# TSH 0 and low T4



## sweetolive (May 14, 2013)

I have been taking 165 mg NP Thyroid for 6 weeks..Went to Doc Monday and my new labs show that my T4 is below normal but my T3 has increased..my TSH is zero...before Doc knew my test results he told me increase my NP Thyroid by 45 mg and come back in 6 weeks...he based the increase on my described symptoms..he has not called to discuss results.

I am afraid to increase by 45mg all at once...I did increase from 165 to 180mg...but, I am thinking that I actually need some T4 and this may be reason I am still feeling tired.....has anyone had a TSH of zero and could this be dangerous especially if I increase as much as Doc instructed me to..Opinions greatly appreciated!!!

Diagnosed as HYPO in 1990's
Took Synthroid until Oct. 2012 & switched to NP Thyroid

Test results July 2013

T4 0.63---- 0.82-1.77
T3 3.6---- 2.0-4.4
TSH---- 0


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## Andros (Aug 26, 2009)

sweetolive said:


> I have been taking 165 mg NP Thyroid for 6 weeks..Went to Doc Monday and my new labs show that my T4 is below normal but my T3 has increased..my TSH is zero...before Doc knew my test results he told me increase my NP Thyroid by 45 mg and come back in 6 weeks...he based the increase on my described symptoms..he has not called to discuss results.
> 
> I am afraid to increase by 45mg all at once...I did increase from 165 to 180mg...but, I am thinking that I actually need some T4 and this may be reason I am still feeling tired.....has anyone had a TSH of zero and could this be dangerous especially if I increase as much as Doc instructed me to..Opinions greatly appreciated!!!
> 
> ...


When taking any form of T3, the T4 is automatically very low and that is not anything to be concerned with; nor is your 0 TSH. What is of concern is your FREE T3.

Looks like you had Total 3, not FREE T3??? Although the lab range looks like Free T3. Can you clarify?

In any case, your doc would want to get your FREE T3 at about 75% of the range given by your lab.

Understanding the Thyroid: Why You Should Check Your Free T3
http://breakingmuscle.com/health-medicine/understanding-thyroid-why-you-should-check-your-free-t3

Dr. Mercola (FREES)
http://www.mercola.com/article/hypothyroid/diagnosis_comp.htm

Free T3 and Free T4 are the only accurate measurement of the actual active thyroid hormone levels in the body. This is the hormone that is actually free and exerting effect on the cells. These are the thyroid hormones that count.


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## Andros (Aug 26, 2009)

sweetolive said:


> I have been taking 165 mg NP Thyroid for 6 weeks..Went to Doc Monday and my new labs show that my T4 is below normal but my T3 has increased..my TSH is zero...before Doc knew my test results he told me increase my NP Thyroid by 45 mg and come back in 6 weeks...he based the increase on my described symptoms..he has not called to discuss results.
> 
> I am afraid to increase by 45mg all at once...I did increase from 165 to 180mg...but, I am thinking that I actually need some T4 and this may be reason I am still feeling tired.....has anyone had a TSH of zero and could this be dangerous especially if I increase as much as Doc instructed me to..Opinions greatly appreciated!!!
> 
> ...


I forgot to say; it would be better to increase by 1/2 of that. I agree w/you 100%.


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## sweetolive (May 14, 2013)

I dont have a copy of my lab work yet...the nurse called with labs and I asked for T3 and T4 results....Those are the numbers she gave me..Maybe, I misunderstood or wrote down wrong.....The nurse is suppose to fax my labs to me today..I will post when they do.......Andros, why would you be concerned if my T3 is 3.6? Is that still too low? I looked at old labs done in May 2013 and my T3 was 3.1 then........Would you take the 15mg increase for 6 weeks, go back to doc and then increase again if needed? I hate not to do as Doc ordered but almost everything I have read says to increase by small doses for 6 wks or so to prevent going hyper...I am really very confused...


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## sweetolive (May 14, 2013)

Hi Andros.........Just got my labs

FT4 0.63---------0.59-1.17
FT3 (Triiodothyroine Free Serum) 3.6--2.0-4.4

What I am even more concerned about is my ferritin level..it is 483...In April it was 287 and I went to hematologist...He told me to make sure to check ferritin levels yearly and he didnt think I had hematomachrosis...that was just 12 weeks ago.......I also have a high Percent Iron Saturation....Now, I dont know if it is my low T3 that is making me so tired or it has something to do with ferritin level...I know this isnt a site to discuss ferritin but I am so upset and worried....Could ferritin level have anything to do with my thyroid disease?


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## StormFinch (Nov 16, 2012)

I don't believe Andros was necessarily concerned with your Free T3 but was simply trying to emphasize that natural thyroid replacements are supposed to be raised or lowered primarily by of your Free T3 results and that both TSH and Free T4 are typically suppressed while taking it. Needless to say, your TSH and Free T4 are perfectly fine for what you're on. Your Free T3 could use a small nudge up since 3.8 is 75% of the range I believe, and someone feel free to correct me if I'm wrong. I agree that a 45 mg jump is way too much all at once.

As for the ferritin, high levels can induce hypothyroidism and Graves disease can sometimes cause high levels. The typical normal test range is 12 - 150 ng/uL for women, though of course labs may vary a bit. Still, that makes your results look quite high. High ferritin can can share a couple of symptoms with thyroid problems such as fatigue, lethargy and joint pain. *However*, looking back over your other posts I see that you've had hypo for at over 20 years. I can't be certain as I'm not a doctor, but I don't think you could have had high ferritin levels for that long without it showing up somewhere, and that could very well mean that this is a new, separate issue.

If it were me, I would cut out all iron and vitamin C (Vit. C causes the body to absorb more iron) in the form of supplements and then make an appointment with another hematologist pronto. Make a list of all your medications, including your regular supplements, to take to with you. Iron rich foods should also be avoided as much as possible until you can get to the bottom of this. That includes iron fortified foods with cereals being at the top of the list, red meats and all organ meats.

Here's hoping you find some answers soon. hugs1


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## Andros (Aug 26, 2009)

sweetolive said:


> I dont have a copy of my lab work yet...the nurse called with labs and I asked for T3 and T4 results....Those are the numbers she gave me..Maybe, I misunderstood or wrote down wrong.....The nurse is suppose to fax my labs to me today..I will post when they do.......Andros, why would you be concerned if my T3 is 3.6? Is that still too low? I looked at old labs done in May 2013 and my T3 was 3.1 then........Would you take the 15mg increase for 6 weeks, go back to doc and then increase again if needed? I hate not to do as Doc ordered but almost everything I have read says to increase by small doses for 6 wks or so to prevent going hyper...I am really very confused...


Concerned meaning you need a small increase to get the FREE T3 to where it should be. It looks to be too low in the range.

I still don't understand if you are talking Total 3 or FREE T3. Could you clarify for us please?


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## sweetolive (May 14, 2013)

I agree that I need a second opinion..The hematologist spent more time lecturing me on the dangers of Armour Thyroid...he didnt really seem concerned about ferritin level just to check once a year...if I wait a year, no telling how high it could be considering in 12 wks it went from 287 to 483...I definitley think something new is going on now to cause high ferritin..I am very worried and will look for another doc...
Thanks for replying to my post...


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## sweetolive (May 14, 2013)

Andros..I thought it was T3...this is what is typed on lab work..

FT3 (Triiodothyroine Free Serum) 3.6--------2.0-4.4


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## Andros (Aug 26, 2009)

sweetolive said:


> Andros..I thought it was T3...this is what is typed on lab work..
> 
> FT3 (Triiodothyroine Free Serum) 3.6--------2.0-4.4


Awesome; it is FREE T3! I did suspect that by the range included but you know, it's your health and well being at stake and I sure would not be happy to know I said something in error.

Thank you soooooooooooooooooooo much.

Now that ferritin. Yikes! Did you have a range for that?


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## sweetolive (May 14, 2013)

Andros, The range is 15-150 so you can see mine is high at 483..I have been feeling very tired for over a year and thought that it was because my T3 level was so low..I spent the last year looking for an Endo or any doc that was knowledgble about Armour..I finally found a doc that has no problem with Armour/NP, actually prefers Armour over Synthroid...3.6 is the highest reading I have ever had and I still feel tired and exhasuted..I think by now, I should be feeling somewhat better and have more energy...

I am thankful that one of the docs I went to for my thyroid did a ferritin test...I dont think anyone has ever checked my ferritin level....

I did notice in reading today that I have many symptoms of Addison's disease...salt craving (which I never have) plus BP of 108/78..fatigue, depression, low appetite,joint aches... Wow, one can drive themselves crazy reading the internet..so many symptoms of thyroid disease mimic other disease...Thanks for replying Andros!


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## StormFinch (Nov 16, 2012)

Olive, I ran across the following earlier today; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3093720/. From what it says, ferritin levels in the 200 - 1000 range aren't all that uncommon, and inflammation can cause raised levels - something not at all unusual with autoimmune conditions. Personally, I would still be looking for a second opinion however.


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## sweetolive (May 14, 2013)

Storm, thanks for the very interesting and informative article...I feel better after reading it just knowing that there are many things that can elevate ferritin level and not all are serious..

I am definitely going to seek a second opinion..thanks again!!


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