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brusselsgriffon 01-21-2013 05:34 PM

Month 11 - labs confusing
Thanks in advance for any guidance :)

Below is the 'journey' of dose changes and lab numbers. The family doctor was concerned that my TSH was so suppressed, but agreed to let it be for a few months to see if my body adjusted. Which it has not. So he suggested we go for 3 months at 75 mgs. I have been on this for about 3 weeks now - no major changes ( did have some naps - have not done this for months... and dry skin again, but time will tell.) I just got my FT4 today - sent to a different facility...I am surprised that it dropped so low on 90 mgs - pretty close to my levels without meds.

I am not sure what I am supposed to do at this point - perhaps these numbers are a normal fluctuation? Is .01 really a concern for TSH?

April 2012 NO MEDS
TSH 2.79 (.20 - 4.00)
FT3 3.8 (4.0 - 6.5)
FT4 12.9 ( 9.0 - 23)
Ferritin 33 (12 - 300) started taking iron supplements in May

May 2012 30 mg THYROID
TSH 2.25 (.20 - 4.0)
FT3 4.2 (3.5 - 6.5)
FT4 13.4 (9.0 - 23.0)

July 2012 60mg THYROID
TSH - .83 (.20 - 4.00)
FT3 - 4.8 (4.0 - 6.5)
FT4 13.0 (9.0 - 23)

October 2012 90mg THYROID
TSH - .03 (.20 - 4.00)
FT3 - 5.9 (4.0 - 7.6)
FT4 - 15.9 (9 - 23)

September 2012 90mg THYROID
TSH - below .01
FT4 - 16.4 (9- 23)
missed the FT3??

December 2012 90 mg THYROID
TSH - .01
FT3 - 5.3 (4.0 - 7.6)
FT4 - 13.7 (9 - 23)

lisa789 01-23-2013 04:31 AM

Re: Month 11 - labs confusing
I'm sorry you're struggling like this.
Am I correct to understand that in the meantime (after the latest labs) your dosage has been descreased till 75?

Your latest labs December 2012, both FT4 and FT3 aren't even midrange yet so a dosage increase would have been warranted instead of a decrease. Unfortunately your doctors seems to focuss on TSH.
to my knowledge thyroid is a brandname of a natural thyroid hormone so contains both T4 and T3. T3 and medication containing T3 such as Armour or thyroid are known to be TSH suppressant so there is no escaping a low TSH in that scenario, unless a person is kept hypo and in other words on a too low dosage.

hang in there

brusselsgriffon 01-23-2013 09:10 AM

Re: Month 11 - labs confusing
Hi, Yes, he did decrease. I did not feel like I could argue with him because the TSH was so low. When I read the boards here - people say shoot for under 1, but I was not finding people reporting .01 as safe. It is so frustrating that the free levels are so low even on a 90 mgs - same as a grain and half of armour. Is it safe to completely suppress one's thyroid?

lisa789 01-23-2013 09:26 AM

Re: Month 11 - labs confusing
the TSH results on T4 only or Armour (or similar) will be completely different. In the prescribing information of Armour (maybe also from thyroid not sure maybe you can check the paper accompanying the bottle), anyway the prescribing information states clearly that it's a known TSH suppressant. if one takes some form of T3 there is no escaping that

midwest1 01-23-2013 09:47 AM

Re: Month 11 - labs confusing
I take natural thyroid hormone. My own TSH hasn't been higher than .02 for about 10 years now. My MD understands the effect of natural hormone on TSH and knows that it's the free levels of T4 and T3 that are most important.

TSH "under 1" is the target for synthetic T4 users. For natural thyroid users, suppression is the usual goal. But still.... It's the free T4/3 that count most.

I can't get over the number of MDs who prescribe natural hormone without knowing how to do it correctly!

brusselsgriffon 01-23-2013 10:06 AM

Re: Month 11 - labs confusing
Hi Midwest - is your TSH sometimes undetectable - and if it is that is acceptable? Is it documented somewhere that natural hormone will suppress the TSH significantly? Then I can share it with my doctor.

lisa789 01-23-2013 10:11 AM

Re: Month 11 - labs confusing
it's in the prescribing information of Armour (you can google that or find it on an Armour bottle - so likely it's also on the paper which comes with the botte of thyroid but not sure about that).

brusselsgriffon 01-23-2013 09:21 PM

Re: Month 11 - labs confusing
I contacted the Canadian company and this was their response :(

Thank you for contacting Erfa Canada 2012 inc. Your physician is
correct. Since your TSH is low this indicates you are taking too much
Thyroid hormones. By reducing the dosage your TSH will increase and you
should be fine. Being on a low TSH can become problematic since taking too
much hormones for a very long time can cause osteoporosis.
Hope this helps.

telus 02-04-2013 09:14 PM

Re: Month 11 - labs confusing
Hi Brussel,
I have been pondering your dilemma for a while. It looks like you may be approaching the point where some people throw up their hands and say natural thyroid does not work for me! I hope that you will not.

I agree entirely with the other posters who have responded to you, however I'd like to try to explain what I think is happening.

First, backup for a minute and consider what your natural normal thyroid produces. A normal thyroid produces about 90 to 100 mcg of T4 and 6 mcg of T3 per day. Some of the T4 is converted by your tissue for a further 24 mcg of T3. If you assume you only absorb 80% of T4 meds, then you need to take 112.5 to 125 mcg to absorb 90-100 mcg.

Second, in the old days doctors found that about 180 mg natural desiccated thyroid (NDT) was kind of the minimum dose that people worked up to, which in the case of ERFA Thyroid contains 106 mcg T4 and 24 mcg T3. Think of this as a minimum "full replacement dose". So you can see why this would be the case, because these number are kind of similar to what a normal thyroid puts out.

Now let's look at what happened when you were on 90 mg Thyroid, which contains 53 mcg T4 and 12 mcg T3. The T3 enters your blood stream fairly rapidly and your T3 level is now high enough to trigger the TSH to go low. TSH is what tells your thyroid to make thyroid hormone, so if TSH is quite low, your thyroid is essentially "turned-off" - it does not make any more T4 or T3. But now you have a problem. You only take 53 mcg of T4 but your body needs around the 90-100 mcg T4, and your thyroid is turned-off. So you are going to be short of T4 and that is going to make you feel hypo. You can see that both your FT3 and FT3 were lower in December than in the October tests. I think that is indicative of your T3 and T4 stores being used up due to your thyroid being shut off.

So, long story short - if you go on to Thyroid you usually need to take a full replacement dose so that you get enough T4 and T3. And it is a typical mistake that doctors make - they don't increase the dose fast enough, because as you can see, once your thyroid is shut-off your are going to start to be hypo if the T4 dose doesn't get increased to a full replacement level.

It is hard to say if 75mg Thyroid will have enough T3 to keep your thyroid shut-off. If it does, then that will be worse because your T4 will be lower yet. On the other hand it may not keep your thyroid shut off and it is possible that your thyroid has enough capacity to make up the gap to your full requirement.

I guess our concern is that your doctor may not be familiar with this situation.

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