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If I have a very surpressed TSH should I decrease my nature-throid?
Hi everyone,
I've been on Nature-throid for close to 6 months after trying Levothyroxine for a year.
Before going on Levo, my TSH was a 6.4 indicating hypothyroidism. My antibodies are normal, and below what is considered for hashimotos.
Since being on NDT, my lab results from October were
TSH: 0.7 (0.4-4.5)
FREE T4: 0.9 (range:0.8-1.8)
FREE T3: 2.6 (range: 2.3-4.2)
I asked my doctor to raise my medication due to feeling very hypo still with things such as coldness, water retention, and fatigue.
She did raise my medication per my request from 90 mg to 113 mg.
My labs were taken again a few days ago. The results were
TSH: 0.08
FREE T4: 1.0
FREE T3: 2.9
I was very happy my FT3/FT4 numbers raised. I would like to get my FT3 up a bit more. However, she told me I need to decrease my medication by half a pill on Sunday's because my TSH is so low. I have had NO hyper symptoms. Normal/low blood pressure, no racing heart, no palpitations. I sweat a bit more now during workouts, but I never used to sweat at all before which was not normal obviously. Overall, I feel better on this dosage.
So- I had a few questions. Do I have to decrease my dosage to raise my TSH? Is it dangerous keeping it this low? Is there anything I can do to raise my FT3 without taking more medication?
My doctor is one of the "good" thyroid doctors recommended to me, and while I trust her judgement im doing better on this dose than the previous dosage.
Thank you all!
I've been on Nature-throid for close to 6 months after trying Levothyroxine for a year.
Before going on Levo, my TSH was a 6.4 indicating hypothyroidism. My antibodies are normal, and below what is considered for hashimotos.
Since being on NDT, my lab results from October were
TSH: 0.7 (0.4-4.5)
FREE T4: 0.9 (range:0.8-1.8)
FREE T3: 2.6 (range: 2.3-4.2)
I asked my doctor to raise my medication due to feeling very hypo still with things such as coldness, water retention, and fatigue.
She did raise my medication per my request from 90 mg to 113 mg.
My labs were taken again a few days ago. The results were
TSH: 0.08
FREE T4: 1.0
FREE T3: 2.9
I was very happy my FT3/FT4 numbers raised. I would like to get my FT3 up a bit more. However, she told me I need to decrease my medication by half a pill on Sunday's because my TSH is so low. I have had NO hyper symptoms. Normal/low blood pressure, no racing heart, no palpitations. I sweat a bit more now during workouts, but I never used to sweat at all before which was not normal obviously. Overall, I feel better on this dosage.
So- I had a few questions. Do I have to decrease my dosage to raise my TSH? Is it dangerous keeping it this low? Is there anything I can do to raise my FT3 without taking more medication?
My doctor is one of the "good" thyroid doctors recommended to me, and while I trust her judgement im doing better on this dose than the previous dosage.
Thank you all!
If you give your doctor a copy of the paper in the link above, then you can also point out the information about the need to test for all three of those. Hypothyroid patients frequently have low stomach acid, which leads to poor absorption of vitamins and nutrients. Thus the probability of having low D, B12 and ferritin.
1 Comments
Gotchya. Thank you!
A good thyroid doctor will treat a hypothyroid patient clinically by testing and adjusting Free T4 and Free T3 levels as needed to relieve hypo symptoms, without being influenced by resultant TSH levels. Symptom relief should be all important, not just lab results, and especially not TSH.
Unfortunately, the medical community is permeated with long held misconceptions about the value of TSH as the primary diagnostic, and as a measure of the adequacy of thyroid med dosage. TSH is a pituitary hormone that is supposed to accurately reflect Thyroid status; however thyroid status is mainly dependent on the biologically active thyroid hormones, Free T4 and Free T3. And TSH cannot be shown to correlate well with either FT4 or FT3, much less correlate with symptoms.
You can confirm what I say by reading at least the first two pages of the following link. I also suggest reading further if you want to get into the discussion and scientific evidence supporting the suggestions on page 2, and the recommendations near the end of the paper. In recommendation no. 10 on page 13 you will find specific information and references to scientific studies from which it was concluded that suppressed TSH does not automatically mean hyperthyroidism, unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
So you can try to use this information with your doctor to get her to reconsider, since you are feeling better and don't want to regress. If that doesn't work you will need to find a good thyroid doctor that understands all this.
One last thing is that hypo patients are frequently deficient in Vitamin D, B12 and ferritin due to low stomach acid from being hypothyroid. So I suggest that if not tested for those, do so and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.
Unfortunately, the medical community is permeated with long held misconceptions about the value of TSH as the primary diagnostic, and as a measure of the adequacy of thyroid med dosage. TSH is a pituitary hormone that is supposed to accurately reflect Thyroid status; however thyroid status is mainly dependent on the biologically active thyroid hormones, Free T4 and Free T3. And TSH cannot be shown to correlate well with either FT4 or FT3, much less correlate with symptoms.
You can confirm what I say by reading at least the first two pages of the following link. I also suggest reading further if you want to get into the discussion and scientific evidence supporting the suggestions on page 2, and the recommendations near the end of the paper. In recommendation no. 10 on page 13 you will find specific information and references to scientific studies from which it was concluded that suppressed TSH does not automatically mean hyperthyroidism, unless there are accompanying hyper symptoms due to excessive levels of Free T4 and Free T3.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
So you can try to use this information with your doctor to get her to reconsider, since you are feeling better and don't want to regress. If that doesn't work you will need to find a good thyroid doctor that understands all this.
One last thing is that hypo patients are frequently deficient in Vitamin D, B12 and ferritin due to low stomach acid from being hypothyroid. So I suggest that if not tested for those, do so and then supplement as needed to optimize. D should be at least 50, B12 in the upper end of its range, and ferritin should be at least 70.
1 Comments
This is great information. I will read the source you posted above.
How do I go about getting my b12, d, and ferritin tested? I asked my primary care to test them and she refused unless I had specific symptoms that called for the tests. When I ask my endocrinologist I just don't want to go about it the wrong way and get another refusal.
How do I go about getting my b12, d, and ferritin tested? I asked my primary care to test them and she refused unless I had specific symptoms that called for the tests. When I ask my endocrinologist I just don't want to go about it the wrong way and get another refusal.
I was on NT and had the same issues... however, even on synthroid, i've dropped my meds at points by 25 mcg and my TSH actually LOWERED. i think it is safe to say that us thyroidless peeps are powered by a different mechanism.
1 Comments
Yes! I still have my thyroid but I totally agree that TSH is really tricky to deal with once on medication. My doctor freaked out about my super low TSH, when my FT4/FT3 were on the very low side. Good luck to you!
Have you tried giving your doctor the info in recommendation 10 on page 13 of the link above? It provides scientific evidence that a suppressed TSH is a common occurrence when taking thyroid med adequate to become euthyroid..
1 Comments
Hi Gimel,
Sorry for the late response! I did send the information to my doctor, however she only agreed to readjust my dose to 113 mg daily (what I was on before) when her previous recommendation was to keep taking the 113 mg but split my dose in half on Sundays only.
She did say yes to my request to test my b12, ferritin, and b12 on my next blood draw along with my TSH, FT3 and FT4 coming up this feb. (which i'm very happy about!)
Although not my first choice, at this point I'm seriously considering self-titrating with NDT very slowly every 2-3 weeks by raising 1/2 a grain to alleviate symptoms, and of course continue going to the lab draws she orders every few months.
Sorry for the late response! I did send the information to my doctor, however she only agreed to readjust my dose to 113 mg daily (what I was on before) when her previous recommendation was to keep taking the 113 mg but split my dose in half on Sundays only.
She did say yes to my request to test my b12, ferritin, and b12 on my next blood draw along with my TSH, FT3 and FT4 coming up this feb. (which i'm very happy about!)
Although not my first choice, at this point I'm seriously considering self-titrating with NDT very slowly every 2-3 weeks by raising 1/2 a grain to alleviate symptoms, and of course continue going to the lab draws she orders every few months.
Thanks for the link. Did you happen to notice Dr. Hoermann was quoted in the link you gave, and is also one of the co-authors of the link I gave you?
I found this online just now - and I find it fascinating. Finally a normal knowledgable doctor... i might print this page and send a copy with the one Gimel gave us - to all the doctors that failed to treat me well.
http://jeffreydachmd.com/2015/05/tsh-suppression-benefits-and-adverse-effects/
http://jeffreydachmd.com/2015/05/tsh-suppression-benefits-and-adverse-effects/
This sounds similiar to my question a few days ago. However when I decrease my Armour - the TSH does not budge only the T3 and T4 (free and total) drops. And then I feel crappy hypothyroid with brain fog. If w are not hyper, dont have heart palpitations, have no abnormal T4 and T3 levels - why on earth these doctors just dont leave us alone and want to decrease dose to make us feel like crap and increase that darn useless TSH? Very frustrated. Why dont these doctors read around and want to make us feel miserable? Aperantly TSH does not matter once we are treated for hypothyroidism.
1 Comments
It is very frustrating! I totally agree. I have no hyper symptoms at all, but my doctor still wants me to decrease my medication. I still do not feel optimal, and my FT3/FT4 are not in the optimal range yet. I'm very hesitant to push too much because it took me so long to find a doctor that would even prescribe me an NDT.
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