Low tsh 0.01 and low t4 12/13 even on levothyroxine

[jparsss]

I have had bloods done and tsh is majorly supressed and t4 is low even on levothyroxine. 12/13 t4 (range 9-19)

I have tingling and leg swelling daily and I'm unsure what this may be.

Any advice or similar story's would be helpful

[Forestgarden]

Hi there, how much levo are you on? Did you get your blood test fairly early morning before taking your levo?

[jparsss in reply to Forestgarden]

Levo is 75mcg

Yes I had done at 10am

[SlowDragon Administrator]

How much levothyroxine are you taking and how long on this dose

Which brand

ALWAYS test early morning, ideally before 9am, only water between waking and test and last dose levothyroxine 24 hours before test

Are you taking any other medications

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you taking

Is your hypothyroidism autoimmune?

Assuming yes……are you strictly gluten free and/or dairy free diet

[jparsss in reply to SlowDragon]

I'm on vit d supplement

Foliate supplements. I didn't take levo for 24 hours and got 13 t4 (9-21 scale)

Getting water retention is legs and tinglin due to retention.

T3 is supplemented at 25mcg. My t3 is now 4. Between 2.4 and 6.5

[SlowDragon Administrator in reply to jparsss]

So taking any T3 will lower or suppress TSH

Did you start T3 slowly…..initially only adding 1/4 tablet

And slowly increasing up to current dose over 2-3 months

How long have you been taking current dose

Do you normally split your T3 as 2, 3 or 4 smaller doses spread over the course of the day

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

What were most recent B12, folate, vitamin D and ferritin results

[SlowDragon Administrator in reply to jparsss]

Ft4 (levothyroxine) is low at just 28% through range

Suggest you try increasing levothyroxine to 87.5mcg per day retest in 6-8 weeks

This will help increase Ft4 and Ft3

How much levothyroxine were you taking BEFORE adding T3

[jparsss in reply to SlowDragon]

I was on 100mcg of levo and then retest year later show how it slowly dropped down. My t3 was then tested and was border line at 2.5. So I added in t3 and it now sits at 4.5

Now on 75mcg as Dr has said tsh is too supressed. However I feel horrendous.

[SlowDragon Administrator in reply to jparsss]

But presumably your GP is unaware that you are taking T3

Taking almost any dose T3 almost always will significantly reduce or suppress TSH …..that’s just what happens when T3 is added

This is why it should be done under the care of a competent endocrinologist

ALWAYS testing with correct timings

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

Typically when adequately treated……aiming for Ft4 and Ft3 at least over 50%

and essential that vitamin D, folate, B12 and ferritin at GOOD levels

[SlowDragon Administrator in reply to jparsss]

Can you answer these questions?

[RockyPath]

If you press a finger into the leg momentarily, does it leave an impression?

If no, this would be characterized as non-pitting edema. Theoretically, when you have sufficient thyroid hormone, you shouldn't have non-pitting edema.

By any chance, are you on a calcium channel blocker for hypertension? This tends to cause non-pitting edema, particularly at the maximum dose.

[Hectorsmum2]

The T3 will reduce your T4 and tsh. So the Low T4 blood result not worrying. You could probably have a slight increase of T3 to see if that helps. Just be guided by T3 result.

[SlowDragon Administrator in reply to Hectorsmum2]

Many members actually find they need both Ft4 and Ft3 at least 50-70% through range

On NDT, Ft4 may more likely be low