T3 mono-therapy

[Elisabeth41]

I would like to know if it is possible for someone who is on T3 mono-therapy to have an in range TSH and feel well?

[Cake-Maker]

I have had T3 monotherapy in the past at various doses. I’ve always felt well but my TSH has never been in range and I’ve never been concerned about that

I would go so far as to say that it’s not possible to dose with T3 monotherapy and have a TSH which is in range. In fact many find that TSH is suppressed.

Dosing with T3 only takes a great deal of care so that you don’t miss your ‘sweet spot’. If you do, you’re likely to feel unwell.

[Elisabeth41 in reply to Cake-Maker]

Thank you Cake-Maker for your reply.

[jimh111]

I think those who need T3 monotherapy usually have a low TSH. I suspect those who don't need it could do well with a TSH within the reference interval.

[Elisabeth41 in reply to jimh111]

Thank you . That's good to know.

[Cake-Maker in reply to jimh111]

Sorry Jim. Could you please clarify? Are you saying that TSH is an indicator of T3 requirement or the result of T3?

[jimh111 in reply to Cake-Maker]

For most people TSH reflects the combined effects of fT3 and fT4 in the blood.There is evidence that TSH stimulates T4 to T3 conversion. So, if someone's pituitary isn't producing as much TSH as it should there will be reduced T3 levels, especially within cells. I believe these people ned T3, perhaps more than is normal.

It's important to distinguish between a TSH that is low because of too much hormone and one that is low because the pituitary is underperforming.

[Cake-Maker in reply to jimh111]

Many thanks Jim. That clarifies your point

[DippyDame]

I'm on high dose T3-only (100mcg) and my TSH has fallen off the range because T3 lowers both TSH and T4

It's not possible to take T3-only in a therapeutic dose,and have TSH in range

TSH is not important in this situation.

on T3-only you must be very aware of your symptoms because they are vital as a dosing guide

Listen to your body....not to a list of numbers!

[Elisabeth41 in reply to DippyDame]

Thank you for taking the time to give your experience.

[Cake-Maker in reply to DippyDame]

I completely agree.

Interestingly my TSH fell out of range even when I had mono therapy of T4 (Levothyroxine) in high dose. Sadly I was soon recognised as a non converter and Levo was replaced with T3.

I am surgically hypothyroid and we are a subset who will always need T3 (either in mono therapy or with Levo) to feel well.

TSH is not a thyroid hormone and with no thyroid and/or use of T3, it becomes redundant and of no consequence in interpreting blood tests. The increasing trend of using only TSH to diagnose and monitor is nothing short of scandalous

[DippyDame in reply to Cake-Maker]

Yes, TSH is a hormone!

TSH is a pituitary hormone.....but yes, it is not a useful or reliable marker.

It was first devised as a test for hypothyroidism ( high TSH)....nothing else.

They then tweaked it as a lazy marker to guide dosing....and the whole mess began causing misery for hundreds

I have a form of Thyroid Hormone Resistance which requires high dose T3-only.....but I had to research and discover that myself....and self medicate

[Cake-Maker in reply to DippyDame]

My apologies. Omitted word ‘thyroid’

Have corrected

[DippyDame in reply to Cake-Maker]

Easily done!

[Cake-Maker in reply to DippyDame]

And your success is because you did it yourself !

[Tina_Maria]

I cannot comment on T3 therapy as I am not on T3, I take levothyroxine only and my TSH has been suppressed since the start of my therapy, which was 21 years ago now. I have accepted that my TSH will never be in range, as I need my T4 on top of the range and my T3 65% through the range to feel well. This ties in with my dose (100mcg), which is spot on with the 1.6 mcg levothyroxine per kg of body weight.

If I reduce my dose by only a little but, I am symptomatic and it does nothing to my TSH. I feel fine on my suppressed TSH, I can exercise a lot and my bones are good. As long as I am monitoring the situation, I accept the risk of my suppressed TSH, as this allows me a good quality of life. I would be more at risk of osteoporosis, if I had my TSH in range, which means that my thyroid levels would be too low and I could not exercise. It is all a fine balance and we all have to decide what works best for us.

[Elisabeth41 in reply to Tina_Maria]

Thank you for your experience, it's good to hear you've found what works for you.

[Cake-Maker in reply to Tina_Maria]

You make very valid points.

[Bertwills]

Yes, I’ve had TSH in range on a dose of 40 mcg which is lowish for monotherapy but if I increase my stomach doesn’t like it. TSH is usually about 1 to 1.5. Adding in T4 causes my TSH to drop out of range. I have felt well on this dose sometimes, unfortunately it varies but that might be due to other causes. Tricky to know.

[Elisabeth41 in reply to Bertwills]

Thank you Bertwills, that is very reassuring to hear. Has your TSH ever been suppressed for a long time during your 'thyroid journey '?

[Bertwills in reply to Elisabeth41]

Yes, often whenever I try combination T3 & T4. I don’t think it’s something to worry about. The difficulty comes with NHS inadequate testing when dosage is based on TSH only.

Just make sure that your nutrition is good & all vitamins & minerals are as recommended here. I protect my bones as best I can this way. I also take a collagen Bone Balance everyday. It increases bone strength. I’m 67 so have to worry about them!

[Elisabeth41 in reply to Bertwills]

Thank you. It is so good to hear of a positive experience. I do follow all the recommendations here. Like you I now find myself in a position where bone care has to become a priority.

[Bertwills in reply to Elisabeth41]

Apparently a trampoline is one of the best ways of exercising for bone health without stressing joints. I’ve got one on my Xmas list.

[Elisabeth41 in reply to Bertwills]

Hope Santa's listening!

[Cake-Maker in reply to Bertwills]

That’s interesting. Do you get a first aid kit for when you fall off - which would be inevitable in my case I’m afraid 😟

[Bertwills in reply to Cake-Maker]

I’ll have to add that to my Xmas list, good thinking! 🤭

[BB001]

T3 has a greater effect on TSH than T4 and it is unlikely that TSH will be in range if you are on anything more than a small dose of T3. Search thyroidpatients.ca for TSH to get some interesting articles.

[Elisabeth41 in reply to BB001]

Thank you for your reply. I will have a look at the articles you suggest.

[sparkly]

I doubt it very much. You don't mention the reason for asking? Is it to keep gp happy having tsh in range?

[Cake-Maker in reply to sparkly]

I wondered too. It’s always good to know why a question is being asked