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TSH 0.18 mU/L

Hi, I was diagnosed with hypothyroidism as an 11 year old some 30 odd years ago. I have been taking 100mcg of thyroxine for the majority of this time only needing adjustment when pregnant, which required a slight increase in dose. For the first time my blood results have come back saying that I need to be on a lower dose of thyroxine, than my standard 100mcg. My dr has suggested 75mcg which I would take as 100mcg alternating with 50mcg.
My free T4 is 17 pmol/L, freeT3 is 4.4 pmol/L and TPO Ab <1.0 IU/ml. I will be going back in 3 months for a recheck of my levels. Has this happened to any one else where after so long being stable there is a reduced need for medication? I am still tired and lethargic, but have been going to the gym daily for about a month. I'm watching my diet more closely also which has seen a reduction in cholesterol levels which means I do not need medication for this. Any ideas or suggestions as to what may be happening would be much appreciated
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Avatar universal
I think you said you are like 41 years old. A total testosterone of 300 for someone your age is very low. You should be closer to 600 which is double your current level.

A level of 300 is closer to what would be expected for about a 60 to 70 year old!!

Unfortunately they lump 25 year old men in with 90 year old men to obtain the ridiculous reference range.  And drs practice reference range endocrinology. Meaning that if you are anywhere in the range they call you normal. Not realizing it is NOT indexed to age.

Low testosterone can cause you the muscle weakness and fatigue as well as other symptoms that can mimic low thyroid.

I would strongly recommend you get at least the following tests for sex hormones from A single blood draw.

Total testosterone
Free Testosterone
Sex Hormone Binding Globulin (SHBG)
Estradiol
DHEA

If you have not also get all cholesterol and lipids tested

All sex hormones and most hormones are built and made from cholesterol.
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4 Comments
Hi....I'll be 53 in July,  I was diagnosed with thyroid cancer a day before my 43 birthday. I'll mark these sex hormones down and see if my primary will give me a blood script, I see her in less then two weeks.  I think they did a lipid tests, don't know about all cholesterol. I'll check and see.

Thank you for your help!
Hi flyingfool,  I found .

Triglycerides             = 96  (0-149)
LDL                               =111    (0-99)
HDL                              =45      (>39)
VLDL                             = 19     (5-40)
Total Cholesterol      = 175    (100-199)
Wish I had your lipid levels!

FYI: Some reading I have done has suggested "too low" of total cholesteron was below 160.  So you are above that.

Your HDL number is great.  I have tried just about everything and nothing seems to get my HDL number higher than about 35.
Hi... I'm sorry but i don't understand what test's you want?  Give me example and i"ll check
Avatar universal
I know from personal experience that when I got back into being hypo a while back, I had a couple of kidney function tests that caused the doctor to send me for more tests.  That doctor only wanted to wait and see if it got any worse.  It did not.  When I got my thyroid meds optimized, the same tests dropped back into range.  
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7 Comments
Hi Gimel ......... I'm also going to see if she'll give me a blood script for reverse T3 along with the others scripts when i see her in a week and a half.
Hi Gimel........ I was reading one of your another article where you are trying to help a women trying to explain conversion between the free's( 4/3)  and reverse T3.  You said there are a lot of factors. You mentioned environmental Toxins and Heavy metals. Can you give me some examples of Toxins or Metals??

I have a reason for asking?
Thanks,
Dallas
Gimel,    I  just wanted to say thank you again for trying to help me with my hypothyroidism problems, I'm going to approach this in a different way from now on. I'm still going to get a second opinion in Delaware in a couple of weeks, maybe that endocrinologist will listen to my symptoms instead of the blood grid. But yes i know when i was working the doctor that i have now looked at the numbers a little differently and symptoms, i couldn't keep the pace of a 8 hour shift and i was given unlimited breaks do to my health problems,( Energy Problems,  Severe Muscle Weakness, etc.)  since my plant closed and i lost my job the same doctor is only looking at certain tests( TSH/ Free T4) and my PCP isn't helping me either, all she wants to do is for me to try different medicines and that it's in my head!

By the way i worked in a Chemical plant for almost 30 years, and we also dealt with heavy metals!!( Copper, Tungsten, etc.)

Thanks again!!!, Hopefully your doing ok in Michigan, and be safe with this virus that's going around.

Dallas
Dallas, thanks for your thoughts.  Likewise I hop you and family avoid this lousy virus.  

I noticed that I failed to give you the following link.  Please have a look at Fig. 1C and you can see the huge effect from Free T3 on the incidence of symptoms.  

https://www.hindawi.com/journals/jtr/2018/3239197/

Please stay in touch and let us know how you are oing.  
Hi Gimel...  Thank you for the link!, It gives great information,  i'll let you know how my doctors appointment went, i see this new endocrinologist in Delaware ( about one hour from my southeastern home in Pa.) in the first week of April. In less they change my date because of this virus that's going around.

Dallas
Hello Gimel,    Hope you and your family are doing well!,

Me, on the other hand.  I'm tired of arguing with these doctor's.   All they  tell me is that normal is good enough.

Now I've been diagnosed with a rare kidney disease (Iga  Nephrology) 7 weeks ago and last week I found out I have some stomach disease/disorder, won't know which one until they do a colonoscopy and EGD.

And I still have all the symptoms as before!!!!!!!!!!!!

Thanks for trying to help!
Keith

Very sorry to hear of your additional ailments.  As you sort those out, if you reach the point of needing a good thyroid doctor, let us know and we will try to locate one in your general area.  Best to you.
Avatar universal
That is pretty low , being only about 6% of the range.
And I expect that the range is typical of laboratory ranges.  It is not based only on people with no testosterone issue, but instead is calculated from all the test results in their database.  So it surely does not represent optimal.  After you get the Free T you will know a lot more, but I expect that you will want to ask your doctor about this.  
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3 Comments
Hi  Gimel...….  Do you know what a eGFR blood test is?
"Estimated glomerular filtration rate is the best test to measure your level of kidney function ". That is about all I know about it.   Why do you ask?  
I'm in the mid 70's, I read that hypothyroidism can lead to kidney problems.  I caught it in the last blood tests they preformed on me. I'll discuss it with my primary when I see her in less then two weeks. The endo did the blood tests and said all blood tests are good.
Avatar universal
What was the reference range shown on the lab report for the total testosterone?  
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1 Comments
I'm sorry, my day to day memory stinks!

264-916 range for total testosterone ( I'm 306)
Avatar universal
Okay, so you do have some of those related to low ferritin, but most of those can also can be related to hypothyroidism, plus you listed previously some  additional symptoms that are typical of hypothyroidism.   So if it were me, I would take the supplements for Vitamin D, and ferritin (iron).    Also, in view of all your symptoms and  since cortisol can have such an effect on thyroid hormone, I suggest testing for saliva (free) cortisol.  Doctors usually will not do saliva testing, and will only do a morning serum cortisol (total cortisol) which is not nearly as revealing as a diurnal saliva cortisol panel of 4 tests during the day.  If you are interested you can order a kit and collect samples and send and get the report in about a week.  Here is a link.  Cost is $135 minus a 5% discount for first order.  

https://store.zrtlab.com/index.php/saliva-testing

I would also try to get your med dosage back to where you were feeling pretty good.  The remaining symptoms you had at that time could have been related to low ferritin.   And I would still like to see you test for testosterone, both total and free.    
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1 Comments
Hi,  They did a total testosterone (306), I see my primary again in two weeks and I'll see if she will give me a free Testosterone blood script.   I go to the endo in Delaware in the first week of April for another opinion, I'll be seeing his Nurse Practitioner and I was told he may stop in for a couple of minutes before I leave.  He's booked until July.
Avatar universal
Sorry, Dallas, but I don't see it in the messages above.   Where do I find the info?
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5 Comments
Hi.

Fatigue ( It's crushing with any exertion)
Memory
Muscle Weakness (crushing with any repetitive motion)
Weight gain
Joint pain and stiffness, muscle aches
Cold sensitivity
Heat intolerance and Humidity
Hoarseness
Muscle twitching
Tingling
Balance issues

I may be evaluated for MS or LUPUS  I was informed.
Not sure why the doctor wants to look for other problems.  You were diagnosed as hypothyroid and are taking 175 mcg of T4.  Usually a dose of T4 like that results in higher FT4 than the untreated state, along with reduced FT3, due to inadequate conversion of T4 to T3. Your test results are not like that , your FT3 of 1.06 is only 24% of its range, while your FT3 is 54% of its range, and you still have multiple symptoms that are typical of hypothyroidism.  

So the first thing you need to do is convince the doctor that you are still hypothyroid, based on all those symptoms.  No doubt the argument will be that you are well replaced since your TSH is in range, along with the FT4 and FT3.   You will need to either convince the doctor or find a good thyroid doctor that will treat clinically, by adjusting FT4 and fT3 levels as needed to relieve those symptoms, without being influenced by resultant TSH levels.  Along with that you need to get your D over 50 ng/mL and your ferritin over 100.  There are reports that low ferritin can cause some pooling of FT3, preventing some from getting into cells.

Have a look at this link, and click on Fig. 1c.   There you will see the effect of FT3 on the incidence of symptoms.  The red line is 21%, the green line is 49%, and the blue line is at 70 % of the range.  Of course the lines represent average effect and everyone can be different in their needs, but it shows clearly that FT3 has much more effect than FT4, represented by the T4 dose.    

Also, if needed there is lots of info showing that thyroid med adequate to relieve symptoms often suppresses TSH.  Out bodies are used to a continuous low flow of thyroid hormone in the untreated state.  When you take a significant dose at one time, it spikes FT4 and FT3 and suppresses TSH for most of the day.  You are not there yet, but you may run into that argument in the future.

Have you made an appointment with the doctor you mentioned?

Hi...… Yes, I go down next month early April.   Remember I told you from 2011-2016 I was on 137mcg of Synthyroid and 60 Armour a day. This is where my levels were around?

TSH= was under 1
Free T4 =  was around 1.30-1.50
Free T3= was around 4.0-4.3

I felt better but I still had the same muscle weakness problems with repetitive motion and crushing energy problems and tingling.  But then in late 2016 I was told by him that my levels are to high and I need to be reduced. The lower they take my dosage the worse I get, from what his nurse told me last month they are going to lower my T4 again because my numbers are still to high.  My question is why from 2011-2016 did he keep me at those high levels that are listed above?

Do Those levels above look Ok to you? or were they to high?
Those levels are not necessarily too high; however, the focus must be on symptom relief.   Those  FT4 and FT3 levels are higher required for most people, which should lead to trying to find out if there are other issues, or if not could be some resistance to thyroid hormone, which is an unusual problem.
Would you say that you find your symptoms in the following list?  
achiness
weakness
fatigue
dizziness
headaches
faster heart rate
hair loss
foggy thinking
memory problems
loss of sex drive
depression
increased irritability
heartburn
abdominal pain
pica, or the compulsive eating of non=food items
pagophagia, or the compulsive eating of ice
numbness or tingling of extremities

Hi..
I don't have Pica,  Pagophagia, heartburn, increased irritability, depression, loss of sex drive, hair loss, Faster heart rate, abdominal pain.
Avatar universal
What were the Vitamin D, B12 and ferritin results?
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7 Comments
Last results were: They don't check Ferritin, B12 and Vitamin D 25 all the time because they are in normal range, these results are about 6 months ago. The TSH and Free T4 are within a month ago.

Ferritin= 74
B12 = 1167
Vitamin D= 39.1
TSH = 3.53
Free T4  = 1.06

I'm still waiting for my primary to post Free T3 Results
Ferritin should be at least 100.  Your B12 is more than needed.  Vitamin D should be at least 50 ng/mL.  So you need to supplement ferritin and D.  The best source for iron that I know is taking a 65 mg tablet of Vitron C, which should be available OTC.  Other good sources are ferrous fumarate, ferrous sulphate, and ferrous bisglycinate.   For D I suggest 2000 IU of D3 daily.  

When you post your thyroid results, please include reference ranges shown on the lab report.  
TSH  =    3.53  (.450-4.500)
Free T4 =  1.06  (.82- 1.77)
Free T3   = 3.3  (2.0-4.4)
Total Testosterone = 306 (264-916)
Before discussing further I need to confirm if you took your thyroid med before the blood draw?

After a thyroidectomy the old procedure was to medicate the patient as needed to suppress TSH, with the belief that it helped prevent return of the cancer.  Now that is no longer the case, but as I understand it you are only taking T3.  Is this correct, and if so, what is the daily dosage?
No,  After the blood is drawn!!!,  No, I'm only taking T4 (Synthroid) 175 a day!!!
Okay, now let's look at the most important indicator of your thyroid status: symptoms.  Please review the following list and tell us which ones you have, if any.

Fatigue
Increased sensitivity to cold  (temp. below 98.6 which is considered normal)
Constipation  ( have to use fiber or laxatives)
Dry skin (have to use moisturizer)
Weight gain  
Puffy face    
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)
insomnia/sleep apnea
I gave that information to you on February 9th.
Avatar universal
You have to look at it in two ways.  One is the effect on TSH for FT3 compared to FT4.  The ATA/AACE Guidelines for Hypothyroidism say the ratio, based on a study, is about 3:1.

The other way to consider it is the effect of symptoms, which would be more important.   For that there is a lot of controversy, so I'll just stick with the effect on TSH, which is all that doctors would be concerned with.

So let's just use the 3:1 ratio.  That means a grain of Armour Thyroid, which contains 38 mcg of T4 and 9 mcg of T3, is the equivalent of  approx. 65 mcg of T4 (38 + 3 times 9 equals 65).    Using that equivalent amount, 137 plus 60 mg of Armour would be approx. 202 mcg of T4 (137 plus 65).  That is higher than the 175 mcg you listed.  

An expert thyroid doctor says that he uses 88 mcg of T4 as the equivalent of one grain of Armour (60 mg).   That would assume a ratio of 5.5 to 1 for T3 to T4.    Interestingly conversion tables typically show 100 mcg of T4 as equivalent to one grain (60) of Armour and equivalent to 25mcg of T3.     This doesn't compute.  For T4 and Armour it would have to assume a ratio of almost 7 to 1.   If you use 100 mcg of T4 being equal to 25 mcg of T3, then that ratio is 4 to 1.  If you use that ratio in calculating the T4 equivalent of one grain of Armour it would be only74 mcg of T4 (38 + 4 times 9 equals 74)

Did I create more questions than answers?  LOL  
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1 Comments
Hi Gimel...….. My primary gave me a blood script for the Free T3,  I was a the lab yesterday.  I should have results by weeks end. They already have done Vitamin D, B12 ands ferritin. I guess I missed those in earlier labs.  But I did forget to ask for reverse T3  and free testosterone, I'm sorry!.  I'll let you know the results.
Avatar universal
Vitamin D should be at least 50 ng/mL. B12 in the upper part of its range, and ferritin should be at least 100.   Free T4 is best around mid-range, or slightly below.  Free T3 needs to be in the upper half of its range, and adjusted from there as needed to relieve hypo symptoms.    Each person may be different in the levels that work best for them.   That is why med dosage should be based on symptom relief, not just lab tests, and certainly not based on TSH.

If you want to confirm any of this, please click on my name and then scroll down to my Journal.  There you will find an Overview of a paper on Diagnosis and Treatment of Hypothyroidism:  A Patient's Perspective.   There is a link to the paper, which provides the supporting scientific evidence. for all that is recommended.  
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13 Comments
Hi Gimel....Thank you for the information, I agree they only look at the normal grid.  
I should also add that you should make sure to delay your morning med dosage until after any  blood draw for thyroid related tests.   Otherwise you can get false high results.  
Yes, on the day of my blood tests I don't take my medicine until after the blood is drawn.  Besides fatigue/ energy problems  I also have muscle weakness problems in my arms and legs with any repetitive tasks. That's why I was asking about the optimal ranges in Free t4, Free t3 and the vitamins.  If I have any more question hopefully you can answer them.  Thanks again for the information
With muscle weakness, you might also want to get tested for  Free Testosterone.   Testosterone is necessary to build muscle.   Also note that the lab will use a reference range based on your age.  Since testosterone goes down with age, the range can be too low to be optimal for you.    Best to have Testosterone levels of a 30-40 year old.  

Also,  when you are going to test again for Free T4 and Free T3, I suggest that you also request tests for cortisol and Reverse T3, to make sure they are not contributing to your symptoms.    When you have test results we'd be happy to help interpret and advise further.  
Hi Gimel....Ok, my next blood work will in the middle of January.  I'll let you know when I get the results.  Thanks again
Hi Gimel......I just got  some of the blood work done, my endocrinologist didn't do some of the ones who suggested. I see my primary in two weeks I'll see if she will get them done for me. (Free Testosterone, Reverse T3 and Free T3)
What were the results of the tests done by the Endo, along with reference ranges shown on the lab report?
I just gave the blood yesterday morning, probably won't get results for a week
Hi Gimel...…...Just received a call from my endo's nurse, all labs are normal and they don't  do free T3 because that has nothing to do with energy levels (that's what I was told). Free t4 and tsh. I should get an email sometime next week with the results.  
Same old BS.   They don't think Free T3 is important and they think that a test anywhere within the range is adequate.  Wrong on both counts.  When you are taking thyroid med, Free T3 is more important than Free T4.    T4 is only a prohormone, available for conversion to T3, which is used by all the cells/tissues  of the body to produce the energy we need for many body functions.  Insufficient tissue T3 effect  causes hypothyroid symptoms.    Doctors like to believe that T4 is automatically converted to T3 as needed, which is not correct.  There are many things that affect conversion.  

Do you know what tests are being done by your PCP?

I should have asked previously what thyroid med and dosage are you taking daily?  Also, please review the following list of typical hypothyroid symptoms used by the Mayo Clinic and tell us which ones you have.  

Fatigue
Increased sensitivity to cold  (temp. below 98.6 which is considered normal)
Constipation  ( have to use fiber or laxatives)
Dry skin (have to use moisturizer)
Weight gain  
Puffy face    
Hoarseness
Muscle weakness
Elevated blood cholesterol level
Muscle aches, tenderness and stiffness
Pain, stiffness or swelling in your joints
Heavier than normal or irregular menstrual periods
Thinning hair
Slowed heart rate
Depression
Impaired memory
Enlarged thyroid gland (goiter)
insomnia/sleep apnea

If you have not had a chance to go to my Journal and read the Overview I mentioned, I highly recommend doing so.  It will give you a lot more insight into the problem you are facing with your doctor.   Based on actions to date, I highly doubt that you can get needed treatment from the Endo.  If you will give us your location, perhaps we can suggest a doctor that has been recommended by other thyroid patients.
Hi....175 synthyroid,  I'm going to try to get my primary to do the ones the endo didn't, I see her in a couple of weeks.
I live 40 miles west of Philadelphia

Symptoms included
Fatigue ( It's crushing with any exertion)
Memory
Muscle Weakness (crushing with any repetitive motion)
Weight gain
Joint pain and stiffness, muscle aches
Cold sensitivity
Heat intolerance
Hoarseness
Muscle twitching
Tingling

I used to be on 137 synthyroid, and 60 Armour. from 2011 to 2017, but then he started changing it and I was reduced,  I had some of the same symptom's as above but I felt better.
With those symptoms and your  daily dose of 175 mcg of Synthroid, I expect that your FT4 will be in the upper half of its range, and your Free T3 in the lower part of its range.  This is a typical pattern with T4 med, due to inadequate conversion of the T4 to T3.    When you see your PCP, along with testosterone, Free T3 and Reverse T3, also try to get tested for Vitamin D, B12 and ferritin, just to be sure of those.    I will do some looking for doctor that I could recommend and post any suggestions in a PM.  to access a PM, click on your name and then from your personal page, click on messages.  
Hi Gimel...…….I forgot to ask, do you have any idea what is a higher dosage,( 137 synthyroid plus 60 armour)  a day or
175 Synthroid a day?, or are they about the same?

Thanks
Avatar universal
Thyroid medication dosage should never be determined by TSH level.  It should be adjusted as needed to relieve hypo symptoms.  Frequently that suppresses TSH below range.  The suppression is due to taking the med at one time, as compared to the usual continuous low flow of thyroid hormone from the gland in the untreated state.   In addition you need to assure that your Vitamin D B12 and ferritin are optimal.  
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Hi Gimel,  What are the optimal ranges for Vitamin D, B12 and Ferritin for a male that had a thyroidectomy do to cancer and do you know what are the optimal ranges for Free T4 and  Free T3 are?   Thanks!
Avatar universal
Yes, exactly, I was told at Walmart over a year ago that they changed suppliers and from that point on I have not been regulated.  It has been back and forth with the values. I had 100 for 25 years.. Now I am back to high. and given a different dose  again. This is the fifth time.
now TSH is 0.18
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Avatar universal
Yes, exactly, I was told at Walmart over a year ago that they changed suppliers and from that point on I have not been regulated.  It has been back and forth with the values. I had 100 for 25 years.. Now I am back to high. and given a different dose  again. This is the fifth time.
now TSH is 0.18
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649848 tn?1534633700
COMMUNITY LEADER
Are those Free T3 and Free T4?  What are the reference ranges?  Reference ranges vary from lab to lab and have to come from your own report.

Do you have hyperthyroidism?  Have you been diagnosed with Graves Disease or Hashimoto's?

Why are they recommending that you have your thyroid removed?
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Avatar universal
i have had thyroid detected for 4years finally they want to take it out my first reading of ,0.18tsh . I feel ill just had breast cancer and feel anxiety to wards operation.t 3 5.5.   t4 is 17.6. Is it good to have it out? im very nervous. joy
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Avatar universal
I am feeling tired, but not sleeping well which is very unusual for me. I usually sleep 8 hours with no problems. The med adjustment is based purely on my TSH
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649848 tn?1534633700
COMMUNITY LEADER
What, if any, symptoms do you have?  Both your FT4 and FT3 are in the upper part of their ranges, and your TSH is low, but if you don't have symptoms that might not be significant.  Is your doctor adjusting your med based only on TSH?  
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Avatar universal
Sorry I forgot to put in my labs ranges. TSH (0.40-4.00mU/L)
Free T4 (9.0-19.0 pmol/L)
Free T3 (2.6 - 5.7 pmol/L)
TPO Ab (<5.6 IU/ml)
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