TSH v low but T4/T3 in range - doc wants to reduce T4

[ironchica]

Hi everyone, hope you’re all having a good day! I wanted to ask for some guidance re my TSH and T4/T3 levels from you wonderful people as you always know more than the docs!

So, my latest blood test in December (with the last meds taken 24hours before) shows

TSH at 0.058uUI/ml (range 0.350-4.95)

T4 0.98ng/dl (range 0.70-1.48)

T3 3.15pg/ml (range 1.58-3.91)

These aren’t typos - ng and pg are what it says on my results.

I feel pretty good on these meds, I’m managing to exercise and also to work on losing weight - both of which I need to do!

But my doc wants me to drop my T4 from 150mg per day to 137mg per day and keep my T3 at 0.025mg per day.

I’m open to the suggestion, but I don’t want to go backwards! (I know we have all seen this happen before!) She did say she would take me down to 125mg per day, which I refused to do, so we had a compromise (my doctor is totally lovely and always supportive to be fair to her!).

I have Hashimoto’s and another immune-related condition called Mast Cell Activation Syndrome, which is quite rare but super involved - the short version is that I’m allergic to many things and have to be super careful to manage food, sleep, stress, exercise, work, avoid perfumes/chemicals etc.

I’m just wondering what others think about this as a way of dealing with the TSH? Do you think there might be another way to do this? I did look at reducing T4 and compensating with a slightly higher T3, but given the relay loop back to the pituitary, I don’t think this would make a difference? Or would it?

As always, it is the fear of feeling worse - even for a short period - but I do get the TSH issue, but my T4 is already at the lower end of the range. So not sure this helps. The reason my endo told me to use T3 in the first place is because he doesn’t think my T4 conversion is very good.

Thank you all in advance for reading and for any help or suggestions you can give 🙏🏻

[SlowDragon Administrator]

FT4: 0.98 pmol/l (Range 0.7 - 1.48)

Ft4 only 35.90% through range

FT3: 3.15 pmol/l (Range 1.58 - 3.91)

Ft3 67.38% through range

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)

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

Your results suggest you need dose INCREASE in Levo

if Ft4 was up to 60-70% through range you might not need any T3

Taking any dose of T3 will significantly lower TSH

What are your most recent vitamin D, folate, ferritin and B12 results

[ironchica in reply to SlowDragon]

Many thanks SlowDragon, yes that makes sense. Although I was on higher T4 previously with no T3 and feeling considerably worse, which is why my endo dropped T4 and added T3. So I think the T3 is a good addition for me.

I don’t have the info on these tests re vitamins D/B12/folate, but I have to supplement both d and B12 (inject B12).

Ferritin - 189 ng/ml (20-275)

I’m not sure when I last had those checked so that would be useful to know…

[SlowDragon Administrator in reply to ironchica]

How much vitamin D

Test twice year when supplementing

vitamindtest.org.uk

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels between injections too

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

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

Post discussing different B complex

healthunlocked.com/thyroidu...

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...

[ironchica in reply to SlowDragon]

Thanks for all of this info SlowDragon, much appreciated. 🙏🏻 I’ll get to work on the B complex.

[greygoose]

I’m just wondering what others think about this as a way of dealing with the TSH?

The TSH doesn't need dealing with. As you're taking T3 the TSH is going to be suppressed because that's what T3 does. And you could stop taking levo altogether and the TSH would still be suppressed. I don't know why doctors don't get this!

Your TSH is suppressed because you don't need it anymore. It only has two jobs: a) stimulating the thyroid to make more hormone, and b) stimulating the process of conversion of T4 to T3. A) you're hypo so your thyroid isn't making hormone any more, and b) you're taking T3 so conversion it not so important. And that's it. Why struggle to raise it at the cost of your health when you don't need it?

Of course, your doctor will probably tell you that a suppressed TSH increases your risk of developing heart problems and osteoporosis. But it doesn't. That's a myth. And it's far more dangerous for your heart and bones to have low levels of thyroid hormones. So, if I were you, I'd tell her thank you very much for your concern, but no, I won't reduce my dose.

[ironchica in reply to greygoose]

Love this grey goose! Thanks so much for taking the time to outline this - it makes perfect sense! I knew I had come to the right place for advice! Many thanks again.

[greygoose in reply to ironchica]

You're welcome.