Can extremely low TSH lower phosphorous level?

[Success5]

Gimel,

I began to feel worse and worse so I went to have my Labs drawn yesterday.  I am self-pay.  I have to drive a long distance to get them drawn.  I have a long-distance holistic Doctor who I speak with periodically on the phone and he goes over my labs.  I do not have a telephone appointment with him until next Thursday.  I knew that things were badly skewed in my body, so thus the necessity to get a new appointment with him instead of waiting until my next appointment time which was going to be September.  Part of my Labs have come back but not all of them yet.  Since I am self-pay, the Company I go with--the Results come back in spurts.  I was quite shocked and taken aback to see that my TSH was 0.01.  I knew that something was wrong because suddenly last week, I noticed my eyebrows had become very sparse.  Also, my upper arms have become very flaccid.  I have always been a fairly active and health-focused individual.  I have not received the TPO or Homocysteine numbers back yet but I see that my phosphorous is low ((2.4) and my Iron binding is 253.  My Free t4 Index is 3.2.  My T4 is 9.6.  My T3 uptake is 33.  My Free T3 is 4.

I did NOT take my Thyroid Medicine before the Draw.

My Ferritin level is 4 down from the highest level on the Reference Range.  I am currently on Armour (2) 60 mg tablets in the Morning.  I also have been taking LDN (low-dose Naltrexone) for the last several months.  I was on 3 mg of it, but am going back to 2.5.  I wake up in the Morning not feeling rested and I think it is because of the getting messed up on the medicine of now seemingly taking too much Armour.  I had to switch to Armour from Naturethroid a few months ago because at that time, the Naturethroid was not able to be delivered to my Pharmacist.

I believe that tomorrow Morning I will split one of the two Armours in half and take 1 1/2 tablets for a few days until I can speak with my Doctor.

Thanks to all the people who help out on this Forum.  I am addressing this to Gimel.  Thank You, Gimel!

[gimel]

A hypothyroid patient should be medicated with thyroid hormone adequate to eliminate the signs/symptoms of hypothyroidism without creating any signs/symptoms of hyperthyroidism.  That state between hypo and hyper is called euthyroidism.  That should be your goal, rather than just going by your body temperature.    To get there I expect that it will take the full 120 mg of Armour, but you can determine that by trial and error between 90 and 120 mg.  In addition you need to make sure your Vitamin D is at least 50 and your B12 in the upper end of its range.  

As for your osteoporosis, note the information on page 16 of the following link.  

http://hormonerestoration.com/files/TSHWrongtree.pdf

High levels of homocysteine are not good.  Note that there is scsientific evidence that hypothyroidism can result in high homocysteine.

[Success5]

Thanks, Gimel--I do not have osteoporosis. I will look at the file you sent.  Thank You very much.

[gimel]

As I reviewed your iron related test results I wondered if you have had a hemoglobin test?  There is a lot to discuss, so please indulge me as I try to go through it all and more questions arise.  

Were you originally diagnosed as having Hashimoto's Thyroiditis?

[Success5]

Yes, I was--not originally, but when I finally went to a Nurse Practitioner who tested more thoroughly.  She tried to get me on the iodine (de-toxing first with the Celtic sea salt to eliminate the bromides).  It did not set well.  I did not tolerate it.  So, I knew after a time what some of the Hashimoto's entailed.  My Hemoglobin is 13.1.
Reference Range is (11.7-15.5).

[gimel]

Based on your lack of having any hyper symptoms and your test results, I think you you should continue on the 120 mg of Armour and stabilize there for  a while.   I will be interested to see your Reverse T3 result.   Vitamin D should be at least 50 ng/mL.  Is your's above that?  I also expect that your B12 is not optimal.  It should be in the upper part of its range.   Taking your ferritin and TIBC together makes me wonder about possible iron related issues.   It is strange to me that your ferritin is that high without taking a large amount of iron.  Along with that your TIBC is low.   I understand the problem with additional labs, but it would be a good idea to also test for serum iron and % saturation.   Those, along with the ferritin and TIBC should identify any issue there.  

[Success5]

The Iron Saturation is 43  Reference Range is (11-50).
The Total Iron is 108 Reference Range is (45-160).
Folate is 23.9 Reference Range is (> 5.4).  The Vitamin D reading has not come back yet.  Homocysteine is high (as usual).   Just got that back today.  I too look forward to seeing my Reverse T3.  My temperature was still almost optimal this Morning.  This Morning I took half my usual dose, and tomorrow I will probably take 2/3 of my usual dose.  I think my optimal dose may be 90 and not 120.  (At least for the time being).  I will keep taking my temperatures periodically to judge about how much medication I think I need.  I am pretty sure that I had too much medication, or there was some kind of 'glitz' that caused that phase that has (hopefully) played out already.  Thanks Gimel.

[gimel]

There is not a lot of iron in a serving of either almond butter or almond milk.  So that makes me wonder about your ferritin level.  Also, what is the range shown for the iron binding?    At 167 your SHBG is very high.  Note the following info about that.  It seems to indicate that you need a test for free Testosterone.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/

Maybe I overlooked it, but how long on the 90 mg of Armour when the blood was drawn for those latest tests.  Also, did you take your morning dose of Armour before blood draw.  If so, how long between taking the med and the blood draw?  Have you ever been tested for Vitamin D?

[Success5]

I did not take my Morning dosage.  I took it after the blood draw.  I am on 120 mg of Armour (two 60 mg tablets).  My Vitamin D level is good.  Forget what it is now, but the Doctor has me on a particularly good kind of Vitamin D.  Yes,  the SHBG was high--I had never had that particular test run.  Thanks for the info concerning the test for free Testosterone.  I will see about the Reference Range on the Iron Binding and get back to you.

[Success5]

The Reference Range for the Iron Binding Test is 250 -450.  Mine was 253.

[gimel]

Why do you think your feelings this morning were due to too much thyroid med?  What are the reference ranges for your T4 and Free T3 tests?

[Success5]

I had the distinct feeling that I was not optimized, but honestly I would have thought that I needed more Armour medication (that is why I had the Lab Draw this week).  It is hard to tell sometimes what is too much and what is too little.  My Doctor goes by the Wilson Temperature protocol, so I took my temperature day before yesterday and the temperature did not indicate that I was low thyroid.  In fact, the temperature was not too far from normal.  This Morning, I still felt not myself (somewhat disoriented and queasy), so I thought it best to see if I could get some of the excess out of my system before medicating again.  Here are the Labs I have so far that I think are relevant and their Reference Ranges.  Ferritin 250 (tops out at 288 on Reference Range) ; Total Protein 6.8 (6.1 to 8.1) ; Phosphate 2.4 (2.5 to 4.5) ; ACTH 16 (6 to 50) ; SHBG 167 (14-73) ; {Reverse T3 has not come back yet} ; Thyroid Peroxidase has dropped from 29 in August 2017 to July 2018 of 14 ; Thyroglobulin has dropped from August 2017 of 55 to July 2018 of 27 ; T3 Uptake 33 (22-35) ; Free T4 1.3 (0.8 to 1.8) ; T4 9.6 (4.5 to 12.0) ; Total T3 130 (76 to 181) ; Free T3 4.0 (2.3 to 4.2) ; Iron binding 253 ; Sodium 154 ; Carbon Dioxide 21 .     Thanks Again, Gimel--No hurry to get back on this. Hope your Day is wonderful.

[gimel]

Just so that we have all your info in one place, following is your prior post.  

I have recently switched to Armour after having been on generic Synthroid for all of those 19 years.  In January, I attempted to go off the Synthroid and treat myself with the bovine desiccated tissue, but apparently I did not take enough.  On my next appointment with the doctor for labs, my TSH was 108.6.  Right away, I went back to the synthetic Synthroid for three days, and then I started the Armour and at the same time discontinued Synthroid.

The doctor had prescribed two (60) mg tablets which would equate to approx. twice what I had been on of the Synthroid (112 mcg.) so I disregarded that and tried to go by the chart, starting out at first with a little under 60 mg, then after three days I took a whole 60mg tablet, then one week later I went to 90 mg. which I am presently on.  This whole process began approximately three weeks ago.  So, I am now on approx. 90 mg.

I am exhausted.  I felt good after ramping up to the 90mg. for about two days, but it did not persist.  I have a follow-up appointment to get labs done (he concentrates totally on TSH only in eighteen days.  Should I now go to the full 120 mg, and if so, will the labs reflect this change by that time? "
________________________________________________

When trying to assess a person's thyroid status, the most important is an evaluation for symptoms that occur more frequently with hypothyroidism.  So as a start please tell us about any and all of your symptoms.    

Next comes biochemical tests needed to confirm the symptoms.  Your TSH was really low, but that is the usual case when taking significant doses of thyroid med.  It means nothing as far as your treatment.  The doctor should not adjust your dosage based on TSH.  Instead the dosage should be adjusted to achieve the following, as concluded in a recent, excellent scientific study:   "Hypothyroid symptom relief was associated with both a T4 dose giving TSH-suppression below the lower reference limit and FT3 elevated further into the upper half of its reference range."  Frequently this requires the inclusion of T3 med to adequately raise the Free T3 level.  

From your test results the Free T4 Index and T3 Uptake are outdated and not very useful.  Save your money on those and always make sure to test for Free T4 and Free T3.   For your T4 and Free T3 test I need to know the reference range shown on the lab report.  

The average daily amount of T4 and T3 produced by the thyroid gland is 100 mcg of T4 and 10 mcg of T3.  This equates to 130 mcg of T4 and instead of what is shown in conversion tables, is approximately the same as 2 grains of NDT med.  The amount of thyroid med required would be higher due to absorption of the med not being 100%.    So taking the 2 grains should not be a problem and it will better prepare you for the doctor, as I see it.  In 18 days you will get the full effect of the T3 in the Armour and probably about 80% of the full effect of the T4 on serum T4 levels.    

A few other questions for you.  Are you male or female?  Do you take any iron related supplements that might account for your ferritin level?

[Success5]

I left another post but don't see it.  Anyway, I am female and I eat a lot of almond butter and drink almond milk.  I am allergic to milk but not to butter.  There is a lot of stuff in my medical history.  I have multiple chemical sensitivities, and there is a lot of food I am allergic to.  I have a history of breast cancer but my last surgery was twelve years ago.  I have a good Doctor who has helped my adrenal status greatly.  He doesn't see me though.  It seems hard to find a good holistic doctor anywhere near me in the Southeast.  Thanks for all your input.  All the Best to You All.  I didn't take my medicine this Morning because I felt that I needed to reduce my seemingly hyper, too much hormone state.  I don't really feel hyper though, just rather weird--disoriented like and queasy.  Again, All the Best to You All.

[Success5]

Again, This is me relating a correction--my Ferritin level was 250.  The Reference Range tops out at 288.  So, I was 38 below the Top of the Reference Range.  Thanks for my being able to correct that.