# Low TSH , low Free T3 and low free T4



## gammagirl (Nov 18, 2013)

Hi everyone ,

I am new to this forum and hope someone can give me some insight as to what is going on . I have been on Thyroid Meds for the last 6-7 years. I started out on Armour for about a year but it gave me anxiety and I just never felt right on it. From June 2008 until Jan 2013 , I was on 150mcg Synthroid and 50 mcg Cytomel. I felt pretty good on that dose - not great but decent. My TSH fluctuated from a low of 0.006 to .01 and my Free T4 and Free T3 where always in the low- normal range. In fact, my Free T4 hovered around 0.9 ( 0.8-1.8). I could never achieve that mid to upper range but since I felt okay, my doctor did not want to increase my meds.

In Nov , 2011, on the same meds during a routine med check, My free T4 fell to 0.76 and Free T3 fell to 1.7 ( 2-3.3) At that point my TSH was 0.006. During the next few months, my Free t4 and Free t3 fell lower even thoughThe TSH remained extremely suppressed. I discussed giving Armour another try in the early part of 2013. It gave me extreme heartburn so I discontinued. Next i tried Naturethyroid. On 113mcg of Natturthyroid and 25mcg of Synthroid, my TSH jumped up to 3 while my Free T3 and T4 remained very low ( 1,9, 0.72) I was advised to increase the Naturethyroid until I reached 226mcg in june 2013, At that point, my Free T3 and T4 were in the normal range 2.5 and 1.2 but I was very bloated and tired. My TSH was 0.2. I stayed on that dose and three months later when I had my blood tested, my Free T3 and T4 levels once again plummeted to 1.9 and 0.78 ( below normal).

I went back on 100mcg Synthroid and 50 mcg Cytomel and immediately, lost my belly bloat but still had afternoon fatigue.My blood work three weeks later revealed that my TSH was very suppressed -0.009 but my Free T3 was in the normal range 3.3 ( 2-4.4) and my Free T4 was normal 0.92 ( 0.82-1.77)

At that time, I went to a new Endocrinologist to figure out why my levels were changing so rapidly and how My Free t's could be so low when my TSH was so suppressed. She immediately said my TSH was way to low and was concerned it could lead to heart and bone disease. She put me on 50 mcg TIrosint and i was to continue with 50 mcg Cytomel. After a week of adjustment- extreme dizziness and fatigue, I started to feel great, The fatigue completely went away. No more being tired in the afternoon and I slept through the night. She wanted me to have just my TSH tested in 4-6 weeks . I questioned her about having the Free's tested and she said that was not necessary. I was a little concerned with that so I got another lab slip from my original doctor to include the Free's. I just got the results and my THS still remains suppressed - 0.06 but my Free T3 and Free T4 have dropped very low 1.6 and 0.56. WHAT DOES THIS MEAN? I feel so much more energy on this med than I have on any other thyroid . I do have some chest pressure and heartburn. I have a little more stomach bloat than on Synthroid but not too much, What else could my levels to stay so low when the TSH is suppressed?


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## Lovlkn (Dec 20, 2009)

gammagirl,

You seem to already know but - you need to drop that endo that will only terst your TSH. You have been on extremely high doses of replacement meds - I'm wondering if you are having some sort of absorbtion interference.

What other medications/supplements are you taking? When do you take your med's and do you take them with a full glass of water? At least 4 hours away from iron and calcium supplements?

Have any doctors run antibodies testing on you? TSI or TPO antibodies?

How much do you weigh? Manufacturer recommended dosing is 1.7mcg replacement per kilogram of body weight.


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## gammagirl (Nov 18, 2013)

Hi, Thanks for the quick response. The reason I did go on Tirosint is because of the suspected absorption problems. Since Tirosint is a liquid capsule with no fillers, the thought is that it would have better absorption with that medication than anything with fillers. I take the Tirosint around 3-5 AM. I drink Coffee at 6AM or later depending on when I wake up and eat between 8-9:30am. The only other vitamin I take in the AM is Vitamin D , fish oil and Vitamin C. I weigh about 145lbs, Work out 4-5days a week.

All the Reverse T3 tests have come back normal, My latest ( and all previous) TPO- normal, Thyroglobulin Antibody- Normal. The only abnormal result I have recently had is low Alkaline Phosphate. Hmm.

I only went to this Endo because my regular doctor was stumped as to what was going on ( why my T's were dropping even on high doses of meds) The new Endo did say that the readings on my FT4 an FT3 may not be accurate because my sex hormone binding globulin is very high and that may indicate that the thyroid hormones are bound. I didn't really follow her.

I do like the energy that the Tirosint is giving me. Its nice not to drag throughout the day. , I would like to find out why my levels suddenly plummeted after years of being on the same dosage of Synthroid and Cytomel.

She may order additional testing that may give me further insight into what is going on. In the meantime, I have my regular doctor to fall back on who is open to whatever I suggest. Its all very strange.


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## Andros (Aug 26, 2009)

gammagirl said:


> Hi, Thanks for the quick response. The reason I did go on Tirosint is because of the suspected absorption problems. Since Tirosint is a liquid capsule with no fillers, the thought is that it would have better absorption with that medication than anything with fillers. I take the Tirosint around 3-5 AM. I drink Coffee at 6AM or later depending on when I wake up and eat between 8-9:30am. The only other vitamin I take in the AM is Vitamin D , fish oil and Vitamin C. I weigh about 145lbs, Work out 4-5days a week.
> 
> All the Reverse T3 tests have come back normal, My latest ( and all previous) TPO- normal, Thyroglobulin Antibody- Normal. The only abnormal result I have recently had is low Alkaline Phosphate. Hmm.
> 
> ...


If you can, it would be good if we could see your rT3 test results w/the ranges included. At the outset, when taking any exogenous form of T3, the Total 4 will be low and it is supposed to be. If you are working out really really hard, I would conjecture you may need more exogenous T3 to bring up that FREE T3. I will reserve this opinion until we get to see your rT3.

TSH is no longer relevant. Muscle mass is more metabolically active than fat. That's a given.


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