Advice on below range TSH, low ferritin, poor absorption and current dosage

[Sandytango]

Dear all, I posted some very odd results 3 months ago and have retested on your advice, twice...two months apart, with similar results. Testing using protocol advised by the group.I am still on 125 levo (eutirox) and 10ml T3 Liotir (liquid). Based in Italy.

I also had symptoms of low B12 including some neurological symptoms. Tests confirmed low B12 and being treated for pernicious anemia with injections. Gastroscopy showed me to have early stage autoimmune gastritis with high anti parietal cell antibodies. I am feeling much better with the B12 injections.

My doctor is concerned re negligible TSH. She says my low dose of T3 shouldnt cause such a low result and wants to reduce my levo. Im afraid to reduce as I felt so ill before on lower dose and disasterous move over to Metavive and now Im actually feeling much better. My weight is only 49kg and levo dose does seem high going on weight. However, FT3 and FT4 seem on the low side indicating my dose if anything is too low???

TSH *0.03 (0.55-4.78)

FT3 2.81 (2.30-4.20)

FT4 1.10 (0.89-1.76)

FERRITIN 30 (10-291)

IRON 92 (50-170)

TRANSFERRIN 256 (250-380)

My ferritin is still low. I am taking iron supplement and trying to eat more iron rich diet, but I suspect the gastritis is reducing absorption? Also wonder if B12 injections are acting on the ferritin? I know I should also post on pernicious anemia group re this...

I would be really grateful for advice on these results and my current dosage as I dont feel confident in my doctor...

Many thanks in advance, so much appreciate all I learn from this group.

[greygoose]

My doctor is concerned re negligible TSH. She says my low dose of T3 shouldnt cause such a low result

She can't say that, because the connection isn't linear. There are so many variables. It's true that some people, with such a low FT3, would have a higher TSH, but we're all different, and our pituitaries all work with different levels of efficiency.

FT3 2.81 (2.30-4.20) 26.84%

FT4 1.10 (0.89-1.76) 24.14%

And your thyroid hormone levels are very low, as you can see from the percentages - they should both be at least over mid-range - so it would be foolhardy to reduce the dose just because the TSH is too low. Problem is, doctors don't understand the feed-back loop and how it works. A low TSH doesn't automatically mean your dose is too high. And, as she's bothered to test the Frees, she should be looking at them, not the TSH, which is of little to no importance once you're taking any amount of T3. You really do need to resist this attempt to reduce your levo.

Are you taking vit C with your iron tablets to help absorption? It can take a very long time to raise levels. I don't think your B12 injections would be having any effect on your iron tablets because they don't come into contact with each other - and if they did, it would be the iron affecting the absorption of the B12, not the other way round.

[Sandytango in reply to greygoose]

Thanks greygoose. She replied hurredly as was off on holiday for the whole of august! I wont change the dose. Trying to get a doctor who understands is proving extremely difficult...getting the B12 deficiency diagnosis was down to paying all the tests privately and from great advice here...Yes Im taking vitamin c which is in the tablet with the iron. I think I'll change brand and see if it improves. Thanks again

[greygoose in reply to Sandytango]

You're very welcome.

[Noelnoel in reply to Sandytango]

I found that a combination of Thorne iron bisglycinate and metabolics ionic iron worked amazingly. Too well in fact. They took my ferritn from low to over range!

[Hedgeree in reply to Noelnoel]

I'd not heard of ionic iron before so just had a brief look. It may help me as my ferritin level seems to have 'stuck' at a low level (being a vegan) despite my best efforts.

Thanks Noelnoel.

[Noelnoel in reply to Hedgeree]

NB Hedgeree

Because I was exasperated by my stubbornly low ferritin I ignored the recommendation of 10 drops as that yields only 13mg, which may be enough to maintain already replete levels but perhaps not enough to impact much on a low or deficient level. I also took a daily dose of the Thorne bisglycinate

I think in my case I took it for too long without testing but I did that because going on past experience of trying for a very long time to raise it without much success, I never considered that even with a higher dose that it would rise so quickly

Happy to say that once I stopped, levels gradually fell to within range. I should probably re-test soon to check they’ve remained good

[Hedgeree in reply to Noelnoel]

Yes it's wise to check your levels again.

Yes I'm very very slowly increasing my ferritin and making sure I get an iron panel done regularly.

Though I just got Medichecks results through this afternoon and they're better than previous results so quite pleasantly surprised. Though inflammation is higher so I think that deems the ferritin not accurate 🤔 (I think) though may have that wrong?

[tattybogle]

Hi Sandytango,

These two post may have useful information you can use in discussions with your gp.

Low but not totally supressed TSH when thyroid hormones are also relatively low is not so much of a concern .. it basically comes down to how you feel about balance of statistical risks against Quality of life .

A lot of the alleged risks of low TSH are actually related to low TSH caused by high thyroid hormone levels, not the low TSH itself :

healthunlocked.com/thyroidu... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-updated-new-study-does-show-small-risk

healthunlocked.com/thyroidu.... tsh-is-just-the-opinion-of-your-pituitary-about-your-dose-but-your-pituitarys-opinion-is-a-bit-warped-once-you-take-thyroid-hormone.

Personally if you feel better at the moment i would strongly resist reducing levo dose with your current fT4 and fT3 results .

Realistically , lowering levo dose slightly is unlikely to make much impact on raising TSH level anyway , as it is most likely the influence of the T3 dose which is having the most impact on TSH level .

[Sandytango in reply to tattybogle]

Many thanks for your reply. Its great to have this evidence to hand to show my doctor, though I will be refusing to lower the dose especially as I feel more alive than I have done for years - even though levels are low. Maybe as B12 levels rise and iron improves....my thyroid levels will also rise. Patience is a virtue!