TSH extremely low but low-ish free T3 and free T4

[Suzanne-j]

Hi, I'm here again. 3 doctors in and six years down the line. I can't seem to get any help.

My results are totally confusing me. I researched and have come up with an idea but would like some feedback.

I was on 2.5 grains of armour but have been switched to Novothyral 100, 8 weeks ago

I have hashimoto 6 years, I'm dairy free gluten free and follow a strict diet. I have a form of blood cancer so am unable to take b12 and iron. However my vit d is very good and I follow the suggested supplements required. Selenium magnesium etc etc, as advise by Dr wentz thyroid pharmacist.

Weight gain it's getting out of control alongside severe constipation!

My latest lab results due to my sweating (soaking) and being jittery! (Anxious and fast) and horrendous constipation.

TSH L 0.01 Range 0.27 - 4.20 mU/L

T4 Total 79.0 Range 66-181 nmol/L

Free T4 14.5 Range 12.0 - 22.0. pmol/L

Free T3 4.81 Range 3.1 - 6.8 pmol/L

I'm desperate to go to the toilet. My diet is good I eat veg and fruit, I'm a seasoned researcher and follow Dr Isabella Wentz. I just need to know why my TSH is so low but my free T3 and free T4 are not where they should be, they are on the low side too and I still feel hypo apart from sweating and anxiety.

I really need help. Please.

[Lalatoot]

Tsh is often low and suppresses when we take t3. My TSH is undetectable.When you take NDT you judge your dose by how you feel and your ft4 and ft3 levels.

Sweating and anxiety are also hypothyroid symptoms.

[Suzanne-j in reply to Lalatoot]

Thank you for your reply. I should up my dose again then and probably go back to Armour. It's all a bit confusing when the symptoms can be both hypo and hyper.

[Lalatoot in reply to Suzanne-j]

It is confusing that is why we need to take ft4 and ft3 levels into account as well as how we are feeling. I was hyperthyroid, had my thyroid taken away and am now hypo. I can say from experience that I have had the same symptoms hypo as I did hyper.

[Suzanne-j in reply to Lalatoot]

Thank you this is so helpful. I appreciate you sharing your thoughts it makes me feel less like I'm going mad.

[joey82]

Your FT3 & FT4 are probably low because your are a poor converter. It's possible to have anxiety with hypothyroidism. Your HP (hypothalamus pituitary) connection won't be getting the adequate T3 it needs to stimulate cortisol release by the adrenals. The adrenals compensate for this by dumping adrenaline into thr body.

[Suzanne-j in reply to joey82]

Thanks for your reply. Do you think this could be why I'm gaining weight so rapidly? My belly fat is so disproportionate to the rest of my body!

[SlowDragon Ambassador]

Novothyral is just levothyroxine on it’s own….no T3

Why were you changing from Armour to levothyroxine

Essential to test vitamin D, folate, B12 and ferritin

[Suzanne-j in reply to SlowDragon]

Novothyral is both t4 and t3 in the ration if 100/15

My Dr changed as it's one tablet and said she was on it and said it would suit me as I'm constantly constipated.

As I mentioned I have a blood condition and am not able to take b12 folate ferritin etc. I am discussing this at my next onco appointment. However vit d is reasonable am am supplementing.

Thank you.

[pennyannie in reply to Suzanne-j]

Even with a split T3/T4 medication you may well find you need to try supplements in order to achieve a regular bowel movement.

I take vitamin C to bowel tolerance.

Are you in the UK as Novothyral is not routinely prescribed on the NHS ?

[Suzanne-j in reply to pennyannie]

Oh that's very useful thank you. Would you be kind enough to tell me what dose and brand please. This is the bane of my life and really gets me down. I take vit D as I've read being low on that can cause it too.

[pennyannie in reply to Suzanne-j]

No thyroid hormone replacement works well until your core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D - are up and maintained at optimal levels .

Do you have any recent results of these ?

We are all different - I'm without a thyroid for starters - and my optimal dose of vitamin C - probably will not be yours - as it' trial error along with what you eat and how fast your metabolism is running.

There are a multitude of products - I just think vitamin C can't hurt me and the excess is excredited out with any luck !

[Suzanne-j in reply to pennyannie]

No recent results for the said vitamins but from past results I know they are not great but also not rock bottom. I make too many red blood cells so I'm not able to supplement with all these vitamins. The doctors have to keep my bone marrow steady otherwise I have to have too many venesections. I'm also trying to put off taking hydroxycarbamide. This is why I reach out on this forum to try and get support for my symptoms etc.

[pennyannie in reply to Suzanne-j]

Is this being prescribed in the UK by the NHS ?

[Suzanne-j in reply to pennyannie]

No a private Doctor. NHS wouldn't even consider any form of t3 for me and I was ill for a long time until I joined here and put myself on Armour before I found a Dr on the thyroid uk list. However he recently passed away so I've had to find another.

[SlowDragon Ambassador in reply to Suzanne-j]

Sorry

Ok yes you’re correct

But obviously your results suggest you’re not on high enough dose

FT4: 14.5 pmol/l (Range 12 - 22)

Ft4 is only 25.00% through range

FT3: 4.81 pmol/l (Range 3.1 - 6.8)

Ft3 better at 46.22% through range

Request 25mcg dose increase in Novothyral

(Think the smallest tablet is 50mcg ….so cut in half to get 25mcg)

[Suzanne-j in reply to SlowDragon]

Sorry that should say 100/20

[pennyannie]

What is printed on the Novothyral outer box - is it a spilt dose - such as 100/20 : 75/15 ;

or just one dose with no split - such as 100 :

[Suzanne-j in reply to pennyannie]

It is printed as 100/20 t4 and t3 respectively.

[pennyannie in reply to Suzanne-j]

OK so you are taking a tablet containing 100 T4 + 20 mcg T3 :

So this breakdown of T3 and T4 is at a 1/ 5 ratio T3 to T4 :

I think Novothyral is a German brand which is not licensed in the UK and made by Merck and think they make one tablet at a 1/4 ratio T3/ T4 which may suit you better if you do not find relief of symptoms on the dose ratio.

[Suzanne-j in reply to pennyannie]

Oh Wow that's so helpful thank you so much I will ask my Dr to prescribe this for me. Could I please ask if you know the t4 t3 of the 1/4 ratio so I can go to her better equipped. Thank you.

[pennyannie in reply to Suzanne-j]

Where are you living and getting your prescription filled ?

Why were you taken off Armour ?

1 grain Armour holds 9mcg T3 + 38 mcg T4 - so at around a 1/4 ratio -

were your bowels easier on Armour - if so likely a 1/4 ratio T3/T4 suits you better :

[pennyannie in reply to Suzanne-j]

Having just done quick look - it seems all the Novothyral split doss are at a 1/5 ratio :

Sorry about that - I'm sure there was a 1/4 - T3/T4 ratio when i last looked a few years ago - but seems not;

[Suzanne-j in reply to pennyannie]

I get my script filled in the UK. I was taken off Armour because a while back my free t3 was good but my t4 and free t4 were always at the very lower end of the range. Plus my Dr said that it might help with the bathroom.

[pennyannie in reply to Suzanne-j]

On NDT - brands of Armour/ Efra - or whatever - it is all about tracking on the T3 :

Once optimally medicated you will have a T3 proportionally much higher in the range than the T4 - it does not matter - and a TSH - low suppressed - as this is how Natural Desiccated Thyroid ' looks ' in blood test results.

NDT does not present the same way of synthetic T3 and T4 medications.

I take NDT but still have lingering hypo symptoms - and why I take vitamin C to bowel tolerance to resole some issues.

[Suzanne-j in reply to pennyannie]

Ok this has been incredibly helpful. It's also made me decide to return to Armour and titrate. For me it's a confidence thing and after losing Dr Callebout I felt so alone. Thanks again

[pennyannie in reply to Suzanne-j]

No worries -

you are not alone with all this - we are here - and keep us in the loop :

[SlowDragon Ambassador in reply to Suzanne-j]

I was taken off Armour because a while back my free t3 was good but my t4 and free t4 were always at the very lower end of the range. Plus my Dr said that it might help with the bathroom.

On NDT Ft4 is almost always low

Some people find they need to add some levothyroxine alongside Armour

[SlowDragon Ambassador]

Please add country you live in to your profile…..

don’t think you are in U.K.?

[Suzanne-j in reply to SlowDragon]

I'm in the UK. I'll add now sorry!

[Suzanne-j in reply to Suzanne-j]

No it says UK already! I do t k is why it doesn't show.

[SlowDragon Ambassador in reply to Suzanne-j]

Try deleting country then save

Then add country back in and save