High TSH, Low FT4 Help Please

[butterflynett]

I have Hashimotos and just had new labs completed. I've been taking Cytomel for about a year now, as my FT3 was previously an issue (low). Now that it has improved some, my FT4 is low and my TSH at an all time high. There are no endos near me that will take my insurance. Was hoping someone could offer some guidance as to what I should be taking for this situation? I once took Levo, but had terrible side effects from it and saw no improvement. I don't want to resume taking it, so would appreciate alternate suggestions.

TSH: 6

Free T4: 0.8

Free T3: 2.9

T3 Uptake: 22

Glucose 97

[SeasideSusie Remembering]

butterflynett

Your FT4 is low because you take T3 only.

You will need to post reference ranges that came with these results so that we can interpret them, ranges vary from lab to lab.

Did you do test as we advise:

* No later than 9am

* Nothing to eat or drink except water before the test

* Day before test split T3 into 2 or 3 doses and take last dose 8-12 hours before the test

* No biotin, B Complex or any supplement containing Biotin for 3-7 days before the test

Have you tested key nutrients Vit D, B12, Folate and Ferritin?

[butterflynett in reply to SeasideSusie]

Yes to all of the test parameters listed. I didn't take Cytomel for 3 days prior to testing.

[SeasideSusie Remembering in reply to butterflynett]

butterflynett

As explained, we must have the reference ranges for your tests to be able to interpret them.

I didn't take Cytomel for 3 days prior to testing.

Why would you do that? Your FT3 is showing a very much lower level than would be your normal circulating level. It should be taken up to and including the day before with the last part of the daily dose 8-12 hours before the test. This makes your result meaningless I'm afraid, to get any sense of your levels you will need to retest following the correct timing.

[jimh111]

How much Cytomel are you taking? Perhaps it is too little although I would try adding i. a little levothyroxine if you can get it. You might be able to tolerate levothyroxine now you are taking Cytomel.

[butterflynett]

I take 12mcg daily

[jimh111]

That's not much, you will need some more levothyroxine or liothyronine.

[butterflynett in reply to jimh111]

What is a typical dosage? That's all my Dr had put me on, but I have read that you get to a point where you should increase it.

[jimh111 in reply to butterflynett]

Liothyronine is 3x as potent as levothyroxine. A typical dose for someone with no thyroid function is 125 mcg levothyroxine. You are on the equivalent of 36 mcg.I would try some levothyroxine in addition to your liothyronine first as it will give you steady hormone levels and be closer to what we get from our thyroid.

If that doesn't work then you could increase your liothyronine.

[Cricket-mas]

Talk to your doctor about desiccated natural thyroid medication. You need both T3 andT4 if you are taking supplemental thyroid medication.

I am in the throes of imbalance and having a devil of a time getting right. I feel functional if I take T3 only, but I now have osteoporosis. Because the T4/T3 ratio in my blood is too low, the parathyroid glands have been calling for calcium to slow down the T3. I also react to high calcium foods like cheese and cabbage (hashimotos itch). And the calcium in the blood slows down the body.

After 12 years of cytomel only, 18 yrs of synthroid only, and recent 20 years of liothyronine only, I am now working on aT4+T3 regimen but the TSH continues to be low--0.008. My doctor wants me to reduce the T3, but because of a very adverse reaction I had to a Covid booster, I fear the pain and exhaustion a reduction in T3 would cause at this time, while I am still recovering. (Thyroid and immune system are connected through the pituitary gland.)

T4 only may feel non-productive, T3 only may make you feel good, but you need both. Keep an eye on your calcium levels as that will help you know if you are out of balance.

[Hashihope]

I can't imagine having high tsh on cytomel. My T4 and TSH are extremely low. I am hoping someone else on here can shed light on this.

[butterflynett in reply to Hashihope]

Yes, I was quite stunned as well and feel defeated quite honestly. Ive begun taking Inositol in hopes of it potentially helping to lower my TSH. I will update later on with the result of this endeavor.