Cytomel and low TSH levels

[Kehaar]

I have been struggling with my thyroid health for many years now. I started this all with a TSH level of 20 7 years ago. I was started on Synthroid and slowly increased dosage to 175mg where I was for a bunch of years and TSH held steady around 0.8-1.0. Over time I have felt good for a few weeks and then I will totally crash for a few weeks so decided to start looking into things again. My new Dr tested;

TSH   0.11mU/L        (0.34-4.82)
T4      17.8 pmol/L     (10-20)
T3        4 pmol/L        (3.5-6.5)
AnthyAB   1034 U/ml         (0-60)
B12    249 pmol/L
Ferritin   60ug/L
D3 108nmol/L

At that time I had done some reading about being in the top quarter (3.5-6.5) of the range for T3 so asked she would be willing to try me on a T3 medication.

She started me on 15mg of Cytomel and lowered my Synthroid to 150mcg. 6 weeks later I went to her office and felt like a million dollars I was so happy with how much better I felt.

My bloodworm at this time was;

TSH      0.04      
T4         12.7      
T3         6.6


She wanted to decrease my synthroid as my TSH was way too low. Anyway short story is she has me lowering it all the time and now my meds are at; 88mcg Synthroid and 25 cytomel and my bloodworm this week is;

TSH   0.02
T4      8 (range 10-20)
T3      4

I am not feeling great and my symptoms are returning but she wants to lower my synthroid more as she is concerned with elevated levels that I will get osteoporosis....

I should also mention that I have done elimination diets and cut out gluten, have added Ashwaghanda and Selenium to my diet daily.

I am really not wanting to lower the levels and can not seem to find anyone who knows more to advise me. I look at these chats often and have gotten a lot of information from them but am not hoping that someone out there can offer me some advise about what to do and who I should look to for help. I also asked for the reverese T3 test this week and am waiting for the results, crazy to me how you have to hound the Dr and pay for these tests to figure out our health.

Anyway, thank you in advance to anyone who has some advise, all the best to everyone who is working hard to try to get to their best self!

[Red_Star]

Yes, your B12 is too low. My B12 serum is at 590 pmol/L (162 - 800 pmol/L) currently and I take B12 sublingual spray daily for autoimmune pernicious anaemia.  My symptoms of not enough B12 show up in days without my spray.

[Kehaar]

Thank you Red Star for taking the time to read and sharing your recommendation for best B12 supplement. I appreciate your time

[Barb135]

Unfortunately, your doctor is placing too much stress on the TSH and not enough on Free T4 and Free T3... It's very normal for TSH to be low or suppressed when on adequate amounts of thyroid hormones.  

It's not true that you will get osteoporosis just by having a low TSH. Osteoporosis correlates with actual thyroid hormones (hyperthyroidism), not TSH... Your actual thyroid hormone levels have to be too high and you have to have hyper symptoms in order to have hyperthyroidism!!! The problem is that when doctors see suppressed TSH, they automatically assume one is hyper, without even really "looking" at the thyroid hormones.  Make sure you point out to her that your actual thyroid hormones are too low, not too high...

In addition to that, most of us on a T3 med, such as cytomel, tend to feel better if we split the dosage into 2 doses, taking 1/2 first thing in the morning and the other half around noon or early afternoon.  That's because T3 is fast acting and gets into/out of your system within a few hours, so taking it in multiple doses keeps levels more stable throughout the day. Be careful taking T3 med after about 3:00 as it can interfere with sleep, but of course, that will depend on your individual schedule.

I've had the same thing done to me for the past 10 yrs and most of the time I feel quite hypo.  

Another thing I see wrong with your blood work is that your vitamin B-12 was way too low at 249.  Although it might have been within the lab's reference range, B-12 needs to be quite high in its range.  I have to keep mine at/near the top of its range, which is 1100, in order to keep symptoms of deficiency at bay. If you aren't supplementing, you should be, in order to bring your level up.

[Kehaar]

Barb thank you so much for your response, I know my message was long and I really appreciate you taking the time to read through and leave me such helpful information. I will absolutely get on the B12 and will start to split my cytomel as well. It also gives me more confidence to go back to my Dr. Again I really appreciate you taking the time.