# Low TSH and low FT4, post thyroidectomy/Graves& Pregnant-TSI causing low TSH?



## Happygal

I am 38 years old. I have Grave's disease and had a thyroidectomy a year ago. After the surgery I was a walking zombie on synthroid and my endo kept wanting to lower my dose since my TSH was still very low. I read Stop the Thyroid Madness and decided to change docs and get on Armour. I felt better on Armour immediately. We are working on getting my levels/ meds stabilized. I am currently on 180 MG Armour. My last lab tests showed TSH *.015* (normal .45-4.5)
Free T3 3.9 (2.0-4.4)
Free T4 *0.79* (.82-1.77). 
To compound things I am 12 weeks pregnant. So my Ob/Gyn lowered my dose of Armour to 90 mg after doing only a TSH (.01). After 3 weeks I was back to zombie tired mode. I brought my last thyroid panel results into my appointment today. She admitted that she should not have changed my Armour and told me to go back to 180 MG Armour.

*I am trying to find out why my TSH is essentially broken and not a good indicator for me at all.* I found some cursory information that TSI may cause TSH to not be reliable post/thyroidectomy. If this is true, does anyone have reliable source information on this that I could bring to my family practice doctor and OB/GYN. They are stumped as to why my T4 is low when my TSH is low. If my TSH can't be used at all, I am thinking that maybe I should be on a larger dose of Armour than 180 MG. Any help would be appreciated.

Thanks.


----------



## Andros

Happygal said:


> I am 38 years old. I have Grave's disease and had a thyroidectomy a year ago. After the surgery I was a walking zombie on synthroid and my endo kept wanting to lower my dose since my TSH was still very low. I read Stop the Thyroid Madness and decided to change docs and get on Armour. I felt better on Armour immediately. We are working on getting my levels/ meds stabilized. I am currently on 180 MG Armour. My last lab tests showed TSH *.015* (normal .45-4.5)
> Free T3 3.9 (2.0-4.4)
> Free T4 *0.79* (.82-1.77).
> To compound things I am 12 weeks pregnant. So my Ob/Gyn lowered my dose of Armour to 90 mg after doing only a TSH (.01). After 3 weeks I was back to zombie tired mode. I brought my last thyroid panel results into my appointment today. She admitted that she should not have changed my Armour and told me to go back to 180 MG Armour.
> 
> *I am trying to find out why my TSH is essentially broken and not a good indicator for me at all.* I found some cursory information that TSI may cause TSH to not be reliable post/thyroidectomy. If this is true, does anyone have reliable source information on this that I could bring to my family practice doctor and OB/GYN. They are stumped as to why my T4 is low when my TSH is low. If my TSH can't be used at all, I am thinking that maybe I should be on a larger dose of Armour than 180 MG. Any help would be appreciated.
> 
> Thanks.


Hi there! Your labs look very good to me. I don't believe your dose should have been lowered. Especially when pregnant. A doc that goes by TSH alone is scary.

This may be helpful.

http://www.thyroidmanager.org/Chapter14/14-frame.htm

Since you no longer have a thyroid, you really should no longer have TSI. Have you had a recent TSI lab test?

Congratulations on your pregnancy!


----------



## GD Women

With TSH .01 your dose is still too high. When TSH is optimal and for pregnant that would be TSH between 1 and 2, FT-4 will be on the low side but within Lab range. I think if you get you TSH to the proper range you just might see FT-4 come a little. You visited a controver


----------



## GD Women

With TSH .01 your dose is still too high. When TSH is optimal and for pregnant that would be TSH between 1 and 2, FT-4 will be on the low side but within Lab range. I think if you get you TSH to the proper range, you just might see FT-4 come up a little. Don't believe ever thing at controversial site(s).

Armour is not a guarantee to cure symptoms. It takes a while for the body to heal from hyperthyroidism after treatment, maybe years. Then there is Graves' symptoms to consider which is not cureable.
If you didn't have RAI after surgery to disable the left thyroid residue, then Antibodies (TSI) can still attack the left over thyroid tissue and cause havoc with your system/symptoms.

TSH is very reliable if you wait long enough between Labs for testing. Actually I would go by all three, especially FT-3 due to being on Armour. I am taking levoxyl and doctor goes by TSH and FT-4, it would only be feasible to go by TSH and FT-3 being on t3 pig Armour.

Thyroid levels effect one another and play an essential part in thyroid. One whacked out might cause the other to be whacked out. Take care of one might take care of the other.


----------



## Happygal

Thanks ANDROS for your reply. I should mention that the lab values I was quoting were before I was pregnant. Also, my TSH has never been anywhere near normal since the Graves.

Can you still have some TSI circulating even after a thyroidectomy?


----------



## lainey

First of all, at 12 weeks pregnant you should be tired, that's the nature of the beast.

Second of all, after a long period of time with the excess energy of hyperthyroidism, many patients find that "normal" levels leave them feeling too tired--you need to get used to a new normal, that is part of the problem.

Armour distorts your labs in such a way that you end up treating to a normal T3, because the TSH and FT4 while on Armour, as you can see, end up suppressed. Armour contains a higher T3/T4 ratio than is found in the human body and its effects are two-fold. Because the ratio is different, T4 in the blood is lower and T3 is higher. The body responds to a high level of T3 in Armour by shutting down TSH production, as in hyperthyroidism, resulting in a low TSH. The Armour itself is presently the likely reason why your labs look like they do.

It's not a good scene if a doctor is prescribing this medication and doesn't know that your lab results are to be expected. The FT3 *MUST* be run to monitor a patient on Armour.

You don't have a thyroid, TSI is a non issue as far as interacting with your medication to produce your lab results.

That said, your medication requirements are going to change throughout the pregnancy, and you should be getting tested every 4 weeks or so and have your meds adjusted accordingly to keep the FT3 in the normal range.

Did anyone ever suggest adding cytomel to the synthroid when you were on it?


----------



## Andros

Happygal said:


> Thanks ANDROS for your reply. I should mention that the lab values I was quoting were before I was pregnant. Also, my TSH has never been anywhere near normal since the Graves.
> 
> Can you still have some TSI circulating even after a thyroidectomy?


This is only a guess; maybe up to 6 months. I will say though that if you have ectopic thyroid anywhere else in your body of if the surgeon did not get all your thyroid (it grows back);yes..............you could still have it.

Ectopic thyroid (you can google) is like endometriosis. The tissue can and does attach to the ovaries (Ovari Struma), the lungs, the heart, the liver...............many many places.


----------



## CMantz

Just adding my .02...I just saw my endo today for my first followup/labs post TT whcih was on 8/24.

Here is what I know....TSH can be suppressed for a very long time...months or even years in Graves patients post RAI or TT. You can NOT base meds on TSH!!! In fact my next blood draw my endo is not even testing for TSH because he understands that my TSH isn't going to come up for some time.

Also, I asked him about Armour today. He said the same thing that lainey said...the ratio of T3/T4 in Armour is much different from what the human body makes. So when on Armour your T3 is going to be much higher. I also know from monitoring other groups...when on Armour, patients WANT their TSH suppressed. Have you had your ferritine checked or your adrenals? That is important when on a natural replacement. In order for the thyroid hormone to work and for you to get to the dose that you need, you have to have your ferritin and adrenals working FIRST.

Also, on another group that I belong to for Graves there is even some mention of Armour causing issues with TSI antibodies.

Check out graves_support and/or thyroidless groups on Yahoo. But keep in mind that they advocate different treatments...one is pro Armour, the other not so much.


----------

