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My tsh has to be so suppressed in order to have a menstrual cycle

My doctor's nurse called after lab work done before appointment. She stated I needed to cut back because I am hyperthyroid ) my TSH was 0.17. She didn't mention my Free t's, but my FT4's are rarely over the middle of the range, and my FT3's most of the time have been below range. In other words, I have low tsh and t3. I have been diagnosed as a hashimoto patient, and did not start with a suppressed TSH. I don't understand why I have to be so low to menstruate. I normally  take 112 mcg of levothyroxine (T4)  and 5 mcg every other day of cytomel (T3), and alternate with 100 mcg some months of the year (seasonal) . Recently, I felt hypo so I modified my dose, about a week before bloodwork to see if I felt better. I went down to 100 mcg, but I took T3 daily instead of every other day. I got a period within a week, that's when I made the appointment and got tested. I had not had a menstrual cycle since October. I did this because I was feeling very hypo (cold, fatigued, broken nails, swollen upper lid (major sign for me) and body aches). I am seeing my doctor on Thursday March 14th. I have classic signs of central hypothyroidism, however my pituitary gland hormones have tested normal in the past. I have a slight elevated growth hormone, NO PCOS, reactive hypoglycemia, B12 deficiency and enlarged red blood cells (pernicious anemia risk).  I don't have signs of hyperthyroidism at all. I had to cut my dose to half until my appointment, and I am already sleeping 10 hours a day. Why is this happening? Any ideas? I am worried because these cuts have shoot up my prolactin levels in the past. This has been a roller coaster for the last 4 years since I had a fever last  6 weeks. My hormones were cut due to the fever and then my dose had to be almost tripled after that. I never had an explanation for this either. I went through I hyper stage and then my hypo got worse is all I know. Every time my TSH is suppressed to almost zero is when my menstrual cycles are normal. My reproductive endo mentioned I have low progesterone levels even when I menstruate and thinks I need more T3. Needless to say this causes fertility issues as well. I don't hink cutting a dose so drastically can be a good thing, even temporarily. Any thoughts I would appreciate them. Thanks
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649848 tn?1534633700
COMMUNITY LEADER
Because T3 medication is fast acting and is used up rather quickly, it needs to be taken on a daily basis; sometimes, even multiple times/day, depending on the dosage.  Taking it every other day, is really doing nothing for you, so as Sally said, that would explain why your period started when you took it daily.

Like Sally, my TSH is always undetectable (< 0.01), so is totally useless for dosing. This is fairly common in those of us who are on replacement hormones, particularly, those with a T3 component.  The doctor must look at the FT levels and symptoms and use those as the guide.

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Avatar universal
Thank you for your reply. Unfortunately, I am in grad school at a different state, and my reproductive endo is rather far now. I think you are correct. I felt better those days that I took 5 mcg daily of T3. I am seeing my OD on Thursday. Her NP called with lab results, and she is not aware of my medical history. My OD has been opened to FT's only lab ranges in the past. I just have to remind her of my situation. We'll see!!!
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231441 tn?1333892766
I agree with your reproductive endo that you need more T3.

If your FT3 is below range you definitely need more T3 and it should be daily (maybe that's why your period came when you were taking it daily).

Can you let the reproductive Endo adjust your meds?
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231441 tn?1333892766
Hello.

Your thyroid meds should be dosed based on your FT3 and FT4 alone.  Both of these should be at least mid--range.  Your TSH should be completely ignored.  In many of us on thyroid meds our TSH is not a good indicator and it is suppressed.  My TSh is usually not measureable, but I am not hyper at all and my FT3 and FT4 are not elevated.

if you are trying to get pregnant it is very important for your FT3 and FT4 to be towards the top of the range.

Why do you take cytomel on alterative days. It has a short half life and should be dose daily or even split and dosed twice daily.

Hypothyroid (or being undermedicated - cosnidering you are already diagnsoed) can also cause elevated prolactin levels in some people.  Of course, elevated prolactin can also prevent ovulation / result in infertility.

I think your doctor should take a fresh look at your case and the approach. Else, maybe you should get second opinion.
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