Low TSH stopping me getting HRT

[EleanorM-G]

I am 45 yrs old, & believe I am in perimenopause.

I had hormonal blood tests done 6 mths ago, which didn’t show this, but was told that didn’t mean I wasn’t peri as hormones go up & down throughout the day….I decided at that time my symptoms weren’t bad enough to try HRT.

I spoke to a doc today as I now feel they are.

I privately treat my under active thyroid with T4 & T3 as the NHS won’t give me T3. I have a very low TSH, which they know about. (Long story.) Many of my symptoms could be thyroid symptoms so they are saying I can’t have HRT as it’s obviously an overactive thyroid caused by my overmedicating. Could that be true? (I’ve felt well on this dosage & the same results for a year now.) They want to do thyroid tests, but of course that won’t include T3, & my TSH will come back low again….

Will I need to reduce T4 & T3 in order to have my TSH rise to be able to try HRT? 🤷🏼‍♀️

Here are my most recent test results (today)

Ferritin, magnesium, serum folate & vit d are missing as there was a prob with my sample.)

Tsh-0.01 (range 0.27-4.20)

T4 total-29.7 (range 66-181)

Free T4-4.2 (range 12.0-22.0)

Free T3-6.20 (range 3.1-6.8)

Vit b12-1467 (145-569)

CRP-7.57 (less than 5)

I will be reducing my B12.

My CRP always comes back high but GP is not concerned if it is below 15.

My symptoms are:

Migraines, Constant thrush, (I used to have this yrs ago before I got my thyroid levels sorted.) extreme tiredness, mood swings, anger, pelvic floor issues.

Am I over medicating? Any advice is appreciated. 😀

Edit to add:

I take Armour thyroid which is a mix of T4- 19mcgs & T3-9 mcgs.

I also take additional T3-25 mcgs.

So that’s s total of 34 mcgs of T3 & 19 mcgs of T4.

When u take T3 I take it in the am & have never spread it out over several doses.

I have a diabetes test once a year. My last was in July & was a good result.

[PurpleNails Administrator]

What’s is your current dose?

Have you tried higher T4 and lower T3 previously?

Your prior post seem to indicate you are well with low FT4 but your FT3 is quite high in range. 

Even if you adjust the T4 & T3 and it’s reflected in a more balanced FT4 & FT3 result I suspect your TSH still isn’t going to respond as doctors expect. 

Do NHS not test FT4 and question why TSH AND FT4 are low? 

Seems very wrong to withhold HRT on the basis your TSH is low when you can explain your thyroid levels are right for you. Seems more about forcing you to treat thyroid how they wish rather than resolving peri menopausal symptoms.

Have you had HBA1C tested, high sugar levels can cause thrush.  I have higher HBA1c with higher FT3.

[EleanorM-G in reply to PurpleNails]

Thank you for replying. 😀

I have edited my post & added my current dosage & the fact that I have a yearly diabetic test.

They do have a low T4 result for me. He didn’t mention it (I assume) as he took one look at my TSH level & already had already decided it was my thyroid causing the symptoms. He was very keen to get rid of me & pass me on to a “more senior, lady doctor.” I have an appointment with her in a month, so I want to get as much information together as I can, in the meantime.

Previously, I took slightly less T3, which raised my TSH a bit, but like you said, it still wasn’t high enough that it would have satisfied this doctor, & my T4 would also be too low to keep him happy.

[PurpleNails Administrator in reply to EleanorM-G]

You’ll  need to point out a below range FT4 even with low TSH means their understanding is wrong.  TSH changes very slowly.   You could reduce lio by 5mcg then increase Levo by 25mcg.  Change 1 thing at a time and allow time for levels to settle usually 6 weeks.  Could take a while of gradual adjustment to balance FT4 & FT3 and you may find TSH still does fully respond.TSH can’t be repaired or made to appear in range quickly or temporarily.  Stopping or reducing dose temporarily to force TSH not a good idea.  Can cause symptoms which linger beyond resorting dose.  It has to be long term.  

[Buddy195 Administrator]

Your TSH is suppressed because you are on combination treatment; that just happens and as long as FT3 and FT4 are within range, there are no long term issues for your health. It is completely wrong to withhold HRT. I would definitely see another GP more sympathetic to HRT when taking combination treatment for a thyroid condition. I had some similar symptoms to yourself which resolved when i found the right dose of HRT treatment for me.

Just double checking your FT4 is below range at 4.2?

[EleanorM-G in reply to Buddy195]

Thank for taking time to reply. 😀

Yes correct, my Free T4 is below range. So this suggests that I am over medicated?

Would you suggest I reduce both T4 & T3 to get this in range? If I am over medicated, this could by the reason I am having these symptoms….

[Buddy195 Administrator in reply to EleanorM-G]

Low FT4 is something SlowDragon might be able to advise you with.

[Serendipitious]

My TSH is close to 0 even without taking T3. I’m the same age as you and I’ve been prescribed HRT. My periods did stop last September. Check my previous posts for more information. Plus I had elevated FSH and LH since December 2020.

[EleanorM-G in reply to Serendipitious]

Thsnk you got your reply. I will check out your posts, thank you. 😀

[SlowDragon Administrator]

Tsh-0.01 (range 0.27-4.20)

T4 total-29.7 (range 66-181)

Free T4-4.2 (range 12.0-22.0)

Free T3-6.20 (range 3.1-6.8)

Exactly how much levothyroxine are you currently taking and which brand

Exactly how much T3

Do you normally split T3 as 2 or 3 smaller doses spread through the day

Even if you don’t normally…..on day before test ALWAYS split T3 as 3 smaller doses and last dose approx 8-12 hours before test

Many people on levothyroxine plus small doses of T3 need Ft4 at least 50-60% through range

You need vitamin D, folate and ferritin levels tested

Exactly what vitamin supplements are you currently taking

[EleanorM-G in reply to SlowDragon]

Thank you for your answer. 😀

I take Armour thyroid which is a mix of T4- 19mcgs & T3-9 mcgs.

I also take additional T3-25 mcgs. The brand is liothyronine sodium tablets, USP

So that’s s total of 34 mcgs of T3 & 19 mcgs of T4.

When I take T3 I take it in the am & have never spread it out over several doses. Thank you, I will split the dose the day before a test.

I take ferrous fumate, magnesium, K2, vit d, b12, b12 complex, iodine, selinium, vit c & cod liver oil.

If I need my free t4 to be halfway through the range, do I need to decrease meds or increase?

[SlowDragon Administrator]

Ferritin, magnesium, serum folate & vit d are missing as there was a prob with my sample.)

Was this a private test

If so ….Are they redoing test ?

[EleanorM-G in reply to SlowDragon]

it was a private test & I have to re pay to do those again. I have been given a HRT appointment with a more senior GP in a mth & they want to do “all my bloods” so I think they will do these for free….

[Gingernut44]

It appears to me that you need a little less T3 and more T4. Only my opinion but, if it was me, I would drop the T3 by 6.25 mcg (a quarter of your tablet) and increase your Armour, slowly, by adding a quarter grain at a time. You need more T4 to raise your FT4 not less.

You are in a tricky situation because your GP isn’t going to want to give you Levothyroxine whilst your TSH is so low and your T3 is so high. Have you never been given Levo by your GP?

One grain of Armour and 25 T3 is an odd combination unless you don’t need your T4 in range but, you won’t know that until you try to raise it. I also notice you’re taking iodine. Have you tested and found to be deficient, if not, I would definitely drop your iodine supplement.

It’s probably best not to change anything, apart from stopping iodine, until you’ve had your bloods done but you should probably come clean and tell your GP exactly what you’re taking. You have to hope your GP is knowledgeable about thyroid dysfunction.