pre-menopausal non-thyroid dosage

[Maramonro]

hello everyone, I am getting into pre-menopause and my TSH is getting suppressed even on the lower dose tirosint. I used to be ok with 125mcg but now even 100 doesn’t balance my TSH. Typically supressed TSH for me is always a bad sign and correlates with my hormonal needs— I feel much worse and symptoms include hair changes, anxiety and weight problems. Do you have any idea how to handle dosage during pre-menopause and how these changes impact people without thyroid and how to address these changes?

Thanks! Marija

[Jaydee1507 Administrator]

TSH can be a pretty bad indicator of your thyroid hormone needs. Much better to look at the free hormone numbers FT4 & Ft3, so what were yours with ranges?

Lower TSH can also be related to low vitamin levels.

Do you have recent results for ferritin, folate, B12 & D3? We need these levels to be OPTIMAL for our thyroid hormone to work well.

[Maramonro in reply to Jaydee1507]

Good point, thanks! My T3 is 3,1 (2.3-4.2) and my T4 is always the same 1.3-1.4(range 0.8-1.8). Everything is normal when my T3 is around 2.6-2.8 and that is when I also feel best. You are right—my ferritin is below normal range and my D3 is always on the lower end but still within the range and its has been like that my entire life(D3 I mean) . I am taking iron supplements now. I am in the USA so could you please recommend a good brand for all these supplements? Thank you!!!

[Jaydee1507 Administrator in reply to Maramonro]

What about your folate and B12? Its always best to test before supplementing.

With below range ferritin you should get an iron panel done.

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Use this calculator to work out how much to take to get your level to 100-150. wildatlantichealth.com/vita...

For our thyroid ormone to work well we need OPTIMAL levels of the above vitamins. As hypo people dont absorb vitaimns well from food we need to supplement continuously to feel well.

[SlowDragon Administrator in reply to Maramonro]

FT4: 1.4 pmol/l (Range 0.8 - 1.8)

Ft4 60.00% through range

FT3: 3.1 pmol/l (Range 2.3 - 4.2)

Ft3 only 42.11% through range

Helpful calculator for working out range

thyroid.dopiaza.org/

Suggests you have room to increase dose levothyroxine

Currently poor conversion of Ft4 to Ft3

Most people when adequately treated will have Ft3 at least 60% through range

Low Ft3 results in low vitamin levels

Low vitamin levels results in poor conversion

Important to maintain OPTIMAL vitamin levels

Vitamin D at least 40ng/mL - USA units

Vitamin D at 80-100nmol in U.K. units

Ferritin at least half way through range

Increasing iron rich foods in diet to improve low ferritin

Essential to test B12 and folate annually

[tattybogle]

a couple of years post menopause i needed a little less levo than i had for 15 yrs previously . and so i became overmedicated (based on clear symptoms of overmedication , even though bloods were not much different from my usual) It wasn't picked up for many months , as we thought all the symptoms were something else. (My 'usual' TSH was about 0.05 or slightly more , and it had fallen a tiny bit to 0.018 and my fT4 was a little bit over range , but it had been much higher on other occasions and had not caused symptoms of overmedication .. no idea of T3 result at this time as NHS don't often test, but presumably my fT3 was higher than my normal)

Menopause (and presumably peri menopause) can alter our thyroid hormone needs because estrogen affects the amount of Thyroid Binding Globulin (TBG) the liver makes .which in turn affects how much of the T4 we take is 'bound' and how much is 'available' as FreeT4 ....and for some of us this change means we just need a bit less and may need to lower dose little bit .

so .... even though many people do feel better with T3 higher than that , and would feel rubbish with T3 that level, we must remember we are all individual.... (see picture below for 10 healthy individuals, some people naturally have much lower T3/T4 levels and feel well at those levels , presumably those people with their natural T4/T3 at 25 % would feel not so great if their T3/T4 were increased to 75% ) .... so if you know YOU usually feel well with your T3 a bit lower than it is now , and your TSH is a bit lower than it usually is when you feel well . then the obvious thing to do is to try reducing your current Levo dose VERY SLIGHTLY to eg 87.5mcg/day (75mcg one day/ 100 the next/ alternate ) or 93mcg /day ( 5 days 100mcg / 2 days 75mcg)

UNLESS you actually feel ok at the moment , you didn't say ? ..... in which case don't worry abut your TSH , because using TSH by itself can sometimes be very misleading . and even using TSH/ fT4 and fT3 can sometimes be misleading if the results don't match with how you actually feel , if this is the case watch and wait and retest in a few months, never adjust dose based 'just' results if you currently feel good .

the big difference between healthy individuals natural T4 and T3 levels (unmedicated)

[asidist in reply to tattybogle]

interesting that in the graphic, though the FT3 and FT4 ratios are variable across individuals, the FT3 and FT4 percentages through the normal range for each person are kinda similar to each other (in other words, no one has one high in range and the other low in range).

(not intended as any sort of statement related to the OP’s question, just an observation about the graphic)

[asidist in reply to tattybogle]

tattyboggle, could you please share the thyroidpatients.ca article that graphic came from?

[tattybogle in reply to asidist]

can't remember of the top of my head .. erm . try putting ' Ankrah-Tetteh et al. 2008 ' into thyroidpatirents ca. search box .. i think that's how i found where i got if from last time someone asked me that .. and of course i forgot to make a note of it , or if i did i forget where.... soz .

Yes , interesting isn't it ,also , about half of 'em have T3 a little bit higher than their T4 .. proving that giving us levo and ending up with our T4 significantly higher than our T3 is totally unphysiological for some of us.

[asidist in reply to tattybogle]

Thanks, that worked! Looks like several thyroidpatients.ca articles use that graphic or a version of it but here’s one: thyroidpatients.ca/2022/06/...

Good point about the FT3 being slightly higher in about half.

Would be SUPER interesting to see this kind of data for a greater number of individuals in all age groups, and have trends broken down by age, gender, and whatever else shows any sort of patterns.

For that matter… would be even more interesting to see data like this for treated individuals who report high levels of well-being long-term.

[Maramonro in reply to tattybogle]

thank you so much this is super useful! You are right— some people feel better when their thyroid levels are on the lower side—I am one of them. I have noticed that no matter what my dose is my T4 levels are always the same, while T3 changes and TSH is always accurate—meaning if my T3 gets closer to 3 my TSH is always suppressed which relates to my bad symptoms so I need to reduce my dose to feel better. So in other words TSH measure in my case is the best indicator.