Sorry if this article has already been posted but I found this a very helpful discussion and guidance piece thyroidpatients.ca/2020/01/...
I'm preparing for battle over my suppressed tsh of over a decade's standing when I see the endocrinologist next week. Despite my obvious hypothyroid symptoms and T3/T4 dragging along the bottom on combined therapy, they still seem to want to reduce my dose.
This article has some helpful bits that I may try to use.
It really doesn't matter if things have already been posted!
We might not want a dozen identical posts in a row but spread out over months and years they serve to catch members' eyes and remind us of things.
Tania's articles are all good - they are truly welcome to thyroid people around the world.
Best of luck.
It appears that somewhere between perfect function and total failure of the pituitary (and/or hypothalamus) is never properly considered.
I have never again found it, but there was an article identifying autoimmune pituitary damage as being far more common and widespread than had been realised. But seemingly only impairing TSH production a bit - not halting it. I am convinced that there can be both autoimmune and non-autoimmune causes of central hypothyroidism. And certain that most endocrinologists do not even appreciate what they can and should do about them. (No - I don't either, but any low TSH without obviously high FT4 and FT3 needs to be looked at as if some degree of hypopituitary function could exist.)
Thank you Helvella, much appreciated. I'm not sure if it was you that first suggested central hypothyroidism as a possibility to me in one of my earlier, very frustrated, posts. This forum has made such a difference to my life, I would have nowhere near the resources to challenge what I'm being told without it, so my sincere thanks for all you do. Which then leaves the question I was just discussing with SlowDragon below - is it central hypothyroidism or is it just the good old suppressed TSH arising from combined treatment. And then how do I discuss this with an NHS endo.... ah well...
Probably the majority of members on levothyroxine plus small doses of T3 tend to end up with very low or suppressed TSH
Unusual if you don’t
Then the battle begins with far too many endocrinologists
Most important results are Ft3, followed by Ft4
I completely agree. Until I went on NDT, my TSH (they never checked anything else) was always sky high with me ending up on 250 of thyroxine, and that is when I went in search of alternatives. And as you say, this resulted in suppressed TSH but better health and figures until I came forward again for 'normal' treatment and now I have the suppressed TSH but the other two are really low too. And I feel full-on hypo on the T3/T4 combo.
It's also a key point around the question of is a suppressed TSH the result of combined therapy or is it something else like problems deep in thepituitary, central hypothyroidism etc. I looked up pituitary testing but it seems rather expensive! But on the evidence in this forum, it's the combined therapy which seems to get the backs up of endos anyway....
Hi Angela, do you think that if you increase the dose of the T3 hormone things will improve, because I am in the same situation too, but only I take l - thyroxine at the moment, and I would like to add the Tiromel in a high enough dose for me?
Honestly, I find this such a dilemma. Have you tested for FT3, FT4 and TSH? This was when everything changed for me, as TSH showed overmedicated/hyperthyroid while FT3/4 showed severely hypo. On NDT I was at the top of the ranges with FT3/4, suppressed TSH as would be expected, but I felt really well. If you know your FT3 level, particularly in relation to FT4, then you know how much actual thyroid hormone you have circulating in your body. I suspect I absorb T4 very badly, and T3 not much better in their synthetic forms, while on NDT, it's slower uptake that is much more effective. Tattybogle has just replied to my other post about absorption with an excellent link to a diogenes post on the subject that is very enlightening. healthunlocked.com/thyroidu...
Yes i tested them, Tsh very low , t4 is fine, but t3 remains low. My hope is in Liothyronine for now. Thanks for your attention.
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Discrimination against central/secondary hypothyroidism 
