 is added

Recommend reducing T3 by 5mcg back to 20mcg and increasing levothyroxine to 100mcg daily…..

Ideally you would reduce T3 first and wait 6-8 weeks before increasing levothyroxine…

But as not been on high dose T3 long could probably change both at same time and retest thyroid levels in 6-8 weeks ……last 5mcg dose T3 maximum of 8-12 hours before test

[monkeybird in reply to SlowDragon]

thank you, I can try that. I do feel better on more t3 and less t4 though…..What is your opinion on the endocrinologist saying that in view of my severe osteoporosis I should just reduce t3 with no increases? Might I be causing myself harm?

Thank you

[SlowDragon Administrator in reply to monkeybird]

some people are better on just T3 or mainly T3

It’s all trial and error what suits each person

Personally I can’t tolerate low Ft4. So take high enough dose levothyroxine to bring Ft4 to 60-70% through range….and 3 x 5mcg T3 to bring Ft3 to similar 70% through range (testing as recommended)

Helpful article on osteoporosis

thyroidpatients.ca/2018/07/...

EXACTLY what vitamin supplements are you currently taking

Essential to test vitamin D twice year when supplementing

Test folate, ferritin and B12 at least annually

Are you on gluten free diet or dairy free diet

[monkeybird in reply to SlowDragon]

I do have all the tests you mention, I am on gluten free, sugar free diet. I am fine with dairy. I take D3, K2, magnesium glycinate 750 mg twice a day, copper, coQ10, zinc, biotin. I eat fermented foods, kefir and bone broth.

Thanks for the article which I will send to my GP

Thanks

[SlowDragon Administrator in reply to monkeybird]

I always thought I was fine with dairy. Recently cut it out for other reasons (on advice of Lipodema specialist)

Astonished to find significant improvement thyroid wise on dairy free …..as well as noticeable reduction in swollen ankles after just 3 months

[monkeybird in reply to SlowDragon]

that’s great to hear. I follow keto, which entails cutting out so many things. I have cut dairy for a couple of weeks without noticing any gains, reluctant to cut any more out as I already have such a strict regime and few pleasures

[SlowDragon Administrator in reply to monkeybird]

yes….I was disappointed to find dairy free is helping….definitely miss butter

[Jaydee1507 Administrator]

Do you also take K2 and magnesium with your vit D. You say your other vits were 'normal' but they have to be OPTIMAL for us to feel well and thyroid hormone to work. So what were they?

[monkeybird in reply to Jaydee1507]

yes I take magnesium and K2 as well. Vitamins optimal

[Lovecake]

I agree with SlowDragon

But also want to add that my TSH is really low. When on T4 only I didn’t feel anywhere near ok unless my TSH was around 0.35

I’m now on 12.4mcg T3 too and my TSH is 0.01

Endo not happy but I’m not over range on FT3 and around halfway through range on FT4.

When taking 10mcg T3 my TSH was 0.02, the endo was ok, I didn’t feel great too many days a week which is why I increased to 12.5mcg.

We are all different and sometimes need to change the dose to see what suits us best.

I’m doing far more than I’ve done in years, so although I’m keeping an eye on how I’m feeling, I’m also enjoying the amount of movement etc which I think does me more good than the sitting around when I had no energy etc.