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.03 TSH levels
Hello, I also have <.03 TSH and my T4 and T3s are within normal range.  I was 200 mcg and now down to 137, ut I am way to tired, constipated and muscle pain, and the doctors not sure what is happening.  Any suggestions as to why the TSH levels are not moving?


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the reason is that my tsh levels are reporting low <.01 and my t4 is 31.4 and that was at 150mcg.  A 137 mcg my  results were as follows:
free t3     4.6  range  3.5 - 6.5
free t4    21.4   range  9.0 - 23.0

tsh  <.03   range  .20 - 4.0

The endo that I was referred to said that I was <.03 since 2002 and feels that I should have never been prescribed thryo med. She actually thought I was using them to loose weight??  I was put on thry way back as I was tired, and very cold, and at sometimes at night when I was sleeping my body would shiver,  I was so cold that my teeth would rattle.  So question to ask is my tsh low or high? I get so confused especially lately, I feel like I can't comprehend the simplest thing.
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Those ranges look fine to me if you are on a T4 med.
There is no way I would come of the meds with an FT3 at that level.
IF and I say stipulate ..IF......you dont need the meds, then your levels would be sky high and they arent.
Question?
Do you still have your thyroid?
And if so.....have you been tested for antibodies?

Normally someone WITH a thyroid AND antibodies...their TSH can stay at ZERO, especially if you have Graves Disease.
Its a well known fact that those with Graves Disease AND a thyroid will very raely get that TSH up.
These are some of the questions you need answers too.

1. Do you have Graves Antibodies? (Test TSI)
2. If you are overmedicated then why isnt the Ft4 out of range?
3. If you are overmedicated then why is the FT3 lower than it should be?


These are all questions I would be asking or .....
I WOULD GO SHOPPING......

DOCTOR SHOPPING.

Get another Doc/Endo because this one obviously has his/her head stuck in the sand.
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Just my opinion, but I think that goolarra's post of 3/9 is right on the mark regarding your FT3 level being too low and contributing to your symptoms.  Remember it should be all about symptom relief, not TSH level.  In order to get symptom relief the level of thyroid medication I have been on suppressed my TSH level to less than .05, for over 25 years now.  You need a source of T3 added to your meds.
Personally, I would not continue to follow the doctor's direction to reduce your current meds.  I agree with the suggestions to find a good thyroid doctor.
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Your FT4 came down nicely with the change from 150 to 137.  It's back in range and looks good.  You just need the T3.  Don't let your doctors put you through hypo he// to prove you need meds...that's cruel.
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649848 tn?1484935765
I agree with gimel and goolarra -- my TSH levels stay lower than yours are and we ignore them so long as my FT3 and FT4 stay good.  

Your FT4 is quite high, even though in range.  You might want to cut back "slightly" on the T4 med and add a small amount of T3 med to bring your FT3 up.  I agree that the low FT3 is most likely what's causing your symptoms.
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Hello again, it's been 6 weeks, and i went to the doctor today to get my results  My TSH is <.03 TSH,  T4 is 22 and the  T3 is 4.6.  So within the next day i will be on 0.1mcg synthroid.   I am so tired and fuzzy brain but the doctor still thinks I need to come off.  So, stay tune for the next blood work:)
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Your FT3 still looks too low.  The reduction to 100 mcg levo is understandable, but what about your hypo symptoms?  Were you still on 137 prior to these labs?
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I am not an expert, but I am and have been down a very familiar road. First, I HIGHLY recommend you get a new doctor. Don't assume this doctor will figure things out. Life is too short, and you deserve to feel good!

I had the same scenario as you, major suppressed TSH (doesn't really matter!) I had cancer so this was good, however I still had MAJOR hypo symptoms. Chilled all the time brain fog, you know...the works fun stuff. I found an awesome doctor that really knows his stuff (Thank you Lord!) He did a host of panels hormones, thyroid, lipid, you name it. I was deficient in quite a few things, and also had a high reverse T3. BTW...I was on a Levo T4 for about 6 months feeling well maybe a handful of days.

I am now on a host of Pure Encapsulation supplements along with iodine, and dessicated Nature Thyroid and my body temp has come up, I am sleeping a tad better and think I am getting there....please please.

I really think you need some T3. Whether Cytomel (synthetic, or Dessicated) I think this will alleviate a majority of your symptoms. Please note that I think an adrenal support system should also be done when implementing T3. Cytomel works very fast and will get you adrenals going. Don't be suprised if you feel hyper the first few times.

In summary.... New Doc....some T3, probably slow converter, and adrenal support (pure encapsulation ADR?)
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Hello Fuel1212, I agree I do deserve to feel good, but I have two endo's and 2 doctors that are telling me to go off the thryoid meds, and so to obtain another doctor will not likely happen as it is tough to find doctors that are taking on new patients.  I asked my doctor today again and he still thinks that once I am totally off the thyroid meds, my tsh will move up.  I asked them about Cytomel and he said that it wouldn't matter as that is what the studies show.

To Goolarra, I have been on 125mcg for the past 6 weeks.

Question, it seems that my T3 has not moved at all.  When I was taking the 150mcg, my levels were t3 4.6 and t4 is 31.4.   When I was taking 137 mcg my  results were T3 4.6 and T4   21.4 . Now at 125, my T3 is 4.6, T4 is at 22 and my TSH in all of this is still <.03 . Why is it that only the T4 seems to move?
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I have always found that my FT3 "lags" FT4.  As I'm increasing, FT4 will go up in six weeks, but FT3 may take a while longer to reflect the rise in FT4.  Of course, the opposite for decreasing.  

T4 is the "storage" form of the thyroid hormones.  No receptors have ever been identified for T4...it has to be converted to T3 before your cells can use it.  So, as long as there are adequate supplies of T4, and your body is still looking for more T3, the level has a tendency to remain the same because you are not converting enough (but you are converting as much as you can).  Another way of saying that is that you have plenty of T4, and your body is converting as much T4 to T3 as it can, but it's still not enough T3.  So, the level is staying the same and most likely will until your T4 falls to a level where your (slow) conversion ability no longer has enough T4 to convert.

However, your FT4 does continue to rise marginally despite the decreases.

You do need a doctor that treats based on symptoms, FT3 and FT4 in that order.  I wish I could suggest an alternative, but I think you will not feel well until you find a doctor who knows what he's doing and is willing to add some T3 to your meds.
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You can get as much T4 and supress the pituitary (TSH) to make the numbers look hyper and overmedicated. The problem, like I said and these docs need to realize is that if you don't convert to the active T3 you are going to have symptoms no matter what doseage, or no doseage. Do you feel hyper...from what I read, it didn't soundl like it. You body will tell you when you are hyper, no matter what the TSH.
Mine is .06 and I have no hyper symptoms, in fact I was not converting and felt hypo.

Question...if you take a close up picture of your eyes especially the corners, do you see a yellowish tint? I am going to bet that you will see this. This is an indication that your liver is not converting and the T4 is buiding up. It collects as carotene I believe?

If you are from IL I have an awesome doctor. Feel free to message me.
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Well, I do not feel hyper at all, more on the hypo side.  I live in edmonton, alberta.  I do have a yellowish tint in the corner of my eyes.  Can you tell me where else I can go to do some more reading to find out more about this?
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okay, another 6 weeks have gone by and the results are .07 tsh level, and the T3 and the T4 didn't move from my last test.  I am exhausted and tired all the time, and the doctor has agreed to keep me on the .1mcg for another 6 weeks as I am way to tired and I felt that if he lowered my meds again my body would be worse off.  Any suggestions on what I can do to give me more energy?  I have been getting a vitamin b shot (gives me energy) every three weeks, but this time it's been 3 days since my shot and I am still exhausted.
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Has your doctor ever considered that the TSH is frequently suppressed below ref. range when taking thyroid meds.  That doesn't mean you are hyper, unless your FT3 and FT4 levels are excessive and you are having hyper symptoms, which is not the case.  My TSH was less than .05 for over 25 years and most of that time I still had lingering hypo symptoms, until I learned about FT3 and adjusted my meds to increase the level.  Now I feel best ever.

I thought you might like to read through some of these patients' remarks about low TSH.

http://www.altsupportthyroid.org/tsh/tshexp1pr.php

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649848 tn?1484935765
I'm another whose TSH stays in the basement (latest was less than 0.03) and I'm a long way from being hyper.  My FT3 and FT4 levels have been good, so we ignore the TSH.  

Since your doctor agreed to let you stay on some T4 med, is it possible that you could approach the idea of T3 med again?  Would it help if you print out some info regarding the use of T3 meds and take it to him?  Some doctors are open to various treatments if you can show that them it's a good thing.  I had a lot of the same issues until I finally got in to see my endo, who immediately put me on cytomel to bring my FT3 levels up.  
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hello again, i am tired and gained a few pounds even though I am dieting and walking running at least 5 days a week, but lately like 4 weeks ago, i got vertigo and I am still not over it.  Does vertigo have anything to do with my meds being lowered??  How can I get my metabolism to work so I don't gain any more weight??  Please and thanks
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Hello, I am wondering if I go to the doctors and ask him to give me 5mcg of Cytomel, and how much do I need of my synthroid?  I am on .1 mcg.  I am hoping by approaching the doctorsw this will help me with foggy brain, tiredness and weight gain.  
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Hi there,

Hope you are feeling better. It looks like you are on 100mcg of Synthroid. You are wondering about the Cytomel. Synthetic T3 works very fast. If it were me, I would start on 2.5mcg of Cytomel a day. Make sure you don't have major hyper symptoms. Eventually, you could go to the 5mcg maybe 2.5 in the morning and 2.5 in the afternoon to keep you going. I wouldnt take it too late because it may effect your sleep.

If it were me, and I am not a doctor, but feel pretty confident in this being where you are. I would guess you are not converting properly. You also may have some adrenal issues. Being from Canada, I would find a good doctor that prescribes ERFA. Start our with 60mg or 1 grain and get some ADR by Pure Encapsulation to support the adrenal with repair. Do that for about 6 months and see where you are of course testing every 3 months or so.

Hope this helps
Fuel
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Hello again,  I have gone back to get my blood results and they are:
free t3   4.1 (ranges 3.5 - 6.5)
free t4  16.6  (range 9.0 - 23.0)
tsh   .79  
YIPPY in one way and Boohoo in the other.  So I went and saw another doctor in the office and he said my levels are fine and to stay at the .1 mcg.  I asked him about the cytomel as I am tired, foggy brain, and weight gain, and he said  "NOPE"  that the levels are all fine and there is no need to change anything. He said that the  T3's are within range, and maybe I should try some Omega fish oils, and or some stress tablets????  So, I am going to see another doctor tomorrow to see if he will do something for me and hopefully prescribe me some cytomel so that I can feel normal again.  Question, what should the are the "normal" counts for the T3 and the t4's?  What should I suggest the doctor give me??  Do I stay at the .1 mcg and the 5 mcg cytomel?
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393685 tn?1425816122
You're close to what many find good. Definately in the majority of patients upping that Free T3 level some could be very helpful.

I saw on the T4 level however. You could drop down to .88 mcg while adding in the .5mcg Cytomel or stay at the .100mcg Synthyroid and still add either a 2.5 mcg or the .5 mcg Cytomel

Either way the Cytomel would be good to push with this other doctor to bump that T3 level more. You are hovering right in the middle where most patients find being in the upper 3/4 to even 95% to the top of the reference range makes them feel better.

I don't think adding more T4 - depending on that alone to convert is good here and the "tweek" of adding in direct T3 could definately be your answer.

You will need to test all these levels in 4-6 weeks after you get the Cytomel and definately start a log after you start that script to track your symptoms to show the doctor you goods/bads since you started. Taking your symptoms and the new labs after you start T3 will determine what you should do next if anything at all.
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Okay, I am so excited.  I went to see an old doctor of mine and I told him what was happening and he left me on .1 mcg of synthroid, and told me to take 3   .5mc of cytomel.  However, I am not sure how I am going to feel so I'll only do 1 for now.  Am I right?
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You are absolutely right.  15 mcg of Cytomel is a relatively high dose.  Many people find that 2.5 to 5 mcg helps tremendously with symptoms.  I think your idea of starting at 5 mcg (you could even split the dose into two during the day) is an excellent one.  Give it a few week at 5 mcg, then increase if it still seems you need it.  Your labs are not that far out of range...in fact, it might even be best to start with 2.5 mcg.  Better to start out slowly and increase than to go at it too fast.  Good luck!
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Hello.... it's been awhile, so I thought I could give you all an update.  I have been taking 2    .5 mcg of cytomel and still on the .1 levo and I am feeling great.  I am not foggy brain, tired, etc but full of life. I just got my blood work back and my blood work is t3  5.5    (3.5 - 6.5) t4  17.00  (9.00 to 23.00) and guess what my tsh is once again <.o3 again.  
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649848 tn?1484935765
Wow - your labs look great (those are FREE T3 and FREE T4, aren't they?) and even better to hear that you feel so good.  It's wonderful to see someone having success with this roller coaster............ I'm so glad you posted, as your experience may help keep others from getting discouraged............

Congratulations.
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Yes, thanks for the update.  We love to hear success stories!  Your labs look great, you're feeling great....don't let your TSH worry you a bit.
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Hello. Well it's been a long time and not sure what happened.  I started to take 25mcg of triiodothyronine and 25synthroid.  Things were going good as I was feeling great and got a revile on my trio meds and started to feel great.  I was alert and then i started to experience anxiety and night sweats.  Got another 20 of the trio meds as I thought it was the compound mixture and now I am tired all day had had one episode of night sweats except for last night it started at three in the morning until I got out of bed at five thirty.  Went to the doctor today and blood tests showed  free. T3. 4.7.  Freet4.  7.2.    Tsh.   36.6.  I am exhausted, hate my weight as all I need to do is look at food and I gain weight. Can I do something to get my thyroid metabolism working right.
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Am I reading correctly that you've been taking 45 mcg of T3 and no T4 recently?

What are the ranges on your FT3 and FT4?  Ranges vary lab to lab, so they have to come from your own lab report.
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Hi, I am on 25 mcg of triiodothyronine and 25 mcg of synthroid.  As for my ranges, my Ft3 is 4.7 and Ft4 is 7.2.  I am experiencing night sweats even when I take 1/2 a capsule of the triidothyronine and 25 mcg of synthroid.  I am foggy brain and not sure what I can do to feel better.
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649848 tn?1484935765
When goolarra asked for the ranges of your tests, she didn't mean the  4.7 for FT3 and 7.2 for FT4 - those are your results...... on your lab report, there should be reference ranges, sometimes in parenthesis beside the result.  If your levels fit inside those ranges, you are considered "normal" by most doctors..  We need to know what those ranges are, in order to see where your levels fall within the ranges.
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okay here they are Ft3 range  (3.5 - 6.5)   t4  (9.0 - 23.0).  I am considering on taking 50mcg of synthroid and 2 X5 mcg of citomel.  The only problem is that if I take the 5 mcg twice a day, my energy level drops and I am lethargic.
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649848 tn?1484935765
Let me put this together and you tell me if I'm right.

FT 3 = 4.7 (range 3.5-6.5)
FT 4 = 7.2 (range 9.0-23.0)

Your FT4 is way below range and your FT3 is low in its range... It seems that you need an increase in your synthroid dosage.

The cytomel should give you energy, not cause it to drop; however, some people do report worsened symptoms with an increase in medication for a period of time.  

I wonder, though, if you should ask your doctor for an increase in synthroid, to something like 50 mcg and maybe only 5 mcg cytomel.
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thanks Barb,  that is what i was thinking of doing on my own. The doctor wants me to stay with the meds, but i am to sick to stay on.  I have 50mcg of synthroid and 10 mcg of cytomel and getting off the triiodothyronine  as I think that it is to strong for me. Am I going about this right and try it?  If so, when should I notice a difference.

Truly appreciate this Barb
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649848 tn?1484935765
"I have 50mcg of synthroid and 10 mcg of cytomel and getting off the triiodothyronine  as I think that it is to strong for me."

Cytomel is the brand name for triiodothyronine; are you taking both brand and generic  triiodothyronine?

It's late in my world, so I'm off to bed, but will check back in, in the morning; otherwise, maybe someone else will come along......
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The triiodothyronine is a compound and from what I understand it's suppose to be like cytomel but long lasting.  I currently take 25mcg of the triiodothyroxine but because it gave me the jitters, and I thought my head would explode I am opening up the capsule and pouring out half the compound and I still feel sick.  If I only take 10mcg of the pill form I wonder if that will drop my t3?  Should I take the 10 mcg first thing together with my 50mcg of synth rood?
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If I unserstand you correctly, and you've been taking 25 mcg of T3 (sounds like it might be time released), if you discontinue the T3 you've been taking and switch to 10 mcg of Cytomel, you can expect your FT3 to drop.

I agree with Barb, your FT4 badly needs to come up.  

As for the T3, have you been taking 25 mcg all at once?  Most people who take T3 meds will split the daily dose in two, taking half first thing with Synthroid and the second half sometime late morning or early afternoon.  T3 is very fast-acting, and that smooths out some of the peaks and valleys.  Most people avoid taking it after about 3:00 pm (on a "normal" sleep schedule) so it doesn't interfere with sleep.  You might have to experiment a little to see what works best for you.
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How do I split it if it's a capsule?  Today I took 50mcg of synthroid and 2    5mcg of cytomel and I am having hot flashes.  Maybe I should only do1 in the morning and another one at lunch?  Thanks so much for all your replies and help lets see if tonight I get the night sweats

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What exactly have you been taking?  How much Synthroid, how much Cytomel and how much of the T3 "capsule"?

You can't effectively split a capsule.  You have to get the meds in another form so you can take less at a time.

Today, when did you take the 50 mcg Synthroid, and when did you take the two 5 mcg Cytomel?

Please, be very specific about exactly what you take when.  
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I am taking 25mcgof synthroid and 25mcg  triiodothyronine capsule form.  My understanding is that this is a compound as it is not found in all the pharmacies I can only go and get it in one place   This morning at eight I took 50mcg of synthroid and 2 tablets of 5mcg of cytomel as I still have some left from last year.  As for the triiod meds they come in a capsule form and I used to open the capsule and empty half close the  capsule and then take it but it felt like my head was going to blow off and lots of anxiety and night sweats.
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If the triiodothyronine capsule is all T3 (25 mcg), that's a big dose, especially to take all at once.  Do you get it at a compounding pharmacy as a prescription, or is it sold over the counter?  

If I were you, I think I'd try taking just 5 mcg of Cytomel in the morning with your Synthroid and taking the other, as you suggested at lunch time.  If you feel better doing that (don't have the jitters, etc.), you can ask your doctor about increasing a little if you still lack energy.
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Its a compound and I am praying that taking 5mcg in the morning and then again at lunch will do the trick. Thanks again goolarra and barb
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Its a compound that is made at one pharmacy cannot buy it over the counter.  I noticed that be taking the 50mcg synthroid and 10mcg of cytomel I get hot flashes during the day. Not sure I understand it as I was taking 25 mcg of triiomeds and only had night sweats and jitters and with 10mcg in pill form I get hot flashed during the day and I am tired
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649848 tn?1484935765
You said on April 14: "I am taking 25mcgof synthroid and 25mcg  triiodothyronine capsule form"......... Now you say: "I noticed that be taking the 50mcg synthroid and 10mcg of cytomel I get hot flashes during the day".

Did you change your synthroid dosage?  Do you I understand correctly, that you now take 50 mcg synthroid and 10 mcg cytomel?

Sometimes, changing a medication or dosage can cause different symptoms.  Also, keep in mind that it takes several weeks for the synthroid to build up in our system, so you won't feel effects of it, right away.
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Hello Barb,
yes I decided to figure this out on my own as the capsule pills were going to give me a heart attack.  The pressure in my head was to much and even when I only took 1/2 the capsule (over 1 week) it still gave me severe headaches.  I have been on the capsules for over three weeks now and not getting better.  I hope I have done the right thing.
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649848 tn?1484935765
How long can you stay on that dosage (50 mcg synthroid, 10 mcg cytomel)?  It's going to take several weeks (or more) to stabilize; do you have enough of each of the pills to go that long?
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Hello, its been awhile and I thought I'd give u all an update.  I have been taking 50 mcg of synthroid and one 5 mcg cytomel in the morning and then another one in the afternoon.  How am I feeling... I am tired and I am still having sweats and my voice is hoarse and can't think straight.  I know I have to wait but for how long.  I am now experiencing day sweats as well as night sweats.  What the heck is going on??  HELP!  Do I have to give it more time?
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Hi, I posted last night but did not add anyone.  Please read my previous post. Thanks
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649848 tn?1484935765
We volunteer our time here, so none of us is online all the time and we can't always respond as soon as comment is posted.

It doesn't sound like you are getting any better, but then it hasn't been all that long since you changed doses and it does take a while for it take effect.  Most of your symptoms are hypo, but being tired can be either, hypo or hyper.  The sweats indicate hyper.  It's really hard to know without seeing another set of labs.

It takes at least 4-6 weeks before a med dose has full effect and you've only been on the 50 synthroid and 10 cytomel for about 10-12 days.  

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Thanks  for all your advice and time and patience. I totally understand and I appreciate everyone's feedback.  I just thought I did it wrong:(.    I guess I need to wait and see
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Could you please tell me who the tyroid dr is in IL? I have had nothing but trouble and no luck at all since having thyroid cancer l9 yrs ago and I have been on every mcg of synthroid there is whith only side affects...esp hair loss to show for it.

could you possiblly email me this at ***@****
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649848 tn?1484935765
Fuel1212 has not been active on the forum, for approximately, 2 years, so it's unlikely, you will get a response.  You might try sending him a PM and see if he still checks, those periodically.
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649848 tn?1484935765
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FL
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MI
1756321 tn?1499064984
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Queensland, Australia
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657231 tn?1453836403
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Northern, NJ