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Can my thyriod start to work again while I take this dose

Hi all, long time since I have been here. To summarize, I am 38 years old and I am struggling with hashimoto disease and to get my thyriod levels optimal. I was taking 75 of Euthyrox every morning.Since my diagnosis three years ago, I struggled with my doc to raise my T4. We do not have any T3 medication here. My problem was the non conversion of T4 into T3 as my T3 was always normal but always in the lower range. I also suffered from bloating, abdominal pain, and gases all the time. So, at the beginning of this year I raised my dose of Euthyrox to 87.5 and I become gluten, dairy, soy and grains free. I also do intermittent fasting for 16 hours daily to improve my body functions.
Because of the pandemic situation I could not do any tests for approximately a whole year but I felt a lot better. Unfortunately, this feeling did not last. Since more than a month, I suffer from shortness of breath, and severe anxiety. My anxiety is through the roof right now and I can barely work. I have also panic attacks. I had panic attack at work and I hardly could control myself. My shortness of breath was worse in some days to the extent that I went to the ER asking them to test me for Covid-19. They refused because I have not any other symptoms ( no fever, no cough, etc..).
I went to my doc and he just asked for thyriod panel and Ferritin test. He refused to do any extra tests. These are the results of the thyriod panel:

Free T3 3.07 pg/ml ref range: (1.7 - 4.2)
Free T4 1.15 ng/dL ref range: (0.89 - 1.76)
TSH 0.371 uIU/ml ref range: (0.55 - 4.78)

No Euthyrox 24 hours before the tests and no Biotin two weeks before the labs.
My ferritin is 6 which is too low ref range (10-120) . I had two problems. My doc wants to decrease my T4 because TSH is low? He said my thyriod may start to work again so I do not need this dose. On the contrary, I want to raise my dose to get Free T3 and Free T4 optimal. What do you think? I can do this because no prescription is needed to have T4 medication but I am afraid that My TSH keep decreasing and now it is actually lower than normal range. Can I become hyper if I do this?

The second problem is my ferritin. I had two choices. Iron infusion or iron tablets. I am afraid of the infusion. I will have to go to the hospital and remain there for a day every time I do the infusion. On the other hand, the gluten free iron tablets I can get contains 17 mg of iron only. My doc said I can not take more than one tablet per day in order not to cause any bowel problems. Does this dose sufficient to increase my ferritin.I eat red meat and liver but probably I had malabsorption problem.

Thanks for support.
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Avatar universal
The first thing to understand is that a suppressed TSH in the normal state without thyroid med is an indication of excessive levels of thyroid hormone.  That is completely different than a suppressed TSH when taking thyroid medication.   In the normal state, the body supplies a continuous low flow of thyroid hormone.  When taking a significant dose of thyroid med all in one dose, or even two doses, it spikes the FT4 and FT3 levels, and causes TSH suppression for the day.   Thus a suppressed TSH when taking significant thyroid med does not mean over-medication.    Just logically why would your TSH be suppressed when your FT4 is only 30% of its range, and FT3 is 55% of its range?    Doctors don't seem to know this or don't believe it, but here is a study showing that a dose of 100-120 mcg of T4 suppressed TSH.  When that same dose was split into thirds and taken at different times of the day, the TSH went up to about 2.  So a suppressed TSH when taking significant thyroid med in one or two doses, is due to the dosing procedure, not the dose.    You will not become hyper, unless the dosage is such that you start having numerous hyper symptoms.  

So you don't want to reduce your med.  You are not taking a large amount when you consider that you basically need a full daily replacement amount.  In addition, I am very surprised that your FT3 is higher in range than your FT4, since you are taking only T4 med, plus your ferritin (which helps conversion of T4 to T3) is extremely low.  Optimal is 100 min.  I have read that such low ferritin (iron) can reduce FT3 getting into dells, causing "pooling of T3 in serum.    That might account for the ratio of your FT4 and FT3.  

If iron infusion is not acceptable then you need to take some large doses of a good iron supplement.  The best ones have both elemental iron and Vitamin C to help absorption.  If you go that route, start with no more than 65 mg and work your way up from there as tolerated.  I expect that you are going to need at least twice that amount daily.  and it will take some time to get to optimal level.   An infusion would get you there much quicker, so you could go on with other changes you might need with your thyroid med.  

One thing further.  If tested for Vitamin D and B12, please post those results.  If not, you need to know those as well.  D should be at least 50 ng/ml and b12 in the upper part of its range.
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Thanks gimel for your detailed response. I appreciate it. So, as you said we should  not judge by TSH when the patient is on thyriod replacement hormones. So, I will not decrease my dose.

(In addition, I am very surprised that your FT3 is higher in range than your FT4, since you are taking only T4 med, plus your ferritin (which helps conversion of T4 to T3) is extremely low.)

The laboratory I deal  is a very trusted one. So, I think there is no way that Free T3 is not correct. Secondly, this is not the first time,  my thyriod tests before shows Free T3 is higher than T4 although my iron problem is a chronic one because of my heavy periods.I do not understand either. Can the conversion do with low iron? Should I repeat Free T3 test?

If tested for Vitamin D and B12, please post those results.  If not, you need to know those as well.  D should be at least 50 ng/ml and b12 in the upper part of its range.

No,I did not tested for them. My appointment with my doc is after three months so I will ask him to test me for them but anyway I started vitamin B12 and D3 supplements.

Currently I will start iron tablets and see how it goes. Thanks a lot.
I reviewed my thyriod tests before and on 50 T4, the thyriod tests read:

TSH 2.21 ( Ref 0.4-4.2)
Free T4 0.85 (Ref 0.8-1.9)
Free T3 3.43 (Ref 2.6-5.4)

On 75 T4, the thyriod tests read:

Free T3:  2.31 (Ref range: 1.7- 4.2)
Free T4:  0.84 (Ref range: 0.75- 1.56)
TSH: 0.856   (Ref range: 0.55- 4.78)

The tests are done in different laboratories. So, yes, I did not understand either how free T4 and free T3 works for me.

Avatar universal
Of course everyone is different in the amount of FT4 and FT3 they need to feel normal.  In addition thyroid is affected by cortisol level and D3 and ferritin (storage form of iron readily available for use)  

Just so you don't get concerned bout taking too much thyroid med, there is a report that said the average thyroid gland produces 94 - 110 mcg of T4 daily along with 10 - 22 mcg of T3.  Replacement thyroid med would have to be even higher than that since the body only absorbs about 85% of the med.  

Looking ahead I expect that you are going to have trouble with that doctor since he is already mis-interpreting your TSH result as being too much med.   I can give you some info to show the effect of single doses of thyroid med on TSH , but I am not very confident the doctor would accept that. and ignore TSH as he should.  Where are you located?
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Thanks gimel for your response. I appreciate your help. You are right and I do not feel that my dose need any decrease as I do not have any hyper symptoms.

(There is a report that said the average thyroid gland produces 94 - 110 mcg of T4 daily along with 10 - 22 mcg of T3.  Replacement thyroid med would have to be even higher than that since the body only absorbs about 85% of the med.).

Interesting study. So, the average person do not need daily more than this. My friend who had no thyriod takes 250 T4 and still had hypo symptoms. I think she suffer from malabsorption issues.

( Looking ahead I expect that you are going to have trouble with that doctor since he is already mis-interpreting your TSH result as being too much med.)

I totally agree. I am from Egypt. All the docs here depend basically on TSH to determine the dose. They ignore me completely when I am even discussing my results with them. One of them told me " What I am doing here if you keep expressing your objection about your daily dose?". So, he told me he knows more than me and I should keep silent.

Thanks God I do not need their prescription to get my T4. So, I go to them for tests and discuss my results here before making my decision. Thanks God there are patients forums who have many experts than doctors who keep us sick.
Avatar universal
When taking an adequate dose of T4 med,  the TSH is usually suppressed below range, which of course is not a concern if you don't have hyper symptoms.    Interestingly TSH itself does have an effect on conversion of T4 to T3.  So patients taking T4 only usually find their fT3 level is lower than needed and often have to add a source of T3 also.

When taking thyroid med, the FT3 is even more important than FT4, since it is FT3 that is used in cells.  I can give you info that proves the importance of FT3 on symptoms.  I will send you a PM.  To access, just click on your name and then from your personal page, click on messages.  

Your friend taking 250 mcg of T4 may well have had absorption issues; however it is most likely she suffered from inadequate FT3 levels due to inadequate conversion of the T4 to T3.  Conversion is also affected by ferritin and selenium.
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1 Comments
Thank you gimel for your valuable info. I will be more than happy to get these info and know about what really makes you hypo. I am very sure now that Free T3 is the active hormone which  makes you hyper or hypo not TSH.
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