Hi
I got my bloods done today and my TSH is very low 0.18 ( 0.23-5). My t4 is low (as expected) and my total T3 is 1.5 (1.3-3).
I am on 30mcg of T3 at the moment.
Should I be concerned about this. Should I reduce my dosage?
I have been feeling pretty rotten recently and maybe this is why?
Thanks
Do not reduce your dose. TSH is frequently suppressed when you are taking liothyronine (T3). Are you just taking T3 or are you taking T4 (levo) as well?
Most doctors are wrong in thinking that you shouldn't have a suppressed TSH.
You may find this page from the Thyroid UK interesting. It gives various myths of hypothyroidism. Many people have to fight to stop doctors reducing their dose.
thyroiduk.org/further-readi...
I hope that helps!
I am just taking T3 at the moment. is my TSH suppose to be suppressed too?
Thanks I will have a read at this. Just got a bit of a shock and as I said I'd be feeling pretty rotten recently.
Thanks again
Apologies, I for typo. I've now edited it to say TSH.
Perhaps you are used to Levo and how that is measured and dosed by doctors that know no better, by TSH. This is not the case for T3 only, it is very different.
On almost any amount of T3 your TSH will get suppressed so then we need to look at your FT3. Do you have an FT3 result?
FT4 is now irrelevant as you aren't taking any and your thyroid isn't producing any.
Some hospitals seem to use Total T3 but I for one don't know how to use it and FT3 is a better measure. You may need to get private tests done.
As your TSH is not yet suppressed I suggest you need a dose increase and feeling unwell is due to being hypo.
Thank you. My TSH is suppressed thought? My free T3 is normally done but for some reason they didn't do it this time. Last month it was 4 (3-6.8) range. I was not aware that this would happen thanks. I'm only on T3 as I don't convert well. I just feel worse now than when I initially started T3 at 10mcg so didn't know if I'd gone too high.
Thanks
Currently your TSH is below range, not suppressed. That would look like 0.01 or similar. It's fine though and thats where it needs to be for you to feel well. T3 gives the thyroid all it needs so it doesnt need to 'call' for more.
Many people feel a lot better on initially having a dose increase or starting T3, and then they slip back. It simply means you still need more thyroid hormone.
call me pedantic lol but just in case anyone reading in future is confused by this :
T3 gives the thyroid all it needs so it doesn't need to 'call' for more.
T3 gives the hypothalamus and pituitary all they need so they don't make TSH to 'call ' for the thyroid to make anymore.. the thyroid doesn't need any T3 (and doesn't make Thyroid Stimulating Hormone TSH)
(unfortunately they are both a bit dumb , and have no idea whether the other bit's of the body think that is enough T3 ( or T4 ) for them .
The problem with the HPT axis feedback loop is that it is only having a conversation between the Hypothalmus / the Pituitary/ and the Thyroid .. it's a clique that ignores anybody else's opinion .
When we have a properly functioning/ responsive thyroid gland that produces variable amounts of ready made T3 enough to suit 'everyone' there is rarely a problem with this conversation being a bit 'cliquey'.
But once we have to rely on 'manual' dosing of thyroid hormones , then some other bits of the body may not be getting what THEY need , but the hypothalamus and pituitary still sit there saying "well ,we've got enough for US ...sod you lot "
Writing as a long term hypo person still in recovery, unfortunately I don't possess enough brain cells to rub together to write something like that, nor will a certain group of members here be able to understand it. I'm sorry if that troubles you.
totally understand ... trying to be helpful, not critical.
Haha ps love the pic, iv got Elhers danlos syndrome, our animal lol
Thanks for all the advice on this
Should I be concerned about this. Should I reduce my dosage?
No and no.
T3 will always lower TSH, frequently to the point of suppression. That's just what it does.
I have been feeling pretty rotten recently and maybe this is why?
I doubt it. It's more likely to be this:
my total T3 is 1.5 (1.3-3).
Total T3 is actually an outdated test, it measures both bound and unbound (free) T3 and it's actually Free T3 that tells us what we need to know, Free T3 is the T3 that is available for the cells to use. We can have a good level of Total T3 but a poor level of Free T3. Your Total T3 is very low in range at just 11.76% through it's range. When on T3 only one expects to see Free T3 in the upper part of it's range.
When did you take your last dose of T3 before the test? T3 should be split into 2 or 3 doses the day before testing and the last dose taken 8-12 hours before the test, this then gives a measure of the normal circulating hormone rather than a false high result if T3 was taken before the test or a false low if T3 was taken too far away from the test.
I took my last dose around 5.30pm and my test was at 8am. I am raging as they always do my free T3 but for some reason didn't this time. I am just still learning about hypo and there is so much to learn so I'm so appreciate of all the advise so thanks.
My last ft3 was 4 (3.1-6.8). I'm just trying to find out what is making me feel so rotten. I'm unsure if it's my thyroid or another thing but it's all the hypo symptoms (tiredness/ fatigue/weight gain). I also have hypopituitarism which makes all my pituatry hormones go out of wak too, they are stabilising now I am on thyroid treatment as my thyroid went untreated for years thanks to Drs not doing right tests. But I still have very low progesterone and testosterone which have the above symptoms too. I just feel abit tired and lost , like fighting a losing battle. Not helpful that my GP knows nothing about any of the endocrine system herself and doesn't really want to learn.
Really appreciate the advise. Thanks so much. I'm gonna keep battling through to find a solution!
Hi Vickisophieunicorn,
To explain bit more :
a) 0.18[0.23 -5] is not really 'very' low ,
It is only very marginally below the "95% population ref range" ~the nature of a '95% population range' is that it excludes the lowest and highest 2.5% of the healthy population.. therefore there will be quite a few healthy people who's normal TSH is 0.18
0.05 would be ' low but not supressed'
<0.05 may /or may not be 'totally supressed' ( it could actually be 0.049, but the < sign means that that particular test machine can't accurately count anything below 0.05)
<0.01 would definitely be 'totally supressed'.
b) a large long term study of patients on Levo found they had no increase in risks (over TSH 'in-range') with TSH between 0.04 and 0.4 ( below 0.04 the risks did increase) healthunlocked.com/thyroidu....
c) The nature of T3 is that it does tend to have a relatively greater suppressive effect on TSH than T4 does .. so it is very very common to see slightly below range or 'low but not supressed' or even 'supressed' TSH in patients who take some T3 ,even though their fT4 and fT3 level are in no way to high for them.
d) a low/or 'lower than their usual' TSH may SOMETIMES indicate the dose is a bit too high , but you can't tell this from just looking at TSH in isolation:
it need to be looked at in comparison to "the TSH that individual usually has when they felt ok on that particular type of thyroid hormone " (ie. if your TSH on T3 was 'usually' 0.6 when you fell well and you then got symptoms of overmedication / or just felt naff, and found your TSH had fallen to 0.18.. then it MIGHT be a sign that dose needed reducing a tad... but it is always unwise to use TSH to adjust dose by , without also looking at fT4 / fT3 AND symptoms all together to get the full picture .
"whether they have added any T3" (ie. compared to their previous 'usual' TSH on Levo alone).. in this case a lower TSH would be expected , and may not indicate any real change in overall level /'effect' of the total thyroid hormone dose .
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Your fT3 is not looking too high but that depends on how long after the last dose of T3 did you take this blood test ?
(Edit* just noticed it's a Total T3 result not freeT3.. so even harder to know what is really going on, and impossible to compare to previous fT3 levels )
have you been on this 30mcg T3 dose long enough to have any previous TSH levels to compare this one to ?
Hi
Yes my last TSH was 0.75
Ft3 was 4
Total 1.6.
Iv been on 30mcg from January so my professor has me testing monthly but he said not to go above the 30mcg as that is plenty for me and he wants it to stabilise.
As I said above, I just feel so so tired and like I'm fighting a losing battle. I have been also getting my ferratin up.
I have hypopituitarism also but this is stabilising from getting on the thyroid meds. I still have all hyp symptoms such as tiredness/brain fog/ fatigue / weight gain etc but I'm not sure if these are related to my thyroid of something else like my low progesterone/ testosterone etc. But I just feel so so so rotten and like a totally different person than I used to be.
Iv so much to learn so thank you for all your info on this!
if you have a diagnosis of hypopituitarism , then they should not be using your TSH to asses your dose of thyroid hormone anyway .
TSH is produced by the pituitary. If it's not making enough of the other pituitary hormones, then it's a reasonable assumption that it's not always making the right amount of TSH either.
Your dose should be assessed and adjusted like it is for someone with central hypothyroidism , using fT4 and fT3 levels . The TSH should be largely ignored if the pituitary is known to be suspect. (and whoever is prescribing your T3 should know this assuming they know you have hypopituitarism and should be making sure your fT4 / fT3 are tested )
Your January fT3 was pretty low at 4 [3.1-6.8] especially for someone taking only T3. That , and your symptoms ( which are typical of hypothyroidism) , all strongly suggest you are undermedicated.
30 mcg is an unusually low dose for someone taking just T3 ... ( there is one person on here shaws who is well on just 25mcg T3 , but they seem to be the exception rather than the rule.... 40 -60mcg is more usual for T3 only, and there are a few people who need more than that)
So it is most likely you need a dose increase in T3.. pay more attention to your fT4 / fT3 and symptoms ,and worry less to your TSH 
Have you actually tried taking levothyroxine AND T3
Many people need addition of small doses of T3 alongside levothyroxine to improve conversion rate
Typically on levothyroxine plus T3 …..then dose levothyroxine is somewhere between 75mcg and 125mcg per day plus T3 around 10-20mcg per day ….often divided as 3 smaller doses spread through the day
If on ONLY T3 then dose is typically between 40mcg and 60mcg per day…..usually split as 2 or 3 smaller doses spread through the day
Day before any blood test ALWAYS split T3 as 3 smaller doses and last dose T3 Approx 8-12 hours before test
Your results suggest you either need to add some levothyroxine or increase T3
Suggest you try adding 25mcg levothyroxine initially
Retest in 6-8 weeks
Last dose levothyroxine 24 hours before test
ESSENTIAL to test vitamin D, folate, B12 and ferritin
What vitamin supplements are you currently taking
I have been feeling pretty rotten recently and maybe this is why?
The TSH doesn't make you feel anything, good or bad, whether it is high or low. It's just a messenger from the pituitary to the thyroid to make more or less thyroid hormone.
The main cause of symptoms is the FT3 level. F (Free) means that it is T3 that is available for use by the body, unlike bound T3, which is bound to a protein for transportation in the blood. And, every single cell in your body needs enough T3 to function correctly, or there will be symptoms of various sorts. That is why hypo symptoms are so varied and non-specific: they can happen anywhere in the body that isn't getting enough T3.
My free T3 is normally done but for some reason they didn't do it this time. Last month it was 4 (3-6.8) range.
If you're FT3 is still only 4 (3-6.8) then that would more than likely be why you feel rotten. It's very low. Were you taking 30 mcg T3 when you got that result? If so, then you probably need to increase even further. I'm on T3 only and I take 75 mcg. That doesn't mean that you need 75 mcg, we're all different, but just saying that 30 mcg isn't a high dose for someone on T3 only.
On the other hand, it might be your very low FT4 causing problems. T4 is often said to be 'just' a storage hormone'. But that's over-simplifying. Whilst I would be at a loss to tell you what else exactly it does, some people do need higher levels of FT4 than yours to feel well, even if they can't convert very well. As I said, we're all different, and I can't tolerate any level of T4 - mine is 0. But could be that you do need to take some. Optimising good health is all trial and error when hypo, and you need to experiement extensively to find what makes you feel good. This is something that 99.9% of doctors fail to understand!
Thank you so so much for this information. Yes my last ft3 was when I was on 30mcg. I actually noticed I started to feel worse when my t4 dropped so I said to my endo prof to maybe include some t4 but he said no. I am going to discuss this again with him. Good to know my T3 is not too high a dose though. I'm also optimising my other vitamins etc , all are good apart from ferratin slightly lower than I'd like in line with my bowel condition.
You're welcome.
How do you take your T3? Do you split it or one dose? I take 15mcg and if I split it I feel awful but if I take it in one go I feel a lot better 🤗
I dose mine twice a day at the moment. Funny I am just about to read a book that suggests taking it all at once throughout night (Dr lowe)
I looked into that and then just opted for taking first thing as my cortisol levels are best in the morning... If I get up for a pee after 4am I take it then but didn't want to make a thing of it as I'd rather sleep through 🤗
It is surprising the difference it can make, thinking is that it has more chance of reaching the cells.... lets face it swimming around in our blood isn't much use to us!
15mcg split for me meant slow achy and lifeless, an afternoon snooze essential... 15mcg in one shot and I can last the day 🤷♀️
Low tsh on meds
Low TSH low T3/T4 please help !
Medical Paper please – low TSH on T3 only
Confused. Why is TSH low but T4/T3 also low?
