I currently take 50mcg Levothyroxine and 2x5mcg Liothyronine. The Liothyronine was started in July this year as a trial and my 75mcg dose of Levo was dropped to 50mcg. As a result of my December blood test (below) my Endo has asked me to halve my Liothyronine to 5mcg. She says my suppressed TSH puts me at risk of increased bone and heart muscle turnover. (I already have osteoporosis.) I was feeling quite well (PMR withstanding): a little more energy, positive mood, reduced constipation etc so am concerned about her advice. My T3 and T4 still look quite low to me. My bloods were taken at 9 am, with only water before, T4 24 hours and T3 11 hours before. What are other's experience of this balancing act?
NHS Results December 2023
TSH 0.05 (0.35-4.94)
Free T4 10.7 (9-19)
Free T3 4.5 (2.4-6)
NHS Results 21/8/23
TSH 0.19(0.35-4.94)
Free T4 10 (9-19)
Free T3 3.7 (2.4-6)
Before the trial my T4 was always at the top of the range and T3 at the bottom.
Thank you for any help you can offer.
Written by
FleetRose
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TSH has nothing to do with bones or hearts. It does not cause osteoporosis. Long-term, very high FT3, as seen in Graves' - which will of cours suppress the TSH - increases your risk. But it is the high FT3 that does it, not the low TSH. Suppressed TSH due to exogenous T3, with FT3 within the range, does not increase any risks.
Honestly, they all just parrot this rubbish without even thinking about it. If they ever stopped and thought about it, they'd see it's all rubbish. Low T3 is far, far worse for your bones. Low nutrients are bad for your bones. Has she ever thought about testing them?
It’s just ridiculous that they keep spouting this rubbish to everyone that suppressed t3 causes osteoporosis! Do you know what evidence they use to support this claim as I’d love to know because I’ve heard this a thousand times
Perhaps there is. There's all sorts of research papers out there, some of them erroneous, some down-right lies or twisted science. But, I don't know which one they got their info from. Start a new thread and ask if anyone knows.
Taking almost any dose of T3 will suppress TSH …..ignore it
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
Was this how you did your test?
Your results strongly suggest you need increase in levothyroxine to 75mcg
Retest in 6-8 weeks
Essential to test vitamin D, folate, ferritin and B12 at next test
T3 is about 3x as potent as T4 in suppressing TSH. Your doses and fT3, fT4 are not high and most likely would not suppress your TSH.
TSH has a very modest effect on promoting bone formation, in practice my guess is this is irrelevant. Studies do tend to associate bone loss with TSH suppression but generally there are not increased fracture rates. In some cases there is concurrent pth damage which probably accounts for the bone loss.
Your TSH is low but your thyroid hormones are certainly not high which suggests the fault lies with you not secreting as much TSH as you would expect for your fT3, fT4 combination. Are you still taking prednisolone? There are studies (e.g. pubmed.ncbi.nlm.nih.gov/114... ) which tend to show prednisolone causes a low TSH. The research isn't very clear but it points to prednisolone interfering with TSH. Maybe your endocrinologist should look at this and learn to view TSH, fT3, fT4 as a whole and not rely only on TSH.
Thank you for your helpful replies. An interesting point about the prednisolone. My blood tests were done as per the recommended protocol. My last vitamin/mineral tests were in April this year:
Ferritin 76.7 (13-150)
Folate 11.57 (>3.89)
Vit B12 115 (37.5-150)
Vit D 101 (50-200)
I'm still not sure whether to lower the T3, as she suggests, or increase the Levothyroxine. I suppose I need to experiment but with only one change at a time. It's very hard to challenge the Endo or to go against her instructions though I will raise the question of the effect of prednisolone. Our communication is by letter only. I will try to be as tactful as I can!
I have very similar results to you and have had intense pressure to get off T3 entirely. I have done so to satisfy GP only to feel absolutely wretched. A few months back I put myself back on T3 and was frankly terrified to tell my Endo but knew I had to come clean. He said “you know your body best. I am only here to guide you. As long as you understand your risks, the final decisions are always yours.” I was so damned relieved! Now to tackle my GP…..
Thank you for your reply Vernonwendy. I'm glad it worked out for you. I will have to be honest with the Endo and say that I am not happy to lower my T3. I do hate having to tread on eggshells all the time but it is a useful reminder that the final decision is in fact mine (as long as she will keep prescribing the T3!)
I have IMPROVED my DEXA scores while on T3-only therapy, 75mcg per day! But the T3 is part of a larger package. I also am on compounded bioidentical estrogen, progesterone, and testosterone HRT (the latter, a gel to rub on, the former two in a tab to dissolve under tongue). Labs are taken every 6 months to make sure all is in balance. (As well as lupus medication, plaquenil, 400mg, which should be irrelevant for bone changes.)
Diet matters too, it seems. I eat 6 prunes a day (there's a study that claims this helps---I don't know, but I like them as dessert substitutes). I also take Vit D3, Zinc, Selenium, and Vit B12, in addition to sometimes taking a basic multivitamin. I eat a low-sodium diet, 1200mg/ day at the very maximum and almost always lower than that, arunf 900-1100, due to a serious bout with several debiitating and extended episodes of Meniere's in 2020-21. I do NOT take calcium supplements and am almost dairy-free (except a bit of ice cream or cheese or yoghurt, not every day, but a couple of times a week). I do eat lots of vegetables and fruits, but also lean meat and some grains. I should probably take Vit K but I keep missing it.
My DEXA scores were T -1.5, -2.0, -2.2, in late 2019, but in late 2022: the first one one is normal, two are improved though still slight osteopenia, -1.5 and -1.5 each. I hope to keep improving.
It took three years, during which I was exercising moderately nearly every day, mostly swimming, which they say does not help bones, and yoga, which does require some strength if you do the kind I do (lots of planks and one-leg-stands and one-arm stands and so on). Also some walking and gardening. And piano-playing. So, nothing too strenuous.
I hope this helps. I cannot live a quaity life without my thyroid medication and HRT and I don't blame you for worrying about this. My thyroid doc was not surprised, but my very negative, anti-T3, closed-minded GP was very surprised, hah!
Thank you for your reply. It seems we are doing many of the same things to help preserve our bone strength. I too am on bio-identical HRT though mine is an oestrogen gel and a progesterone pill - no testosterone. I take the same supplements though mine include calcium citrate which I understand is less likely to block the arteries than the carbonate form. It is a powder so I take a slightly lower dose as I'm not sure I need added calcium. I've been eating my 6 prunes a day for many years! I have also invested in a Marodyne vibration platform. This a medical grade platform, much less powerful than the Power Plates used in gyms. I practise yoga but my problem regarding bone health is that I have Polymyalgia. This means that my exercise and movement is severely limited. I also have to take long term steroids (13 months so far but likely to continue for some years). Steroids cause osteoporosis which I had even before the polymyalgia diagnosis. Not a good place to be!
I'm sure low T3 does not help bone health so I will try to persuade my Endo that I should stay on my current dose and not reduce.
Thank you, FleetRose! This is good info about the machine and I’ll check it out. I have lupus as well (usually kept at bay with Plaquenil but now I’ve got to go off it after 26 yrs—a long story for. A different topic) so I’ll be returning to your post for info, and I do understand about the exercise issues! Best of luck.
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