Does taking T3 with T4 suppress TSH, evidence please?

[Coachv]

I am taking 115 mg T4 and 10mg T3 daily and I feel reasonably okay. But my annual check has come round and now I need the 'TSH is suppressed' conversation. GP wants me to reduce my dose due to suppressed TSH. Its been suppressed for some years and so far I have avoided reducing the dose, but as I am 58 and 'menopausal' GP are getting agitated. Recently I decided to reduce my T4 from 125 daily as I was getting some occasional mild palpitations, which have now stopped, and I don't want to reduce further as when I reduced it to 100 mg t4 I felt bad.

Please has anyone any articles which dispute the link between suppressed TSH and osteoporosis and/or indicate that taking some T3 can suppress TSH.

I feel okay and am also doing weight bearing exercise.

thanks!

Val

[shaws Administrator]

I don't know if the following is helpful but you can email [e-mail] and ask for a copy of the following article in Pulse Online by Dr Toft, ex President of the British thyroid association, of which this is an excerpt:-

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.

****

This is a link re osteoporosis and their are lots of interesting topics at the top of the page.

web.archive.org/web/2010112...

[Coachv in reply to shaws]

Dear Shaws

thanks very much, I will have a look at this, also saw the other post about TSH, oh dear its all very complicated

Val

[shaws Administrator in reply to Coachv]

It is only complicated because really we shouldn't be having to research to get ourselves better but if we don't it is us and our families who suffer in the end.