TSH below zero! Now what? (Hashimoto)

[jeffbursens]

Dear companions,

I have an important question.
My last blood work from one mouth ago revealed a TSH of - 0.16. (ranges 0.3-4.5)
Though my levels of free T3 & T4 were midrange and maybe even slightly lower than they should be.
FT3: 3.30 (ranges 2.1-4.2)
FT4: 1.02 (ranges 0.7-1.8)

I'm on 112,5 levothyroxine and 12,5 cytomel daily dose.
Is it safe to have a TSH that low?
Can I even upgrade my meds to 125 levo a day? I still feel hypo and under medicated.
I did hear about the 'optimal' values between the ranges were a lot of people are on their best in their 'sweet spots'.
If the rule of thumb is that FT4 has to be 50% of the range and FT3 upper half to upper third, i's logical that I'm still hypo. This all being said, will my TSH drop even more when I go to 125?

I don't understand the link between TSH and the FT3 & FT4 results. How can I have such a low TSH and still not reach the recommended levels?

Thanks everyone and shoot back if you feel like!
Jeff Bursens

[gimel]

You can certainly increase both your Free T4 and Free T3 levels, as necessary to relieve symptoms.  In addition, Vitamin D and ferritin levels can affect how thyroid hormone is metabolized.  Since hypo patients are frequently too low in the range for both, I suggest that you should ask to be tested for both at next opportunity.  D needs to be around 55-60.  Ferritin should be around 70 minimum for men.  

A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T3 and Free T4 as necessary to relieve symptoms, without being constrained by resultant TSH levels.  You can get some good insight into clinical treatment from this link written by a good thyroid doctor.

http://www.hormonerestoration.com/Thyroid.html

The reason I say the above about resultant TSH levels is that hypo patients taking adequate doses of thyroid meds frequently find that their TSH becomes suppressed.  That does not mean hyperthyroidism, unless it is accompanied by hyper symptoms, due to excessive levels of Free T3 and Free T4.  I have had a TSH of about .05 or less for well over 25 years without ever having hyper symptoms.  And there are other members with similar experiences.  

[jeffbursens]

Thanks alot for your comments!

My symptoms are dry skin, hair, nails, swelling of the face and pale skin. Those are the main symptomes I have....
Espacially the puffy face is very irritating for me. I look so much worse when it kicks...

Thanks again for your advices!

[gimel]

I would only add that I would double check the TSH result.  Don't see how it could be less than zero.  

Please tell us about symptoms you have.  

[flyingfool]

When taking T3 it is almost assured that your TSH will be suppressed and thus testing for it is basically useless.

TSH is a screening test at best and once on Thyroid med I do not pay much attention to it as FT3 and FT4 are more important along with symptoms and how you feel.

Yes it is possible to increase the T4 medication.  That will have to be something you work out with your Dr.

Please understand that a Low TSH causes NOTHING.  It is of no concern if you are NOT hyper or having HYPER sysmptoms.

TYou mention the rule of thumb to feel well.

Your test resutls show you to be:

FT4 = 27% with the rule of thumb to be 50% or a tad bit higher

FT3 = 57% with the rule of thumb to be 50% to 67%.  Many people need to be towards the 67% of the range to feel well. But really this is not a bad result.

So based upon your continued symptoms and your ranges showing room to improve it would seem reasonable to discuss increasing your medication and your T4 med would seem the likely candidate.  As many people even with adequate FT3 still feel "off" until they also get their FT4 range in balance.  Others are fine with high FT3 and low FT4.  Everyone is different.