my wife is subclinical Hypo, been on 1 grain of Thyroid-S for the past couple of years. Started HRT in Aug 2023, blood test done in Dec, numbers had gone down, increase to 2 grain. Last bloodwork done Mar 2024. Numbers gone down again but TSH is now suppressed.
I’m completely confused.
Any thoughts?
For each test: What time of day was it done, did she fast, and exactly how many hours before the test was her last Thyroid-S dose?
How old is your wife, when did perimenopause start for her, or is she already menopausal?
Do you have results for any of the following:
-Ferritin
- Vit D3
- Vit B12
- Folate
What other medication, vitamins, supplements, etc is she taking?
What are her symptoms/how does she feel?
Has she ever has a positive antibody test?
What do you mean when you say “sub clinical”?
Hi FallingInReverse,
Time of bloodwork was Monday 10AM. Last thyroid meds was Saturday morning so 48 hours between.
She is 50, is in menopause hence the hormone replacement therapy.
We do not have any of those results. She takes a multivitamin.
Her symptoms are: fatigue, lethargy, feeling hot, brittle nails, high cholesterol, weight gain, hot flashes, insomnia.
Never had a positive anti-body test
The doctor first prescribed NDT for her as she was having symptoms, but her bloodwork was in range just at the upper end he used the word ‘sub-clinical’.
The question for me is that she’s been stable for years It just all changed in the last few months!
Although we don’t know anything else about you but the post, the most glaring thing that sticks out is indeed the HRT.
That and her very very low Free T4 and Free T3. Have they ever been higher than that?? What were her TSH and FT4 and FT3 when she started Thyroid S? The 48 delay from last dose might be lowering all these, so that’s important to consider.
Estrogen and thyroid have a 2 way relationship. Many women go through life fine, then peri/menopause and thyroid both act up at the same time. There are regular posts here from people like your wife - Many women are on thyroid hormones stable sometimes for decades, then peri/menopause hits and it shakes up the whole system!
When did her symptoms listed above start? Presuming sometime before last August when you started HRT?
Knowing nothing else, I’d say that’s what has changed.
That being said - all of the above questions I asked can also point to other variables For example:
-Test timing & prep matters: TSH is highest in the morning, if your tests over time are done at different times of day, the results won’t be apples to apples. Were all three tests 10 am, fasting, did you always stop any supplements with biotin 3-5 days before the tests? Was last thyroid s dose ALWAYS 48 hours prior? Also curious why 48 hours… does she usually dose every other day?
And please confirm she was on the new dose steady for a solid 6-8 weeks before testing.
Note- her TSH is acting just as we would expect, you increased her dose, the pituitary has noticed and knows it doesn’t need to send out the request for more, hence low TSH. Our goal is around 1, with tons of us well below 1.
(Edit-but with more info on how your tests were done, and the impact of the 48 hour gap, we can revisit the low TSH and low Free Ts)
Also - her high cholesterol is a SYMPTOM caused by her dreadful FT3. That will improve when she gets closer to her optimal dose.
Vit/Minerals: How long has she been taking a multi? Generally the collective wisdom of this forum does not recommend multivitamins for hypo folks. First, you shouldn’t supplement without firstctesting for deficiency. Multis usually have too little of what you may need, too much of things you don’t and sometimes they can really work against you (ie, you should not take a multi with iodine, and if it has biotin it will interfere with the thyroid tests, and if there is iron that will block many of the vitamins AND your thyroid hormones if taken too close. The 4 vits/minerals above are the ones that are important to be OPTIMAL not just “in range.” They are required for your body to make use of the thyroid hormones you have. When they are deficient, your thyroid doesn’t stand a chance of working well for you.
Going forward, for a complete picture of thyroid health, we look for:
1) TSH
2) Free T3
3) Free T4
Plus these vitamins
4) ferritin
5) folate
6) B12
7)Vit D3
****Consistently test all at the same time, around 9 am is best if you can. Fasting before. No biotin for 3-5 days before. Wait a full 6-8 weeks after a dose change ****
BTW, I knew right away you were in the US when I saw the T3 uptake test. It’s outdated and not useful, but it seems to be the only thing our doctors know!
Lastly, your wife was likely never sub clinical. That’s defined by a high TSH, normal free Ts, and typically no symptoms. What was her TSH, FT4 and FT3 upon that diagnosis?
Yes, it is common to need to increase thyroid meds when start HRT. It can take months to settle.
You need to look at the "frees" and ignore the TSH. Her free T3 went up a little with the increase in dose but both are still inadequate so no wonder she feels rough.
She needs better treatment but make sure you get the testing protocol right as Fallinginreverse said and sort out the supplements.
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