There's absolutely no way that your results could be overactive! Did your doctor give you a reason why she thought this?
The reason that your T4 hasn't been tested is probably because your TSH is now in range so the labs won't automatically check it. This actually goes against the official guidelines which recommends that both TSH and T4 should be checked while optimising therapy, which is definitely the stage that you are still at. See the second half of page 25 at acb.org.uk/docs/TFTguidelin... UK Guidelines for the Use of Thyroid Function Tests
"The measurement of both TSH and FT4 is required to optimise thyroxine replacement therapy"
A TSH of 2.93 means that you still need more thyroxine. See this article on normal TSH at tinyurl.com/yyodja
and also this article aimed specifically at GPs in their own magazine, 'Pulse':
"Endocrinologist Dr Anthony Toft answers GP Dr Pam Brown’s questions on thyroiditis, thyroid eye disease and thyroxine dosing"
This is an extract from question 6:
"6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?
The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).
Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.
While taking both hormones it is important serum TSH is normal and not suppressed. If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed."
You were severely hypothyroid when diagnosed and it can take *ages* to even begin to feel well again I'm afraid. I found that rather than feeling 'better' I was 'less bad' in some respects at first. I found that I didn't tire quite as much and my recovery time became less and pain eased a bit.
Take care not to do too much at once, pacing works best. Getting a burst of energy (yes it will come!) and then doing loads can really knock you back, often for many days. Try to do about 70% of what you think you can do and always keep a bit of energy in reserve if at all possible. It's not easy to do at all (been there got the Tshirt!) but it does help.
Do you know why TSH has to be normal and not suppressed when adding t3? I take both t4 and t3 and my TSH is suppressed but ft4 and ft3 are high within the normal range and I do not have any symptoms of hyper - blood pressure/pulse are fine? This has been the situation for some time and I assumed it was OK because I read Dr Toft's book and it does not mention that you should not be TSH suppressed if taking both t4 and t3.
Hi Nicky, It's because of the possible effects on the heart and bones. Doctors know that patients who become hyper (and I mean those who are at those levels naturally, not hypo and taking meds) with over range levels of T4 & T3 and a suppressed TSH are far more likely to get bone and heart problems, e.g. osteoporosis and atrial fibrillation.
It used to be thought that it was the high levels of T4 and T3 causing osteoporosis but some recent studies have shown that TSH is needed as part of bone turnover and suppressive levels can cause bone problems. See springerlink.com/content/26...
Having said that, my TSH is suppressed like yours and has been for years but I feel really ill if I reduce my meds (currently Erfa Thyroid but was Armour & T3) so I intend to carry on as I am. At least I am currently well and have a good quality of life again after far too many years of barely existing.
If I reduce meds I can't walk far, or quickly either, so that in itself would have a negative effect on my bone density, as would the many years of ill health and subsequent inactivity before I was finally diagnosed as hypothyroid and treated.
It's a bit of a catch 22 but I couldn't bear to go back to the miserable existence that I had before. If I had heart problems I might have to consider reducing meds but I don't, the palpitations and breathlessness that plagued me when I was hypo have all gone.
"Some patients have made an informed decision to take a higher dosage of thyroid replacement than is required to maintain the TSH level within the reference range. This usually results in a TSH level of <0.1 or <0.03 mU/L. This is a risk especially in those with dysrythmias such as atrial fibrillation and those with osteoporosis. In such circumstances the informed patient’s decision is recorded and followed."
Thank you for replying so quickly. I suppose that I had piece of mind despite the suppressed TSH having read Dr Toft's book, but when I noticed the Pulse article differed in saying the suppressed TSH was acceptable only for people taking T4 and not a combination I started to be more concerned.
I, like you, would not like to take less medication and am in the process of trying to get a trial of natural desiccated thyroid on the NHS... the continuing search to feel better goes on!
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