New Dr, Low TSH on T3

[Vdubbers]

Hello. I've got a new Dr and I've been asked to have a telephone appointment following recent blood tests. I'm on T3 and I know it's going to be about low TSH. Due to menopause brain fog I can't remember the info needed argie my case regarding this being OK when on T3. Does anyone have the information please? 🤔 Ps. I'll post test results when I have them.

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

On T3 - day before test split T3 as 2 or 3 smaller doses spread through the day with last dose 8-12 hours before test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

See detailed reply by SeasideSusie

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Most people on combination therapy find they need BOTH Ft4 and Ft3 at least 60-70% through range

Plus OPTIMAL vitamin levels

Previous posts suggest you were not on high enough dose levothyroxine and ferritin was too low

How much levothyroxine are you taking

How much T3

Do you split your T3

As you have Hashimoto’s are you gluten free/dairy free

[SlowDragon Administrator]

You may need to see endocrinologist to get INCREASE in levothyroxine

If GP wants to reduce dose levothyroxine based solely on low TSH you can refuse

If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

LEVO DOSE SHOULD NOT BE DETERMINED BY TSH

Diogenes/Toft paper:

bmcendocrdisord.biomedcentr...

healthunlocked.com/thyroidu...

The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:

Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis

February 2020 Journal of Clinical and Translational Endocrinology 19:100219

DOI: 10.1016/j.jcte.2020.100219

LicenseCC BY-NC-ND 4.0

Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich

LlINK TO PAPER:

ncbi.nlm.nih.gov/pubmed/320...

sciencedirect.com/science/a...

Research showing Levo and T3 combo superior for heart

healthunlocked.com/thyroidu...

from PULSE magazine for GP's... The article is available from ThyroidUK

If you want a copy of the article then email [e-mail]

and ask for a copy of the Dr Toft article in Pulse magazine. The quote is in answer to question 6.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine:

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

[Vdubbers in reply to SlowDragon]

Thank you for your thorough reply. Yes I followed guidelines re medication prior to blood draw.

I'm still waiting for blood results . However in addition to these I am posting previous tests, 1 from Dr's in April, 1 from medicheck in July.

I take 100 T4 morning, 10 mcg T3 morning and 10mcg afternoon (1pm). B complex daily, selenium and iodine kelp daily. Ashwaganda and magnesium. On HRT bioidentical hormones that I buy myself. Lots of symptoms but I don't know what relates to what! Hypothyroidism, menopause, fibromyalgia! Migraines, anxiety, daily headache, depression, muscle pain... the list goes on 😖

I'm struggling with food, tummy issues, lost weight, lack of desire for food. So much food upsets my stomach I don't know what to eat. Not gluten or dairy free, but avoid where possible. Hopefully I've answered all questions? Thanks so much. Sorry for download of so much info 😢

Ok

[SlowDragon Administrator in reply to Vdubbers]

Iodine and kelp are NOT recommended for anyone on replacement thyroid hormones, especially with Hashimoto’s

So strongly recommend you stop kelp

Day before test …split T3 as 10mcg waking, 5mcg mid afternoon and 5mcg at 8-9pm

what vitamin supplements are you taking

Folate is too low

Vitamin D needs improving

No point being “almost “ gluten free

Suggest you consider cutting it completely

Only make one change at a time or you can’t tell what’s helping

Stopping kelp first

Vitamin D

Improving to at least around 80nmol-125nmol

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Do you also supplement magnesium

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator]

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...