help me understand TSH with supplemented T3

[jazzyme1978]

I am new to T3 supplementation.  Is the goal of supplementation with T3 to make the tsh near zero?  I'm confused at what is optimal for a hypothyroid patient.

[Barb135]

Since the advent of TSH becoming the gold standard for thyroid testing, doctors have been taught that TSH is the only thing they need to test for, and that the only treatment necessary is T4 - many refuse to prescribe anything but synthroid.  

First off, I think a lot of doctors don't even know that the body can't use T4; that it has to be converted to T3 prior to use.  Secondly, they "assume" that the conversion process will always work, and as we well know, it doesn't.  Third, there are those doctors who believe that anything within the ranges is acceptable, and again, as well know, that's not the case.  

That's why it's so hard to find good thyroid doctors.  

We, patients, understand this because we've been through; we've had to fight doctors to get the treatment we need. We've done a lot of research to learn these things. Most doctors, including many endos, practice only what they learn in med school; many of them don't keep up with new protocols, whether for lack of time, or lack of interest.  Until they change what doctors are learning in med school, getting adequate care for hypothyroidism will be difficult at best.  Some doctors are "trainable", meaning they will try to learn from their patients, others are very stubborn, set in their way and think they know it all, so they refuse to listen to their patients and/or take them seriously.

There's my rant on doctors......

T3 is available in the U.S. as Cytomel, which is a brand name, liothyronine (generic equivalent to Cytomel) and the desiccated hormones, such as Armour, Nature Throid, ERFA and compounds.

[Moondog1117]

Hi, Barb.

Why are doctors generally so opposed to treating with T3 meds and focus on T4?  Seems those here who respond to others' questions have a good handle on all this.  Why don't treating physicians ???  And, further, what medications are available for them to treat T3?  My T3 level in March was at 2.8 (lowest end of the range is 2.3)  No mention of treating it at all.  Levo causes breathing difficulty for me and I simply cannot take it.  Meanwhile....God only knows what's going on with my thyroid and overall health.  (Although I can tell you, it's NOT good.)

[Barb135]

Forgot to mention that the reason we focus on FT3 is because that's the hormone that's actually used by the individual cells; it helps drives energy, metabolism and other body functions.  

FT4 is a storage hormone and must be converted to FT3 in order to be used.  The reason many of us are on T3 is because something goes awry with the conversion process and the FT4 is not converted to FT3 adequately.

Neither FT4, nor TSH correlate with symptoms, while FT3 does.

[Barb135]

The goal of supplementing with T3 is to alleviate symptoms, no matter what the TSH is.  

TSH neither causes nor alleviates symptoms, and is, at best, an indicator of thyroid conditions.  Once a thyroid condition has been confirmed, TSH often becomes totally irrelevant.  

Many of us find that we do best with FT3 in the upper 1/3 of its range and FT4 about mid range.  Many of us on medication with a T3 component have very low or suppressed TSH, but as I said, TSH becomes irrelevant.