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TSH way low with Normal & High T4 ??
I have been taking Thyroid hormone replacement since 1993 or so and am now 54. When I started thyroid hormone once I got it stabilized I have been ok and it has been mostly consistent. Earlier this year my Thyroid test was TSH .05, T4 8.80, T3 1.60 (way low on TSH, everything else ok.). At the time I was taking Armour thyroid- 1 g one day, 1/2 G the next. So the doc switched me to Levothyroxine .88 mg. I retested a week ago and my test was, TSH .05, T4 22.90, T3 1.70 (way low on TSH and way high on T4). So I went and had a ultrasound of my thyroid and they saw multiple colloid nodules in both lobes. So they did a biopsy. I am now waiting for the results which will take 10 days because of holidays (I live in Central america). So...I am of course anxious to hear about the biopsy but also confused about why my TSH is so low (and has not changed) with both a normal and high reading of my T4. Any thoughts, suggestions and recommendations? Thank you.
OMG. A doctor that is not rigidly tied to TSH levels. We may all have to travel to Mexico and join you. Thanks for the update.
Hi all,
I went to the endocronologist in Mexico. He was good, actually said not to worry about TSH levels....yeah. So now I am waiting for the biopsy results and the thyroid panel that that has the FT#, etc. I will then email him the results and see him again the end of this month.
Interesting info is that because I took anti parasite medication they tend to Iodine in them and he thinks that that is why my T4 was so high. I took the meds for almost a month. GOOD THING FOR PEOPLE TO KNOW.
I went to the endocronologist in Mexico. He was good, actually said not to worry about TSH levels....yeah. So now I am waiting for the biopsy results and the thyroid panel that that has the FT#, etc. I will then email him the results and see him again the end of this month.
Interesting info is that because I took anti parasite medication they tend to Iodine in them and he thinks that that is why my T4 was so high. I took the meds for almost a month. GOOD THING FOR PEOPLE TO KNOW.
Hi Gimel,
Thanks for the info. I also found out that there is an Endocrinologist that comes to the clinic every 2 weeks. So I hope to see him this Saturday with a friend that speaks Spanish. I will also see him again in 2 weeks when my tests are back. We will see how he approaches things.
I also found out that they can do the thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (TGab). So a full thyroid panel with 6-8 tests is only $133.00 US..............way less than I would pay in the US.
I am in my first 6 months of menopause (my year without a menstral cycle was July 2009). I was talking to a nurse friend and she said she thinks there has been very little research about how menopause affects they thyroid, adrenal, etc. hormones. Do you know of any info? You guys are great. Thanks.
Thanks for the info. I also found out that there is an Endocrinologist that comes to the clinic every 2 weeks. So I hope to see him this Saturday with a friend that speaks Spanish. I will also see him again in 2 weeks when my tests are back. We will see how he approaches things.
I also found out that they can do the thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (TGab). So a full thyroid panel with 6-8 tests is only $133.00 US..............way less than I would pay in the US.
I am in my first 6 months of menopause (my year without a menstral cycle was July 2009). I was talking to a nurse friend and she said she thinks there has been very little research about how menopause affects they thyroid, adrenal, etc. hormones. Do you know of any info? You guys are great. Thanks.
I think this quote will explain the conversion issue. "Once T4 is in the blood, another part of the body's network takes over, using cortisone, a hormone secreted by the adrenal gland, to convert T4 to T3 in the peripheral tissues, primarily the liver and kidneys, from which T3 is sent into the bloodstream".
Regarding dosage, taking 50 one day and 100 the next is acceptable. but you can usually split the thyroid pills as necessary to get close to your desired dose daily. For example, splitting both the 50 and 100 mcg and taking half of each daily.
Looking forward with interest to see the test results and ranges.
Regarding dosage, taking 50 one day and 100 the next is acceptable. but you can usually split the thyroid pills as necessary to get close to your desired dose daily. For example, splitting both the 50 and 100 mcg and taking half of each daily.
Looking forward with interest to see the test results and ranges.
Hi folks,
Thanks again for all your info and support so far. With the holidays it has taken awhile to find out info. I am going to Mexico today to get a Ft3, Ft4, tsh test today. It will take a week to get the results. My biopsy test is not back yet.
I do have a few questions. If my thyroid gland is no longer working How does the T4 turn into T3?
Because I am taking levothyroxin it seems it would be fine since it is slow acting to take 100 one day and 50 the next to balance it out to 75 or so. I ask because I can only get 50, 100, etc. here no in between doses.
As a reminder I was taking .088 and have been taking about .066 for the last week and a half. My T4 was up to 22.90, but lets see what happens with the Free T tests. Like someone mentioned I have not had strong hyperthyroid tests. I have no problem sleeping and have in fact been gaining weight not loosing it. I have always been low thyroid so that is different for me. What would be some mild examples of over active? Thanks again, appreciate the help. Will reposrt back on any results.
Thanks again for all your info and support so far. With the holidays it has taken awhile to find out info. I am going to Mexico today to get a Ft3, Ft4, tsh test today. It will take a week to get the results. My biopsy test is not back yet.
I do have a few questions. If my thyroid gland is no longer working How does the T4 turn into T3?
Because I am taking levothyroxin it seems it would be fine since it is slow acting to take 100 one day and 50 the next to balance it out to 75 or so. I ask because I can only get 50, 100, etc. here no in between doses.
As a reminder I was taking .088 and have been taking about .066 for the last week and a half. My T4 was up to 22.90, but lets see what happens with the Free T tests. Like someone mentioned I have not had strong hyperthyroid tests. I have no problem sleeping and have in fact been gaining weight not loosing it. I have always been low thyroid so that is different for me. What would be some mild examples of over active? Thanks again, appreciate the help. Will reposrt back on any results.
Hi Gimel,
I am not sure why they never said what the cause of my thyroid problem was,...
So I have been taking .088 mg. and my T4 was 22.90. So you think take it down to about the 60s. i can cut the pill such that I should be able to get it to about .066, instead of just in half which would be .044. Like I said I will retest and see if I can get the Free T3 T4 tests. Thanks again
I am not sure why they never said what the cause of my thyroid problem was,...
So I have been taking .088 mg. and my T4 was 22.90. So you think take it down to about the 60s. i can cut the pill such that I should be able to get it to about .066, instead of just in half which would be .044. Like I said I will retest and see if I can get the Free T3 T4 tests. Thanks again
Sounds like you had Hashi's and now your thyroid is non-functioning. In order to get your T4 meds to the 60 range, you can split the tablets as required, plus you can take more one day than another, and hit whatever daily average you want that way. This works fine, since T4 is a slow reacting med, compared to T3 meds. That's just my opinion, because I would not want to drop too far, while waiting to be retested.
Thanks, i couldn't figure out how to even ask a question on his site.
I will try to see about getting the tests. I also hope to find an endocrinologist someplace close by.
Originally 1993 or so I had symptoms of low thyroid like tired all the time, dry skin, hair, very low energy, nails brittle, cold all the time. Never got any diagnoses except hypothyroid (low). I started with a small dose of thyroid, felt better and it slowly got increased and I have been on it since.
I had thought of getting off years ago, but was discouraged to by doctors.. The ultrasound I just got on my thyroid the doctor said it wasn't working anymore.
I will try to see about getting the tests. I also hope to find an endocrinologist someplace close by.
Originally 1993 or so I had symptoms of low thyroid like tired all the time, dry skin, hair, very low energy, nails brittle, cold all the time. Never got any diagnoses except hypothyroid (low). I started with a small dose of thyroid, felt better and it slowly got increased and I have been on it since.
I had thought of getting off years ago, but was discouraged to by doctors.. The ultrasound I just got on my thyroid the doctor said it wasn't working anymore.
The difficulty in getting something posted on Dr. Lupo's site is that they only allow a handful of questions each day and it is difficult to hit the right time.
I would really like to see a followup test for the thyroid hormones, hopefully FT3 and FT4, or at least total T4 and total T4. Also, you didn't clear up my question about the cause of you originally being treated for hypothyroidism.
I would really like to see a followup test for the thyroid hormones, hopefully FT3 and FT4, or at least total T4 and total T4. Also, you didn't clear up my question about the cause of you originally being treated for hypothyroidism.
I have looked an treid to figure out how to post a question on the Thyroid cancer, nodules, etc. post with Dr. Mark Lupo MD, I am missing something because I have not been able to figure it out. I have looked 3 times and well......?? Any clues. Thanks.
Hi, In Sept. my FT3 was 6.02, so they switched me from Armour thyroid to Levothyroxin, because they felt the T3 was to high and thought I would do better without the T3 supplement. See Sept reading below.
FT4 = 1.0, Reference range 0.61-1.27 ng/dl
TSH = .01, Reference range 0.40-4.6 uIU/mL
FT3 = 6.02., Reference range 2.4-4.2 pg/ml
The next reading is from Dec. 18th. I wonder if I should retest it to be sure it was accurate.
TSH .05, range 0.3-6.20 ulU/L
T4 22.90, range 5.70-11.40 ug/dl
T3 1.70 range 0.40-1.81 ng/ml
I agree I don't know why it was so high. The doctor I am seeing had suggested I stop taking thyroid hormone all together and I said I thought that was not a good idea. So I suggested halving my dose. I do not think I can get 60, but perhaps I should retest and also get another opinion. There is not an Endocrinologist in country here as far as I know. So I will also check in the neighboring countries. I appreciate all your help and will see on Mon (might be a holiday) or Tuesday about what tests they can do at the lab here. I will not get my biopsy test till after the first of the year sometime.
FT4 = 1.0, Reference range 0.61-1.27 ng/dl
TSH = .01, Reference range 0.40-4.6 uIU/mL
FT3 = 6.02., Reference range 2.4-4.2 pg/ml
The next reading is from Dec. 18th. I wonder if I should retest it to be sure it was accurate.
TSH .05, range 0.3-6.20 ulU/L
T4 22.90, range 5.70-11.40 ug/dl
T3 1.70 range 0.40-1.81 ng/ml
I agree I don't know why it was so high. The doctor I am seeing had suggested I stop taking thyroid hormone all together and I said I thought that was not a good idea. So I suggested halving my dose. I do not think I can get 60, but perhaps I should retest and also get another opinion. There is not an Endocrinologist in country here as far as I know. So I will also check in the neighboring countries. I appreciate all your help and will see on Mon (might be a holiday) or Tuesday about what tests they can do at the lab here. I will not get my biopsy test till after the first of the year sometime.
You haven't mentioned whether the doctor identified any specific cause for your being hypo. If so, would like to know that, since nodules can result from problems such as Hashimoto's , for example.
Looks to me like you were doing fine earlier in the year, but your doctor was medicating you based on TSH and incorrectly decided that your TSH test result was too low and changed your meds. It's too bad the doctor did not understand that thyroid patients frequently have TSH suppressed below the low limit when on medication, especially Armour or other T3 type meds. A low TSH doesn't mean that you are hyper. You are hyper only if you have hyper symptoms. So while on medication, I would basically ignore TSH and mainly concentrate on your symptoms and the T3 and T4 test results. In my opinion, TSH should never be used as a diagnostic, by which to determine meds.
In addition, having you take 1 gr. one day and 1/2 grain the next day shows that the doctor really does not understand very much about thyroid meds, either. With any meds containing T3, the daily dose should be equal, and many patients get the best result by splitting their daily dose into half and taking it in the morning and the afternoon, because T3 is so much faster acting than T4.
I am a bit puzzled as to why your T4 result was that high recently, since your FT3 and FT4 results were within range in Sept. If you have Hashi's then that can cause erratic results at times. Regarding your recent reduction in meds, was this your decision, or the doctor's? I'm not so sure I would have cut meds so much, since you are not experiencing any overt hyper symptoms. Since it takes 4-5 weeks to get the full effect of a T4 med change, and not wanting to switch over to hypo, I would be more conservative and go back up to the 60's area while waiting for the test results. Just my opinion.
Looks to me like you were doing fine earlier in the year, but your doctor was medicating you based on TSH and incorrectly decided that your TSH test result was too low and changed your meds. It's too bad the doctor did not understand that thyroid patients frequently have TSH suppressed below the low limit when on medication, especially Armour or other T3 type meds. A low TSH doesn't mean that you are hyper. You are hyper only if you have hyper symptoms. So while on medication, I would basically ignore TSH and mainly concentrate on your symptoms and the T3 and T4 test results. In my opinion, TSH should never be used as a diagnostic, by which to determine meds.
In addition, having you take 1 gr. one day and 1/2 grain the next day shows that the doctor really does not understand very much about thyroid meds, either. With any meds containing T3, the daily dose should be equal, and many patients get the best result by splitting their daily dose into half and taking it in the morning and the afternoon, because T3 is so much faster acting than T4.
I am a bit puzzled as to why your T4 result was that high recently, since your FT3 and FT4 results were within range in Sept. If you have Hashi's then that can cause erratic results at times. Regarding your recent reduction in meds, was this your decision, or the doctor's? I'm not so sure I would have cut meds so much, since you are not experiencing any overt hyper symptoms. Since it takes 4-5 weeks to get the full effect of a T4 med change, and not wanting to switch over to hypo, I would be more conservative and go back up to the 60's area while waiting for the test results. Just my opinion.
The test results below are the latest ones from a week ago and my test was, The reference ranges are different for the ones done in the states versus the ones done here where I live.
TSH .05, range 0.3-6.20 ulU/L
T4 22.90, range 5.70-11.40 ug/dl
T3 1.70 range 0.40-1.81 ng/ml
The test results in my email above the FT3 and T4 was from the states in September. They don't do the Free T3and T4 here. I might have to go to Mexico to get those tests.
Regarding symptoms, I have felt a bit hyper and not able to relax that easy. I retested because we changed my thyroid hormone fro Armour to Levothyroxin and needed to monitor dosage.
I will check on Monday or Tuesday and see which tests they can do here. Thanks again everyone.
.
TSH .05, range 0.3-6.20 ulU/L
T4 22.90, range 5.70-11.40 ug/dl
T3 1.70 range 0.40-1.81 ng/ml
The test results in my email above the FT3 and T4 was from the states in September. They don't do the Free T3and T4 here. I might have to go to Mexico to get those tests.
Regarding symptoms, I have felt a bit hyper and not able to relax that easy. I retested because we changed my thyroid hormone fro Armour to Levothyroxin and needed to monitor dosage.
I will check on Monday or Tuesday and see which tests they can do here. Thanks again everyone.
.
You haven't really discussed whether you have symptoms. Adjusting medication and hormone levels should be primarily for the purpose of alleviating symptoms.
COMMUNITY LEADER
I'm confused. Which set of tests is the most recent? The ones you just posted or the ones in your original post? And are the reference ranges the same for both sets of results?
Thanks so much. I will put the range down below.
FT4 = 1.0, Reference range 0.61-1.27 ng/dl
TSH = .01, Reference range 0.40-4.6 uIU/mL
FT3 = 6.02., Reference range 2.4-4.2 pg/ml
I am not sure what tests they can or cannot do here since I live in Central America. I will have to check. My thyroid has always been stable in the past and I have always been diagnosed with low thyroid. So it is different getting the high reading of the T4 being 22.90 renge 5.70-11.40 ug/dl (I don not think they do free T# and T$ here. I will find out when they open up after the holiday. Thanks for your info, it is reassuring to know that things might not be as off as I think. By the way happy holiday.
FT4 = 1.0, Reference range 0.61-1.27 ng/dl
TSH = .01, Reference range 0.40-4.6 uIU/mL
FT3 = 6.02., Reference range 2.4-4.2 pg/ml
I am not sure what tests they can or cannot do here since I live in Central America. I will have to check. My thyroid has always been stable in the past and I have always been diagnosed with low thyroid. So it is different getting the high reading of the T4 being 22.90 renge 5.70-11.40 ug/dl (I don not think they do free T# and T$ here. I will find out when they open up after the holiday. Thanks for your info, it is reassuring to know that things might not be as off as I think. By the way happy holiday.
COMMUNITY LEADER
Do you have the lab's reference ranges for the FT4 and FT3? It's really hard to comment without them because labs use different ranges depending on the method of testing and we can't see where you fall within the range.
Cutting your med in 1/2 is quite drastic and you may end up with an issue later on.
I would suggest that you not worry so much about the TSH -- *MY* TSH stays at about 0.01-0.03 all the time, but FT4 and FT3 are barely mid range........Concentrate more on symptoms and the FT's....I also have multiple nodules.
Have you been tested for thyroid antibodies to see if you have Hashimoto's Thyroiditis? That's an autoimmune disease in which antibodies attack the thyroid and will eventually kill it. You should get tested for thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (TGab). Hashimoto's is the most common cause of hypothyroidism.
Cutting your med in 1/2 is quite drastic and you may end up with an issue later on.
I would suggest that you not worry so much about the TSH -- *MY* TSH stays at about 0.01-0.03 all the time, but FT4 and FT3 are barely mid range........Concentrate more on symptoms and the FT's....I also have multiple nodules.
Have you been tested for thyroid antibodies to see if you have Hashimoto's Thyroiditis? That's an autoimmune disease in which antibodies attack the thyroid and will eventually kill it. You should get tested for thyroid peroxidase antibodies (TPOab) and thyroglobulin antibodies (TGab). Hashimoto's is the most common cause of hypothyroidism.
Thanks, when I was in the States I got those tests. End of august they were FT4 = 1.0, TSH = .01, FT3 was high 6.02. I think that is why they took me off the armour and put me on the levothyroxine. I do not think they do tests for Free t3 and t4 here, but I will check and see. I have halved my levothyroxin from 88 to 44 for now, since it was 22.90 for the T4. I am waiting for the biopsy....which I won't get till next month.
Hi,
it is normal to have suppressed TSH while on armor. Once medicated many find that TSH is not such a good way of monitoring levels.
You need to have your meds adjusted based on the basis of Ft3 and FT4, not T3 and T4, which are not so accurate.
Anyway, sounds like the levothyroxine needs to be reduced a little.
it is normal to have suppressed TSH while on armor. Once medicated many find that TSH is not such a good way of monitoring levels.
You need to have your meds adjusted based on the basis of Ft3 and FT4, not T3 and T4, which are not so accurate.
Anyway, sounds like the levothyroxine needs to be reduced a little.
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