T3/T4 combo maintaining in range TSH

[Laundretta]

I’m just wondering, does anybody do this either by design or by accident?

[McPammy]

I do this by design. When I get my bloods tested every 3 months by my GP I get them tested 2hrs after taking my T3 medication. I use to not take my meds prior to a blood test and my levels were always low but in range. T3 4.5 (3,7-6.0). I wanted to understand how high my levels got with taking meds 2hrs in. My T3 level is usually 5.5 (range 3.7 to 6.00) I know then it doesn’t get higher which means my TSH is in range which it always is last time it was 0.54 (0.35-5.50). My T4 is always on the lowish side 10.10 (7.86-14.41). I take 5mcg t3 twice a day 8hrs apart and 68mcg t4 twice a day also. I take liquid levo which helps me get my dose accurate for myself.

If I ever start to feel over medicated symptoms which I do occasionally (irritated, hungry, waking too early) I drop one of my levo doses for that day, next day I’m fine again. I never drop or alter my t3 doses ever. I feel even though my t4 is lowish it can be the T4 rather than T3 making me feel over medicated for some reason.

I started to manage my TSH when I was first diagnosed as a very poor converter of t4 to t3 ( only 8%) as my NHS endocrinologist threatened me with withdrawing my t3 prescription if my TSH went suppressed. Horrible man. So I thought I’d mange it then. It’s worked in my favour as I feel pretty brilliant most of the time and full of energy and life. If my levels get too high I get negative symptoms. I need to keep my TSH in range I feel. After all a healthy person wouldn’t have a suppressed TSH so that’s what try to mirror. I have read on here so many being fine with a suppressed TSH but I just can’t. I think my horrible NHS Endo might have done me a favour dare I say. Now he and my private endocrinologist are very happy with my blood results and have absolutely no problem in prescribing T3 for the past 5 years now.

[HealthStarDust in reply to McPammy]

Thanks for sharing. I certainly didn’t feel good on a low and suppressed TSH (levo only mind).

[Laundretta in reply to McPammy]

Very interesting, thanks for sharing. Mines pretty supressed - 0.01 ish usually. But I feel well, no signs of over medication. I do my bloods at 0830 before meds, but I might do the next one post meds out of interest.

[Wua13262348 in reply to McPammy]

When you take your thyroid hormones 2 hrs before a thyroid blood test, is this both T4 Levo and T3 Lio? I can see the sense in it. I am interested in case I need to manipulate my blood results in the future.

[McPammy in reply to Wua13262348]

I take my T3 2hrs before and have taken levo 2hrs before also. I have done the test also without taking medications. I prefer to know I’m not going over or under levels.

My gp is on board with the way we test my levels. He thinks it’s a good idea also. My TSH is never suppressed and I feel very well 99% of the time. I can get blips on over medication. When this happens I reduce my levo by half a dose and that generally fixes it. I never alter my T3 doses or timings except going on holiday into a different time zone.

[Jaydee1507 Administrator]

Many NHS Endo's insist on an in range TSH on combination therapy. This usually means that their patient is under replaced and still suffering hypo symptoms despite being on the combi therapy.

[McPammy in reply to Jaydee1507]

Think I’m lucky as I certainly don’t feel under replacement. I feel bloody marvellous.

[Jaydee1507 Administrator in reply to McPammy]

You're definitely very lucky. Few people can deal with a low FT4 and in range TSH on combination. I certainly couldn't.

[McPammy in reply to Jaydee1507]

I don’t know though as doesn’t ndt have low amounts of t4 and much higher t3 in it. And that is natural.

[Jaydee1507 Administrator in reply to McPammy]

Firstly although NDT is said to be 'natural' it is processed and has excipients just like Levo & T3.

NDT is 'natural' for a pig, humans need a higher amount of T4, usually.

NDT doesn't suit everyone and some users need to add some Levo in.

[DippyDame]

The following will help explain why TSH is not a reliable marker... following it's use in diagnosis.

thyroidpatients.ca/2021/07/...

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bmcendocrdisord.biomedcentr...

Time for a reassessment of the treatment of hypothyroidism