# I'm not worried about a low TSH, but how to deal with PCP?



## Scanders (Sep 9, 2015)

I made an adjustment to my levothyroxine dose in early December to 88mcg alternating with 100mcg. I think I'm feeling all right. PCP wanted labs done to monitor for homeostasis. I had the labs done by a private lab for the first time, and it really is more cost-effective than the doctor's lab (T4 and TPO were included as well, and still less expensive than just these three with the other lab.) Here are the results:

T3, FREE

3.1

N

2.3-4.2

pg/ml

T4, FREE

1.40

N

0.89-1.76

ng/dl

TSH

0.063

L

0.550-4.780

uIU/ml

If my math is right (I don't trust my math, to be honest) FT3 is just below mid-range, but definitely improved, and FT4 is barely above mid-range. (This lab uses a different reference range than the other lab.) I could be wrong, but I think she'll have an issue with the TSH being low. I don't think I can omit it when I give her these results. But how do I sound somewhat intelligent as we have a dialogue about this? I don't think I would need to decrease my dose, but I'm worried she will want to do that. I think I need to state my case with some science behind it as to why TSH isn't the end-all/be-all. I still have my thyroid, if that matters.

Thank you!


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## creepingdeath (Apr 6, 2014)

I'm not a doctor but I can give you some advice, my opinion and some theories from personal experience.

First you probably should tell your doctor that you are changing your dose as an experiment because you're not getting any better.

I myself, can't tolerate synthetics but I did take it at the beginning of my thyroid disease for two years.

I got worsening symptoms within two weeks from taking Levothyroxine for the 1st time and continued to get worse the more I took.

The doctor I was seeing then only did TSH & occasionally free T4.

The results were always within range and the Levo did shrink my enlarged "goiter" thyroid but I felt more hypo with worsening symptoms.

I eventually got on desiccated thyroid and felt better almost immediately.

This is my theory to why lab ranges looked good but I felt worse on T4 only synthetics.

I've come to this conclusion after years of studying everything I could about thyroid disease, specifically Hashimoto's.

The pituitary gland responds to lowering "T4" in your system and not T3.

Taking T4 synthetic only fooled my pituitary into thinking everything's good and shrinks my thyroid but symptoms get worse than taking nothing.

Only till I paid out of my own pocket did I find out I was not converting T4 to T3.

My free T3 was below range and reverse T3 was above range.

The reason for not converting is from Pharmaceutical lies from the makers of T4 only synthetics.

Synthetic T4 is bioequivalent which means it should act the same as what your thyroid makes naturally but is not chemically the same. It is not bioidentical as the medical community and pharmaceutical companies want you to think.

The chemical structure & formula is very different.

My TSH now after taking desiccated thyroid is way below range but my free T4 & T3 are like they should be naturally.

If I were you I'd tell your doctor your tired of the run a round and you're not waiting for a hormone that's supposed to be the exact same as what your thyroid makes to start working.

If your doctor disagrees find a new doctor.

It literally took me 5 years of battling & 5 different doctors till one listened to me.

I'm treated now by clinical symptoms and labs to make sure my cholesterol is good.

I wish you the best of luck & don't give up till you feel the best you can.

It's your body and not the doctors and they work for you...&#8230;&#8230;.


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## GOLGO13 (Jun 13, 2018)

this article may help...or find another doctor

https://thyroidpatients.ca/2020/01/21/7-ways-to-raise-tsh-without-reducing-thyroid-dose/


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## GOLGO13 (Jun 13, 2018)

Also...do you take biotin supplements? Your free numbers don't match up with your TSH really...looks like possible interference. Though I think they affect free numbers also (biotin).


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## creepingdeath (Apr 6, 2014)

What about the results of your TPO antibody test?

High antibodies can mess with TSH results also.


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## Scanders (Sep 9, 2015)

Thank you for the responses, and I'm sorry I wasn't more clear. While I had to do some convincing after my last labs, the PCP made that adjustment in med--I didn't act independently--because I wasn't quite feeling well. It took some going back and forth, respectfully, of course. So I feel all right now, certainly nothing that makes me think I need an adjustment in meds at this point. And I think my frees look all right, actually. It's just that I have to report these results, and my concern is that the frees will be ignored because of that low TSH, so I was just asking for help with scientific talking points. I wanted to be proactive, if you will.

I don't take a biotin supplement. There was a TPO test in this profile. The result was 39, with normal range being <60.

In my simple brain, the low TSH simply means that I have enough thyroid hormone, and we don't need to scream for more. I mean, if I have enough hormone, why would I have TSH? Or, antibody results that are "negative" aren't the same as "0", and maybe there are just more blocking antibodies that keep my TSH low. My TSH was undetectable for a looong time before moving into hypo-range.


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## GOLGO13 (Jun 13, 2018)

How long did you wait before you tested from the dose change? I suggest at least 6 weeks.

What time of day did you take the tests? I suggest early in morning before you take your dose. This will be when it's at it's highest. And be consistent everytime.

How are your Iron levels? Suggest taking all 4 Iron tests and Ferritin. My Iron levels were low and that affected how the thyroid meds worked.

Let them know you are feeling better and let them know you want to wait until you test again to see if anything has changed.


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## creepingdeath (Apr 6, 2014)

Most doctors would lower your dose if TSH is lower than the lab range no matter what.

I had a professor of endocrinology tell me it does not matter what your symptoms are as long as Thyroid Stimulating Hormone is within range.

That if I still had symptoms that I had something else causing those symptoms.

He also told me when I ask about the alternative "desiccated thyroid" that this type of hormone is no longer produced and Synthroid T4 only is the only thyroid hormone available anymore . That if I can't tolerate the hormone to switch to another brand which is the same . I tried every brand even synthetic combo and T3 alone.

They all caused horrible side effects and did nothing for original symptoms but make them much worse.

I ripped up my lab results right in front of this so called professional, called him a blatant liar and walked out of his office.

He obviously has been being paid off by a pharmaceutical company to push their synthetic wonder drug. Every pharmacy I called had most brands of desiccated thyroid in stock...&#8230;.

I found an old fashioned country doctor who had no problem at least letting me try Armour thyroid.

Within the 1st week on the lowest dose of Armour I could feel myself getting better.

And I've been taking it ever since.

When you see your doctor tell him/her that you feel good on your current dose.

If the doctor wants to change the dose because TSH is low...&#8230;.refuse...&#8230;&#8230;.

Remember this doctor works for you and it's your body that you know better than anyone else.

Find another doctor if they disagree with you.

again...good luck and let us know how it went....


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## Scanders (Sep 9, 2015)

I'm getting the hang of lab testing now--I waited about 3 months from dose change to have best chance of homeostasis. I tested first thing in the morning, and did not take levothyroxine that day until after labs. That's how I always do it to be consistent. I think past doctor's behavior may have me worrying unnecessarily. If I feel all right, but the doc is worried about the TSH, then yes, respectfully request to leave it alone and retest again at a later date. If she refuses, then I guess I need to look elsewhere. Okey doke, let's see where this takes me... Thanks for the help!


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## Lovlkn (Dec 20, 2009)

> In my simple brain, the low TSH simply means that I have enough thyroid hormone, and we don't need to scream for more. I mean, if I have enough hormone, why would I have TSH? Or, antibody results that are "negative" aren't the same as "0", and maybe there are just more blocking antibodies that keep my TSH low. My TSH was undetectable for a looong time before moving into hypo-range.


I totally agree - not having TSH should indeed point to you being in perfect range. More likely - you have stimulating antibodies such as TBII. I have TBII and do not have TSH when in 1/2-3/4 ranges for both FT-4 and FT-3. I shut one MD up when I told them this a long time ago and insisted they run TBII - which of course I was above range in.



> T3, FREE 3.1 N 2.3-4.2 pg/ml T4,*((3.25-3.715))* FREE 1.40 N 0.89-1.76 ng/dl *((1.325-1.54)) *TSH 0.063 L 0.550-4.780 uIU/ml


I edited in ((bold)) the 1/2-3/4 of the Free ranges. Free T-4 is perfect. Free T-3 is still below mid range.

How do you feel? If you feel good then these labs with your low range TSH are fine. For me running this low a TSH has had absolutely zero impact negatively on my bones. If your doc freaks about the TSH then ask for the TBII test. I bet $1 its elevated.


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## Scanders (Sep 9, 2015)

I think I feel all right. Could I feel even better? Maybe. But I can't point out enough symptoms just now to justify asking for an increase. And while FT3 might be a smidge low, this is probably the closest it's been to mid-range in a couple of years. I had a bone scan a few years ago and it was good. I've reported the labs--haven't heard back. But I think I'm ok letting things ride for now, and I hope my PCP is fine with it, as well. Thanks Lovkin!


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## Scanders (Sep 9, 2015)

I saw a doctor for something non-thyroid, and she ran a ferritin test. I recalled ferritin being mentioned here. My result was in the normal range, but lower than she wanted to see and she added an iron supplement. Looking back, hgb has been checked, but I don't see that my ferritin has ever been checked before. Not that long ago I had my thyroid labs rechecked, and they seemed pretty stable, but I felt a little "off". Could the ferritin maybe be contributing? I thought maybe it was just extra pandemic stress. I'm curious to see if increasing the ferritin helps how I feel generally.(Can feeling cold be from low ferritin? Fatigue? Tinnitus?)

Thanks for your thoughts!


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## GOLGO13 (Jun 13, 2018)

I suggest getting your full iron levels checked (all 4 tests in addition to ferritin). Supplementing iron is tricky I understand so be careful with that long term. My wife had some issues from taking that for too long.

I found my levels turned around with a focus on nutrition. But I'm a man and it could be a bit different if you are a lady. More common to have Iron issues in women.

So poor Iron levels do affect thyroid hormone processing from my research and experience (at least that's what I think happened).

Low iron can certainly impact things in general. Suggest getting a high quality multivitamin from a company like Pure Encapsulations and see if that helps with general nutrition.


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## Scanders (Sep 9, 2015)

Thank you. Interesting that multivitamins for women over 50 typically do not have iron--mine doesn't. The doctor recommended adding ferrous sulfate just two days per week, which seems reasonable considering that my level is in the low-normal range, but she said it's not optimal and just wants to bump it up a bit. She's leaving thyroid monitoring to my PCP. So, just when I think I have things figured out on this journey, here's another factor to take into consideration. I've read that lack of ferritin may have some role in hair loss. Maybe getting ferritin more optimal will help some of my hair come back? Here's hoping.


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## GOLGO13 (Jun 13, 2018)

I think they do not put in Iron because supplementing with Iron is tricky. So better to have the Iron separate from the multi.


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## Lovlkn (Dec 20, 2009)

Floridix is a great iron supplement liquid which is much easier on your system. Do you still have monthly cycles? Ferritin levels will be lowest just after so keep track of when you are being tested within your cycle if you have one.

My issues were - inability to tolerate T3 hormone, restless leg.

I ended up opting for endometrial ablation and now iron levels are over range slightly. No more restless leg and I've not had issues with T3 hormone since.


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