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TSH results came in at .02??

I had a TTT in 1992 due to a 5 CM tumor. Most all of that time I have been at .3 and .05 mg of Levothyroxine. In 2014 Istarted 15 mcgs of Lio daily. My last TSH came in at .02, normally around 2. Should I stop the T3? The morning of the blood labs I took no thyroid rxs. Whta could cause this?
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Avatar universal
Assuming that your thyroidectomy was  complete, that dosage would be far too little.   Depending on weight, a full daily replacement amount would be closer to the daily output of an average thyroid gland.  That would be approx. 94-110 mcg of T4 and 10-22 of T3.   Med dosage would have to be even higher to account for only about 80% absorption.  

A good thyroid doctor will treat a hypothyroid patient clinically, by adjusting Free T4 and FreeT3 levels as needed to relieve hypo symptoms.  without being influenced by resultant TSH levels.  Symptom relief should be all important, not just lab test results.  

I expect that your doctor is adjusting your dosage based only on TSH level, which is wrong.   Most hypo patients taking adequate thyroid medication will have suppressed TSH levels.  This does not mean hyperthyroidism unless there are hyper symptoms due to excessive levels of Free T4 and Free T3.  TSH suppression in those cases is due to taking the med in only a short time as compared to the usual slow flow of thyroid hormone over the whole day, in the untreated state.  So it is the dosing regimen that suppresses TSH, not the dose.  

There is a very important recent study that you should be aware of and use to try and get your doctor to treat you adequately.   I think it fits your situation exactly.  The authors concluded that,  "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. "

https://www.ncbi.nlm.nih.gov/pubmed/29396968

I have more info for you, but first please tell us about any symptoms you have and also post your Free T4 and Free T3 results and reference ranges shown on the lab report.   Also if tested for Vitamin D, B12 and ferritin please post those as well.  
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getting a thyroid panel done next Thursday which I will get the expanded #'s
Avatar universal
Doctors always want to test for TSH.  Make sure they also test for Free T4 and Free T3 (not Total T4 and Total T3).  It would also be good to test for Vitamin D, B12 and ferritin.  

Do not stop your med.  I fully expect that you need an increase if you have hypo symptoms.   So please tell us about any symptoms you have.  
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I did and will have all those test done. Will post results
Avatar universal
Symptoms????
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Test Name In Range Out Of Range Reference Range Lab TSH 0.12 L 0.40-4.50 mIU/L UL T4, FREE 1.5 0.8-1.8 ng/dL UL T3, FREE 2.9 2.3-4.2 pg/mL UL IRON AND TOTAL IRON UL BINDING CAPACITY  IRON, TOTAL 85 50-180 mcg/dL  IRON BINDING CAPACITY 359 250-425 mcg/dL (calc)  % SATURATION 24 20-48 % (calc)  VITAMIN B12 291 200-1100 pg/mL VITAMIN D,25-OH,TOTAL,IA 24  L 30-100 ng/mL EN
the above test I had stopped the T4 by .05 mg, from .3 mg and .5 mg, now 300mcg, stopped the 15 mcg of T3. I am still low on TSH but the rest looks okay. I do take D3 1,000 IU daily
Avatar universal
Before assessing your test results, I need to know about any symptoms you have.  
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chronic fatigue, sleeping all the time, hunger, weight gain. You would think with 350 mcgs of T4 I would be hyper but I am not, but the first TSH was .02, cut back by 50 mcgs of T4 then went to .12 (still low) cut out T3.  Biggest symptom is fatigue.  
Avatar universal
Forget TSH when taking thyroid med.  It is irrelevant and misleading to doctors who don't understand why it is suppressed.   If you are too high on med dosage it will show up as hyper symptoms due to excessive levels of Free T4 and Free T3.  

Even though your med dosage probably seems high to you and doctor, the most important consideration must always be symptoms, supported by test results for Free T4 and Free T3,  initially Reverse T3 and cortisol, and also Vitamin D, B12 and ferritin.    The symptoms you mention are typical of being hypothyroid.   In addition your Free T4 level of 1.5 is more than adequate, since it is 70% of its range.  Your Free T3 of 2.9 is only at 32% of its range, which is too low.  There are studies showing that symptom relief required Free T3 to be at least at 50% of its range.    In addition,  in view of your T4 dose, I think you need to be tested for Reverse T3.  RT3 is a mirror image molecule of T3, but  it is biologically inactive,and, in excess,  can offset the effect of  Free T3.  Higher than needed FT4 levels also may contribute to excess conversion of T4 to RT3.  So I suggest that you try to get tested for Reverse T3 and a Free T3 from same blood draw.   At the same time I also suggest a cortisol test since hypothyroid patients  have a tendency to also be low in cortisol.  

Vitamin D is important for good thyroid function.  Your D is too low so you need to supplement with a total of about 3000 IU of D3 daily to optimize.  D should be at least 50 ng/mL.  You also need a ferritin test.  I see the iron tests done,  but ferritin is a readily available, storage form of iron and is often a precursor  to low iron levels.  Ferritin should be at least 100.  B12 also affects your energy level and your B12 is way too low.  The range is ridiculously broad.  B12 should be in the upper part of its range, so you need to supplement that also.  

You are going to need some med changes to optimize your FT4 and FT3 levels, as well as supplementing to optimize the other important variables listed.   Do you think your doctor is going to be willing to do these additional tests and also make med changes as needed to relieve your hypothyroid symptoms.   Or is the doctor one that gets alarmed (unnecessarily) by suppressed TSH?  

If you want to confirm what I have said, click on my name and then scroll down to my Journal and read at least the Overview of a paper on Diagnosis and Treatment of Hypothyroidism: a Patient's Perspective.  
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thanks
Avatar universal
I agree with gimel.

your FT4 is if anything too high, and I would think a reduction of your T4 med makes sense.

I also agree that FT3 level is far too low and an INCREASE in your T3 dose would make sense.

B12 is WAY too low!  and can cause fatigue and you should supplement.  I would recommend sublingual B12 as it is absorbed into the blood under your tongue and has better absorption rate.  You can get these over the counter and you know they are sublingual because they will either say it, or if not, it will mention a flavor.  Tablets that are NOT sublingual have no need to have a flavor.

I also agree your D3 is too low.  This can also cause fatigue problems.

I agree RT3 testing makes sense.  RT3 is made from the conversion of T4.  And can be a body's natural "go to" method if the body senses that there is too much T4 available.  And given your higher value of FT4 is certainly possible.  The problem is that your FT3 level is still too low, and leaves you feeling HYPO at the cellular level because of potential excess RT3 and lack of sufficient active FT3.

If your Dr keeps insisting on following TSH for adjusting your dose. You will need to do one of two things.  1) EDUCATE your doctor which is NOT always very easy to do and some are arrogant and s imply will NOT be open to the idea.  2) find a new Doctor.  And that is not always easy as the next doctor is fairly likely to be as uninformed and uneducated on good thyroid treatment as your first.  MANY of us have had to go through SEVERAL doctors to find one who will be willing to treat you based on symptoms taking into account blood labs, but ignoring TSH.  Option #2 is, or can be a painful and long process.  

But if you want to feel well.  YOU need to be treated so that YOU feel well.  NOT simply adjust meds to a magic number, as all of us feel well at a different balance and number.  Modern doctors seem to have forgotten this fact.  And they are afraid to be sued if they give a prescription outside of "normal" dosage or are unwilling to move up into the higher parts of the so called "normal" or reference ranges.

A rule of thumb for most people to feel well.  They will need BOTH of the following.

1) Free T4 to be 50% of the range or slightly higher.  You are I believe at about 70% of the range.  no need to be that high and is what MAY be causing the RT3 issue. But without testing RT3, you really do not know if this is an issue or not.

AND - that means in addition to #1

2) Free T3 to be 50% to as high as 66% of the range.  Many people need to be towards the 60 to 66% of the range with this active thyroid hormone.  As Gimel pointed out.  you are at a dismal 32% of the range of the ACTIVE thyroid hormone.

Remember at ALL of your symptoms are consistent with being LOW thyroid.  But are probably compounded by your low B12 and low D3 levels.
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