Reduce Levo to increase TSH?

[Andie222]

Hello everyone.

I am taking a combination of T3 and T4. My blood results are now nicely high in the range and I’m feeling better since starting T3. However, not surprisingly my TSH is supressed. My endo has told me to reduce my T4 from 100 to 75 (rather a big decrease in one go) because this will bring the TSH up a little.

Is that right? I thought taking T3 results in supressed TSH pretty much regardless of how much T4 I take. Have I got that wrong?

I don’t fancy such a big decrease in T4 in one go, so I might reduce a little bit, but I don’t want to make myself ill. Any advice please?

[pennyannie]

Hello Andiie :

Without seeing the results and ranges of your T3 and T4 it's hard to say anything sensible :

You are right however about the effects of T3 on a TSH and to be perfectly honest once on any form of thyroid hormone replacement the TSH is the least important of the these 3 results.

What is important is that you feel improved so why jeopardise your progress ?

[DippyDame]

if you feel better don't be persuaded to alter the dose.

How much T3 are you taking with the 100mcg levo?

However, not surprisingly my T3 is supressed.

Did you mean to say your TSH ( not FT3) is now suppressed?

TSH is not a reliable marker though medics seem to believe otherwise....goodness only knows why they haven't caught up. It's a lazy and inaccurate way to monitor dosing!!

thyroidpatients.ca/2021/07/...

Without seeing recent labs we can only judge by how you feel....it's not all about numbers!

If you feel fine think twice about accepting a different dose

As an old medic friend of mine used to say, "Listen to your body"!

[Andie222 in reply to DippyDame]

Ah yes, I did mean my TSH is surpressed! Thank you. I’ve edited my post. I am taking 6.25x2 doses a day, so not a huge amount, but it has made a difference.

My blood results are… TSH 0.01, FT4 20.2 (12-22), FT3 6.6 (3.1-6.8).

[DippyDame in reply to Andie222]

If you feel well I'd suggest you stick with that dose.....

Out of interest, did you consider raising your levo dose to increase FT3, by conversion ...before adding T3?

Your FT3 is on the high side but some of us need that....it should be kept in range ( or very close) to avoid overmedication.

Have you optimised vit D, vit B12, folate and ferritin to support conversion/ thyroid function?

Good to hear you feel better.

[jimh111]

I would reduce your LT4 and see how you go, see how you feel. A reduction from 100 to 75 is not much especially as you are taking 12.5 mcg LT3 which is equivalent to around 40 mcg LT4. T3 doesn't always suppress TSH, it's purely a question of overall hormone dose. It's not good to have a high normal fT4 as it is associated with cardiac problems and cancer.

[Andie222 in reply to jimh111]

Hello Jim, when you say high normal FT4, do you mean high within the range? I thought we only needed to be concerned if it was over range, but I may have misunderstood.

[jimh111 in reply to Andie222]

Yes, in the higher part of the reference interval. People with an fT4 in the lower third live longer.

[Sparklingsunshine in reply to jimh111]

They may live longer but do they have good quality of life? I think many of us would rate quality over quantity.

[jimh111 in reply to Sparklingsunshine]

These are studies mainly in healthy people, they have similar TSH and fT3 and presumably feel just as well. The issue for hypothyroid patients is that combination therapy will allow a lower fT4 which the evidence suggests is safer.

[Sparklingsunshine in reply to jimh111]

So as most thyroid patients aren't on combination therapy I guess its a moot point unfortunately.

[jimh111 in reply to Sparklingsunshine]

It's a scandal, monotherapy puts patients on above average T4 levels and increased risk.

[Sparklingsunshine in reply to jimh111]

Absolutely agree with you.

[Zazbag in reply to jimh111]

Please could you explain this a bit more? I'm guessing if you advocate not having a high-normal FT4 level, then you must support having a high-normal FT3 level?

Personally I feel unable to function without both my FT4 and FT3 being high-normal. I'm not sure why that is, but I'm guessing tissue hypothyroidism might have something to do with it. Does that change anything?

[jimh111 in reply to Zazbag]

I would advocate having fT4 in the lower half of its reference interval with an average fT3. Some people need higher levels and the best approach seems to be to increase the T3 rather than T4.

[Zazbag in reply to jimh111]

But what if those levels make you feel awful?

SlowDragon what are your thoughts? I remember you said you need FT4 and FT3 high in range to feel well...?

[jimh111 in reply to Zazbag]

If you needed a higher fT4 to feel well then there's no choice. In my personal experience adding a little T3 is more effective than pushing T4 up.

The evidence I've seen suggests a higher fT4 is more dangerous than a higher fT3, I describe it here healthunlocked.com/thyroidu... . Thus, if I have the choice I would take a little more T3 rather than more T4.

[MrPeaPaw]

Thanks for saying that, Jim. I take T3 only and still have an "in range" TSH, just barely, being at the top of the range.

My doctor has just authorized an increase in T3 so I'm now taking 40 mcg.