Levothyroxine CRASHED my TSH!

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SkyWarn

Active Member
Hey Guys. My T4 is always low, for years. And I am always tired. But MY TSH has always been normal. My prolactin is also also slightly elevated by about 6 points, for the past 10 years.
I went to a new doc and she decided to try me on 50 mcg of daily levothyroxine. I just tested 8 weeks in, and my TSH crashed to .032 while my T4 is now slightly in the normal range. I am reading that very Low TSH can end to dangerous heart problems. I am tempted to just stop the levothyroxine but read that can also be very dangerous. I need some advice. Also, I never had high sugar and here my glucose spike to 138. Although this was not a fasting test and I ate 2 hours prior. My labs are below.

Labs 8/22/19
Free T4 .97 (normal .78 -2.9)
TSH ultra sensitive .032 (normal .465 to 4.6)
Glucose 138

Labs 1/5/19
TSH 1.7
Free T4 .60
Glucose 95
 
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Sean Mosher

Member
We need to see a complete set of labs here.
I don't see anything with respect to T3, FreeT3, RT3.
Very incomplete picture unfortunately.
We need to rule out elevated RT3 and/or a conversion problem.
 

SkyWarn

Active Member
We need to see a complete set of labs here.
I don't see anything with respect to T3, FreeT3, RT3.
Very incomplete picture unfortunately.
We need to rule out elevated RT3 and/or a conversion problem.

This recent test was done by my GP who doesn't do the other testing. My RT3 was normal back in June prior to starting levothyroxine. I am going to try to get into the endo this week for the complete workup. I regret starting the levothyroxine at this point. I crashed my TSH for only a slight bump in T4. I read there is a risk of AFib with that low a TSH
 
I agree with Sean about your labs being woefully inadequate in fact you test a couple of the more useless tests in that arena...TSH and T4. T4 is quite common to see on the lower side of the lab range, almost normal, actually. yet absent is the active Thyroid hormone, T3, and almost crucial, reverse T3.

Treating without those test is fairly irresponsible.

TSH
Free T3
Free T4
Reverse T3
Antibodies

lastly, treating with T4 alone is often a very flawed method as it makes a huge assumption that the body will convert it to T3 which most times it does not or just shuttles it off to Pooling; RT3.
 

SkyWarn

Active Member
When people are looking to try and help you "normal" doesn't mean anything and in isolation back THEN doesn't apply to anything NOW.

I understand Vince. I'm just posting what I have. My real concern here is that ultra-low TSH since starting the levothyroxine.
I will get those tests done this week and find out if I can safely stop the levothyroxine
 

Gman86

Member
First off, trialing T4 only therapy is pretty pointless. It’s almost impossible to get optimal on T4 only therapy.

Second, you have nothing to worry about with your low TSH. Having a low TSH has no negative health effects as long as you’re on exogenous thyroid medication. Any health problems you are referencing, in regards to low TSH, is in people that naturally have a low TSH.

Having a low TSH while on thyroid medication is the same thing as having very low LH and FSH on TRT. Neither is anything to worry about. So no need to stress about it. Just make sure you get on either NDT, synthetic T4/T3 combo, or T3 by itself. You’re never going to feel great on T4 by itself. It’s not even worth getting labs done on T4 only therapy, imo. But if you do get labs done, obviously get a full panel done. Getting just TSH and free T4 done is about as pointless as it gets.
 

SkyWarn

Active Member
First off, trialing T4 only therapy is pretty pointless. It’s almost impossible to get optimal on T4 only therapy.

Second, you have nothing to worry about with your low TSH. Having a low TSH has no negative health effects as long as you’re on exogenous thyroid medication. Any health problems you are referencing, in regards to low TSH, is in people that naturally have a low TSH.

Having a low TSH while on thyroid medication is the same thing as having very low LH and FSH on TRT. Neither is anything to worry about. So no need to stress about it. Just make sure you get on either NDT, synthetic T4/T3 combo, or T3 by itself. You’re never going to feel great on T4 by itself. It’s not even worth getting labs done on T4 only therapy, imo. But if you do get labs done, obviously get a full panel done. Getting just TSH and free T4 done is about as pointless as it gets.

Thats reassuring regarding the Low TSH. Yesterday I googled Low TSH and everything pointed to A-fib and other heart problems.
I am calling the endo to get the full panel. Frankly I am surprised, before starting levothyroxine my T4 was low, but not dramatically low. It only increased slightly on the medication, while crashing the TSH. I will see what the T3 is.
 

Vince

Super Moderator
The old way of treating a person's thyroid, is by giving them T4 and then getting TSH in range. The only thing you don't know, are you converting T4 into free T3? Hopefully most doctors have moved on since then, I doubt it though.
 

SkyWarn

Active Member
The old way of treating a person's thyroid, is by giving them T4 and then getting TSH in range. The only thing you don't know, are you converting T4 into free T3? Hopefully most doctors have moved on since then, I doubt it though.
I have an appointment to go in tomorrow for the full thyroid labs. She feels the issue is not my thyroid, but the pituitary. Dr is insisting on an MRI of the pituitary because my prolactin is chronically elevated. Its a mild elevation of 10 points. Prior to starting the Levothyroxine My TSH and T3 were normal with only a low T4. She thinks the fact that the TSH is normal with a low T4 points to the gland in the brain.
 

VacationMan

Active Member
It's normal for TSH to tank when taking thyroid meds.

In your case, TSH is low and T4 is low. I wouldn't say that's specifically an issue worthy of medicating as long as your T3/FT3 levels are in normal range. Remember that the body takes T4 and converts it to the usable T3/FT3 hormone. If T3 level is good, I'd leave things jolly well enough alone, as T4 is converted to the T3 that your body actually uses. If this is the case, your body is doing a good job of converting T4 to T3.

TSH just signals the body to make more T4, so it can be converted to T3. Again, if your T3 levels are good...see?

It's like folks get on HRT and get concerned when luteinizing hormone (LH) tanks. That's 100% plausible since they're supplementing your body with testosterone. LH signals the testes to make more testosterone. When the body has enough testosterone, the body stops making LH.
 

SkyWarn

Active Member
So I finally got all my labs from the endo:)

This is just before starting Levothyroxine in July:

Cortisol AM: 9.8 ref range 4.0-22
SHBC 24 ref range 10-50
Prolactin 20.5 HIGH ref range 2-18
T4 Free 0.6 LOW ref range 0.8-1.8
TSH 1.3 ref range .40-4.5
T4 Calculated 1.1 LOW ref range 1.4-3.8
T4 Total 4.4 LOW ref range 4.9-10.5
T3 Uptake 25 ref range 22-35
Antibodies - non reactive

Last weeks results 6 weeks after beginning 50mcg Levothyroxine:

TSH 0.035 LOW ref range .40-4.5
T4 Free 1.1 ref range 0.8-1.8
T3 Uptake 29 ref range 22-35
 
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