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Fertility question - TSH high, FT3, FT4 normal
Hi everyone,
I am hoping for some input on my latest thyroid numbers. A little background - My husband and I are now trying to conceive, as I thought my thyroid was finally regulated after 9 months on levothyroxine. Last year I was diagnosed with Hashimoto's. My TSH was very elevated (57), FT3 and FT4 were low, antibodies were present - so there is no question that I had full-blown autoimmune hypothyroidism. My primary care physician started me at 125 mcg of levothyroxine (taking a "start high, move down" approach to dosing.) Over the course of 4 months, she moved me down to 112 mcg, and then 100 mcg, because bloodwork showed I'd gone hyper. I then started being treated by an endocrinologist, who immediately dropped me to 75 mcg, with no new bloodwork, based only on reflexes and symptoms (and horrified by my PCP's approach.) My next bloodwork showed that at the 75 mcg dose, TSH was 1.93, FT4 was very slightly elevated, so, he dropped me again, to 50 mcg. These are my numbers (now about a month old - it took me forever to get the results) for that bloodwork:
TSH = 5.22 (0.27-4.20)
FT3 = 2.6 (2.0-3.5)
FT4 = 1.47 (0.90-1.60)
So, FT4 is good, FT3 is good (maybe on the lower end of normal though?) but the TSH is elevated. My endocrinologist will not up my dosage because FT4 is good. My question is - does the elevated TSH matter AT ALL if the other numbers are fine? (I'm not talking about subclinical hypothyroidism and deciding whether someone has a thyroid problem - I mean in my case, with a clear problem and having been treated for close to a year.) Would it be normal to up the dosage (or maybe take an extra pill or two a week) to lower the TSH? I am pretty much asymptomatic at this point, and would be unconcerned about the TSH, except that absolutely everything I have read about fertility and thyroid issues says that the optimal TSH level for conception is between 1.0 and 2.0. I am wondering if those who give this "optimal level" are assuming a better correlation between TSH and thyroid hormones - that is, is 1.0-2.0 stated because of an assumption that anything over 2.0 will coincide with low thyroid hormone levels, but my body doesn't quite work that way? Or, does having too much TSH in itself cause problems for fertility?
If anyone has any medical knowledge about this or personal experience (particularly with the fertility issue) I would love to know!
I am hoping for some input on my latest thyroid numbers. A little background - My husband and I are now trying to conceive, as I thought my thyroid was finally regulated after 9 months on levothyroxine. Last year I was diagnosed with Hashimoto's. My TSH was very elevated (57), FT3 and FT4 were low, antibodies were present - so there is no question that I had full-blown autoimmune hypothyroidism. My primary care physician started me at 125 mcg of levothyroxine (taking a "start high, move down" approach to dosing.) Over the course of 4 months, she moved me down to 112 mcg, and then 100 mcg, because bloodwork showed I'd gone hyper. I then started being treated by an endocrinologist, who immediately dropped me to 75 mcg, with no new bloodwork, based only on reflexes and symptoms (and horrified by my PCP's approach.) My next bloodwork showed that at the 75 mcg dose, TSH was 1.93, FT4 was very slightly elevated, so, he dropped me again, to 50 mcg. These are my numbers (now about a month old - it took me forever to get the results) for that bloodwork:
TSH = 5.22 (0.27-4.20)
FT3 = 2.6 (2.0-3.5)
FT4 = 1.47 (0.90-1.60)
So, FT4 is good, FT3 is good (maybe on the lower end of normal though?) but the TSH is elevated. My endocrinologist will not up my dosage because FT4 is good. My question is - does the elevated TSH matter AT ALL if the other numbers are fine? (I'm not talking about subclinical hypothyroidism and deciding whether someone has a thyroid problem - I mean in my case, with a clear problem and having been treated for close to a year.) Would it be normal to up the dosage (or maybe take an extra pill or two a week) to lower the TSH? I am pretty much asymptomatic at this point, and would be unconcerned about the TSH, except that absolutely everything I have read about fertility and thyroid issues says that the optimal TSH level for conception is between 1.0 and 2.0. I am wondering if those who give this "optimal level" are assuming a better correlation between TSH and thyroid hormones - that is, is 1.0-2.0 stated because of an assumption that anything over 2.0 will coincide with low thyroid hormone levels, but my body doesn't quite work that way? Or, does having too much TSH in itself cause problems for fertility?
If anyone has any medical knowledge about this or personal experience (particularly with the fertility issue) I would love to know!
Hi, I'm wondering if you ever found an answer to your question. I'm wondering the same thing, as I have normal FT4 and very low TSH (so, the opposite of your problem, but I too am hypothyroid and probably just taking too much meds). I'm lowering my dose and will hopefully get my TSH into a normal range, but for the purposes of TTC in the next few months, I'm wondering the same thing you were. Does TSH matter if FT4 is normal and we are asymptomatic?
Thanks for your response. Yeah, I am just on levothyroxine (generic Synthroid) a T4 replacement. I haven't had a problem with it, although Synthroid is what was actually prescribed, and the pharmacy filled it with generic. I always make sure I'm getting levothyroxine from the same manufacturer. I've found it to be effective and my symptoms have gone away, and all of my numbers have made sense until now. I understand the difference between TSH and the thyroid hormones, and the fact that TSH is a hormone produced by the pituitary gland. I didn't, in this question, ask if the Free T3 looks too low (as you suggest), but that IS also a question I have. My endocrinologist didn't question it, as it is within the normal range, but I have wondered if it should be higher and if, as you say, I have a conversion problem.
What prompts you to think I have a pituitary problem? In general I have had the high TSH/low Free Ts typical of people with thyroid problems, and antibodies are present, hence my diagnosis of Hashimoto's. Is it the fact that there doesn't seem to be quite the correlation between TSH and Free Ts that is usually seen? That is, as I posted, initially my TSH was WAY high (57) when the Free Ts were low, but they were not quite as low as one might expect given my incredibly high TSH. And even here, my free Ts are within the normal range, but my TSH is high, just outside the lab's normal range. Are you thinking an overactive pituitary gland? All of my numbers since going on levothyroxine (until these latest numbers) have been as one would expect - with my high initial dosage, I went hyper, so my TSH was extremely low and my free T4 (the only thing they tested at the time) was high. That situation continued, to varying degrees, as my dosage was adjusted downward. With my numbers before the most recent numbers, TSH was well within the normal range, and free T4 was just VERY slightly above normal, so I'm not even sure a downward adjustment was needed, but it was adjusted downward by 25 mcg. Now is the only time that my free Ts have been normal but my TSH high. I don't know that there is anything to suggest a pituitary problem other than maybe thinking, as my endocrinologist has suggested, that my pituitary gland is unusually sensitive to even slightly out of balance thyroid hormones.
My main question is about these numbers as they relate to fertility. Everything I have read had said that the TSH should be between 1.0 and 2.0 for optimal fertility. Yet, as far as I know, it's the actual thyroid hormones, and not thyroid stimulating hormone, that affect fertility. So, I want to know from a medical standpoint whether an elevated TSH matters to fertility if the free Ts are "normal." I want to know if those who say TSH should be between 1.0 and 2.0 say that because for most people, a TSH above 2.0 would probably coincide with somewhat low free Ts. And, many doctors only test TSH rather than testing the free Ts. So I am curious if that guideline of TSH between 1.0 and 2.0 can be thrown out as long as the actual thyroid hormones are within normal ranges. OR, does having too much thyroid stimulating hormone, regardless of thyroid hormone levels, have a negative effect on fertility, too?
(As for the free T3, I am interested in what you have to say about taking a T3 supplement to further suppress TSH... but would the free T3 level as it is now be problematic to fertility? It's on the lower end of normal, but still normal.) Also, like I said I am asymptomatic at this point. If it weren't for trying to conceive, I wouldn't be concerned about these numbers.
What prompts you to think I have a pituitary problem? In general I have had the high TSH/low Free Ts typical of people with thyroid problems, and antibodies are present, hence my diagnosis of Hashimoto's. Is it the fact that there doesn't seem to be quite the correlation between TSH and Free Ts that is usually seen? That is, as I posted, initially my TSH was WAY high (57) when the Free Ts were low, but they were not quite as low as one might expect given my incredibly high TSH. And even here, my free Ts are within the normal range, but my TSH is high, just outside the lab's normal range. Are you thinking an overactive pituitary gland? All of my numbers since going on levothyroxine (until these latest numbers) have been as one would expect - with my high initial dosage, I went hyper, so my TSH was extremely low and my free T4 (the only thing they tested at the time) was high. That situation continued, to varying degrees, as my dosage was adjusted downward. With my numbers before the most recent numbers, TSH was well within the normal range, and free T4 was just VERY slightly above normal, so I'm not even sure a downward adjustment was needed, but it was adjusted downward by 25 mcg. Now is the only time that my free Ts have been normal but my TSH high. I don't know that there is anything to suggest a pituitary problem other than maybe thinking, as my endocrinologist has suggested, that my pituitary gland is unusually sensitive to even slightly out of balance thyroid hormones.
My main question is about these numbers as they relate to fertility. Everything I have read had said that the TSH should be between 1.0 and 2.0 for optimal fertility. Yet, as far as I know, it's the actual thyroid hormones, and not thyroid stimulating hormone, that affect fertility. So, I want to know from a medical standpoint whether an elevated TSH matters to fertility if the free Ts are "normal." I want to know if those who say TSH should be between 1.0 and 2.0 say that because for most people, a TSH above 2.0 would probably coincide with somewhat low free Ts. And, many doctors only test TSH rather than testing the free Ts. So I am curious if that guideline of TSH between 1.0 and 2.0 can be thrown out as long as the actual thyroid hormones are within normal ranges. OR, does having too much thyroid stimulating hormone, regardless of thyroid hormone levels, have a negative effect on fertility, too?
(As for the free T3, I am interested in what you have to say about taking a T3 supplement to further suppress TSH... but would the free T3 level as it is now be problematic to fertility? It's on the lower end of normal, but still normal.) Also, like I said I am asymptomatic at this point. If it weren't for trying to conceive, I wouldn't be concerned about these numbers.
The Free's are the active thyroid hormone in the body. TSH is a pituitary function test.
It looks to me that you are having a conversion issue here. Are you on a generic T4 med? I highly recommend that you ask your Dr to prescribe brand name only of T4 meds. You might ask for a trial of T3, it may do the trick and increase your t3 level and supress your tsh perfectly. It all depends upon if you have a thyroid dr who understands T3.
It may also warrant a follow up with further pituitary testing. Only my opinion of course.
It looks to me that you are having a conversion issue here. Are you on a generic T4 med? I highly recommend that you ask your Dr to prescribe brand name only of T4 meds. You might ask for a trial of T3, it may do the trick and increase your t3 level and supress your tsh perfectly. It all depends upon if you have a thyroid dr who understands T3.
It may also warrant a follow up with further pituitary testing. Only my opinion of course.
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