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Low TSH, low FT3 & FT4
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by Emmy4337, Dec 16, 2009
43 years old. Hashi diagnosed in 2/2007, partial TT 4/2006 (negative for suspected cancer) on Armour 75 mg to 120 mg increasing does from 4/06 to 8/09.  Changed to Nature-Throid 8/09 130mg in morning.  Numbers fluxuate greatly and I feel like crap.  Any suggestions?  Endo just changed me to synthroid 137mg on 12/14. She is willing (she says) to add T3 is need be. Says can't regulate on T3/T4 mix and low TSH means will get a-fib and osteo.  Labs to be run 1/18/10 to check TSH, FT3 & FT4.  Very scared I'm going to go truely hypo.  Bone scan great 2 years ago. High cholesterol ranging from 222-305 since 8/2001. Sometimes the dr. or lab didn't run the FT 4 as requested.  Any suggestions?  Family is against dessicated and to get them off my back I agreed to try synthroid.
TSH FT4 FT3
0.29 1.14 457
2/3 of my thyroid removed
0.48 295
1.6 260
1.04 0.8 236
0.21 0.82 224
<.04 313
25.23 190
0.13 0.94 356
0.08 317
0.88 289
0.11 0.86 330
0.11 0.76 201
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Member Comments (27)
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by TamraW, Dec 16, 2009
Find an endo who treats your frees and not your TSH, which is a pituitary hormone and not a direct indicator of what the thryoid is doing.

Much of the negative publicity about the natural drugs comes from misinformation spread by the big pharma synthetic compaines.

However, if the natural stuff doesn't work for you, then try synthetics.

I'm on synthetics. I have a doctor who is willing to treat my symptoms, then my frees, and he doesn't really pay much attention to TSH. Who cares that your TSH is below one if your frees are low?

Here's the site where I found my endo:
http://www.thyroid-info.com/topdrs/

My endo treats 75 percent thyroid, not diabetes, as so many do. That's what happened with my last endo who refused to raise my Synthroid higher than 75 or add Cytomel because the beloved TSH was 1.2. I'm now on 112 Synthroid and 5 Cytomel. I honestly don't know my current TSH because my new endo hasn't tested it lately, but I feel great, and isn't that what's most important?

:) Tamra
Avatar_m_tn
by gimel, Dec 17, 2009
Just a couple of thoughts to add to Tamra's info.  Many doctors mistakenly interpret a low TSH level as a great concern, because they have the "Immaculate TSH Belief".  By this I mean that they think TSH is a diagnostic, by which to determine medication and dosage.  It is inadequate as a diagnostic.  At best it is only an indicator, to be considered along with more important indicators, which are symptoms and the levels of the actual biologically active thyroid hormones, which are free T3 and free T4. TSH is a pituitary hormone that is affected by many variables and does not correlate very well at all with hypo symptoms.  TSH only affects the body by signaling the thyroid glands to produce more/less of the actual thyroid hormones that regulate metabolism and many other body functions.  

A low TSH result can only indicate potential A fib problems, if it is correctly signaling that the levels of the active thyroid hormones are too high.  My question would be why not just monitor and adjust the levels of FT3 and FT4, rather than relying on TSH?  For example, since I am on medication, my TSH level has been less than .05 for over 20 years, without any hyper type problems.  In fact I suffered with lingering hypo symptoms until my FT3 and FT4 levels were finally adjusted properly.  
Avatar_m_tn
by gimel, Dec 17, 2009
Sorry, I hit the wrong button.  I also wanted to add that in regard to the issue of osteoporosis, here is a previous reply I made to another member.


Keep in mind that numerous sources have said that conditions for bone loss are not caused by excessive thyroid levels.  If bone loss conditions don't exist, then thyroid levels would have no impact.  If bone loss conditions already exist, higher metabolism due to increased thyroid levels may increase the rate of bone loss.  Effective treatment should be to address the conditions causing bone loss, not by withholding thyroid meds.
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by Emmy4337, Jan 22, 2010
Just got my labs back after a month on Synthroid

TSH - .02 range .34-5.60
FT3 - 3.46 range 2.39-6.79
FT4 - 1.48 range .58-1.64
Cholesterol - down from 250 to 211
Glucose - down from 93 to 87
Anti Thymoglobulin  - 40 range 0-40
Anti Thyroid PeroxAB  -55 range 0-40

Dr., of course, wants to lower Synthroid from 137 to 125.  I want him to leave it and add T3 or atleast add T3 if lowering it. Waiting on email response from him about adding T3. Lots of aches and hair dropping out which I think/hope T3 will help.  I wonder if I need more time at this dose 137, for my body to adjust to converting T4 into T3.  Ultrasounds was good, no nodules, but atrophied since I have basically been on supressive dose since having thyroid partially removed. I had a bone density test 2 years ago and it was great.

Any suggestions on what I can say to the dr. so he won't lower my dose?  Thanks!
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by TamraW, Jan 22, 2010
FT4 looks good. I would seriously consider T3 therapy. Cytomel has made all the difference for me. Many of us do not eliminate hypo symptoms without T3 therapy. My FT3 levels were in the upper 1/3, but my endo still added a small amount, 5, Cytomel, which I break off and take small amounts throughout the day. That little boost was what I needed.

:) Tamra
Avatar_f_tn
by Emmy4337, Jan 22, 2010
Thanks, I'm hoping he will agree.  Do you have extremely low TSH as well?

Well I just got a call back from his office.  He is willing to keep me on 137 to see if the FT3 comes up any more and then run labs and discuss.  He threw out the old "osteo problem developing from low TSH" and "it's dangerous to have too low a TSH".  I will go with that for now and see if it gets any better in 6 weeks.  I doubt it but I can live like this for 6 weeks and that way I will seem like I am trying.  I'll even request the bond density test again to see if I have had any kind of loss while on suppressive dose.  Not sure what else to do.  Any suggestions?
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by TamraW, Jan 22, 2010
Emmy, my TSH is a 0.04. Try to get your endo to wrap his brain around that!

From page 81 of Thyroid Power by Richard Shames, MD and Karilee Shames, RN, PHD:

The controversy started some years ago, when this research data was just beginning to be collected. The results suggested that thyroid hormone replacement was associated with a lowered bone density. Many doctors then became fearful of thyroxine and tried to treat hypothyroidism with as little medicine as possible...However, the studies at that time lacked the data available today from third generation TSH assays and high-resolution bone densitometers. In addition, the groups of patients then being analyzed lacked the diversity necessary for accurate study. With further research studies pouring in, it now seems that thyroid medication- even in the higher doses that some people need to feel best- does not increase one's fracture risk in later years.

:) Tamra
Avatar_m_tn
by gimel, Jan 24, 2010
I have had a TSH lf less than .05 for over 25 years.   To supplement what Tamra posted, here is a quote form another doctor.


"Increased bone loss with higher thyroid levels occurs only in persons who are already in a bone-losing state, because thyroid hormones increase all metabolic activities in the body. So if you're losing bone you will lose it faster when your thyroid levels are raised. Such is the case with postmenopausal women who are not on estrogen (Appetecchia 2005). Bone loss with TSH-suppressive thyroid therapy is not seen in most men or in younger premenopausal women because they are not losing bone to start with. The problem of bone less should be addressed by restoring the sex hormones and Vit. D, not with keeping someone's thyroid hormone levels low! "
Avatar_m_tn
by 6hashi, Jan 25, 2010
According to the Eltroxin (levothyroxin sodium) brochure from 2005 :

"Effects on Bone Mineral Density
In women, long-term levothyroxine therapy has been associated with increased bone
resorption, thereby decreasing bone mineral density, especially in postmenopausal
women on greater replacement doses or in women who are receiving suppressive doses of levothyroxine sodium. The increased bone resorption may be associated with increased serum levels and urinary excretion of calcium and phosphorous, elevations in bone alkaline phosphatase and suppressed serum parathyroid hormone levels. Therefore, it is recommended that patients receiving levothyroxine sodium be given the minimum dose necessary to achieve the desired clinical and biochemical response."