I've been on levothyroxine for at least 20 years. My doctor prescribed T3, at my asking, around 2017. I am 56 and 2 years ago I had a dexa scan that showed borderline osteopenia in my hips and early osteopenia in my lower back. I have always been active, and was only 54 at that time and was a little shocked.
A few months ago I went to the gynecologist for a yearly exam. I've been seeing her for 5 years. I am required to disclose medications before each visit so she's aware that I'm taking T3 and T4. She's never commented on it.
Recently in my state (I'm in the US), all doctors have switched to the same portal software so any doctor you visit will be able to see patient notes, test results, etc. This is the first time this doctor has seen my blood tests for thyroid.
She told me that I was overmedicated based on my non-existent TSH level. She told me that the doctors at our main teaching hospital, with which she is affiliated, think T3 is fake medicine and they don't prescribe it. She also said T3 causes bone loss, which is probably why my dexa scan shows osteopenia.
She also said being over medicated is likely causing my hairloss.
I have a doctor's appointment on Monday to discuss other bloodwork for PBC and I don't know if I should ask him about this. Does anyone have more info about T3 and bone loss?
EDIT: my last thyroid numbers:
TSH: 0.015 (0.3 - 4)
T3; 2.880 (2.3 - 4.2)
T4: 1.340 (0.7 - 1.53)
Ferritin: 92.8 (13 - 150)
Written by
KristinCC
To view profiles and participate in discussions please or .
Oh dear! She doesn't know much about thyroid, does she.
You cannot dose by the TSH, it's only a rough guide to thyroid status and on its own it doesn't tell you very much at all. Your TSH could be completely suppressed, yet your FT3 still too low. And taking T3 will almost always suppress your TSH. So, that was wrong!
If T3 is a 'fake medicine' why does a healthy thyroid make it? Answer: because your body needs it. It is the active thyroid hormone - T4 is basically a storage hormone that doesn't do much until it's converted to T3 - and every single cell in your body needs it too function correctly.
T3 could cause bone loss if there's too much of it or too little. But just taking the right dose of T3 will not cause bone loss. I don't know why so many doctors thing this!
Your hair-loss is more likely to be caused by being under-medicated, not over-medicated. What's more, she has no proof that you are over-medicated. Silly woman.
And all that raises the question: is osteopenia really a thing?
Thank you for that article link! That is very interesting and makes me feel better.It's funny, my doctor is very into the old WHO study that started the whole hormone scare. So much so that he wouldn't prescribe HRT for me when I asked for it, which is why I started seeing the other doctor who told me T3 medication was fake medicine.
I agree with GreyGoose’s suggestion that T3 is likely not to be the cause of any osteopenia that has been diagnosed. I’ve been taking T3 for the last two years alongside T4 as well and constantly have the fight with my GP about suppressed TSH and threatening to reduce my meds.
However, just to clarify, the article referenced is discussing the WHO (World Health Organisation) definition for osteoporosis and osteopenia, for which this this Green Med study suggests is not appropriate, and that may well be the case, although it then goes on to cast dodgy (imo) aspersions about the medicalisation of menopause (suggesting that HRT is not really necessary - I would counter that it very much is and I have been on HRT for 5+ yrs!) so that does make me doubt it’s overall validity, especially since I’m not familiar with this source.
However, this is not the WHI (Women’s Health Initiative) that incorrectly interpreted the breast cancer link to Hormone Replacement Therapy (HRT) or called MHT in the US, but I was under the impression that the WHI itself have admitted their interpretation was flawed originally, so doctors who aren’t aware of this need to educate themselves appropriately or we can encourage them to do so! There are certainly many US obgyn medics on social media who encourage the use of HRT. Dr Mary Claire Havers and Dr Corinne Menn to name a couple, as well as Dr Louise Newson in the UK who has an app, Balance, that has a great deal of free resources that you can access.
Not all women take HRT, you know. I don't. And - touch wood - I get along fine without it. I tried it once but didn't like it, so I've done without it ever since. And I'll be 80 in a couple of months time.
Yes, you are right. I'm not sure why I was confusing WHO with WHI 😄.
I also follow all those women on social media, which gave me the courage to begin hormone therapy. Thankfully there are doctors who are willing to educate when other doctors are not!
She's a gynecologist, not meant to be treating your thyroid, so you don't have to listen to her and you don't have to do what she says. It's not her area of expertise so she really shouldn't be meddling.
Yes, I was very upset by her comment. I thought it was interesting, not in a good way, that she was second guessing my GP's decision to add it. I already take HRT, which is why I started going to her in the first place since my GP wouldn't prescribe it for me 😭 I began taking it right after starting menopause.
How much levothyroxine and how much T3 are you taking
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
is this how you did test
What vitamin supplements are you taking
Please add most recent vitamin D, folate and B12 results
I am taking 88 mcg levothyroxine once daily and 5 mcg liothyronine 2x daily. I did the blood test as you described.
Because I have pernicious anemia, I inject B-12 every third week, so I no longer do blood tests fot it. As for D and Folate, I don't know. My insurance won't cover the bloodwork so I haven't tested those two in awhile.
I'm not taking any other vitamins or supplements. Just estrogen patch and progesterone.
As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance
Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need separate methyl folate couple times a week
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)
I'm not taking any vitamin D at the moment, though I know I should. I normally take a vitamin D / K2 supplement, but stopped in the summer because I was outside so much. I need to start taking it again. I live in Utah and it's cold and snowy and we haven't even seen the sun for 3 weeks now.
I have taken magnesium off and on, but everything I try seems to upset my stomach.
I love my GP, but he simply will not move away from the TSH when dosing. He's willing to decrease my T4 even more (I was on 100 mcg before adding T3) based on TSH, but he won't increase anything.
I have fairly extreme hairloss and chronic diarrhea which I personally attribute to thyroid, but he does not agree.
I have not tried that brand of magnesium. I will look in to it! I have been tested for celiac and was negative. But I have been gluten and dairy free since around 2017.
Honestly, there is more knowledge of thyroid hormone pharmacogenetics here on Healthunlocked Thyroid than in the entire medical establishment in the USA. I have heard so many loony ideas from board-certified specialists who I’ve seen that I sometimes wonder if any of them have the slightest idea what they are doing.
Did you have a DXA prior to the one that suggested osteopenia, or were they just going by your score?
I have noticed that imaging is often used to build revenue from treatment. “Your scan shows osteopenia. You should start on a pharmaceutical treatment. (And we get a kickback for prescribing it)”
The insurance company earns money on the things they cover. If they don’t cover it, it’s because they haven’t figured out how to get a piece of the action.
Sometimes you have to abandon an ignorant meddling medical practice and try someplace different. Dump the gynecologist. Sounds like your GP is a good one.
Of course, I understand that this isn’t an option for everyone, but sometimes it’s worth the sacrifice - I’m in the US and a rural area where the medical services are limited; I’ve had to travel and pay for those expenses and services that were not covered by my Medicare
In my case it was cataract surgery - my vision was so poor that as a child I was walking into telephone poles before my parents got my eyes checked - so when I was ‘eligible’ for the surgery, my eyes were still pretty bad; but to get the correction I needed I had to pay out of pocket for the procedure that the doctor recommended for optimal outcomes 🌺
I would keep the gynaecologist for the HRT and keep the doctor who is prescribing you T3. 5mcg T3 is an extremely low dose and would have not caused osteopenia. It's more likely to be that you are on the wrong balance of T4/T3 for your body. Too little T3 can also cause osteopenia.
This was my first DEXA scan. My doctor keeps pushing me to have another, but I'm hesitant. One, I don't think my insurance will pay for another so soon after the first, and two, I don't want to know if it's become worse 😅
Bone density changes slowly. The protocol is to measure every two years. Meanwhile you can take Jarrow Bone Up.
I also take Strontiun Citrate. It cannot be taken at the same time as the calcium supplement so I do it with a dinner that doesn’t include any calcium-rich foods.
When you do have the next DXA, use the same machine. Otherwise there will be differences in calibration and software.
It’s all guesswork, unless you have a family history.
I went undiagnosed with hypothyroidism for a number of years. I think that’s what contributed to my osteopenia. And sitting at a desk for four decades.
Or you could shop around for a xray facility that’ll give you a cash discount, and then stick with them. But bone remodeling goes on perpetually and slowly.
Yes, do use same machine & hopefully same rad will read. My understanding is to inform that you are taking strontium. Strontium is a heavier element than calcium so the rad needs to make numerical adjustment.
Hi I had a bad trip last May --achilles ripped out part of heel bone -emergency surgery. Had DXA scan Aug. - shocking! I have been on NDT for 35yrs., but I don't attribute it to my osteoporosis as #s good & I feel good. Got slack on vitamin supplements. My endo said I will be taking D3 (K2MK7) rest of my life --body doesn't convert sunshine like it used to (I'm 73, active, live in VA) Check out the website for Algaecal. You can get a great bit of info on bone mineral density. Use their products or cobble together from other companies. Don't know your insurance, but when you are @risk of bone loss, insurance companies may cover more than biannually; esp Medicare. I'd kick to the curb the dr. who is ?s the liothyronine I have "fired" a few drs. over the years due to their ?ing of some testing & rxs. Good Luck!
Thank you! I hope you are full recovered from your surgery! I was recently hiking in the snow. I had spikes on, but managed to slip one foot off the trail and down the mountain. The other foot stayed in place because of the spikes. I eventually got loose, but not before twisting my knee and my foot. It was very painful. I can't imagine how painful ripping out part of your heel bone would be ❤️
I will definitely look at that website you recommended. And one take away theme from this thread is vitamin D. I took some this morning and plan to keep it up 😊
a few weeks ago one of the administrator's posted a link for formula of how much Vitamin D one would need to take based on their recent level & their desired level. Whoa, thought I was taking adequate amt. of VitD & corresponding K2MK7-eye opener. Sorry for your injury- My trip was going into my shed...I do a lot of hiking when I can and it was my shed that took me down😆 Still trying to walk pre-injury
I am 47 and last year my bone density scan shows that I too have Osteopenia which is the worst in my hip (almostOsteoporosis) , I do not take T3 medication & have only been on Levothyroxine for a few years. So, I don't believe that is the cause for yours.
Perhaps. The Osteopenia started in my 30s, my thyroid was fine back then so it could have maybe made the inevitable worse 🤷♀️. Unfortunately I think it's a hereditary problem, my Grandma (with a normal thyroid) needed hip replacement & also my Mother who did have Hashis like me.
There are some articles on the subject at this site. There is no risk factor from the studies that are used for the statement on osteoporosis. There were some poor quality studies on TSH that commented on T3 but did not establish a link. Good luck.
I've read other comments which I concur with. HRT will help with bone loss as will the right amount of T3, you are just in range, Have they looked at Calcium?
I don't have a thyroid, wonder what they would do with me.
If its not very sunny where you live take daily dose Vitamin D at least in the winter, advise testing. Essential for bones and helps with Thyroid meds.
Looking at your thyroid hormone levels, I can't see any danger to your bones from T3. As far as I'm concerned your FT3 is on the low side. I know that many doctors pull the cardio and/or bone card when it comes to Lio. The only thing I could think of that supports their view is as follows:
Both low and high levels of T3 cause bone loss. Because of the shorter half life of T3, as compared to T4, there are peaks and troughs when taking Lio. Excessive levels of thyroid hormones, even transiently, can accelerate bone resorption (breakdown) more than bone formation, increasing the risk of bone loss and osteoporosis, particularly in postmenopausal women.
Having said this,
a) seen that you split your dose, it should help maintain steadier T3 levels, reducing peaks and troughs.
b) once the thyroid does not function the way it normally would, it is close to impossible to get it right with thyroid hormone replacement. A functioning thyroid (and pituitary gland) will adjust to the body's needs, which replacements can't do.
c) the body makes T3, when everything works as it should, which means that it is needed. If the body loses the ability to produce it in sufficient amounts, it has to be artificially added. Will it be the perfect solution? No. (see b)
d) there are quite a few other factors that cause osteoporosis. Looking just at T3 is extremely shortsighted, as far as I'm concerned. I had been diagnosed with osteoporosis long before I started on Lio. If anything, my FT3 was far too low at that point. So was my vitamin D, by the way. And, because I was so fatigued for years, I was seriously missing any form of bone building exercise. I moved as little as possible, because I had no energy. Starting to take T3 allowed me to start exercising again. I assume the osteoporosis was caused by a combination of factors, some of which have been removed, I think, by the addition of T3 and vitamin D supplementation.
From what I understand, once the thyroid is not working as it would naturally do, it is completely inadequate to make any assessments solely based on TSH, especially when an autoimmune process is involved. The whole thyroid panel and the symptoms are the most important factors. If the TSH happens to be within interval, that's just a bonus, but not necessary.
The available research will cause confusion, because there are those who have come to the conclusion that combination thyroid hormone replacement, let alone T3 only replacement, is unnecessary or even detrimental. And then there are proponents of exactly that for increase of health and quality of life. The same goes for TSH. There are those who fanatically adhere to the TSH as absolute guideline and those who see other factors as equally or even more important. Doctors will go by what comes from their organizations, like the AMA, and do not have the time (or willingness) to dive into research. Many also do not dare to oppose/challenge their organization (even if they knew better) for fear of loosing their license.
Anyway, those are my views. I know, I took it a step further from osteopenia to osteoporosis, but I assume this is what the doctor is concerned about. There are different opinions as to whether osteopenia is even a valid medical condition or whether pharmaceutical companies promoted the concept of osteopenia to expand markets for osteoporosis drugs. But that would be a whole other discussion.
Hi I’ve also just gone from my last DEXA scan being osteopenia to my latest one now saying osteoporosis, so waiting for my appointment to discuss, my T4 & T3 levels are good ( I take T3 also ) I had a surgical menopause at 43 and didn’t tolerate HRT there was not as not much choice around back then and the Premarin which I was given which made me feel terrible was made from pregnant mares urine 🤢 so I did without , sadly no one told me of the risks to my bones 😞. That and low thyroid hormones not being adequately treated as going by TSH for so many years I feel has contributed to my bone health.
Not sure how the appointment will go I’m dreading it as in the past 5 years since I’ve been on T3 and now have good levels my bone health has deteriorated ? My calcium and vitamin D levels were good at my last bloods in December, I take Vitamin D3 with K2 & magnesium.
Also awaiting a haematology appointment for low white cell count apparently it’s been like this for years and my amazing GP picked it up and asked for further test as I have underlying widespread pain I’m thinking another autoimmune lupus or RA ? Maybe it’s all connected ?
Thank you ☺️I do hope you too get some answers, T3 has changed my life I hope they’re not going to blame that and take it away from me , My endocrinologist ordered this scan he did the same 5 years ago before giving me T3 , but I can’t get in touch with him and actually read the results on my NHS app so seeing my GP next Monday to discuss x
Let's just hope that it is not another autoimmune disease. Inadequate thyroid hormone replacement can also cause widespread pain, by the way. Does not have to be the cause, but can. Just saying. Talking from experience and the wisdom of a rheumatologist, whom I was referred to for suspected fibromyalgia. Fingers crossed for you that all works out to your benefit.
Thanks buddy both T4 &T3 levels are good , I actually suspected RA or fibromyalgia I had the Blood tests for rheumatoid arthritis and they came back clear but my CRP test range was (01-10) my result was 5 so I was told it wasn’t ? But then I read 20% of RA patients don’t test positive I’m just hoping the haematology shows something , I’m struggling everyday I really need some answers 🤞🏻
It is so difficult to find answers and solutions for so many health issues. And I found that I can only be optimistic for a certain amount of time and then I need a short break from optimism before I go, "This will fix it! Nope! But this will be solution! Nope! Oh, I feel much better. Nope!" again. But there have been yeses in my 50 year experience with health issues, medication, the medical system etc. and I found that it is worth being hopeful. So I would like to wish you hope and strength for 2025 and beyond. ♥️
I know you're worried but the T4 is most likely the culprit for bone loss. Also , possibly you have low VitD3, low magnesium and low K2. You need all 3 of those to be able to keep calcium in bi e and keep good bones. Levothyroxine leeches calcium from bones over time if you don't keep up good vitamins and minerals. Most hypothyroid people are naturally low in VitD3, K2 and magnesium. Is there any way you could get a blood test for bone profile done and a blood test for magnesium.deficiency ? :/ Do you feel well on your t4 & t3 meds or do you have hypo symptoms still ? You have room to Increase the t3 and t4 meds too. Low TSH is normal when taking both t4 & t3 meds. :/
My insurance won't pay for those tests, but my doctor will order them for me if I ask. It's just a matter of paying out of pocket. The last vitamin D test was out of pocket and was $50. That was several years ago so I assume the price has probably gone up. The test was on the lower end of normal so I do know I really should be taking it.
My symptomshave leaned more towards hyperthyroidism. My doctor was expecting to see hyperthyroidism and was surprised by the bloodwork showing hypothyroid. My main impetus for testing 20 years ago was severe anxiety and panic attacks that started out of nowhere. I saw a therapist and he suggested getting thyroid tested. And he was right. Once I started on T4 I felt better. Both my mom and sister are hypothyroid.
Now, I have anxiety again, but I don’t know if it's due to thyroid or if it's situational. I've had some extremely stressful family situations that have been ongoing over the last three years that I'm struggling to cope with. I'm in the US, so there are a whole bunch of other anxiety inducing situations happening.
I'm always exhausted, but that happened with menopause. I rarely sleep more than 4 hours a night anymore. I'm not sure what feeling normal or good actually feel like 🙃
Be careful when levels are “within range”. Several “low in range) or “high in range” results could mean illness when considered together. Your T3 is kind of low while your T4 is a bit higher than I’d be comfortable with. But most of the studies linking thyroid replacement hormone with bone loss looked at elevated T4 and TSH in post-menopausal women already at risk, coming up with the conclusion low TSH is evil.
Kind of a shame your Gyn is so obtuse - some are actually quite savvy about thyroid hormones, as are many NP’s.
Fake medicine?? Good heavens. Sounds like they don’t know about non conversion of T4 to T3. How do you FEEL?? That’s so important! You can check out my posts but basically my TSH has been way under 1 since 2000 I had those same arguments and started on a small dose of T3 a few years back which stopped me feeling underactive whereas one doctor was determined to say I was over medicated….so wrong.
Good luck and hope you have friends to support you and back you up.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
TSH Supressed, T3 2.7, T4 12 & Antibodies 38
Do I need to adjust my meds?
Thyroid will shut down??
Bone loss from thyroid meds Levothyroxine.
Quitting T3
