Endo advises to Reduce T4 for TSH

[missrees]

Hi everyone!

I know that we have one of these posts every week but I want to share my latest communication with Endo. I had my first appointment with him end of last year and he was very sceptical about the use of T3 - it will cause osteoporosis BUT he was willing to prescribe and test with his ultimate goal to increase my TSH which is low and has been low. He prescribed the following:

T4 - 75mg

T3 - 20mg

Readings end of last year:

TSH: 0.01 (.27-4.20)

T4: 12.7 (11-25) - 12.14%

T3: 5.2 (3.10-6.8) - 57%

B12: 609 (180-900)

Folate: 8.9 (>3)

Ferritin: 58 (15-300)

Vit D: 64.2 (50-250)

TPO: 11.6 (0-115)

TgAB: <9 (0-34)

Latest readings

TSH: 0.01 (.27-4.20)

T4: 14.1 (11-25) - 22%

T3: 5.4 (3.1-6.8) - 62%

His letter : based on the test the TSH is still low and would suggest a dose reduction of T4 down to 50mcg and 20 mcg T3 - if you want to remain on the combined treatment. And to test again in 6 weeks.

I'm scared to lower T4 that low because i remember being on that and feeling so ill before (but i wasn't taking T3 then). What do you think/thoughts? I'm still overweight, exhausted, thin hair, forgetful, clumsy - all those great hypothyroid attributes - but don't want to make them worse.

Thanks 😘

[SlowDragon Administrator]

was test done as recommended…..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

Taking almost any dose of T3 will almost always suppress TSH ……that’s just what T3 does

Many, many members only feel well when Ft4 and Ft3 are at least 50-60% through range

Have you retested vitamin levels

EXACTLY what vitamin supplements are you taking

Vitamin D, ferritin and folate all needed improving

[missrees in reply to SlowDragon]

Blood test wasn't best as the appointment they gave was midday. I hadn't eaten and no caffeine and yes for the levo and T3. So - yes that could definitely have had an impact on results.

Vitamins that i've been taking since the last test are:

Vit D

Ferrous Fumurate (although all the GP's don't think that i have a problem, of course)

Selenium

Zinc

Magnesium Glycinate 3-in 1 (+ malate + citrate)

My restless legs aren't so bad at the moment and only happen if I am tired - so that is good news.

HRT is not so great and hopefully seeing someone about that and perhaps switching to a different medication - that might help with the edema!

Do you think i should retest everything before lowering T4? And i know that T3 will lower TSH - so if i lower T4 I'm not sure that will get the increase in the TSH that the endo will want. Maybe

I have been at between 50-60% through the range for T4 previously but maybe haven't had the T3 in the perfect spot at that time or the HRT.

[jgelliss in reply to missrees]

Lower my T4 gives me aches and Pain. I would be very careful lowering the T4.

[SlowDragon Administrator]

Can see on your other posts you have Restless Legs Syndrome

Important to maintain Ferritin at least over 100 with RLS

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 3-5 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

[AKatieD]

Retesting may give you yet lower results for free T3 and T4 (if not TSH), but as they are already low, especially the T4 that he wants to reduce, I would argue rather than accept.

He will probs ignore you but I would point out the low free T4 and say that suggests you need more levo and that you would like an increase in dose please. He can only say no, but I would try it.

You could argue for more T3 too but I am guessing it would be pointless and the T4 may increase your T3 anyway. If he offers less lio for an increase to levo would refuse that too, pointing out free T3 is not high either so you would like to see how the levo does first.

Depends how determined you are prepared to be in the face of "informed"opposition. I can't claim to be that myself as I just buy it abroad, lol, but wish I could.

[missrees]

thanks  AKatieD - yes exactly. I have a feeling that he’s trying to make it difficult for me and won’t agree. At my first appointment he already had a paper on his desk ready for me to read about the dangers of T3 with regard to osteoporosis. So it was : if you want to use the combination you need to increase your TSH. But I find it really strange that he’d want to reduce T4. I might try for a 2nd opinion - hahaha! 🤣 somewhere…!