# Low TSH, low free T3, and low free T4. Need help!



## Savestheday (Jun 18, 2011)

Long story short, I've been on thyroid medicine for a little over a year now. I started out on Cytomel only because my labs were all within normal range but the doctor thought I could benefit from some T3. A few months ago I still didnt feel the way I thought I should; could still use more energy and had the weight gain. I was put on 1 grain of Armour and 25 mcg of Cytomel. Well a few months of this and I didn't feel any better so I decided to try a new doctor who is an M.D. but with a more alternative side because I believe I have adrenal fatigue as well and my old doctor didn't believe in that.

The new doctor gave me an IV of dmps for a heavy metal provocation test, and gave me Nature-throid to try (1 grain). The next day (while still on Armour even though I missed a full day's medicine) I had a blood test for my thyroid. There results were:

TSH: .03 (.4-4.5)
Free T4: .5 (.8-1.8) 
Free T3: 1.7 (2.3-4.2)

My heavy metals test showed no heavy metals, and I am still waiting on my saliva cortisol results to show if I have adrenal fatigue. About a week after being on Nature-throid, I started getting symptoms of what I thought were hyper symptoms (lots of anxiety/panic, nervousness, lightheadedness when standing or sitting up too long, some nausea, muscle weakness/fatigue in arms and legs, hypoglycemia symptoms if I don't eat in time etc.) so the next day I reduced both medicines to 1/4 of each pill, and the day after that I stopped the Nature-throid all together.

While having these symptoms on Nature-throid and Cytomel, I went to my general practitioner to see if something else was going on. She did a metabolic panel and some other things which all came out normal except my thyroid results which were:
TSH: <.01 (.4-4.5)
Free T4: .7 (.8-1.8)
Over the next few days I started to feel better, but now I am feeling very bad again with the anxiety, nervousness, and weakness in arms and legs. I have been reluctantly taking a Xanax to help me sleep until I can get to my original endocrinologist on Tuesday (today is now Saturday).

My question is, does anyone know why all of my levels are so low, and if I should be taking my thyroid medicines? I've been only taking 1/4 of my Cytomel which is 6.25 mcg because I thought these were hyper symptoms, not hypo. I can't stand this anxiety! Please help, any info is greatly appreciated! Sorry for such a long post, thank you!


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## lainey (Aug 26, 2010)

All "natural" thyroid products have a T3/T4 ratio that is greater than what is normally found in the body. The product of that is lab results that will show a low TSH and low Free T4. In a sense, those numbers in your labs are "normal" given the medication you were/are taking.

Some people react very strongly to T3 in any form, including cytomel. You were taking two types of T3 at once, which is generally not good practice.

Your second set of labs do not include free T3. These are NECESSARY when taking any form of T3, as you need to measure it also. The explanation for your symptoms may be found there.

A full antibodies panel--TPO and TSI--would be revealing also, to see which sets of antibodies you have. It is possible to have both blocking and stimulating antibodies, which, when present, do make it difficult to medicate the patient.


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## Lovlkn (Dec 20, 2009)

lainey has given very good advice.



> I was put on 1 grain of Armour and 25 mcg of Cytomel.


This is simply an insane dose combination and would make anyone feel horrible.

I have never heard of anyone taking Armour and adding even more T-3 to the mix.

I wonder if your labs are off because of absorbtion due to how/when you take your replacement meds.

How often/when do you take them? With or without food and away from calcium and iron supplements?


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## Savestheday (Jun 18, 2011)

Thank you for your replies. I felt best at about 75 mcg of Cytomel, no T4, but still not the way I think I should have felt. Still some fatigue, trigger point muscle pain, still couldn't lose weight etc, but my doctor lowered it because my free T3 level was a little over the high end range. Once I was on the lower dose (25 mgc) I realized that the higher dose was giving me constipation and making me feel dizzy when standing (maybe it lowered my blood pressure). The doctor was going to give me Synthroid to try along with the 25mcg of Cytomel, but I asked if I could try Armour since I had heard good things as opposed to Synthroid. 25 mcg of Cytomel plus the 8 or 9mcg of T3 in the Armour/Nature-throid is nowhere near 75 mcg of T3 like I was on. So, my assumption is that he wanted to keep me on T3 since I got a little help from it, and then see if a small amount of T4 would boost me up to feeling where I should. I've been on this dose since March and didn't feel any different which is why I went to another doctor to see if adrenal fatigue could be playing a part in this. I just don't understand how I was feeling ok/no different with low labs, and then 2-3 weeks later after changing meds can bring on the symptoms with similar labs.

Also, I was taking 1/2 of each in the morning and afternoon. I was starting to feel better when I stopped the Nature-throid completely and on 1/4 of Cytomel but after a few days the symptoms came back again which leads us to the present day. I just don't know if my symptoms are hyper, or hypo. I know sometimes they can overlap.

The first levels I posted were from when I felt ok on Armour, the second posted levels are from a week on NatureThroid. These labs were only done a few weeks apart.

Thyroid peroxidase antibodies: 16 (<35)
Reverse T3: 14 (11-32)

Thanks!


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## lainey (Aug 26, 2010)

At 75 mcg of cytomel you were taking the equivalent of 300 mcg of T4 which by anyone's standards is a huge dose, and no surprise, with T3 over the range you were overmedicated.

The T4 in any form is ultimately converted by the body to T3. So likely, the combination did not net you as much as a dose decrease as you may think.

>>my assumption is that he wanted to keep me on T3 since I got a little help from it, and then see if a small amount of T4 would boost me up to feeling where I should<<

The goal of replacement is to get your levels into a good spot in the ranges and go from there. On T3 replacement, this is usually at between 50-75% of the lab range for free T3. Higher than that, and you are likely to have symptoms of hyper.

The only way to tell what the origin of your symptoms is would be to have the proper lab work. At this point it would be the free T4, free T3, TSH and the TPO and TSI antibodies. Low iron, low vitamin D and many other things can also mimic the symptoms of hypothyroid and should be ruled out.

Many people find that they have lingering symptoms even when "properly" medicated. At that point, changing the thyroid medications is not necessarily effective.


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## Savestheday (Jun 18, 2011)

People can be properly treated with high doses of T3 only. My lab results showed I was perfectly fine on 62.5 mcg of Cytomel yet still had some lingering symptoms which leads me to believe that the adrenals or progesterone/estrogen are involved. When I was on 75 mcg, my labs were only a point or 2 high, so I was barely hyper on paper but I didn't feel like it. People with fibromyalgia (I have muscle pain) are sometimes treated for good with very high doses of T3.

My problem with my abnormal labs started when I added T4 3 months ago. I'm just trying to figure out why adding a little bit of T4 screwed every level up in such an odd way. If I'm too hypo now, my TSH should be high, not as low as it is. I've never had any level as low as they are now.

I have had all the proper labwork done, and I am not deficient in iron, ferritin, vitamin D, zinc, and I have not tested positive for any antibodies.


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## lainey (Aug 26, 2010)

While people can be treated with T3 medication only, it is not common or conventional to do so. Doctors who prescribe T3 medications in any form should be aware themselves of the necessity to then measure the free T3 in the blood, and also should be aware of the way in which it alters the lab results to make them appear abnormal.

The first T3 could well have been low because you missed the dose that day. You were after all also measuring the effect of the dose decrease, and it may have been too much, or there could be some other error in the lab measurement.

>>If I'm too hypo now, my TSH should be high, not as low as it is. I've never had any level as low as they are now<<

First of all, your TSH still reads very suppressed, or hyper. The T4 reading is influenced by the medication you are taking as well, so it doesn't give an accurate picture. We don't have a more current free T3 to truly evaluate the medication you are taking.

I will repeat that your lab results of low TSH/T4 were proper for the medication that you are taking, especially when taking T3 only.

T3 medication SUPPRESSES, or LOWERS, TSH. That is what your labs are showing. Your low TSH/T4 in lab your lab results is expected for the medication you were taking.

At one point in the recent past, your labs showed a T3 over the range. This additionally will lower the TSH. T4 also tests as low, because that is what the thyroid produces, and at that point, it was not doing so (even if it could) because of the high level of T3/low TSH from an outside source. There was no reason to add T4 to "adjust" that number because 1) it was correct for the medication you were on 2) ADDING T4 in any form at that point, because it is converted also to T3 does not help the situation. Raising the T4 isn't going to make it better because ultimately that will make the T3 higher (more hyper). The free T4 number should be low on T3 medication.

Regardless of how you felt symptom-wise, a free T3 over the range, even if it is "only a point or too higher" is overmedication and not a healthy state to be in. As you can see, symptoms alone don't always match the results, as there are many that are common to both hyper and hypo--among them fatigue, anxiety and weight gain. Perhaps your dose should be changed, but once again, it is impossible to say without seeing a Free T3 number--which you do not have in your recent labs.

The proper blood work that I was referring to includes a FREE T3 so that everyone has an idea of where you are exactly right now. You could be having symptoms because you are still overmedicated or undermedicated, but there is no way to tell without the labs.

>>I started out on Cytomel only because my labs were all within normal range<< If the medication isn't working, in the sense that it did not resolve your symptoms, perhaps you are correct that it isn't necessary to begin with.


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## Andros (Aug 26, 2009)

lainey said:


> While people can be treated with T3 medication only, it is not common or conventional to do so. Doctors who prescribe T3 medications in any form should be aware themselves of the necessity to then measure the free T3 in the blood, and also should be aware of the way in which it alters the lab results to make them appear abnormal.
> 
> The first T3 could well have been low because you missed the dose that day. You were after all also measuring the effect of the dose decrease, and it may have been too much, or there could be some other error in the lab measurement.
> 
> ...


That is correct; one needs some T4 to complete this process which is essential to good health. But too much T4 is no good either when one is on a med containing T3 such as Armour. The way I look at it; these pharmaceutical companies have the ratio figured out pretty good when it comes to Armour®, Thyroid®, Naturethroid® etc..

Deiodinases
http://www.jci.org/articles/view/29812


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