I cannot believe this, I finally convinced my endocrinologist to order a complete thyroid tests.Please help me to know your views of the results. I'm taking 50 mcg/day Thyroxine(Synthroid) ; divided to 2 part(25mcg twice a day). with 15mcg Liothyronine Sod 5mcg tablet/day(I take 10mcg in the morning and 5mcg in the afternoon). Thanks to this wonderful group and administration teaching me how to advocate for myself, to have abetter thyroid management in last few years.Please help me to interpret the new results. My Primary physician is very upset about my TSH result, I'm at risk that he might change the whole treatment plan after a new order of blood test next month:Thanks
-TSH Value=0.15 Normal range=0.27-4.20 u/U/ml
-TSH Receptor AB(TRAB) Value<1.10 Normal Value <=1.75 (iu)L
-Total T3 Value=1.4 Normal range=0.8-2.0 ng/mL
-Thyroid Stimulating Immunoglubolin(TSI)-ARUP Value=<0.10 Normal Value<=0.54(iu)L
-Free T4 Free Thyroxine Value0.76 Normal range: 0.93-1.70ng/dL
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sunsetssr
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50 mcg Synthroid is a very low dose for someone who has been on treatment for hypothyroidism for 30 years, so it isn't a surprise that your Free T4 is under range as a result.
Note that Synthroid is just a brand name for Levothyroxine.
Do you feel any benefit from splitting your Levo? Some of us do, some of us don't.
Your TSH being under range is probably what prompted the test for TRAB antibodies. They were testing to see if you were suffering from hyperthyroidism/Graves' Disease. Your result was negative for TRAB so you don't have Graves. It was a bit excessive to have tested for TRAB (in my opinion), because people with Graves would normally have a very high Free T4 and a very low TSH e.g. 0.001, neither of which you have.
Why is your doctor upset about your TSH? You are the one living with it! It's a bit low but the rest of your results don't indicate over-treatment. To me your Free T4 indicates under-treatment of hypothyroidism.
What time of day was your blood taken for these tests? TSH varies according to time of day and if you were tested around mid day or afternoon your TSH would naturally be low.
See these links (both discussing the same research) :
Your Total T3 is well within range, in fact is exactly middle of the range, so you aren't over-dosed with T3. The big problem is that it was your Total T3 that was measured instead of your Free T3. Free T3 is the active thyroid hormone and gives a better idea of how well you are doing.
There are people on the forum who have found they have adequate levels of Total T3 but have extremely poor levels of Free T3, and they have felt dreadful. There is no way to know without a Free T3 result if you are one of those people. The fact that you take T3 probably helps you avoid having very low Free T3, but I'm only guessing.
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The main thing that comes to mind for me is that your under-range TSH and under-range Free T4 suggest that you might have Central Hypothyroidism (CH). In CH the pituitary is faulty and is unable to produce sufficient TSH for your needs. With insufficient TSH the thyroid is not sufficiently stimulated and so T4 levels are low (like yours).
BUT, your unusual combination of results could be caused by your T3 intake. It is often seen on this forum that T4 drops and TSH drops when T3 is added to treatment.
In people with CH the only safe way to treat is to ignore the TSH completely and treat people based on their Free T4 and Free T3.
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I have noticed before that some USA patients are prescribed lower doses of Levo and higher doses of T3 than is usually seen in the UK. Given that taking T3 causes TSH and Free T4 to drop it probably explains why US doctors sometimes get upset by their patients' results.
I think that T3 might have been introduced too early, and your Levo should have been increased before T3 was added - but then I'm not a doctor, I'm just a hypothyroid patient.
The average healthy person with no thyroid problems allegedly produces approx 100mcg T4 per day and approx 10mcg T3 per day, or so I've read somewhere.
I would assume that your Levo dose is too low and your T3 might be a smidgen too high. But if your doctor is obsessed with your TSH staying in range then you probably won't get him/her to agree to the changes I've suggested, which would need to be changed one at a time.
In your shoes I would suggest asking for a 12.5 or 25 mcg increase in T4 first (don't mention your T3). It will lower your TSH further but should increase your Free T4. Then when you've adapted to the higher level of T4 you might want to reduce your T3 by a tiny amount.
However if your doctor is determined your TSH should stay in range this will be difficult.
It shows TSH levels in healthy people with healthy thyroids. (Watch out for differences in units of measurement).
As you can see from the graph, healthy people with healthy thyroids can have very low TSH which would probably disturb doctors if these people were ever tested for thyroid disease.
Thanks so,so much for a great analysis of the test results. The reason i was tested for TRAB is mainly due to extreme eye dryness after I recovered from Conjunctivitis, so my eye specialist was trying to find out if TED/thyroid eye disease or DED/dry eye disease is the cause. Please see my replay at the end of your second comment. I thank you again for your 2nd reply and the great recommendation.
Greetings again, I cannot thank you enough for the excellent recomendation. I have already increase the levothyroxine 12.5 mcg which will be 25 mcg in next 2 weeks and tolerated the higher dose well(with no anxiety and palpitation like before). Will have another blood test(which I always do in early morning) in one month to see if the Free T4 has improved. I need your help in calculation of the total thyroid medication in my body. For example, if I'm not wrong 10mcg of T3, really add 4 times to Free T4(10x4=40 plus 75mcg levothyroxine=111.5 mcg total T4 in the body). This is what I learned from this group. Am I wrong ? I need to convince my PCP on total medication(T4) in my body and the way I feel comfortable in my skin and functional before he plays with my dosage. Thanks again for your time and caring reply.
Thanks a lot for your reply.My vitamins and nutritional supplements I take is the same as what I reported before the only exception is I take Magnisium Glycinate 400 mg every night to help with the quality of the sleep.Have question for you. If I remember correctly, on one of discussion posts, it was recommended T3 result is more effective if the# is toward the MAXIMUM of the normal range? In my case T3=1.4 which is only 50% of the normal range.The other recommendation from the group was if T3 is increased, then T4 will be eventually will be increased. I hope I'm not too confused and a bad student to learn from this wonderful group. Pls advise.
That looks like if you need more t4! I would add 12.5 in the morning and evening and do a new blood test in 4 weeks! The free t3 and t4 levels are to low. Better is ft4 1.3 and ft3 3.3 up to 3.5/6...depends on how you need it.
Thanks for your reply. As you know different lab have different way of reporting or recording. As you mentioned in USA or at least in California the value and the normal range is exactly the way I reported.Thanks again.
So than it makes sense to take a little bit more t4 and that see what it does with the ft3 level. Maybe you need 2.5 less than.. But lets see how are you feeling with this level?
In the US you can go to Quest or LabCorp and order your own tests unless you live in the New England states.
Your PCP can also order all the appropriate thyroid tests you need (TSH, Free T4, Free T3) and can order any thyroid replacement hormones needed (levothyroxine/Synthroid, liothyronine/Cytomel, NDT/Armour, NP Thyroid). Many endocrinologists refuse to order Free T3 - which is the most important one which actually affects how you body functions.
Thanks for your reply, till now he is monitoring me through authorization from the health insurance. No need for private lab in this stage but will remember the resources for the future. Have already a lab. appointment in one month. I will tell him all the options I have learned for this group to advocate for myself . Thanks again
I’m a low TSH girl. If my dose was dependent on TSH I would be on 75 µg and very ill. For my weight 15 stone I needed and felt well on 150 µ g of Levothyroxine. I’ve lost weight due to ill health (viral meningitis) so all my levels are to cock and I’m in process of rebalancing. Anyway my sweet spot may have moved so I have to find it but the blood work should guide not dictate. There is nothing to say perhaps other medication, accidents, illnesses move us out of wellness and when this happens need to get back.
However the blood test should be a guide only. If you click on my face there is a bio and posts that discuss various aspects. Your circumstances are different being on combo but the MAIN issue is your wellness.
Also nothing is mutually exclusive. I fell off a horse a few times and have had concussion at least once could pituitary be a bit ‘off’ as a result? Who knows? They always look for absolutes - and miss the nuances.
Hi, I'm so sorry to hear about your challenges with the recent illnesses. Bless your heart for a good analysis of test results and the symptoms as a patient you have experienced. In my situation when I take high dose of levothyroxine , I feel ill and have a heart polpitations. Hard to convince a doctors about what is right dose for you even in a University and research oriented facility. Thanks again for the word of encouragement. I keep advocating for my sanity and a well balance thyroid hormone .
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