Is it even possible to to have a normal TSH if you're taking T3/T4.... AND still feel well?

[muppetme]

Is it even possible to to have a normal TSH if you're taking T3/T4.... AND still feel well?

[greygoose]

Well, not for me it isn't. But I believe it is for some people.

[Buddy195 Administrator]

Combination treatment is renowned for suppressing TSH.

Are you experiencing difficulties with your GP because you are self sourcing Liothyronine? I know you recently asked for endo recommendations (replies by PM only) but if this endo supports your current treatment plan, let’s hope this will get your GP on board.

[DippyDame]

T3 naturally lowers TSH.

"A normal TSH", whatever that actually means is likely to vary with each individual depending on their pituitary function and recognising that TSH varies throughout the day. TSH is highest around 9am

For a more reliable thyroid evaluation both FT4 and FT3 should be measured.....not only do you establish hormone levels but you can check T4 to T3 conversion which is an important factor.....and frequently missed by medics!

High FT4 with low FT3 indicates poor conversion and (usually) the need to add some T3

Science shows that relying on TSH alone, after medication is introduced is not a reliable marker.

bmcendocrdisord.biomedcentr...

It appears that what we are witnessing constitutes an unprecedented historic change in the diagnosis and treatment of thyroid disease, driven by over-reliance on a single laboratory parameter TSH and supported by persuasive guidelines. This has resulted in a mass experiment in disease definition and a massive swing of the pendulum from a fear of drug-induced thyrotoxicosis to the new actuality of unresolved designation of hypothyroidism. All of this has occurred in a relatively short period of time without any epidemiological monitoring of the situation

I don't believe that aiming for a "normal" TSH is any guarantee that you will feel well

FT3 is the important result, followed by FT4

However because we are all different I suppose by good luck rather than by good judgement someone might hit a combination of "normal/ in range TSH and good health, when taking T4/T3 combo.

I would absolutely not rely on TSH only!

TSH is a pituitary, not a thyroid, hormone. It measures a combination hormone level of FT4 and FT3 so gives no indication of those important individual levels

It is basically a signal to tell the thyroid if it needs to alter the amount of hormones it produces....more or less

When mediction is introduced this can skew those results making TSH unreliable

Getting medics to understand this is another matter....in current times they are often wrongly taught that TSH is the gold standard test.

It is just a cheap, quick and inaccurate way to attempt to evaluate thyroid function and can leave the patient over, or more often undermedicated

Personally, my answer is an unequivocal, "NO!"

[McPammy]

I have normal TSH blood tests results. I check my bloods after I’ve taken my T3 liothyronine and T4 levothyroxine so I know I’m not going over their levels. My T3 result is usually high but never over, it was 5.6 (3.7-6.0) last time and I keep my T4 mid range as that’s adequate I feel. Prior to finally being prescribed T3 my T3 results were 3.9. So T3 has gone from 8% to about 85%. My TSH is usually around 1.00 - 1.50 (0.35-5.50). I have checked my bloods without taking my thyroid meds and then the TSH remains the same but the levels drop at least a couple of points. I feel it’s important to know how low your levels get and how high they get also. This way if you don’t go over or under your TSH will stay in range. Importantly you want to feel well and symptom free. For myself symptoms are only ever brought on if levels are too high or too low. I’m symptom free with in range TSH.

We generally visit our GP prior to being diagnosed as we have symptoms of TSH being too high or too low as the thyroid begins to fail. Then we are given t4 or t3 or both hormone replacements to bring levels back to normal. If we continue to over or under replace these hormones artificially symptoms will persist. So, the aim is to manage and balance your t4 and t3 levels with the hormone replacements. And aim for a healthy persons TSH and levels which are never over or under levels.

[tattybogle]

well , yes it's clearly possible for a few people, but for others ('lots of' others) it simply isn't.

If for no other reason than it keeps interactions with doctors simpler , it's certainly worth trying whatever tools we have to keep TSH in range, or at least 'measurable' eg . by experimenting with slightly lower doses to find the lowest doses that work effectively , splitting both T4 and T3 doses over the day rather than taking all in one lump.... but if this doesn't work and the lowest dose needed leads to low , or even supressed TSH , then so be it..... but this will inevitably bring ongoing hassle every time we need doctors for anything, because they are not going to change their minds or their training on the issue of low TSH any time soon .

i started adding T3 this year and after 8 wks on 75mcg levo + 9 mcg T3 my TSH was 2.9 with fT4 at 56% ( 12 hrs after last half a dose) ... and fT3 56% ( at peak ... ie , 3 hrs after last 3mcg dose ) .. so it is clearly not true that taking 'any' dose of T3 will lead to supressed TSH.... however i felt really lousy on that dose and have since increased levo dose to about 92mcg and am now feeling better than i was then, but still not quite right , so we'll have to wait and see what TSH is next time i test ... i would ideally like to keep my TSH at least 'measurable' , but if it's not possible then so be it ...i'm much more interested in how well i can function than my TSH level.

but my current situation is not typical , my fT4 and TSH levels have been doing unusual things for the last few years , it used to be very low (0.05 ish) for many years on just levo, then fT4 went through the roof and reducing levo even slightly caused TSH to rise as high as 5.3 and fT3 to plummet , despite fT4 still being 91% .